bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 10183: Structural Characteristics of Patients With Superior Vena Cava Foci Initiating Atrial Fibrillation: Analysis With Electrocardiogram-Triggered Computed Tomography
Authors: Oka Satoshi , Yamagata Kenichiro , Miyazaki Yuichiro , Wakamiya Akinori , Shimamoto Keiko , Ueda Nobuhiko , Nakajima Kenzaburo , Kamakura Tsukasa , Wada Mitsuru , ishibashi kohei , Inoue Yuko , Miyamoto Koji , Nagase Satoshi , Aiba Takeshi , Kusano Kengo
Published: June 2023

Introduction:
The superior vena cava is the most common source of non-pulmonary vein foci in atrial fibrillation.

Hypothesis:
Predicting the existence of non-pulmonary vein foci prior to the catheter ablation procedure is helpful because recent one-shot ablation technologies are designed to isolate only the pulmonary veins. We aimed to clarify the structural characteristics of patients with superior vena cava foci initiating atrial fibrillation.

Methods:
We enrolled 331 consecutive patients with atrial fibrillation who underwent computed tomography cardiac imaging before radiofrequency catheter ablation treatment. The patients were divided into superior vena cava (+) and (-) groups according to having superior vena cava foci or not. The characteristics of 27 patients per group, identified with propensity score matching, were compared.

Results:
The superior vena cava (+) group exhibited superior vena cava crescent signs, defined as a curve-shaped superior vena cava with two narrow pointed ends, more frequently (40.7% vs. 7.4%,
p
=0.004), and a right atrial volume larger than the superior vena cava (-) group (95.6 ± 20.8 vs. 83.5 ± 18.7 mL,
p
=0.030). Multivariate logistic regression analysis revealed that the superior vena cava crescent sign (odds ratio, 8.45; 95% confidence interval, 1.52-46.99) and right atrial volume ≥ 80 mL (odds ratio, 4.66; 95% confidence interval, 1.22-17.79) were independent predictors of superior vena cava foci.

Conclusions:
Patients with superior vena cava foci exhibited more frequent superior vena cava crescent signs and larger right atrial volumes. These characteristics may help clinicians choose the appropriate ablation technology.
Abstract 10186: Accuracy Study of Wearable Devices for Monitoring Blood Pressure in Acute Stroke Patients
Authors: Chang Hong , Li Peipei , Tian Siying , Zhang Xinyue , Zhao Jie
Published: June 2023

Objective:
The fluctuations of blood pressure in the acute stage of stroke are associated with neurological deterioration and poor prognosis. Although continuous monitoring of blood pressure changes becomes possible with the emergence of wearable blood pressure monitoring equipment, the accuracy of the equipment is still in doubt. Here, the accuracy of the optoelectronic-based wearable device for blood pressure monitoring in hospitalized patients with acute stroke were investigated and verified.

Methods:
Thirty-five acute stroke patients in the Department of Neurology of a teaching hospital were recruited. With the blood pressure values measured by bedside ECG monitor as the gold standard, wearables devices (wearable wrist watch) and bedside ECG monitors were monitored sequentially the same upper limb at the same time and recorded every 2 hours during the first 24 hours of admission. Receiver operating characteristic (ROC) curves were employed to determine the optimal cut off points and tests of sensitivity, specificity, kappa coefficients were conducted.

Results:
The average age of participants (male 17, female 18) was 61.91 ±8.72 years. 414 groups of blood pressure values were measured and ranged from 74/41 to 221/124 mmHg. The kappa value of systolic blood pressure (SBP) measured by wearable wrist watch and bedside ECG monitor was 0.768, with 89.1% sensitivity and 87.7% specificity (Table 1-A). And the kappa value of diastolic blood pressure (DBP) was 0.648, with 94.6% sensitivity and 67.9% specificity (Table 1-B). The area under ROC curve for SBP diagnosis and DBP diagnosis of wearable wrist watches were 0.941

(
p
< 0.001, Figure 1-A) and 0.939 (
p
< 0.001, Figure 1-B) respectively. There was no significant difference in SBP and DBP between these two methods (
p
>0.05, Table 3).

Conclusions:
The accuracy of wearable wrist watch for measuring patient blood pressure with acute stroke is good enough for ambulatory blood pressure monitoring of acute stroke patients.
Abstract 10190: Recurrent Pulmonary Hypertension After Balloon Pulmonary Angioplasty in Patients With Inoperable Thromboembolic Pulmonary Hypertension
Authors: Takano Ryo , Aoki Tatsuo , Asano Ryotaro , Ueda Jin , Tsuji Akihiro , Ogo Takeshi
Published: June 2023

Backgrounds:
Balloon pulmonary angioplasty (BPA) improves hemodynamics and prognosis in patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH). Though it has been reported that recurrent pulmonary hypertension (PH) after pulmonary endarterectomy is rare, the recurrence rate of PH after BPA remains to be clarified. In this study, we examined the frequency of recurrent PH after BPA in the long-term period and the risk factors.

Methods:
We retrospectively reviewed consecutive 200 CTEPH patients (65±12yrs., Male 43(22%)) who completed BPA procedures from July 2009 to December 2020 and had hemodynamic evaluation after the procedures and extracted the patients with recurrent PH who had a mean pulmonary arterial pressure (mPAP) <25 mm Hg after BPA and developed PH (mPAP ≥25 mm Hg) during follow-up and had a clinical deterioration requiring additional treatment. As risk factors for recurrent PH, we investigated the known risk factors for the development of CTEPH, and the types of oral anticoagulants (warfarin or direct oral anticoagulant).

