Age Of Patients Research Articles

JCCG ALL-B12: Evaluation of Intensified Therapies With Vincristine/Dexamethasone Pulses and Asparaginase and Augmented High-Dose Methotrexate for Pediatric B-ALL.

The JCCG ALL-B12 clinical trial aimed to evaluate the effectiveness of unvalidated treatment phases for pediatric ALL and develop a safety-focused treatment framework. Patients age 1-19 years with newly diagnosed B-ALL were enrolled in this study. These patients were stratified into standard-risk (SR), intermediate-risk (IR), and high-risk (HR) groups. Randomized comparisons assessed the effectiveness of vincristine (VCR)/dexamethasone pulses in the SR group, evaluated the effects of L-asparaginase (ASP) intensification in the IR group, and compared standard consolidation including block-type treatment with experimental consolidation with high-dose methotrexate (HD-MTX) intensified with VCR and ASP in the HR group. Of 1,936 patients enrolled, 1,804 were eligible for the experimental treatment. The overall 5-year event-free survival and overall survival rates were 85.2% (95% CI, 83.5 to 86.8) and 94.3% (95% CI, 93.1 to 95.3), respectively. The cumulative incidence of relapse and postremission nonrelapse mortality was 13.2% (95% CI, 11.6 to 14.8) and 0.6% (95% CI, 0.3 to 1.0), respectively. Random assignment in the SR group showed no significant benefit from pulse therapy. In the IR group, ASP intensification had limited effects. In the HR group, standard block therapy and HD-MTX yielded equivalent outcomes. The ALL-B12 trial achieved favorable outcomes in a nationwide cohort by stratifying treatment on the basis of risk and balancing treatment intensity. This study not only demonstrated that existing standard of care can be further refined but also indicated that improvement in outcomes with intensified chemotherapy has reached a plateau.

Safety and Efficacy of GLP-1 Agonists in a Cohort of Patients with Fontan Circulation.

There are a growing number of adult patients palliated to a Fontan circulation. As these patients age, many develop symptomatic heart failure (d'Udekem et al in Circulation 130:S32-S38, 2014) that is exacerbated by acquired comorbidities such as obesity and hypertension. Increased body mass index (BMI) and adiposity have been associated with worse hemodynamics and clinical outcomes in these patients (Yogeswaran et al in J Am Hear Assoc: Cardiovasc Cerebrovasc Dis 12:e026732, 2023). Recently, glucagon-like peptide-1 (GLP-1) agonists, originally developed to treat diabetes mellitus, received FDA approval for weight loss and have been shown to reduce the risk of cardiovascular events in the general population (Vilsbøll et al in BMJ 344:d7771, 2012). There are limited data on these medications in patients with a Fontan circulation. We conducted a retrospective review of adults with Fontan circulation followed in our adult congenital heart disease (ACHD) clinic between 2009 and 2023 and identified 8 patients prescribed GLP-1 agonists. We found that GLP-1 agonists were well-tolerated and led to modest reduction in weight and blood pressure. Further study of the use of these medications in this population is warranted.

