bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 13707: Body Mass Index and Mortality in Adults With Atherosclerotic Cardiovascular Disease in the United States
Authors: Taha Mohamad B , Acquah Isaac , Valero Elizondo Javier , Yahya Tamer , Hagan Kobina , Javed Zulqarnain , Mahajan Shiwani , Satish Priyanka , Rana Jamal S , Patel Kershaw , Cainzos Achirica Miguel , Nasir Khurram
Published: April 2024

Introduction:
The association between body mass index (BMI) and mortality risk has been previously shown to follow a J- shaped pattern, with a greater mortality risk at the lowest and highest BMI levels. However, this association has not been fully evaluated in a population with atherosclerotic cardiovascular disease (ASCVD). We examined the BMI-mortality associations in the general population, and in a population with ASCVD.

Methods:
We used data from 2006-2014 National Death Index-linked National Health Interview Survey, a US nationally representative survey, for adults ≥ 18 years. Participants were classified based on self-reported ASCVD. BMI was calculated based on self-reported height and weight and was classified as normal/overweight (BMI 18.5-29.9 kg/m
2
), obesity class 1 (30-34.9 kg/m
2
), class 2 (35-39.9 kg/m
2
), and class 3 (≥40 kg/m
2
); participants who were underweight (<18.5 kg/m
2
) were excluded. Multivariable cox proportional hazards models were used to examine the risk of all-cause, cardiovascular, and non-cardiovascular mortality.

Results:
A total of 252,9568 adults, including a weighted 8.1% (or 18.6 million annually) with ASCVD, were included in the analysis. During a median follow-up of 4.5 (IQR: 2.5-6.8) years, (1179 million person-years), mortality rates, both cardiovascular and non-cardiovascular, were higher in the ASCVD group compared to the general population (
Fig: panel A
). In the general population, those with obesity class 3 had a higher risk of cardiovascular and non-cardiovascular mortality compared to individuals with normal/overweight, whereas individuals with obesity class 1 had a lower non-cardiovascular mortality risk. An overall similar pattern of association was observed in the ASCVD population in non-cardiovascular, but not cardiovascular, mortality (
Fig: panel B
).

Conclusion:
Greater BMI categories were associated with higher non-cardiovascular, but not cardiovascular, mortality in the ASCVD population.
Abstract 13711: End-Stage Renal Failure and Bleeding Complications in Patients Undergoing Percutaneous Coronary Intervention: A Contemporary System-Wide Analysis
Authors: Bimal Tia , Bhuiyan Md , Gandotra Puneet , Haggerty Gregory , Selim Samy , Ong Lawrence , Gruberg Luis
Published: April 2024

Background:
Patients with chronic kidney disease (CKD) and significant impairment of kidney function (eGFR of 15-29 ml/min/1.73m
2
)
(
CKD Stage G4
)
and patients with an eGFR of <15 ml/min/1.73m
2
, or who require some form of dialysis (CKD Stage G5) are often referred to as end-stage renal failure (ESRF)
.
These patients tend to have more severe coronary disease and worse outcomes following percutaneous coronary intervention (PCI).

Aim:
To compare the in-hospital bleeding complications and major adverse cardiac and cerebrovascular (MACCE) events in CKD Stage G4 with CKD Stage G5 (dialysis) patients undergoing PCI.

Methods:
Between 12/2010 and 03/2018 a total of 1,534 ESRF patients underwent PCI at 6 hospitals in our system. Patients were divided into two groups, those with an CKD Stage G4 (n=954) and those on dialysis CKD Stage G5 (n=580). Bleeding complications were classified according to Bleeding Academic Research Consortium (BARC). BARC 4 (coronary bypass grafting-related bleed) and BARC 5 (fatal) bleeding events were excluded. Chi square statistical analysis was used for categorical values and t-test for continuous variables. P<0.05 was considered significant.

Results:
Clinical characteristics, bleeding complications, and in-hospital outcomes are shown in the Table. Patients with CKD Stage G4 were older, had a higher percentage of female patients and more often presented with a STEMI when compared with CKD Stage 5 (dialysis) patients. Bleeding (BARC ≤2 and 3) rates were similar between the two groups. Although mortality and MACCE (Death/MI/Stroke/Major Bleed) rates were numerically higher in Stage G4 patients, it did not reach statistical significance.

Conclusion:
In a contemporary analysis of ESRF patients undergoing PCI, CKD Stage G4 and CKD Stage G5 (dialysis) patients had low and comparable rates of moderate and severe bleeding complications. Furthermore, in hospital MACCE rates were low and similar in these two groups.
Abstract 13712: Clinical Predictive Tool for Pediatric Cardiac Patients on Extracorporeal Membrane Oxygenation Therapy and Ultrafiltration
Authors: Sedler Jennifer , Sutherland Scott M , yarlagadda vamsi V , Jahadi Ozzie , Uber Amanda M , Kwiatkowski David
Published: April 2024

Introduction:
Fluid overload is common among pediatric cardiac patients receiving ECMO. It is often treated with in-line ultrafiltration (UF) with some patients progressing to continuous renal replacement therapy (CRRT). We assessed whether requiring CRRT was associated with increased morbidity and mortality compared to UF alone. Additionally, we evaluated characteristics associated with the progression from UF to CRRT to create a clinical decision support tool to help identify patients likely to require CRRT.

Hypothesis:
Pediatric cardiac patients on ECMO who require CRRT have increased morbidity and mortality compared to UF alone and can be identified at the time UF is initiated.

Methods:
Retrospective chart review of patients age ≤18 years treated with ECMO from 1/14-12/19 at a single quaternary care cardiac ICU. Bivariate comparisons using Chi-square or Fisher’s Exact and Mann-Whitney U tests were used as appropriate. ROC curve was used to create a tool predictive of the need for CRRT at the time of initiation of UF.

