bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 9688: Isoproterenol Assisted Differentiation Between Sludge and Organized Thrombus of Left Atrial Appendage to Help Guide Percutaneous Closure
Authors: Hyder Syed A , Goyal Sandeep , Vannan Mani , Liu Shizhen
Published: June 2023

Background:
Percutaneous left atrial appendage (LAA) closure is contraindicated in patients with LAA thrombus. It can be challenging to distinguish slow flow (sludge) from organized thrombus on echocardiography. Recent case reports have shown that isoproterenol infusion can distinguish LAA sludge from thrombus, however, no mid/long-term outcome data exists.

Methods:
A retrospective study was conducted on 32 patients who underwent Watchman™ implantation at Piedmont Atlanta Hospital during 2021. Patients were divided into two groups, 1) clear LAA [Standard] and 2) suspected LAA thrombus versus sludge [Sludge]. The Sludge group underwent isoproterenol infusion prior to implantation of Watchman™ device. Data gathered included demographics, medical history, procedural data, and 6-months outcomes defined as TIA, CVA, or device related thrombus. Chi-square and T-test was used for statistical analysis.

Results:
The cohort had 8 patients (25%) in Sludge group with remaining 24 patients (75%) in Standard group. The Sludge group was younger at 73.5 years compared to 77.0 years for Standard group [p=0.02]. Other baseline characteristics including sex, comorbidities, and history of prior TIA/CVA were similar among both groups. Median CHA
2
DS
2
VASc Score was 5.0 for Standard and 4.5 for Sludge group [p= 0.21]. All patients in Sludge group had successful clearance with isoproterenol; median dose required was 6 mcg. LAA dimensions were similar with the median device size being 27 mm for both groups [p= 0.343]. At 45-day follow-up, one patient in Standard group had device related thrombus; it resolved on subsequent scan. At 6-months, one patient in Sludge group had experienced TIA; no patients underwent CVA.

Conclusions:
LAA thrombus is an absolute contraindication for percutaneous LAA device implantation, however, it can be difficult to differentiate between sludge and organized thrombus. This study demonstrates that intraprocedural isoproterenol infusion can be used to clear LAA sludge by improving LV contractility. No significant difference in mid-term outcomes was observed in our study groups, suggesting that isoproterenol assisted differentiation of LAA sludge from thrombus may allow successful LAA closure in cases that are deemed to have LAA sludge.
Abstract 9694: Incidence and Outcomes of Hospitalized Patients With Torsades de Pointes
Authors: Sudesh Saurabh , Rubin Geoffrey A , Waase Marc , Saluja Deepak , Dizon Jose , Wan Elaine Y , Biviano Angelo , Garan Hasan , Yarmohammadi Hirad
Published: June 2023

Introduction:
TdP is a polymorphic VT that occurs with prolonged QT interval and can cause sudden cardiac death. Trends in incidence and outcomes of TdP during the COVID-19 pandemic are not well-established. We aim to report incidence of intrahospital TdP and VT, baseline characteristics of patients with TdP, and trends in post-TdP recovery and mortality before and during the COVID-19 pandemic.

Methods:
Patients with diagnoses of VT and TdP from 2016-2020 at our institution were included. The diagnosis was confirmed after analysis of the patients’ ECGs. Demographics, medical history, and hospital course data were collected. Chi-square/Fisher’s exact, one-way ANOVA, and logistic regression analyses were conducted.

Results:
Seventy-four patients were included in the analysis. Average age was 60 ± 17, and 57% were male. Fifty-two (70%) patients were in the ICU at time of TdP. Co-morbidities included hypertension (53%), atrial fibrillation/flutter (41%), diabetes mellitus (34%), CAD (26%), and CKD (22%). Average LVEF was 39 ± 19%. Forty-two (57%) underwent emergent defibrillation, 19 (26%) required transvenous pacing, and 7 (10%) were administered isoproterenol for acute management of TdP. Median recovery time of QTc interval to <500ms was 3 days. Twenty-two (30%) received an ICD. Follow-up device check data was available for 15 patients; 4 had at least 1 episode of NSVT. Fifteen (20%) patients died during their admissions. The proportion of patients with VT that had TdP increased in 2020 compared to prior years (p<0.001). However, the proportion of patients with TdP that died during admission was not significantly different across 2016-2020.

Conclusions:
The proportion of patients with TdP relative to those with VT increased significantly in 2020, concurrent with the first wave of the COVID-19 pandemic. The absolute number of hospitalized patients with TdP did not change from 2016-2020. Mortality rate in patients with TdP did not differ significantly from 2016-2020.
Abstract 9699: Phenotypic Features of Coronary Atheroma Associated With Coronary Physiological Mismatch: Insights From Fractional Flow Reserve and Near-Infrared Spectroscopy Findings
Authors: Murai Kota , Kataoka Yu , Iwai Takamasa , Sawada Kenichiro , Matama Hideo , Miura Hiroyuki , Honda Satoshi , Fujino Masashi , Yoneda Shuichi , Takagi Kensuke , Otsuka Fumiyuki , Asaumi Yasuhide , Tsujita Kenichi , Noguchi Teruo
Published: June 2023

Introduction:
FFR and resting indexes (RI) have been recognized as physiological measures to assess myocardial ischemia. Despite their clinical applicability, discrepancy between two measures infrequently occurs. Mechanistically, inducement of hyperemia is a determinant of FFR but not RI. Since lipidic plaque material could be accumulated through endothelial dysfunction, this plaque phenotype may affect vessel response, contributing to physiological mismatch. Near-infrared spectroscopy (NIRS) enables us to evaluate lipidic burden in vivo.