Automated lung segmentation on chest MRI in children with cystic fibrosis

IntroductionSegmentation of lung structures in medical imaging is crucial for the application of automated post-processing steps on lung diseases like cystic fibrosis (CF). Recently, machine learning methods, particularly neural networks, have demonstrated remarkable improvements, often outperforming conventional segmentation methods. Nonetheless, challenges still remain when attempting to segment various imaging modalities and diseases, especially when the visual characteristics of pathologic findings significantly deviate from healthy tissue.MethodsOur study focuses on imaging of pediatric CF patients [mean age, standard deviation (7.50 ± 4.6)], utilizing deep learning-based methods for automated lung segmentation from chest magnetic resonance imaging (MRI). A total of 165 standardized annual surveillance MRI scans from 84 patients with CF were segmented using the nnU-Net framework. Patient cases represented a range of disease severities and ages. The nnU-Net was trained and evaluated on three MRI sequences (BLADE, VIBE, and HASTE), which are highly relevant for the evaluation of CF induced lung changes. We utilized 40 cases for training per sequence, and tested with 15 cases per sequence, using the Sørensen-Dice-Score, Pearson’s correlation coefficient (r), a segmentation questionnaire, and slice-based analysis.ResultsThe results demonstrated a high level of segmentation performance across all sequences, with only minor differences observed in the mean Dice coefficient: BLADE (0.96 ± 0.05), VIBE (0.96 ± 0.04), and HASTE (0.95 ± 0.05). Additionally, the segmentation quality was consistent across different disease severities, patient ages, and sizes. Manual evaluation identified specific challenges, such as incomplete segmentations near the diaphragm and dorsal regions. Validation on a separate, external dataset of nine toddlers (2–24 months) demonstrated generalizability of the trained model achieving a Dice coefficient of 0.85 ± 0.03.Discussion and conclusionOverall, our study demonstrates the feasibility and effectiveness of using nnU-Net for automated segmentation of lung halves in pediatric CF patients, showing promising directions for advanced image analysis techniques to assist in clinical decision-making and monitoring of CF lung disease progression. Despite these achievements, further improvements are needed to address specific segmentation challenges and enhance generalizability.

Abstract 4136463: Novel Systemic Inflammatory Biomarkers Can Predict Significant Coronary Disease in High Risk Patients

Background: Coronary artery disease (CAD) is a major cause of morbidity and mortality worldwide. Chronic inflammation is a known risk factor for atherosclerosis, plaque formation, disease progression, and plaque instability. Novel inflammatory biomarkers have been recently linked to excess risk of adverse cardiovascular events, including incident myocardial infarction. Elevated inflammatory biomarkers may help identify patients at higher risk for severe CAD. Aim: This study aimed to evaluate the use of novel systemic inflammatory markers in predicting the pretest probability of severe CAD in patients referred to diagnostic coronary angiography in a single tertiary care center. Methods: This was a prospective observational cohort study enrolling consecutive patients referred to diagnostic coronary angiography in a tertiary care center. Preprocedural laboratory results were obtained from medical charts, including complete blood counts with differentials. Three novel systemic inflammatory markers were computed using existing mathematical formulas: systemic immune-inflammation index (SII = neutrophil count*platelet/lymphocyte); systemic inflammation response index (SIRI = neutrophil*monocyte/lymphocyte); and systemic immune inflammatory response index (SIIRI = neutrophil*monocyte*platelet/lymphocyte). The primary study outcome was severe CAD defined as the presence of ≥70% stenosis in one of three main coronary arteries requiring percutaneous coronary intervention). The outcome was adjudicated by an independent reviewers blinded to computations of biomarkers. Result: The sample included 264 patients (age 59.3±10.8, 47% Females). Overall, 84 patients (32%) met the primary study outcomes. In univariate analysis, those with severe CAD had significantly higher SIRI (2.9±0.7 vs. 2.6±0.6, p = 0.001) and SIIRI (8.4±0.8 vs. 8.1±0.7, p = 0.015) compared to their counterparts. In multivariate analysis adjusted for age and sex, only SIRI was an independent predictor of severe CAD. Using SIRI > 20.8 (upper quartile) was associated with nearly three-fold excess risk of severe CAD (OR = 2.72, 95% CI 1.45-5.09). Conclusion: Elevated SIRI, a marker of ongoing systemic inflammatory response, could be indicative of severe CAD. As an inexpensive biomarker based exclusively on complete blood count, SIRI can be used to prioritize patients referred for diagnostic angiography and potentially expedite treatments in those at higher risk for coronary events.

