bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 13534: A Systematic Review and Network Meta-Analysis of Non-Metastatic Castrate Resistant Prostate Cancer Therapy Cardiotoxicity
Authors: Aziz Moez K , Molony Donald , Smith Catrin , Holder Travis , Mody-Bailey Neal , Brunckhorst Oliver , Roland Jerry , Owen Christopher , Song Jeffrey , Iacobucci Alexander Samuel , Galan Jacob , Choi Lily , Fatakdawala Mariya , Sanchez Darren , Thames Emma , Imber Jared , Swaby Justin , Xiao Daniel , Zarker Andrew , Kostrzanowska Gabriela , Magill Resa , Gandaglia Giorgio , Howell Skyler , Koutroumpakis Efstratios , Ziaolhagh Ali , Plana Juan C , Ali Abdelrahman , Yusuf Wamique , Iliescu Cezar , Canfield Steven E
Published: December 2023

Introduction:
For non-metastatic castrate resistant prostate cancer (M0CRPC) with a prostate-specific antigen doubling time of < 10 months, European Association of Urology (EAU) guidelines recommend androgen deprivation therapy (ADT) plus either enzalutamide, apalutamide, or darolutamide as first-line therapy. However, this recommendation does not account for potential cardiotoxicity of treatments. Hypothesis: We expect differences among first-line therapies for the five International Cardio-Oncology Society (IC-OS) cardiotoxicity domains: heart failure, myocarditis, vascular toxicity, hypertension, and arrhythmias.

Methods:
We searched Ovid Medline, Elsevier Embase, and the Cochrane Library for randomized clinical trials (RCTs) from inception until August 2022. Studies with clearly stratified M0CRPC reporting at least one first-line therapy and cardiotoxicity domain were included. RCTs were grouped into mid- (< 24 months) and long-term (> 24 months) studies based on median duration of follow-up. Frequentist fixed-effect network meta-analysis was performed to estimate risk ratio (RR) and 95% confidence intervals (CI).

Results:
For hypertension and vascular toxicity, 3 mid- and 3 long-term studies were found. Two mid- and 3 long-term studies assessed arrhythmias. For heart failure, 2 mid- and 2 long-term studies were found. All studies had a similar placebo population treated with ADT alone. Median follow-up times for mid- and long-term studies are shown in Figure 1. We did not find any RCTs assessing myocarditis. However, compared to other first line therapies, ADT plus enzalutamide was associated with increased risk of hypertension in the mid- and long-term. Increased risk of vascular toxicity was also detected but only in the long-term (Figure 1).

Conclusions:
Enzalutamide is associated with higher risk of cardiotoxicity compared to other first-line androgen receptor targeted antagonists.
Abstract 13558: Age-Dependent Change of Electrocardiographic Characteristics and Cardiac Events in the Long QT Syndrome Type-3 With E1784K Mutation of
SCN5A
Authors: Kamada Hiroyuki , Shimamoto Keiko , Miyazaki Yuichiro , Wakamiya Akinori , Ueda Nobuhiko , Nakajima Kenzaburo , Kamakura Tsukasa , Wada Mitsuru , ishibashi kohei , Inoue Yuko , Miyamoto Koji , Nagase Satoshi , Kato Yoshiaki , Sakaguchi Heima , Asano Yoshihiro , Takahashi Kazuhiro , Shimizu Wataru , Ohishi Mitsuru , Kusano Kengo , Aiba Takeshi
Published: December 2023

Introduction:
The pathogenic variant of E1784K in
SCN5A
is known as an overlapped phenotype; long-QT syndrome type-3 (LQT3) and Brugada syndrome (BrS), however it is still unclear age-dependent changes of the ECG findings and which ECG parameters are associated with cardiac events (CEs) in LQT3 patients with
SCN5A
-E1784K.

Methods:
Total 79 LQT3 patients with
SCN5A
-E1784K (45 probands, 42 males, age 23±17 years, QTc interval: 500±33 ms) were enrolled from the NCVC LQTS registry (2003~2023). We retrospectively evaluated age-dependent change of the clinical characteristics, ECG parameters and those associated with CEs.

Results:
Overall, 14 (18%) patients had CEs (10 syncope and 4 ventricular fibrillation), in which 8 occurred under 25 years old, but 6 occurred more than 35 years old. Thus, we divided all into two groups: younger (n=51) or older (n=28) than 30 years old. The younger group shows higher prevalence of male and proband compared with older group, and half of the syncope occurred during exercise. In the ECG parameters, P-R interval and QRS width were significantly longer in older group, in contrast, presence of T-wave alternance, notched, biphasic T-wave and bradycardia were more prevalent in younger group although the QTc interval and QTc peak-end were not different between the two group. Univariate analysis for CEs shows that longer QTc peak-end interval and absence of family history of LQTS are associated with CEs in younger group, whereas in older group, not only the longer QTc peak-end interval and absence of family history but also the Brugada ECG were associated with CEs. Finally, multivariate logistic regression analysis for all patients revealed that longer P-R interval, QTc peak-end and absence of family history of LQTS were independently associated with CEs (p=0.049, p<0.001, p=0.001, respectively). ROC analysis revealed that P-R interval ≥180 ms and QTc peak-end interval ≥86 ms were significantly related to previous CEs.

Conclusion:
In LQT3 with
SCN5A
-E1784K variant, ECG parameters were age-dependently altered and longer P-R and QTc peak-end interval as well as absence of family history of LQTS can be associated with CEs. Furthermore, in adult patients, more careful follow-up should be required for those with LQT3 overlapped with BrS ECG.
Abstract 13563: Long-Term Prognostic Value of Afterload Mismatch Index in Acute Decompensated Heart Failure With and Without Reduced Left Ventricular Ejection Fraction
Authors: Yamada Takahisa , Watanabe Tetsuya , Morita Takashi , Kawasaki Masato , Kikuchi Atsushi , Kondo Takumi , Kawai Tsutomu , Nishimoto Yuji , Seo Masahiro , Nakamura Jun , Fujita Takeshi , Taniichi Masanao , Chang Yongchol , Fukunami Masatake
Published: December 2023

Backgrounds:
Ventricular-arterial coupling has been shown to have physiologic importance in heart failure. At the acute worsening of heart failure, increased ratio of pulmonary capillary wedge pressure to systemic systolic pressure (PCWP/SBP) might reflect the degree of afterload mismatch. However, there is no information available on the long-term prognostic value of PCWP/SBP in patients with acute decompensated heart failure (ADHF), relating to reduced left ventricular ejection fraction (LVEF).

