bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 10604: Critical Role of Cardiac Imaging of Mechanical Complication in ST Elevation Myocardial Infarction: Left Ventricular Free Wall Rupture Diagnosed With CTA and Echocardiography
Authors: Lombardo Caroline , Lee Christopher , Choi Eunjung , Kuhlman Heather , Taub Cynthia C , Henkin Stanislav , Costa Salvatore P
Published: June 2023

Case Presentation:
An 81-year-old male with a thymoma (treated with surgery including partial pericardiectomy 25 years prior) presented to his local ER with chest pain radiating to his back. Vital signs were stable. EKG showed ST elevations in the lateral leads with Q waves. Troponin was positive. Diagnosis included STEMI as well as possible aortic dissection. CT angiography (CTA) did not show dissection; however, contrast extravasation and left ventricular (LV) free wall rupture was noted. Patient was not given thrombolysis and transferred for tertiary care. On arrival, the patient was pain free, hemodynamically stable, and an echo was obtained. Color Doppler and echo contrast confirmed a LV outpouching along the lateral wall with a “narrow neck” consistent with a pseudoaneurysm (PsA, figure 1). CT surgery declined an emergent operation due to the high risk of mortality with early operative intervention and recommended initial conservative management. After 48 hours, a repeat CTA showed increased size of the PsA (figure 2). The patient chose to be managed medically and eventually passed away 8 days after presentation.

Discussion:
This patient had a contained LV rupture as a STEMI complication. The CTA showed LV rupture and thrombolysis was avoided. Echo confirmed the diagnosis. This case highlights 1) the utility of imaging in in the diagnosis of LV rupture as it is usually limited by early mortality, and 2) its role in differentiating PsA from true aneurysm, which is characterized by a contained wall rupture while true aneurysms develop due to a weakened, but intact, wall.
Abstract 10605: Percutaneous Debulking of Tricuspid Valve Endocarditis in Severe Covid-19 Pneumonia After Prolonged Advanced Life Support: A Case Series
Authors: Morton Kara F , Heindl Brittain F , McElwee Samuel , Litovsky Silvio , Ahmed Mustafa I , Clarkson Stephen
Published: June 2023

Background:
Over the past two years, the utilization of venovenous extracorporeal membrane oxygenation (VV-ECMO) for the treatment of coronavirus disease 2019 (Covid-19) acute respiratory distress syndrome (ARDS) has increased. While supporting respiratory function, VV-ECMO requires large-bore indwelling venous cannulas which risk bleeding and infections, including endocarditis.

Case Summary:
We describe the cases of a 48-year-old female and 39-year-old male patient hospitalized for Covid-19 pneumonia who developed ARDS and right ventricular failure, requiring VV-ECMO and Protek Duo cannulation. The female patient was decannulated from VV-ECMO after 123 days, but subsequently developed a segmental pulmonary embolism and tricuspid mass measuring 6.4 x 5.5 x 0.5 cm (fig A). After 116 days of VV-ECMO support, the male patient developed a tricuspid valve vegetation measuring 1.4 x 1.1 cm (fig B) with an adjacent right atrial component measuring 2.1 x 1.3 cm. The Inari FlowTriever system was used to percutaneously remove both the pulmonary embolism from the female patient and the tricuspid masses from both patients. Pathological examination of the mass from the female patient demonstrated
Candida albicans
endocarditis in the setting of
Candida
fungemia (fig C). Pathologic examination of the specimens from the male patient demonstrated endocarditis consistent with
Pseudomonas aeruginosa
in the setting of
Pseudomonas
bacteremia (fig D). Both patients experienced resolution of fungemia and bacteremia after percutaneous vegetation removal, and after prolonged hospital courses were discharged with supplemental oxygen.

Discussion:
VV-ECMO and right ventricular support devices are invasive and associated with bloodstream infection and infective endocarditis. Percutaneous debulking of valvular vegetations, associated with these right-sided indwelling catheters, may be an effective method of source control to prevent progression to valve surgery.
Abstract 10642: Hemodynamics One Year Post Pediatric Heart Transplant Are Associated With Pre-Transplant Variables and Correlate With Mortality
Authors: Tadros Hanna John J , Denfield Susan W , Qureshi Athar , Hope Kyle , Puri Kriti , Price Jack , Tunuguntla Hari P , Choudhry Swati , Adachi Iki , Dreyer William , Spinner Joseph
Published: June 2023

Background:
Hemodynamics (HDS) after pediatric heart transplant (PHT) are understudied and may predict future outcomes. We sought to identify variables associated with normalization (NML) of HDS in the 1
st
year post-HT and determine association with post-HT outcomes.

Methods:
HDS were collected from patients who underwent HT between 2013-2020 without a history of pre-HT mechanical support and with at least 3 catheterizations in the 1st year post-HT. NML was defined as 2 consecutive catheterizations with pulmonary vascular resistance index (PVRi) < 3Wu/m
2
, cardiac index (CI) > 2.5L/min/m
2
, and pulmonary wedge pressure (PCWP) <12 mmHg. Freidman repeated measure was used to assess HDS over time and Cox regression associations with NML and long-term mortality.

Results:
Among 97 patients included, PCWP decreased, CI increased, and PVR remained stable over the 1
st
year post-HT (Figure 1A). Only 50% (n=47) had NML by 1 year. Median time to NML was 181 days (IQR 355). Mean PCWP and PVR over the 1st year were higher in non-NML vs NML patients (13.3 vs. 10.8, p<0.001; 2.2 vs. 1.8, p=0.024). On multivariate analysis, patients with retransplant (HR 2.91, p<0.001) and normal HDS at the 1
st
post-HT catheterization (HR 4.08, p<0.001) were more likely to have NML, while those with pre-HT congenital heart disease (HR 0.46, p=0.043) were less likely (Table 1/Figure 1B). NML by 1 year-post-HT was not associated with long-term mortality (p=0.794), but lower CI (HR 0.10, p=0.048) and higher PCWP (HR 1.44, p=0.006) at 1 year post-HT were associated with mortality.