Results:
The median follow-up period from final BPA session was 42 [24,62] months. BPA significantly improved mPAP (39±10 to 22±5mmHg, P<0.01) and cardiac output (CO) (3.6±1.1 to 4.1±1.1 L/min, P<0.01). Recurrent PH was observed in 13 of the 200 patients (6.5%) during the follow-up period and the estimated 5-year recurrence rate was 8.9%. The median period from final BPA to recurrence was 20 months [12,47 months], and 6 cases (46%) recurred PH within a year after BPA. In these patients, mPAP deteriorated from 21±2 to 29±5mmHg (P<0.01) but not CO (4.07±0.69 to 3.81±0.50L/min, P=0.46). Of the 13 recurrent PH patients, 9 required additional BPA, and 6 required additional medication. However, the 5-year survival in the recurrent PH and non-recurrent PH groups were comparable (100% and 96.1%, P=0.50). Any risk factors for recurrent PH were not detected. The recurrence rate of PH in those with direct oral anticoagulant (83 cases (42%)) was similar to that in those with warfarin (3.6% and 8.6%, P=0.16).

Conclusions:
Recurrent PH after BPA is rare and not associated with the known risk factors for CTEPH. The prognosis in the recurrent PH group with additional treatments is similar to that in the non-recurrent group.
Abstract 10194: Acute Pericarditis in Patients With Breast Cancer - A Statewide Study
Authors: Shindler Daniel M , Sargsyan Davit , Barbayannis Georgia , Cabrera Javier , Kostis John B , Kostis William J ,   For the Myocardial Infarction Data Acquisition System (MIDAS) Study Group.
Published: June 2023

Introduction:
Acute pericarditis has not been linked to long-term heart-specific morbidity in breast cancer patients. Carcinomatous pericardial involvement has been detected at autopsy in 10-20% of breast cancer patients. In clinical practice, when it comes to primarily echocardiographically-diagnosed pericardial diseases: pericardial effusion, cardiac tamponade, and pericardial constriction have all been reported in breast cancer patients. Acute pericarditis is primarily a clinical non-imaging bedside diagnosis derived from the combination of chest pain, pericardial rub, and typical electrocardiographic changes, irrespective of the presence or absence of pericardial fluid on imaging. It can be the initial clinical manifestation of a malignancy.

Methods:
The Myocardial Infarction Data Acquisition System (MIDAS) database is an ongoing, longitudinal, and validated database that comprises discharge data, along with demographics, comorbidities, and length of hospital stay; for all patients with cardiovascular diseases admitted to every non-federal acute care hospital in the state of New Jersey. We searched for the diagnosis of acute pericarditis (ICD-9 codes 420.0, 420.90, 420.91, and 420.99), in first hospital admissions of female patients with breast cancer (ICD-9 codes 174.0-174.9) between January 1995 to December 2015. Controls were female breast cancer patients without the diagnosis of acute pericarditis.

Results:
There were 60,435 female patients with breast cancer. Of those, 253 (0.4%) were also diagnosed with acute pericarditis on the same admission as the first breast cancer diagnosis, or later. Analysis for comorbidities showed that 116 (45.8%) of the 253 patients with acute pericarditis had admissions for heart failure, as opposed to 26.4% (15,895 out of 60,182) of breast cancer patients without acute pericarditis (p < 0.00001).

Conclusions:
Since New Jersey has a diverse population that resembles the profile of the United States in age, gender, and race/ethnicity; our findings could also be generalized to other geographic areas, and may help with future clinical guidelines. Although it is rare, acute pericarditis in breast cancer patients can indicate long-term cardiovascular morbidity.
Abstract 10198: Using Weakly Supervised Machine Learning to Label Atrial Fibrillation in Real-World Intensive Care Unit Telemetry Data
Authors: Rooney Sydney R , Kaufman Roman , Goswami Mononito , Pinsky Michael R , Miller J. Kyle , Al-Zaiti Salah , Dubrawski Artur , Clermont Gilles
Published: June 2023

Introduction:
Atrial fibrillation (AF) alerts from clinical monitoring systems are often inaccurate. Recently reported AF detectors utilize curated, publicly-available databases for model training. Real-world data rather than curated databases would be better suited to improve upon these inaccuracies, but labeling high-frequency waveform data over ICU stays would require significant clinician hours.

Hypothesis:
We hypothesize that AF can be accurately and efficiently labeled in stored, real-world telemetry data through clinician-made heuristics describing AF that inform a weakly supervised AF detection model.

Methods:
We examined high-frequency telemetry data from 72 beds in a tertiary care center using a commercial monitoring system. Previously described time- and frequency-domain heart rate variability features centered over 10-second segments were calculated. K-means clustering was applied over RR interval Poincaré plots (RR
n
vs RR
n+1
) to describe rhythmic patterns. Over 20 features and associated clinician-driven heuristics delineating AF from other rhythms informed a weakly supervised AF labeling algorithm. Performance was evaluated on ~100 independent, hand-labeled segments.

Results:
Over 10,000 10-second telemetry segments from 657 ICU patients were used to train our weakly supervised model. The model had an AUC of 0.91 and accuracy of 88%. Positive predictive value and sensitivity were 0.67 and 0.82 for AF segments and 0.95 and 0.89 for non-AF segments. Compared to our commercial monitoring system, our model demonstrated significant improvement in AF F1 score (0.73 vs 0.56) with the same F1 score for non-AF rhythms (0.92). The most influential features on AUC included a standard measure of heart rate variability (pNN20) and rhythm clustering pattern (sum of squared error).

Conclusions:
We demonstrated a time-saving means of labeling AF in a large, real-world telemetry database through weak supervision. Features describing heart rate variability and RR interval irregularity through clustering techniques led to intuitive, clinically sound rules for identifying AF. Our contribution permits the creation of much larger, more clinically relevant datasets with AF clearly labeled for improved study and care of this population.
Abstract 102: Pharmacological Selective Inhibition Of Astrocyte Metabolism Improves Neurological Recovery After Cardiac Arrest In Rabbits
Authors: Faucher Estelle , Fanny Lidouren , Abi Zeid Daou Yara , Ghaleh Bijan , Tissier Renaud , Kohlhauer Matthias
Published: June 2023

Introduction:
Astrocytes promote cerebral inflammation during neuronal focal ischemic injury and lactate consumption by neurons. However, the physiopathological role of astrocytes remains to be established during cardiac arrest.