Abstract 4141445: Long-Term Predictive Value of 4D Flow MRI in Bicuspid Aortic Valve Patients: A 10-Year Assessment for Aortic Surgery Risk

Introduction: Bicuspid aortic valve (BAV) is associated with progressive ascending aorta (AAo) dilation, often leading to aneurysms, dissections, and ruptures. Thus, current guidelines recommend preventive surgery for AAo dilation. Recent 4D flow MRI studies show that BAV morphology causes abnormal transvalvular flow patterns, increasing wall shear stress (WSS), a trigger of aortic growth. Further studies have delineated areas of abnormally high WSS by comparing to estimates of matched controls, and show promise in detecting risk for aortic growth. However, since the long-term prognostic significance of this marker is unclear, we aimed to quantify WSS in BAV patients to assess its value in predicting the need for aortic surgery up to 10 years post-4D flow MRI acquisition. Methods: BAV patients without prior surgical intervention scanned before April 1, 2014 were identified. Using medical records, patients were categorized as ‘operated’ if they underwent aortic surgery post-scan and ‘non-operated’ if they were surgery-free for at least 10 years post-scan. 4D flow MRIs were processed with an AI pipeline, including 3D segmentation of the aorta, followed by peak velocity (PV) and WSS quantification in the AAo (Fig. 1A-C). Patient-specific WSS heatmaps were computed relative to a map based on the WSS of 10 or more sex and age-matched controls. Relative areas of elevated WSS in the AAo were then calculated (Fig. 1D-F). Results: 115 patients were included, with 73 non-operated (age: 42.5±11.5y, 49M) and 42 operated patients (age: 53.5±12.1y, 34M). The mean baseline mid-AAo diameters for non-operated and operated patients were 3.8±0.6 cm and 4.1±0.5 cm, respectively. Among operated patients, the mean scan to surgery time was 5.7±3.3y. All three 4D flow metrics were significantly higher in operated compared to non-operated patients: PV: 2.6±0.6 vs. 1.7±0.4 m/s (p<0.01); WSS: 2.2±0.5 vs. 1.6±0.4 Pa (p<0.01); relative area of high WSS on heatmaps: 31±12 vs. 15±13% (p<0.01). Conclusions: 4D flow MRI parameters provide long-term predictive value in BAV patients, as elevated peak velocity, wall shear stress, and relative area of high wall shear stress on heatmaps are associated with subsequent aortic surgery within 10 years post-scan.

Abstract 4122247: Impact of serum chloride levels for ventricular arrhythmias in patients with heart failure undergoing cardiac resynchronization therapy

Background: As previous reports of ventricular arrhythmia (VA) as a prognostic marker of mortality in heart failure (HF) patients included those with implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy (CRT) devices, little is known about the risk factors of VA among patients undergoing cardiac resynchronization therapy (CRT), especially those without previous VA. The prognostic role of electrolyte abnormalities has been highlighted in HF patients. This study evaluated the impact of serum chloride levels for VA and all-cause death in patients with HF who underwent CRT without VA before CRT implantation. Methods: From the retrospective cohort of 397 HF patients (age 63+/-13, male 74%) who undergoing CRT implantation between 2010 and 2020, this study enrolled 175 patients (82% implanted CRT with a defibrillator) without a previous history of VA (sustained ventricular tachycardia (VT) of ventricular fibrillation (VF)). We studied the impact of serum chloride levels before CRT implantation. The primary endpoint was defined as VA, VA with ICD therapy and sudden cardiac death. The secondary endpoint was all-cause mortality. Results: During median follow-up of 35 months, 53 patients (30%) experienced VA. Patients with VA had a tendency toward high LVESV (172ml vs. 150ml, p<0.09) and low left ventricular ejection fraction (26 vs. 29, p<0.09), and significantly reduced rate of angiotensin converting enzyme inhibitors or angiotensin receptor blockers (30% vs. 70%, p<0.05) at the time of CRT implantation. The rate of CRT responders was significantly higher in patients without VA than with VA (59% vs. 40%, p<0.05). The cut-off value of chloride for VA was determined to be 102mEq/l using receiver operating characteristic analysis. The patients with chloride ≤102mEq/l had significantly higher rates of VA (41% vs. 25%, log-rank p<0.05) and mortality (33% vs. 18%, log-rank p<0.05) (Figure). By multivariate cox analysis, the level of chloride had an independent predictive value of VA in patients with CRT (hazard ratio [HR] 1.08 per 1mEq/l decrease, 95% confidence interval [CI] 1.00-1.16, p<0.05) (Table). Conclusions: The chloride level had a predictive value for VA after CRT implantation in HF patients without previous VA. The management of electrolytes, including chloride, might be important for preventing fatal arrhythmia in patients with HF undergoing CRT implantation.