Conclusion:
Only half of PHT recipients have NML of HDS at 1-year post-HT. The CI and PCWP at 1 year post-HT correlated with long-term mortality.
Abstract 10678: Structural and Functional Changes of the Right Ventricle in Sprague Dawley and Wistar Rat Models of Pulmonary Arterial Hypertension
Authors: Neves Liomar A , Rosas Paola C , Wang Hongjian , Senese Peter B , Gralinski Michael R
Published: June 2023

Introduction:
Assessment of right ventricle (RV) function and structure are essential to determine the efficacy of new PAH drugs preclinically. This study compared RV function, structure, and hemodynamics in response to monocrotaline (MCT) in Sprague Dawley (SD) and Wistar rats.

Methods:
SD and Wistar rats (194-243 g) were administered either 0.9% NaCl or MCT (60 mg/kg) on Day 0. On Day 23, RV function and structure were evaluated by echocardiography. On Day 24, RV pressure-volume relations were assessed, and heart and lung weights were collected.

Results:
MCT treatment resulted in dilated RV hypertrophy in both strains, but the magnitude of changes were different between strains. RV internal diameter during diastole (61%, p=0.0003) and systole (67%, p=0.001), RV end-diastolic (51%, p<0.0001) and systolic (80%, p<0.0001) area were greater in MCT/SD than MCT/Wistar. MCT/SD also showed increased right atrial area (110%, p=0.0002) vs. MCT/Wistar. Due to increased load, MCT/SD tended to develop a thicker RV free wall (22%, p>0.05) than MCT/Wistar. Systolic dysfunction was observed with MCT treatment in both strains; however, the MCT/SD showed a greater decrease in RV fractional area change (-51%, p=0.009) than MCT/Wistar. The tricuspid annular velocity and annular plane systolic excursion were slightly decreased in MCT/SD compared to MCT/Wistar (p=NS). RV catheterization showed similar MCT-induced increases in RV end systolic and diastolic pressures in both strains. However, the decrease in cardiac output was more pronounced in MCT/SD (-30%, p<0.0001) than in MCT/Wistar. Increase in RV weight normalized by tibia length (RV/TL) and Fulton’s Index was observed with MCT treatment; but the degree of hypertrophy was more pronounced in MCT/SD (57% RV/TL and 37% Fulton’s Index) than MCT/Wistar.

Conclusions:
Our results showed that while similar hemodynamic changes were observed in SD and Wistar rats in response to MCT, the magnitude of dilated RV hypertrophy and systolic impairment was exacerbated in SD vs. Wistar rats.
Abstract 107: Systemic Allogeneic Mesenchymal Stem Cell Administration Does Not Attenuate Early Post-resuscitation Brain Injury Or Inflammation In A Porcine Model Of Cardiac Arrest
Authors: Tajlil Arezou , Zel Rosy , Wadhwani Alexandra , Nsumbu Dorcas , Young Rebeccah , Weil Brian R
Published: June 2023

Introduction:
Based on emerging evidence that systemic inflammation exacerbates post-resuscitation organ injury, we recently tested the efficacy of allogeneic mesenchymal stem cell (MSC) administration early after return of spontaneous circulation (ROSC) in a porcine model of cardiac arrest (CA). Initial results indicate that MSCs attenuate post-ROSC cardiac dysfunction, but it is unclear if these protective effects extend to the brain. Accordingly, we aimed to determine if systemic allogeneic MSCs reduce early post-ROSC brain injury and inflammation in swine.

Methods:
Swine (n=33) were subjected to 10 min CA followed by mechanical CPR with defibrillation and epinephrine (EPI; 0.015 mg/kg iv). Animals that achieved ROSC (n=19) were blindly randomized to intra-arterial saline (n=9) or allogeneic bone marrow-derived MSCs (55±2 x 10
6
; n=10) 30 min post-ROSC. Blood sampling was performed for 4 hours post-ROSC to quantify serum neurofilament light chain (NFL) levels, after which brain tissue was collected for post-mortem quantification of regional neuronal injury (H&E), activated microglia (IBA-1), and inflammatory gene expression (PCR) vs. healthy control swine (n=8).

Results:
Animals resuscitated from CA exhibited a significant increase in neuronal injury throughout the brain vs. controls that was not affected by MSC treatment (
A
). Similarly, the post-ROSC rise in serum NFL was not different between saline-treated and MSC-treated animals (2.5±0.6 vs. 2.5±0.8 fold-change vs. baseline; p=0.94). A significant increase in activated microglia (
B
) and inflammatory gene expression (
C
) was observed throughout the brain in both CA groups vs. healthy controls, with particularly prominent changes in the striatum but no notable differences between treatment groups.

Conclusions:
Despite favorable effects on the heart, systemic allogeneic MSC therapy after ROSC does not significantly affect early markers of brain injury and inflammation in a porcine model of CA.
Abstract 10715: Therapeutic Efficacy of Drpitor1a, a Novel Dynamin-Related Protein 1 (DRP1) Inhibitor, in Preclinical Pulmonary Arterial Hypertension
Authors: Wu Danchen , Jansen-van Vuuren Ross D , Das Gupta Asish , Chen Kuang-Huieh , Al-Qazazi Ruaa , Martin Ashley , Breault Nolan M , Mewburn Jeffrey D , Lima Patricia D , Jones Oliver , Archer Stephen L
Published: June 2023

Introduction:
Dynamin-related protein 1 (DRP1) is a large GTPase that mediates mitotic fission (the division of mitochondria which is coordinated with mitosis, ensuring equitable distribution of mitochondria to daughter cells). In pulmonary arterial hypertension (PAH) pulmonary artery smooth muscle cells (PASMC), mitotic fission, and DRP1 activity are increased, contributing to its hyperproliferative phenotype. We investigated the therapeutic efficacy of Drpitor1a, a novel, small molecule, Drp1 GTPase inhibitor, in a rat PAH model.

