bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 14023: Myocardial Perfusion Abnormalities: A Potential Biomarker for Ventricular Arrhythmias in Hypertrophic Cardiomyopathy Young Patients?
Authors: Chevalier Philippe , Deliniere Antoine , MILLAT Gilles , Asatryan Babken , Janin Alexandre , BESSIERE Francis , Boiteux Clement , Haddad Christelle
Published: June 2023

Introduction:
Despite progress in the field, risk stratification for sudden death in patients with hypertrophic cardiomyopathy (HCM) remains challenging. Although ventricular arrhythmias (VA) account for most of these events, the mechanisms responsible for cardiac arrest in HCM are not understood.

Hypothesis:
Abnormalities in myocardial perfusion may create an arrhythmogenic substrate in HCM patients.

Methods/ Results:
A 12-year-old boy was admitted to our department after an out-of-hospital cardiac arrest, with documented ventricular fibrillation while running. A non-obstructive asymmetric HCM was diagnosed with echocardiography (max LV wall thickness 32 mm). He had one conventional risk factor for SCD. Genetic testing revealed a heterozygous state for a MYH7 variation: p.Glu500Ala (NM_000257.3:c.1499A>C). This variation was classified as “probably pathogenic” (class 4 according to ACMG). His father and his 15-year-old brother were heterozygous for the same variant and were asymptomatic. The brother displayed a similar HCM phenotype. The patient received an implantable defibrillator and suffered from appropriate exercise-related shocks within 6-months despite sotalol therapy (160 mg bid). Because the VA occurred always when the patient was engaged in vigorous physical activity despite beta blocker and since he could not refrain from physical activity, thallium-201 myocardial scintigraphy was performed. To further understand the arrhythmogenic phenotype, his brother underwent the same investigation. Significant uptake perfusion defects in both initial and delayed images were evident in the proband (15%) but not in the asymptomatic brother. Treatment with antianginal drug (amlodipine 5 mg/day) was initiated. With 10 mg/day amlodipine was associated with a significant improvement of the scintigraphy (6% versus 15% perfusion defect). At a follow-up of 12 months, there was no recurrence of VA.

Conclusions:
Regarding HCM patients, the present report 1) strengthens the hypothesis that myocardial perfusion defects may identify patients at risk for VA, 2) suggests that tailored anti-ischemic prescription may be useful, and 3) underscores the need of prospective studies quantifying ischemia in HCM patients with exercise-induced VF.
Abstract 14027: Use of Anticoagulation or Antiplatelets in Patients With Cardiac Arrest Without ST-Segment-Elevation or Percutaneous Coronary Intervention
Authors: Maqsood Muhammad H , Ashish Kumar , Zhao David X , Rab Syed T , Vallabhajosyula Saraschandra
Published: June 2023

Introduction:
There are limited data on the use of anticoagulation (AC) and anti-platelet (AP) agents in addition to aspirin compared to standard of care (aspirin alone) in cardiac arrest (CA) patients without ST-segment-elevation and not undergoing a percutaneous coronary intervention.

Hypothesis:
We hypothesized that use of AC/AP agents in CA is associated with lower mortality compared to aspirin alone.

Methods:
A comprehensive literature search was performed from inception to 09/30/2021 of the PubMed/EMBASE databases. Studies of adult patients comparing AC/AP to aspirin alone were evaluated for short-term mortality (30-days survival/survival to hospital discharge), significant bleeding, and return of spontaneous circulation (ROSC). Odds ratio (OR) with 95% confidence intervals (CI) were calculated using DerSimonian-Laird method.

Results:
Of a total 5337 studies, five studies (2 randomized trials and 3 observational studies) with 3,696 subjects (1,196 intervention and 2,500 placebo arm) were included. Overall, there was no evidence of publication bias using either funnel plot or eggers test. For RCT studies, mean age was 60.8 years (males 79.2%), while for observational study mean age was between 58 to 62.3 years (males 58-62.3%). Use of AP/AC was associated with higher rates of major bleeding (odds ratio [OR] = 2.43 [95% confidence interval {CI} 1.35- 4.37]; p=0.003; I2=7%; 4 studies) compared with aspirin alone. There was no significant difference in ROSC (OR= 1.24 [95% CI 0.68-2.26]; p=0.49; I2=57%; 3 studies) and short-term mortality [OR= 1.24 [95% CI 0.87-1.76]; p=0.24; I2=69%; 3 studies) between intervention and placebo arm.

Conclusions:
In this meta-analysis, use of concomitant AC/AP therapy with aspirin in CA without ST-segment-elevation or percutaneous coronary intervention was associated with higher rates of bleeding without improvement in short-term mortality or ROSC.
Abstract 14030: Characterization of Lipid Profiles, Lipid Management Medications, Medical Resources Utilization and Health Care Outcomes in Medicare Age Patients With COPD in an Academic Center
Authors: Bhattarai Mukul , Deshpande Radhika , Patel Raj , Regmi Manjari R , Kulkarni Abhishek , Graves Mark
Published: June 2023

Introduction:
Recent studies have shown dysregulation in lipid metabolism may contribute to various lung diseases including COPD. The lipid profile in patients with COPD is incompletely understood which may affect the clinical outcomes.

Objective:
To perform elaborative investigation on lipid profile in COPD patients and clinical outcomes

Methods:
A retrospective database reviews from single academic medical center

Results:
The study population included 1360 patients, over the age of 65 with a diagnosis of COPD in a 2-year period. The presence of coronary artery disease, cerebrovascular disease, and peripheral artery disease was measured. The variables measured include lipid profile, lipid medications, number of hospitalizations, number of clinic and emergency room visits (Table 1). 38% of COPD patients have cardiovascular disease (CVD) compared to the prevalence of vascular disease in the population as a whole (27%). The average triglyceride (TG) in the patients with COPD was greater than TG in patients without COPD (150 vs. 135, p=.03). 38% of COPD patients with CVD have a TG > 150. 19% of COPD patients with coexisting vascular disease had an LDL >100. Anti-lipid medications in COPD patients were sub-optimally utilized.