Abstract 4137396: Evolution of Tricuspid Regurgitation and Clinical Outcomes in Patients with Heart Failure with Preserved Ejection Fraction: Insights from the PURSUIT-HFpEF Registry

Background: Tricuspid regurgitation (TR) is prevalent in patients with heart failure with preserved ejection fraction (HFpEF). However, due to its high vulnerability to hemodynamic loads, the long-term observation may heighten its prognostic values. Purpose: To investigate the evolution of TR and its impact on clinical outcomes in patients with HFpEF. Methods: An analysis was performed from a prospective multicenter observational registry for HFpEF (PURSUIT-HFpEF Registry) conducted in the Osaka region of Japan. A total of 1238 patients hospitalized for acute heart failure (HF) (diagnosed by using Framingham criteria) met the inclusion criteria: an LVEF ≥50% and brain natriuretic peptide level ≥100 pg/ml. After excluding patients who died within 1 year, we included 761 patients (age 82 ± 9 years; men, 45%; atrial fibrillation, 37%) whose echocardiographic data at discharge and 1 year were available. Results: At discharge, 165 patients (21.7%) had moderate to severe TR, which increased to 185 patients (24.3%) at 1 year. Patients were categorized into 4 groups based on the TR evolution: no or mild TR that remained unchanged (n = 522 [69%]), no or mild TR that worsened to moderate to severe (n = 74 [9.7%]), moderate to severe TR that improved to no or mild (n = 54 [7.1%]), and moderate to severe TR that remained unchanged (n = 111 [15%]). During a subsequent follow-up of 33 months, patients with persistent moderate to severe TR had significantly higher mortality rates than the other groups (25.7% vs. 27.0% vs. 27.8% vs. 44.1%, log-rank p < 0.001). Even after adjusting for age, sex, body mass index, left atrial diameter, and left ventricular filling pressure, persistent moderate to severe TR was independently associated with subsequent mortality (hazard ratio, 2.06, 95% confidence interval 1.42-2.99, p < 0.001) Conclusions: During a one-year follow-up, changes in the TR severity were not rare in patients with HFpEF. Persistent moderate to severe TR alone was associated with subsequent mortality, highlighting the need to address persistent TR to improve the prognosis.

Abstract 4132909: Hemodynamic Indices of Right Ventricular Function Differentially Predict Adverse Clinical Outcomes in Heart Failure with Preserved vs Reduced Ejection Fraction