Methods:
A single dose of monocrotaline (MCT, 60mg/kg, SC) or PBS was injected to female Sprague-Dawley rats on day 0 (n=20 for MCT and n=15 for PBS). On day 14, the development of PAH was confirmed by echocardiography and the rats were randomized for treatments. An indwelling catheter was implanted through the left jugular vein on day 15. Drpitor1a (1mg/kg) or normal saline (NS) was administered by IV every 48 hours from day 17 to day 27. Right ventricular (RV) structure and function were assessed on day 28 with echocardiography. Pulmonary hemodynamics was evaluated on day 29 using right heart catheterization (RHC).

Results:
MCT rats developed PAH with RV dysfunction on day 14. There was no statistical difference between the Drpitor1a and NS groups at randomization. At the endpoint, MCT+Drpitor1a rats, vs. MCT+NS rats, had a significantly reduced severity of pulmonary hypertension evident as longer pulmonary artery acceleration time (PAAT) and lower pulmonary vascular resistance index. Drpitor1a also improved RV function, evident as greater RV free wall thickening (RVFWT%), increased tricuspid annular plane systolic excursion (TAPSE), and increased cardiac index (CI). Drpitor1a regressed pulmonary artery medial thickening and inhibited RV hypertrophy without hepatological, renal or hepatic toxicities.

Conclusion:
Drpitor1a is a safe and effective treatment for preclinical PAH.
Abstract 10740: Effects of Renin-Angiotensin-Aldosterone-System Inhibitors on Coronary Atherosclerotic Plaques: Results From the Paradigm Registry
Authors: Williams Curtis , Han Donghee , Takagi Hidenobu , Fordyce Christopher , Sellers Stephanie , Blanke Philipp , Lin Fay Y , Al-Mallah Mouaz H , Budoff Matthew J , Cademartiri Prof. Dr. Filippo , Chinnaiyan Kavitha M , Conte Edoardo , Marques Hugo , Gottlieb Ilan , Hadamitzky Martin , Shin Sanghoon , Lee Byoung Kwon , Virmani Renu , Samady Habib , Choi Jung Hyun , Berman Daniel , Narula Jagat , Bax Jeroen J , Leipsic Jonathon , Chang Hyuk-Jae
Published: June 2023

Introduction:
Coronary CT Angiogram (CCTA) has become a powerful tool in the diagnosis and risk stratification of coronary artery disease (CAD), but can also provide unique insight into the effects of pharmacotherapy on the progression of atherosclerosis. Although Renin-Angiotensin-Aldosterone-System (RAAS) inhibitors are indicated in patients with stable CAD, their impact on the progression of coronary atherosclerosis is unclear.

Methods:
We performed a prospective, multinational study consisting of a registry of patients without history of CAD who underwent serial CCTAs at an interscan interval of >2 years. Patients taking RAAS inhibitors were propensity matched to RAAS inhibitor naïve patients based on clinical and CCTA characteristics at the baseline. Atherosclerotic plaques in CCTAs were quantitatively analyzed for percent atheroma volume (PAV) according to plaque composition (necrotic core, fibro-fatty plaque, fibrous plaque, and calcium) using predefined Hounsfield unit thresholds.

Results:
Of 1,248 patients from the registry, 299 RAAS inhibitor taking patients were matched to 299 RAAS inhibitor naïve patients. Over a median interval of 3.9 years, there was no significant difference in annual progression of total PAV between RAAS inhibitor naive vs taking patients (0.75 vs 0.79 %/year,
p
= 0.66), nor was there any difference in the progression of necrotic core (-0.02 vs 0.002 %/year,
p
= 0.09), fibrofatty plaque (-0.03 vs.0.05 %/year,
p
= 0.67), fibrous plaque (0.29 vs 0.25 %/year,
p
=0.91), or calcified plaque (0.51 vs. 0.51 %/year,
p
= 0.37).

Conclusions:
Within this cohort of patients, the use of RAAS inhibitors over a period of nearly 4 years did not have a measurable impact on progression of total atherosclerotic plaque or any plaque subtypes assessed by CCTA. These results suggest that the benefit of RAAS inhibition is independent of an effect on coronary plaque progression.
Abstract 10774: An Ambulatory Syncope Service is a Safe Pathway to Reduce Hospital Admissions
Authors: Wang Brian X , Reddy Rohin , Gothandaraman Balaji
Published: June 2023

Introduction:
Syncope affects up to 50% of people during a lifetime and is a common presentation to Emergency Departments (EDs). The Ambulatory Emergency Care Unit (AECU) Syncope pathway was established at our institution as a route by which low-risk patients presenting with syncope can undergo investigations without requiring hospital admissions as well as reducing length of stay for patients awaiting cardiology input.

Hypothesis:
The AECU Syncope pathway at Northwick Park Hospital, London, UK is safe and effective in reducing hospital admissions.

Methods:
We conducted a retrospective study of patients seen via the AECU Syncope pathway in 2020. These were referrals from the Emergency Department, General Practice and Inpatient departments for 24-hour tapes and echocardiograms.

Results:
A total of 221 patients were referred to the AECU syncope pathway in 2020. Of these, 36 patients (16%) had abnormalities on 24-hour tape. The majority were ectopics (n=12) but patients were also found to have arrhythmias (n=10), bradycardia (n=8) and heart block (n=6). 10 patients had aortic valve dysfunction identified on echocardiogram: 4 had severe aortic stenosis and the rest had milder classifications of aortic valve dysfunction. In total, 42 of the 221 patients had an abnormality on echocardiogram and/or 24-hour tape. Of these 42 patients, 14 were discharged as their abnormalities were insignificant for further cardiology input. 28 were referred to cardiology clinic for review as an outpatient. In terms of readmissions, 6 patients had readmissions within 30 days but only 1 patient had a readmission attributed to syncope, and this was a presyncope episode for which the patient was safety netted for during the previous admission. There were no deaths reported within 30 days of presentation. Within 1 year, there were 2 deaths, but neither were attributed to a major adverse cardiovascular event.