Conclusions:
COPD patients had poorly controlled lipid profile including elevated TG and LDL levels. These patients are at high risk for adverse events that include CVD, frequent ER visits and hospital readmission. The anti-lipid medications were underutilized. It is highly recommended to identify barriers to optimum care and seek resources and strategy to mitigate difficulties in lipid management in patients with COPD to prevent adverse outcomes.
Abstract 14033: Assessment of Psychology Services Partnered With Clinical Care to Improve Cardiovascular Risk Factor Control
Authors: Toole Joseph , Freedman David , Vartak Natasha , Vrany Elizabeth , Goschin Simona , Kogan Jerome , Gianos Eugenia
Published: June 2023

Introduction:
Psychological distress greatly impacts cardiovascular disease, and targeted efforts to improve access to psychological services in cardiology care may aid in the reducing of cardiovascular risk factors. The objective of this preliminary study was to assess the impact and characterize the need for and use of short-term psychotherapy in cardiology by partnering a supervised postdoctoral psychology fellow with our cardiovascular prevention and women’s heart programs.

Methods:
A retrospective chart review was performed from January 2019 to June 2022. Participants included 36 patients engaged in preventive cardiology who attended at least one therapy session (mean age=57.6 years; 72% female; 19.4% Black, 8.3% Hispanic, 47.2% White, 24.9% other ethnicity). If available, hemoglobin A1C, LDL, weight, BMI, and blood pressure were recorded within six months pre- and post-therapy.

Results:
Mental health diagnoses included MDD (22.2%), GAD (47.2%) and adjustment disorder (25%). Comorbidities included HLD (69.4%), HTN (66.6%), CAD (41.6%) and DM (16.6%). 17 patients were former smokers, and one was a current smoker. More than half (52.8%) attended ≥6 psychotherapy sessions, 38.9% attended ≥6 preventive cardiology visits and 2.7% attended a nutritionist visit in the same time frame. In patients with HTN with both pre- and post-therapy measurements (n=24), 50% were above goal (130/80) pre-therapy and 20.8% post. Regarding weight (n=27), 48.2% lost weight. Among patients with LDL≥100 pre-therapy (n=9), 55.5% achieved LDL <100 post-therapy. Among patients with an A1C≥5.7 pre-therapy (n=8), 12.5% lowered their A1C to <5.7.

Conclusions:
Although further studies are needed to assess the benefit of each component of care, our preliminary study shows the demand for and potential benefit from psychological services when delivered concurrently with preventive cardiology visits. There was a high level of engagement, with over half of patients attending six or more therapy sessions. Marked improvement in blood pressure, LDL, and weight were noted. These preliminary findings raise the possibility that expanding access to psychological services in clinical cardiology care may be a model to reduce excess cardiovascular risk.
Abstract 14039: The Cardioprotective and Anti-Inflammatory Effect of Inhaled Nitric Oxide During Fontan Surgery: A Prospective Randomized Study
Authors: Kolcz Jacek , Karnas Elzbieta , ZUBA SURMA Ewa K
Published: June 2023

Introduction:
Open heart surgery that requires cardiopulmonary by-pass (CPB) evokes tremendous stress and inflammatory responses, affecting postoperative organ function, morbidity, and mortality. Although part of this reaction triggers protective and anti-inflammatory phenomena, it is harmful, particularly in patients with single ventricle congenital heart defects during Fontan surgery. Unfortunately, there is no perfect anti-inflammatory and stress defence strategy despite decades of research.

Hypothesis:
This study aimed to investigate the influence of nitric oxide (NO) inhaled directly into the oxygenator during CPB on a proteome profile of inflammatory cytokines, metabolic response markers, heart and lung protection indicators, and the early clinical outcomes.

Methods:
The study involved 115 patients randomized to the Fontan-NO group, receiving NO inhalation (n=48) and the Fontan group, not receiving NO (n=49). Eighteen patients were excluded from the study. The clinical data were prospectively analyzed. Proteome profiler essays were used for repeated measurements of investigated analytes.

Results:
Fontan-NO patients had significantly lower levels of lactate (p=0.04) and glucose (p=0.02), lower pulmonary artery pressure (p=0.03) and catecholamine index (p=0.042), shorter ventilatory support time (p=0.03) and ICU stay (p=0.04). Plasma factors analysis has shown a significantly higher concentration of interleukin-10, tissue inhibitor of metalloproteinase, prolactin, and angiopoietin and a lower concentration of interleukin-6, interleukin-8, interleukin-1β, granulocyte-macrophage colony-stimulating factor, pentraxin, matrix metalloproteinase-8, troponin-I, CK-MB, and insulin in Fontan-NO group. Multiple regression analysis revealed the influence of Il-6 and Il-8 on respiratory support time and ICU stay and the relationship between catecholamine index, duration of effusions, and indicators of myocardial damage.