Methods:
We analyzed 122 target lesions with FFR≤0.80 in 116 stable CAD subjects receiving PCI. Physiological mismatch was defined as FFR≤0.75 and RI>0.89. Physiological indices [RI, FFR and delta-FFR (=resting Pd/Pa-FFR)] and NIRS/IVUS-derived plaque measures were compared in target lesions stratified according to FFR (≤ or >0.75) and RI (≤ or >0.89) values.

Results:
The averaged FFR, RI and delta-FFR values were 0.73±0.06, 0.86±0.08 and 0.17±0.05, respectively. Physiological mismatch was observed in 10.7% of analyzed lesions. While there was no significant difference in % diameter stenosis across 4 groups (p=0.36), physiological mismatch was associated with a larger % plaque area (max%PA) (p=0.02). Furthermore, greater maximum 4-mm lipid core burden index (maxLCBI
4mm
) was observed in those exhibiting physiological mismatch (Figure). On multivariate analysis, maxLCBI
4mm
but not max%PA predicted physiological mismatch (Table). Further analysis demonstrated that lesions causing physiological mismatch more likely exhibited a larger delta-FFR (p<0.01). Of note, delta-FFR was correlated with maxLCBI
4mm
(p=0.03, R=0.20) but not max%PA (p=0.09, R=0.15).

Conclusions:
Lipidic plaque material was a potential contributor to physiological mismatch, driven by its enhanced hyperemic response. Our findings suggest the potential association of lipidic materials with vasomotion and physiological mismatch.
Abstract 9746: Atrial Fibrillation Among the Elderly With Amyloidosis Admitted for Acute Ischemic Stroke in the United States
Authors: Ramphul Kamleshun , Verma Renuka , Kumar Nomesh , Ramphul Yogeshwaree , Khalid Muhammad Rahman , Sombans Shaheen , Mejias Stephanie G , Kumari Komal , Lohana Petras , Arti Fnu
Published: June 2023

Introduction:
Amyloidosis can disrupt several tissues, including the heart, causing various cardiac arrhythmias. Factors influencing the presence of Atrial Fibrillation in the elderly with amyloidosis admitted for Acute Ischemic Stroke (AIS) have been sparsely studied.

Methods:
Elderly patients of ages 60 and more with a diagnosis of amyloidosis and a principal diagnosis of Acute Ischemic Stroke (I63.x) were filtered from the 2019 National Inpatient Sample (NIS). All forms of Atrial Fibrillation and multiple risk factors were also identified via their appropriate codes provided by HCUP and based on recommendations from past studies.

Results:
Our analysis found 1570 elderly amyloidosis patients admitted for AIS in 2019. Among them, 490 cases (31.2%) also had a diagnosis of Atrial Fibrillation. Predictors of atrial fibrillation included hypertension (aOR 1.543, p=0.024), chronic pulmonary disease (aOR 1.541, p<0.01), use of intravenous tissue plasminogen activator (aOR 2.062, p<0.01), old CABG (aOR 3.350, p<0.01), current anticoagulation therapy (aOR 13.426, p<0.01), supraventricular tachycardia (aOR 3.970, p<0.01). Smoking (aOR 0.680, p<0.01), diabetes (aOR 0.597, p<0.01), and ventricular tachycardia (aOR 0.504, p= 0.033) showed lower risks. While a higher mortality rate was seen among patients with Atrial Fibrillation (30 deaths, 6.1% in Atrial Fibrillation vs. 4.6% in others), the result was not statistically significant (p=0.213). Patients with Atrial Fibrillation were also older (80.35 vs. 76.11 years) but had a shorter stay (6.22 vs. 6.81 days) with a lower mean hospital charge ($77,977.01 vs. $78,940.89).

Conclusions:
While various factors can influence the odds of Atrial Fibrillation in the elderly with amyloidosis admitted for acute ischemic stroke, it did not increase mortality risk.
Abstract 9752: Racial Differences in Prevalence and Impact of Subclinical Myocardial Injury Risk Factors
Authors: Soliman Mai Z , Kozman Sylvia , li yabing , Ahmad Muhammad
Published: June 2023

Introduction:
Racial differences in the prevalence and prognostic significance of electrocardiographic (ECG) subclinical myocardial injury (SCMI) have been reported. We examined whether these differences are explained by differences in the prevalence of SCMI risk factors or due to a differential impact of the same risk factors

Methods:
This analysis included 5,852 participants (58.5±13.1 years, 53.9% women, 52.5% white) from the Third National Health and Nutrition Examination Survey. SCMI was defined as the presence of a Cardiac infarction/injury score ≥ 10 points on the ECG. Logistic regression analysis was used to examine the association between potential SCMI risk factors with SCMI, overall and stratified by race. To examine if racial differences existed between risk factors and SCMI, multiplicative interaction terms between each risk factor and race were tested.

Results:
SCMI was more common in whites (23.3%) followed by black (21.8%), then Mexican Americans (18%); p-value <0.01. Heterogeneity in the distribution of risk factors was observed. Whites were more likely to be older with a higher prevalence of dyslipidemia compared to other races. On the other hand, Blacks had a higher prevalence of hypertension compared to others, but a similar prevalence of obesity as Mexican Americans. Also, Mexican Americans were more likely to have lower income with a higher prevalence of diabetes and no regular exercise, than other races. Significant risk factors for SCMI were age, male sex, smoking, diabetes, hypertension, obesity, and no regular exercise. ECG left ventricular hypertrophy was associated with lower odds of SCMI. The associations of diabetes and no regular exercise with SCMI differed by race (Table).

