bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 15921: Reaching Patients With Hypertension: A Model of Remote Blood Pressure Monitoring Plus Team-Based Care
Authors: Shanab Bassel M , Tseng Leslie Y , Kelley Lauren , Landock Millie , Astudillo Katia , Hickman Carolyn , Wang Yanting , Ellis Peter , LaMonaca Katherine , O'Connor Duffany Kathleen , Carlotta-McDonald Giselle , Ramirez Yamira , Santilli Alycia , Spatz Erica S
Published: December 2023

Background:
Social determinants of health (SDoH) significantly impact hypertension (HTN) control, yet are not addressed as part of the medical model. We used a team-based approach, integrating remote blood pressure monitoring (RBPM), pharmacists, and community health workers (CHWs) to address HTN among patients with persistently uncontrolled HTN referred from cardiology fellows clinics. This study assesses the impact of this model in achieving BP control.

Methods:
Pharmacists screened patients for SDoH using a tool adapted from the Accountable Health Communities initiative and managed BP during biweekly virtual visits. Patients with SDoH were referred to Project Access-New Haven for CHW support. We describe clinical characteristics, SDoH, program metrics, and BP changes among the first 100 patients. We also assessed predictors of BP control (< 130/80 mmHg) using multivariable logistic regression.

Results:
Among referred patients, multiple SDoH were identified; 18% of whom accepted support by a CHW (Table). BP decreased from a mean of 154/86 mmHg to 135/78 mmHg (mean reduction 20/8 mmHg). BP control was associated with greater medication adherence, having diabetes and competing health priorities. There was no association between SDoH and BP control.

Conclusions:
A team-based care model with pharmacists and CHWs was effective in reducing BP among low income patients with multiple SDoH and persistently uncontrolled HTN. SDoH was not associated with achieving BP control, suggesting that this model may overcome or attenuate SDoH impacting BP control. Still, half of patients did not achieve BP control, highlighting the need for continual partnership and program improvement.
Abstract 15925: Comparative Mortality, Safety, and Cost Among Stroke Patients Who Received Implantable Loop Records Compared to Continuous External Cardiac Monitors
Authors: Dhruva Sanket , Ameli Omid , Redberg Rita F , Murillo Jaime , Chaisson Christine E , Cohen Ken
Published: December 2023

Background:
Implantable loop recorders (ILR) are increasingly used to screen for atrial fibrillation (AF) among patients with stroke, but real-world outcomes are lacking.
Goal:
To determine comparative effectiveness, safety, and costs of ILR compared with continuous external monitors (CEM) and Holter monitors in a real-world setting of patients with stroke.

Methods:
This retrospective cohort analysis used the Optum Labs Data Warehouse, which contains longitudinal, de-identified administrative claims. The cohort included patients with recent stroke who received cardiac monitoring from 1/1/2016 - 6/30/2021, comparing those with ILR to those with CEM (>48 hours to 30 days) or Holter (≤48 hours). Eligibility criteria included: ischemic stroke during 6 month baseline; continuous enrollment with medical and pharmacy coverage; no evidence of pacemaker, implantable cardioverter-defibrillator, AF, left atrial appendage ablation, or oral anticoagulants. The primary outcome was 12-month all-cause mortality, secondary outcomes included new diagnosis of AF + initiation of anticoagulants, hemorrhagic stroke, and total and device-related costs. Final analyses were adjusted for CHA
2
DS
2
-VASc score.

Results:
Among 48,801 individuals, 18.9% received ILR, 59.5% CEM, and 21.6% Holter. Groups had similar demographics and comorbidities (Table). Compared to those with CEM, the ILR group had higher odds of a new diagnosis of AF plus initiation of anticoagulants (OR 2.27; (95% CI 2.09, 2.48)), and hemorrhagic stroke (OR of 1.60 (95% CI 1.34, 1.93)). There was no difference in mortality. Unadjusted direct medical cost of monitoring was substantially higher in the ILR group ($13,975) compared to CEM ($449) and Holter ($149).

Conclusions:
Although the use of ILRs was associated with increased detection and treatment for AF, there was no impact on all-cause mortality. ILR was associated with increased hemorrhagic stroke and higher costs.
Abstract 15929: Safety Profile of Ultrasound Enhancing Agents in Echocardiography Across Yale New Haven Health System
Authors: Alam Md Mashiul , Jeyashanmugaraja Gini P , McNamara Robert L , Shkolnik Evgeny
Published: December 2023

Background:
Ultrasound Enhancing Agents (UEAs) are increasingly used in echocardiography for delineation of endocardial border and detection of left ventricular (LV) thrombus with reported rate of serious adverse reactions from 0 to 0.029%. Contemporary utilization and safety data of UEA in echocardiography are scarce.

Aims:
We aimed to obtain contemporary data on comparative safety of UEA Lumason and Definity in inpatient and outpatient settings across large academic healthcare system.

Methods:
A retrospective database analysis of all echocardiograms performed within Yale New Haven Health System (YNHHS) between January 1, 2019 to December 31, 2022 was done. Echocardiography reporting software captured type of UEA as well as any observed adverse reaction. All reported adverse events were manually chart reviewed through electronic medical record for confirmation and grading severity. American College of Radiology (ACR) criteria for contrast agent reaction were used for grading to mild, moderate, or severe reaction. Adverse reactions differences were analyzed with Pearson’s chi-square and predictors were identified by Logistic regression.

Results:
Out of 305,749 echocardiograms 91,215 (29.83%) required UEAs. In total, 430 (0.47%) adverse events were reported. Lumason (49216, 54.42%) and Definity (41077, 45.42%) were mainly used agents with 158 (0.32%) and 270 (0.66%) reactions recorded, respectively (p<0.001). There were more mild reactions with Definity (245, 0.6%) Vs Lumason (124, 0.25%) (p <0.001), and more severe reaction with Lumason (13, 0.026%) Vs Definity (3, 0.007%) (p=0.0322). Females had higher chance of having any form of contrast reaction (OR 1.707; 95% CI: 1.412-2.065). Older age (OR 0.984 per 1 year; p <0.0001) and higher heart rate (OR 0.993 per 1 bpm; P = 0.050) were associated with a decreased chance of reaction. Ejection fraction and body mass index were not associated with adverse events.