Conclusions:
NO inhaled into the oxygenator during CPB can alleviate the inflammatory response, improve myocardial and lung protection, and reduce metabolic stress in patients with a single ventricle undergoing Fontan surgery. The observed effects can influence short-term clinical outcomes.
Abstract 14042: Cmr Demonstrates Key Differences in Patients Undergoing De Novo CRT versus CRT Upgrades
Authors: Bilchick Kenneth C , Bivona Derek , Morales Frances , Abdi Mohamad , Wang Yu , Oomen Pim , Gao Xu , Malhotra Rohit , Mangrum J. M , Darby Andrew , Monfredi Oliver , Mehta Nishaki M , Mason Pamela , Mazimba Sula , Kramer Christopher M , Epstein Frederick H
Published: June 2023

Introduction:
Patients with cardiac resynchronization therapy (CRT) upgrades with right ventricular pacing (RVP) dependence may have a different prognosis after CRT and require a distinct implementation strategy.

Hypothesis:
Left ventricular (LV) size/function, optimal AHA segments for LV pacing, and survival post-CRT is different for patients with RV pacing undergoing CRT upgrade procedures.

Methods:
Cardiac magnetic resonance (CMR) with cine imaging, DENSE strain mechanical activation mapping, and scar imaging was performed prior to implants of CRT systems that were "de novo" (Group 1) or upgraded from pre-existing pacemakers or ICDs with RVP (Group 2) and without RVP (Group 3). Optimal LV pacing sites were identified based on latest activation. Patients were followed for clinical outcomes.

Results:
In 92 patients (23.5% female, 65.8 ± 10.7 years old), the baseline LVEDVI by CMR was significantly smaller in RVP upgrade (Group 2) patients (101.8 +/- 34.3 cc/m
2
) compared with de novo (Group 1; 140.5 +/- 38.2 cc/m
2
); p=0.001) and non-RVP upgrade patients (Group 3; 153.6 +/- 46.4 cc/m
2
; p=0.001) (Figure 1). RVP upgrade patients also had the widest baseline QRS (178.2 +/- 26.6 ms v. 159.7 +/- 18.5 ms in Group 1 v. 154.5 +/- 20.1 ms in Group 3; p = 0.001) and were more likely to have latest mechanical activation in an anterior LV segment (50%) versus Group 1 (10%) and Group 3 (35%) patients (p = 0.0007). As shown in Figure 2, RVP upgrade patients had the worst survival (p = 0.007).

Conclusion:
Patients with RVP dependence undergoing CRT upgrades are more likely to have smaller baseline LV volumes by CMR, greater QRS durations, optimal pacing sites in anterior segments, and unfavorable survival.
Abstract 14052: Impact of Sex and Age on Left Ventricular Remodeling in Patients With Chronic Aortic Regurgitation
Authors: Akintoye Emmanuel O , Saijo Yoshihito , Braghieri Lorenzo , Badwan Osamah , Patel Hardik , Dabbagh M. Marwan , Jellis Christine L , Desai Milind Y , Rodriguez L L , Grimm Richard A , Griffin Brian P , Popovic Zoran B
Published: June 2023

Introduction:
Women and older patients with chronic aortic regurgitation (AR) have disproportionately higher rates of adverse events compared to men and younger patients, respectively. Yet, guidelines recommend same left ventricular (LV) dimension thresholds for intervention in all. While experimental animal models suggest different rates of LV remodeling by sex and age, there is paucity of data in humans with AR

Methods:
We included consecutive patients with isolated moderate or severe AR who were serially monitored by echo between 2010 & 2016. The 2 main endpoints were change in LV volumes indexed to body surface area (LVEDVi & LVESVi ) and adverse events (heart failure hospitalization, urgent surgery, or death)

Results:
786 patients [mean (SD) age 58 (16) yrs & 31% women] were included. Median (IQR) follow up was 25 (12-44) months. A moderate increase in LV volumes was observed overall, although women consistently had smaller LV volumes compared to men (
Fig 1
). Similarly, compared to younger patients (<60 yrs), older patients (≥60 yrs) persistently had smaller LV volumes (
Fig 1
). Despite having smaller LV volumes, women and older patients were more sensitive to change in LV volumes, with higher rate of events per unit increase in volume e.g., HR per unit increase in LVEDVi was 1.01 (1.00-1.02) for men and 1.03 (1.01-1.07) for women (
P
int
=0.01) (
Fig 2
)

Conclusions:
Independent of BSA, women and older patients with significant AR maintained smaller LV volumes than men and younger patients, respectively, on serial evaluation. Yet, they were more sensitive to change in LV volume. Sex and age-specific LV volume thresholds for timing of AR surgery are needed to address disparity in outcomes
Abstract 14058: Racial Bias in Pulse Oximetric in Pediatric COVID Patients
Authors: Savorgnan Fabio , Acosta Sebastian , Borges Nirica
Published: June 2023

INTRODUCTION
Pulse oximetric (Sp02) may overestimate patient oxygen saturation. This bias is possible more pronounced in patients of black ethnicity. The current study aimed to assess whether SpO2 accurately predicted laboratory oxygen saturation (SaO2) in symptomatic hospitalized pediatric patients with covid 10. And whether disparities between black and white race ethnicity existed.

Methods:
This retrospective study evaluates covid 19 patients between May 2020 and December 2021 admitted to Texas Children's Hospital (TCH). We used multivariate logistic regression to examine the association between race and bias in Sp02. The bias is defined as the difference in SaO2 and SpO2. All analyses were performed using Python Statsmodels v0.12.2.

Results:
There were 4300 patients with covid with complete physiological data in the Sickbay and electronic chart system. Figure 1 shows a paired SpO2 and SaO2 comparison between the white and black hospitalized pediatric patients with covid 19. Figure 2 depicts the paired bias comparison between the black and white hospitalized pediatric patients with covid 19. Multivariate logistic regression showed that the black race-ethnicity is associated with worse bias (OR (95%CI) = -1.94 (-3.22, - 0.65), p<0.003) in the non-invasive oxygen saturation.