Hypothesis:
We hypothesized that inhibition of astrocytes metabolism by the citric acid cycle inhibitor fluorocitrate (FC) could improve the neurological recovery after a cardiac arrest.

Methods:
Anesthetized male New-Zealand rabbits randomly received an intrathecal injection of saline (Control) or FC (10 nmol/kg, “FC”) just before 10 min of ventricular fibrillation. In a first set of experiment (n=6 per group), we determined after resuscitation the cerebral consumptions of lactate and glucose by measuring their arteriojugular differences and the cerebral extracellular concentrations of several metabolites using a microdialysis probe during 4 h after cardiac arrest. In a second set of experiments (n=7 per group), neurological dysfunction was evaluated 24 h after cardiac arrest. Neuronal death and astrogliosis were quantified histologically.

Results:
In the first set of experiment, cerebral lactate consumption was significantly decreased in FC vs Control after cardiac arrest (6.4±2.3 and 14.5±4.7mmol/L/min, respectively). Extracellular concentration of lactate, pyruvate, glucose, glycerol or glutamate were similarin the 2 groups. In the second set of experiment, neurological outcome was significantly improved in FC vs Control at 24 h after cardiac arrest (19±7 vs 55±9% of neurological dysfunction score, respectively).

Conclusions:
Specific inhibition of citric acid cycle of astrocytes by FC is neuroprotective after cardiac arrest in rabbits.
Abstract 10248: Incidence and Case-Fatality Rate of Stroke in Argentina: The EstEPA Population Study
Authors: Ameriso Sebastian F , Alet Matias J , Pujol Lereis Virginia A , Melcon Mario O
Published: June 2023

Introduction:
Stroke epidemiology varies among different populations. The burden of stroke is high in low- and middle-income countries. Reliable population data is needed to assess the impact of stroke and to develop policies aimed to improve stroke care in our region.
Objectives:
EstEPA is a population-based project assessing prevalence, incidence, mortality and burden of stroke in General Villegas, Buenos Aires, Argentina (pop=30,864 inhabitants). We determined incidence of stroke (first-ever and recurrent stroke) and stroke case-fatality rate from 2017 to 2020.

Methods:
First-ever strokes, recurrent strokes and transient ischemic attacks were ascertained and case-fatality rate was obtained. Diagnoses were based on standard AHA/WHO definitions. Study population included all persons residing in General Villegas in the three-year period. Hospitals, households, nursing homes, death certificates and several overlapping sources were surveyed.

Results:
We assessed 92,592 person-years. There were 155 cerebrovascular events, of which 115 were first-ever strokes (74%), 21 recurrent strokes (13·5%) and 19 transient ischemic attacks (12·5%). The annual crude incidence rate of first-ever strokes was 124·2 per 100,000 person-years, while it was 109·7 per 100,000 (95% CI 89·7-129·8), 72·4 per 100,000 (95% CI 47·8-97·0) and 86·9 per 100,000 (95% CI 58·5-115·2) when standardized by the Argentine population, Segi's World population and WHO World population, respectively. The crude incidence rate according to the different subtypes of stroke was 93·4 per 100,000 person-years for ischemic stroke, 18·4 per 100,000 person-years for hemorrhagic stroke and 10·8 per 100,000 person-years for subarachnoid hemorrhage. Incidence increased after age 70. Case fatality rate at 30 days of first-ever strokes was 19·4%.

Conclusions:
In this first population-based comprehensive stroke epidemiological study in Argentina, first-ever stroke incidence in an urban population was 124·2 per 100,000 person-years. This is lower than the incidence in other countries in the region. It is similar to reported incidence in Western developed countries. Stroke case-fatality rate was comparable to other population-based Latin-American studies and most developed countries.
Abstract 10249: Infective Endocarditis: A Diagnostic Challenge
Authors: Galani Jemi , Chami Hassan , Kraft Colleen
Published: June 2023

Case:
A healthy 30-year-old female with past medical history of eczema and no prior cardiac history presented with altered mental status, fever, neck stiffness and photophobia. Blood and CSF cultures grew methicillin susceptible
Staphylococcus aureus
, and the patient was started on nafcillin and linezolid. Bacteremia source was unclear, presumed to be minor skin breaks on her hands. MRI brain revealed multiple cerebral septic emboli, prompting concern for infective endocarditis. However, TTE and TEE were negative for vegetations, valve thickening, and valvular regurgitation. Blood cultures remained positive for MSSA despite dual antibiotic therapy and by hospital day 4, she began experiencing shortness of breath and new Janeway lesions were noted on exam. Repeat TTE and TEE were also negative for endocarditis. To further evaluate for an arterial source of seeding, CTA chest/abdomen was obtained which was unremarkable. Given persistence of bacteremia despite dual antibiotic therapy and unknown left-sided source, whole body PET CT scan was obtained which showed focal FDG uptake in the mitral annulus/valve region. Repeat TEE the following day showed a mitral valve ring abscess, a 1.2x0.4cm vegetation involving the P3 segment of the mitral valve, perforation at the mitral valve annulus, and new moderate mitral regurgitation. After a risk benefit discussion, the patient opted for conservative management with serial monitoring over surgical repair. She was treated with six weeks of nafcillin and four weeks of linezolid. Most recent TEE showed resolution of valvular abscess and vegetation with continued moderate mitral regurgitation.