Results:
Of 131 ECMO patients, 45 (32%) underwent UF and 13 (10%) UF then CRRT. Patients who required CRRT had a higher creatinine and BUN at time of UF initiation (p=0.04 and p=<0.01), longer time on ECMO (p=<0.01), a lower rate of renal recovery (p=0.02), and higher mortality (p=0.01). Using ROC analysis, presence of ≤3 of 7 variables (BUN >20 and GFR <60 at UF initiation, low MAP and RPP 12 hours before initiation of UF, total fluid overload > 10%, daily fluid balance > 50mL/kg in the 24 hours prior to UF initiation, and urine output <1ml/kg/hr in the day prior to UF initiation) had a positive predictive value of 87.5% and negative predictive value of 50.0% for the use of UF alone (AUC 0.801; p=0.002).

Conclusions:
Pediatric cardiac patients treated with ECMO and UF who require CRRT demonstrate increased morbidity and mortality compared to UF alone. A novel clinical tool may assist in stratifying patients at UF initiation.
Abstract 13713: Short-Term Outcomes of Acute Mitral Regurgitation in Patients With Takotsubo Cardiomyopathy
Authors: Alqam Bilal , Habash Fuad , Gheith Zaid , Vallurupalli Srikanth , Maskoun Waddah
Published: April 2024

Introduction:
Takotsubo cardiomyopathy (TC) is characterized by significant transient left ventricular dysfunction that is not due to obstructive coronary artery disease. Acute mitral regurgitation (MR) has been described in previous studies as a complication of TC, but short-term outcomes are not well studied. The aim of our study was to investigate the rates and outcomes of patients diagnosed with TC with acute MR in the Veteran Affairs (VA) system.

Methods:
We performed a retrospective study using chart review for patients diagnosed with TC between 2005 and 2018 in the VA national database. We included patients who met the Mayo Clinic diagnostic criteria for TC. We collected data for demographics, clinical course, and outcomes.

Results:
287 patients (70.7% males) were included, Median age was 64 years, 18.8% were known to have coronary artery disease, 34.1% were diabetic and 60.3% had hypertension. 96% of patients had apical variant of TC. Moderate to severe MR was present in 8.7%; of those 48% were either new or significantly worsened MR when compared to previous echocardiograms prior to TC. MR was mostly diagnosed in patients with apical TC (91.7%). There was no significant difference in the rates of diagnosis of new MR in men compared to women (3.4% vs 6% p=0.34). There was also no significant difference in the in-hospital mortality rates between patients with new moderate-severe MR vs no-trivial MR (0% vs 8.7%, p = 0.61). At 30-day follow up there was no significant difference in mortality rates in patients with moderate-severe MR compared to no-trivial MR (9.1% vs 2.5%, p = 0.22). On follow up echo for patients who survived, all patients had resolution of the MR.

Conclusions:
In patients diagnosed with TC with new moderate-severe MR, there was no significant difference in mortality rates in the hospital or at 30-day follow up.
Abstract 13715: Efficacy of Implantable Cardioverter-Defibrillators/Cardiac Resynchronization Therapy Defibrillator Remote Monitoring in Patients With Heart Failure: A Bayesian Meta-Analysis of Randomized Controlled Trials
Authors: Al-abdouh Ahmad , Mhanna Mohammed , Barbarawi mahmoud , As Sayaideh Mohammad , Abusnina Waiel , Jabri Ahmad , Alzu’bi Hossam , Abu Rmilah Anan , Haq Ikram-Ul , Michos Erin , Deshmukh Abhishek
Published: April 2024

Introduction:
Remote monitoring using implantable cardioverter-defibrillators (ICDs) or cardiac resynchronization therapy defibrillator (CRT-D) can be used as an adjunctive diagnostic tool to traditional hospital and clinic visits to monitor the volume status of patients with heart failure (HF).

Methods:
We searched PubMed, Cochrane Library, and ClinicalTrials.gov (inception through February 4th, 2021) for randomized controlled trials (RCTs) evaluating ICDs/CRT-D remote monitoring versus standard of care in patients with HF. Of 642 articles retrieved after removing duplicate items, we included 11 RCTs encompassing 5,965 patients. Absolute risk difference (ARD) with 95% credible interval (CrI) was estimated. Pooled (posterior) risk difference was computed using Bayesian hierarchical methods, random effects model and weakly informative prior.

Results:
The ARD for mortality was centered at -0.01 (95%CrI: -0.03; 0.01, Tau: 0.02), with 82% probability of ARD of ICD/CRT-D remote monitoring with respect to control being less than 0. The ARD for cardiovascular mortality was centered at -0.03 (95%CrI: -0.11; 0.05, Tau: 0.10), with 84% probability of ARD of ICD/CRT-D remote monitoring with respect to control being less than 0. The ARD for HF admissions was centered at -0.00 (95%CrI: -0.07; 0.06, Tau: 0.08), with 57% probability of ARD of ICD/CRT-D remote monitoring with respect to control being less than 0 [Figure].

Conclusions:
This meta-analysis suggests that ICD/CRT-D remote monitoring in patients with HF is associated with a higher probability of reduced all-cause mortality, and cardiovascular mortality compared with standard care. However, ICD-CRT/D remote monitoring was associated with minimal probability of difference in HF hospitalizations.
Abstract 13720: Safety Follow Up in Cardiovascular Implantable Electronic Devices After Catheter Based Ablation Procedures
Authors: Butt Muhammad Umer , Haddadin Faris I , Hamade Hani , Yousaf Adnan , jabri ahmad
Published: April 2024

Background:
Catheter ablation is effective in the treatment of arrhythmias. The effect of ablation on Cardiovascular Implantable Electronic Devices (CIED) in long-term follow-up is unknown.

Objectives:
To study the impact of radiofrequency catheter ablation on various arrhythmias in patients with pacemakers and implantable cardiac defibrillators.

Methods:
We studied 119 consecutive patients with pacemakers and defibrillators who underwent various catheter-based procedures from 2011 to 2018. Various generator and lead parameters were compared before and after the procedure using paired sample t-test. Incidence of device-related complications was recorded as a percentage.