Conclusions:
The AECU syncope pathway presents a viable, efficient and safe route by which low-risk patients who are under investigation for a presumed syncopal episode can receive cardiology input without requiring a prolonged hospital admission. In doing so, there is a significant benefit to hospitals by reducing strain on bed space and staffing, thereby improving patient flow.
Abstract 10776: A Supervised Classification Model Detects Fontan Patients Based on Clinical Notes With Higher Accuracy Than ICD Codes
Authors: GAO YUTING , AL-GARADI MOHAMMED A , Book Wendy M , Ivey Lindsey , Rodriguez Fred H , Raskind-Hood Cheryl L , SARKER ABEED
Published: June 2023

Introduction:
The Fontan operation palliates single ventricle heart defects. As native anatomy varies, Fontan cases cannot always be identified by ICD9 or 10CM codes.

Hypothesis:
We sought to train and evaluate a supervised machine learning (ML) system to identify Fontan cases based on unstructured clinical notes in a large database.

Methods:
160 adult Fontan patients from validated clinical data at a single tertiary referral center with available text notes were studied. The imbalanced data set had more non-Fontan cases than Fontan patients; thus we created multiple datasets with different positive : negative case ratios ranging from 1:2 to 1:10. We used stratified 80-20 training-testing splits of data. Vectorized representations of text notes were used as features. We trained a Support Vector Machine (SVM) model, mostly used for text classification, to identify Fontan cases from notes. For each dataset, we performed random 80-20 data splitting 10 times and reported average F
1
score (harmonic mean of recall/sensitivity & precision/positive predictive value) over the positive class.

Results:
The model achieved a mean F
1
score of 0.95 for the positive class on the data split with 1:2 positive-negative ratio. Increasing data imbalance from 1:2 to 1:10 did not substantially impact performance. The mean F
1
score over all data splits was 0.94, and SD 0.01. We also computed precision, recall, and F
1
score of ICD codes to identify Fontan patients. Performance comparisons between ICD codes only and Natural Language Processing (NLP)/ML are in Table 1.

Conclusions:
A supervised classification model more effectively detects Fontan patients based on clinical notes with higher accuracy than ICD codes. The model is robust and insensitive to data imbalance. Findings suggest our model may work effectively in real-world data. Since the sensitivity of ICD codes is high but PPV is low, it may be beneficial to apply ICD codes as a filter prior to applying NLP/ML to improve performance.
Abstract 10864: Reduction in Right Ventricular Strain is Associated With Increased Mortality in Acute Pulmonary Embolism
Authors: Eguchi Shunsuke , Pfeiffer Michael , Peterson Brandon , Ruzieh Mohammed , Gao Zhaohui , Boehmer John , Gorcsan John , Wilson Ryan
Published: June 2023

Introduction:
Right ventricular (RV) systolic dysfunction has been identified as a prognostic marker for adverse clinical events in patients presenting with acute pulmonary embolism (PE). However, problems exist in identifying RV dysfunction using conventional echocardiography. Strain echocardiography is an evolving imaging modality which measures myocardial deformation and can be used as an objective index of RV systolic function.

Hypothesis:
We hypothesized that RV strain analysis is prognostic of mortality in patients with acute PE.

Methods:
Retrospective cohort study of 177 patients with acute PE between 2010 and 2017. Strain analysis was retroactively applied. All echocardiograms were completed within 48 hours of diagnosis. RV global longitudinal strain (RVGLS) was applied using TomTec®. The primary outcome was all-cause mortality at 30 days and in-hospital mortality. T-test statistical analysis was performed. Receiver operating characteristic (ROC) curves and Kaplan-Meier curves were used for evaluation.

Results:
Study quality was sufficient to perform RVGLS analysis in 157 patients (90.2%). Mortality at 30 days and in-hospital mortality occurred in 12.7% and 8.9% of patients respectively. Comparing 30-day mortality, there was a significant reduction in RVGLS compared to survivors (13.0% ± 3.0% vs 19.6% ± 3.5%, p < 0.001). In-hospital mortality as well showed a significant difference (13.1% ± 3.3% vs 19.3% ± 3.7%, p < 0.001). Using ROC curves, we chose a RVGLS value of 17.5% (sensitivity 90%, specificity 74%) to predict 30-day mortality. Patients with RVGLS worse than 17.5% had 18 times higher risk of 30-day mortality compared to patients with RVGLS better than 17.5% (HR 18.4, 95% CI= 4.2-79.7, p < 0.001. Figure).

Conclusions:
RV strain have significant prognostic value in patients with acute PE, and identifying those at higher risk of death. Assessment of RV strain has promise for clinical applications.
Abstract 10904: Integrins Signaling Represents an Exciting Therapeutic Avenue to Counter Vascular Remodeling and Right Ventricular Failure in Pulmonary Arterial Hypertension
Authors: Lemay Sarah-Eve , Montesinos Mónica S , Grobs Yann , Yokokawa Tetsuro , Shimauchi Tsukasa , Breuils Bonnet Sandra , Martineau Sandra , SALEM MABROUKA , Bourgeois Alice , Romanet Charlotte , HUANG XINQIANG , Dowling James , Lu Min , Ray Adrian , Potus Francois , Provencher Steeve , Boucherat Olivier , Bonnet Sebastien
Published: June 2023

Pulmonary arterial hypertension (PAH) is characterized by progressive obstruction of pulmonary arteries (PAs), culminating in right ventricular (RV) failure and premature death. Like cancer cells, PA smooth muscle cells (PASMCs) isolated from PAH patients exhibit exaggerated proliferation and resistance to apoptosis in response to extracellular matrix remodeling. Integrins, members of the cell adhesion receptors superfamily, are known to promote cell proliferation, survival, hypertrophic growth and fibrosis, which are key elements contributing to PAs remodeling and RV failure. Therefore, we hypothesized that integrins signaling could promote PAH-PASMC proliferation and resistance to apoptosis contributing to PAs vascular remodeling, and RV maladaptive hypertrophy and fibrosis, leading to RV failure.