Discussion:
We found a bias in the measurement of Sp02 about Sa02 in symptomatic hospitalized pediatric patients with the diagnosis of covid 19; furthermore, the race-ethnicity is related to an increased bias in the reading of Sp02 about Sa02. Like the previous studies, we consistently found more bias in reading Sp02 about Sa02 in the black population.
Abstract 14079: Association Between Serum Uric Acid Level and Metabolic Syndrome in a Rural Japanese Population: A Multi-Center Study
Authors: Kobatake Hiroshi , Mikami Shinsuke , OSAWA AYANO , Kinoshita Mirai , Harada Yu , Tanaka Kouichi , Nakano Yukiko
Published: June 2023

Introduction:
Several reports have showed associations between serum uric acid (UA) levels and metabolic syndrome (MetS). Limited information, however, is available concerning the prospective relation between UA and the risk of developing MetS.

Hypothesis:
Hyperuricemia would be related to higher odds for MetS in a rural Japanese population.

Methods:
We evaluated 2406 subjects (1275 male subjects, 1131 female subjects; mean age 49.9 years) who underwent health examination programs in 2008 and 2013, who were free of MetS in 2008. We conducted this multi-center study in two hospitals located in northern Hiroshima prefecture.

Results:
At baseline, hyperuricemia was detected in 258 male subjects (20%) and 41 female subjects (3.6%). Subjects with hyperuricemia at baseline had significantly higher MetS prevalence in 2013 than those without (male subjects: 14.7% vs. 9.1%, P=0.01; female subjects: 9.8% vs. 1.7%, P=0.008). Compared with subjects in the first quartile of uric acid levels at baseline, the age-adjusted odds ratios (ORs) for cumulative incidence of MetS among subjects in the second, third, and fourth quartile were, 0.77 (95% confidence interval (CI), 0.40-1.48; P=0.43), 1.79 (95% CI, 1.05-3.06; P=0.03) and 2.17 (95% CI, 1.28-3.70; P=0.004), for male subjects. Compared with subjects in the second quartile of uric acid levels at baseline, the age-adjusted ORs for cumulative incidence of MetS among subjects in the third, and fourth quartile were 2.46 (95% CI, 0.47-12.9; P=0.29), 7.34 (95% CI, 1.65-32.6; P=0.009), for female subjects. Multivariable logistic analysis revealed that hyperuricemia was significantly associated with cumulative incidence of MetS in male and more significantly in female subjects (male: OR, 1.79 [95% CI, 1.19-2.69; P=0.005], female: OR, 6.34 [95% CI, 2.03-20.0; P=0.002]).

Conclusions:
Hyperuricemia is a significant predictor of MetS in rural Japanese population and more significantly in female.
Abstract 14090: Measures of Discrepancy Between Cystatin C and Creatinine Are Associated With Body Composition in the General Population and in Heart Failure
Authors: Braghieri Lorenzo , Nguonly Austin S , Pinsino Alberto , Fares Maan , Sayer Gabriel T , Uriel Nir , Demmer Ryan T , Colombo Paolo C , Yuzefpolskaya Melana
Published: June 2023

Background:
Sarcopenia is associated with disability and mortality. Coexistence of sarcopenia and obesity (sarcopenic obesity) relates to particularly poor outcomes. The prevalence of sarcopenia is increased in heart failure (HF) up to ~50%. Dual-energy x-ray absorptiometry (DXA) is the gold standard for body composition assessment but is limited by cost and radiation exposure. We studied whether the relationship between two renal biomarkers (ie, serum creatinine (sCr) - muscle mass dependent, and cystatin C (CysC) - muscle mass independent) could be used to reliably estimate body composition in the general population and in HF.

Methods:
We included National Health and Nutritional Examination Surveys participants who underwent DXA between 1999 and 2002. Multivariable linear models assessed the association between sCr/CysC and CysC- and sCr-based estimated glomerular filtration rate difference (eGFRdiff) with DXA-derived appendicular skeletal muscle index (ASMI m
2
) and total body fat percentage (TBF%). Sample weights were used to account for complex survey design to ensure that estimates were representative of the general US population.

Results:
Among 3280 participants (44±22.9yo,49%F,190 with HF), 440, 1241, and 359 met criteria for sarcopenia, obesity and sarcopenic obesity. Overall and in HF, mean ASMI and TBF% were 7.4m
2
and 32.5% and 7.0m
2
and 36.9%, respectively. Overall and in HF, higher sCr/CysC and eGFRdiff were associated with increased ASMI and decreased TBF% (
Table
). sCr/CysC was the lowest in patients with lowest ASMI tertile (<6.26 m
2
) and highest TBF% tertile (>40.3%) (
Fig
). A similar pattern was also seen in HF.

Conclusions:
Measures of discrepancy between sCr and CysC are strongly associated with gold-standard measures of body composition both in the general and HF populations. This biomarker approach is easy and inexpensive, allowing clinicians new opportunities for timely recognition and possibly early treatment of sarcopenic obesity.
Abstract 14107: Virtual Cardiac Point-of-Care Ultrasound Curriculum Among Residents: A Medical Education Project
Authors: Kaur Arpanjeet , Balboul Yoni , Gandhi Kruti , Rothman Adam
Published: June 2023

INTRODUCTION:
Point-of-care ultrasound (POCUS) is becoming increasingly important for rapid assessment and diagnosis in a variety of clinical situations. With the ongoing COVID-19 pandemic, the aim of this study is to determine whether a virtual POCUS session can improve learner competency in assessing left ventricular (LV) systolic function.