Results:
The mean age was 64.5 years. 88 patients had CHF (73.9 %). 63 Patients had CAD (52.9 %). 8.93 % and 41.3 % of patients had single and dual-chamber ICDs respectively. The rest of the patients had dual-chamber or biventricular pacemakers. 63.2 % of patients had Pulmonary Vein Isolation, Atrial Tachycardia, or Atrial Flutter ablation. 13.5 % of patients had AVNRT ablation and 20.3 % of patients had PVC or VT ablation. The Median follow-up interval was 8 weeks. No changes in before or after the ablation procedure in the atrial sensing ( 3.37± 1.60mV vs 3.40 ± 1.95 mV , P .52) and pacing thresholds ( 0.85mV± 0.46mV vs 0.82± 0.43 mV, P .35) , impedance (471.83± 106 ohm vs 447.57± 88.64 ohm , P .07) was noticed. Similarly, there was no difference in RV lead sensing and pacing threshold, but paradoxically there was a decrease in RV impedance after ablation (549.77± 173ohm vs 507.40 ± 129.0 ohms, p <0.004). There was no difference in the LV lead parameters. There were no complications as lead dislodgement, stroke, hypotension, or death.

Conclusion:
Any type of catheter-related ablation is safe and efficacious in patients with pacemakers and defibrillators and there was no generator or lead-related complications noticed on interval follow-up.
Abstract 13728: Gender and Socioeconomic Bias in Patients With Atrial Fibrillation
Authors: Mishra Pooja , Malik Maham , jabri ahmad , Hamade Hani , Butt Muhammad Umer
Published: April 2024

Background:
Atrial fibrillation (AF) is one of the most common arrhythmias. We aimed to study both, the gender and socioeconomic bias in AF patients and outcomes in terms of ablations and all-cause mortality.

Methods:
This was a cross-sectional study using a large population-based database, Explorys. Data were collected from electronic health records of approximately 63 million patients until October 2019 using the search terms - AF, persistent AF, ablation operation for arrhythmia. Among all AF patients, we used insurance status (Medicare, private, and Medicaid) as a surrogate for socioeconomic status. For each gender and insurance type, we investigated all-cause mortality.

Result:
Out of 1.7 million patients, 712,700 patients had atrial ablation procedures. The distribution of insurance was as: Medicare 46.5%, private 50.2%, and Medicaid 3.3%. 45 % of total ablated patients were female. Females had overall Higher mortality as compared to males in general (10.64 % versus 7.82%; p<0.0001). Using binary logistic regression there was heterogeneity in the mortality with the highest mortality in the females in the Medicaid insurance group as compared to the private insurance group (Adjusted OR=1.5; 95% CI: 1.4-1.6).

Conclusion:
The prevalence of AF is almost similar in males and females. However, ablations in men are thrice as common when compared to females, and <5% of the Medicaid population end up getting ablations suggesting that there is a treatment bias in our society.

Clinical Implications:
Our findings suggest that there is a healthcare disparity in females, especially with low socioeconomic status. We will conduct a retrospective study of patients in our hospital to further investigate the above findings and implement measures to overcome these barriers such as close follow-up, early referral to electrophysiologists.
Abstract 13734: Biomechanical Comparison of Atrioventricular Valve Repair Strategies in Hypoplastic Left Heart Syndrome
Authors: Kidambi Sumanth , Moye Stephen , Lee James , Cowles Teaghan , Rob Wilkerson , Paulsen Michael J , Woo Joseph Y , Ma Michael
Published: April 2024

Purpose:
Atrioventricular valve (AV) regurgitation in hypoplastic left heart syndrome (HLHS) remains a challenging problem with no clear consensus on optimal repair strategies. We sought to evaluate the effect of AV repairs on leaflet biomechanics.

Methods:
Explanted fetal bovine tricuspid valves and right ventricles were sutured onto annular and ventricular mounts derived from imaging data of HLHS patients. The annulus underwent an average areal dilation of 21% with preferential dilation of the free wall (Fig 1A). The specimens were then placed in a previously validated univentricular heart simulator and subjected to the typical flows and pressures seen at Norwood, Glenn, early Fontan, and late Fontan stages. The valves underwent repair via De Vega suture annuloplasty (AP) or anteroseptal commissuroplasty (CP). Leaflet forces pre- and post-repair were measured using optical strain sensors (fiber Bragg grating) sutured to each leaflet edge. Statistical significance was determined using paired t-test.

Results:
A total of 8 AP and 7 CP specimens underwent testing. Regurgitation decreased from 2+ to <1+ following both repairs. With AP, forces in the tricuspid valve anterior (TVAL), posterior (TVPL), and septal leaflets (TVSL) as a percentage change from pre-repair were [TVAL:-12.6%, p<0.001

Conclusions:
Force reduction was seen only in the anterior and posterior leaflets with CP in contrast to the global reduction seen in AP. This difference may compound with cardiac cycling and impact the longevity of the repair. Future studies with more complex pathologies and repair strategies can help develop more tailored techniques.
Abstract 13741: Impact Of Cannabis Use Disorder On Outcomes Of Hospitalization Due To Acute Myocardial Infarction
Authors: Theli Abhinay , Sampath Shrikanth , Gadaga Cecilia , Abdella Bahredin , SHARMA SHILPI , Rahim Naima A , Patel Krupa , Desai Darshi , Desai Saral , Patel Achint
Published: April 2024

Background:
The prevalence of cannabis use disorder (CUD) has increased in the US especially following its legalization in various states. Few smaller studies have reported that CUD has been associated with increased Acute Myocardial Infarction (AMI) but reduced mortality. There is limited and inconclusive literature on the impact of concurrent CUD on AMI outcomes especially in the younger population.

Hypothesis:
To estimate the impact of CUD on hospitalizations due to AMI in the young population from the largest available database.