Methods:
We studied 240 patients admitted for ADHF (with LVEF<40% [HFrEF, n=110] and without LVEF<40% [n=130]), who underwent right heart catheterization at the admission and were discharged with survival. PCWP/SBP was obtained at the admission. The study endpoint was cardiovascular death (CVD).

Results:
During a mean follow-up period of 5.2±4.4 yrs, 59 patients had CVD. PCWP/SBP was significantly higher in patients with than without CVD (0.216±0.078 vs 0.172±0.064, p<0.0001). Multivariate Cox regression analysis revealed that PCWP/SBP was significantly associated with CVD, independently of prior heart failure hospitalization, body mass index, estimated glomerular filtration rate, and serum sodium level. Patients with high PCWP/SBP (>0.206 determined by ROC analysis: AUC 0.668[0.586-0.749]) had a significantly greater CVD risk than those with low PCWP/SBP (≤0.206) in both groups with and without HFrEF(with: 36% vs 11%, p=0.016; without: 42% vs 18%, p=0.0057).

Conclusions:
PCWP/SBP, an index of afterload mismatch, could provide the long-term prognostic information in patients admitted with ADHF, regardless of reduced LVEF.
Abstract 13566: Voice as a Biomarker to Detect Acute Decompensated Heart Failure: Pilot Study for the Analysis of Voice Using Deep Learning Models
Authors: Lee Jieun , KIM Eung Ju
Published: December 2023

Acute decompensated heart failure (ADHF) is a systemic congestion state requiring timely management. Admission for ADHF is closely related to the readmission and post-discharge mortality in patients, which makes it imperative to detect ADHF in its early stage. Body fluid overload due to ADHF can change voice characteristics by causing edema of lung, larynx, and vocal cord. Voice is a noninvasive and accessible biomarker which can be monitored even in telemedicine practices, but there are few studies in the area. We hypothesized that there would be certain differences of voice characteristics in patients with ADHF when admitted to the hospital and at discharge. This was a prospective study conducted in a tertiary hospital in Korea. Patients with ADHF needed admission were eligible for enrollment, and those with respiratory infection, sepsis, lung/vocal cord disease, acute coronary syndrome, or serum creatinine>3mg/dL were excluded. A total of 112 patients were enrolled between July 1, 2020 and December 31, 2022. Voice was recorded two times: at admission for ADHF, and at discharge. Patients were asked to phonate five Korean vowels (‘a/e/i/o/u’) for 3 seconds each, and then to repeat the sentence ‘daehan minkook manse’ five times. Voice was classified by Convolutional Neural Networks (CNNs). Mel-Spectrogram was conducted to convert the audio from waveform to the spectrogram, and then, transfer learning was done to further classify the voice characteristics. Deep learning models including DenseNet, InceptionNet, and ResNet were conducted to classify voice samples and identify potential characteristics associated with ADHF. We trained the models to classify whether certain voice belongs to ADHF state or recovered state. We treated it as a binary classification task, and the best performing model achieved a classification accuracy of 79% with DenseNet. Interestingly, the classification accuracy conducted with CNNs was highest for ‘u’ achieving 72%, compared to other vowels. To the best of our knowledge, this is the first study to try to detect ADHF with voice using deep learning models, especially with CNNs. We achieved a best classification accuracy of 79%. Our results proposed the possibility of voice as a useful biomarker to detect ADHF in its early stage.
Abstract 13573: Association of Increased Eicosapentaenoic Acid to Arachidonic Acid Ratio With Early Restoration of Coronary Blood Flow in ST-Elevation Myocardial Infarction
Authors: Yamada Ryota , Nakamura Takamitsu , Horikoshi Takeo , Uematsu Manabu , Yamaguchi Kazuyuki , Kobayashi Tsuyoshi , Ando Ryota , Yoshizaki Toru , Watanabe Yosuke , Kuroki Kenji , Nakamura Kazuto , Sato Akira
Published: December 2023

Background:
Early restoration of coronary blood flow is important to reduce myocardial damage in patients with ST-elevation myocardial infarction (STEMI). Cardiovascular protection of increased levels of eicosapentaenoic acid (EPA) to arachidonic acid (AA) has been shown in recent clinical trials. Therefore, this study examined whether increased EPA / AA ratio was related to early restoration of coronary blood flow in STEMI patients underwent primary percutaneous coronary intervention (PCI).

Methods:
Serum levels of EPA, AA, and EPA/AA ratio were measured in consecutive 216 STEMI patients. The angiographic findings of TIMI-flow grade in the infarct related artery before PCI were compared between patients with and without increased EPA / AA ratio (>0.291).

Results:
TIMI-flow grade 3 before PCI were obtained in 25 (11.6%) of all study patients. Smaller enzymatic infarct size was obtained in patients with TIMI-flow grade 3 before PCI compared with TIMI-flow grade 0-2 before PCI (Peak CK-MB; 358 ± 252 mg/dL, vs. 280 ± 260 mg/dL, p <0.05). There were significant differences between 2 groups in the distribution of TIMI-flow grade (p<0.05). Moreover, multivariate logistic regression analysis showed that patients with increased EPA/AA ratio was significantly associated with the presence of TIMI-flow grade 3 before PCI after adjustment for conventional risk factors (OR 5.0, 95% CI 1.92-12.8, p<0.01).