Discussion:
We present a case of high grade MSSA endocarditis in a young, healthy patient without pre-existing valvular disease, causing mitral valve perforation. Infective endocarditis remains a challenging diagnosis, and this case highlights the diagnostic utility of FDG PET CT scan in such complex cases.
Abstract 10253: Integrating Mental Health Screening Into a Health System for Measurement-Based Care of Patients With Peripheral Artery Disease
Authors: Scierka Lindsey , Mena-Hurtado Carlos , Romain Gaelle , Provance Jeremy A , Bradley Brooklyn , Lynch Shannon , Bascombe Alexandria , Siddiqui Waleed Tariq , Rahman Mufti , Bogra Pragati , van Roij Evy , Nagpal Sameer , Lorusso Francine , Velazquez Eric J , Churchwell Keith B , Smolderen Kim G
Published: June 2023

Introduction:
Multi-dimensional assessments of patient reported outcomes (PROs) are becoming increasingly important in optimizing patient-centered care for chronic conditions such as peripheral artery disease (PAD). We aimed to demonstrate the feasibility of a health system integrated workflow to incorporate mental health screenings into the outpatient PAD clinic workflow.

Methods:
In a large academic center, we administered three validated psychological assessments to consecutive outpatients between March 3, 2021 and July 7, 2021. Assessments were administered as part of an in-person patient navigation system (Yale PRO-QI) and was supported by online data collection. Assessments included the Patient Health Questionnaire-8 (PHQ-8) for depression, the Generalized Anxiety Disorder-7 (GAD-7) for anxiety, and the Perceived Stress Scale-4 (PSS-4) for stress. Validated cutoffs were used to screen for depression and anxiety (
>
10 = depression or anxiety, respectively) and stress (>6 = high stress).

Results:
There were 104 assessments collected for 98 participants with a mean age of 68.6
+
12.0 years old, 38.8% female, 86.7% White, 9.1% Black and 2.0% Asian or American Indian. The majority (72.5%) were seen for a routine follow-up visit. Two participants (2.0%) screened positive for generalized anxiety disorder. For depression, 12.2% screened positive. Almost half of all participants (47.9%) had higher levels of stress compared with a normative population. There were no statistically significant associations between the risk of positive screening and visit type.

Conclusions:
Measurement-based care metrics are becoming a standard best practice in routine clinical operations. Psychosocial screening instruments can be integrated in PAD outpatient care and highlight opportunities to improve integrated behavioral care pathways to provide the best care for this vulnerable population.
Abstract 10261: Adverse Childhood Experiences Are Linked to High Blood Pressure During the First Trimester and Hypertensive Complications During Pregnancy
Authors: Helwig Nathaniel J , Shreffler Karina , Schwager Laura , Thomas Emily , Jenkins Nathaniel
Published: June 2023

Introduction:
Adverse Childhood Experiences (ACEs) are associated with impaired vascular function in young adult women, and increased blood pressure and CVD risk later in life.
Hypotheses:
We hypothesized that exposure to ACEs would be associated with an increased risk of first trimester hypertension and subsequently with hypertensive complications during pregnancy.

Methods:
Exposure to ACEs, self-reported incidence of first trimester hypertension (HT) and hypertensive complications in pregnancy (HTCs), as well as age, education, chronic health conditions, gravidity and BMI were obtained from women enrolled in a clinic-based longitudinal study of women ages 16-38 who were enrolled in their first prenatal visit. To avoid potential confounding of severe obesity, we restricted analyses to only those women with a BMI <40 kg/m
2
. Consequently, 135 pregnant women (age = 26 ± 6; BMI = 27 ± 6; gravidity = 2.7 ± 1.5) were included in this analysis; however, data from 20 women was missing for HTC incidence (n =115). The sample was diverse (49% Non-White) and had a high prevalence of ACEs (41% with ≥4 ACEs). Logistic regression models were used to examine the association of ACE exposure with the probability of HT and HTCs. Models included: (1) ACEs alone, and (2) ACEs following adjustment for age, BMI, gravidity, Race, and chronic health conditions.

Results:
Exposure to ACEs predicted HT (OR [95% CI] = 1.32 [1.10 - 1.59]) and HTC (1.26 [1.03 - 1.52]) incidence. Following full adjustment, the odds of HT increased 51% for each additional ACE (1.51 [1.03 - 2.22]). Following full adjustment, the odds of HTC increased 40% for each additional ACE (1.40 [1.06 - 1.83]). In each of the fully adjusted models, only chronic health conditions were also a significant predictor.

Conclusions:
ACE exposure is an important risk factor for HT and HTC, especially when considered alongside existing chronic health conditions. Screening for ACEs may be a worthwhile public health strategy to identify women at risk for hypertension and hypertensive complications in pregnancy. However, larger scale, longitudinal cohort studies are needed to confirm and to further understand these associations.
Abstract 10267: Decreasing Hospitalization Rate and Improvement in Mortality Following Acute Haemorrhagic Stroke From 2002-2017: An Australian Statewide Cohort Study of 35433 Patients
Authors: Hsu Arielle C , Vijayarajan Vijayatubini , Cheng Yeu-Yao , Shun Matthew Wei Shun , HYUN Karice , Chow Vincent , Brieger David , Kritharides Leonard , NG Chin Chwan
Published: June 2023

INTRODUCTION:
Haemorrhagic stroke (HS) is an important cardiovascular cause of mortality worldwide. In Australia, long term temporal trends in HS hospitalisation rates and predictors of mortality are unknown.

Methods:
All New South Wales residents with first-ever HS from 2002-2017 were identified from the Centre-for-Health-Record-Linkage statewide databases. Mortality tracked to 31 Dec 2018 via the death registry were adjusted for age, sex, admission year, referral source, surgical evacuation of HS status, and comorbidities in multivariable regression analyses.