Background: While the critical role of right ventricular dysfunction (RVD) in heart failure (HF) is increasingly recognized, the prevalence and prognostic impact of RVD across HF subtypes is poorly understood. Research Questions/Aims: We aimed to characterize differences in hemodynamic indices of RV function among patients with HF with preserved vs reduced ejection fraction (HFpEF, EF≥50% vs HFrEF, EF<50%) and to examine associations of RVD with longitudinal clinical outcomes by HF subtype. Methods: We identified patients with prevalent HF undergoing clinically indicated right heart catheterization at Massachusetts General Hospital (2005-2016). We examined three RV hemodynamic indices: right atrial to wedge pressure ratio (RA/PCWP), RV stroke work index (RVSWI), and pulmonary artery pulsatility index (PAPi). We used multivariable linear regression to assess differences in RV indices in HFpEF vs HFrEF. We then used Cox models to examine the association of each index with HF hospitalizations (HFH), major adverse cardiac events (MACE), and death, stratified by HF subtype. Models were adjusted for age, sex, BMI, hypertension, diabetes, lung disease, sleep apnea, and prior MI. Results: Of 2,062 patients (age 66 years, 33% women), 1,242 (60%) had HFrEF and 820 (40%) had HFpEF. RVD (RVSWI <450 mm Hg*ml/m 2 ) was present in 27% of HFrEF vs 21% of HFpEF patients. Those with HFpEF had higher RA/PCWP (β 0.12, SE 0.05, p=0.012) and RVSWI (β 0.22, SE 0.05, p<0.001) relative to HFrEF. Over 4.1 median years follow-up, 915 HFH, 1,066 MACE, and 1,116 death events occurred. Among those with HFrEF, lower PAPi was associated with greater risk of HFH (HR 0.84 (0.77, 0.92); p<0.001) and MACE (HR 0.88 (0.81, 0.96); p=0.003), and higher RVSWI was associated with greater risk of death (HR 1.17, (1.07, 1.27); p<0.001, Figure ). In contrast, in those with HFpEF, only higher RA/PCWP was associated with greater risk of death (HR 1.11 (1.00, 1.23); p=0.042). Conclusion: RVD occurs frequently in both HFrEF and HFpEF, and hemodynamic measures of RV function are associated with greater risk of MACE, death, and HFH. Importantly, the prognostic value of RV indices varied by HF subtype, highlighting key differences in the role of RVD in HFrEF vs HFpEF.

Abstract 4138640: Learning Curve for Left Bundle Branch Area Pacing Lead Implantation

Background: Left bundle branch area pacing (LBBAP) has shown promising outcomes at experienced centers, but less is known about the learning curve with new adoption of LBBAP. We conducted a retrospective analysis (2020-2023) of the learning curve for LBBAP at our center. Methods: Procedural success and complications in adult patients undergoing LBBAP by operators with >5-years’ experience in device implantation were compared between operators’ experience ≤10th (LBBAP inexp ) vs. >10th (LBBAP exp ) LBBAP implant. Successful LBBAP was defined as left ventricular activation time (LVAT) ≤80 ms. Results: Seven operators implanted LBBAP in 288 patients (age 73±11 years, 38% women): 68 (24%) in LBBAP inexp vs. 220 (76%) patients in LBBAP exp groups with similar baseline characteristics (all p >0.05). The median number of implants per operator was 22 (range 8-83). Table 1 shows the procedural characteristics and ECG results. Post-implant LVAT ≤80 ms was less frequent in LBBAP inexp compared to LBBAP exp (56.9% vs 72.4%, p=0.04, Figure 1 ). There were no differences in paced QRS duration ≤130 ms (75.9% vs. 76.1 %, p=1.0) or operator self-identified success (85% vs. 91%, p=0.2). With new single-/dual-chamber device implants, there was no difference in implant duration (103.4±31.8 vs. 101.6±38.5 minutes, p=0.3) but there was longer fluoroscopy in LBBAP inexp (12.6±10.1 vs. 8.2±8.0 minutes, p<0.0001, Figure 1 ). The average number of attempts at LBBAP was lower in LBBAP inexp vs. LBBAP exp (2.0 ± 1.5 vs. 2.9 ± 2.9, p=0.03). There was no difference in complications between the 2 groups ( Table 2 ). Conclusion: Operators use less fluoroscopy, make more attempts at LBBAP and more frequently achieve LVAT ≤80 ms after their first 10 implants.