METHODS:
An hour long session, involving a short lecture and fourteen practice questions was created. The questions consisted of cardiac ultrasound clips from real patients, evaluated by three POCUS experts. For each clip, LV systolic function was classified as hyperdynamic, normal, reduced, or severely reduced. The session was given separately to a group of interns (n1=30) and a group of senior residents (n2=39) virtually via Zoom. Series of clips were shown as the lecture progressed and participants recorded their answers as either hyperdynamic, normal, reduced, or severely reduced using the polling feature within the Zoom platform. Effect size as the percent of correct responses was calculated. Data was analyzed using SPSS software with independent t-test and paired t-test analysis with a level of statistical significance as p ≤0.05.

Results:
The intern group had a mean score of 69.9% [SD 21.8%] and the resident group had a mean score of 74.2% [SD 21.5%]. All participants achieved a mean score of 66.6% [SD 26.0%] during the first half of the lecture, which then improved to 77.6% [SD 14.2%] in the second half [p value 0.547]. Both groups showed similar overall trends, although these were not statistically significant. When combined, extremes of LV function (hyperdynamic and severely reduced) were better recognized than more subtle differences (reduced and normal) [81.4%±18.1 vs 55.2±15.9; p = 0.001] overall.

Conclusion:
Compared to the conventional in-person approach, this study highlights the potential for virtual didactic sessions in POCUS training with impressive results when recognizing extreme cardiac findings.
Abstract 14109: Safety and Effectiveness of Trans-Catheter Tricuspid Valve Repair in the Elderly and Very Elderly Patients
Authors: Soellner Victoria , Schnupp Steffen , Ajmi Issameddine , Amami Majdi , Mahnkopf Christian
Published: June 2023

Introduction:
Symptomatic tricuspid regurgitation (TR) is associated with a high mortality rate and high HF-related hospitalization. Symptomatic therapy in the elderly and very elderly patients remains weak in controlling severe TR. Patients with an increased risk of surgical repair of the TR seemed to benefit from transcatheter tricuspid valve repair procedures.

Hypothesis:
Therefore, we thought to analyze the postprocedural safety and success of the transcatheter tricuspid valve repair in octogenarians and older patients.

Methods:
Elderly patients with severe and symptomatic TR were presented and evaluated in the heart team. Patients with high surgical risks underwent transcatheter tricuspid valve repair procedures in our center. Post-procedural transthoracic echocardiography (TTE) procedure was performed to determine the TR grade and exclude procedure-related complications.

Results:
Thirty-three consecutive patients, older than 80 years (84.45 ±3.12, 14 men and 19 women, who received transcatheter TR repair between September 2021 and January 2022 were enrolled. The baseline characteristics are presented in table 1. Procedural success, defined as reducing the TR to grad I-II, was achieved in 97 % of the patients (3.79±0.65 vs. 1.55±0.56, P = 0.011). All patients improved in the New York Heart Association functional class (2.85±0.50 vs. 1.39±0.056 30 days after the intervention). No procedure-related death was registered. 87.9 % (n=29) survival rate was achieved 3 months after the intervention. No clip embolization was detected in 3 months echocardiography control.

Conclusions:
Our preliminary results indicate that transcatheter tricuspid valve repair procedures are safe and effective therapeutic option in elderly and very elderly patients with severe TR and high surgical risks. Therefore, this therapy should be considered despite age and comorbidities for effective symptomatic treatment in this cohort.
Abstract 14114: Sex Differences in the Etiology and Burden of Heart Failure Across the Sociodemographic Index: Analysis of 204 Countries and Territories, 1990-2019
Authors: Wei Sunny , Miranda J. Jaime , Mamas Mamas , Zuhlke Liesl , Kontopantelis Evan , Thabane Lehana , Van Spall Harriette G
Published: June 2023

Background:
Heart failure (HF) is a global epidemic.

Objectives:
We assessed sex differences in HF across country income.

Methods:
Using Global Burden of Disease (GBD) data, we assessed sex differences in HF prevalence, etiology, morbidity, and temporal trends between 1990-2019 across 204 countries and territories and disaggregated results by country income (SDI or gross national income).

Results:
In 2019 there were 56.2 million (95% uncertainty interval [UI] 46.4-67.8 million) HF cases worldwide, with over half in females. HF morbidity was estimated at 5.1 million (95% UI 3.3-7.3 million) years lived with disability, distributed equally between the sexes. Overall, ischemic heart disease was the top cause of HF in males, and hypertensive heart disease the top cause in females. Between 1990-2019, there was an increase in total HF cases, but the age-standardized rate per 100,000 decreased by 7.1%, more so in males (9.1%) than females (5.8%). High-income regions experienced a 16.0% temporal decrease in age-standardized rates, from 877.5 to 736.8 per 100,000, while low-income regions experienced a 3.9% increase, from 612.1 to 636.0 per 100,000. Trend directionality was largely consistent in both sexes. Asia, sub-Saharan Africa, and Middle East experienced a temporal increase in age-standardized HF rates in both sexes, related to increasing ischemic heart disease. Globally, there was an increase in age-standardized HF rates due to calcific aortic valve disease and hypertensive heart disease, and a decrease due to ischemic heart disease, although regional and sex differences were noted.

Conclusions:
Age-standardized HF rates are increasing in the Middle East and low-SDI regions of the world, with sex differences in etiology and trends that offer targets for intervention.
Abstract 14123: AF Ablation Using a Novel “Single-Shot” Map-and-Ablate Spherical Array Pulsed Field Ablation Catheter: Impact of Application Repetition on PV Isolation Durability in the
PULSE-EU Study
Authors: Reddy Vivek Y , Turagam Mohit K , Petru Jan , Koruth jacob s , Funasako Moritoshi , Hala Pavel , Skoda Jan , Chovanec Milan , Sediva Lucie , Neuzil Petr
Published: June 2023

Introduction:
Preclinical studies have revealed that pulse field ablation (PFA) lesion dimension increases with consecutive applications at a similar electric field. Whether durability of pulmonary vein isolation (PVI) is
predicated
on repetitive PFA applications is unknown. In the first-in-human
PULSE-EU
clinical trial (NCT05164107), the ability of this map-and-ablate PFA catheter to achieve durable PVI was assessed, both with single
vs
repetitive PFA applications.