Conclusion:
UEAs are frequently used in routine echocardiography studies. Adverse reactions to UEA were rare and mostly mild. Severe reactions were more frequent with Lumason than Definity. Female sex, younger age and lower heart rate were associated with increased incidence of adverse reactions.
Abstract 15930: Using Charlson Comorbidity Index to Predict 1-Year All-Cause Mortality in ICD Recipients
Authors: Newhouse David , Rangavajla Gautam , Dhande Mehak , Bhonsale Aditya , Kancharla Krishna , Voigt Andrew , Shalaby Alaa , Estes Nathan A , Jain Sandeep , Saba Samir
Published: December 2023

Introduction:
Primary prevention implantable cardioverter-defibrillators (PP-ICD) are indicated in patients with left ventricular ejection fraction (LVEF) ≤ 35% despite 3 months of maximally tolerated guideline directed medical therapy (GDMT), who are expected to survive at least 1 year. The Seattle Heart Failure Score, commonly used for evaluation of 1 year survival, only addresses heart failure mortality. The Charlson Comorbidity Index (CCI) is a validated model of comorbid conditions used to predict 1-year all-cause mortality.

Objectives:
We aimed to create a predictive model using the CCI to guide eligibility for PP-ICD based on predicted 1-year all-cause mortality in patients with severe cardiomyopathy.

Methods:
We analyzed clinical data from the University of Pittsburgh Medical Center, a large multi-hospital system, between January 2010 and July 2021. Patients receiving PP-ICD were included. We used a logistical regression model based on patients’ CCI, age, race, mean number of GDMT medications, the presence of coronary artery disease (CAD), and baseline LVEF.

Results:
Of the total cohort of 2,864 patients (mean age 67±12 years; Male 69%; White 85%; LVEF 24±7%; CAD 62%), 235 (8.2%) patients died within 1 year. Patients were on average prescribed 2.0±0.8 GDMT agents and had a mean CCI of 1.4± 1.6. CCI was significantly associated with adjusted 1-year mortality (OR 1.41 per standard deviation of CCI, 95% CI 1.35-1.71, p< 0.001). A receiver operator curve was generated (Figure 1) and a CCI cutoff of 1.54, yielded a sensitivity of 71% and a specificity of 59% (AUC 0.70).

Conclusions:
Our data demonstrate that a model incorporating the CCI can predict 1-year all-cause mortality in PP-ICD recipients with modest accuracy and could therefore assist in shared-decision making around PP-ICD therapy. Future work should focus on refining the model for higher predictive accuracy.
Abstract 15932:
Lactobacillus
Suppresses Glycoprotein-130-Mediated Microtubule Remodeling to Support Right Ventricular Function in Pulmonary Arterial Hypertension
Authors: Prisco Sasha Z , Blake Madelyn , Vogel Neal , Kazmirczak Felipe , Weir Edward K , Thenappan Thenappan , Prins Kurt W
Published: December 2023

Introduction:
Microtubules (MTs) are crucial for cardiomyocyte function as they regulate t-tubule structure, nuclear morphology, and gap junction protein localization. Glycoprotein-130 (GP130) signaling promotes pathological MT remodeling and right ventricular (RV) dysfunction in pulmonary arterial hypertension (PAH), but the trigger for the inflammation-MT connection is unknown. Microbiome dysbiosis activates systemic inflammation, and levels of the anti-inflammatory bacteria
Lactobacillus
are associated with RV function in rodents. However, the direct effects of
Lactobacillus
on GP130 signaling, MT remodeling, and RV function in PAH are unknown.

Methods:
Rats were randomly allocated into 3 groups: control, MCT-water, and MCT rats given
Lactobacillus
(MCT-
Lactobacillus
). Echocardiography and pressure-volume loops defined RV function. Next-generation sequencing evaluated the composition of the bacterial components of the fecal microbiome. SomaScan proteomics quantified the serum proteome. RV and jejunal morphology were assessed with light and super resolution confocal microscopy. The relationship between
Lactobacillus
abundance and RV response to afterload was assessed in 65 PAH patients.

Results:
Lactobacillus
augmented RV function (A) and reduced RV hypertrophy and fibrosis without altering PAH severity.
Lactobacillus
shifted the serum proteomic signature towards control (B) and reduced circulating GP130 ligands, normalized RV t-tubule architecture (C), MT density (D), and nucleus size (E), and prevented connexin-43 lateralization in RV cardiomyocytes (F).
Lactobacillus
restructured the microbiome, and concomitantly improved jejunal epithelial cell morphology with increased villus/microvillus length and glycocalyx thickness. PAH patients with fecal
Lactobacillus
had superior RV adaptation as afterload increased (G).

Conclusion:
Lactobacillus
combats GP130-mediated MT remodeling to support RV function.
Abstract 15948: Highly Suspicious Yet Diagnostically Unrevealing Left Ventricular Free-Wall Rupture Following STEMI
Authors: Prasai Astha , Babayale Omofolarin , Salah Mohamed Mohamed , Latifi Ahmad N , Sarji Rawa
Published: December 2023

Introduction:
Left ventricular wall rupture is a rare but lethal complication following a ST elevation myocardial infarction (STEMI). We present a case of left ventricular free-wall rupture not identified on echocardiography and CT angiography (CTA) despite high suspicion who underwent emergent lifesaving mediastinal exploration and repair.

