bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 16487: Implementation of a Web-Based Cardiac Rehabilitation Program in Rural Australia Improves Access
Authors: Nesbitt Katie , Champion Stephanie , Foote Jonathon , Gebremichael Lemlem G , Clark Robyn A , Beleigoli Alline
Published: December 2023

Introduction:
Involvement in cardiac rehabilitation (CR) programs reduces death, reoccurring cardiac events, also improving quality of life. Globally, CR attendance and completion is poor, with referral and non-attendance rates ranging from 20-50%.

Hypothesis:
To evaluate the effectiveness of an interactive web-based CR program as an alternative mode of delivery, to improve access and attendance.

Methods:
The RE-AIM implementation framework. Patients eligible for CR, residing in a rural and remote areas between July 2021-June 2022

Results:
A total of 828 rural patients participated, 50 choosing the web-based mode of delivery. Web patients were younger, (60, SD 11.9 vs 68.5 years, SD 11.9; p<0.001). Sex distribution did not differ between web and non-web, 17 (34%) males in web and 195 (23.5%) non-web (p=0.167). Myocardial infarction was the predominant reason for referral in both groups (64.3% vs 35.6%, p=0.049). Mean BMI was higher in the web compared to non-web (33.6, SD 8.0 vs 29.8, SD 6.0; p=0.025). Program completion was higher for non-web than for the web-based patients (17; 34% vs 553;71.4% p=<0.001). Web-based patients reported overall program satisfaction (77.8%). Clinicians reported the web-based program as high quality (71.4%). There was an increase in web-based enrolments with concurrent reduction in usual care resulting from COVID pandemic restrictions. Patient fidelity to entry of self-reported data was high in the web-based with all patients completing a pre-assessment and 50% a post-assessment. Change in risk factor control did not differ between the groups. There was no significant difference in patients’ preference by age or gender for web-based or other modes of CR. Web-based program enrolment was associated with a lower chance of CR completion (OR 0.19; 95% CI: 0.100, 0.372; p<0.001) after adjustment for age and gender.

Conclusions:
The web-based program provides an alternative flexible mode to complete CR, having met the demands of COVID pandemic restrictions. It has been integrated and successfully used by patients and clinicians, capturing a cohort who fit into the 20-50% not attending a CR program. Strategies for improving completion of web-based programs need further investigation.
Abstract 16496: Future Hypertension Risk Among a Peripartum Cardiomyopathy Cohort From Kaiser Permanente Northern California
Authors: Fairman Alix P , Choo Monica , Xu Richie Houhong , Joshi Nikhil , Gunderson Erica P , Pursnani Seema
Published: December 2023

Introduction:
Women have unique sex-specific risk factors related to pregnancy and reproduction that are increasingly recognized as risk-enhancing factors for atherosclerotic cardiovascular disease (ASCVD). While studies have established hypertensive disorders of pregnancy as a risk factor for long-term maternal CVD and mortality, the long-term cardiovascular sequelae following peripartum cardiomyopathy (PPCM) are not as well established.

Aims:
To determine whether the occurrence of PPCM increases later risk of hypertension.

Methods:
Retrospective case-control study of pregnant patients identified within a Kaiser Permanente Northern California (KPNC) cohort of women with and without peripartum cardiomyopathy between 1998-2004, with up to 23 years follow up.

Results:
We identified 62 PPCM cases, matched by age, delivery year, gestational age, pre-existing hypertension, hypertensive disorders of pregnancy, and hyperlipidemia to a control group of women without PPCM (Table 1). There was a statistically significant greater odds of incident essential hypertension among those with PPCM, 58.1% compared to 20.4% of matched controls, OR 5.39 (95%CI: 2.9, 10.02) at a mean 11 years of follow-up.

Conclusion:
In the KPNC cohort, PPCM was a predictor for the development of essential hypertension later in life.*P<0.0001Table 1. Baseline demographic and cardiovascular risk factors for women with peripartum cardiomyopathy compared to a matched cohort. Unless otherwise specified, numbers shown represent frequency (percentage of total).
Abstract 16504: Hospital Frailty Risk Score (HFRS) Predicts Adverse Events in Patients Undergoing Elective Percutaneous Left Atrial Appendage Closure (LAAC) With WATCHMAN Device
Authors: Patil Shivaraj , Rojulpote Chaitanya , Bhattaru Abhijit , Atri Avica , Tito Sahana , Atri Viha , Khraisha Ola
Published: December 2023

Introduction:
Frailty and its association with adverse events are well-known in transcatheter aortic valve replacement. However, this association has not been well-studied in patients undergoing Left Atrial Appendage Closure (LAAC).

Hypothesis:
Frailty predicts adverse events in patients undergoing elective LAAC with WATCHMAN device.

Methods:
Patients aged ≥65 years who underwent elective LAAC with WATCHMAN device were identified using ICD-10 procedure code 02L73DK from the 2016-2018 HCUP-NIS Database. Hospital Frailty Risk Score (HFRS) was calculated for each patient based on 109 ICD-10 diagnosis codes and classified into non-frail (HFRS < 5) and frail (HFRS score ≥ 5) groups. In-hospital major adverse event (MAE) was defined as the composite of mortality, stroke (ischemic or hemorrhagic) or TIA, bleeding or transfusion, vascular complications, myocardial infarction, systemic embolization, and pericardial effusion or tamponade requiring pericardiocentesis or surgery. Multivariate regression and receiver operating characteristic (ROC) analyses were used to assess the relationship between the HFRS and MAE.

Results:
28,050 patients (Age = 77.3 ± 6.4 years; Female = 42.6%) were included, and 4.7% experienced in-hospital MAE. Frail patients (HFRS score ≥ 5) constituted 12.5% of the cohort. Frail patients were older and had a more significant proportion of women. Rates of MAE were significantly greater in frail patients (4% vs. 9.7%; p<0.001). Increasing Hospital Frailty Risk Score was associated with a greater risk of in-hospital MAE. The AUC - ROC was 0.63 (Figures: A and B).