Conclusions:
Racial differences in the prevalence of risk factors do not explain racial differences in SCMI. Among risk factors, diabetes and lack of physical exercise partially explain the higher prevalence of SCMI in Whites.
Abstract 9757: Real World Experience With Anticoagulation in Atrial Fibrillation Patients After Pulmonary Vein Isolation: Associations With Cha
2
Ds
2
-vasc Score, Sex and Maintenance of Sinus Rhythm
Authors: Wang Tom Kai Ming K , Chan Nicholas , Cremer Paul C , Kanj Mohamed H , Baranowski Bryan , Saliba Walid I , Wazni Oussama M , Jaber Wael A
Published: June 2023

Background:
Guidelines recommend using the CHA
2
DS
2
-VASc score to determine anticoagulation decisions in atrial fibrillation (AF) patients, including those who undergo pulmonary vein isolation (PVI), however this may not consistently occur in the real-world setting because of other clinical factors. We sought to evaluate the anticoagulation prescription patterns in AF patients 1 year PVI at our institution.

Methods:
Consecutive AF patients undergoing PVI in our prospective registry during 2014-2018 who were alive at 1-year post-PVI were studied. Anticoagulation prescription rates at this time-point were adjudicated, and correlated to CHA
2
DS
2
-VASc score, sex and maintenance of normal sinus rhythm (NSR) at 1 year.

Results:
Amongst 4596 patients undergoing PVI, mean age was 64.1±10.0 years, 3308 (71.2%) were male, and based on CHA
2
DS
2
-VASc Score anticoagulation was not indicated, can be considered and indicated in 872 (19.0%), 1183 (25.7%) and 2541 (55.3%) patients respectively. At 1-year after PVI, 3504 (76.2%) patients were on anticoagulation, and 792 (17.2%) had recurrence of AF. Anticoagulation rates by sex, CHA
2
DS
2
-VASc Score category and NSR at 1-year after PVI are illustrated in the Figure. Anticoagulation was continued in over half of AF patients without classic CHA
2
DS
2
-VASc indication particularly in those with AF recurrence and women, while they were mildly under-prescribed in those with indication, especially for those without AF recurrence and men.

Conclusion:
In a large real world cohort of patients post PVI, anticoagulation is prescribed independent of CHA
2
DS
2
-VASc score, and is affected by both sex and NSR status. Factors determining continuous anticoagulation after successful PVI may include parameters not covered in the CHA
2
DS
2
-VASc score such as return of atrial mechanical function on echocardiography, valve disease or extra-cardiac pathologies.
Abstract 9761: Risk Factors for Cardiopulmonary Resuscitation Among Acute Ischemic Stroke Admissions in the United States; An Overview From the National Inpatient Sample
Authors: Ramphul Kamleshun , Verma Renuka , Kumar Nomesh , Ramphul Yogeshwaree , Kumari Komal , Bawna fnu , Sombans Shaheen , Mejias Stephanie G , Arti Fnu , Lohana Petras , ALJAREH AMR W , tufail Muhammad Umer
Published: June 2023

Introduction:
Recent studies have shown an improvement in survival among Cardiopulmonary resuscitation (CPR) cases in several situations. However, risk factors of CPR among patients admitted for Acute Ischemic Stroke (AIS) remain uncertain.

Methods:
Our analysis used the most extensive US inpatient database, the 2019 National Inpatient Sample, to identify patients diagnosed with CPR among adults of ages 40 and more admitted with a principal diagnosis of AIS. We also queried the different cardiac arrhythmias seen in these patients. Multivariable analysis was used to find the adjusted odds ratio(aOR) of requiring cardiopulmonary resuscitation.

Results:
Our study found 1425 AIS patients requiring cardiopulmonary resuscitation, which was also more common in patients of ages 40-60 (aOR 1.168), diabetics (aOR 1.160), with heart failure (aOR 1.130), hypotension (aOR 1.932), hepatic failure (aOR 3.317), renal failure (aOR 1.856), respiratory failure (aOR 18.223), gastrointestinal hemorrhage (aOR 1.960), hyperkalemia (aOR 2.258), and hypokalemia (aOR 1.265). Smokers (aOR 0.663), Females (aOR 0.878), and those with hyperlipidemia (aOR 0.689) were less likely to need CPR. Several cardiac arrhythmias were noted among those who needed CPR, such as supraventricular tachycardia (6.0% vs. 1.4%), and ventricular tachycardia (19.6% vs. 1.6%), paroxysmal atrial fibrillation (11.9% vs. 9.7%), and ventricular fibrillation (13.3% vs. 0.1%). Finally, CPR patients were slightly younger (mean age 69.82 vs. 70.89) with a longer (mean length of stay 11.48 vs. 5.01 days) hospitalization. A higher mortality rate was also found as 1030 patients died (72.3% vs. 3.6%).

Conclusions:
We observed several significant potential risk factors for CPR among AIS patients. Further studies, strategies, and changes in protocols among AIS admissions may benefit the long-term prognosis.
Abstract 9784: All-Cause Mortality and Cardiovascular Events in Cancer Patients Undergoing Hematopoietic Stem Cell Transplantation (Kurume-CREO Study)
Authors: Morikawa Nagisa , Shibata Tatsuhiro , Nohara Shoichiro , Shibao Koudai , Fukumoto Yoshihiro
Published: June 2023

Backgrounds:
Recent advances in chemotherapy and supportive therapy have resulted in improved clinical outcomes in cancer patients undergoing hematopoietic stem-cell transplantation (HSCT). However, there is limited evidence regarding prognosis, cardiovascular (CV) events and their predictors in patients undergoing HSCT. Therefore, we investigated the predictors for all-cause death and CV events in cancer patients undergoing HSCT.

Methods:
We enrolled 490 patients with hematological malignancies (n=399) and breast cancer (n= 91) in a prospective observational cohort study (Kurume-CREO study) in Kurume University from October 2016 to February 2021. Patients were followed up every 6 months after enrollment until August 2021. Outcomes were all-cause death, CV death and non-fatal CV events, the last defined as ≧ Grade 2 cardiac or vascular events based on CTCAE (Common Terminology Criteria for Adverse Events) v4.0-JCOG version.