Methods:
Under general anesthesia, paroxysmal AF pts underwent PVI using the spherical array PFA catheter (Globe; Kardium Inc, Canada) delivered with a deflectable 19Fr transeptal sheath and ICE-guidance. Using a custom mapping system, the PFA catheter rendered contact and voltage anatomic maps (

Figure

). The spherical array is positioned at the PV ostium and PFA is performed (1.6-2 kV/lesion, ungated 3s pulses). Follow-up was post-procedure EGD and brain MRI within 1 day, and invasive remapping at ⁓2 months.

Results:
A total of 21 pts (age 63±11 years; M/F 33%/67%) underwent PVI in 2 groups: Gp1-single PF application/PV, and Gp2-3 PF applications/PV. In Gp1 (n=11 pts) and Gp2 (n=10 pts), PVI was acutely successful in 100% of PVs in both groups. Pulse delivery times and total procedure times were 75.2±7.4 sec/pt
vs
24.5±5.5 sec/pt and 73.2±13.7 mins​
vs
93.7±18.5 mins​ in Gp2 vs Gp1. There was no stroke/TIA, pericardial effusion, phrenic nerve injury, or esophageal complications. EGD was normal in all 9/9 pts. Brain MRI showed silent cerebral lesions (DWI+/FLAIR-) in 3/16 (18.8%) pts. PV remapping revealed durable PVI in 25/40 (62.5%) PVs in 10 pts in Gp1, compared with all 34/34 (100%) PVs in 9 pts in Gp2; this translates to all PVs being durably isolated in 27% vs 100% (p<0.05) of pts in Gp1 and Gp2.

Conclusion:
The “single-shot” map-and-ablate spherical array PFA catheter can safely isolate PVs. Repetitive PFA applications is key for lesion consolidation to improve PVI durability.
Abstract 14169: Quantitative Echocardiographic Assessment and Optimal Criteria for Early Intervention in Asymptomatic Tricuspid Regurgitation
Authors: Akintoye Emmanuel O , Wang Tom Kai Ming K , Nakhla Michael , Hajj Ali Adel , Fava Agostina , Akyuz Kevser , Popovic Zoran B , Pettersson Gosta B , Gillinov A M , Xu Bo , Griffin Brian P , Desai Milind Y
Published: June 2023

Introduction:
Tricuspid regurgitation (TR) is associated with poor outcome and high operative mortality due to late presentation; yet the optimal timing for TR intervention remains controversial, especially in asymptomatic patients. We evaluated the prognostic value of echocardiographic parameters to inform early intervention in asymptomatic TR

Methods:
We identified cohort of consecutive asymptomatic patients with moderate to severe (3+) or severe (4+) TR who underwent echocardiography at Cleveland Clinic during 2004-2018. Quantitative TR as well as right heart size and function parameters were determined and their prognostic utility and optimal thresholds for all-cause mortality were assessed in time-to-event analyses

Results:
In 325 asymptomatic TR patients (mean age 68 years; 79% female), there were 132 deaths (41%) over a median follow up of 7 years (IQR 4-11). Among the twenty echocardiographic parameters evaluated, right ventricle free wall strain (RVFWS) and tricuspid regurgitant volume (RVol) were the strongest predictors of mortality in the cohort. The optimal discriminatory thresholds for these parameters were RVFWS <-19% and RVol >45 mL (
Fig 1
). The 5-year survival rates (95% CI) by number of risk factors (RF) were 93% (86-96%), 65% (55-74%), and 38% (26-49%) for no RF, one RF, and both RF, respectively. Compared to symptomatic TR, mortality was lower for asymptomatic TR with no RF [HR (95% CI) =0.10 (0.04-0.29)] or one RF [0.29 (0.14-0.58)], but similar for asymptomatic TR with both RF [1.11 (0.56-2.19)] (
Fig 2
)

Conclusion:
RVFWS and RVol are key prognostic markers that can be serially monitored to inform optimal timing of intervention for severe asymptomatic TR
Abstract 14180: Characteristics and In-Hospital Outcomes of Haemochromatosis in Heart Failure
Authors: Ahmed Raheel , Sherif Akil A , Mohammed Selma , Deshpande Saurabh , Khan Hassan , Wafa Syed Emir Irfan , Somers Virend K , Sawatari Hiroyuki , Padmanabhan Deepak , Khanji Mohammed , Chahal Anwar
Published: June 2023

Introduction:
Cardiovascular complications are the main contributors towards morbidity and mortality in hemochromatosis. Iron overload can cause arrhythmias and heart failure (HF). There is a paucity of data on haemochromatosis and the burden of HF and its sequalae.

Hypothesis:
To determine characteristics of HF patients with and without haemochromatosis, and in-hospital outcomes (mortality, length of stay (LOS), mechanical circulatory support, and cardiac transplantation).

Methods:
Patients with HF, with and without hemochromatosis, were identified from the Nationwide Inpatient Sample Database.