Case:
A 52-year-old male with past medical history of hypertension presented with typical chest pain. He was found to have STEMI with 100% left anterior descending (LAD) artery occlusion and underwent percutaneous coronary intervention to mid LAD. Post procedure, he developed atrial fibrillation with rapid ventricular rate, pericarditis, increasing pericardial effusion (Figure 1), and cardiogenic shock. He underwent intra-aortic balloon pump placement with no improvement in hemodynamics and subsequently an Impella 5.5 was placed. On post MI Day 3, he underwent pericardial window in the setting of shock and increasing pericardial effusion. Intraoperative TEE showed signs of tamponade physiology (Figure 2). Repeat echocardiograms and CTA was unrevealing of a rupture. Post MI day 6, he had increasing output from the drains and increasing pericardial effusion with complete right ventricular collapse on bedside echocardiogram. Emergent mediastinal exploration revealed left ventricular (LV) free-wall rupture which was repaired with a bovine patch. Hemodynamics improved and goal directed medical therapy was started.

Discussion:
Free wall rupture is a rare complication post MI and is reported in only 0.01% of STEMI. It usually occurs within 1 week, majority occurring within 24 h of MI. Small LV wall rupture can be challenging to diagnose on cardiac imaging. This case emphasizes the importance of having a high index of suspicion for diagnosing free wall rupture in patients presenting with hemodynamically unstable pericardial effusion post STEMI. Prompt pericardiocentesis and surgical intervention lead to a good outcome.
Abstract 15953: Stressed Into a STEMI
Authors: Osama Muhammad , Nand Nikita , Salar Tooba , Mohamed Mohamed Salah S , Pendela Venkata Satish , Shah Sanjay K
Published: December 2023

Introduction:
Chest pain is the second most common presenting symptom in the emergency department (ED). 5.1% of all presentations with chest pain are acute coronary syndrome (ACS). ACS includes ST-segment elevation myocardial infarction (STEMI), non-ST segment elevation myocardial infarction (NSTEMI), and unstable angina (UA). We present a case of UA that progressed to STEMI after a regadenoson stress test.

Case:
A 55 years old male with 30 pack-year smoking history presented to the ED with sudden onset, sharp, left-sided chest pain associated with diaphoresis that lasted a few minutes. EKG showed sinus rhythm with premature ventricular complexes without ischemic changes. High sensitivity troponin at 0, 1, and 3 hours were within normal limits. While he was undergoing a radionucleotide stress test, he reported severe chest pain immediately after the regadenoson injection. Bedside telemetry showed ST elevation in inferior leads. EKG was consistent with 1mm ST-elevation in leads II, III, and aVF. He underwent an emergent coronary angiogram which revealed 100% occlusion in the mid-right coronary artery (RCA) and 80% in the second marginal distribution. He received a drug-eluting stent to RCA with the resolution of his chest pain.

Discussion:
Rupture or erosion of atherosclerotic plaque exposes the underlying thrombogenic core which can lead to occlusion of the coronary artery. A partial occlusion due to an unstable plaque can lead to UA or NSTEMI. STEMI results from complete occlusion of the coronary circulation. In our case, the patient presented with unstable angina however undergoing a stress test triggered him to STEMI. The administration of regadenoson led to coronary vasodilation, resulting in the redistribution of coronary blood flow away from the nearly occluded RCA but what led to plaque rupture at the same time leading to a STEMI is unclear.

Conclusions:
A regadenson stress test can trigger STEMI in patients with unstable angina however the mechanism is unclear
Abstract 15967: Unravelling the Role of Deoxyhypusine Synthase-Mediated Hypusination of eIF5A in Pulmonary Arterial Hypertension
Authors: Lemay Sarah-Eve , Grobs Yann , Romanet Charlotte , Martineau Sandra , SALEM MABROUKA , Shimauchi Tsukasa , Breuils Bonnet Sandra , Bourgeois Alice , Theberge Charlie , Potus Francois , Provencher Steeve , Bonnet Sebastien , Boucherat Olivier
Published: December 2023

Introduction:
Pulmonary Arterial Hypertension (PAH) is characterized by progressive distal pulmonary arteries (PAs) obstruction leading to heart failure and death. PA smooth muscle cells (PASMCs) from PAH patients display a “cancer-like” phenotype that contributes to PA remodeling. Appreciation of the pivotal role of translational control in hyperproliferating diseases is steadily increasing. In this regard, eukaryotic translation initiation factor 5A (eIF5A) was shown to provide cancer cells with a competitive advantage by increasing translation of mRNAs with oncogenic proprieties. Strikingly, eIF5A is the only protein containing the unique spermidine-derived amino acid hypusine required for its function. Hypusine formation is catalyzed by the sequential actions of deoxyhypusine synthase (DHPS) and deoxyhypusine hydrolase (DOHH). We hypothesized that increased
Hyp
eIF5A in PAH-PASMCs is required to promote translational efficiency of a set of factors conferring a higher survival and proliferative capacity, leading to pulmonary vascular remodeling.

Methods/Results:
As assessed by LC-MSMS and WB, expression levels of DHPS, DOHH and both total and hypusinated forms of eIF5A were found increased in PAs and PASMCs from PAH patients and animal models.
In vitro
, both molecular and pharmacological inhibition of DHPS and DOHH significantly attenuated PAH-PASMCs survival (WB Survivin; Annexin V labeling) and proliferation (WB MCM2, PLK1; Ki67 labeling and EdU incorporation). Hypusine signaling promoted the expression of a broad array of proteins involved in oxidative phosphorylation, supporting the bioenergetic requirements of cell survival and proliferation (LC-MSMS, WB, Seahorse).
In vivo
, smooth muscle cells-targeted inactivation of one allele of
Dhps
conferred partial protection against the development of Sugen/Hypoxia (Su/Hx)-induced PAH in mice. Accordingly, pharmacological inhibition of DHPS using GC7 improved hemodynamics (RVSP, mPAP, CO) and vascular remodeling (EVG) in monocrotaline and Su/Hx rats with established PAH.