Results:
The mean age ± standard deviation of all study subjects was 63.7 ± 13.4 years old. Among them, 107 all-cause deaths (21.8%), 84 CV events (17.1%, 3 CV deaths) were observed during the follow-up period (median:713.5 days). In this study, 60 patients (all were patients with hematological malignancies) received HSCT. The 3-year survival rate was 63.6% (Figure 1A) and the 3-year CV event-free rate was 70.7% (Figure 1B) in 60 patients with HSCT. Age- and sex-adjusted Cox proportional hazards analysis showed that hypoalbuminemia (p=0.02), anemia (p=0.03), low platelet count (p=0.0009) and history of depression (p=0.01) were associated with all-cause mortality and non-fatal CV events were associated with receiving a second HSCT (p=0.006).

Conclusions:
Nutritional status and anemia were associated with all-cause mortality and second HSCT was a risk factor for future CV events in patients undergoing HSCT. Thus, oncologists should carefully monitor cancer patients, particularly after second HSCT, and consult with cardiologists.
Abstract 9808: Deletion of Arrdc4 Enhances Myocardial Glucose Transport and Ameliorates Ischemic Injury
Authors: Nakayama Yoshinobu , Masihuddin Aliya , Abdali Syed A , Yoshioka Jun
Published: June 2023

Cardiomyocytes depend on glycolysis instead of oxidative phosphorylation during hypoxia and utilize glucose as a primary anaerobic energy source. Cardiac glucose transport is facilitated by the expression of glucose transporters (GLUT1 and GLUT4) on the cell surface. The arrestins are a family of proteins that regulate the signaling and trafficking of different receptors and transporters on the plasma membrane. As a scaffold protein, beta-arrestins mediate endocytosis and signal termination of beta-adrenergic receptors in cardiomyocytes. However, unlike the well-characterized beta-arrestins, the physiological roles of the related proteins termed alpha-arrestins remain largely unknown in the heart. In this study, we discovered for the first time that a member of alpha-arrestins, Arrestin Domain-Containing Protein 4 (Arrdc4), functions as a regulatory scaffold protein of GLUT1 and controls cardiac glucose metabolism. We found that Arrdc4 interacts with GLUT1 and promotes its endocytosis in cardiomyocytes. Interestingly, the cardiac expression of Arrdc4 is significantly upregulated by myocardial ischemia. Arrdc4 decreases cell surface expression of GLUT1 and suppresses glucose transport in the wild-type (WT) mouse heart. Then, we generated a novel Arrdc4 knockout (KO) mouse using CRISPR/Cas9 genome editing and characterized the effects of Arrdc4 in an animal model of myocardial infarction (MI) by coronary artery ligation in vivo. Surprisingly, Arrdc4-KO mice exhibit smaller infarct size, fewer apoptotic cells, and higher left ventricular (LV) fractional shortening, resulting in better post-MI survival than WT mice. Furthermore, using the Langendorff perfusion system, we found that Arrdc4-KO hearts augment cardiac glucose transport and preserve better LV mechanical function during anaerobic perfusion than WT hearts ex vivo. These results demonstrate that Arrdc4-KO cardiomyocytes coordinately maintain the optimal expression of GLUT1 on the cell surface, which leads to a metabolic rearrangement to secure energy homeostasis under oxygen- and nutrient-limited environments. In conclusion, we identified Arrdc4 as a new adaptor protein for GLUT1 in cardiomyocytes and a key player in cardiac metabolism in the ischemic heart.
Abstract 9817: Shift Work Disrupts Circadian Rhythm and Mitochondrial Quality Control in the Heart
Authors: Rabinovich Inna , Kirshenbaum Lorrie A
Published: June 2023

Circadian mis-alignment is a disturbance in the normal 24-hour light/dark cycle that regulates physiological processes in all living organisms. Mis-alignment of the circadian, such as seen in shift workers, is associated with increased risk of ischemic heart disease and worsened outcomes following myocardial infarction. However, the mechanisms by which circadian disruption leads to cardiovascular disease, is still in its infancy. In this study, we show that short-term shift work leads to loss of critical cellular quality control mechanisms from impaired autophagy gene expression. When subjected to cardiac ischemia, shift work mice exhibit greater cardiac injury and ventricular dysfunction, compared with non-shift work control mice. Cardiac dysfunction coincided with morphological defects to mitochondria and accumulation of cellular debris from impaired autophagy. Notably, shift work mice subjected to an exercise protocol prior to ischemia, had restored autophagy gene expression, resulting in a concomitant increase in autophagic flux. Restoring autophagy rescued cardiac dysfunction and attenuated morphological and structural impairments to mitochondria. Interestingly, however, exercise failed to rescue autophagy gene expression and protect against cardiac dysfunction in Clock d19 mice which are genetically deficient for Clock gene activity. These findings demonstrate that the cardioprotective effects of exercise are in part related to improved cellular quality control mechanisms that increase autophagy. Our data provide the first direct evidence that circadian mis- alignment exacerbates cardiac injury in shift work models from impaired autophagy quality control mechanisms.
Abstract 9837: Outcomes of Thirty Day Readmission in Patients With Heart Failure on Index Hospitalization Undergoing Transcatheter Aortic Valve Replacement (TAVR): Insights From the United States Nationwide Readmission Database
Authors: Zahid Salman , Hashem Anas , Atti Varunsiri , Ullah Hameed , Salman Fnu , Rahman Mansoor , Kawsara Mohammad , Khan Muhammad Z , balla sudarshan
Published: June 2023

Introduction:
Heart failure (HF) remains one of the most common cardiac comorbidity among patients undergoing Transcatheter Aortic Valve Implantation (TAVR).

Hypothesis:
Patients with acute HF at index admission hospitalized for TAVR have worse 30-day readmission outcomes.

Methods:
We used the United States Nationwide Readmission Database to identify patients undergoing TAVR from 2015 to 2019 using ICD 10 codes.