Conclusions:
Increased levels of EPA /AA ratio is independently associated with early restoration of coronary blood flow, leading to reduced myocardial damage in patients with STEMI. These results might support the new strategy of administration of EPA before PCI in STEMI care.
Abstract 13586: Sex-Specific Association Between Perivascular Inflammation and Plaque Vulnerability
Authors: Kinoshita Daisuke , Suzuki Keishi , Yuki Haruhito , Niida Takayuki , Fujimoto Daichi , Minami Yoshiyasu , Dey Damini , Lee Hang , McNulty Iris , Ako Junya , Ferencik Maros , Kakuta Tsunekazu , Jang Ik-kyung
Published: December 2023

Introduction:
Females were reported to have lower levels of perivascular inflammation assessed by pericoronary adipose tissue (PCAT) attenuation than males. However, the sex-specific difference in the association between perivascular inflammation and plaque vulnerability is unknown.

Objective:
The aim of this study was to investigate the sex-specific association between perivascular inflammation and plaque vulnerability.

Methods:
Patients who underwent coronary computed tomography angiography (CTA) and optical coherence tomography (OCT) were enrolled. All images were analyzed at a core laboratory. The level of perivascular inflammation was assessed by PCAT attenuation on CTA and plaque vulnerability by OCT. Patients were divided into three groups according to the tertile range of PCAT attenuation (T1: ≤ -72.7 HU, T2: -72.8 - -66.9 HU, or T3: ≥ -67.0).

Results:
A total of 888 lesions in 363 patients were included; 176 lesions in 77 females (2.3 plaques per patient) and 712 lesions in 286 males (2.5 plaques per patient). Females were older (median [IQR] age: 71 [66-78] vs. 64 [56-72],
P
<0.001) but had less severe coronary artery disease than males. Thin-cap fibroatheroma (TCFA) was more prevalent, and lipid index and macrophage grade were greater in T3 group than T1 group in females, but there was no difference among three groups in males (T3 vs. T2 vs. T1 in females: 45.5%* vs. 34.2% vs. 21.0; 1448 ± 1183* vs. 1140 ± 1000 vs. 942 ± 975; 14 ± 12* vs. 9 ± 14 vs. 7 ± 10; respectively; T3 vs. T2 vs. T1 in males: 32.0% vs. 27.1% vs. 25.0; 1273 ± 1140 vs. 1191 ± 1128 vs. 1060 ± 1138; 9 ± 12 vs. 8 ± 9 vs. 7 ± 10; respectively; * indicates
P
<0.05 vs. T1) (Figure).

Conclusions:
A higher level of perivascular inflammation was associated with higher plaque vulnerability in females, but not in males.
Abstract 13587: Hemoglobin Levels Can Predict Early Rehospitalization in Advanced Heart Failure Patients Listed for Heart Transplantation Without Inotropes or Mechanical Circulatory Support
Authors: Suenaga Tomoyasu , Fujino Takeo , Ishikawa Yusuke , Shinohara Keisuke , Hashimoto Toru , Matsushima Shouji , Ide Tomomi , Yagita Miho , Komman Hitoshi , Toyosawa Masayo , Tsutsui Hiroyuki , Shiose Akira , Kinugawa Shintaro
Published: December 2023

Background:
Anemia is a common comorbidity which often coexists in patients with heart failure (HF), and is associated with poor clinical outcome. However, it is unclear whether hemoglobin value has clinical impact in advanced HF patients.

Hypothesis:
Hemoglobin value influence the clinical outcome of patients with advanced HF.

Methods:
We retrospectively reviewed clinical data of ambulatory advanced HF patients who were listed for heart transplantation at our institute without intravenous inotropes or mechanical circulatory support (MCS) between 2011 and 2022. We divided the patients with a hemoglobin of lower or higher than the median value, and compared a composite of all-cause death and rehospitalization for HF within 1 year.

Results:
We enrolled consecutive 38 HF patients (28 males, 49±11 years old). All patients had New York Heart Association III or IV symptoms. The median hemoglobin value at the time of listing for heart transplantation was 12.9 g/dL, 42% met the criteria of anemia, and 67% had iron deficiency. Patients in the lower hemoglobin group were characterized by lower body mass index (19.7±3.0 vs. 21.7±3.1 kg/m
2
, P=0.049), lower systolic blood pressure (84.0±7.6 vs. 88.9±6.2 mmHg, P=0.034) and lower albumin (4.0±0.4 vs. 4.3±0.3 g/dL, P=0.031) than those in the higher hemoglobin group. Age, prevalence of male, left ventricular ejection fraction and brain natriuretic peptide were comparable between the two groups. No patient died in either group at 1 year. The HF rehospitalization-free survival rate was significantly lower in the lower hemoglobin group (41% vs. 82% at 1 year, P=0.020). By multivariate Cox regression analyses, hemoglobin as a continuous variable was an independent predictor for early HF rehospitalization (odds ratio 0.70, 95% confidence interval 0.49-0.97, P=0.030).

Conclusion:
Lower hemoglobin was a predictor of early HF rehospitalization in ambulatory advanced HF patients listed for heart transplantation without inotropes or MCS.
Abstract 13602: Compliance With the Atrial Fibrillation Better Care (ABC) Pathway in Public and Private Healthcare Units From a Middle-Income Country
Authors: Santos Itamar S , Goulart Alessandra C , Varella Ana C , Romagnolli Carla , Olmos Rodrigo D , Gebara Otavio C , Gooden Tiffany E , Thomas G. Neil N , Lip Gregory , Lotufo Paulo A , Bensenor Isabela M ,   NIHR Global Health Rsch Group on Atrial Fibrillation Management
Published: December 2023

Introduction:
The ABC pathway (A: Avoid stroke; B: Better symptoms; C: Comorbidities and lifestyle management) has been proposed to ensure a holistic or integrated care approach to atrial fibrillation (AF) management. There are scarce data about compliance with this strategy in low- and middle-income countries, where the AF populational burden is likely to increase.

Hypothesis:
Compliance with ABC pathway (ABC-compliance) in Brazil is low and associated with certain patient characteristics.

