bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 12891: Outcomes After Heart Failure Hospitalization Among Patients With Myeloproliferative Neoplasms
Authors: Leiva Orly , Alvarez-Cardona Jose , Brunner Andrew , How Joan , Hobbs Gabriela
Published: December 2023

Introduction:
Myeloproliferative neoplasms (MPNs) are chronic leukemias associated with increased risk of cardiovascular (CV) events. MPNs most commonly harbor mutations in the
JAK2
gene, which has been associated with adverse cardiac remodeling in mouse models of cardiomyopathy and heart failure (HF). Prior studies suggest patients with MPN are at increased risk of HF. However, in-hospital and readmission outcomes of patients with MPN admitted for HF have not been well characterized.

Methods:
Adult patients admitted with HF from January 2017 to December 2018 MPN were identified using the National Readmission Database. Propensity score matching (PSM) was performed to match 1 MPN for 10 non-MPN controls. Primary outcomes were in-hospital death and 90-day CV-related, HF-related and all-cause readmissions

Results:
Patient characteristics after PSM are described in Table 1. Patient characteristics were well-balanced between MPN and non-MPN groups after PSM. MPN patients had similar rates of in-hospital mortality but higher rates of bleeding during index hospitalization. MPN patients had increased risk of in-hospital death (OR 1.17, 95% CI 1.00 - 1.35) and 90-day CV-related (HR 1.10, 95% CI 1.02 - 1.18) and all-cause readmissions (HR 1.24, 95% CI 1.17 - 1.31) but not HF-related (HR 1.05, 95% CI 0.97 - 1.14).

Conclusions:
Among patients hospitalized for HF, MPN was associated with increased risk of in-hospital death, and 90-day CV-related readmissions. Further investigation is needed in order to improve outcomes in patients with MPN and HF.
Abstract 12917: Incremental Utility of 3D Printing to Guide the Surgical Management of Cardiac Sarcoma
Authors: Kassab Joseph , Bakhshwin Ahmed , Klatte Ryan , Chedid El Helou Michel , El Dahdah Joseph , Layoun Habib , Roselli Eric E , Harb Serge C
Published: December 2023

Background:
Intimal sarcoma is an extremely rare and aggressive malignancy that originates in the heart and major vessels. Due to its rarity, ambiguous clinical presentation, and rapid progression, diagnosing and treating this neoplasm presents significant challenges.

Case presentation:
A 61-year-old female with a history of left atrial sarcoma underwent mass excision in 2019 and 2020, along with several rounds of chemotherapy and immunotherapy. A follow-up cardiac MRI revealed a concerning lesion in the posterior left atrium with evidence of interval size progression on a subsequent CT, suggestive of a recurrence (Panel A). To aid in surgical planning, 3D segmentation of the patient's CT scan was performed, and a 3D model of her heart and lesion were printed (Panel B). This was particularly valuable as it was her third redo surgery, and there were concerns about the surrounding anatomy. Upon reviewing the multimodality imaging and 3D model, the patient was deemed a suitable candidate for a redo surgery. She underwent left atrial sarcoma resection with left atrial floor reconstruction using a bovine pericardial patch and left inferior pulmonary vein reimplantation (Panel C). Histological studies were consistent with recurrent intimal sarcoma (Panel D). The patient is currently in remission.

Conclusion:
Multimodality imaging was crucial in diagnosing the recurrence of the sarcoma. However, 3D printing of the heart and lesion with detailed segmentation of the left atrium and surrounding structures played a significant role in surgical planning. This highlights the growing use of 3D printing in cardiac surgery planning.
Abstract 12939: Friend or Foe: Increased Access to Care via Patient Portals
Authors: Moorhead Jeffrey B , Jeong Kwonho , Abebe Kaleab , Harrington Christina , Magnani Jared W , Johnson Amber E
Published: December 2023

Background:
Patient portals are secure online websites that grant patients access to their medical record. Portal use is associated with improved chronic disease management. Whether the use of patient portals is associated with cardiac outcomes is less well known and deserves further study. We examined the association of patient portal use with cardiac events among a large cohort of patients with CVD. We expected to find differences in portal use by sociodemographic info. We hypothesized that portal use would be negatively associated with cardiac events.

Methods:
De-identified data for adult patients meeting inclusion criteria were obtained between January 2018 and October 2021. The association of portal use with demographic factors was assessed using t-test and/or chi squared. Our primary outcomes were emergency department (ED) visit or all-cause readmission. We used a Cox model adjusting for demographic and clinical covariates at an alpha of 0.05.

Results:
The Table summarizes our findings. There was a significant difference in portal use by sex, race, ethnicity, English proficiency, and marital status. The Figure shows the adjusted findings that portal use was associated with higher hazards of ED visits and all-cause readmission at one year.

Conclusions:
Our data demonstrate that sociodemographic factors are associated with online patient portal use at a single institution. Contrary to our hypothesis, we found that portal use portends increased ED visits and hospitalization (lower event-free survival). These data suggest that patient portal access and closer clinician scrutiny may lead to increased health services utilization.
Abstract 12943: Long-Term Ablation Outcome in Patients With Coexistent Metabolic Syndrome and Long-Standing Persistent Atrial Fibrillation Undergoing First Catheter Ablation: Results From a Propensity-Matched Population
Authors: Mohanty Sanghamitra , Torlapati PremGeeta , gianni carola , MacDonald Bryan , Mayedo Angel , Della Rocca Domenico G , Burkhardt John D , Gallinghouse G , Al-Ahmad Amin , Horton Rodney , Bassiouny Mohamed , Di Biase Luigi , Natale Andrea
Published: December 2023

Introduction:
Procedure-outcome after catheter ablation in long-standing persistent atrial fibrillation (LSPAF) is reported to be highly variable with different ablation approaches. Metabolic syndrome (MS), a pro-inflammatory state, is also considered to be closely associated with recurrent AF.