Using NanoString, we found that members of the fibronectin-binding integrin (FiBI) family were the most abundantly expressed in PASMCs and RV fibroblasts (RVFbs) isolated from PAH patients. By western blot (WB), we showed that FiBIs expression is significantly changed in distal PAs, PASMCs, PA endothelial cells and decompensated RV from PAH patients compared to controls (p<0.05).
In vitro
, pharmacological inhibition of FiBIs decreases PAH-PASMCs proliferation (WB: PLK1; Ki67 labeling; p<0.05, n=5) and resistance to apoptosis (WB: Survivin; Annexin V labeling; p<0.05, n=5). These effects were associated with a decreased activation of FiBIs downstream signaling, FAK and MAPK pathways. In adult rat cardiomyocytes and human RVFbs, FiBIs inhibition decreases phenylephrine-induced hypertrophy (f-actin labeling; p<0.001) and TGFβ1-induced RVFb activation (WB: αSMA, and Col1; p<0.05).
In vivo
, in both moncrotaline and sugen/hypoxia rats with established PAH, pharmacological inhibition of FiBIs alone or in combination with macitentan and tadalafil improves hemodynamic (mPAP, CO, TAPSE, RVFAC; p<0.05) and vascular remodeling (EVG; p<0.01). In the PA banding rat model, inhibition of FiBIs attenuates RV failure (CO, TAPSE, RVEDP, RVFAC; p<0.01).

Our results suggest that integrins play a key role in the pathophysiology of PAH in both the lungs and the RV. Their inhibition provided significant beneficial effects both
in vitro
and
in vivo
.
Abstract 10907: Woven Coronary Artery: A River With Many Currents
Authors: Sullivan Alexander E , Holder Tara , O'Leary Jared M
Published: June 2023

Introduction:
Congenital coronary artery anomalies can increase the risk of cardiovascular events and sudden death. A woven coronary artery is a rare abnormality with multiple lumens in a single vessel, giving the appearance of complex coronary plaque or a dissection flap on coronary angiography.

Clinical Case:
A 57-year-old man with group IV pulmonary hypertension and chronic right-sided heart failure presented for consideration of pulmonary endarterectomy. He underwent preoperative coronary angiography which demonstrated nonobstructive disease within the left anterior descending and circumflex arteries and a complex lesion in the right coronary artery (RCA- Figure 1). The lesion was further evaluated using intravascular ultrasound (IVUS) which demonstrated numerous, complex, communicating lumens and fenestrations within a single external elastic lamina suggestive of a woven coronary artery anomaly (Figure 2). This was recognized as a benign abnormality for which the patient was managed medically, and he underwent a successful pulmonary endarterectomy several days later.

Discussion:
Woven coronary arteries are rare and complex lesions made up of numerous lumens often found in the proximal to mid-RCA. These lesions typically permit normal blood flow and are found incidentally in asymptomatic patients. Woven coronary arteries can be mistaken for complex lesions, dissection, or recanalized thrombus, leading to unnecessary and potentially dangerous percutaneous coronary intervention. Woven arteries should not be treated with angioplasty in the absence of thrombotic occlusion as this can lead to arterial vessel damage. Intracoronary imaging, including IVUS, is vital to differentiate woven coronary arteries from other coronary pathologies.

Conclusion:
Woven coronary arteries may mimic dissection or recanalized thrombus, but can be promptly recognized as a benign congenital anomaly with intracoronary imaging modalities such as IVUS.
Abstract 10935: Long-Term Maturity and Extensibility of an
In S
itu
Regenerated Aortic Wall Induced by a Novel Synthetic Hybrid Knit
Authors: Nemoto Shintaro , Konishi Hayato , Suzuki Tatsuya , Suzuki Akiyo , Katsumata Takahiro , Yamaguchi Ayuko , Hibino Kiyoe , Sakaue Takeshi
Published: June 2023

Introduction:
A novel synthetic hybrid warp-knit with non-biodegradable (polyethylene terephthalate: PET) and biodegradable (poly-L-lactic acid: PLLA) yarns coated with crosslinked gelatin (OFT) has been used to induce in situ canine aortic wall regeneration. A recent pivotal clinical trial in Japan revealed the effectiveness and safety of this approach in pediatric cardiac surgery.

Hypothesis:
The regenerated aortic wall will show long-term extensibility with tissue maturation as the biodegradable yarns dissolve.

Methods:
An oval-shaped defect created in the canine descending aorta was filled with a patch using OFT or a currently used material (ePTFE or bovine pericardium). At 2 to 4 years after implantation, the patch-implanted aorta was explanted for histological examination and stretch-testing.

Results:
OFT induced a well-matured aortic wall characterized by a layered endothelium and an intima of aligned collagen fibers and smooth muscle. Bridging tissues containing capillaries developed across the remaining non-absorbable yarns. Material degradation indicated by calcium deposition was not apparent in the OFT-regenerated wall, but was clear in walls generated by currently used materials, in which only avascular collagen layers developed. The OFT-regenerated wall maintained physiological strength and was extensible by 80 to 200% of the starting width.

Conclusions:
The aortic wall regenerated over the OFT patch continued to mature without material degradation in the long term and showed favorable extensibility that could not be achieved with currently used materials. These long-term findings provide strong support for the suitability of use of OFT as a surgical material in pediatric cardiac surgery.
Abstract 10951: Temporal and Global Trends of the Incidence of Sudden Cardiac Death in Hypertrophic Cardiomyopathy: A Meta-Analysis
Authors: Abdelfattah Omar M , Martinez Matthew W , Sayed Ahmed , ElRefaei Mohamed , Abushouk Abdelrahman , Hassan Ahmed , Masri Ahmad , Winters Stephen L , Kapadia Samir R , Maron Barry J , Rowin Ethan J , Maron Martin
Published: June 2023

Introduction:
Since hypertrophic cardiomyopathy(HCM) initial description, sudden cardiac death (SCD) has been the most feared complication of HCM.

Hypothesis:
Temporal, geographical, and age-related trends of SCD rates in HCM have drastically decreased over time.