Conclusions:
HFRS predicts adverse events after LAAC. HFRS could be implemented in hospital information systems to facilitate the identification of at-risk patients.
Abstract 16514: Head-to-Head Comparison of Quantitative Image Quality on Rubidium-82 Myocardial Perfusion Positron Emission Tomography Between a Digital Silicon Photomultiplierand Conventional Scanner
Authors: Hashimoto Hidenobu , Han Donghee , Mark Hyun , Kuronuma Keiichiro , Dey Damini , Slomka Piotr J , Berman Daniel
Published: December 2023

Introduction:
The purpose of this study was to compare rubidium-82 positron emission tomography (
82
Rb PET) myocardial perfusion imaging (MPI) findings and quantitative image quality measures between the digital silicone photomultipliers (SiPM) scanner and a conventional scanner.

Methods:
We studied 24 consecutive patients (mean age 71.2±2.2 years) who underwent two clinically indicated rest/stress
82
Rb PET MPI examinations on two scanners, one using a SiPM-based PET scanner (Biograph Vision, Siemens Healthineers) and the other using a conventional photomultiplier tube (PMT)-based PET scanner (Discovery 710, GE Healthcare). Inclusion criteria were: 1) interval between the scans <2 yr (median 1.1 yr, 95% CI: 0.9-1.4), 2) no interval revascularization, and 3) no interval symptom changes. Stress and imaging protocols were the same.
82
Rb doses were 925 MBq at rest and stress. Image quality was assessed using blood background coefficient-of-variation (COV), myocardium to blood signal to noise ratio (SNR) and contrast to noise ratio (CNR) calculated from the
82
Rb images.

Results:
Between two scanners, there were no significant differences in perfusion and functional measures, including summed stress score (SiPM: 1.6 ± 0.7 vs. PMT: 1.8 ± 0.8, p=0.21), summed rest score (SiPM: 2.7 ± 1.0 vs. PMT: 3.1 ± 1.2, p=0.34), LV function (LVEF, SiPM: 62.6 ± 2.8 vs. PMT: 61.4 ± 2.8, p=0.82) and volumes (LVEDV, SiPM: 62.6 ± 2.8 vs. PMT: 61.4 ± 2.8, p=0.51). Image quality measures significantly improved (Figure), with lower COV (SiPM: 15.3 ± 0.8 vs. PMT: 19.3 ± 1.1, p=0.006), higher SNR (SiPM; 26.4 ± 1.8 vs. PMT; 20.5 ± 1.5, p<0.001) and CNR (SiPM; 14.2 ± 1.2 vs. PMT; 11.4 ± 1.1, p=0.02).

Conclusions:
82
Rb PET MPI performed with SiPM-based a PET scanner showed significantly better image contrast and less noise compared to a PMT-based PET scanner. These findings suggest that the SiPM based PET scanner provides more previse evaluations for patients undergoing
82
Rb PET MPI.
Abstract 16523: Trends and Outcomes of Preeclampsia Hospitalizations According to the Nationwide Inpatient Sample 2016-2020; An Updated Retrospective Population-Based Study
Authors: Evbayekha Endurance O , Jelwan Yara , Gaibor Carlos , Kuttab Rani , Bastidas Leonela , Desai Purav , Markson Favour , pohlman thomas
Published: December 2023

Introduction:
Preeclampsia occurs in about 5-8% of pregnancies and is a leading cause of maternal morbidity and mortality. We aimed to study the inpatient population with preeclampsia.

Hypothesis:
The disparity gap remains apparent in maternal health, and minority populations would have poorer outcomes

Methods:
We conducted a retrospective analysis using the 2016 to 2020 Nationwide Inpatient Sample (NIS) database. Using ICD-10 codes, we identified all hospitalizations with a primary diagnosis of preeclampsia. We adjusted for confounders and used a multivariate logistic regression model to estimate the odds ratio (adjusted odds ratios (aOR)) of our outcomes of interest.

Results:
There were 126,255 primary preeclampsia hospitalizations (PRE) during the study period, of which 2.2% (2,736) had eclampsia (ECL). There was an increase in the number of PRE hospitalizations from 24459 (24.5 per 1000 deliveries) in 2016 to 28448 (28.4 per 1000 pregnancies) in 2020 (p <0.0001). Contrary to PRE admissions, there was a considerable decrease in hospitalizations or diagnoses for ECL from 958 (1 per 1000 deliveries) in 2016 to 417 (0.4 per 1000 deliveries) in 2020 (p<0.0001). The mean age was 29 years (SD=6.3), and the mean length of hospitalization was 4 days (SD=3.6). Compared to their Caucasian counterparts, the risk of eclampsia was higher in the minority populations, with aOR of 2.4 (CI 2.1-2.6, p<0.0001) in the Black, 1.3 (CI 1.1-1.4, p<0.0001) in the Hispanic, 1.01 (CI 0.8-1.3, p=0.7) in the Asian, and 1.7 (CI 1.1-2.4, p<0.0001) in the Native-American populations. Furthermore, the PRE group had a higher likelihood of postpartum acute kidney injury, 9.6 (CI 7.8-11.6, p<0.0001), and postpartum cardiomyopathy 3.3 (2.9-3.9, p<0.0001).