Purpose:
We evaluated the long-term outcome with different ablation strategies in patients with coexistent MS and LSPAF

Methods:
Consecutive patients with LSPAF and MS undergoing their first catheter ablation were classified into two groups;
group 1:
standard ablation: PVAI extended to the entire posterior wall (PW) plus empirical isolation of superior vena cava (SVC) and
group 2:
standard ablation+ ablation of non-PV (NPV) triggers. Ablation strategy was based on operators’ discretion. In order to attenuate the between-group imbalance of the baseline covariates, a propensity score-matching technique was used resulting in 108 and 432 (1: 4) patients in gr 1 and 2 respectively. Arrhythmia-monitoring was performed quarterly for 1 year and biannually afterwards. Ablation success was assessed off-antiarrhythmic drugs (AAD).

Results:
All patients received PVAI plus isolation of left atrial PW and SVC (standard ablation). Following the standard ablation, high-dose isoproterenol challenge (25-30 μg/min for 10-15 min) was performed in group 2 (n=432) patients to identify non-PV triggers. These were detected in LAA (294, 68%), CS (315, 73%), inter-atrial septum (125, 29%) and crista terminalis (76, 17.6%). These sites were ablated using additional radiofrequency energy. Isoproterenol challenge to reveal non-PV triggers was not performed in group 1 (n=108) patients. Procedural complications included 3 (2.7%) and 6 (1.4%) groin hematomas in group 1 and 2 respectively (p=0.31). At 6 years of follow-up, the single-procedure off-AAD success rate was 19 (17.6%) in group 1 and 231 (53.4%) in group 2 (p<0.001)

Conclusion:
In our study patients with LSPAF and metabolic syndrome, standard ablation plus ablation of all detectable non-PV triggers during the first procedure was demonstrated to be significantly more effective in achieving long-term arrhythmia-free survival compared to standard ablation alone.
Abstract 12955: Shear-Dependent Changes in Blood Viscosity Negatively Affect Energetic Efficiency in Patient-Specific Models of the Fontan Circulation
Authors: Wei Heng , Cao Kellie , Pahlevan Niema M , Cheng Andrew L
Published: December 2023

Introduction:
Since blood flow through the lungs is passive in patients with the Fontan circulation, cardiac output is sensitive to power loss through the pulmonary vasculature. Prior small
in vitro
studies of how changes in blood viscosity at venous shear rates (“non-Newtonian behavior”) affect power loss have yielded conflicting results. The purpose of this study was to evaluate the extent to which non-Newtonian behavior contributes to power loss in a large number of pediatric patient-specific models of the Fontan circulation.

Hypothesis:
Shear-dependent changes in blood viscosity cause increased power loss in the low-shear Fontan circulation.

Methods:
Pulmonary vascular geometry was segmented from clinical cardiac MRI images. Pressure and velocity fields were then calculated using computational fluid dynamic simulations. Cardiac index was set at 2 L/min/m2 to simulate a low cardiac output state. A constant viscosity model (“Newtonian”) was compared to a shear-dependent viscosity model (“non-Newtonian”). Power loss was calculated by simplified power loss (using bulk flow and pressure changes) and viscous dissipation rate (using element-wise shear rates and viscosities). Both metrics were indexed to adjust for cardiac output and body surface area. Wilcoxon signed-rank test was used to compare differences between the two viscosity models.

Results:
Twenty patients (mean 10.9 years, 35% female) were included. Mean viscosity was nearly 10-fold higher in the non-Newtonian vs. Newtonian simulations (mean non-Newtonian to Newtonian viscosity ratio 9.7, SD 0.6). Accordingly, power loss by both metrics was significantly larger for the non-Newtonian simulations (
Figure
).

Conclusions:
Shear-dependent increases in blood viscosity cause increased power loss in computational models of the Fontan circulation under low cardiac output conditions. Further studies are needed to evaluate the degree to which this correlates with clinical outcomes.
Abstract 12969: Role of Elevated High-Sensitivity Cardiac Troponin T in Determining the Clinical and Angiographic Outcomes in Patients With Chronic Total Occlusion Undergoing Percutaneous Intervention: A Meta-Analysis
Authors: Damarlapally Nanush , Sawhney Aanchal , Verma Jyoti , Klair Harroop Singh S , Kolli Dhanush , SINGH SIBIA Birimroz , Chalasani Vardhan , Reddy Rasya , Kolli Jithin Teja , Desai Rupak , Sachdeva Rajesh , Kumar Gautam , Paul Timir K
Published: December 2023

Background:
Percutaneous Coronary Intervention of Chronic Total Occlusion (CTO-PCI) leads to higher periprocedural myocardial injury (PMI); however, the prognostic value of high-sensitive-Cardiac Troponin T (Hs-cTnT) in CTO-PCI outcomes is not well studied. This review evaluated the association of Hs-cTnT with major adverse cardiovascular events (MACE) following CTO-PCI.

Methods:
We conducted a thorough literature search in PubMed, Scopus, Embase, and Google Scholar, using relevant keywords, to identify studies up to 2022. The primary outcome of interest was MACE, which included all-cause mortality, PMI, target vessel revascularization (TVR), and target vessel re-occlusion (TVRO). Pooled odds ratios (OR) and 95% confidence intervals (CI) were estimated using binary random-effects models. Heterogeneity was assessed using I
2
statistics.