Abstract 4138622: Cardiac Rhabdomyosarcoma: An Updated Review of the English Literature From 1980 Through 2023

Cardiac Rhabdomyosarcoma (CR) is a rare malignant neoplasm of the heart occurring in all age groups and genders. It can arise anywhere in the heart with varied clinical presentation. Available data on CR are mainly from case reports and series that are limited by small sizes. The purpose of this study was to characterize the epidemiology, presentation, management, hospital course, and outcomes of CR published in the English literature from 1980-2023. Methods: We reviewed and included all published case reports with a diagnosis of CR in adult patients (age >18 years) on PubMed and Google Scholar using the keywords “primary cardiac tumor” and “cardiac rhabdomyosarcoma”. Data was extracted onto an Excel spreadsheet for analysis and the outcomes of interest were demographics, clinical presentation, diagnostic modalities, management, complications, and outcomes. We used descriptive statistics to analyze the data. Results: Among a total of 97 patients from 19 countries included in this study, 54% were males and the median age was 49 years (range 18-80). The main symptoms were dyspnea (37.1%), palpitations (23.7%), chest pains (16.5%) and syncope (6.5%). Hypotension or heart failure and arrhythmias were present in 10.3% and 9.3%, respectively and 5.2% had pericardial effusion. In addition to those with metastatic tumors, 22.7% had chronic co-morbidities. The majority of the cases were primary tumors (85.6%), and the remainder were (14.4%). All patients had at least one imaging modality including echocardiography (89%) and CT/MRI (84%). The commonest sites of cardiac involvement were the left atrium (35%), right atrium (33%), right ventricle (20%), and left ventricle (12%). Approximately 68% involved a single cardiac site while 32% involved multiple sites. Among the patients, 96% underwent surgery while 33% and 25% had chemotherapy and 25% radiotherapy, respectively. The median length of hospital stay was 11 days (range, 2-68 days), and mortality was recorded in 79.3% (77/97) of the patients. The median survival time was reported in 42 patients, and it was 6 months (range, 0-36 months). Conclusion: Cardiac rhabdomyosarcoma is a rare and aggressive malignant neoplasm. Most cases are primary tumors with poor outcomes such as a very short median survival time and a very high mortality rate despite the combination of surgery, chemotherapy, and radiotherapy. This calls for further research into the early diagnosis and optimal management strategies to improve outcomes.

Abstract 4122134: Relationships between aortic valve area planimetry on four-dimensional cardiac computed tomography and survival following transcatheter aortic valve replacement

Background: Aortic valve area planimetry (AVA CT ) is feasible on four-dimensional computed tomography (4D-CT) for grading aortic stenosis severity, with superior spatial but inferior temporal resolution to echocardiography, however its prognostic utility is not well-established. We evaluated the prognostic value of AVA CT in patients with significant aortic valve stenosis undergoing transcatheter aortic valve replacement (TAVR). Methods: We studied 1035 native aortic valve stenosis patients (age 79.0±9.0 years, 429 (41.5%) women) undergoing TAVR during 2019-2020. AVA CT and indexed to body surface area (AVAi CT ) were retrospectively measured on contrast-enhanced 4D-CT at peak systole, and standard statistical analyses performed to evaluate its associations with all-cause mortality during follow-up. Results: Mean AVA CT and AVAi CT were 1.02±0.21 cm 2 and 0.53±0.12 cm 2 /m 2 respectively, with 240 (23.2%) deaths during mean follow-up of 2.1±0.9 years. Areas under curves and optimal thresholds for identifying severe aortic stenosis (defined as AVA<1.0 cm 2 on echocardiography) were 0.78 and <1.10 cm 2 for AVA CT and 0.83 and <0.65 cm 2 /m 2 for AVAi CT . AVA CT and AVAi CT below these thresholds representing severe aortic stenosis were independently associated all-cause mortality during follow-up, with hazards ratios (95% confidence intervals) of 1.84 (1.34-2.53) and 2.38 (1.48-3.81) respectively in multivariable analyses. The Figure illustrates Kaplan-Meier survival curves for the cohort based on A) AVA CT and B) AVAi CT thresholds. Conclusion: Optimal thresholds of AVA CT (<1.10 cm 2 ) and AVAi CT (<0.65 cm 2 /m 2 ) were independently associated with worse survival in patients undergoing TAVR, indicating that AVA CT and AVAi CT as potentially useful additional imaging biomarkers in the diagnostic and prognostic evaluation of aortic stenosis patients.