Methods:
Databases were systematically searched to Nov 2021 for studies reporting on SCD event rates in HCM. Patients with SCD equivalents (appropriate ICD shocks and non-fatal SCD) were excluded. Random-effects model was utilized to pool study estimates calculating the overall incidence rates(IR) for each time-era, geographical region, and age-group. We analyzed 2 eras (before vs. after 2000, following implementation of ICD in HCM). Following 2000, 5-year intervals were used to reflect the temporal change in SCD.

Results:
98 studies (N=70,510patients and 431,407patient-years) met inclusion criteria. Overall rate of HCM SCD was 0.43%/year (95% CI: 0.37-0.50%; I
2
=75%; SCD events:1,938; person-years of follow-up: 408,715), with young patients(<18 years) demonstrating a>2-fold-risk for SCD vs. adults(18-60years) (IR:1.09%; 95% CI: 0.69-1.73% vs. IR: 0.43%; 95% CI: 0.37-0.50%)(P-value for subgroup differences:<0.01). Contemporary SCD rates from 2015-present were 0.32%/year; significantly lower compared to 2000 or earlier (IR: 0.32%; 95% CI:0.20-0.52%, vs. IR: 0.73%; 95% CI:0.53-1.02%,respectively). Reported HCM-SCD rates were lowest in North America (IR: 0.28%;95% CI:0.18-0.43%) and highest in Asia(IR: 0.67%; 95% CI:0.54-0.84%).

Conclusions:
Contemporary HCM-related SCD are low (0.32%/year) representing a 2-fold decrease compared to prior treatment eras, with young HCM patients at the highest risk. SCD risk stratification maturation and primary prevention ICD application are likely responsible for the notable decline in SCD trends. Moreover, worldwide geographical disparities in SCD was evident, underscoring the need to increase access to SCD prevention for all HCM patients.
Abstract 10966: Autoimmune Limbic Encephalitis Mimicking Inferior Myocardial Infarction on ECG
Authors: Zeitjian Armen , Noor Benjamin , Chand Robin
Published: June 2023

Case Presentation:
A 64 year-old man was brought to the emergency department (ED) after being found down, awake, but unresponsive by family. In the ED, he denied chest pain and shortness of breath. His past medical history included coronary artery disease status-post coronary artery bypass grafting, heart failure with reduced ejection fraction, and paroxysmal atrial fibrillation. On physical exam, he was hemodynamically stable, oriented to self and place with no other significant neurological findings. The field and ED electrocardiograms (ECGs) (Figure 1) were consistent with an acute inferior ST elevation myocardial infarction (STEMI). The patient underwent emergent coronary angiography via left heart catheterization which showed no acute lesions requiring intervention. Initial pertinent lab work included a peak troponin-I of 0.095 ng/mL and serum sodium of 126 mmol/L. Collateral information revealed that the patient has progressive memory loss and intermittent episodes of hand tremors with non-purposeful eye movements. He also had a witnessed faciobrachial dystonic seizure, which is pathognomonic for Leucine-rich, Glioma Inactivated-1 (LGI-1) autoimmune encephalitis. Serum and CSF analyses were positive for LGI-1 IgG antibodies, confirming the diagnosis. The patient was treated with high-dose steroids, IVIG, and valproic acid with improvement in seizure activity and cognitive status, and discharged on prednisone and levetiracetam.

Discussion:
Per review of the current literature, central nervous system pathology may induce sympathetic overactivity causing transient myocardial injury, referred to as neurogenic stunned myocardium. This can manifest as left ventricular dysfunction, myocardial injury, and/or ECG changes consistent with myocardial infarction. This case presentation highlights an example of a seizure leading to neurogenic stunned myocardium with an ECG showing an acute inferior STEMI.
Abstract 11026: Proteomic Signatures of Ischemic and Non-Ischemic Heart Failure in a Community Cohort
Authors: Kuku Kayode O , Park Ho Young , Shearer Joe J , Joo Jungnam , Dulek Brittany , Bielinski Suzette J , Roger Veronique L
Published: June 2023

Introduction:
Coronary disease is the most common cause of heart failure (HF). HF is classified as ischemic (IHF) or non-ischemic (NIHF) based on this etiology. IHF and NIHF have distinct mechanisms not accounted for by ejection fraction (EF) and an improved understanding of the differences could drive the discovery of novel therapeutic targets. We therefore sought to identify proteomic signatures between IHF and NIHF.

Methods:
Proteomic profiling using the SomaScan®1.7K was performed using plasma samples from HF patients in a community cohort (Rochester Epidemiology Project, 2003-2012). IHF was defined by prior myocardial infarction, percutaneous coronary intervention or coronary artery bypass graft, or obstructive disease in at least 1 vessel on coronary angiography. We compared the protein expression levels between IHF and NIHF using t-test and applied the Benjamini-Hochberg false-discovery rate (FDR) procedure for multiple comparisons. We explored pathway analysis for functional annotations using the biological process component of the Gene Ontology Resource (Panther 17v).

Results:
Among 1,388 patients, there were 518 IHF patients (age: 75±12years, 39.4% female, NYHA Class III/IV: 72.5%, EF:45±15%), and 870 NIHF patients (age: 75±14years, 53.6% female, NYHA Class III/IV: 66.9%, EF:49±17%). Among 7335 plasma proteins quantified, 63 unique proteins (FDR < 0.05) were differentially expressed between IHF and NIHF. Thirty-seven proteins including Troponin-I and T, and Myoglobin showed increased expression in IHF compared to NIHF and 26 including IGFBP-3 showed decreased expression. Pathophysiologic pathways including angiogenesis, coagulation, and lipid metabolism were represented in IHF, while inflammation and remodeling signaling pathways were dominant in relation to NIHF.