Methods:
We included 700 patients (46% women, 69±15 years) with confirmed AF. Participants were recruited from private and public healthcare units in São Paulo city. We built logistic regression models to analyze if age, sex, race, HAS-BLED scores, or healthcare sector (public or private) were associated with lack of ABC-compliance (Table 1).

Results:
‘A’, ‘B’, ‘C’ and ABC-compliance occurred in 42%, 82%, 50%, and 21%, respectively. In multiple models (Table 2), lack of ABC-compliance was associated with female sex and high HAS-BLED scores. Lack of ‘B’ component compliance was associated with non-White race. Treatment in public units was positively associated with a lack of ‘A’ component compliance but this was inversely associated with a lack of ‘C’ component compliance. Age and ABC-compliance were not independently associated.

Conclusions:
Compliance with ABC pathway in our healthcare setting was low. Female sex and high HAS-BLED scores were markers of poor compliance with this integrated approach. Patients treated in private health units may have higher access to oral anticoagulants, while better comorbidity control in public health units may reflect a less segmented system of care.
Abstract 13607: The Lipoprotein(a)-Induced Soluble CD36/Interleukin-6/RAS Homolog Family Member A-GTP Signaling Axis Promotes M1 Macrophage Polarization in Coronary Artery Spasm
Authors: Hung Ming-Yow , Yeh Chi-tai , Yadav Vijesh Kumar , Fong Iat-Hang
Published: December 2023

Background:
We previously demonstrated that lipoprotein(a) (Lp(a)) mediated coronary artery spasm (CAS) through α7-nAChR/p38 MAPK/IL-6/RhoA-GTP signaling stimulation, macrophage M1 polarization and activation of human coronary artery smooth muscle cells (HCASMCs). While CD36, as a scavenger receptor for oxidized low-density lipoprotein, was correlated with coronary vasoconstriction in an
in-vivo
study, whether Lp(a) effects are related to soluble CD36 (sCD36) dependent/IL-6/RhoA-GTP inflammatory signalling remain unknown.

Methods:
In patient monocyte-derived macrophages (PMDMs) and HCASMCs the relevance of Lp(a)/sCD36/IL-6/RhoA-GTP signaling axis were investigated through computational biology and experimental approaches.

Results:
Plasma sCD36 levels in 25 CAS patients were significantly higher than that in 10 controls (p < 0.01). Serum Lp(a) level was positively correlated with sCD36 (r
2
=0.41, p < 0.01) in patients with CAS rather than without CAS. The RNA-sequencing revealed a significant and strong co-overexpression between the CD36 and RhoA in PMDMs and HCASMCs. Compared with untreated or low-density lipoprotein (LDL)-treated macrophages, Lp(a)-treated macrophages exhibited markedly enhanced CD36 mRNA expression (p < 0.01) and activity (p <0.01),
in vitro
and
ex vivo
. Lp(a), but not LDL, preferentially stimulated CD80+ macrophage (M1) polarization. While shRNA- mediated or Amentoflavone-, a natural CD36 suppressor, mediated functional loss of CD36 lowered Lp(a)-induced CD80+ macrophage pool, shCD36 and Overexpressed-CD-CD36 suppressed and activated Lp(a)-upregulated sCD36, TNF-α, NFκB, IL-6 and RhoA-GTP protein expression levels, respectively, in HCASMCs.

Conclusion:
Lp(a) stimulated sCD36/IL-6/RhoA-GTP signaling in macrophages from CAS patients and HCASMCs, suggesting the contribution of Lp(a)-induced sCD36/IL-6/RhoA-GTP signaling, macrophage M1 polarization, and inflammation of HCASMCs in CAS development.
Abstract 13624: Worrisome Atrial Fibrillation-Related Mortality Trends in Older Adults From 1999-2019
Authors: Singireddy Shreyas , Ibrahim Sammudeen , Allihien Saint-Martin , Brar Mandeep , Andanamala Haripriya , Chawla Raghav , Ummidi Asha , Kesiena Onoriode
Published: December 2023

Introduction:
The U.S. population is aging with concurrent increases in atrial fibrillation (AF) burden. However, AF-related mortality trends among adult’s ≥75 years have not been investigated. The purpose of this study was to assess the trends and regional differences in AF-related mortality among older adults in the United States.

Methods:
Death certificates from the CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research) database were examined from 1999 to 2019 for AF-related mortality in adult’s ≥75 years of age. Age-adjusted mortality rates (AAMRs) per 100,000 persons was calculated and stratified by year, sex, race/ethnicity, and geographic region.

Results:
Between 1999 and 2019, 323,349 AF-related primary deaths occurred among adult’s ≥75 years. The AAMR more than doubled from 44.8 (95% CI, 43.8 to 45.8) in 1999 to 91.7 in 2019 (95% CI: 87.2 to 89.6)). Women had consistently higher AAMR than men from 1999 (AAMR women: 45.8 vs men: 42.3) to 2019 (AAMR women: 93.2 vs men: 88.4). White adults had the highest overall AAMR (77.5), followed by NH American Indian/Alaska Native (41.6), NH Black (41.3) and NH Asian or Pacific Islander adults (36.6). AAMR also varied substantially by region (overall AAMR: Midwest 77.6; West: 75.0; Northeast: 71.6; and South: 69.7). States in the top 90th percentile of AF-related AAMR were Oregon, Idaho and Utah, which had approximately double the AAMRs compared with states that fell into the lower 10th percentile such as South Dakota and Florida.