Conclusions:
Our five-year inpatient analysis revealed that while preeclampsia hospitalizations increased, eclampsia decreased. It also highlighted a higher likelihood of eclampsia in Black, Hispanic, and Native-American women and a subsequent increased risk for postpartum cardiomyopathy and acute kidney injury. Tailoring individualized maternal cardiovascular care based on risk stratification is crucial in these populations.
Abstract 16533: Non-Invasive Insulin Resistance Evaluation Using Carotid Pressure Waveforms in Framingham Heart Study
Authors: Liu Jing , Niroumandi Soha , Petrasek Danny , Pahlevan Niema M
Published: December 2023

Introduction:
Insulin resistance (IR) and the resultant hyperinsulinemia not only lead to the onset of diabetes but also are shown to elevate the risk of heart failure and underlie a spectrum of cardio-metabolic pathologies in both diabetic and non-diabetes patients. Measuring IR is challenging owing to reliance on an invasive and time-consuming procedure called a glucose clamp study, which is known as the gold standard method of assessing IR. However, this method is not routinely available in most clinical settings. The Homeostasis Model Assessment of IR (HOMA-IR) is a validated tool for evaluating IR calculated based on fasting glucose and insulin concentrations obtained from fasting blood samples. Determining optimal cut-off values for HOMA-IR has been challenging since its distribution varies across different demographic characteristics and populations.

Aim:
This study aims to facilitate the screening of HOMA-IR by introducing a new method that utilizes a non-invasive carotid pressure waveform to assess HOMA-IR.

Methods:
We extracted Intrinsic Frequency Analysis-derived features from carotid pressure waveform to detect HOMA-IR using machine learning. A non-diabetic cohort from Framingham Heart Study (FHS) (n=5427, 53% female, age range 19-90) was used to develop and test the proposed method. The method was developed on 80% of the data and blindly tested on 20%
.

Results:
Using thresholds of 0.5 and 3 for the low (carefree) and high (alarming) zones of HOMA-IR in FHS dataset, respectively, the performance of detecting high HOMA achieved an area under curve (AUC) of 0.82 on the blind test set data (n=1085) (Fig.1; ROC: receiver operating characteristic curve).

Conclusion:
The non-invasive nature of the proposed method facilitates the screening of metabolic disease risks based on HOMA-IR level inferences from noninvasive carotid pressure waveforms, which can be implemented in routine clinical practice using inexpensive standard hand-held tonometry devices.
Abstract 16543: New-Onset Infective Endocarditis in Diabetic Patients Receiving SGLT2I and DPP4I: A Population-Based Cohort Study
Authors: Chou Oscar Hou In , Guo Tianyu , Chung Cheuk To T , Jing Fengshi , Chan Jeffrey S , Satti Danish Iltaf , Pang Ronald T , Lee Sharen , Wong Wing Tak Jack , cheung bernard , Tse Gary , Zhou Jiandong
Published: December 2023

Background:
Sodium-glucose cotransporter-2 inhibitors (SGLT2I) have been suggested to have beneficial effects against infection. However, the comparative risks of new onset infective endocarditis between SGLT2Is and dipeptidyl peptidase-4 inhibitors (DPP4Is) remain unknown.

Objective:
This real-world study aims to compare the risks of infective endocarditis upon exposure to SGLT2I and dipeptidyl peptidase-4 inhibitors (DPP4I).

Methods:
This was a retrospective population-based cohort study of patients with type-2 diabetes mellitus (T2DM) on either SGLT2I or DPP4I between 1st January 2015 and 31st December 2020 using a territory-wide registry in Hong Kong. The primary outcome was new-onset infective endocarditis. The secondary outcome was cardiovascular-related mortality. Propensity score matching (1:1 ratio) using the nearest neighbour search was performed. Multivariable Cox regression was applied to identify significant associations.

Results:
This cohort included 75638 T2DM patients (median age: 62.3 years old [SD: 12.8]; 55.79 % males). The SGLT2I and DPP4I groups consisted of 28774 patients and 46864 patients, respectively. After matching, 104 and 161 endocarditis events in the SGLT2I and DPP4I groups occurred over a follow-up of 5.6 years. SGLT2I use was associated with lower risks of infective endocarditis (Hazard ratio [HR]: 0.58; 95% Confidence Interval [CI]: 0.41-0.81; p=0.0016) and cardiovascular mortality (HR: 0.49; 95% CI: 0.33-0.72; p=0.0002) compared to DPP4I use after adjustments for demographics, comorbidities, medications, renal function and HbA1c levels. Similar associations were observed in subgroup analyses by gender, hypertension, arrhythmia, or renal disease, competing risk and sensitivity analyses.

Conclusions:
SGLT2I use is associated with lower risks of new-onset infective endocarditis compared to DPP4I.
Abstract 16556: Tafamidis: A Game Changer in Transthyretin Cardiomyopathy? A Systematic Review of Efficacy and Safety
Authors: Hussain Bilal , Hamza Mohammad , sattar yasar , Patel Bansari , Song David , Patel Neel N , Duhan Sanchit , Cheema Mustafa Sajjad , Naeem Minahil , Waqar Hafiza Hareem , Lactana Sharaad , Alraies M Chadi C
Published: December 2023

Introduction:
FDA approval of tafamidis as a treatment for Transthyretin cardiomyopathy (ATTR-CM) was preceded by demonstrating clinical efficacy and safety based on double-blind trials that showed reduction in mortality, and cardiovascular-related hospitalization. We conducted a systematic review to assess the safety and efficacy using present literature.

Methods:
7 studies were included in this meta-analysis from PubMed and Embase comparing tafamidis treatment to no tafamidis for ATTR-CM. Mantel-Haenszel method was used to calculate pooled log odds-ratio (OR) for binary outcomes and Hedges’ g using inverse-variance method for continuous outcomes.