Abstract 4136085: The Prognostic Impact of Thrombocytopenia at 6 months after Transcatheter Aortic Valve Replacement: A Retrospective Multicenter Study

Background: Transient thrombocytopenia after transcatheter aortic valve replacement (TAVR) is a common phenomenon. Thrombocytopenia after TAVR during the perioperative period has been reported to impact prognosis. However, the impact of thrombocytopenia in the mid-term post-TAVR period is currently unknown. Methods: A retrospective observational study was conducted on 1405 patients who underwent TAVR from May 2016 to February 2023 at four institutions. Of these, 850 patients were analyzed. Patients who underwent dialysis (67), converted to an open chest surgery (8), had a Valve-in-Valve procedure (30), underwent a direct aortic approach (16), had a malignant tumor (66), and patients whose platelet levels could not be measured at 6 months after TAVR due to death or dropout were excluded from the analysis. The clinical follow-up occurred at 1, 6, and 12 months after the procedure. Laboratory testing was conducted before TAVR, during the perioperative period, 1 month post-procedure, and 6 months later. The decrease in platelet count (DPC) 6 months after TAVR was calculated by the following formula: [(Baseline platelet – 6 months platelet)/baseline platelet *100]. A receiver operating characteristics curve was plotted for all-cause mortality at 1 year and DPC at 6 months. The calculated cutoff value for the DPC at 6 months (28.68%) was utilized to classify and compare the two groups. Multivariate logistic regression models were also used to examine the association between the DPC at 6 months and all-cause mortality at 1 year. Adjusted for propensity score matching, the DPC was compared at 6 months in self-expandable and balloon-expandable prosthetic valves. Result: Of the 850 eligible patients (age: 85.5 ± 4.9 years), 31 (3.4%) died between 6 months and 1 year after TAVR. The DPC at 6 months after TAVR was 11.9 ± 22.5%. Multivariate logistic regression analysis including the DPC at 6 months, age, gender, and STS score showed that the DPC at 6 months was independently associated with all-cause mortality at 1 year (odds ratio: 1.03, 95% confidence interval: 1.005-1.046, p=0.01). After adjustment for propensity score matching, the balloon-expandable prosthetic valve had a higher rate of thrombocytopenia at 6 months (15.0% vs. 9.6%, p=0.04). Conclusion: The DPC at 6 months after TAVR may predict all-cause mortality at 1 year.

Pay attention to the impact of cardiopulmonary comorbidities on the management strategies of pulmonary arterial hypertension

With the increasing age of patients with pulmonary arterial hypertension (PAH) at diagnosis, multiple comorbidities are more and more common in these patients, especially cardiopulmonary diseases. This article introduces the incidence of PAH combined with cardiovascular disease and/or chronic lung disease, elaborates on the impact of cardiopulmonary comorbidities on the diagnosis, prognosis, and targeted drug treatment strategies of PAH, and proposes management recommendations for PAH patients with comorbidities, aiming to further improve the diagnosis and treatment level of pulmonary hypertension.

Abstract 4138225: In-Hospital Outcomes of Percutaneous Coronary Intervention (PCI) in patients primarily admitted with ST-Elevation Myocardial Infarction (STEMI) at PCI centers versus patients transferred from non-PCI centers, a retrospective study involving the National Inpatient Sample (NIS 2016-2021) database.