Methods:
We derived a study sample from the National Inpatient Sample (NIS) for the years 2007-2018. Hospitalizations due to AMI among the age group of 18-49 were identified using previously validated ICD-9-CM/ICD-10-CM. Cannabis use disorder and other diagnosis of interests were identified by ICD-9/10-CM codes. Primary outcome of interest was in-hospital mortality. We then utilized the Cochran Armitage trend test and multivariable survey logistic regression modeling to analyze impact of CUD on AMI outcomes.

Results:
Out of a total 819,354 hospitalizations due to AMI among the young population, 33,488 (4.1%) had concurrent CUD. AMI patients with CBD were younger (40 vs 44 years; p<0.01), male (78.1.2% vs 71.6%; p<0.01) and African American (35.2% vs 15.8%; p<0.01). CUD was also associated with lower utilization of PCI (OR 0.9; 95%CI 0.9-0.9; p:0.03). There was no significant difference in CABG utilization, mechanical ventilation requirement and cardiac arrest in patients with and without CUD. In-hospital mortality was lower in the CUD group as compared to non-CUD (1.3 vs 1.7; p<0.01). After adjusting with patient and hospital level characteristics, comorbidities and confounding factors, CUD was associated with lower in-hospital mortality (OR 0.7; 95%CI 0.6-0.9; p<0.01) and discharge to facilities (OR 0.9; 95%CI 0.8-0.9; p:0.02).

Conclusion:
Our study found lower PCI utilization as well as lower in-hospital mortality and discharge to facilities among the young AMI patients with CUD. Our study cannot establish causal relationship and further studies are required for in-depth exploration and identify possible mechanisms of cannabis on myocardial infarction and its severity.
Abstract 13763: Usefulness of Echocardiography to Diagnose Diabetic Cardiomyopathy in Real World Practice
Authors: Swiatkiewicz Iwona , Patel Neeja T , Taub Pam R
Published: April 2024

Introduction:
Diabetic Cardiomyopathy (DbCM) is an underrecognized form of stage B heart failure (SBHF) which is associated with increased risk of overt heart failure (HF) in patients with type 2 diabetes (T2D). Two-dimensional echocardiography (2DE) can aid in identifying T2D patients with DbCM. This study aims to evaluate the usefulness of 2DE parameters for diagnosing DbCM.

Hypothesis:
Combination of echocardiographic features can help identify patients with DbCM.

Methods:
Retrospective review of medical records of T2D patients who had 2DE at UC San Diego Medical Center within 2016-2017 was conducted. Patients with DbCM were defined as T2D patients without overt HF and with echocardiographic demonstration of SBHF defined as left ventricular ejection fraction (LVEF) ≥45% and at least one of the following echocardiographic criteria: left atrial volume index (LAVI) ≥34 mL/m
2
, left ventricular mass index (LVMI) >95 g/m
2
in women and >115 g/m
2
in men, peak early mitral inflow velocity to early diastolic mitral annular velocity ratio (E/E’) ≥13, and right ventricular systolic pressure (RVSP) >35 mmHg, while excluding co-morbidities which can contribute to SBHF. Our study did not evaluate impaired longitudinal strain (GLS), an additional echocardiographic early indicator of SBHF and DbCM.

Results:
Out of 499 T2D patients who had 2DE, 454 (91%) had LVEF≥45%. Of them, 256 patients (56.4%) had at least one additional echocardiographic criterion, thus met criteria for SBHF. After excluding patients with overt HF, uncontrolled hypertension, coronary artery disease, valvular heart disease, or other cardiomyopathies, 14.8% of patients with SBHF met criteria for DbCM. Elevated LAVI, LVMI, E/E’ and RVSP were found in 63.2%, 26.3%, 44.7% and 34.2% of DbCM patients, respectively. Elevated LAVI and E/E’ occurred in 81.6% of DbCM patients, providing the most robust parameters for diagnosing DbCM.

Conclusions:
In T2D patients with preserved LVEF and probable DbCM, left atrial enlargement and elevated E/E’ are the most prevalent echocardiographic findings. The LAVI, E/E’, RVSP and LVMI, which are all readily detectable by 2DE, improve identification of patients at high-risk of developing overt HF in T2D patients with preserved LVEF in support of DbCM diagnosis.
Abstract 13766: The Use of Echocardiography to Assess Regional Strain Abnormalities in Patients With Chronic Mitral Regurgitation
Authors: Dagan Gil , Alcalai Ronny , Leibowitz David
Published: April 2024

Background:
Patients with primary mitral regurgitation (MR) secondary to mitral valve prolapse (MVP) have regional LV fibrosis in myocardial segments adjacent to the posterior papillary muscle detected by MRI not seen in other patients with MR.. Echocardiographically determined strain is associated with LV fibrosis. Patients with chronic MR are generally followed by echocardiography, however no study has utilized echocardiography to examine regional strain variations in these patients. The object of this study was to examine regional myocardial strain in patients with chronic MR with and without MVP.

Methods:
Patients undergoing routine transthoracic echocardiography for the assessment of chronic severe MR were included. Patients with secondary MR, ejection fraction < 50%, other significant primary valve disease, history of cardiomyopathy, ischemic heart disease, previous cardiac surgery or pacemaker implantation were excluded. The primary MR subjects were be divided into MVP or non-MVP cohorts. MVP was defined as displacement of 1 or both mitral leaflets by at least 2 mm below the mitral annulus in parasternal long-axis view. Global and segmental strain analysis in 17 left ventricular segments was performed offline and results of the MVP and non-MVP groups compared.