Results:
Tafamidis was associated with decreased odds of mortality (OR 0.55, 95% CI 0.42-0.73, I2=41%, p<0.0001) and reduced CHF exacerbations (OR 0.71, 95% CI 0.51-0.99, I2= 0%, p= 0.04). While, CHR related hospitalizations (OR 0.35, 95% CI 0.07-1.67, I2= 87%, p= 0.19), atrial arrythmias (OR 0.98, 95% CI 0.67-1.42, I2= 0%, p= 0.9), change in left ventricular ejection fraction (OR 0.78, 95% CI -0.32-1.87, I2= 91%, p= 0.16), left ventricular end-diastolic diameter (OR -0.12, 95% CI -0.41-0.18, I2= 0%, p= 0.4), interventricular septal thickness from baseline (OR -0.26, 95% CI 0.56-0.04, I2= 0%, p= 0.08) were not statistically different for tafamidis compared to no tafamidis for ATTR-CM.

Conclusion:
Tafamidis treatment in ATTR-CM is associated with reduced all-cause mortality and CHF exacerbation. These observations are consistent with the ATTRACT trial supporting the efficacy of tafamidis in the treatment of ATTR-CM.
Abstract 16565: Machine Learning Model for Predicting Mortality in Acute Myocardial Infarction Patients Managed With or Without Beta-Blocker
Authors: Cha Jinah , Ahn Woo Jin , Rha Seung-Woon , Choi Byoung Geol , Choi Se Yeon , Byun Jae Kyeong , Hyun Sujin , Park Soohyung , Kang Dong Oh , Park Eun Jin , Choi Cheol Ung , Noh Yung-Kyun , Jeong Myung ho
Published: December 2023

Introduction:
Optimal personalized medical therapy is crucial for reducing the mortality risk of acute myocardial infarction (AMI). But, assessing the potential individual benefits of beta-blockers (BB) remains challenging despite the consensus of current guidelines.

Hypothesis: The hypothesis is that machine learning (ML) models can predict the mortality benefit of BB for individual AMI patients, thus helping to identify subgroups with the highest clinical benefit.

Methods:
A total 13,104 AMI patients registered in the Korea AMI registry (KAMIR)-National Institutes of Health (NIH) were included in the study. After exclusion of in-hospital death (N = 505), datasets were randomly allocated to the training (N = 8467) and test datasets (N = 4132) by 2:1 ratio. Binary GLM Logistic Regression, Subspace Discriminant, Kernel Naive Bayes, Boosted Trees and KNN were used to train the ML model. Patients were stratified into quartiles (Q1, Q2, Q3, Q4) based on the estimated risk.The low-risk group comprised Q1 and Q2, while the high-risk group consisted of Q3 and Q4.

Results:
Binary GLM Logistic Regression outperformed other models in the 5-fold cross validation test (area under the curve = 0.85, sensitivity = 98.6%). Errors of estimated mortality were within 0.3% for all quartile groups. High-risk group identified by the ML model demonstrated significant reduction in mortality with the usage of BB, whereas no such benefit was observed in the low-risk group. Additionally, subgroups of chronic kidney disease (CKD), anemia, and old age (>65) displayed notable reduction in mortality when managed with BB, in the high-risk group.

Conclusions:
With the successful performance of ML model predicting mortality, we identified subpopulations within AMI patients who are highly likely to benefit from the usage of BB. Clinical decision-making could be potentially optimized for individual AMI patients by application of the ML model, through personalized risk scoring and identification.
Abstract 16570: Benchmarking Risk-Adjusted Outcomes in Congenital Heart Surgery
Authors: Subramanyan Ram Kumar , Thibault Dylan , OBrien Sean , Gaynor J W , Shahian David M , Bacha Emile , Badhwar Vinay , Caldarone Chris , Dearani Joseph A , Fernandez Felix , Jacobs Jeffrey P , Overman David M , Pasquali Sara K , Rainey Tabitha , Romano Jennifer , Shashidharan Subhadra , Tweddell James , Mayer John E
Published: December 2023

Background:
Robust models exist to predict risk-adjusted mortality following congenital heart surgery. It is known that underlying diagnosis modifies predicted risk of operations, and institution-level outcomes vary based on their unique case mix. We therefore evaluated risk-adjusted outcomes for a subset of diagnosis-procedure (D-P) combinations within the Society of Thoracic Surgeons' (STS) congenital heart surgery database (CHSD).

Methods:
A clinician panel identified the most frequently encountered D-P combinations in CHSD between 07/2017 and 06/2021. Candidate modeling techniques were compared in a random 80% development cohort. Model performance was assessed using internal and cross-validation calibration, discrimination plots and optimism adjusted C-statistics. The final selected model was evaluated in the 20% validation sample.

Results:
The chosen subset of D-P combinations represented 45,384 of 87,589 (52%) unique episodes of surgical care in CHSD during this time-period. The development cohort (36,350 episodes) had 1.8% mortality (667 deaths). All candidate models had excellent discrimination with C-statistics ranging from 0.862 to 0.876. The model with the best combination of discrimination, calibration, and clinical face validity was a modified version of the current STS mortality risk model. This version included all current risk model variables with the addition of indicator variables for D-P combinations. In the 20% validation sample (9,034 episodes), this model was well calibrated (Figure) and had excellent discrimination (C = 0.879).

Conclusion:
We describe a cohort of D-P combinations widely encountered in the STS CHSD. Further, we refined the existing STS CHSD risk model for application to these D-P dyads to derive empirical risk-adjusted benchmark outcomes. This approach will benefit quality improvement efforts at an institutional level and may have implications for publicly reporting congenital heart surgery outcomes.
Abstract 16610: A New Left Ventricle Vortex Formation Time for Clinical Assessment of Diastolic Filling Efficiency Based on Direct Mechanical Ventricular-Vascular Coupling: Evaluation in Heart-Failure and Healthy Cohort
Authors: Bilgi Coskun , Lin Ben A , Pahlevan Niema M
Published: December 2023

Introduction:
The mechanical coupling of the left ventricle (LV) and aorta creates the apical motion of the atrioventricular plane (AVP), resembling a piston-cylinder system, impacting early diastolic filling (J Am Heart Assoc. 2017;6:e004903). Furthermore, several clinical studies have suggested the vortex formation time (VFT) as an indicator of LV diastolic function (Eur. Heart J. Cardiovasc. Imaging. 2012;13(5):385-93). However, conflicting results exist in previous clinical studies, potentially due to deviations from the original fluid dynamics definition of VFT in a piston-in-cylinder setting. In this study, we propose a new VFT approach to assess LV diastolic filling performance based on direct mechanical ventricular-vascular coupling.