Conclusion:
We showed for the first time that hypusine signaling is implicated in PAH development and represents a new promising therapeutic target.
Abstract 16064: Prognostication of Cardiopulmonary Exercise Testing in Heart Failure With Reduced Ejection Fraction on Optimized Guideline-Directed Medical Therapy
Authors: Ramanlal Riddhi , Inampudi Chakradhari
Published: December 2023

Introduction:
Cardiopulmonary exercise testing (CPET) is a valuable tool for predicting outcomes in patients with heart failure. Peak oxygen consumption (VO2) and minute ventilation/carbon dioxide production (VE/VCO2) are important prognostic factors in heart failure with reduced ejection fraction (HFrEF). However, prior studies have not examined the impact of optimization of guideline-directed medical therapy (GDMT) on the utility of CPET in prognostication.

Hypothesis:
This study aims to investigate the prognostic value of CPET in a cohort of HFrEF patients who are compliant with all four GDMT components: beta-blockers (BB), ace-inhibitors (ACEi)/angiotensin II-receptor-blockers (ARB)/angiotensin-receptor-neprilysin inhibitor (ARNI), mineralocorticoid receptor antagonist (MRA), and sodium-glucose cotransporter-2 (SGLT2). This will be compared to patients with HFrEF who are not fully optimized on GDMT to determine variation in the statistical significance of prognostic factors.

Methods:
We retrospectively analyzed data from 176 HFrEF patients who underwent CPET for prognostication purposes. The patients were followed for one year after. CPET testing was completed between January 2020 to June 2022. LVEF was evaluated by echocardiography, completed within 3 months of the CPET. From the data, 125 participants had an LVEF less than or equal to 40%. Of those, 71 were compliant with all four GDMT components, while 54 were not.

Results:
After one year, there were 16 events (MSR, transplant, or death) in the GDMT-optimized group comprised of 71 participants. Peak VO2 was higher in the no-event group and was notably the only statistically significant predictor of adverse event (p =0.0162). Similarly, of the 54 participants on less than four GDMT components, 13 adverse events occurred, and the strongest predictor was again peak VO2 (p=0.0027). In addition, VE/VCO2 slope were lower (p= 0.0234) and circulatory power were higher (p=0.0044) in the no-event group.

Conclusions:
In patients with HFrEF that are optimized on GDMT, peak VO2 is consistently the most robust and only statistically significant prognostication tool on CPET for MCS, transplantation, or death within one year.
Abstract 16065: AICD Lead Endocarditis With Large Vegetation Complicated by Septic Pulmonary Embolism
Authors: Mirza Noreen , Rayad Mohammad Nabil , Mirza Mariam , Farouji Iyad , Correia Joaquim
Published: December 2023

Introduction:
Infective endocarditis of an automatic implantable cardioverter-defibrillator (AICD) lead is a rare and serious complication. Less than 4% of AICD related endocarditis cases are caused by
Enterococcus faecalis
. Herein, we report a rare case of a patient with an infected AICD lead and a large vegetation caused by
Enterococcus faecalis
.

Case Presentation:
A 66-year-old male with a history of mitral valve replacement, heart failure with reduced ejection fraction status post AICD and hypertension presented with loss of appetite, subjective fevers and chills. Initial vitas were significant for tachycardia and tachypnea. Physical examination revealed lethargy and an irregular rate and rhythm. Initial labs showed an elevated WBC count, elevated C-reactive protein, elevated D-dimer, negative procalcitonin, negative High-sensitivity troponins and elevated BNP. Electrocardiogram showed atrial fibrillation. Echocardiogram showed an EF of 25-30% with a vegetation on the right ventricular lead. A CT angiogram chest was done and showed a right pulmonary artery embolism. Blood cultures were positive for
Enterococcus faecalis
. The patient was started on IV antibiotics, anticoagulation and he underwent open removal of the AICD along with multiple vegetations with the largest being 3.5cm. He recovered well post-operatively.

Discussion:
Cardiac device endocarditis is a difficult to manage condition that has been increasing in incidence over the years. Persistent infection is a problem faced when a patient has AICD endocarditis since these infections are typically resistant to many antibiotics necessitating surgical removal of the AICD. Patients that present with large vegetations larger than 2.5cm are at highest risk of complications. These complications include septic pulmonary emboli as seen in our patient, pulmonary abscess formation and pneumonia. Early diagnosis and lead extraction has been related to the highest reduction in mortality.
Abstract 16067: The Impact of a Prehospital Mobile Cloud ECG Transmission System on Myocardial Damage and Mid-Term Mortality in Patients With ST-Elevation Myocardial Infarction
Authors: Toyofuku Takaaki , Unoki Takashi , Inamori Taiji , Nakayama Tomoko , FUKUDA Toshiki , Matsura Junya , Hasegawa Satoko , Konami Yutaka , Suzuyama Hiroto , Inoue Masayuki , horio eiji , Kodama Kazuhisa , Taguchi Eiji , Sawamura Tadashi , Sakamoto Tomohiro , Nakao Koichi , Koyama Jyunjiro
Published: December 2023

Background:
Guidelines recommend that the door-to-balloon time (DTBT) should be reduced to ninety minutes or less in patients with STEMI. As such, it is critical that ambulance teams are adequately trained and equipped to identify STEMI utilizing ECG recorders and telemetry when necessary.

Aims:
This single-center study aims to evaluate the impact of the prehospital mobile cloud 12-lead ECG transmission system (SCUNA
®
, MEHERGEN GROUP) on reducing DTBT, myocardial damage, and mortality in STEMI patients.