Results:
A total of 246,211 weighted hospitalizations for TAVR were included in the analysis, out of which 83,347 (33.9%) had heart failure on index hospitalization. The median age of patients without AHF was 81 years [IQR: 75-86] and 82 years for those with AHF [IQR: 75-87], p=0.02. The burden of comorbidities in terms of chronic kidney disease, end-stage renal disease, and heart failure with reduced and preserved ejection fraction was higher for patients with AHF on index admission. Among patients who got readmitted at 30-days, readmission rate (12.3% vs. 10.4%, p<0.01) and 30-day readmission mortality (5.4% vs. 3.0% , p<0.01) were higher in patients with AHF on index admission. Similarly, patients with AHF had higher rates of acute kidney injury, cardiogenic shock, need for an Intra-aortic balloon pump, and Impella at 30-day readmissions. In terms of resource utilization, length of stay (LOS) increased by one day and the cost of re-hospitalization was higher with AHF ($9,227 vs. $8,910, p=0.01). Kaplan Meier survival curve showed reduced survival at 30-days for patients who had AHF on index admission (log-rank test p<0.01)

Conclusions:
We report worse 30-day readmission outcomes in terms of higher mortality, readmissions, and resource utilization in TAVR index hospitalizations complicated by AHF. Further studies are needed to better understand the risk predictors and interventions to prevent adverse outcomes in this higher-risk cohort undergoing TAVR.
Abstract 9847: Association of Stroke and CHADSVASc With Left Atrial Scar in Patients Undergoing Catheter Ablation for Atrial Fibrillation
Authors: Devera Justin , Kwan Wilson , Mendoza Matthew , Zadeh Andrew , Ho Ivan C , Zaman Junaid
Published: June 2023

Introduction:
Recurrent atrial fibrillation (AF) is estimated to occur in at least 20% of patients with paroxysmal or persistent AF who undergo catheter ablation (CA). Recent studies have suggested that extent of left atrial (LA) scar is of prognostic value, but it is unknown whether there is an association with patient co-morbidities.

Hypothesis:
Patients with structural heart disease or prior thromboembolic events have more LA scar and greater risk of AF recurrence.

Methods:
We retrospectively studied 117 patients who underwent CA for AF at our institution. Only ablations using the same method for radiofrequency ablation of pulmonary vein antra were included. We evaluated the association between demographic variables, LA volume, history of stroke, AF recurrence (defined as AF relapse more than 3 months after CA) and LA scar quantified by 3D electroanatomic mapping using simple regression and Kaplan-Meier analyses.

Results:
Mean age was 64 years, 68% were male, 60% had paroxysmal AF, 34% had persistent AF, and 6% had long-standing persistent AF. Recurrence of AF occurred in 22% of patients overall, and was significantly associated with systolic heart failure (HF) (p=0.042), number of prior cardioversions (CV) (p=0.014), left ventricular ejection fraction (LV EF) (p=0.02), LA volume (p=0.032), and atrial flutter (p=0.014). Total LA scar was significantly associated with CHA2DS2-VASc score (p=0.0095) and history of stroke or transient ischemic attack (TIA) (p=0.031).

Conclusion:
AF recurrence is more likely to occur in patients with LV dysfunction, prior CV, increased LA volume, and atrial flutter during CA. Total LA scar was not associated with clinical AF recurrence. However, we demonstrate a new association between LA scar burden, CHA2DS2-VASc score and history of stroke or TIA. This may explain why patients do not need to be in AF at the time they develop thromboembolic events, as enduring LA scar may contribute to the pathogenesis of stroke.
Abstract 9854: Socioeconomic Status: A Key Determinant of Cardiac Rehab Participation Among Medicare Beneficiaries
Authors: Thompson Mike P , Hou Hechuan , Daramola Temilolaoluwa , Likosky Donald S , Pagani Francis D , KETEYIAN Steven J , Sukul Devraj
Published: June 2023

Introduction:
Participation in cardiac rehabilitation (CR) is poor, with disparities across patient demographic and clinical subgroups. Lower CR participation and completion rates may be associated with patients residing in socioeconomically distressed communities.

Hypothesis:
Patients undergoing surgical and percutaneous coronary revascularization living in distressed communities have lower rates of CR participation and completion.

Methods:
Medicare beneficiaries undergoing coronary revascularization (July 2016-December 2018) were identified using 100% Medicare claims data. The primary exposure was the quintile of distressed community index (DCI), with 1st and 5th quintiles representing the least and most distressed communities, respectively. CR participation and completion were defined as attending ≥1 session and attending 36 sessions within 1 year of discharge based on CPT codes in outpatient files. Multivariable logistic regression was used to evaluate the relationship between beneficiary DCI quintile and CR participation and completion.

Results:
Among 414,730 beneficiaries, 23.4% lived in the 1st DCI quintile and 16.4% lived in the 5th quintile. Patients in the 5th DCI quintile tended to be younger, non-white, dual eligible for Medicare/Medicaid, and more comorbid. Overall, 155,872 (37.6%) patients participated in ≥1 CR session, and 45,591 (29.3%) of those patients completed all 36 sessions. CR participation decreased as DCI quintile increased, with participation 12.0 percentage-points lower in the 5th vs 1st DCI quintile (Table). There were no significant differences in completion of 36 sessions across DCI quintiles.