Results:
Our analysis included four studies investigating 1499 post-CTO-PCI patients (mean age 66.77±10.09 years, 81.5% male). Patients with multivessel disease, retrograde approach, and previous PCI or coronary artery bypass graft procedures were more likely to present with elevated Hs-cTnT levels due to the complexity of the procedure. No difference in baseline comorbidities was noted in patients with and without elevated Hs-cTnT, including diabetes and hypertension. There was no significant association between Hs-cTnT levels and MACE (OR:1.56 p=0.25), TVR (OR:2.03, p=0.22), PMI (OR:3.45, p=0.07), and mortality (OR:2.35, p=0.14) (
Figure 1)
. However, a significant association was found between Hs-cTnT levels and TVRO [OR:8.78 (95% C.I. 3.64-21.17) p<0.01, I2 0%].

Conclusion:
Patients with elevated Hs-cTnT levels have a nine-fold higher risk of TVRO than those with normal levels in CTO-PCI. Periprocedural Hs-cTnT measurement can be utilized for risk stratification of TVRO after CTO-PCI with no association with MACE. Overall smaller sample size warrants more randomized studies to substantiate the results.
Abstract 12982: Underutilization of Intravenous Iron in a Contemporary Population of Ambulatory Heart Failure Patients in Canada
Authors: Alajmi Fahad , Kang Mehima , Altamimi Abbas , Clarke Brian , Davis Margot , Virani Sean , Toma Mustafa
Published: December 2023

Background:
Intravenous iron has been shown to improve quality of life and exercise capacity in patients with heart failure and reduced ejection fraction (HFrEF) with iron deficiency anemia. We undertook this study to understand the utilization rates of IV iron in a Canadian heart function clinic.

Methods:
This retrospective analysis was carried out on all heart failure (HF) patients referred to a tertiary care Heart Function Clinic (HFC) who would have been eligible for intravenous iron therapy from January 2020 until December 2022. Our inclusion and exclusion criteria were based on the FAIR HF trial. Inclusion criteria was left ventricular ejection fraction (LVEF) of ≤40% for patients with New York Heart Association (NYHA) class II or ≤45% for NYHA class III, hemoglobin level of 95 to 135 g/L and iron deficiency. The data and decision to recommend IV iron was based on initial HFC consultation and pre-appointment investigations.

Results:
Out of 1360 charts reviewed, 920 patients had a complete data set in order to determine eligibility. Of those, 127 (13.8%) met IV iron eligibility criteria as per the FAIR HF trial. Of those eligible, 64.6% were male, 98.4% had HFrEF and 1.6% had heart failure with mildly reduced ejection fraction (HFmrEF) (p<0.001). The mean LVEF for those meeting criteria for IV iron was 28.3±7.6% vs 36.1±13.7% for those ineligible (p<0.001). Mean NYHA class for those meeting criteria for IV iron was 2.3±0.5 vs 2.1±0.7 for those ineligible (p<0.001). Only 3 (2.4%) of the eligible patients were recommended or received IV iron, while 2 (1.6%) others had received IV iron prior to HFC visit (Fig). There were no significant differences in the proportion of patients receiving optimal quadruple therapy HF management between both cohorts (p=0.07).

Conclusion:
Our study demonstrates a significant underutilization of IV iron administration in eligible HFC patients, presenting many missed opportunities to improve patient quality of life.
Abstract 13000: Twiddler’s Syndrome - A Rare Cause of Pacemaker Malfunction
Authors: Sachdeva Amitoj , Gomez Jorge , Sarmiento Joseph
Published: December 2023

Description of Case:
A 76-year-old female with a past medical history of chronic atrial fibrillation and symptomatic tachycardia and bradycardia status-post dual-chamber pacemaker with right atrial and ventricular leads who presented with dyspnea on exertion. TTE showed normal biventricular function and no significant valvular abnormalities. Upon further evaluation of her pacemaker, she was found to have a very high ventricular capture threshold suggesting RV lead failure. The patient underwent RV lead replacement. The inspection of the pacemaker pocket during the procedure showed manual dislodgement of both tie-down sleeves and the pacemaker leads required untangling. A new RV lead was subsequently placed. Upon further imaging review, displacement of the previous RV lead was evident from initial placement. In addition, the patient had previously had a history of interval diaphragmatic stimulation as well. Overall, the presentation was felt to be consistent with Twiddler’s Syndrome.

Discussion:
Twiddler’s or Reel Syndrome occurs when conscious or subconscious self-manipulation and spinning of the pulse generator result in lead dislodgement and loss of pacing and pacemaker malfunction. The reeling of the leads around the generator can also cause stimulation of the brachial plexus or phrenic nerve stimulation and subsequent rhythmic arm twitching or diaphragmatic pacing, respectively. It has previously been reported in cases of single- and dual-chamber ICDs, deep brain stimulators, and spinal nerve stimulators with varying presentation. The diagnosis requires clinical suspicion based on history, physical exam, imaging, or surgical inspection suggesting the displacement of leads with evidence of coiling of the wires around the pacemaker. Treatment often requires revision and focus should be maintained on patient education for both primary and secondary prevention of Twiddler’s Syndrome.
Abstract 13005: Depletion of XCR1+ Conventional Dendritic Cell After Myocardial Infarction Improved Adverse Cardiac Remodeling via CXCR3 Chemokine Signaling
Authors: Inui Hiroyasu , Nishida Makoto , Saga Ayami , Omatsu Takashi , Tanaka Katsunao , Okada Takeshi , Ohama Tohru , Koseki Masahiro , Yamashita Shizuya , Sakata Yasushi
Published: December 2023

Introduction:
We have demonstrated immune reactions of probucol treatment on cardiac remodeling using SR-BI KO/ApoeR61
h/h
(SRBI KO) mice in which ischemic myocardial injury is induced by high fat diet. In the previous study, we identified the role of XCR1
+
conventional dendritic cells 1 (cDC1)-activated CD4
+
T Helper-1 (Th1) cells after ischemic myocardial injury.

Hypothesis:
Deletion of XCR1
+
cDC1 cells after myocardial infarction (MI) might improve adverse cardiac remodeling through the suppression of Th1 cells.