Conclusions:
High-throughput proteomic techniques are able to delineate IHF versus NIHF patients based on distinct biomarkers and pathophysiologic processes.
Abstract 11030: Decreased CD34
+
Cell Count is Associated With Coronary Allograft Vasculopathy in Heart Transplant Recipients
Authors: Poglajen Gregor , Poljancic Laura , Zbacnik Rok , Frljak Sabina , Zemljic Gregor , Cerar Andraz , or Nea , Okrajek Renata , Šebetjen Miran , Vrtovec Bojan
Published: June 2023

Introduction:
The underlying mechanisms of coronary allograft vasculopathy (CAV) after heart transplantation remain incompletely understood.

Hypothesis:
As CD34
+
cells represent one of the key determinants of coronary vascular homeostasis we investigated the potential association between CAV and CD34
+
cell count in heart transplant recipients.

Methods:
In a single-center prospective pilot cohort study we included 59 adult heart transplant recipients without history of congenital heart disease, multi-organ transplantation or oncologic therapy. All patients underwent coronary CT angiography and the presence of CAV was defined in accordance with the ISHT criteria. At the time of CT angiography, we collected blood samples and measured CD34
+
cell count using Beckman-Coulter Navios EX flow cytometry with standard antibodies according to ISAGE protocol as well as biomarkers of angiogenesis using Luminex assay kit.

Results:
CAV was present in 15 patients (25%; Group A) and absent in 42 patients (75%; Group B). The two groups did not differ in age (62±11 years in Group A vs. 60±11 years in Group B, P=0.56), gender (male: 100% vs. 80% in Group B, P=0.07), heart failure etiology (ischemic: 53% vs. 43%, P=0.50), presence of hypertension (60% vs. 63%, P=0.80), diabetes (33% vs. 25%, P=0.54) or renal insufficiency (53% vs. 43%, P=0.50). Also, donor age (44±14 years in Group A vs. 43±12 years in Group B, P=0.66), allograft ischemic time (202±72 min vs. 190±68 min, P=0.57), tacrolimus trough levels (8.8±3.8 μg/L vs. 7.4±1.9 μg/L, P=0.14), MMF dose (2067±442 mg vs. 2178±606 mg; P=0.52) and statin therapy (86% vs. 75%; P=0.36) were comparable. While total leukocyte count was similar in both groups (7.7±2.1x10
9
/L in Group A vs. 6.8±2.2x10
9
/L in Group B, P=0.60), we found significantly lower CD34
+
cell count in Group A compared to Group B (1.33±0.45x10
6
/L vs. 2.23±1.45x10
6
/L, P=0.02). Conversely, VEGF serum levels were significantly lower in Group A than in Group B (0.09±0.06 ng/L vs. 0.14±0.09 ng/L; P=0.03).

Conclusions:
Decreased CD34
+
cell count and increased VEGF serum levels appear to be associated with CAV in heart transplant recipients. Further studies are warranted to investigate the potential of CD34
+
cells in prevention and treatment of CAV in this patient cohort.
Abstract 11036: Aortic Valve Calcification is Associated With an Increased Risk of Mortality in Patients With Low Flow Low Gradient Moderate Aortic Stenosis
Authors: Mogensen Nils Sofus Borg , Carter-Storch Rasmus , Annabi Mohamed-salah , Grenier-Delaney Jasmine , Moller Jacob , Ovrehus Kristian Altern , Pibarot Philippe , Dahl Jordi Sanchez , Clavel Marie-Annick A
Published: June 2023

Introduction:
Aortic Valve Calcification (AVC) measured by computed tomography (C-CT) and Dobutamine stress echocardiography (DSE) are both important when determining AS severity in low flow low gradient (LFLG) AS. It is generally accepted that AS is moderate if aortic mean gradient is <40mmHg on DSE and AVC is not severe.

However, recent studies suggest that patients with moderate AS may have a worse outcome than expected when treated medically.

Objective:
To examine the correlation between AVC and mortality in patients with LFLG moderate AS on both DSE and C-CT when treated medically.

Method:
88 Patients with LFLG AS (aortic mean gradient <40 mmHg, aortic valve area <1.0 cm
2
& stroke volume index (SVi) <35ml/m
2
) and moderate AS on DSE and C-CT were identified from two prospective studies. AVC ratio was calculated as AVC divided by the sex-specific AVC threshold for severity; 2000 AU in males and 1200 AU in females.

Results:
Optimal threshold of AVC ratio to predict 2-year mortality was 0.68 on ROC-curve (AUC=0.72).Patients were stratified according to AVC ratio: 51 (58%) presented with AVC ratio <0.7 and 37 (42%) with AVC ratio 0.7–1.0. 2 year survival was lower in the latter group (79.5±0.1 vs 46.9±0.1% - Figure 1). Age (78±9 vs 75±11, p=0.32), sex distribution (females 33 vs 41%, p=0.49) and DSE SVi increase (18±24 vs 18±12%, p=0.94) were similar in both groups.

Patients with AVC ratio <0.7 presented with higher LVEF (50±15 vs 44±15%, p=0.08) and lower aortic mean gradient at rest (20±7 vs 23±6 mmHg, p=0.01) and during DSE (21±14 vs 29±15 mmHg, p=0.03).

In univariate Cox regression AVC ratio >0.7 was associated with mortality: HR 2.91 [1.43-5.9], p=0.003. AVC ratio >0.7 remained associated with mortality after adjustment for LVEF, aortic mean gradient, age and sex: HR 2.66 [1.24-5.7], p=0.012. Especially in patients with reduced LVEF: HR 3.47 [1.49-8.09], p=0.004.

Conclusion:
In patients with LFLG moderate AS an AVC ratio > 0.7 is associated with increased risk of mid-term mortality.
Abstract 11074: A Model for Predicting Cardiovascular Events in Acute Decompensated Heart Failure Patients With Decreased Renal Function
Authors: Deguchi Tomokazu , sato miki , Kohyama Noriko , Fujita Kanako , nagumo sakura , Suzuki Hiroshi , Ebato Mio , KOGO MARI
Published: June 2023

Background:
The models for predicting cardiovascular events, including medication data such as dosage and the number of medications, have not been well studied. This study aimed to develop a model, including medication data, for predicting cardiovascular events within one year after discharge in acute decompensated heart failure (ADHF) patients with decreased renal function.