Conclusions:
CR participation was significantly lower in more socioeconomically distressed communities, but there were no differences in completion rates. Strategies to reduce disparities in CR participation in distressed communities should focus on barriers to initial enrollment after qualifying events.
Abstract 9858: Trends in Lipid-Lowering Prescriptions by Statin Intensity — United States, 2017-202
Authors: Sekkarie Ahlia , Park Soyoun , Therrien Nicole L , Jackson Sandra , Woodruff Rebecca , Attipoe-Dorcoo Sharon , Yang Peter , Sperling Laurence , Loustalot Fleetwood V , Thompson-Paul Angela M
Published: June 2023

Introduction:
Almost 30% of US adults have elevated low-density lipid cholesterol (LDL-C) increasing their risk of atherosclerotic cardiovascular disease (ASCVD). The 2018 American College of Cardiology/American Heart Association Multisociety Cholesterol Guideline recommends maximally tolerated statin for those at increased ASCVD risk and add-on therapies (ezetimibe and PCSK9 inhibitors) for those at very high risk with LDL-C≥70 mg/dl, but prescription fill trends are unknown.

Methods:
Using the IQVIA Total Patient Tracker database (covering ~93% of outpatient retail prescriptions in the US) from Q1 2017–Q1 2022, we determined counts of patients who filled low-, moderate-, or high-intensity statins alone and with ezetimibe or PCSK9 inhibitors. Overall percent change and joinpoint regression were used to assess trends.

Results:
From Q1 2017–Q1 2022, patients filling any statin intensity increased 25% with the greatest increase in high-intensity statins (64.1%). Concurrent fills of high-intensity statin and ezetimibe rose 210%, with an increase in slope by Q2 2019 for all statin intensities (p<0.001, Figure A). Patients filling a PCSK9 inhibitor and all statin intensities increased over the study period (2124% for high-intensity), with increases in slope in Q2 2019 and continued increase in fills but less sharp rise in Q1 2020 (p<0.001, Figure B).

Conclusions:
Increasing prescription fills of high-intensity statins and add-on ezetimibe and PCSK9 inhibitors indicate uptake of guideline-concordant lipid-lowering therapies for cardiovascular disease prevention. There is need for continuity of PCSK9 inhibitor therapy which may have been disrupted during COVID-19.
Abstract 9859: Randomized Comparison of Bare Metal Stents Plus Colchicine vs Drug Eluting Stents: Preliminary Analysis of the Orca Trial (Oral Colchicine in Argentina)
Authors: Rodriguez-Granillo Alfredo Matias M , Correa Sadouet Camila , Mieres Juan , fernandez-Pereira Carlos , Cristodulo Roberto , Pavlovsky Hernan , Curotto Valeria , Swieszkowski Sandra , MILEI JOSE , Barbagelata Alejandro , Kastrati Adnan , Rodriguez Alfredo E
Published: June 2023

Background:
The use of colchicine has been associated with reduction of adverse cardiac events in patients with coronary artery disease (CAD). The role of this drug after percutaneous coronary intervention (PCI) with bare metal stents (BMS) has not been evaluated against isolated PCI with drug eluting stents (DES).

Aim:
The study was designed to test an improved cost-effectiveness with BMS plus colchicine (group BMS+C) compared to DES alone (group DES), provided its noninferiority in terms of major adverse cardiac events (MACE) at 1 year.

Methods:
This is a prospective, multicenter, randomized controlled trial performed in 4 centers. The trial has been registered at clinicaltrials.gov (NCT04382443). Study protocol and informed consent have been approved by an Independent Ethical and Review Board Committee and were presented to Argentina National regulatory authorities for Health, Technology and Medications. Patients in the BMS+C group received 0.5mg oral doses twice a day of colchicine for 3 months. Outpatient visits were scheduled at 1, 3, 6 and 12 months as well as at 3 and 5 years. Primary endpoints were to compare cost-effectiveness and MACE defined as composite of death, myocardial infarction (MI), cerebrovascular accident and ischemia-driven target vessel revascularization.

Results:
During February 2020 to April 2022, 412 patients with clinically indicated PCI were randomized in the study. Because 2 patients with COVID 19 at the time of randomization were excluded, the final study population was composed of 410 patients (205 patients in each group). Baseline demographic and angiographic characteristics were well balanced diabetes 19.5% vs 21.4%, Acute Coronary Syndromes 78% vs 75%, ST elevation MI 23% vs 21% multiple vessel CAD 44% vs 46%, culprit left anterior descending artery 58% vs 57.8%, peripheral vascular disease 3.4% in BMS+C and DES groups respectively.2.9% of patients in BMS+C didn’t complete the treatment for side effects (diarrhea). Presently, patients were follow at mean of 381 days ( range 45 to 839),1 -year follow-up was completed in 61%.

Conclusion:
A 3-month treatment with colchicine after PCI with BMS was feasible and safe. Final 1-year clinical outcomes and cost-effectiveness results will be available at the time of presentation.
Abstract 9865: Acute Infarcts on Brain MRI Following Aortic Arch Repair With Circulatory Arrest: Insights From the ACE Cardiolink-3 Randomized Trial
Authors: Chen Chih-Hao , Peterson Mark D , Hibino Makoto , Mazer David , Chu Michael W , dagenais francois , Teoh Hwee , Quan Adrian , Dickson Jeffrey , Verma Subodh , Smith Eric E
Published: June 2023

Introduction:
Our objective was to investigate the frequency and distribution of new ischemic brain lesions detected by diffusion-weighted imaging (DWI) on brain MRI after aortic arch surgery.

Methods:
This was an imaging sub-analysis of the ACE CardioLink-3 randomized controlled trial which compared the safety and efficacy of innominate vs axillary artery cannulation during elective proximal aortic arch surgery. All participants in the trial underwent pre- and post-operative MRI. New ischemic lesions were defined as lesions on post-operative DWI that were not visible on the pre-operative DWI.