Results:
28 patients (mean age 63 ±14 yrs ; 23F/5M) of whom 11 had MVP and 17 had non-MVP disease were included in the study. Patients in the MVP group were significantly younger (59.2 ± 16 vs 69 ± 11 p = 0.05) then in the non-MVP group. Standard echocardiographic measurements including ejection fraction were similar except for estimated PA pressure which was lower in the MVP group, (31.3 ± 6.9 vs 42.6 ± 11.9 mmHg p-value = 0.008).Global strain was normal and similar in the two groups (-21.3 ± 4.4% vs -19.9 ± 2.9%; p = 0.30). (Patients with MVP had significantly reduced segmental strain in the inferior basal segment ( -11.2 ± 9.7 in the MVP group, -18 ± 2.6 in the non-MVP group, p-value 0.037). No other segments showed significant differences between the MVP and non-MVP groups

Conclusions:
Our findings suggest that patients with chronic MR and MVP have significantly reduced echocardiographic strain in the inferior base when compared to patients with MR secondary to other causes.
Abstract 13768: Gender Differences in ICD-Related Complications in the PRAETORIAN Trial
Authors: Knops Reinoud , Olde Nordkamp Louise R , Delnoy Peter Paul H , Boersma Lucas V , Kuschyk Juergen , El-Chami Mikhael F , Mittal Suneet , Smeding Lonneke , Van Der Stuijt Willeke , De Weger Anouk , Brouwer Marc , Vernooy Kevin , Betts Tim , Wright David , Wilde Arthur A ,   PRAETORIAN investigators
Published: April 2024

Introduction:
The PRAETORIAN trial has investigated the difference in complications between the subcutaneous implantable cardioverter-defibrillator (S-ICD) and the transvenous ICD (TV-ICD). Retrospective studies suggest that women experience more ICD-related complications, specifically related to the lead, than men. We aimed to evaluate this gender difference as a subanalysis of the PRAETORIAN trial.

Methods:
The PRAETORIAN trial (NCT01296022) is an international multicenter randomized trial. Patients with a class I or IIa ICD indication with no need for pacing therapy were randomized 1:1 to receive either an S-ICD or a TV-ICD and followed for a median of 49.1 months. ICD-related complications included all complications related to the lead or generator that led to medical or surgical intervention. Lead-related complications were defined as complications directly caused by insertion or chronic placement of the ICD lead, or leading to extraction, repositioning or replacement of the ICD lead.

Results:
A total of 849 patients were included, of whom 167 (19.7%) were female. ICD-related complications occurred in 6/89 women in the S-ICD group and 11/78 women in the TV-ICD group (HR 0.46, 95%CI 0.17-1.25). In men, 25/337 in the S-ICD group and 33/345 in the TV-ICD group had an ICD-related complication (HR 0.77, 95%CI 0.46-1.29). Kaplan Meier curves of both genders are shown in the figure. In Cox regression analysis, women had a higher risk of lead-related complications (HR 2.1, 95%CI 1.04-4.16, p = 0.04).

Conclusions:
Our prospective data show a more prominent trend in women to experience more ICD-related complications with the TV-ICD. This difference may be due to a significantly higher risk of lead-related complications in women. However, numbers are low and more research is needed to gain more insight into the gender-specific risks and benefits of ICD therapy.
Abstract 13770: Systemic Intervention to Increase the Frequency of Genetic Counseling and Testing in Eligible Dilated Cardiomyopathy Patients
Authors: Mohananey Akanksha , Rosenbaum Andrew , Kruisselbrink Teresa M , Prochnow Carri A , Lin Grace , Redfield Margaret M , Pereira Naveen L
Published: April 2024

Background:
Although genetic testing (GT) in dilated cardiomyopathy (DCM) enables molecular diagnosis, family screening and provides prognostic information, it is underutilized. Our hypothesis was that systemic intervention (INT) in the heart failure (HF) clinic could increase the frequency of GT for DCM.

Methods:
Eligible DCM patients in a 17-month period before and after the INT were compared for frequency of genetic counseling and GT uptake. The INT comprised of the following: 1. Pre-emptive cardiovascular genomics e-consult (with a specialist in genetic DCM) for all new HF patients that could be canceled by the treating physician if the patient was considered ineligible or was uninterested. If eligible and patient was willing, 2. They were shown a video in person on genetic testing for DCM prepared by a genetics counselor 3. A trained HF clinic nurse provided answers to questions and completed the test requisition 4. Educational material was provided to the patient 5. Results were reviewed electronically and communicated to the patient via letter or phone call by the physician completing the e-consult. Clinical genetics consultation was available throughout the study period. Standard commercially available cardiomyopathy gene panels were used for GT.

Results:
There were 162 eligible DCM patients before and 194 after the INT. DCM patients were more likely to undergo genetic counseling post-INT versus (vs) pre-INT (33.5% vs 14.8%, OR 2.9, 95% CI 1.7-4.8,
P
<.0001). Similarly, DCM patients were more likely to undergo GT post-INT vs pre-INT (27.3% vs 13%, OR 2.5, 95% CI 1.4-4.3,
P
=.001). Consequently, the total number of patients who were diagnosed to have likely pathogenic or pathogenic DCM-related genetic variants increased from 2 pre-INT to 6 post-INT. These variants were detected in the following genes:
FLNC
(n=2),
TTN
(n=2),
DES
,
LMNA
,
PLN
and
TNNT2
.

Conclusion:
An intervention that was pre-emptive, easily accessible and available to the healthcare provider was successful in raising the rates of genetic counseling and testing in DCM patients seen in the HF clinic. Whether such low-cost interventions will enhance cascade screening and provide an opportunity for precision medicine remains to be determined.
Abstract 13772: Anticoagulation Guideline Adherence in 4,500 Patients With Newly Diagnosed Atrial Fibrillation: Insights From the Prospective DUTCH-AF Registry
Authors: Seelig Jaap , Trinks-Roerdink Emmy M , Chu Gordon , Pisters Ron , de Vries Tim A , Ten Cate Hugo , Geersing Geert-Jan , Rutten Frans H , Huisman Menno V , Hemels Martin E ,   DUTCH-AF Investigators
Published: April 2024

Introduction:
Non-adherence to guidelines and off-label dosing of oral anticoagulants (OAC) is common in atrial fibrillation (AF), but the extent hereof in newly diagnosed AF patients is uncertain.