Results:
There were 35433 patients (51% male) admitted for HS. Age-adjusted mean (±SD) admission rates were higher for males than females (63.6±6.2 vs 49.9±4.4 admissions-per-100,000-persons-per-annum respectively, p<0.001). Annual admission rates declined for both sexes from 2002-2017 (male: 74.4 to 52.5 vs female: 55.2 to 43.6 admissions-per-100,000-persons, both p<0.001 for linear trend). Admission rates were highest in patients ≥60yo but significantly declined from 2002-2017 in both sexes, while admission rates for <60yo patients remained static. Crude in-hospital and 1-year mortality post-HS were 22.5% and 38.2% respectively. Adjusted in-hospital and 1-year mortality post-HS were lower in 2017 compared to 2002 (adjusted odds ratio [aOR]=0.56, 95% confidence interval [CI]=0.49-0.65; adjusted hazard ratio [aHR]=0.73, 95%CI=0.66-0.80, respectively) (all p<0.001). Annual rates of surgical evacuation were static during study period (10.4% per year). Surgical evacuation was associated with better in-hospital and 1-year mortality (aOR=0.47, 95%CI=0.42-0.53; aHR=0.49, 95%CI=0.45-0.53, both p<0.001 respectively). Increasing age and higher Charlson comorbidity index independently predicted greater in-hospital and 1-year mortality. Male sex was associated with lower in-hospital mortality (aOR=0.88, 95%CI=0.83-0.93, p<0.001) but not at 1-year.

Conclusion:
Age-adjusted admission rates for HS fell between 2002-2017 for both sexes, driven mostly by ≥60 age groups, with adjusted in-hospital and 1-year mortality improving by 43% and 27% respectively. Strategies to improve survival including greater access to surgical evacuation should be further explored.
Abstract 10273: Proteomic Analysis of Chronic Kidney Disease (CKD) in Heart Failure With Preserved Ejection Fraction (HFpEF)
Authors: Jehangir Qasim , Qian Chenao , Cohen Jordana B , Salman Oday , Zamani Payman , Ebert Christina , Greenawalt Danielle , Dongre Ashok , Zhao Lei , Chang Ching-Pin , Gordon David A , Ramirez-Valle Francisco , Cappola Thomas P , Chirinos Julio A
Published: June 2023

Introduction:
CKD is highly prevalent in HFpEF and is associated with increased morbidity and mortality. The biologic correlates of CKD in HFpEF are not well understood. We conducted a plasma proteomics analysis to assess biologic pathways associated with CKD in HFpEF.

Methods:
We utilized biosamples from TOPCAT for
de novo
measurements of 4776 plasma proteins using the SomaScan (version 4) proteomic assay, among 218 participants enrolled in the Americas. Linear regression and pathway analyses were used to study the relationship of proteins and pathways to the estimated glomerular filtration rate (eGFR). All regression estimates are standardized (per unit increase in z score) to facilitate comparisons.

Results:
After correction for multiple comparisons, we identified 73 proteins associated with eGFR. The strongest positively associated proteins were contactin-4, contactin-1, laminin-2, tenascin-X, and neuropilin-2. Proteins with the strongest negative association were transmembrane emp24 domain-containing protein 10, desmocollin-2, beta-2-microglobulin, neutrophil gelatinase-associated lipocalin, and cystatin C (
Figure 1
). Biologic pathways associated with eGFR included complement system, acute phase response signaling, apoptosis, lysosomal expression and regulation, inflammation, fibrosis, chondroitin and dermatan sulfate degradation, notch signaling, and gluconeogenesis (
Figure 2
).

Conclusions:
Using a broad proteomics approach, we identified novel biomarkers and pathways associated with renal dysfunction in HFpEF. Further research is required to assess whether targeting these pathways can ameliorate renal dysfunction in HFpEF patients.
Abstract 10294: Center Level Factors Associated With Improved Length of Stay Following Stage 1 Palliation: An Analysis of the NPC-QIC Registry
Authors: Foote Henry , Thibault Dylan , Dominguez Gonzalez Carla , Hill Garick D , Minich Luann , McCrary Andrew , Hill Kevin D
Published: June 2023

Introduction:
Stage 1 single ventricle palliation has the longest associated length of stay (LOS) of STS benchmark operations. Patient level factors that contribute to prolonged hospitalization have been identified, but center level factors have not been explored. We aim to identify center level factors that drive post-Stage 1 palliation LOS.

Methods:
We analyzed data prospectively collected by the National Pediatric Cardiology Quality Improvement Collaborative Phase II registry. We included all infants who underwent stage 1 followed by either stage 2 or death. We excluded centers with fewer than 10 cases and centers or patients with missing key variables. Our primary outcome was center level LOS. We grouped centers into quartiles based on median LOS for all patients at each center and compared patient and center level characteristics between highest and lowest performing quartiles using univariable analyses.

Results:
Of 2510 infants (65 sites), 1831 (30 sites) met study criteria (61% male, 61% white, 17% premature, 73% with hypoplastic left heart as primary cardiac diagnosis). There was wide inter-center variation in LOS (1st quartile centers: median 28 days [IQR 19, 47]; 4th quartile: 62 days [35, 96], p<0.001). Shorter LOS correlated with more outside hospital days alive prior to stage 2, after accounting for readmissions (correlation coefficient -0.49, p<0.001). Compared to 7 low performing centers, 8 high performing centers were more likely to perform the Norwood with an RV-PA conduit (64% v 48%, p<0.001), extubate patients earlier (10 days [7, 15] v 14 days [11, 25], p<0.001), start enteral feeds sooner (9 days [7, 13] v 13 days [10, 22], p<0.001), and were more likely to discharge patients on nasogastric feeds (57% v 19%, p<0.001) vs G-tube feeds (7% v 41%, p<0.001) (Table 1).

Conclusions:
There was significant inter-center variation in post-Stage 1 LOS. Modifiable center-level practices may be targets to standardize practice and reduce overall LOS across centers.
Abstract 10345: Comparison of Clinical Characteristics, Positive Airway Pressure Usage, and Healthcare Resource Utilization in Obstructive Sleep Apnea Patients With Heart Failure With Preserved vs Reduced Ejection Fraction
Authors: Sert Kuniyoshi Fatima H , Malhotra Atul , Cole Kate V , Malik Anita , Pépin Jean-Louis , Cistulli Peter A , Benjafield Adam V , Somers Virend K ,   on behalf of the medXcloud group
Published: June 2023

Introduction:
The prevalence of obstructive sleep apnea (OSA) in heart failure (HF) patients varies from 30 to 50%. The differences in clinical characteristics, healthcare resource utilization (HCRU), and positive airway pressure (PAP) usage between HF with preserved ejection fraction (HFpEF) vs. HF with reduced ejection fraction (HFrEF) in OSA patients are not well known.