Methods:
Using Xcr1
+/DTRvenus
mice, which allow the XCR1-expressing cell elimination by treatment with diphtheria toxin (DT), permanent coronary ligation was conducted. DT was injected into Xcr1
+/DTRvenus
mice 1 day after MI (XCR1 depleted-MI group). We analyze cDCs and CD4
+
T cell subsets by flow cytometry.

Results:
The XCR1 depleted-MI group showed improvement of EF evaluated by cardiac MRI (p<0.05). In CD4
+
T cell subsets, Th1 and Tregs were significantly localized in border and infarcted area, while Th1 cells were decreased in XCR1 depleted-MI group (p<0.001). To elucidate the mechanism of the predominant reduction of Th1 cells, we focused on CXCR3 chemokine receptor and its ligands, CXCL9 and CXCL10. CXCR3 is enriched on Th1 in the heart after MI, while it is not enriched on Tregs. Regarding the precise source of CXCL9 and CXCL10 in the ischemic heart, the percentage of XCR1
+
cDC1 cells were most predominant in the cDCs subsets expressing CXCL9 and CXCL10 (p<0.001). These results suggested that XCR1
+
cDC1 cell-derived CXCL9 and CXCL10 are significant contributor to the chemotaxis of CXCR3
+
Th1 cells after MI. Finally, we analyzed autopsy samples of human MI cases to demonstrate clinical significance. CXCR3
+
Th1 and XCR1
+
cDC1 cells were detected significantly more in the infarcted area than in marginal zone.

Conclusions:
The modulation of XCR1+cDC1-activated CXCR3
+
Th1 cells could be a novel therapeutic target to reduce post-MI remodeling.
Abstract 13006: Telemedicine Disparities in Ambulatory Cardiology Patients in a Large Academic Health System
Authors: Shah Lochan M , Wu Colin , Tackett Sean , Sadauskas Lily , Hughes Helen , Gilotra Nisha A
Published: December 2023

Introduction:
Although the COVID-19 pandemic prompted rapid expansion of telemedicine, the effect of system-wide digital health strategies on vulnerable populations remains to be understood. Given video visits offer several advantages over audio-only visits, telemedicine encounters are typically preferentially scheduled as video visits; however, access complexities may lead to audio-only encounters and exacerbate the digital divide.

Aim:
We aimed to identify sociodemographic characteristics associated with telemedicine visit modality in the outpatient cardiology population in a large academic health center.

Methods:
We assessed all outpatient cardiology telemedicine visits from 1/1/2020-12/31/2021 via the Johns Hopkins Telemedicine Equity Dashboard, which sources its data from the electronic medical record. Our primary outcome was visit modality, with an adverse outcome defined as video-to-audio visit conversion. The first telemedicine encounter for each unique patient was included (accounting for 85% of all telemedicine encounters during study period). We assessed predictors of video-to-audio visit conversion using simple and multivariate logistic regression with relevant pre-determined sociodemographic variables (see
Figure
).

Results:
There were 47,961 total telemedicine encounters, spread between 39,381 unique patients. Odds of conversion from video to audio-only visit increased with age, with the highest odds of conversion to audio-only visit in patients age 75+. Non-White race, Medicaid, Medicare and self-pay insurance status, and higher social deprivation index (SDI) quintile were also associated with increased odds of audio-only modality.

Conclusion:
Current telemedicine strategies would benefit from further analysis and targeted intervention to develop a more equitable digital care delivery system, particularly for patients that are older, non-White, do not have private insurance, and live in areas with higher SDI.
Abstract 13014: Cardiac Arrhythmias, Hypotension and Need for Vasopressors Following Admissions for Addisonian Crisis; an Analysis via the 2016-2020 National Inpatient Sample
Authors: Ravalani Abhimanyu , Ramphul Kamleshun , Memon Rahat A , Sombans Shaheen , Lohana Petras
Published: December 2023

Introduction:
Addisonian crisis(AC) is a life-threatening complication secondary to acute adrenal insufficiency. Various cardiac arrhythmias and complications can be seen during such episodes. While fluids and glucocorticoid replacement therapies are the main steps in management, critically ill patients often also require vasopressors (VP) to maintain an adequate Mean Arterial Pressure.

Methods:
We queried adults with AC from the 2016-2020 National Inpatient Sample. The incidence of several cardiac arrhythmias and cardiac events was estimated. The need for VP among hypotensive cases and their impact on mortality were also analyzed.

Results:
There were 28430 adult cases of AC with a mean age was 55.59 years (SEM 0.106) and involved predominantly females (62.9% of all cases). Several cardiac arrhythmias were also reported, such as atrial fibrillation (12.6%), supraventricular tachycardia (1.7%), ventricular tachycardia (1.5%), ventricular fibrillation (1.8%), and atrial flutter (1.8%). A diagnosis of hypotension was also reported in 23.2% (6590 cases) of cases, while 16.7% (4755 cases) had hyperkalemia. Among patients with hypotension, 305 (4.6%) cases also needed VP. Higher use of VP in hypotensive cases was observed among Hispanics (vs. Whites, aOR 1.772, 95% CI 1.195-2.627), Males (aOR1.826, 95% CI 1.407-2.371, p<0.01), history of hypertension (aOR1.670, 95% CI 1.232-2.263, p<0.01), prior stroke (aOR 1.741, 95% CI 1.111-2.726, p=0.015), or cirrhosis (aOR 2.185, 95% CI 1.084-4.406, p=0.029). Hypotensive patients requiring the use of VP were older (mean age 62.10 vs. 55.53 years, p<0.01), and with a higher mean Charlson Comorbidity Index (CCI) score (mean score 4.44 vs. 2.97, p<0.01) than those not requiring VP. Overall, 18.0% of hypotensive patients using VP died (vs. 2.2% not requiring VP, aOR 4.950, 95% CI 2.974-8.238, p<0.01).