Methods:
The DUTCH-AF registry prospectively enrolls patients with newly diagnosed AF since July 2018. We used data available up to November 2020. Anticoagulation guideline and label adherence were assessed at diagnosis of AF using the 2016 European guideline recommendations and the European Medicines Agency labelling. Predictors for label non-adherence were assessed using logistic regression.

Results:
Throughout the Netherlands, 4,500 patients were registered in DUTCH-AF. Mean age was 69.6±10.5 years, 41.5% were female. Anticoagulants were prescribed in 90.1% of patients with a class I OAC recommendation. In patients with a class IIa OAC recommendation, females were more often treated with anticoagulation than males (89.6% vs 81.2%, p<0.001). Antiplatelet monotherapy and vitamin K antagonists were used infrequently, but its use was most common in patients with a high predicted stroke risk. Off-label use of non-vitamin K oral anticoagulants was uncommon (6.2%), but of the 394 patients who were prescribed a reduced dose, 34.3% were treated off-label (Figure). Independent predictors for off-label reduced dose use were (i) older age (odds ratio (OR) 1.07 per year, 95%-confidence interval (CI) 1.04-1.11, p<0.001), (ii) lower creatinine clearance (OR 0.95 per ml/min, 95%-CI 0.94-0.96, p<0.001), (iii) lower body mass index (OR 0.95 per kg/m
2
, 95%-CI 0.91-1.00, p=0.04) and (iv) concomitant antiplatelet therapy (OR 4.19, 95%-CI 1.88-9.34, p<0.001).

Conclusion:
In newly diagnosed Dutch AF patients, non-adherence to anticoagulation guidelines and off-label dosing at diagnosis are uncommon, with deviations from recommendations seen more frequently in high-risk patients. These results provide important insights for practicing clinicians.
Abstract 13777: Engineering of Bacterial Nano Cellulose-Based Small Diameter (CSD) Vascular Graft for Coronary Artery Bypass Grafting
Authors: Fusco Deborah , Meissner Florian G , Pisanu Alessia , Podesser Bruno , Winkler Bernhard , Marsano Anna , Eckstein Friedrich
Published: April 2024

Coronary artery disease, mostly caused by atherosclerosis of coronary arteries, is one of the leading causes of death worldwide (Naghavi
et al.
, 2015). In the context of coronary artery bypass grafting (CABG), internal mammary arteries, radial arteries and saphenous veins cannot be always used as autologous arterial substitutes (Ishii
et al.
, 2016) e.g. in patients with multivessel disease (Wipperman
et al
., 2009). Synthetic vascular grafts (e.g., Dacron (PET), Teflon (ePTFE)) are an alternative option only to autologous grafts for substitution of vessels with an inner diameter >8 mm (Wippermann
et al.
, 2009; Weber
et al
., 2017). The aim of the project is to develop a Cellulose-based Small Diameter (CSD, 3-4 mm) vascular grafts for coronary artery bypass made of Bacterial nano-Cellulose (BC) reinforced with a Cobalt Chrome mesh. The hypothesis of the study is that CSD vascular grafts are biomechanically suitable to substitute autologous small diameter vessels. In a proof-of-concept study predecessors of these CSD grafts were already used for CABG on pigs. After 4 weeks, angiography showed fully open grafts with no dissection and no narrowing at distal anastomoses. Histology of the explants showed endothelialization from autologous endothelial cells and formation of neointima.The CSD graft is generated in a customized bioreactor providing a temperature- and oxygen-controlled culture environment. BC is synthetized and deposited by
Gluconacetobacter
around a gas-permeable silicone tube delivering 100% of oxygen. Biological and morphological analyses will be performed and CSD patency will be tested in an
in vivo
large animal model. It was manufactured up to 20 cm long CSD vascular grafts with a 3-4 mm inner diameter (inner wall thickness 0.5 mm), a circumferential tensile strength of 0.34 ± 0.09 MPa (Force at the breaking point of 1.29 ± 0.28 N), and a burst pressure up to 515.5 ± 94.7 mmHg. Based on an
in vitro
cytotoxicity test CSD graft resulted not toxic (>70%, n=3). These data indicate the engineered CSD graft as a promising alternative to autologous grafting for coronary artery bypass surgical procedure.
Abstract 13778: Disease Modelling and Gene Therapy of Hereditary Hemorrhagic Telangiectasia Combined With Pulmonary Artery Hypertension
Authors: Shi Jian , Lai Xingqiang , Wu Guifu , Liang jianwen , Wei Wenbin
Published: April 2024

Introduction:
Hereditary hemorrhagic telangiectasia combined with pulmonary arterial hypertension(HHT-PAH) caused by pathogenic variants of
ACVRL1
gene progresses with poor prognosis. However, there is few treatments, thus developing novel models and innovative therapy is crucial. Combination of iPSCs with gene editing technologies may be a promising applications to illuminate the disease.

Hypothesis:
Gene editing is a promising therapy for HHT-PAH with
ACVRL1
gene mutations.

Methods:
Patients with HHT-PAH who carrying
ACVRL1
heterozygous c.1270C>G mutation were recruited. The reprogramming factors (Oct3/4, Sox2, c-Myc, and Klf4) were transferred into the PBMCs by using non-integrating Sendai virus. The obtained hiPSCs were passaged, individually isolated and expanded 3 weeks after reprogramming factors transduction. The mutated
ACVRL1
gene was repaired by CRISPR Base Editing tools to generate ACVRL1
corrected
-iPSCs line. Both the patient-specific iPSCs and ACVRL1
corrected
-iPSCs were differentiated into induced endothelium. EC adhesion and survival were tested in the endothelial lines.