Objective:
To compare clinical characteristics, PAP usage, and HCRU in OSA patients with HFpEF vs HFrEF.

Methods:
Retrospective cohort study using US administrative claims data linked to objective PAP usage data over one year. HFpEF and HFrEF were identified by ICD-9/10 codes associated with healthcare encounters 1 year before starting PAP therapy. Pearson’s Chi-squared and Wilcoxon rank-sum tests were used as applicable to compare baseline characteristics and PAP usage, and the pre to post-PAP initiation difference in the number of health care encounters.

Results:
In total, 7,419 patients with HF and OSA were identified, of which 57% had HFpEF. HFpEF patients were majority female (54%) and older than those with HFrEF (64.1 ± 11.52 vs 59.7 ± 11.24 years, p<0.001). HFpEF had a higher overall comorbidity burden, although coronary artery disease, atrial fibrillation, and other arrhythmias were more prevalent in HFrEF. Both prior to and after PAP therapy, HCRU was higher in HFpEF patients compared to HFrEF (Table 2a). There were no differences in PAP usage between HFpEF and HFrEF (3.6 ± 2.9 vs 3.7 ± 3.0 hrs/night, p=0.070) over the first year of PAP therapy. There was a significant reduction in ER visits and all cause hospitalizations after 1 year of PAP therapy initiation, which was similar between groups (Table 2b).

Conclusions:
Although there were differences in clinical characteristics between HFpEF and HFrEF patients with OSA, and HFpEF is associated with greater HCRU, PAP therapy usage was similar, and both groups experienced a similar reduction in HCRU after the first year of PAP initiation.
Abstract 10366: Ep3 Receptor Contributes to Renal Ischemia and Inflammation During Development of Renal Pathologies and Hypertension in Pgis Deficient Mice
Authors: Xu Yineng , Ge Jiahui , Guo Tingting , Guo Jinwei , Lin Rui , Tan Xiangzhai , Yu Gang , Chen Xijian , Leng Jing , Zeng Ruhui , He Dong , Xie Kaiqi , Liu Bin , zhou yingbi
Published: June 2023

Introduction:
Abnormalities in prostacyclin synthase (PGIS) cause hypertension and/or renal pathologies in humans and mice due to increased thromboxane A2 (TxA
2
) produced by platelets and/or kidneys. However, the kidney, which is the key organ in blood pressure regulation, mainly produces prostaglandin E2 (PGE
2
), which could evoke renal vasoconstriction via activating the E prostanoid receptor-3 (EP3) and the Tx prostanoid receptor (TP; the receptor of TxA
2
). We hypothesized that increased PGE
2
in the kidney contributes to hypertension and renal pathologies in the above-mentioned disorders via activating the EP3 receptor.

Methods:
To unravel the effect of PGE
2
, we first generated mice deficient for both PGIS and EP3 (

Pgis
-/-
Ep3
-/-

) or both PGIS and cyclooxygenase-1 (

Pgis
-/-
Cox-1
-/-

). To further exclude the effect of TxA
2
produced by the platelet COX-1, chimeric mice with

Cox-1
-/-

in hematopoietic cells were created by bone marrow transplantations of

Pgis
-/-

and

Cox-1
-/-

mice.

Results:
Significant increases in blood pressure and heart-to-body-weight ratio were observed in

Pgis
-/-

mice compared with WT mice, which were secondary to renal inflammation and fibrosis. In contrast,

Pgis
-/-
Ep3
-/-

had less renal damage resulting in fewer cardiovascular disorders. Furthermore, compared with WT kidneys,

Pgis
-/-

kidneys showed increased levels of PGE
2
without PGI
2
and TxA
2
production as measured with high performance liquid chromatography-mass spectrometry. EP3 deficiency drastically diminished the decrease in renal blood flow evoked by ACh in

Pgis
-/-

perfused kidneys. Interestingly,

Pgis
-/-
Cox-1
-/-

mice, but not

Pgis
-/-

mice engrafted with bone marrow cells from

Cox-1
-/-

mice, displayed a much smaller extent of renal fibrosis than

Pgis
-/-

mice.

Conclusions:
Increased levels of PGE
2
in the kidney contribute to hypertension and renal pathologies in PGIS abnormalities via activating the EP3 receptor. Our findings suggest a novel mechanism for intrarenal PGE
2
regulation of blood pressure and renal hemodynamics.
Abstract 10399: Population-Level Implications of Empagliflozin for Heart Failure With Preserved Ejection Fraction in the United States
Authors: Talha Khawaja Muhammad , Butler Javed , Greene Stephen J , Aggarwal Rahul , Anker Stefan D , Vaduganathan Muthiah , Fonarow Gregg C
Published: June 2023

Introduction:
The indication for empagliflozin has been expanded to patients with heart failure (HF) and left ventricular ejection fraction (LVEF) >40% after findings of significant reduction in HF hospitalizations (HFH) and cardiovascular mortality (CVM) in the EMPEROR-Preserved (Empagliflozin Outcome Trial in Patients With Chronic Heart Failure With Preserved Ejection Fraction) trial.

Objective:
To quantify the estimated United States population-level impact of reducing worsening HF events with empagliflozin in LVEF >40%.

Methods:
A projected adult HF population (age >18) eligible for empagliflozin, obtained using weighted data from the National Health and Nutritional Examination Survey (2015-2018) was mapped onto newly eligible LVEF distributions, >40% overall and those >40% to 65% from the Get With The Guidelines Heart Failure registry. Number needed to treat (NNT) at 3 years for worsening HF events (urgent HF visits, total HFH and CVM) and total HFH, were calculated using rate difference from the EMPEROR program to estimate population-level treatment effects.