Conclusions:
AC presents with multiple cardiac arrhythmias. VP use in hypotensive cases was more common in Hispanics, Males, patients with a history of hypertension, stroke, or cirrhosis. Hypotensive patients requiring VP were also sicker and had a higher mortality rate. Thus, AC management and diagnosis must be prompt to reduce the odds of mortality.
Abstract 13023: Trends and Disparities in Cardiovascular Deaths in Non-Hodgkin Lymphoma: A Population-Based Retrospective Study in the United States From 1999 to 2020
Authors: Tan Min Choon , Yeo Yong Hao , Ibrahim Ramzi , Tan Min Xuan , Lee Justin , Deshmukh Abhishek , Guha Avirup
Published: December 2023

Background:
Non-Hodgkin lymphoma (NHL) survivors are at increased risks of cardiovascular disease related death (CVD) compared to the general population.

Objective:
This study sought to determine the longitudinal trends in mortality attributed to CVD with comorbid NHL by race, sex, and geographic location.

Methods:
We queried the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research database among patients aged 18 and above from 1999 to 2020. Patients were identified when the primary causes of death were ischemic heart diseases (ICD 10 I20-I25), cerebrovascular diseases (I60-I69), or hypertensive disease (I10-I15), and NHL (C82-C85) was a contributing cause of death. We calculated age-adjusted mortality rates (AAMRs) per 1,000,000 individuals and determined the trends over time by estimating the annual percent change using the Joinpoint regression program.

Results:
In the 22-year study period, a total of 22,778 CVD with comorbid NHL were identified. Overall, there was a significant decrease in annual trends for the AAMRs of CVD from 6.91 per 1,000,000 individuals in 1999 to 4.12 per 1,000,000 individuals in 2020 (p<0.05), with an annual percent decrease of 3.3. Overall, men recorded a higher AAMRs compared to women (6.76 vs 3.45, p<0.05). When stratified by race, White individuals had the highest AAMRs (5.07), while the AAMRs for American African, Asian, American Indian individuals were 3.01, 2.77, and 2.48 per 1,000,000 individuals respectively. The AAMRs were higher in the rural region than in the urban region (4.97 vs 4.78, p<0.05). Among all consensus regions, South region had the highest AAMRs.

Conclusion:
In conclusion, our study revealed a significant decrease in cardiovascular disease related deaths with comorbid NHL over the past two decades. It provides valuable insights into the effectiveness of management of comorbid CVD or CVD risk factors in patients with NHL.
Abstract 13033: Usefulness of MR-Derived Left Ventricular Global Longitudinal Strain and Left Atrial Strain to Predict Cardiovascular Events in Patients With HFpEF
Authors: Katahira Masataka , Kiko Takatoyo , Endo Keiichiro , Yamakuni Ryo , Ishii Shiro , Yoshihisa Akiomi , Fukushima Kenji , Ito Hiroshi , Takeishi Yasuchika
Published: December 2023

Background:
The aim of this study was to evaluate the prognostic value of left ventricular global longitudinal strain (LVGLS) and left atrial strain (LAS) obtained from magnetic resonance imaging (MRI) feature tracking in patients with heart failure with preserved ejection fraction (HFpEF).

Method:
We retrospectively enrolled 150 patients with HFpEF who underwent cardiac MRI from 2015 to 2022. LVGLS and LAS were evaluated from cine mode MRI images. The end point was defined as a composite of all-cause death, myocardial infarction and hospitalization due to decompensated heart failure.

Results:
At a follow-up of 4.3 ± 2.0 years, 27 events occurred. After dividing the patients into four groups by the median LVGLS and the median LAS, the event-free rate was significantly lowest in the group of LVGLS > -14.3% and LAS < 13.0% than any other groups (P =0.002). In the Cox proportional hazard analysis, LVGLS and LAS were independent predictors of cardiac adverse events in the patients with HFpEF.

Conclusion:
The assessment of combined LVGLS and LAS was useful to evaluate risk stratification in the patients with heart failure with HFpEF.
Abstract 13046: Lysophosphatidic Acid Activates Spinal TRPV1 Signaling and Contributes to Myocardial Ischemia/Reperfusion Injury
Authors: Wu Chao , Sun Meiyan , Qile Muge , He Shufang
Published: December 2023

Introduction:
Lysophosphatidic acid (LPA) has been shown to directly activate transient receptor potential vanilloid 1 (TRPV1) on primary nociceptors via the binding site of K710 to produce acute pain. However, it is unclear whether LPA participates in myocardial ischemia/reperfusion (I/R) injury by activating TRPV1 receptors.

Hypothesis:
We hypothesize that LPA contributes to myocardial I/R injury by acting on TRPV1 receptors in the spinal cord, and that blocking the interaction between LPA and TRPV1 could exert cardioprotective effects.

Methods:
Wild type male C57BL/6 mice underwent myocardial I/R injury, and LPA levels in cerebrospinal fluid (CSF) were measured. LPA synthesis inhibitor HA-130 or exogenous LPA were intrathecally administrated during myocardial ischemia. Additionally, CRISPR/Cas-9 edited TRPV1K710N knock-in mice and a peptide V1-Cal targeting the K710 region were utilized to block the interaction of LPA with TRPV1.

Results:
The levels of LPA in CSF of the I/R group were found to be 1.5-fold higher than those of the sham group (Fig.1B, p=0.0001). Intrathecal administration of HA130 reduced infarct size (Fig.1C, p=0.0021) and CSF LPA levels (Fig.1D, p=0.0018). The CSF LPA levels were positively correlated with infarct size (Fig.1E, p<0.0001). Intrathecal administration of LPA caused a 1.4-fold rise in infarct size relative to I/R group in wild type mice (Fig.1F, p<0.0001), but not in TRPV1K710N mice (Fig.1F, p>0.9999). LPA treatment enhanced the activation of spinal TRPV1 receptors following I/R injury in wild type mice, but not in TRPV1K710N mice (Fig.1 G-I). Further, the V1-Cal peptide reduced myocardial I/R injury, as well as the protein levels of TRPV1 and pTRPV1 in spinal cord (Fig.1 J-M).