Methods:
Cardiac MRI was used on 69 healthy individuals and 19 heart failure (HF) patients. The clinical cohort (37% women) had a mean age of 46 [± 17.5] years and BMI of 24.8 [±4.5]. LV valvular diseases were excluded. VFT was assessed using the original L/D definition, where L represents ascending aortic recoil motion (piston displacement) and D represents the mitral valve orifice. Aortic displacement was measured on the three and four-chamber MRI scans by tracing the AVP. Mitral valve orifice was determined as the average of commissure distance (short-axis images) and the leaflet tip distance (three-chamber view).

Results:
The new VFT approach yielded a mean[± std.] of 4.73[±0.89] for the healthy group, and considerably lower values (3.24±0.83) for the patients with HF (figure 1).

Conclusions:
The proposed VFT based on the mechanical ventricular-vascular coupling and original fluid dynamic formulation, demonstrates a theoretical optimal value of approximately 4 in healthy individuals, while significantly lower in HF. This novel VFT has the potential to address existing discrepancies regarding the clinical significance of VFT and establish it as a promising indicator of left ventricular filling efficiency.
Abstract 16611: The Feasibility of Artificial Intelligence in Interpretation of the Treadmill Test
Authors: Kim Yoo Ri , Lee Kihong
Published: December 2023

Introduction:
The treadmill test (TMT) is commonly used as a screening test to identify myocardial ischemia. The sensitivity of the TMT in diagnosing obstructive CAD was approximately 50%, with a specificity of approximately 90%. However, the challenge with TMT is the variability in interpretation.

Hypothesis:
We aimed to develop an Artificial intelligence (AI) to interpret TMT. The primary endpoint was the accuracy comparison between the initial assessment (of AI or cardiologist) for obstructive CAD.

Methods:
Out of a total of 800 TMTs performed on adults for any clinical indications in 2018-2020, Of these, we used 500 as training data, 200 as validation data, and 100 as test data. A one-dimensional convolutional block was applied to each of the 12 leads of the TMT, and then all the leads were concatenated to apply a dense layer, which was then trained to predict the presence of obstructive coronary artery disease. This deep learning model was developed based on convolutional neural networks (CNNs) using TensorFlow (Google, Mountain View, CA, USA) and Keras packages based on the Python language. TMT were simultaneously interpreted by an AI algorithm or by the cardiologist. This assessment was subsequently reviewed by blinded interventional cardiologist who provided a final report of obstructive coronary artery disease (CAD) with coronary compute tomography.

Results:
The mean age was 58.1 (20-78) years, 68% were male, and 33% had obstructive coronary artery disease (≥70% stenosis in at least one vessel). The performance of AI was compared with that of conventional TMT. Accuracy of AI model was comparable to cardiologist (0.720 vs. 0.680,
p
=0.845) F1 score was also similar between AI and cardiologist (0.440 vs. 0.384.
p
=0.845)

Conclusions:
Artificial intelligence is comparable to a cardiologist in the initial interpretation of the treadmill test. These approaches might be applicable to data obtained from wearable electrocardiography technologies during exercise.
Abstract 16644: Unusual Manifestation of Acute Pericarditis in the Setting of Primary Biliary Cirrhosis
Authors: Bayat Aqieda , Syed Alveena , Ali Ambreen F , Atar Mustafa , Dong Tiffany , Klein Allan L
Published: December 2023

Introduction:
Primary biliary cirrhosis (PBC) is an immune-mediated liver disease leading to destruction of intrahepatic bile ducts and cirrhosis. However, its association with pericarditis has not been investigated. Here, we describe a case of a female with PBC who presented with severe pericardial disease.

Clinical Case:
A 57-year-old female with past medical history of primary biliary cirrhosis, thrombocytosis and type 2 diabetes who presented with sudden onset sharp chest pain, worse with movement or breathing. Workup was notable for elevated D-dimer, CT chest with no evidence of pulmonary embolism but did reveal a moderate pericardial effusion, further confirmed on echocardiogram. Nuclear stress test was unremarkable. CRP 13 mg/dL and ESR 82 mm/hr. Given concern for pericarditis, she was started on colchicine and ibuprofen. On further evaluation in clinic, cardiac MRI showed severe LGE and edema consistent with active pericarditis (figure 1) with mild constrictive physiology and worsening inflammatory markers (ESR 95 mm/hr, us-CRP 118mg/L). Therefore, decision was made to start triple therapy with the addition of prednisone. Repeat cardiac MRI 6 months later showed resolution of LGE and pericardial edema (figure 2). Given clinical improvement, patient was tapered off steroids, started anakinra and weaned off ibuprofen and colchicine. She remained on anakinra for two years after which she was transitioned to single therapy with colchicine with no episodes of recurrence.