Results:
Of 102 patients who underwent surgery, 71 (70%) had new ischemic lesions on DWI and the total lesion number across all participants was 391. The average lesion number in patients with at least one ischemic lesion was 5.5±4.9, and were similar in the right (3.3±2.7) or left (3.6±2.8) hemispheres (p=0.49). The most common lesion patterns were single or multiple cortical infarcts. Half of the lesions (n=183, 47%) were in the middle cerebral artery territory, while 24% were in the infratentorium. 42% of patients had lesions distributed in both anterior and posterior circulation, 21% in anterior circulation only, and 7% in posterior circulation only. Besides, 20% had lesions in watershed areas. There were no differences in distribution between patients in the innominate vs axillary artery cannulation groups. In multivariable regression models, more severe white matter hyperintensity on pre-operative MRI (odds ratio per 1-score increase of Fazekas scale 1.80; p=0.02) and lower nadir temperature during operation (odds ratio per 1°C decrease, 1.14; p=0.05) were associated with having any new ischemic lesion, while older age (risk ratio per 1-year increase 1.02; p=0.03) and lower nadir temperature (risk ratio per 1°C decrease, 1.06; p=0.06) were associated with higher lesion numbers.

Conclusion:
In patients who underwent elective proximal aortic arch surgery, new ischemic brain lesions were common, and mostly identified as scattered cortical infarcts in the middle cerebral artery territory. Advanced age, underlying small vessel disease, and lower nadir temperature during operation were risk factors of presence and burden of new ischemic lesions after surgery.
Abstract 9867: Does Pain at Hospital Discharge Predict Transition From Hospital to Home and 12-month Mortality Among Patients With Heart Failure?
Authors: Smith Asa B , Jung Miyeon , Pressler Susan J
Published: June 2023

Introduction:
Pain is present in 37%-68.9% of hospitalized patients with heart failure (HF), but little is known about how pain at discharge influences transition from hospital to home or 12-month mortality. The aims were to examine if pain at discharge predicts 1) return to home status and 2) 12-month mortality among hospitalized patients with HF.

Methods:
In this prospective study, data were obtained from a dataset of 1,475 patients with HF hospitalized at 3 tertiary-care hospitals from 2009-2017. Pain at discharge (yes/no) was obtained from medical records using ICD-9 or ICD-10 codes. Return to home status (yes/no) and all-cause 12-month mortality were obtained from medical records. Descriptive statistics, independent samples t-tests, and χ
2
were used to describe the sample. Logistic regression was computed to address the aims.

Results:
The sample was 59.5% women and 40.5% men. The mean age was 68.6 (SD 13.6) years. Race was 53.6% Black and 46.4% White. Of 1,475 patients, 239 (16.2%) had pain documented at discharge. Patients with pain documented at discharge were younger compared to patients without pain (p<.001). One hundred sixty-five of 239 patients (69.0%) with pain and 831 of 1,236 patients (67.2%) without pain returned to home (χ
2
=0.297, p=.585). At 12 months after discharge, 20 of 239 patients (8.4%) with pain had died compared to 134 of 1,236 patients (10.8%) without pain (χ
2
=1.31, p=.252). In logistic regressions, pain at hospital discharge was not a statistically significant predictor of return to home status or 12-month mortality (Table 1).

Conclusions:
Over 30% of patients with HF did not return to home after hospitalization. Patients with HF have significant transitional care needs, including pain management. Future studies are needed to determine the phenotypes of pain among patients with HF, evaluate associations between pain at discharge and transitional care needs, and design innovative strategies to ameliorate pain.
Abstract 9916: Prognostic Value of Simultaneous Analysis With Myocardial Flow Reserve and Right Ventricular Strain by Hybrid
13
N-ammonia Positron Emission Tomography/Magnetic Resonance Imaging in Coronary Artery Disease
Authors: Endo Keiichiro , Kiko Takatoyo , Yamakuni Ryo , Misaka Tomofumi , Yamaki Takayoshi , Nakazato Kazuhiko , Fukushima Kenji , Takeishi Yasuchika
Published: June 2023

Introduction:
Myocardial flow reserve (MFR) derived from
13
N-ammonia positron emission tomography (PET) is used to predict adverse cardiac events in the patients with coronary artery disease (CAD). Right ventricular (RV) strain measured by magnetic resonance imaging (MRI) is used to evaluate RV function. This study aimed to evaluate the prognostic value of combined MFR and RV strain measured by hybrid
13
N-ammonia PET/MRI in patients with CAD.

Methods:
Sixty-one patients who underwent
13
N-ammonia PET/MRI were enrolled. MFR was calculated from dynamic acquisition of
13
N-ammonia PET under vasodilator stress with intravenous injection of adenosine. RV global longitudinal strain (GLS) was measured by wall motion tracking techniques in cine-mode MRI. The end points were defined as a composite of all-cause death, myocardial infarction, sustained ventricular arrhythmia, hospitalization due to decompensated heart failure, and revascularization.

Results:
At a follow-up of 2.8 ± 1.9 years, 21 events occurred. Kaplan-Meier analysis showed that the event-free rate was significantly lower in the group with MFR < 1.80 than that with MFR ≥ 1.80 (P < 0.001, Figure a). Additionally, the event-free rate was significantly lower in the group with RVGLS > –18.22% than that with RVGLS ≤ –18.22% (P = 0.025, Figure b). After dividing the patients into four groups by the median MFR and the median RVGLS, the event-free rate was lowest in the combined group of MFR < 1.80 and RVGLS > -18.22% than any other groups (P < 0.001, Figure c). In the Cox proportional hazard analysis, MFR and RVGLS were independent predictors of cardiac adverse events in the patients with CAD.

Conclusion:
The simultaneous assessment of MFR and RV strain by
13
N-ammonia PET/MRI revealed the feasibility of precise risk stratification for cardiac events in patients with CAD.
Abstract 9925: Patient-Reported Treatment Satisfaction in Etripamil-Mediated Conversion of Supraventricular Tachycardia to Sinus Rhythm: Results From the NODE-301 Study
Authors: Ip James E , Stambler Bruce S , Plat Francis , Coutu Benoit , Mondesert Blandine , Verma Atul , Shardonofsky Silvia , Camm Alan J
Published: June 2023

Introduction:
Etripamil is a fast-acting, intranasally administered non-dihydropyridine, L-type calcium channel blocker in development for medically unsupervised self-administration to treat AV nodal-dependent paroxysmal supraventricular tachycardia (PSVT). The objective of this analysis was to compare patient-reported effectiveness and relief of symptoms for patients whose PSVT terminated (converters) versus non-converters within 10 and 30 minutes of etripamil treatment.