Methods:
In June 2018, SCUNA were integrated into the regional emergency medical service (EMS) departments in Uki and Kamimashiki cities in Kumamoto, Japan. We examined and compared door-to-catheterization laboratory time (DTCT), DTBT, peak CK, CK-MB levels, as well as 1-year mortality rates of STEMI cases in the four years before and after the introduction of the SCUNA. From June 2014 to May 2022, a total of 338 STEMI patients were transferred to our institute by ambulances from the two EMS departments. After excluding 29 patients with onset to reperfusion times exceeding 24 hours and 66 patients who were transferred without the use of SCUNA following its introduction, 243 consecutive STEMI patients who underwent emergency percutaneous coronary intervention (PCI) were included in the study. The patients were divided into two groups, 130 patients prior to SCUNA introduction (Pre-SCUNA), 113 patients after SCUNA introduction (Post-SCUNA).

Results:
There were no significant differences in age, gender, past medical history or Killip classification between the two groups. DTCT, DTBT, and onset to reperfusion time (OTRT) were significantly reduced in the Post-SCUNA group compared to the Pre-SCUNA group (Pre-SCUNA: 40 min vs. Post-SCUNA: 25 min; p < 0.01, 71 min vs. 53 min; p < 0.01, and 201 min vs. 166 min; p = 0.02, respectively). No significant differences were observed between peak CK and CK-MB levels in the two groups. Kaplan-Meier analysis revealed that SCUNA did not improve 30-day and 1-year outcomes compared with the Pre-SCUNA groups.

Conclusion:
While the prehospital mobile cloud ECG transmission system effectively reduced DTBT, it did not lead to a notable reduction in myocardial damage or mortality rates.
Abstract 16077: Aortic Valve Thrombus and Acute Right Ventricular Failure in Recent Left Ventricular Assist Device Recipient: A Rare Case
Authors: Chia Ricardo , Boyer Brandon , Pietrandrea Peter , Giyanani Nisha , Douedi Steven , Singh Deepak , Ross Ronald , Moshiyakhov Mark , Barn Kulpreet
Published: December 2023

Case reports of aortic root thrombus with embolism leading to right ventricular (RV) failure in patients left ventricular assist devices (LVAD) are extremely rare in the literature, and often result in significant mortality. This is a case of a 52-year-old male who recently underwent destination-therapy HeartMate 3 LVAD implantation, on chronic warfarin, with history of non-ischemic cardiomyopathy, atrial fibrillation, and heparin-induced thrombocytopenia, who presented with chest pain and dyspnea. Initial evaluation was remarkable for tachycardia, troponin of 0.7 ng/dl, BNP 705, and INR 1.68. Argatroban was initiated, along with diuresis for volume overload on examination. Transthoracic echocardiogram showed stable findings with borderline RV dysfunction. On the following day, persistent chest pain and uptrend of troponin to 34 ng/dl were concerning for acute coronary syndrome (ACS), and plans were for left heart catheterization. However, a TEE revealed partial thrombus layering in the aortic valve and sinus of Valsalva with concerns for embolization through the right coronary ostia. RV assessment showed evidence of severe dilation and acute RV failure. Patient underwent emergent RV assist device (RVAD) placement (ProtekDuo and CentriMag) by cardiothoracic surgery. After mechanical RV support, there was progressive improvement of its function, and successful RVAD decannulation was attained. The patient was recently seen in the heart failure clinic with sustained recovery. Cases of aortic root thrombus with embolism leading to ACS in LVAD patients are extremely rare. As in our case, troponin elevation, subtherapeutic INR, and aortic root thrombus, allowed early clinical recognition and appropriate management of patient’s RV failure, which is imperative for successful outcomes in LVAD patients. Aortic valve thrombus should be considered in LVAD patients presenting with ACS, and early invasive strategy without valve assessment should be cautioned.
Abstract 16079: Outcomes Among Heart Failure Patients With Non English Language Preference
Authors: Latif Zara , Makuvire Tracy , Modest Anna , Quintero Pinzon Pablo A , Wadhera Rishi K , Gelfand Eli , Rodriguez Fatima , Warraich Haider
Published: December 2023

Introduction:
Non-English Language Preference(NELP) has been associated with inequitable care with prior studies highlighting increased risk of readmissions and lower patient satisfaction with care. However, outcomes of patients with heart failure with reduced ejection fraction (HFrEF) who identify as NELP in the United States have not been previously reported.

Aims:
To evaluate clinical outcomes of HFrEF patients with NELP compared to English-speaking patients.

Methods:
We performed a single center propensity score matched retrospective cohort study of HFrEF patients who received care between 2010-2022. We compared 5-year mortality, guideline directed medical therapy (GDMT) utilization, length of stay, and readmissions between NELP and English-speaking HFrEF patients. In secondary analyses, we divided NELP by major language group (Spanish, Russian, Other).

Results:
Our cohort consisted of 2136 English-speaking patients (mean age 82 years, 42% female) and 961 NELP patients (mean age 83 years, 41% female). NELP HFrEF patients had higher rates of angiotensin converting enzyme inhibitor/angiotensin receptor blocker and sodium glucose cotransporter 2 inhibitor use compared to English speakers (Table). Unadjusted 5-year mortality among NELP patients was lower compared to English speakers with a hazard ratio of 0.8 (95% CI 0.68-0.94), but this difference was attenuated after adjusting for race.NELP patients were more likely to have ED visits (69% vs. 65%) but less likely to have inpatient admissions (82% vs 85%) (both p<0.05). In our secondary analysis, Spanish speakers were more likely to be on more GDMT classes compared to English speakers while Russian speakers had increased risk of readmissions and longer length of stay compared to English speakers.