Conclusions:
Our results suggest that LPA activates spinal TRPV1 signaling and contributes to myocardial I/R injury. Blockade of the interaction between LPA and TRPV1 in spinal cord may be a promising therapeutic approach for myocardial ischemic injury.
Abstract 13060: Nutritional Status is Associated With Cardiac Death in Patients With Chronic Limb-Threatening Ischemia Undergoing Endovascular Intervention
Authors: Ito Nobuhiro , Kanda Daisuke , Fukumoto Daichi , Ohmure Kenta , Shimono Hirokazu , Tabata Hiroyuki , Ikeda Yoshiyuki , Ohishi Mitsuru
Published: December 2023

Introduction:
Chronic limb-threatening ischemia (CLTI) represents the end-stage manifestation of peripheral artery disease. The Wound, Ischemia, and foot Infection (WIfI) clinical stage has been thought to have a prognostic value in patients with CLTI.

Research Questions:
The relationship between cardiac death in patients with CLTI undergoing endovascular intervention (EVT) and malnutrition is unknown.

Methods:
This retrospective study investigated 200 consecutive patients with CLTI and we individually assessed WIfI clinical stage and nutritional status assessed using Geriatric Nutritional Risk Index (GNRI). We then compared cardiac death after EVT between a WIfI stage 1, 2 group and a stage 3, 4 group, and investigated association between baseline characteristics.

Results:
In 200 consecutive patients, 123 patients (62%) showed WIfI stage 1 or 2, and the remaining 77 patients (38%) had WIfI stage 3 or 4. Age was significantly higher in the WIfI stage 3, 4 group [median 75, interquartile range (IQR) 68-82] compared with the WIfI stage 1, 2 group (median 70, IQR 63-79, p=0.004). GNRI was significantly lower in the WIfI stage 3, 4 group than in the WIfI stage 1, 2 group (median 88, IQR 80-97 vs. median 103, IQR 94-111, p<0.001). Median duration of follow-up was 966 days (IQR, 540-1268 days). Incidences of all-cause and cardiac deaths were higher in the WIfI stage 3, 4 group than in the WIfI stage 1, 2 group (27% vs. 15%, p = 0.047 and 12% vs. 3%, p = 0.040, respectively). Kaplan-Meier analysis showed a significantly lower survival rate in the WIfI stage 3, 4 group than in the WIfI stage 1, 2 group (p=0.002 by log-rank test). Cox proportional hazard univariate analysis revealed that WIfI stage 3, 4 group [Hazard ratio (HR); 4.22, 95% confidence interval (CI): 1.29-13.72, p = 0.012], GNRI (HR;0.93, 95%CI:0.87-0.97, p=0.002), Hemodialysis (HR;4,67, 95%CI:1.28-16.96, p=0.010), Statin (HR;4,52, 95%CI:1.00-20.43, p=0.022), LVEF (HR;0.96, 95%CI:0.92-0.99, p=0.045) were correlated to cardiac death. Multivariate analysis models adjusted for relevant factors showed GNRI (HR;0.93, 95% CI:0.86-0.99, p=0.019) was significantly associated with cardiac death.

Conclusion:
GNRI may be a crucial independent predictor for cardiac death in patients with CLTI undergoing EVT.
Abstract 13067: Conduction System Pacing to Achieve Cardiac Resynchronization Therapy: Is There a Sex Difference in Response Rates?
Authors: Kocovic Nikola , Houtz Brady , Pavri Behzad B
Published: December 2023

Background:
It is well established that in patients with dyssynchronous heart failure related to left bundle branch block (LBBB) and reduced left ventricular ejection fraction (LVEF), females show higher response rates than males when cardiac resynchronization (CRT) is achieved by conventional biventricular (BiV) pacing. Whether this sex difference is also true when CRT is achieved via conduction system pacing is unknown.

Hypothesis:
There is no difference between women and men in response rates when CRT is achieved by conduction system pacing (CSP), either by His bundle pacing (HBP) or by left bundle area pacing (LBAP).

Methods:
Patients who underwent CSP with a baseline LVEF ≤40% and a QRS duration ≥140 milliseconds (ms) were retrospectively selected from a CSP database maintained at our institution. 52 patients were included: 17 females and 35 males. Baseline clinical, electrocardiographic, echocardiographic, and follow up data were gathered and analyzed. Electrocardiograms and echocardiograms closest to the dates of implant and at last known follow up were used. Super-response was defined as absolute EF improvement ≥15%.

Results:
At baseline, there were no statistically significant differences in clinical, electrocardiographic, and echocardiographic characteristics between females and males except for higher prevalence of coronary disease in men, and higher percentage use of guideline directed medical therapy in men (Table 1). At median follow up of 113 days, there were no differences in electrocardiographic or echocardiographic response, number of super-responders, and mortality between females and males (Table 1).

Conclusions:
Unlike conventional CRT where females show superior response rates, CRT with CSP seems to provide comparable benefits in females and males. If confirmed in larger data sets, this may represent an important advantage of CSP over conventional CRT.
Abstract 13105: Applying Proteomic CV and Kidney Prognosis Risk in T2D Patients to Identify High-Risk Patients
Authors: Hinterberg Michael , Simpson Missy , Paterson Clare , Chadwick Jessica , Kuzma Jessica , Williams Stephen A
Published: December 2023

Background:
The interdependence of cardiovascular and kidney health in T2D requires understanding the combination of disease risk. Proteomic surrogate models for cardiovascular risk and kidney prognosis have been developed and validated, but not in a combined manner in T2D patients.