Results:
The patient-specific iPSCs showed typical morphology with high alkaline phosphatase activity and normal karyotype (46, XX). Pluripotency markers OCT4, NANOG, SOX2, and TRA-1-60 were confirmed by Immunofluorescence staining and qRT-PCR. Markers of three germ layers, TUBB3+ , αSMA+ and SOX17+ cells were found in the differentiated cell population as revealed by immunostaining
in vitro
. These two iPSCs cell lines formed teratomas composed of tissues derived from three germ layers in immunodeficient mice. Fluorescence-activated cell sorting analysis showed that most of patient-specific iPSCs and ACVRL1
corrected
-iPSCs population expressed the mature EC surface marker CD144 or CD31, and none of cells expressed the early mesoderm marker KDR during the differentiation process. Cell adhesion and survival capacity were preserved in ACVRL1
corrected
iPSC-ECs, which were similar to the control, whereas these functions were significantly impaired in patient-specific iPSC-ECs.

Conclusions:
This study presented an
in vitro
cell model for exploring the pathogenesis of HHT-PAH and gene editing therapy might be a novel strategy.
Abstract 13780: Aggressive Hydration and Contrast-Induced Acute Kidney Injury Following Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction: A Randomized Controlled Study
Authors: Liu Yong , Chen Jiyan , Tan Ning , Liu Jin
Published: April 2024

Objective:
To evaluate the efficacy of aggressive hydration compared with general hydration for contrast induced acute kidney injury (CI-AKI) prevention among patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI).

Methods:
The ATTEMPT study is an open-label, randomized controlled study at 15 teaching hospitals in China. A total of 560 adult patients were randomly assigned (1:1) to receive aggressive hydration or general hydration treatment. Aggressive hydration group received preprocedural loading dose of 125/250 mL normal saline within 30 minutes, followed by postprocedural hydration performed for 4 hours under left ventricular end-diastolic pressure guidance and additional hydration until 24 hours after pPCI. General hydration group received ≤500 mL 0.9% saline at 1 mL/kg/h for 6 hours after randomization. The primary endpoint is CI-AKI, defined as a >25% or 0.5 mg/dL increased in serum creatinine from baseline during the first 48-72 hours after primary angioplasty. The safety endpoint is hydration relative acute heart failure.

Results:
From July 2014 and May 2018, 469 patients were enrolled in the final analysis. CI-AKI occurred less frequently in aggressive hydration group than in general hydration group (21.8% vs. 31.1%; RR 0.78, 95% CI 0.61 to 0.98). Hydration relative acute heart failure did not significantly differ between the aggressive hydration group and the general hydration group (7.9% vs. 6.9%, RR 1.07, 95% CI 0.77 to 1.48). Several subgroup analysis showed the better effect of aggressive hydration in CI-AKI prevention in male, renal insufficient and non-anterior myocardial infarction participants.

Conclusions:
Comparing with general hydration, the peri-operative aggressive hydration seems to be safe and effective in preventing CI-AKI among patients with STEMI undergoing pPCI.
Abstract 13782: Platelet Aggregation and Adenosine Levels Among Patients With Stable Chronic Coronary Artery Disease Taking Ticagrelor or Prasugrel
Authors: Menezes Fernando , Furtado Remo , Dalçóquio Talia , Genestreti Paulo , Bertolin Adriadne , Baracioli Luciano , Scanavini Marco , oliveira beatriz , Franci Andre , Silva Marli , Roggerio Alessandra , Ferrari Aline G , Lima Viviane , Pereira Cesar , Nakashima Carlos A , Strunz Celia , Salsoso Rocio , Soffiatti Carla , Baldo Vanessa , Nicolau Jose C
Published: April 2024

Introduction:
Both, ticagrelor and prasugrel are important anti-ADP drugs, being superior to clopidogrel in patients with acute coronary syndromes (ACS). Whether those drugs have different effects among patients in the long run (> 1 year) after ACS, however, is not completely understood. We therefore sought to directly compare the pharmacodynamic action of ticagrelor vs prasugrel in patients with chronic coronary artery disease (CCAD).

Methods:
This was a prospective, double blinded, randomized trial that compared platelet inhibition and adenosine levels with ticagrelor (180mg loading dose, followed by 90 mg BID) versus prasugrel (60mg loading dose, followed by 10 mg QD). Patient was eligible if suffered a documented episode of ACS at least 1 year before randomization, had age between 18 and 75 years, and was using aspirin 100 mg chronically. Platelet aggregation between groups was compared with the Multiplate ADP® assay, performed at baseline and after 15 days on study medication. Adenosine plasma levels were measured with
high
performance liquid
chromatography
at the same time points.

Results:
We randomized 87 patients (mean age 61,3 years, 83,9% with prior coronary angioplasty), being 40 allocated to ticagrelor and 47 to prasugrel. The study main results are described at Figure 1 (platelet aggregation) and Figure 2 (plasma adenosine levels).

Conclusion:
In stable patients after ACS, despite significant higher levels of adenosine plasma levels in the ticagrelor group, in comparison with the prasugrel group, similar levels of platelet inhibition were observed in both groups, suggesting that the role of adenosine in platelet aggregation is not an important one.
Abstract 13788: Systematic Review: Utility of Human Immune Responses to Group A Streptococcus Antigens as a Diagnostic Indicator for Acute Rheumatic Fever
Authors: Salie Taariq M , Rampersadh Kimona , Muhamed Babu , Engel Kelin , Zuhlke Liesl , Dale James , Engel Mark E
Published: April 2024

Introduction:
Previous studies have established that group A streptococcus (GAS) antibody titre is correlated with a diagnosis of acute rheumatic fever (ARF). However, results vary in the usefulness of GAS antibodies, particularly anti-Streptolysin-O (ASO) and anti-DNase B, in confirming a recent GAS infection. Therefore, we sought to provide, from published studies, an evidence-based synthesis of the correlation of streptococcal serology to establish the usefulness of immunological data in aiding the diagnosis of ARF. These findings are anticipated to have implications where echocardiography is not freely available, especially where ARF is rampant.

Methods:
We conducted a comprehensive search across a number of databases. Applying a priori criteria, we selected articles reporting on studies, regardless of study design, that evaluate the levels of antibodies against GAS-specific antigens in ARF subjects against control values or a published standard. Data were extracted onto data extraction forms, captured electronically and analysed using STATA software. Risk of bias was assessed in included studies using the Newcastle-Ottawa Scale .