Conclusions:
NELP patients are heterogeneous with multiple group differences in GDMT use and admissions.Further research is needed to provide culturally-competent, equitable care for HFrEF patients.
Abstract 16172: Impella Use in Large Post-Infarct Ventricular Septal Rupture
Authors: Hintz John P , Feldman Daniel R , Chaudry Hannah I
Published: December 2023

Background:
Ventricular Septal Rupture (VSR) is a deleterious complication associated with myocardial infarction (MI). The most common form of mechanical circulatory support (MCS) utilized in post-MI complications is intra-aortic balloon pump (IABP). Impella is a far less commonly used modality as there is the potential for right-to-left shunting and a chance of mechanical perforation of the heart. Below is a case where an Impella 5.5 catheter was necessary to bridge a patient for surgical repair.

Case presentation:
A 76-year-old male patient presented to an outside hospital with an acute inferior ST-elevation myocardial infarction. He was treated with thrombolysis and was emergently taken to the catheterization lab where he underwent stenting of his RCA with plan to medically manage his non-culprit disease. His hospital course was complicated by cardiogenic shock with an echocardiogram that demonstrated a large VSR (Figure 1). A right heart catheterization demonstrated a significant left-to-right shunt (Qp/Qs ratio of 6:1) which necessitated mechanical support with an IABP as per standard of care. Post-IABP his Qp/Qs ratio improved to 1.6:1 but he continued to be under supported and remained in cardiogenic shock. Surgical repair of the VSR was planned for 1-week post-MI so he was transitioned to an Impella 5.5 catheter in order to stabilize and bridge him for surgery. Patient underwent surgical VSR repair and CABG on hospital day 7. Post-op he did well and was later discharged to rehabilitation center with subsequent recovery.

Conclusions:
If properly managed, utilization of an Impella catheter can be an effective tool to stabilize patients in post-MI VSR with refractory cardiogenic shock and bridge patients towards surgical repair. It is particularly effective when additional MCS support is required beyond the contemporary IABP and it can be used to stabilize patients for longer durations to ultimately avoid emergent surgery.
Abstract 16245: Prevalence and Time Course of Adverse Events After a Biopsy Diagnosis of Antibody-Mediated Rejection in Pediatric Heart Transplant Recipients
Authors: Everitt Melanie D , Pahl Elfriede , Koehl Devin A , Cantor Ryan S , Kirklin James K , reed christine , Zinn Matthew D , McCormick Amanda D , Yester Jessie , Thrush Philip , Schauer Jenna , Lee Donna
Published: December 2023

Background:
Antibody-mediated rejection (AMR) is of great relevance when assessing therapies to improve survival for pediatric heart transplant (HT). Biopsy (EMB) is the most specific means for diagnosing AMR. This study explores the impact on survival and adverse events after treated rejection (TRej) in children with AMR on EMB (any pAMR 1h or i, 2, or 3) vs acute cellular rejection (ACR).

Methods:
Children in the Pediatric HT Study transplanted between 1/2015-6/2022 who survived ≥2 weeks and had at least 1 TRej with EMB data were included. Survival was compared after 1st TRej with any AMR to pure ACR. Secondary outcomes of infection, malignancy, and cardiac allograft vasculopathy (CAV) after 1st TRej were assessed. Risk factors for mortality after AMR were identified using Cox proportional hazard modeling.

Results:
Among 3172 HT recipients, 906 (29%) had at least 1 TRej. Of these, 697 (77%) had EMB data to determine the presence of AMR. At the 1st TRej episode, 261 (37%) children had features of AMR. Median time to 1st Trej was earlier in those with AMR vs ACR, 0.11 vs 0.29 yrs. p=0.001. Survival after 1st TRej with AMR was worse than ACR in the 1st yr post HT (A); however, survival was similar when 1st TRej occurred after year 1 (B) (Figure 1 A, B). The AMR group had higher panel reactive antibody at HT, more congenital heart disease (CHD), and more had ABO incompatible HT (all p<0.05). There was no difference in time to 1st infection, malignancy, or CAV between those with treated AMR vs ACR. Multivariate predictors of graft loss after AMR were younger age, CHD, and ECMO at HT, and hemodynamic compromise at TRej (all p<0.048). Neither AMR grade nor concomitant ACR was associated with graft loss after AMR.

Conclusion:
This is the largest analysis of contemporary outcomes of EMB-confirmed AMR in pediatric HT. Findings underscore the impact of early AMR on graft loss and the need for tailored therapies. Similar time to infection after AMR vs ACR is notable since immune targets of therapy often differ.
Abstract 16291: Regional Variability in Cardiovascular MRI Access and Utilization in the U.S. Population From 2017 to 2019
Authors: Li Jennifer M , Ho David R , Husain Nazia , Finn J. P , Goldfarb James W , Fuisz Anthon R , Saeed Ibrahim M , Nguyen Kim-Lien
Published: December 2023

Background:
Despite clinical guidelines and scientific data supporting the use of cardiovascular magnetic resonance (CMR) imaging in multiple applications, CMR continues to be underutilized in the United States (U.S.).

Objective:
This study aims to capture geographic variability, access, and CMR practice patterns in the U.S. between 2017 and 2019.

Methods:
Commissioned reports from the Society of Cardiovascular Magnetic Resonance (SCMR), and data from a nationwide survey of CMR centers were used. Medicare claims for CMR studies from 2019 were compiled by the Moran Company. Surveys designed to collect data on center-specific characteristics were sent to 155 CMR centers identified through SCMR email listserve and Medicare claims data. Survey responses were reviewed to ensure only one response was captured from each center.

Results:
A total of 592 imaging centers were included in the Moran report and 112 unique centers responded to the survey. Of the centers included in the report, 47% billed for less than 10 of the most frequent study (CMR for morphology w/ dye) in 2019. The total density of CMR centers was 15.6 centers per million U.S. Medicare Part B beneficiaries. CMR centers are more dense in geographic areas of lowest socioeconomic disadvantage (based on the Area Deprivation Index), low poverty, and lowest percent of people lacking health insurance. Sixty-eight percent of survey responders were cardiologists, and 28% were radiologists. Seventy-two percent of centers reported performing 81-100% of their CMR exams in an academic healthcare system. Centers performing >500 scans per year had an average of 19 years of experience, whereas centers performing <50 scans had an average 3.5 years’ experience. The most common response for approximate patient wait time for CMR was 2 weeks to 1 month (45% of responses).