Methods:
NODE-301 (NCT03464019) is a randomized, double-blind, placebo-controlled phase 3 study. Patients self-administered the study drug (etripamil 70 mg) or placebo intranasally in response to a perceived SVT episode and were then monitored for 5 hours. Perceived treatment effectiveness was assessed via the Treatment Satisfaction Questionnaire for Medication 9 (TSQM-9) effectiveness domain and patient-reported relief of symptoms was assessed by item 2. Converters and nonconverters were compared via 2-way ANOVA.

Results:
Of 107 patients who self-administered etripamil in response to a positively adjudicated SVT episode, 34 (32%) converted to sinus rhythm within 10 minutes, and 56 (54%) converted within 30 minutes. For both time points, converters had significantly higher mean TSQM domain scores for drug effectiveness and symptom relief compared with nonconverters (
Table
;
P
<0.001).

Conclusion:
Patients with PSVT who self-administered etripamil in response to an SVT episode reported higher effectiveness and better symptom relief when their episode was resolved within the first 10 and 30 minutes of the 5-hour monitoring period.
Abstract 9927: Insufficient Monitoring and Inaccurate Evaluation Characterize the Heart Failure Symptom Perception Process
Authors: Lee Solim , Nolan Amy , Guerin Julie , Koons Brittany , Matura Lea Ann , Jurgens Corrine Y , Dickson Victoria V , Riegel Barbara
Published: June 2023

Perceiving symptoms is needed before one can respond to symptoms, but little is known about the difficulties experienced by patients with heart failure (HF) as they engage in the complex processes of symptom monitoring, awareness, and evaluation.

Aim:
To explore difficulties in symptom perception and describe the characteristics of patients who consistently perceive HF symptoms.

Methods:
Using a convergent mixed methods design, we enrolled a purposeful sample of 40 adults with an unplanned hospitalization for HF symptom exacerbation. Quantitative data were obtained from the electronic health record and the Self-Care of Heart Failure Index (SCHFI v 7.2, scale scores 0-100, higher score = better self-care). Qualitative data from 1:1 semi-structured interviews exploring the symptom perception process were analyzed using directed content analysis. For data integration, individual difficulties in the SCHFI symptom perception processes of monitoring, awareness, and evaluation were anchored on the qualitative data. Two groups with different symptom perception consistency were identified from interviews. Group differences were examined using independent T, Mann-Whitney,

Chi
2

, and Fisher’s Exact tests.

Results:
The sample was 50% male, 45% non-white, mean age 62 years, and 75% NYHA III-IV. Most (72.5%) demonstrated adequate symptom perception (SCHFI score ≥70). The consistent symptom perception group (n=27, 67.5%) had no difficulties in symptom monitoring, awareness, and evaluation while the inconsistent group reported insufficient symptom monitoring and/or inaccurate symptom evaluation. The consistent group was more experienced with HF and visited the emergency department more frequently in the past year. There were no group differences in age, gender, race, NYHA class, and HF stage (Table 1).

Conclusion:
Symptom perception interventions may be particularly useful early in the HF trajectory to enhance symptom monitoring and evaluation abilities.
Abstract 9928: Risk Stratification for Amputation in Patients With Symptomatic Peripheral Artery Disease After Lower Extremity Revascularization: Insights From VOYAGER PAD
Authors: King R. Wilson , Nehler Mark R , Patel Manesh R , Debus Sebastian , Anand Sonia S , Canonico Mario Enrico , Buchanan Cullen , Capell Warren , Hess Connie N , Ycas Joseph , Hsia Judith A , Muehlhofer Eva , Haskell Lloyd P , Berkowitz Scott D , Bauersachs Rupert , Bonaca Marc P
Published: June 2023

Introduction:
Amputation is a severe consequence of peripheral artery disease (PAD), and systems for risk stratification have been developed. The performance of these systems in trials of PAD patients after successful lower extremity revascularization (LER) and receiving modern medical therapies has not been well described.

Hypothesis:
Risk of amputation is associated with the Rutherford Chronic Limb Ischemia class as well as the wound, ischemia, and foot infection (WIfI) grade in patients with PAD after LER.

Methods:
Patients in the VOYAGER PAD trial were assigned a Rutherford class at baseline and follow up. A WIfI score was assigned by 2 vascular specialists blinded to outcome and treatment allocation. Incidence of the composite of first major or minor amputation through 3 years were calculated by risk group.

Results:
Of 6,564 randomized, Rutherford was available in 6543 and WIfI in 6471. Due to the trial’s inclusion criteria, no Rutherford 6/WIfI high risk were included. Despite successful LER, there was a stepwise increase in the risk of amputation (p<.001) with increasing baseline Rutherford classification (Figure 1A) with incidence at 3 years of 22.4% in Rutherford 5. Risk was also associated with WIfI (Figure 1B); however, those classified as “very low” risk still a 15% incidence of amputation. When stratified by diabetes mellitus (DM), those with DM were at higher risk in all WIfI classes. Those with DM classified as "very low" risk had a higher incidence of amputation than patients without DM stratified as “moderate risk”.

Conclusions:
In a large clinical trial of patients with symptomatic PAD post successful LER, high incidences of amputation were observed despite contemporary medical therapies. In patients eligible for the study, Rutherford and WIfI both stratify risk; however, those with WIfI “very low” risk still had high incidences of amputation. Risk in those with DM was higher in each WIfI class suggesting that this could be considered in risk stratification.