Discussion:
PBC commonly exists with liver autoimmune disorders, but its association with pericardial disease has not been investigated. NSAIDs are often used as first-line therapy for pericarditis, but can be detrimental in advanced liver failure, often seen in patients with PBC. Steroid use is not only advantageous in pericardial disease but also in PBC. As a result, it is critical to identify the link between pericardial disease and PBC to determine appropriate therapeutic management.
Abstract 16665: Traditional Risk Factors and Acute Coronary Syndrome Free Survival
Authors: Cenko Edina , Yoon Jinsung , Fabin Natalia , Vasiljevic zorana , Mendieta Badimon Guiomar , Zdravkovic Marija , vavlukis Marija , Kedev Sasko , Milicic Davor , Badimon Lina , Manfrini Olivia , Bugiardini Raffaele
Published: December 2023

Introduction:
Recent studies claim that the discriminatory power of traditional risk factors (RF) in predicting acute events and mortality from coronary heart disease (CHD) is low. This claim implies a potential misinterpretation, which may negatively affect healthcare organizations

Aim:
To investigate the association between the four traditional RF, hypertension, current smoking, hypercholesterolemia and diabetes, and the lifetime occurrence of first acute coronary syndrome (ACS) and consequent mortality

Methods:
We analysed data of 70953 Caucasian patients presenting with first ACS, but without prior CHD enrolled in the ISACS Archives. RF were used to stratify patients into mutually exclusive categories using a balancing strategy by inverse probability weighting. Trends were evaluated by the Pearson's correlation coefficient (r). Primary endpoints were patient’ age at hospital presentation for ACS and rates of all-cause mortality within 30 days after hospital admission

Results:
For fatal ACS (n=6097), exposure to at least one RF ranged from 77.6% in women to 74.5% in men. The presence of all four RF significantly (P trend<0.001) decreased the age at time of ACS event by nearly half a decade compared with the absence of any RF in both women (from 67.1 to 61.9 years) and men (from 62.8 to 58.9 years). Similar trends were observed for fatal ACS among women (from 73.3 to 67.6 years) and men (from 69.3 to 63.2 years). Current smoking (ORs 4.17 in women; 3.00 in men) and hypercholesterolemia (ORs 1.34 in women; 1.44 in men) were the predominant RFs for premature ACS presentation, with diabetes being the largest for death from premature ACS (ORs 1.50 in women; 1.65 in men). In contrast, there was an inverse association between the presence of RFs and the risk of 30-day mortality. The risk ratios (RR) among individuals with at least one RF vs those with no RFs were 0.72 (95%CI 0.65-0.79) in women and 0.64 (95%CI 0.59-0.70) in men. This association was consistent among patient subgroups

Conclusions:
In contrast with recent thinking, the presence of traditional RFs is associated with very high lifetime risk of developing ACS and markedly shorter survival. Public health policies should still place significant emphasis on traditional RFs and the lifestyle behaviors causing them
Abstract 16682: Artificial Intelligence Predicts All-Cause and Cardiovascular Mortalities Using 12-Lead Electrocardiography
Authors: Park Je W , Kwon Oh-Seok , Kim Daehoon , Yu Hee Tae , Kim Tae-Hoon , Uhm Jae-sun , JOUNG BOYOUNG , LEE Moon Hyoung , Hwang Chun , Pak Hui-Nam
Published: December 2023

Introduction:
Electrocardiography (ECG) can be easily obtained at a low cost and includes voltage and time interval representing heart conditions. We hypothesized that artificial intelligence (AI) detects a subtle abnormality in 12-lead ECG and may predict individual mortality.

Methods:
Among 502,411 population in UK Biobank, 42,096 individuals had 12-lead ECG from 2013 to 2022. Among 41,572 survival group, after adjusting the following inclusion criteria; normal sinus rhythm, age under 60 years, PR interval 120~200ms, QTc interval 350~460ms, and QRS duration 70~100ms, 4,512 individuals were enrolled in this study. We developed and tested convolutional neural network (CNN) model to predict all cause death, cardiovascular (CV) death, or sudden cardiac arrest (SCA). The study population were divided into train (80%), validation (10%), and test (20%) set.

Results:
Among 4,512 patients with median 3.7 years [IQR; 2.7-5.1] of follow-up, the rate of all-cause mortality was 11.6% (524). In overall study population, median age was 55.5 years and proportion of male sex was 42.2%. The patients with all-cause death were older (p<0.001) and had more comorbidities (p<0.001). In the train set, CNN model showed 0.93 in AUC for predicting all-cause death. In the test set, CNN model showed consistent good performance power (AUC 0.90) for all-cause death. In subgroup analysis, 102 of 4153 (2.46%) and 57 of 4065 (1.40%) patients experienced CV death and SCA, respectively. The performance power in test set were 0.90 in AUC for CV death and 0.87 in AUC for SCA.

Conclusions:
AI detects and predicts future all-cause death, CV death, and SCA in median of 2.6 years by analyzing standard 12-lead ECG in generally looking normal sinus rhythm
Abstract 16694: Impact of Frailty in Non-Valvular Atrial Fibrillation Elderly Patients on Anticoagulation Therapy
Authors: Matsui Kunihiko , Kusano Kengo F , Akao Masaharu , Tsuji Hikari , Hiramitsu Shinya , Hatori Yutaka , Odakura Hironori , Ogawa Hisao
Published: December 2023

Background:
As the number of elderly people increases, we see more chances to consider anticoagulant therapy for elderly people with frailty.

Research Question:
Does frailty affect the outcome of anticoagulation therapy?

Goals:
To show the impact of frailty to the effectiveness and safety of anticoagulant therapy with rivaroxaban in elderly Japanese non-valvular atrial fibrillation (NVAF) patients.

Methods:
The GENERAL (GENeral practitioners and Embolism pRevention in NVAF patients treated with RivAroxaban: real-Life evidence) study was an observational study of elderly NVAF patients with rivaroxaban at general practice settings in Japan. We employed multiple imputation for missing baseline characteristics, and propensity score (PS) matching to estimate the treatment effect of frailty accounting for the patients’ imbalance. In each imputed and PS matched data set, the treatment effects of frailty were assessed with Cox proportional hazard models for each outcome.