Hypothesis:
Combining the results of independent proteomic risk models for 4-year cardiovascular risk and kidney prognosis will identify patients at highest risk for MACE, better than eGFR.

Methods:
Plasma from 1,220 participants with T2D from the Atherosclerosis Risk in Communities (ARIC) study visit 5 were assayed for >5,000 proteins using the SomaScan® assay; 34.2% had incident MACE (MI, stroke, HF hospitalization, or death). Predictions from a validated proteomic CV risk model were calculated, as well as a de novo kidney prognosis model developed and validated in the Chronic Renal Insufficiency Cohort and Fenland cohort. Patients were stratified by predefined CV risk bins and sub-stratified by 2x kidney prognosis risk, and compared to eGFR stratification. Log-odds of Kaplan-Meier (KM) event rates were compared between strata.

Results:
Proteomic kidney risk predictions did not sub-stratify patients at low/medium CV risk (p > 0.05), but did stratify high-risk CV patients, with highest CV and kidney risk patients (5.6% of patients; p < 0.05) having a KM-estimated 63.4% 4-year MACE rate, more than 8 times the low CV risk group. Conversely, stratification using a corresponding eGFR threshold did not significantly stratify high-risk CV patients. High CV risk MACE types were different depending on proteomic kidney risk sub-stratification (chi-square p < 0.015), and participants with increased kidney risk had more HF hospitalizations (39.7% of MACE).

Conclusions:
Among patients with T2D and elevated proteomic markers for CV risk, an independent proteomic risk model for kidney prognosis can be applied to identify a significantly larger proportion of patients at risk for MACE.
Abstract 13115: Association of Hospital Racial Composition and Anticoagulation for Atrial Fibrillation: A Nationwide Study
Authors: Essien Utibe R , Kim Nadejda , Hausmann Leslie , Washington Donna L , Mor Maria , Litam Terrence , Boyer Taylor , Gellad Walid , Fine Michael
Published: December 2023

Introduction:
Anticoagulation reduces stroke risk in atrial fibrillation (AF). Patient-level studies show significant Black-White disparities in any anticoagulant and direct oral anticoagulant (DOAC) prescribing. Little is known about whether such disparities exist at the hospital level, thus we examined the association of hospital racial composition and anticoagulant initiation.

Hypothesis:
Hospitals with higher rates of Black patients would have lower anticoagulation.

Methods:
We conducted a retrospective cohort study of patients with incident AF treated at a VA medical center (VAMC) from 2018-2021. Our independent variable was hospital racial composition, defined by the proportion of Black patients cared for at a VAMC, with Quartile 1 (Q1) being the lowest, and Quartile (Q4) being the highest. We used a multivariable logistic regression model, adjusting for clinical factors (e.g., stroke and bleeding risk), year of diagnosis, and region, to estimate the odds of any anticoagulant and/or DOAC initiation by hospital racial composition.

Results:
We identified 86,436 patients with incident AF at 140 VAMCs, 10.5% Black, 89.5% White, mean age 73 years. Patients in Q4 were younger with similar stroke and bleeding risk to those in Q1. Overall, any anticoagulant use was 73.4% in Q1 and 71.4% in Q4 and lower for Black vs. White patients in both quartiles (Q1: 68.9% vs. 73.5%; Q4: 69.1 vs. 72.0%). The odds of initiating any anticoagulant overall were lower in Q1 hospitals compared to Q4: adjusted odds ratio (aOR): 0.85; 95% CI 0.73-0.99; p=0.04. DOAC use was similar in Q1 and Q4 (67.6% vs. 67.2%) though lower for Black vs. White patients in both quartiles (Q1: 57.4% vs. 67.7%; Q4: 63.3 vs. 68.5%). There was no significant difference overall in the odds of initiating DOAC in Q1 hospitals compared to Q4, aOR: 0.96; 95% CI 0.83-1.12; p=0.61.

Conclusions:
In a national study of patients with AF in the VA, we observed a significant difference in any anticoagulant but not DOAC initiation by hospital racial composition. Racial differences in anticoagulant use existed across quartiles, as in prior work. These data suggest that racial disparities in anticoagulant use in the VA, a safety net health system, may require local rather than national-level solutions alone to eliminate them.
Abstract 13139: Preliminary Efficacy of a Cognitive Restorative Nature Intervention to Improve Attention, Self-Care, and Health-Related Quality of Life in Heart Failure
Authors: Jung Miyeon , Apostolova Liana , Moser Debra K , Gradus-Pizlo Irmina , Gao Sujuan , Wang Suzanne , Algashgari Elham , Smith Asa , Rogers Jeff , Ofner Susan , Pressler Susan J
Published: December 2023

Background:
Cognitive dysfunction is prevalent among patients with heart failure (HF) and decreases self-care behaviors and health-related quality of life (HRQL).

Goal:
The purpose was to test preliminary efficacy of a newly developed virtual reality-based cognitive restorative nature intervention (Nature-VR based on Attention Restoration Theory) on improving attention, HF self-care, and HRQL.

Methods:
In this 2-group randomized controlled trial, 73 patients with Stage C HF were enrolled. The Nature-VR intervention group (n=37) viewed 3-dimensional nature pictures delivered by a virtual reality headset for 10 minutes/day, 5 days/week for 4 weeks. The attention control group (n=36) viewed 3-dimensional urban pictures (Urban-VR) delivered by a virtual reality headset at the same frequency of Nature-VR. Outcomes were: attention measured by Oral Trail Making A and Digit Span Forward; HF self-care measured by Self-care of Heart Failure Index; and HRQL measured by Minnesota Living with Heart Failure Questionnaire. Outcomes were assessed at baseline, 4, 8, 26, and 52 weeks by telephone interviews due to COVID-19 pandemic. Linear mixed models with intention-to-treat analysis were used to test effects of group, time, and group-by-time interactions.