Conclusions:
Although CMR volume is increasing in the U.S., CMR access continues to demonstrate marked geographic variability. While almost half of centers are performing just a handful of scans annually, the greatest volumes are noted in well-established programs with years of experience. Identification of specific barriers to CMR access will be useful for future advocacy efforts and quality improvement initiatives.
Abstract 16302: Beyond the Veins: A Critical Right Atrial Termination Site in High Burden Paroxysmal Atrial Fibrillation Identified Using Spatiotemporal Dispersion After Failure of High Quality Pulmonary Vein Isolation
Authors: Manongi Ngoda , Goldbarg Seth
Published: December 2023

Case Presentation:
A 55 year-old female with two-year history of persistent atrial fibrillation (AF) presented for elective catheter ablation. Her smart watch recorded frequent prolonged episodes of AF, and event monitoring confirmed 71% AF burden. Metoprolol improved her symptoms only slightly. At the beginning of the procedure, patient’s rhythm was on sinus (NSR). During the completion of pulmonary vein isolation (PVI), the patient developed typical flutter, which degenerated into AF during ablation. Biatrial dispersion mapping in the right atrium (RA) revealed a single highly dispersed area in the posterior RA. Ablation at this site immediately terminated AF to NSR. The patient was non-inducible and remains free of AF.

Discussion:
Maintenance of NSR in AF is associated with improved clinical outcomes and quality of life. Catheter ablation has the highest efficacy for minimizing AF burden. PVI has a success rate of 67-89% in treating patients with paroxysmal AF and PVI alone is typically employed. A dispersion area is characterized by local clusters of electrograms which may or may not be fractionated, and display interelectrode time and space dispersion such that activation is spread over the entire AF cycle length. Identification and ablation of dispersion regions in persistent AF has demonstrated a high acute termination rate and improved outcomes in early follow-up, but is difficult to reproduce (Seitz et al. 2017). Here, we present a case of a patient with high burden paroxysmal AF who underwent PVI but remained in AF. Using visual dispersion mapping, we were able to identify a critical RA dispersion area, which rendered patient non-inducible (Figure 1).
Abstract 16310: Adherence of Randomized Controlled Trials in Heart Failure to Consort Reporting Standards
Authors: Jalloh Mohamed Bella , Bot Veronica A , Borjaille Cristiana , Van Spall Harriette G
Published: December 2023

Introduction:
Randomized control trials (RCTs) have changed care in Heart Failure (HF), but the reliability of results is contingent on trial validity and transparent reporting. The Consolidated Standards of Reporting Trials (CONSORT) checklist was developed in 1996 and subsequently updated to guide the design and reporting of RCTs, but the adherence of HF RCTs to CONSORT remains poorly understood. This study sought to evaluate the adherence of HF RCTs to the CONSORT 2010 update and to examine temporal trends in trial reporting in HF trials.

Methods:
We searched MEDLINE, EMBASE and CINAHL for HF RCTs in high-impact journals between 2000 and 2020. The primary outcome measure was RCT CONSORT statement or CONSORT extension reporting presented as mean CONSORT score. Descriptive statistics were calculated for CONSORT scores. We used the Jonckheere-Terpstra test to examine temporal trends and employed multivariable linear regression to evaluate the association between prespecified trial characteristics and the mean CONSORT score.

Results:
There were 221 RCTs, and mean CONSORT score was 69.7% (SD 11.5). Adherence to CONSORT reporting standards improved from 61.5% (SD 11.1) in 2000-2003 to 76.5% (SD 8.8) in 2016-2020 (
P
<.001). Adherence was greater in two-group parallel individual-level RCTs (β =6.22 95% CI: 3.14, 9.30;
P
<.001) than in other trial types. Drug (β= -3.91, 95% CI: -7.32, -0.50;
P
<.001) and device/surgical (β= -2.82 (95% CI: -7.56, 1.93;
P
<.001) interventions were associated with lower adherence to CONSORT reporting standards than other interventions, while publication after 2010 was associated with greater adherence (β=10.96, 95% CI: 8.37, 13.55;
P
<.001). Funding source did not appear to have an association with adherence (β=1.51, 95% CI: -1.53, 4.55;
P
=.33).

Conclusions:
Among HF RCTs published in high-impact journals, adherence to CONSORT reporting standards has improved over time, but remains variable and suboptimal overall.
Abstract 16315: Associations Between Angiogenic Biomarkers in Early Pregnancy and Predicted 30-year Risk of Cardiovascular Disease 2-7 Years After Delivery
Authors: Awoyemi Toluwalase , Huang Xiaoning , McNeil Rebecca , Varagic Jasmina , Pemberton Victoria L , Catov Janet M , Bairey C Noel N , Chung Judith , Haas David , Levine Lisa , Saade George , Silver Robert , Reddy Uma , Mercer Brian , Yee Lynn , Greenland Philip , Grobman William , Khan Sadiya S
Published: December 2023

Introduction:
The placenta is a vascular organ that secretes angiogenic proteins during pregnancy. Abnormalities in these biomarkers are associated with higher risk for adverse pregnancy outcomes, which include hypertensive disorders of pregnancy (HDP) and gestational diabetes (GDM). However, the association between abnormalities in angiogenic proteins and long-term CVD risk is uncertain.

Aims:
To determine the association between angiogenic placental proteins measured in early pregnancy and predicted 30-year risk of CVD 2-7 years after delivery.