Conclusions:
AF-related mortality in U.S. adult’s ≥75 years has continuously increased since 1999. The highest AAMRs were observed among White adults and women, and among patients living in the Midwest and western regions of the United States. Targeted strategies are needed to prevent and treat AF among older adults to curb increasing levels of AF-related mortality.
Abstract 13645: Prognostic Value of Aortic Valve Calcification in Asymptomatic Patients With Non-Severe Aortic Valve Stenosis and Preserved Ejection Fraction
Authors: Ye Zi , Foley Thomas A , Gajjar Rohan , Enriquez Sarano Maurice E , Michelena Hector I
Published: December 2023

Introduction:
Criteria for aortic valve intervention (AVI) in severe aortic stenosis (AS) rely on symptoms, left ventricular ejection fraction (LVEF) and AS severity. Computed tomography-based aortic valve calcification (CT-AVC) scores associated with severe AS also have prognostic value, but this remains unexplored in patients with non-severe AS. We aimed to assess the prognostic value of AVC in asymptomatic patients with nonsevere AS and preserved LVEF.

Methods:
We retrospectively identified 395 patients with ≥mild AS but less-than-severe AS by echocardiography, who had CT-AVC assessed within six months. AVCscore was quantified offline by Agatston method (TeraRecon software), and also indexed by LV outflow track area, i.e., AVCdensity. Patients were followed until AVI or death. The primary outcome was all-cause death under medical surveillance.

Results:
In 395 patients, mean age was 73±12 years, 61% were men, mean aortic valve area 1.2±0.3cm2, mean gradient 28±9 mmHg, peak velocity 3.4±0.5 m/s, LVEF 64±6%. During a follow-up of 2.2[0.74-4.94] years, 220 patients had AVI and 82 patients died. Both AVCscore and AVCdensity were associated with AVI-free survival and the best AVCscore thresholds associated with mortality were 853 in women and 1183 in men by log-rank test (both p<0.001). High AVCscore and high AVCdensity were associated with increased hazard for all-cause death in unadjusted and adjusted analyses (Figure), and after further adjustment for echocardiographic severity (all p ≤0.01).

Conclusions:
In asymptomatic patients with less-than-severe AS, sex-specific CT-AVC scores differentiate those at higher risk for death versus lower risk. Whether AVI could modify this risk remains to be proven.
Abstract 13650: Trends in Women Cardiac Operators of Structural and Interventional Procedures in the United States
Authors: Dandu Sowmya , Akhlaq Hira , Imburgio Steven , Pozdniakova Helen , Udongwo Ndausung , Mararenko Anton , Eltawansy Sherif , ASIF ARIF , Patel Palak , Demchuk Beverly , Kiss Daniel , Almendral Jesus , Heaton Joseph
Published: December 2023

Background:
Women have historically been underrepresented in cardiology workforces. Throughout the United States, there is a major underrepresentation of women in cardiology as operators within structural proceduralists and interventional cardiology (IC).

Methods:
We extracted data from the Medicare Provider Utilization and Payment Database (MPUPD) from 2013 to 2020. The MPUPD is an administrative database of services rendered to Medicare patients enrolled in a fee-for-service program. We sought operators who performed >10 procedures using procedure codes for percutaneous transcatheter closure of congenital atrial septal defect (ASD) with implant and percutaneous coronary intervention, transcatheter mitral valve replacement via transcutaneous edge to edge repairs (TEER), and percutaneous left atrial appendage closure (PLAAO) using relevant CPT codes. The proportion of women operators was analyzed across the 8-year period.

Results:
Between 2013 and 2020, women on average represented 3.02% of the 1,260 cardiac operators identified. Despite the number of total structural operators performing 10 or more procedures increasing from 9 to 871 over the 8-year period, the proportion of women remained unchanged at less than 4.5% (P = 0.712) (Figure 1). By procedure, the total ASD, TEER, and PLAAO operators have increased, though the proportion of women operators remained constant over time (P = .913, .725 and .891). Over the studied period, there were no women operators identified with over 10 operations in 28 states (56%) for any structural procedures, 49 states (98%) for ASD procedures, 39 states (78%) for TEER, and 33 states (66%) of PLAAO.

Conclusion:
Women continue to represent an overwhelming minority of structural cardiac operators. Despite a rapid rise in the total number of operators, the proportion of female operators has not increased. Prospective studies are needed to investigate the underlying factors contributing to these sex-related differences.
Abstract 13656: Effects of Left Ventricular Ejection Fraction and NYHA CHF Class on Baroreceptor Function in Congestive Heart Failure
Authors: Beegle Christina , Gulko Daniel , Kenitz Jacqueline , Petrossian Gregory , Torosoff Mikhail
Published: December 2023

Background:
Autonomic dysfunction is an important component in congestive heart failure (CHF) pathophysiology. The combined effects of reduced ejection fraction and advanced CHF Class on baroreceptor function in CHF have not been well investigated.

Methods:
A single center prospective study included 118 consenting patients, 68.3 ± 14.2 years old, 50 females (42.3%), BMI of 30.1 ± 8.5 kg/m
2
, with histories of HTN in 97 (82.2%), CAD in 64 (54.2%), diabetes in 49 (41.5%), and COPD or asthma in 39 (33.1%). Class I or II CHF were documented in 32 (27.1%), class III in 53 (44.9%), and class IV in 33 (28%) patients. Mean LV EF was 44.5+/-13.9%, HFrEF was present in 41 (34.7%) patients. Baroreceptor function was assessed by measuring resting and lowest heart rates (HR) during voluntary breath holding.

Results:
Despite treatment with beta-adrenergic blockers in 92 (78%) and non-dihydropyridine calcium channel blockers in 7 (5.9%) patients, increased CHF class was associated with significantly increased resting (71.7 ± 14.4 bpm in Class I-II, 73.1 ± 13.6 bpm in Class III, and 80.8 ± 16.9 bpm in Class IV, p=0.027) and breath holding HR (68.9 ± 15.3 bpm in Class I-II, 69.9 ± 12.2 bpm in Class III, and 80 ± 16.1 bpm in Class IV, p=0.002). In addition, when compared to the rest of the cohort, HFrEF patients manifested with increased resting (80.9 ± 14.5 vs. 71.6 ± 14.6 bpm, p=0.001) and breath holding HR (77.6 ± 13.9 vs. 69.7 ± 14.7 bpm, p=0.006). In multivariate analysis, both increased CHF NYHA class and reduced LVEF retained statistically significant independent effects on resting (p=0.037 and p=0.001, respectively) and breath holding HR (p=0.005, each).