Results:
A projected 4,794,524 adults with HF are eligible for empagliflozin therapy. The population was predominantly male (57%) and white (67%), with a mean age of 66 years. Of this total population, 2,619,248 would be estimated as newly eligible with LVEF >40% and 2,310,960 with LVEF >40% to 65%. A projected 923,426 (95% CI, 769,893 – 1,076,959) worsening HF events would be prevented across the LVEF spectrum with empagliflozin over 3 years, out of which 301,738 (95%CI: 251,570, 351,906) and 295,341 (95%CI: 246,236 – 344,446) would be prevented in LVEF >40% and LVEF >40% to 65% subgroups, respectively. Moreover, an estimated 614,179 (95% CI, 512,063 – 716295) total HFH events would be prevented across the LVEF spectrum, out of which 201,159 (95%CI: 167,713 – 234,604) and 218,386 (95%CI: 182,076 – 254,696) total HFH events would be prevented in LVEF >40% and LVEF >40% to 65% subgroups, respectively.

Conclusions:
In addition to the proven benefit in HF with LVEF ≤40%, optimal implementation of empagliflozin in the US for treatment of HF with LVEF >40% has the potential to prevent/postpone an additional 300,000 worsening HF events over 3 years.
Abstract 10416: Influenza Vaccine Among Patients With Coronary Artery Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Studies
Authors: Hamed Mohamed , ABDELSALAM MAHMOUD , Abowali Hesham , Al-Azizi Karim , Rao Mohan , Jneid Hani , Khalife Wissam , Elbadawi Ayman
Published: June 2023

Introduction:
Trials evaluating the efficacy of influenza vaccine in secondary prevention among patients with prior coronary artery disease (CAD) have yielded mixed results. We sought to evaluate the efficacy of influenza vaccine in reducing cardiovascular events among patients with prior CAD.

Methods:
MEDLINE, EMBASE, and Cochrane databases were searched without restrictions through March 2022 for Randomized Controlled Trials (RCTs) that evaluated the outcomes of influenza vaccine versus control in patients with prior CAD. We conducted a pairwise meta-analysis comparing outcomes among the influenza vaccine. The primary outcome was all-cause mortality.

Results:
The final analysis included 5 trials with a total of 4,187 patients and the weighted median follow-up duration was 12 months. The influenza vaccine group was associated with 46% relative risk [RR] reduction in all-cause mortality compared with control group. (2.8% vs. 5.1%; RR 0.56; 95% confidence interval [CI] 0.41-0.76; I
2
=0%). The influenza vaccine group was also associated with lower composite of MACE (6.3% vs. 9.9%; RR 0.63; 95% CI 0.52-0.78), and cardiovascular mortality (2.5% vs. 4.7%; RR 0.54; 95% CI 0.39-0.74). There was no significant difference among both groups in acute myocardial infarction (MI) (RR 0.77; 95% CI 0.53-1.13), ischemia—driven revascularization (RR 0.89; 95% CI 0.52-1.53) and hospitalization for heart failure (RR 0.91; 95% CI 0.91 0.21-4.00).

Conclusion:
a meta-analysis of RCTs showed that influenza vaccine was associated with lower major adverse cardiac events (MACE), all-cause mortality, and cardiovascular mortality in patients with prior CAD. Further efforts are warranted to improve influenza vaccination rate in patients with CAD.
Abstract 10426: An Interesting Presentation of Angina Due to Left Posterolateral to Right Posterolateral Coronary Artery Fistula
Authors: Nadipalli Vivek , Mahmood Ahmed , Lodhi Muhammad Uzair , Hussain Bilal , Khan Sohail , cuevas christel , Alexander Thomas
Published: June 2023

Background:
Arterial-to-arterial fistula between right posterolateral and left posterolateral coronary arteries is rare and available literature on it is scarce.

Case Presentation:
A 60-year-old male with type 2 diabetes mellitus and dyslipidemia presented with shortness of breath and chest tightness. Given his symptoms and poor functional status, myocardial perfusion imaging with regadenoson was performed. The myocardial perfusion imaging study was abnormal with evidence of ischemia in the inferoseptal myocardium. The patient proceeded to the cardiac catheterization lab for selective right and left coronary angiography. Contrast injection revealed non-obstructive coronaries; however, an arterial-to-arterial fistula between the right posterolateral (RPL) branch and left posterolateral (LPL) branch was present (Figure 1A and 1B). Further characterization of the fistula showed the presence of left-to-right and right-to-left filling, indicating a LPL to RPL coronary artery fistula (CAF). The patient was managed conservatively with aspirin, statin, and anti-anginal therapy.

Conclusion:
There remains a need for diagnostic and therapeutic guidelines to address CAF. Conservative treatment is an option for small CAFs and serves as a potential alternative to catheter-based and surgical closure.
Abstract 10430: Radial First! Ulnar Next? Forearm Arterial Anatomy Study
Authors: Gopalakrishnan Prabhakaran , Campbell Blake , Prabhakaran Shakthi , Shah Tahir , Aung Su Sandi , Htay Yan Naung
Published: June 2023

Introduction:
In patients with small Right Radial Artery (
RRA
), access site failure may result in a radial to femoral crossover.

Methods:
The arterial anatomy of the distal forearm was studied using ultrasound in 167 hospitalized patients. The radial and ulnar artery dimensions were imaged in triplicates. The average cross-sectional area (CSA) and average diameter (AD) were measured using open-source ImageJ software. Variations in distal forearm arterial anatomy (branches) were documented.