Results:
The search strategy yielded 534 studies, from which 24 met the inclusion criteria, reporting on evaluation of titres for SLO (n=10), DNase B (n=9), anti-streptokinase (ASK) (n=3) amongst others. Elevation in titres was determined by comparison with controls and upper limit of normal (ULN) antibody values as determined in healthy individuals. Meta-analysis of case-controlled studies revealed moderate odds ratio (OR) correlations between ARF diagnosis and elevated titres for SLO (OR=10.57; 95% CI, 3.36 to 33.29; 10 studies) and DNase B (OR=6.97; 95% CI, 2.99 to 16.27; 7 studies).

Conclusions:
While providing support for incorporating SLO and DNase B in the diagnosis of ARF, we present the following reflections: an elevation in SLO and DNase B levels are not consistently associated with an ARF diagnosis; increasing the number of GAS proteins in the test is warranted to improve sensitivity; paired (acute and convalescent) samples could provide a more accurate indication of a rising titre. Use of community-based controls as a standard is not a reliable marker by which to gauge recent GAS infection
Abstract 13789: Identification of a Proteomic Signature Showing Ongoing Inflammation in Severe Rheumatic Heart Disease
Authors: Salie Taariq M , Yang Jing , Medina Carlos R , Geifman Nophar , Zuhlke Liesl J , Frain Simon , Whetton Anthony , Keavney Bernard , Engel Mark E ,   RHDGen Network Consortium
Published: April 2024

Introduction:
Rheumatic heart disease (RHD) remains a major source of morbidity and mortality in developing countries. A deeper insight into the pathogenetic mechanisms underlying RHD could provide opportunities for drug repurposing, guide recommendations for secondary penicillin prophylaxis, and/or inform development of near-patient diagnostics.

Methods:
We conducted a proteomic study in 215 African patients with severe RHD and 230 controls, using the SWATH-MS technique. We applied a machine learning (ML) approach to feature selection among the 366 proteins quantifiable in at least 40% of samples, using the Boruta wrapper algorithm. The case-control differences and contribution to AUC of the ROC for each of the 56 proteins identified by the Boruta algorithm were calculated by Logistic Regression adjusted for age, sex and BMI. Biological pathways and functions enriched for proteins were identified using ClueGo pathway analyses.

Results:
Adiponectin, complement component C7 and fibulin-1, a component of heart valve matrix, were each higher in cases when compared with controls. Ficolin-3, a protein with calcium-independent lectin activity that activates the complement pathway, was lower in cases than controls. The top 6 biomarkers from the Boruta analyses conferred an AUC of 0.90 indicating excellent discriminatory capacity between RHD cases and controls.

Conclusions:
These results support the presence of an ongoing inflammatory response in RHD, at a time when severe valve disease has developed, and distant from previous episodes of acute rheumatic fever. This biomarker signature could have potential utility in recognizing different degrees of ongoing inflammation in RHD patients, which may in turn be related to prognostic severity.
Abstract 13792: Integration of Proteomic and Transcriptomic Signatures in the Failing Right Ventricle of Rats With Monocrotaline Induced Pulmonary Arterial Hypertension
Authors: Hindmarch Charles C , Tian Lian , Xiong Ping Y , Potus Francois , Bentley Rachel , Al-qazazi Ruaa , Prins Kurt W , Archer Stephen L
Published: April 2024

Pulmonary arterial hypertension (PAH) is a chronic disease characterized by cellular remodeling in the pulmonary circulation. Pulmonary vascular obstruction, stiffening and constriction elevate pulmonary artery pressure and right ventricular (RV) afterload leading to failure (RVF). In a model of PAH induced by injection of monocrotaline (MCT, 60mg/kg sc) RV decompensation was confirmed. Then the RV proteome was analyzed using Mass Spectrometry (LC-MSMS). Proteomics revealed 1,277 differentially regulated proteins. Integration of this proteome with our previously published transcriptomic study of RVs harvested from an independent group of rats with MCT-induced PAH revealed 410 common targets, 15 of which were both highly enriched at protein (corrected
q
-values <0.05) and mRNA level (corrected
p-adjust <0.05
). Most regulated pairs were increased in RVF, including: Atrial natriuretic peptide protein (7.55-fold, transcript = 4.19-fold), Thrombospondin-4 protein (5.56-fold, transcript = 4.4-fold), Periostin (protein = 3.83-fold, transcript = 4.56-fold), Latent transforming growth factor beta binding protein 2 (2.67-fold, transcript = 4.16-fold), Heme oxygenase 1 (4.59-fold, transcript = 2.05-fold), Transforming Growth Factor Beta-1-Induced Transcript 4 Protein (3.82-fold, transcript = 2.1-fold), Transmembrane glycoprotein NMB (3.21-fold, transcript = 2.35-fold), S100 calcium-binding protein A4 (2.43-fold, transcript = 1.93-fold), Collagen XVIII, alpha 1 (2.59-fold, transcript = 1.61-fold), Ankyrin repeat domain 2 (4.04-fold, transcript = 2.49-fold), Procollagen-Lysine 2-Oxoglutarate 5-Dioxygenase 1, (6.89-fold, transcript = 2.3-fold), Tenascin-C (5.18-fold, transcript = 2.53-fold). In contrast, ATPase Na+/K+ Transporting Subunit Alpha 2 3.47 (protein = 3.47-fold, transcript = 2.23-fold) and Glutathione S-Transferase Zeta 1 (protein = 1.97-fold, transcript = 2.38-fold) were downregulated in RVF. A functional analysis of this list of regulated protein/transcript pairs revealed

enriched functions include mitochondrial metabolism, cellular respiration and purine metabolism. Our integrated multiomic approach is validated by independent datasets and provides a molecular context for RVF in MCT-induced PAH.