Conclusion:
Decreased LV ejection fraction and increased CHF class independently and significantly contribute to autonomic dysfunction in CHF patients. Heart rate changes indicating abnormal baroreceptor function in CHF patients are apparent despite treatment with medications affecting chronotropic response.
Abstract 13660: Endovascular Ultrasound Renal Denervation for Resistant Hypertension: A Systematic Review and Meta-Analysis of Randomized Sham-Controlled Trials
Authors: Felix Nicole , Antonio Pinheiro Braga Marcelo , Nogueira Alleh , Vallperde Joao Gabriel , de Assis Oliveira Sofia , Costa Thomaz A , Pinto Luis Claudio , Silaid Muxfeldt Elizabeth
Published: December 2023

Background:
Radiofrequency renal denervation (RDN) is used as a treatment for resistant hypertension, although its efficacy is still under evaluation. Similarly, ultrasound RDN, a less invasive technique, has yielded inconsistent results in this population. Hypothesis: Ultrasound RDN may lower blood pressure in patients with resistant hypertension. Aims: To compare the efficacy of ultrasound RDN versus a sham procedure in treating resistant hypertension.

Methods:
We systematically searched PubMed, Cochrane Library, and Embase in May 2023 to include randomized sham-controlled trials assessing the efficacy of ultrasound RDN. Statistical analyses were performed using Review Manager 5.4.1 using generic inverse variance weighting to pool mean ± standard deviation and least square mean ± standard error.

Results:
We included three studies comprising 323 patients with resistant hypertension on ≥ three antihypertensive medications, of whom 51.7% were randomized to RDN. Follow-up at analysis ranged from 8 to 24 weeks. There were no significant differences between groups in terms of change from baseline in 24-hour ambulatory systolic blood pressure (SBP; MD -2.15 mmHg; 95% -5.07, 0.76; p=0.15; Fig. 1A), 24-hour ambulatory diastolic blood pressure (DBP; MD -1.19 mmHg; 95% CI -2.91, 0.53; p=0.18; Fig. 1B) or office SBP (MD -1.71 mmHg; 95% CI -9.62, 6.20; p=0.67; Fig. 1C).

Conclusion:
In this meta-analysis, ultrasound RDN did not significantly reduce blood pressure in patients with resistant hypertension as compared with a sham procedure.
Abstract 13679: Personalized Guidance of Edge-to-Edge Transcatheter Tricuspid Valve Repair
Authors: Patrascu Alexandru , Ott Ilka
Published: December 2023

Introduction:
Transcatheter edge-to-edge tricuspid valve repair (T-TEER) for tricuspid regurgitation (TR) is always guided by TEE.

Hypothesis:
Safety and efficacy of T-TEER can be increased by multimodality imaging (MMI) guidance.

Methods:
From December 2020 to January 2022, we performed T-TEER in 40 inoperable patients. All patients received TTE, TEE and cardiac CT screening, and were assigned to a MMI (n=17) guidance group, provided good TTE acoustic window, or otherwise classical TEE (n=23).

Multimodality imaging employed the 4 right-sided chamber views. Accordingly, the 1-chamber view was obtained in the transgastric short-axis view on TEE, but also from a modified subcostal TTE short axis. The 2-chamber view was visualized from a low-esophageal position, or from a parasternal long axis view of the right ventricle. The 3-chamber view was seen on mid-esophageal TEE 50-100°, but also in the parasternal short axis view. Finally, the 4-chamber view was obtained on mid-esophageal 0-30°, or the classical four-chamber TTE view. CT derived fluoroscopic angulations of these views allowed interventionalists and imaging specialists to speak a common language.

Results:
Device success was achieved in all patients, with 1.5±0.6 implanted clips / patient in the MMI vs 1.5±0.5 in the TEE group (p=0.851). Device times were 66.1±35.1 vs 58.7±27.5 minutes (p=0.459). TR reduction was successful in 94% vs 95% of patients, p=1.000. Two- or more grade TR improvement occurred in 65% vs 52% of cases. There were no device associated complications but 3 TEE-related gastro-esophageal bleedings occurred in the 2
nd
group. By 12 months, 4 vs 8 patients (p=0.504) were readmitted for acute heart failure, and 2 vs 4 (p=0.686) died. NYHA class decreased by one grade in all survivals. However, Kansas City Cardiomyopathy Questionnaire score and 6-minute walk distance significantly increased in each respective group, more with MMI (
Δ
29±21.4 vs 22±13.6 points, p=0.227;
Δ
101±100.4 vs 85±64 meters, p=0.121).

Conclusions:
A patient-tailored MMI approach to T-TEER guidance, by using TTE in patients with good acoustic window and cardiac CT for fluoroscopic determination of the 4 right-sided chamber views, is feasible and improves safety, procedural success and, in turn, clinical outcomes.
Abstract 13688: Association Between Daylight Saving Time and Acute Myocardial Infarction in Canada
Authors: Al Samarraie Ahmad , Godbout Roger , Goupil Remi , Paul Suarasan Catalin , Russo Melina , Kanj Samaya , Dano Mathilde , Roy Justine , Reiher Laurence , Rousseau Guy , Pichette Maxime
Published: December 2023

Background:
Recent studies have suggested an increased risk of AMI following daylight saving time (DST) transitions in cohorts of American and European patients. We aim to validate this finding in a Canadian population.

Methods:
We performed a retrospective cohort study of patients admitted to the Hôpital du Sacré-Coeur de Montréal, with a diagnosis of AMI requiring a PCI. Patients aged ≥18 years hospitalized between 2018 and 2022 were included. The primary endpoint was the incidence of AMI two weeks following DST transitions. The secondary endpoint was infarct size by biomarker assessment and LVEF.