Results:
Between 2016-2019, 2,940 (0.06%) of 4,823,994 HF patients had hemochromatosis. The hemochromatosis cohort was younger (mean age, 68 vs 71 years), predominantly men (63% vs 52%), White (77% vs 64%), and had less cardiovascular comorbidity burden (coronary artery disease (41% vs 51%), atrial fibrillation (45% vs 46%), hypertension (20% vs 24%), hyperlipidaemia (44% vs 53%), diabetes (42% vs 49%) and obesity (18% vs 25%), compared with HF patients without hemochromatosis (p<0.01 for all). However, hemochromatosis patients had a higher concomitant third degree atrio-ventricular block (1.2% vs 0.7%), ventricular tachycardia (7.8% vs 5.4%), ventricular fibrillation (0.5% vs 0.3%), chronic liver disease (24% vs 6%) and anemia (51% vs 37%) [p<0.01]. The hemochromatosis patients had a higher mean LOS (6.1 vs 5.4 days, p<0.01), need for mechanical circulatory support (0.9% vs 0.6%, p<0.01) and cardiac transplantation (0.2% vs 0.1%, p<0.01). Mortality (2.0% vs 2.7%, p=0.09) was comparable between the groups.

Conclusion:
Despite younger age and lower burden of cardiovascular comorbidities, patients with hemochromatosis had a higher burden of arrhythmias, need for mechanical circulatory support and cardiac transplantation and a higher LOS. This warrants the need to devise early management strategies for HF patients with hemochromatosis.
Abstract 14187: Neighborhood Walkability and Cardiovascular Risk in the United States
Authors: Motairek Issam , Makhlouf Mohamed H.E. , Nasir Khurram , Deo Salil V , Rajagopalan sanjay , Al-Kindi Sadeer
Published: June 2023

Walkability may be associated with increased physical activity and thus may confer protection against cardiovascular disease and associated risk factors. We sought to characterize the association between neighborhood-level cardiovascular diseases and risk factors with neighborhood walkability across most US census tracts.

Methods:
The Centers for Disease Control and Prevention (CDC) PLACES dataset provided census-tract level prevalence of coronary artery disease (CAD) and cardiovascular risk factors (hypertension, high cholesterol, obesity, and diabetes). These data were matched with census tract population-weighted walkability index from the CDC’s smart location database. We calculated the mean prevalence of each cardiovascular health indicator by quartile of walkability score. We also fit a multivariable linear regression model to estimate the association between walkability index and the prevalence of CAD adjusting for age, sex, race, and the CDC'S social vulnerability index, a validated metric of socioeconomic status.

Results:
70,123 census tracts were analyzed nationwide. Across walkability quartiles Q1 (least walkable) through Q4 (most walkable), we found a statistically significant decrease in the prevalence of CAD (7.0% to 5.4%). Similarly, there was a decrease in the prevalence of CVD risk factors including hypertension (35.5% to 29.7%), high cholesterol (34.5% to 29.7%), obesity (35.0% to 30.2%), and diabetes (11.6% to 10.6%) across walkability quartiles (
Figure
). After multivariable adjustment, continuous walkability index was negatively and significantly associated with the prevalence of CAD (β = -0.09, p < 0.0001).

Conclusions:
This nationwide analysis demonstrates that neighborhood walkability is associated with a lower prevalence of cardiovascular risk factors and CAD.

Figure:
Mean prevalence of cardiovascular health indicators according to walkability index quartile. BP = blood pressure, CAD = coronary artery disease.
Abstract 14188: An Unexpected Cause of Anterior ST Segment Elevation After Coronary Intervention
Authors: Requena Armas Carlos A , Del Cid Fratti Juan , Garg Rimmy , mungee sudhir
Published: June 2023

Background:
ST elevation (STE) in V1 to V3 is traditionally labeled as anteroseptal infarction due to occlusion of the LAD proximal to the septal branches. An important and uncommon cause for similar ECG findings is an isolated RV myocardial infarction due to occlusion of the proximal RCA and/or its branches. We present a case of anteroseptal ST elevation after jailing of a conus branch during percutaneous coronary intervention (PCI) to the RCA.

CASE:
89-year-old female with history of moderate aortic stenosis (AS), hypertension, hypercholesterolemia, and prior stroke presented with progressive dyspnea on exertion and 3 days of chest tightness. Initial echocardiogram showed an EF of 64% and severe AS with peak velocity of 4.27 m/s, mean gradient of 45 mmHg and aortic valve area of 0.43 cm
2
. Coronary angiography showed severe stenosis of the proximal RCA successfully treated with intravascular lithotripsy and drug-eluting stent deployment with jailing of the conus branch. The LAD and LCX had mild nonobstructive disease. Patient developed chest pain after the procedure with new STE in V1 to V3. She was taken for emergent cardiac angiogram due to suspected occlusion of the LAD however this showed unchanged anatomy with patent stent in the RCA and no new severe stenosis or occlusion of the left coronary arteries. There was no flow in the jailed conus branch that was not intervened on due to small vessel size. A repeat echocardiogram showed new mild RV dilatation with unchanged EF and normal LV wall motion. Patient had resolution of the chest pain and STE within 2 hours and was discharged home in stable condition.

Conclusion:
Occlusion of a conus branch artery with associated isolated RV myocardial infarction is an uncommon cause of STE in anteroseptal leads. High index of suspicion is important to anticipate and manage potential complications like ventricular arrhythmias and RV failure.
Abstract 14196: Methamphetamine Use is Associated With Increased In-Hospital Mortality After Aortic Dissection: The National Inpatient Sample Perspective
Authors: Nyembo Philippe F , Gamam Abdulrahman
Published: June 2023

Introduction:
Aortic dissection is a rare complication associated with methamphetamine abuse. Mortality in aortic dissection is high, however outcomes in methamphetamine associated aortic dissection have not been investigated. In this study, we describe the impact of methamphetamine use on in-hospital mortality in patient who presented with an acute aortic dissection using a large inpatient database.