Results:
Of 73 patients, 41 were women. Self-reported race was 1 Asian, 12 African American, and 60 White. Mean age was 66 years. NYHA class was I/II=33, III=30, and 10 were missing. Sixty-eight patients (93%) completed the interventions; 56 (79% of 68) had ≥ 80% adherence; 51 (70%) completed the study. In mixed models, no significant group-by-time interactions were found in attention, HF self-care, and HRQL. HF self-care (maintenance, management, symptom perception, and confidence) significantly improved over time (p < .001) in both groups. There was significant improvement on symptom perception (p= .004, better in Nature-VR). HRQL showed significant group (p = .041, worse in Nature-VR) and time effects (p = .047, both groups improved).

Conclusions:
Although preliminary efficacy of Nature-VR compared with Urban-VR was not supported, HF self-care and HRQL improved over 52 weeks. Future testing is indicated of multimodal interventions that include Nature-VR to improve improving self-care and HRQL.
Abstract 13157: Multivariable ECG Machine Learning is Superior to QRS Duration and Traditional ECG Criteria for Detecting Left Ventricular Hypertrophy in Patients With Left Bundle Branch Block
Authors: DeBauge Ashley , Harvey Christopher , Fairbank Tyan , Ranka Sagar , Jiwani Sania , Sheldon Seth , Reddy Madhu , Noheria Amit
Published: December 2023

Introduction:
The utility of ECG to diagnose left ventricular hypertrophy (LVH) in patients with left bundle branch block (LBBB) is limited. We sought to compare the diagnostic yield of ECG using (i) QRS duration, (ii) published LVH criteria, and (iii) machine learning (ML) models to detect increased left ventricular mass indexed (LVMi) in the setting of LBBB.

Hypothesis:
ML is superior to QRS duration and LVH criteria to detect LVH among LBBB.

Methods:
12-lead ECGs were processed to reconstruct orthogonal X, Y, Z leads using Kors’s matrix and obtain root-mean-squared (3D) ECG. R wave, S wave and overall amplitudes, voltage-time-integrals (VTIs), and other ECG features were extracted from all ECG leads. ML algorithms [logistic regression (LR), support vector classifier (SVC), decision trees (DT), random forest (RF), gradient boosted machine (GBM) and boosted trees (BT)] were trained to predict increased LVMi (women >95 g/m
2
, men >115 g/m
2
) from ECG features on a training set of 2668 ECGs with typical LBBB and echocardiogram within 45 days before or after ECG. LVM was calculated using the ASE formula. We obtained ROC AUCs for prediction of increased LVMi by (i) QRS duration, (ii) published LVH criteria, and (iii) ML models in a separate validation set of adults with typical LBBB.

Results:
Among the validation set of 413 adults (53% women, age 73±12 yr) with LBBB, QRS duration alone had a higher AUC (women 0.657, men 0.703) for diagnosing increased LVMi compared to standard LVH criteria (Table). RF (women 0.688, men 0.738), GBM and DT models had better AUCs than QRS duration alone.

Conclusions:
In patients with LBBB, QRS duration ≥150 in women and ≥160 in men is a superior predictor of LVH than traditional voltage-based ECG criteria, but ML methods outperform all traditional ECG criteria and QRS duration.
Abstract 13161: Efficacy of Thoracic Endovascular Aortic Repair versus Best Medical Therapy in Treatment of Type B Aortic Dissection: A Meta-Analysis
Authors: R.Motawea Karam , S. Rozan Samah , H. Elhalag Rowan , M. Abdelwahab Abdelrhamam , Al Hennawi Hussam , Elshenawy Salem , Mohamed Mai , Chébl Pensée , Salem Madian Mohamed , Elsayed Elsayed Hewalla Mostafa , Swed Sarya , Klugherz Bruce
Published: December 2023

Background and aim:
Techniques in endovascular therapy have evolved offering a promising alternative to medical therapy alone in Type B aortic dissections (TBADs). The aim of this meta-analysis is to compare mortality and overall complications in thoracic endovascular aortic repair (TEVAR) with best medical therapy (BMT) in patients with TBADs.

Methods:
We included any randomized control trials, case controls, prospective or retrospective cohort and cross sectional studies that compared TEVAR versus BMT for the treatment of type B aortic dissection. Multiple electronic databases were searched to identify relevant articles including PubMed, Scopus, and Web of Science. Review Manager (RevMan) software, version 5.4 was used to perform the analysis.

Results:
A total of 1966 studies were screened with 32 studies included. Thirty-two cohort studies including 150836 patients (19512 TEVAR and 131324 BMT) were included. TEVAR was associated with a significantly lower 30-day mortality rate compared to BMT (RR= 0.79, CI= 0.63, 0.99, P = 0.04) notably in patients ≥ 65 years of age (RR=0.78, CI=0.64, 0.95, P=0.01). TEVAR group had a statistically significant prolonged length of hospital (MD= 3.42, CI= 1.69, 5.13, P = 0.0001), and ICU stay (MD= 3.18, CI= 1.48, 4.89, P = 0.0003) compared to BMT. BMT was associated with increased overall complications (RR= 1.50, CI= 1.20, 1.86, P = 0.0003) and stroke (RR= 1.52, CI= 1.29, 1.79, P < 0.00001). No statistically significant difference in late mortality (1, 3, and 5 year), intervention-related (acute renal failure, spinal cord ischemia, myocardial infarction, respiratory failure, and sepsis), was noted between both groups.

Conclusion:
In patients with TBAD, TEVAR was associated with a decreased risk of 30-day mortality rate and overall complications compared to BMT. More randomized control trials are needed to support our findings.