Results:
1142 charts were reviewed with 775 patients meeting the inclusion criteria (244 in the study group and 531 in the control group). Baseline clinical characteristics were comparable between both groups. (Table 1) The rate of AMI per day following DST transitions was 1.74 compared to 1.90 during control periods. DST was not associated with an increase in AMI (IRR = 0.92, 95% CI 0.79 - 1.07, p = 0.295). (Table 2) During the spring shift, the IRR was 0.83, p = 0.106, and during the autumn shift, the IRR was 1.01, p = 0.933. The rate of AMI was higher on the first day following DST, but it did not reach statistical significance (rate of AMI per day = 2.00; IRR = 1.05; p = 0.845). The transition to DST was not associated with a larger infarct size by CK-MB assessment, but LVEF was significantly slightly higher following DST transitions (LVEF 50 ± 11 % vs 48 ± 10 %, p = 0.038).

Conclusion:
In this cohort of Canadian patients, there was no significant association between DST transitions and the incidence of AMI. LVEF was higher following DST transitions, but infarct size was similar between study and control groups.
Abstract 13691: New Model for Prevention and Management of Venous Thromboembolism After Heart Valve Surgery
Authors: He Meng , Zhu Zhihui , Lai Yongqiang , Zhang Xiwei
Published: December 2023

Introduction:
Venous thromboembolism (VTE) is one of the possible complications that can occur after heart valve surgery. Exploring effective VTE prevention and management models for post-cardiac surgery is an important issue in perioperative management.

Hypothesis:
We hypothesized that a new model for VTE prevention and management can effectively reduce the incidence of VTE in patients undergoing heart valve surgery.

Methods:
A total of 1200 patients who underwent heart valve surgery were included in this study and randomized in a 1:1 ratio into the control group and new management group. The control group received basic VTE prevention measures, while the intervention group implemented a newly designed VTE prevention and management protocol in addition to the basic preventive measures. The protocol included multidisciplinary team training and assessment, a comprehensive VTE evaluation mechanism, proper execution of preventive measures, physical and mechanical prophylaxis, patient rehabilitation training, and education. The primary outcome measure was the incidence of perioperative VTE, and secondary outcome measures included the occurrence of postoperative pulmonary embolism and all-cause mortality after heart valve surgery.

Results:
The intervention group included a total of 600 patients, with 57.6% being male and an average age of 56.7 ± 13.4 years. The control group also included 600 patients, with 55.5% being male and an average age of 57.5 ± 12.8 years. There were no significant differences in general clinical data between the two groups. The incidence of in-hospital deep vein thrombosis (DVT) in the intervention group was significantly lower than that in the control group (0.3% vs 1.5%, P<0.05). However, there were no significant differences between the two groups in terms of in-hospital pulmonary embolism and early postoperative all-cause mortality. The intervention group showed a significantly higher accuracy rate in VTE risk assessment compared to the control group (91.3% vs 87.9%, P<0.05).

Conclusions:
The new model for VTE prevention and management can effectively reduce the incidence of VTE in patients undergoing heart valve surgery, providing important evidence for the prevention and management of VTE in cardiac surgery.
Abstract 13699: Comparing Patency Benefits of Pulmonary Stent Implantation and Balloon Angioplasty in Pulmonary Vein Stenosis: A Systematic Review and Meta-Analysis
Authors: Batool Izza , Khan Muhammad Khuzzaim , Zohaib Muhammad , Siddiqui Fatima , Ashraf Muhammad Talal , Khan Ibrahim Ahmed , Shah Shreeja , Al Hennawi Hussam , Klugherz Bruce
Published: December 2023

Introduction:
Pulmonary vein stenosis (PVS) may arise from various conditions and result in significant morbidity and mortality. Transcatheter approaches, including pulmonary stent implantation (PSI) and pulmonary balloon angioplasty (PBA) are associated with restenosis risks. We conducted a meta-analysis comparing PSI and PBA to understand restenosis risk and complications rate.

Methods:
We conducted a comprehensive search of PubMed, Google Scholar, Scopus, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases from inception until May 2023. A total of 1233 studies were screened, and 11 studies were included in our analysis. Our primary outcomes of interest were the risk of restenosis requiring reintervention, 5-year freedom from restenosis, and the risk of procedure-related complications. We calculated odds ratios (ORs) with corresponding 95% confidence intervals (CIs) using a random-effects model and performed a meta-regression analysis.

Results:
We included a total of eleven observational studies in our meta-analysis, comprising 780 patients with PVS, 335 of whom underwent PBA and 445 underwent PSI. Our analysis showed that PSI was associated with a lower risk of restenosis requiring reintervention compared to PBA (OR 0.34, 95% CI 0.13, 0.87, P= 0.02). PSI was also associated with a significantly higher 5-year freedom from restenosis (OR 4.42, 95% CI 1.11, 17.62, P= 0.04) than PBA. There was no significant difference in the risk of procedure-related complications between PSI and PBA. Our meta-regression analysis revealed that age of patient and stent size did not significantly affect the risk of restenosis requiring intervention.

Conclusions:
PSI offers superior patency benefits compared to PBA for PVS. PSI was associated with a lower risk of restenosis requiring reintervention and a higher 5-year freedom from restenosis. Bases on these findings, PSI is the preferred strategy for the treatment of pulmonary vein stenosis.
Abstract 13716: Implanting an Extravascular ICD in Patients With a Prior Subcutaneous ICD
Authors: Amin Anish , Cornell Sarah , Venditti Robert , Wiggenhorn Christopher , Cline Matthew , Sanders Prashanthan , Sagi Venkata
Published: December 2023

Background:
The Extravascular Implantable Cardioverter Defibrillator (EV ICD) has been demonstrated as an effective therapy to treat sudden cardiac death using a substernal lead position. Limited data regarding the use of EV ICD in patients with prior subcutaneous ICD (S-ICD) is available.

Methods:
The EV ICD Pivotal study database was reviewed for subjects with a prior S-ICD. Procedure times were compared using the Wilcoxon rank-sum test.