Results:
The mean CSA and AD for the largest of the bilateral radial and ulnar arteries - Largest Forearm Artery (
LFA
), were 5.4 ± 2.5 mm
2
(1.1 → 13.3 mm
2
) and 2.6 ± 0.6 mm (1.2 → 4.1 mm) respectively. The mean CSA and AD for RRA were 4.8 ± 2.5 mm
2
(0.7 → 13.3 mm
2
) and 2.4 ± 0.6 mm (0.9 → 4.1 mm). In 46% of patients, RRA was not the LFA. The ulnar artery was larger than the radial artery in 25% of patients in the right wrist and 29% in the left wrist. The left radial was larger than the right radial in 31% and the left ulnar was larger than the right ulnar in 42%. In 58% of patients, RRA was < 2.5 mm (outer diameter of common radial access sheaths). In 24% of patients, RRA was <2 mm. In patients with RRA < 2.5 mm, 17% had another artery >2.5 mm and 6% had another artery > 3 mm. Men had 53% larger CSA compared to women. Smoking, intravenous drug use, diabetes, hyperlipidemia, peripheral vascular disease, chronic kidney disease (CKD), and hemodialysis predicted smaller-sized forearm arteries. CKD patients had 33% smaller CSA compared to patients without CKD. In 23 patients (14%), one or more of the forearm arteries had branches in the distal forearm. In 12 patients (7%), branches were seen in RRA.

Conclusions:
Right Radial Artery was not the largest forearm artery in almost half the patients. Right Radial Artery was smaller in size than common radial access sheaths in more than half of the patients. Of these patients, 17% had a different forearm artery > 2.5 mm that could be accessed instead of Femoral Artery. Female sex and CKD predicted smaller forearm artery sizes increasing the risk of radial access failure. Ultrasound use is advisable to identify the best forearm artery for access and avoid accessing smaller accessory branches that were seen in 7% of right radial and 14% of one or more forearm arteries.
Abstract 10437: Venoarterial Extracorporeal Membrane Oxygenation Rescue Therapy in Vasoplegic Shock Due to Calcium Channel Blocker Overdose: 5 Year Single Center Experience
Authors: Elkhapery Ahmed , Boppana Hemanth Krishna , Vallabhajosyula Saarwaani , Hashem Anas , Malik Hanan , Hall Cameron
Published: June 2023

Introduction:
Over 15,000 incidences of Calcium Channel Blocker (CCB) overdose were reported by the American Association of Position Control Centers (AAPCC) in 2020, resulting in 45 deaths from pure CCB overdose and 176 deaths from multidrug overdose involving CCBs. We present a single-center experience on the use of VA ECMO in the management of refractory hypotension due to CCB toxicity.

Hypothesis:
VA ECMO is effective and can be life-saving in vasoplegic shock from drug overdose

Methods:
We retrospectively reviewed our ECMO registry in the last 5 years to identify patients who were started on ECMO support for refractory hypotension due to drug overdose.

Results:
We found 5 patients who were started on VA-ECMO for drug overdose, all involving CCBs. Mean age was 60. They had persistent lactic acidosis and hypotension after fluid resuscitation, requiring escalating doses of vasopressors until they were on or near the maximum. All patients were started on hyperinsulinemia euglycemic protocol and 3 patients received methylene blue. The mean time to intubation was 11.2 ± 4.14 hours. An echocardiogram demonstrated intact systolic function in all patients. VA-ECMO was started within 11.2 ± 4.5 hours of admission. Pressor requirements quickly improved on ECMO support. Average time on ECMO was 69 ± 48.6 hours. 4 of 5 patients improved quickly and were extubated within 10 days (mean: 4.88 ± 2.95). In these 4 patients, the length of ICU stay was 8.5 ± 3.87 days, and hospital stay was 11.75 ± 2.06 days. One patient had a protracted course due to renal failure, pneumonia, and concern for North-South Syndrome. Cannulation was switched to subclavian/axillary approach, but that was complicated by left arm ischemia and switch to VV-ECMO after 44 hours of VA-ECMO. She was discharged after a 46-day hospital stay.

Conclusions:
VA-ECMO support is effective and lifesaving in patients with refractory shock from CCB toxicity. Early referral to ECMO capable center should be considered in these patients.
Abstract 10445: Detection of Viability and Clinical Implications Using Pet/Mri in Patients With Acute Myocardial Infarction
Authors: Park SaeHyun , Son Byung-ju , Kim Hong-ju , Choi Kang-Un , Nam Jong-Ho , Lee Chan Hee , Son Jang-Won , Kim Ung , Park Jong-Seon , Shin Dong Gu
Published: June 2023

Background:
The purpose of this study is to evaluate the role of viability on PET-MRI to predict improvement of echocardiographic findings such as regional wall motion index and left ventricular ejection fraction after successful percutaneous coronary intervention (PCI) for patients with acute myocardial infarction (AMI).

Method:
A total of 154 patients with AMI who was performed cardiac PET/MRI within 7 days after PCI were enrolled were enrolled. We performed TTE twice before and after in We performed TTE twice before and after PCI in 103 patients. We categorized these patients according to presence of viability on PET-MRI: group A (N=53, patients with viability on PET-MRI) and group B (N=50, patients without viability on PET-MRI) and compared. The primary end point is improvement of regional wall motion abnormality (RWMA) on TTE.

Results:
Clinical and angiographic findings were similar between the two groups during follow-up of 11months. Among 53 patients in group A, 30 patients (56.6%) showed the result of slight improvement of RWMA on TTE and among them 13 patients (24.5%) showed result of disappeared RWMA on TTE. In contrast, among 50 patients in group B, 22 patients (44%) showed the result of slight improvement and among them, only 4 patients (8%) showed result of disappeared RWMA on TTE. The proportion of patients who showed slight improvement of RWMA between two groups are not statistically significant (p=0.201). But, the proportion of patients who showed disappeared RWMA between two groups are statistically significant (p=0.024).

Conclusions:
PET/MRI is useful tool to detect viability in patients with AMI. It seems to be predictable to improve cardiac function for the patients with viability on PET-MRI.