Methods:
We queried the 2017 National Inpatient Sample database to identify all admissions age 18 years or older with a discharge diagnosis of aortic dissection. We accounted for survey design and built a multivariable logistic regression model to evaluate the impact of methamphetamine use on in-hospital mortality after an acute aortic dissection, while controlling for patient demographics, hospital characteristics and multiple co-morbid conditions.

Results:
A total of 30,060 cases of acute aortic dissection were identified, of which 395 had a history of methamphetamine use disorder. Patients with aortic dissection and history of methamphetamine use disorder were younger, male with higher incidence of co-morbid smoking and history hypertension compared to those without history of methamphetamine use disorder (Table 1). We found that in-hospital mortality for aortic dissection was significantly higher among methamphetamine users despite controlling for multiple co-morbid conditions and patient demographics, OR 3.52 (95% CI 1.73 - 7.13); p - value 0.001.

Conclusions:
To our knowledge, this is the first population study to demonstrate that patients with a history of methamphetamine use disorder are at increased risk of death in the hospital after acute aortic dissection. Factors contributing to these findings necessitates further prospective investigations to prevent morbidity. Special attention should be paid to young patients presenting with aortic dissection and methamphetamine use disorder should be suspected.
Abstract 142: Community-wide Bystander-focused Interventions And Sex Disparities In The Receipt Of Bystander Cardiopulmonary Resuscitation In Public
Authors: Blewer Audrey L , Shahidah Nur , Pek Pin Pin , Ng Yih Yng , Tan Colin , de Souza Carl Ross , Ng Wei Ming , White Alexander , Leong Benjamin S , Ostbye Truls , Ong Marcus E
Published: June 2023

Introduction:
Female sex is associated with lower receipt of bystander cardiopulmonary resuscitation (BCPR) in public. Telephone-assisted CPR (TCPR) may attenuate this known sex difference. It is unknown whether the introduction of community-wide, bystander-focused interventions may reduce this known sex difference and improve outcomes for females.

Objectives:
We sought to assess whether implementation of bystander-focused, out-of-hospital cardiac arrest (OHCA) interventions attenuated the sex difference seen in receipt of BCPR. We hypothesized that implementation of bystander-focused interventions would reduce the known difference observed in males compared to females in receipt of BCPR in public.

Methods:
We conducted a retrospective study of adult, non-traumatic OHCAs from the Singapore OHCA registry (1/2011-12/2020). Bystander-focused interventions included TCPR (7/2012 - present), CPR/AED training (04/2014 - present), and myResponder (4/2015 - present). We examined the differences between males vs females in receipt of BCPR in public using descriptive statistics, a sex-intervention interaction term, and hierarchical regression modeling.

Results:
The registry contained 19,321 events (2011-2020). Excluding pediatric, traumatic, EMS witnessed, and healthcare facility arrests, 18,925 events were analyzed. Of these, mean age was 68±16 and 64% were male. BCPR was administered in 56% of the events, with 61% of males and 54% of females receiving BCPR in public (p-value <0.01). Females had a 29% decreased odds of receiving BCPR compared to males in public (OR: 0.72 (95% CI: 0.58-0.90), p-value <0.01). With inclusion of implementation of bystander-focused interventions as an interaction term with sex, the difference in receipt of BCPR between males and females was no longer observed (p-value: ns). The sex-intervention interaction term was statistically significant (p-value<0.01). No sex differences were observed when modelling survival as an outcome.

Conclusion:
The introduction of community-wide, bystander-focused interventions may lessen differences seen in receipt of BCPR by males and females in public. Further research on OHCA interventions is needed to increase provision of BCPR and consider addressing this disparity.
Abstract 14241: Feasibility and Safety of Non-Contrast Optical Coherence Tomography Imaging Using Hydroxyethyl Starch in Coronary Arteries
Authors: Kang Dong Oh , Nam Hyeong Soo , Kim Sunwon , Yoo Hongki , Kim Jin W
Published: June 2023

Background/Objectives:
Contemporary high-resolution intracoronary optical coherence tomography (OCT) requires injection of flushing media for image acquisition. There is a growing need for an alternative flushing media other than iodine contrast to reduce the risk of acute kidney injury. To address this issue, we investigated the safety and feasibility of hydroxyethyl starch (pentastarch) as a flushing media for OCT image acquisition and compared with the contrast media flushed images.

Methods:
We prospectively enrolled 43 patients with 70 coronary lesions (46 stented and 24 pre-stented or non-culprit lesions). Paired OCT images were obtained by manual injection of iodine contrast (average 12 mL), followed by pentastarch (average 15 mL). A total of 162 runs (81 pairs) were analyzed and each OCT pullback was assessed on a frame-by-frame basis by automated customized lumen contour and stent strut segmentation algorithm.

Results:
Image quality as assessed by proportion of clear image segments were comparable between the contrast media and pentastarch flushed images (93.3% vs. 93.7%; p=0.501). Pixel-based flushing capability showed no significant difference between the paired image segments (median(IQR), 0.951(0.947-0.953) vs. 0.951(0.949-0.952), p=0.264; Figure). Quantitative measurements of minimal stent area (R
2
=0.977, p<0.001), minimal lumen area (R
2
=0.983, p<0.001) correlated well between the paired OCT runs. There were no clinically relevant complications associated with OCT imaging with pentastarch such as anaphylaxis, life-threatening arrhythmia, or acute renal deterioration.

Conclusions:
Intracoronary OCT using pentastarch is safe and technically feasible without affecting the optical signal intensity and overall image quality. Non-contrast imaging with pentastarch significantly reduces the obligatory iodine contrast load, therefore, could be considered as a promising strategy in high-risk patients for renal impairment.