Results:
Of the 316 subjects that had an implant attempt in the EV ICD Pivotal study, 9 subjects at 3 sites had history of a prior implanted S-ICD. All were male with a mean age of 59.6 ± 14.4 years. Mean Body Mass Index (BMI) was 29.5 ± 4.7. Five subjects had secondary prevention indication. Mean follow up duration was 1.4 ± 0.7 years. The study protocol required S-ICD explant prior to study enrollment. The mean time between S-ICD explant and EV ICD implant was 35 ± 19 days. Procedure times were similar to denovo EV ICD implant. Median times from first incision to final suture, inclusive of defibrillation testing, for subjects with and without prior S-ICD were 79 (IQR, 69 to 108) and 60.5 (IQR, 52 to 84.5) minutes, respectively (P=0.10). All subjects were defibrillated with 30 J or less at implant. There were no major intraprocedural complications and only 1 major complication during the follow up period, an implant site infection at 18 months. The Florida Patient Acceptance Survey, issued at 6 months post-implant, demonstrated high device acceptance rate with little or no body image concerns. Two subjects each had an appropriately treated episode of spontaneous sustained monomorphic VT, one terminated by ATP and the other terminated by shock following ATP.

Conclusions:
The EV ICD System can be successfully implanted in patients who previously had an S-ICD. History of S-ICD did not significantly increase procedure time. The EV ICD had a high acceptance in this subgroup and may provide advantage over S-ICD due to its smaller size, and ability to deliver ATP.
Abstract 13721: Coronary Artery Calcium for Risk Stratification Among Persons With Very-High High-Density Lipoprotein Cholesterol
Authors: Razavi Alexander C , Mehta Anurag , Budoff Matthew J , Gianos Eugenia , Wong Nathan , Vaccarino Viola , Van Assen Marly , De Carlo N , Rozanski Alan , Miedema Michael , Rumberger John A , Mortensen Martin B , Shaw Leslee J , Nasir Khurram , Blumenthal Roger S , Rohatgi Anand , Quyyumi Arshed A , Sperling Laurence , Whelton Seamus P , Blaha Michael J , Berman Daniel , Dzaye Omar
Published: December 2023

Introduction:
Persons with very-high high-density lipoprotein-cholesterol (HDL-C) may experience an increased mortality risk. However, the predictors of mortality among those with very-high HDL-C remain unknown.

Hypothesis:
Compared to traditional risk factors, coronary artery calcium (CAC) will more strongly stratify risk among individuals with very-high HDL-C.

Aims:
Among individuals with very-high HDL-C, to 1) calculate crude all-cause mortality rates across the burden of traditional risk factors and CAC, and 2) identify independent risk factors associated with all-cause mortality.

Methods:
There were 335 primary prevention patients from the CAC Consortium who had very-high HDL-C (
>
80 mg/dL in men,
>
100 mg/dL in women) and available information on traditional CVD risk factors. Crude all-cause mortality rates were calculated per 1,000 person-years. Multivariable Cox proportional hazards regression assessed the association of traditional risk factors and CAC with mortality.

Results:
The mean age was 58.6 years old, 51.0% were women, 51.3% had prevalent CAC, and the median HDL-C was 100 mg/dL. There were 20 deaths (6.0%) over a median follow-up of 10.5 years, 7 (2.1%) of which were attributable to CVD. There was a stepwise higher crude mortality rate per 1,000 person-years across increasing CAC burden (
Central Illustration
). Independent of traditional risk factors, each 100 Agatston Unit increase in CAC score was associated with a 7% higher hazard of all-cause mortality (HR: 1.07, 95% CI: 1.01-1.12) and individuals with CAC
>
1000 experienced a 5.75-fold higher hazard of mortality when compared to CAC=0 (HR: 5.75, 95% CI: 1.26-26.24). Beyond age, no traditional risk factor was associated with mortality in multivariable analyses.

Conclusion:
Measurement of CAC on non-contrast cardiac computed tomography may facilitate risk assessment among individuals with very-high HDL-C.
Abstract 13750: Concomitant Transcatheter Debulking of Right Heart Vegetations During Extraction of Transvenous Device System for Endocarditis: An Eight Case Series
Authors: Doty Brandon K , Lee Bridget , Brider Jamarcus , Mahtani Arun , Gabrah Kirollos , Al-Hindi Feross , Nair Devi
Published: December 2023

Background:
Right heart (RH) infective endocarditis (IE) is a rare but serious complication of transvenous devices (TVD) often requiring system extraction. Surgery is often necessary for large vegetations or when bacteremia persists despite antibiotics.

Objective: To evaluate outcomes of patients who underwent transcatheter debulking of IE-related RH vegetations in the setting of a transvenous device endocarditis.

Methods:
Patients with TVD and IE with RH vegetations were included in this analysis. Half of the patients were debulked using a thrombus aspiration system, while in the other half a hydrodynamic thrombectomy system was used. This was completed via a femoral approach with intracardiac echocardiography guidance. Intra and post-procedural outcomes were recorded.

Results:
Eight patients with a median age of 58 years, 62.5% male, with TVD, IE, and RH vegetations were included. Vegetations were located on the TV (2), RA lead (4), RV lead (2) and the floor of the RA along the cavotricuspid isthmus (1). The largest vegetation in this series was 5 cm by 2 cm with a volume of 62.83 cm3 and the smallest was 0.4 cm by 0.3 cm with a volume of 0.15 cm3. All patients had substantial vegetation burden causing clinically significant valve dysfunction. The vegetations were successfully debulked in all eight cases. Post-procedure imaging in all eight patients showed at least a 80% reduction in vegetation burden. All patients with TVP leads underwent successful extraction of the pacing systems. All patients tolerated their procedures well and remained free of infection at follow-up after completing a 6-week course of intravenous antibiotics. There were no procedure-related adverse events recorded within 30 days of intervention.

Conclusion:
TCD is a potential alternative in patients with device infection and large vegetations who are not candidates for surgical intervention. Long-term implications of this intervention in this high-risk population needs further studies.