Results:
A total of 5,717 (mean 79.3 years old, male 64.8%) were observed for a mean of 2.0 years and up to 3 years. Of these, 485 (8.5%) were classified frailty. Variable missing rates ranged from 0% to 35%. After the imputation and matching, the patients' backgrounds were well matched and balanced between two groups. Frailty was not associated with the primary endpoint: stroke/systemic embolism (Hazard Ratio [HR] 1.128, 95% Confidence Interval [CI]: 0.500 - 2.547, p=0.767). Also, frailty was not associated with all-secondary endpoints (Figure 1). In the sensitivity analyses with the complete cases, the cases with any missing variables were deleted, frailty was significantly related with outcome events except for the bleeding events (Figure 2).

Conclusion:
In our study results, frailty did not affect the effectiveness or safety of anticoagulant therapy with rivaroxaban for this population. However, we should consider the necessity and benefit for this population to start anticoagulant therapy.
Abstract 16697: Chronic Venous Insufficiency is Associated With Increased Risk of Limb Events in Patients Undergoing Lower Extremity Revascularization
Authors: kim gwangsil , Hess Connie N , Hsia Judith A , Bonaca Marc P
Published: December 2023

Introduction:
Chronic venous disease is associated with an increased risk of cardiovascular (CV) events, possibly due to systemic inflammation and increased oxidative stress.

Hypothesis:
To evaluate the impact of chronic venous insufficiency (CVI) on the risk of subsequent CV and limb events in patients undergoing lower extremity revascularization (LER).

Methods:
Real-world data from the University of Colorado health system, which serves a diverse population of rural and urban patients, were extracted from TriNetX (Cambridge, MA, USA) for patients undergoing LER from 2015 to 2022. The cohort was divided into those with vs without concomitant CVI and assessed for subsequent limb events (defined as major amputation or re-intervention) and CV events (defined as stroke, myocardial infarction or death). Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated between propensity score (PS)-matched patients with and without CVI.

Results:
Among 5090 patients with LER, the 1370 (27%) with concurrent CVI were older (67±14 vs. 66±14,
p
<0.01) and had more comorbidities such as hypertension (72 vs. 58%,
p
<0.01), diabetes (40 vs. 30%,
p
<0.01), chronic kidney disease (32 vs. 18%,
p
<0.01), and obesity (28 vs. 15%,
p
<0.01). During the 2-years following LER, occurrence of CV (37.2% vs. 31.9%) and limb events (27.0% vs. 18.0%) was higher among patients with CVI (upper panel). After PS matching, limb events remained significantly more frequent (HR 1.53, 95% CI 1.273-1.829) in the group with CVI (lower panel).

Conclusion:
Among patients undergoing LER, the presence of concurrent CVI identifies a population at significantly increased risk for subsequent limb events.
Abstract 16711: Outcomes of Severe Mitral Stenosis With the Revised Severity Criteria: Mitral Valve Replacement versus Percutaneous Mitral Valvuloplasty
Authors: Kim Dae-Young , Cho Iksung , Kim Kyu , Gwak Seo-Yeon , Ha Kyungeun , Lee Hee Jeong , Ko Kyu-Yong , Shim Chi Young Y , Ha Jong-Won , Kim William , Kim In-Jai , Lee Seonhwa , Kim Incheol , CHOI KANGUN , Kim Hojeong , Son Jang-Won , Hong Geu-Ru
Published: December 2023

Introduction:
Mitral stenosis (MS) severity is determined by mitral valve area (MVA); the threshold for severe MS was raised from MVA of 1.0 cm
2
to 1.5 cm
2
in recent guidelines.

Hypothesis:
This study aimed to compare the clinical outcomes, according to percutaneous mitral valvuloplasty (PMV) versus mitral valve replacement (MVR) treatment strategy, of severe MS patients with the updated criteria for the subgroups categorized by MVA of 1.0 cm
2
and 1.5 cm
2
.

Methods:
From the Multicenter mitrAl STEnosis with Rheumatic etiology (MASTER) registry of 3,140 patients, we included severe MS patients who underwent PMV or MVR between January 2000 and December 2021 except previous valvular surgery/intervention, at least moderate other valvular dysfunction, and thrombus at the left atrium/appendage. Moderately severe MS (MS-MS) and very severe MS (VS-MS) were defined as 1.0 cm
2
<mva≤1.5 cm2 and MVA≤1.0 cm
2
, respectively. Primary outcomes were a composite of cardiovascular (CV) death and heart failure (HF) hospitalization. Secondary outcomes were a composite of primary outcomes and redo-intervention.

Results:
Among 442 patients (mean 56.5±11.9 years, women 77.1%), the MVR group (n=260) was older, had more comorbidities, higher echoscore, larger left chambers, and higher right ventricular systolic pressure than the PMV group (n=182). During a mean follow-up of 6.9±5.2 years with inverse probability weighted matching, primary outcomes did not differ, but the MVR group experienced fewer secondary outcomes (p=0.010). In subgroup analysis of MS-MS and VS-MS patients, primary outcomes did not differ. However, the MVR group in VS-MS patients showed better secondary outcomes (p=0.012) (Figure).

Conclusions:
PMV or MVR did not influence CV mortality or HF hospitalization in both MS-MS and VS-MS. However, due to increased early redo-intervention in the PMV group in VS-MS, MVR would be the preferable option without clear evidence of suitable morphology for PMV.
Abstract 16716: Clinical Parameters Associated With Temporary Transvenous Pacing for Patients Presenting With Complete Heart Block
Authors: Barve Nishad , Prasad Rahul , Prasad Rohan , Mahalwar Gauranga , Lao Nicole Mae , Bashir Hanad , Mangira Caroline , Iyer Indiresha
Published: December 2023

Introduction:
Patients presenting with Complete Heart Block (CHB) are emergently referred for placement of a temporary transvenous pacemaker (TTVP) for hemodynamic stability. Data on the immediate management and outcomes of such patients are lacking.