Methods:
In this analysis, we included nulliparous individuals from the prospective multicenter nuMoM2b Heart Health Study (nuMoM2b-HHS) with available data on angiogenic protein concentrations in the first trimester (vascular endothelial growth factor [VEGF], placental growth factor [PlGF], endoglin, and soluble fms-like tyrosine kinase-1 [sFLT-1]). The primary outcome was predicted 30-year risk of CVD based on the Framingham model, which integrates traditional risk factor levels into an absolute risk estimate. Multivariable linear regression estimated associations between log-transformed angiogenic protein concentrations and predicted 30-year risk of CVD, adjusting for maternal age, gestational age, insurance type, and smoking status at the first trimester visit. Analyses were repeated stratified by HDP or GDM.

Results:
Of 987 nuMoM2b-HHS participants included, the mean age was 26.9 (SD 5.9) years and the mean gestational age at biomarker assessment was 11.4 (1.6) weeks. Higher log-transformed concentrations of VEGF (per 1-SD) were associated with greater predicted 30-year risk of CVD by 0.68% (0.34, 1.02). Conversely, higher log-transformed concentrations of endoglin and sFlt-1 were associated with lower 30-year predicted risk of CVD by 0.85% (-1.15, -0.55) and 0.70% (-1.00, -0.41), respectively. There was no association between PlGF and 30-year predicted risk of CVD. Results were similar in those with or without HDP or GDM.

Conclusions:
Concentrations of VEGF, endoglin, and sFLt-1 measured in early pregnancy were associated with predicted long-term risk of CVD 2-7 years after delivery in all birthing individuals whether or not they experienced an adverse pregnancy outcome.
Abstract 16324: A Deep Learning Electrocardiogram Model Identifies Risk of Incident Heart Failure in Patients With Subclinical Hypothyroidism
Authors: Yagi Ryuichiro , Macrae Calum , Deo Rahul C , Goto Shinichi
Published: December 2023

Introduction:
Subclinical hypothyroidism (SH) is associated with an increased risk of heart failure (HF). However, there are no established measures to predict HF development within the SH population.

Hypothesis:
Risk of incident heart failure in SH can be predicted from a 12-lead electrocardiogram using features extracted by a convolutional neural network-based model.

Methods:
To test the hypothesis, we developed a convolutional neural network (CNN)-based model to detect ECG features linked with low thyroid function by training to discriminate the presence of hypothyroidism from 10,745 ECGs (2,693 from patients with low free T4 (FT4) and 8,052 from age, sex-matched patients without evidence of low FT4). The model was applied to baseline ECGs from an external cohort of 2,293 patients with SH (defined TSH >4.5mIU/L and FT4 within 0.9-1.9ng/dl) to estimate the cardiac phenotype induced by hypothyroidism (ECG-hypothyroidism score). Cumulative incidences of HF admission were compared between groups stratified by the tertile of the model output (low, intermediate, and high score groups). Adjusted hazard ratios (aHR) were calculated using Cox proportional hazard model.

Results:
HF admission was more frequent in the high score group (9.60/100 person-year), compared with the intermediate or low score groups (5.08 and 2.29 per 100 person-year in the, respectively;
Fig
). Subgroup analyses by sex and age group yielded similar results. The association between the ECG-hypothyroidism score and HF admission remained significant after adjustment for patient characteristics, conventional ECG abnormalities, and baseline thyroid function (high vs low score group: aHR 3.56, [95%CI, 2.26-5.61]; high vs intermediate score group: aHR 1.78, [95%CI, 1.25-2.54]).

Conclusions:
The CNN-based model, trained to detect prevalent hypothyroidism, accurately identified patients at high risk for HF admission within the SH population using baseline ECG.
Abstract 16327: Machine Learning-Based Prediction of Clinical Frailty Scale Based on Gait Analysis in Elderly Patients With Heart Failure
Authors: Nakao Motoki , Nagai Toshiyuki , Mizuguchi Yoshifumi , Takahashi Yuki , Abe Takahiro , KAKINOKI SHIGEO , Imagawa Shogo , Matsutani Kenichi , Saito Takahiko , Takahashi Masashige , Hirata Kenji , Ogawa Takahiro , Shimizu Takuto , Otsu Manabu , Chiyo Kunihiro , Anzai Toshihisa
Published: December 2023

Background:
Although frailty assessment is recommended for guiding treatment strategies and outcome prediction in elderly patients with heart failure (HF), most frailty scales are subjective, and the scores vary among raters. We sought to develop a machine learning-based automatic rating method/system/model of the clinical frailty scale (CFS) for patients with HF.

Methods:
We prospectively examined 358 elderly (≥75 years) with symptomatic chronic HF patients (mean age 82.3±5.2 years, left ventricular ejection fraction 58 [IQR 45-67]%) from six sites between January 2019 and September 2022. The CFS was evaluated based on the modified Delphi method by 10 independent trained cardiologists as the gold standard. We obtained body-tracking motion data using OpenPose
®
, a deep learning-based pose estimation library, on a smartphone camera. Predicted CFS was calculated from 128 key features, including gait parameters, using the extremely randomized trees (ERT) model. To evaluate the performance of this model, we calculated Cohen’s weighted kappa and intraclass correlation coefficient (ICC) between the predicted and actual CFSs. The studied patients were divided into derivation (from a university hospital) and validation (from other five sites) cohorts.
Results:
In the derivation (n = 181) and validation (n = 177) cohorts, the ERT model showed sufficient agreement between the actual and predicted CFSs (kappa 0.864, ICC 0.864 and kappa 0.796, ICC 0.796, respectively) (
Figure
). During a median follow-up period of 421 (IQR 280-616) days, the higher predicted CFS was independently associated with a higher risk of all-cause death (HR 1.97, 95% CI 1.21-3.20) adjusted for the MAGGIC mortality risk prediction score, N-terminal pro-brain natriuretic peptide, and serum albumin levels.

Conclusions:
Machine learning-based algorithms that automatically rate the CFS are feasible, and the predicted CFS is associated with the risk of all-cause death in elderly patients with HF.