Methods
This study included 443 first-time admitted ADHF patients with decreased renal function in the Showa University Fujigaoka Hospital between January 2015 and December 2019. Decreased renal function was defined as an eGFR < 60 mL/min/1.73 m
2
at discharge. The primary outcome was cardiovascular events (cardiovascular death and first heart failure rehospitalization) within one year after discharge. The model for predicting events was developed using predictive factors extracted by multivariate analysis. The cardiovascular events curves were visualized using the Kaplan-Meier method and estimated using a log-rank test.

Results
The incidence of cardiovascular events was 20.1%. By multivariate analysis, atrial fibrillation (AF), weight loss < 5% during admission, brain natriuretic peptide (BNP) ≥ 200 pg/mL at discharge, polypharmacy (≥ 10 drugs), and beta-blockers use below the maintenance dosage were significantly associated with an increased risk of cardiovascular events. The hazard ratios of the five factors for the cardiovascular events were scored (AF, weight loss, polypharmacy, and beta-blockers dosage = 1 point; BNP = 2 points) and patients divided into three groups. The cardiovascular events rate in the high-risk (≥ 4 points) group was four times as high as the rate in the low-risk (≤ 2 point) group (one-year events rate: 41.0% vs 9.2%, p < 0.001, Figure).

Conclusions
The developed model for cardiovascular events, including polypharmacy and beta-blockers dosage, will be useful for planning more aggressive and earlier management in ADHF patients with decreased renal function.
Abstract 11093: Spike Proteins Increase Endothelial Calcium via TRPV4
Authors: Xing Hang , Harrington Elizabeth O , Feng Jun
Published: June 2023

Introduction:
Endothelial dysfunction plays a central role in the pathogenesis of acute respiratory distress syndrome (ARDS) with COVID-19. Transient receptor potential vanilloid 4 (TRPV4), a cation channel ubiquitously expressed, can regulate inflammatory cytokines that play key roles in in acute lung injury/ARDS. However, it is unknown whether spike proteins can affect TRPV4 activity and related Ca
2+
signaling in pulmonary microvascular endothelial cells.

Hypothesis:
We hypothesized that spike protein causes activation of TRPV4 channels, resulting in increases in intracellular Ca
2+
, may lead to pulmonary endothelial dysfunction.

Methods:
Intracellular Ca
2+
concentrations in human lung microvascular endothelial cells (HLMECs) were measured by calcium imaging in the presence of SARS CoV-2 Spike protein S1, receptor-binding domain (RBD) of S1, or protein S2 with or without co-incubation of the selective TRPV4 antagonist (HC-067047).

Results:
The intracellular Ca
2+
concentration of HLMECs was significantly increased when incubated with S1 (1, 10nM) or S1 RBD (1, 10nM) for 12, 24, 48 hours, relative to control or S2 (p<0.05, respectively, Fig. A, B). Co-incubation of HC-067047 (500nM) significantly attenuated Ca
2+
intracellular influx upon treatment with S1 (10nM, 24 hours, p<0.05) or S1 RBD (10nM, 24 hours, p<0.05) (Fig. C). TRPV4 sensitive current density was significantly increased when incubated with S1 (10nM) or S1 RBD (10nM) for 24 hours (p<0.05 vs. control, respectively, Fig. D-G), whereas co-incubated with HC-067047 (500nM) significantly reversed the S1 (10nM, 24 hours, p<0.05) or S1 RBD (10nM, 24 hours, p<0.05) induced increases of TRPV4 sensitive current density (Fig. D-G).

Conclusions:
The of SARS CoV-2 Spike protein S1 and S1 RBD caused the activation of TRPV4 channels, resulting in increased intracellular Ca
2+
, may lead to pulmonary endothelial dysfunction.
Abstract 11096: Impact of Rhythm versus Rate Control in Atrial Fibrillation on All-Cause Mortality, Hospitalization and Stroke: A Systematic Review and Meta-Analysis
Authors: Ibrahim Ramzi , Olagunju Abdulbaril , Moradi Ali , Fath Ayman R , Mihyawi Nawfal , Yeneneh Beeletsega
Published: June 2023

Introduction:
Many randomized controlled trials (RCTs) compared rate control vs rhythm control therapy in patients with atrial fibrillation (AF). In this study, we systematically reviewed these RCTs and performed a meta-analysis of the outcomes comparing the two therapies.

Methods:
We searched PubMed, Medline, EMBASE, and SCOPUS databases until April 30, 2022 for all RCTs investigating AF rate vs rhythm control. We used the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) for constructing and reporting this review. We assigned I
2
>50% as an indicator of statistical heterogeneity among the RCTs. We analyzed all-cause mortality, stroke rate, heart failure (HF) hospitalization, and total hospitalization between the two groups. We estimated the risk ratios (RR) with a random-effects model using the Mantel-Haenszel technique and calculated the 95% confidence intervals (CI). A P-value <0.05 was considered significant. All analyses were performed using Review Manager 5.3.

Results:
Twenty-one RCTs comprising 11,547 patients (77% male) were included. Between the two therapy groups, there was no significant difference in all-cause mortality (RR 1.02 [0.90-1.16],
P=0.75
), HF hospitalization (RR 1.04 [0.83-1.32],
P=0.72
), or stroke rate (RR 1.15 [0.88-1.50],
P=0.32
). Nonetheless, rate control was associated with reduced total hospitalizations (RR 0.77 [0.64-0.94],
P=0.01
). (Figure 1)

Conclusions:
Atrial fibrillation rate control therapy has similar outcomes to rhythm control in terms of all-cause mortality, HF hospitalization, and stroke rates, but a lower rate of total hospitalizations. Findings are consistent with multiple prior studies showing noninferiority of rate control to rhythm control.

Figure 1 - Forest plots highlighting the outcomes of both treatment strategies on AF: A) All-cause mortality, B) Heart failure hospitalization, C) Stroke, and D) Total hospitalization.