Methods:
Data collected through retrospective chart review of patients presenting to the Emergency Department (ED) at 3 regional referral hospitals from 10/2017 to 9/2022 with a diagnosis of new CHB; included age, sex, clinical, laboratory and ECG data, medications, interventions and length of stay(LOS).

Results:
There were 230 patients (106 women), mean age 77 years. Of these 94 were on beta blockers, 55 on calcium channel blockers. Syncope, dizziness and dyspnea were common symptoms. Pause > 3 seconds was seen in 50 patients. Sympathomimetics were used in 55 patients and 179 patients were admitted to the ICU. There was no statistical difference in demographics, clinical features, ICU utilization and LOS. A TTVP was placed in 72(31%) and a Permanent Pacemaker (PPM) prior to discharge in 182 patients, a median of 1 day from ED presentation. By site, there were 71, 74 and 85 patients of whom TTVP was placed in 38%, 15% and 40% and a PPM in 76%, 82% and 79% in the 3 regional centers. The median LOS was 3 days. Univariate logistic regression was used to assess for predictors of TTVP placement (SAS® Version 9.4, Cary, NC). Syncope, Initial SBP, Shock, Pause > 3 seconds, Acute MI, and Serum K were associated with higher odds of patients getting TTVP. SBP > 160mmHg was associated with lower odds of needing TTVP.

Conclusions:
TTVP was infrequently needed (31%) among patients presenting to the ED with CHB. Initial SBP, Shock, Acute MI, Pause > 3sec and Serum K were associated with TTVP placement. Higher SBP was associated with lower odds of needing a TTVP. There seems to be a difference in TTVP utilization rate between centers. Prospective data related to the acute management of CHB is needed to identify variations in utilization of TTVP between centers.
Abstract 16734: Patterns of Inflammatory Activation in Cardiovascular Disease: Insights From the Randomized Colchicine PCI Trial
Authors: Talmor Nina , Pillinger Michael , Leonard Ana , Curovic Fatmira , Shah Binita
Published: December 2023

INTRODUCTION:
Recent studies demonstrate that neutrophils accumulate in atherosclerotic lesions and that neutrophil counts correlate with disease severity. The randomized double-blind Colchicine-PCI study demonstrated that colchicine attenuated systemic inflammation (IL-6, CRP) after percutaneous coronary intervention compared with placebo.

GOALS/AIMS:
We characterized neutrophil activity in patients across a spectrum of cardiovascular phenotypes, including severity of coronary artery disease (CAD) and presentation of acute myocardial infarct (AMI).

METHODS:
The Colchicine-PCI biomarker sub-study enrolled 478 participants with pretreatment assessment of inflammatory biomarkers. White blood cell count and differential were performed using a hematology analyzer. Soluble markers of neutrophil activity, including neutrophil extracellular traps (NETs), and systemic inflammation were assessed using multiplex assays. Neutrophil surface markers of activity and neutrophil platelet aggregates were assessed using an Accuri C6 flow cytometer.

RESULTS:
We observed neutrophil concentration, adhesion, transmigration, and activation, as well as increased NETs complexes; but no difference in extent of neutrophil platelet aggregation or systemic inflammation in patients with versus without obstructive CAD. Conversely, in patients with versus without AMI, neutrophil markers of adhesion and transmigration did not differ, but systemic markers of inflammation and neutrophil activation were elevated.

CONCLUSION:
This single-site, prospective study is the largest neutrophil biorepository in patients with cardiovascular risk factors. Inflammatory activation, and particularly neutrophil profiles, differ in patients with obstructive CAD and in the setting of AMI.
Abstract 16737: Explantation of LVAD in Recovered Alcohol Induced Cardiomyopathy
Authors: Campbell Jenna , Mehta Samir P , Shakir Muhammad A , Banerji Sourin , Hamid Syed Ali
Published: December 2023

Durable Left Ventricular Assist Device (LVAD) is an important modality for bridge or destination therapy for patients with end-stage heart failure. However, there is a paucity of evidence guiding management for LVAD explantation in patients with sufficient myocardial recovery as this only occurs in 1-3% of cases. We present a case of a patient with LVAD placement due to alcoholic cardiomyopathy with subsequent removal of his LVAD three years later.

Description of Case:
A 51-year-old male with a history of alcohol induced cardiomyopathy with an LV ejection fraction of 10% s/p Heartmate II LVAD implant 3 years ago was evaluated for LVAD explantation. Over the course of one year, LVAD speed was decreased and ejection fraction (EF), cardiac output (CO) and cardiac index (CI) were monitored. Prior to explantation, the patients EF was 50% with a CO of 5.6L/min and CI 2.7 L/min/m2. Following successful explantation, a repeat echocardiogram 3 months later revealed an EF of 45%. Right heart catheterization revealed CO of 5.3L/min and CI 2.6L/min/m2. Patient was discharged on guideline directed medical therapy with continued improvement.

Discussion:
Mechanical, histological, and biochemical myocardial improvement has been described in LVAD recipients. There is a paucity of data to guide recovery assessment and candidacy for explantation. The 2023 ISHLT guidelines have attempted to synthesize the available data and outline the major considerations. Assessment should be done at low LVAD speeds with incorporation of data from patient’s clinical status, echocardiography, right heart catheterization, and cardiopulmonary exercise testing. Utilization of LVAD as a bridge to recovery was feasible in our patient given careful assessment of recovered cardiac function as outlined by aforementioned criteria.

LVAD explantation after heart recovery remains a rare phenomenon. As access to cardiac transplantation remains limited, consistent use of guideline directed medical therapy allows for the possibility of heart recovery along with explantation. We present a case of successful and maintained myocardial recovery after LVAD explantation. Cases such as this would benefit from standardization of LVAD explantation guidelines for optimal long-term survival for patients.