Background: Timely transfer for PCI is paramount in the management of STEMI. This has been shown to reduce myocardial damage, optimize reperfusion therapy and mitigate the post procedural complications associated with PCI. This study's aim was to describe the in-hospital outcomes associated with acute inter-hospital transfer of patients with STEMI for PCI in comparison with patients directly admitted to a primary PCI center. Methods: The National Inpatient Sample (NIS) was used to identify patients who underwent PCI for STEMI between the years 2016-2021. Based on several transfer indicators, primarily admitted patients and patients with acute inter-hospital transfer were identified. Logistic and linear regression models were used to analyze the primary outcome of in-hospital mortality and secondary outcomes of length of hospital stay, hospital charge, and occurrences of post-procedure complications. Results: Observations were weighted to obtain a national estimate of 748,430 patients with known transfer status who underwent PCI for STEMI. Of these, 625,520 patients were primarily admitted at PCI centers and 122, 910 patients were transferred from non-PCI centers. The mean age of patients with STEMI undergoing PCI was 62 years, and 72 % of the patients were male. There was no significant difference in mortality between patients transferred and patients primarily admitted for PCI due to STEMI. However, patients transferred had longer hospital stay and significantly higher healthcare cost, with a mean difference of 0.72 days (95% CI: 0.65 - 0.81 days, p-value <0.000) and $3,354 (95% CI: $339 - $6371, p-value <0.029), respectively. Patients transferred also had significantly higher odds of post procedure complications, including cardiogenic shock (Odds ratio: 1.49, 95% CI: 1.08 - 2.06, p-value <0.014), cerebrovascular accident (Odds ratio: 3.64 , 95% CI: 1.15 - 11.45, p-value <0.014) and kidney failure (Odds ratio: 2.10 , 95% CI: 1.09 - 4.02, p-value <0.026). Conclusion: Patients with STEMI who were transferred for PCI experienced longer hospital stay and incurred higher healthcare costs. These patients had significantly higher odds of post procedure complications including cardiogenic shock, cerebrovascular accidents and kidney failure.

Abstract 4137448: Systemic Heparin Administration Does Not Inhibit microRNA Amplification in Patients with Myocardial Infarction

Purpose: MicroRNAs (miRs) have been proposed as biomarkers of myocardial infarction (MI), but prior evidence has demonstrated that heparin, commonly administered to patients presenting with MI, inhibits amplification during quantitative PCR (qPCR). The purpose of this study was to determine whether qPCR amplification of miRs is reduced in plasma of patients receiving heparin and if heparinase reverses this effect. Methods: Blood samples were collected and plasma recovered from patients with normal coronary arteries who had undergone CT coronary angiography ( N=5 ) or who had received intravenous heparin at the time of invasive coronary angiography( N=8 ). Blood was also collected at the time of invasive coronary angiography from patients presenting with ST elevation MI ( N=9 ). RT-qPCR was performed to quantify levels of 84 cardiac miRs, and Cel-miR-39-3p was utilized as a spike-in control. MiR qPCR was also performed following the addition of heparinase to plasma from 2 patients without MI treated with heparin and 2 patients presenting with MI who had received heparin. Results: Mean age of patients was 57 years, and 55% of patients were male. As compared with control patients, the cycle number for cel-miR-39-3p was significantly increased for patients receiving heparin (Figure 1a). No difference was seen in levels of cel-39-3p in heparin-treated patients with respect to the presence or absence of MI. Cel-miR-39-3p cycle times decreased when heparinase was added to samples from heparin-treated patients (Figure 1b). In contrast, heparin did not increase cycle times in any of the cardiac miRs tested, and cycle times decreased even further for miRs 499a-5p and 208b-3p in patients with MI (Figure 2). Conclusions: Systemic heparin treatment inhibits qPCR amplification of cel-mir-39-3p but does not inhibit endogenous miR amplification under these conditions. MiRs 499a-5p and 208b-3p are potentially important candidates for MI detection and quantification.

Abstract 4123926: Suprasomatic Serial Growth of Right Heart Structures in Fetuses with Hypoplastic Left Heart Syndrome Demonstrated by Fetal Echocardiography

Background: In hypoplastic left heart syndrome (HLHS), the single right ventricle (RV) accounts for the entire cardiac stroke volume. This physiology may produce elevated transpulmonary flow velocities and dilation of the right heart structures. Little data exists regarding normal right heart dimensions and transpulmonary velocities in relation to somatic growth in these fetuses. We sought to assess serial changes in the size of right heart structures and pulmonary valve (PV) velocities in fetuses with HLHS and compare findings to fetuses with normal cardiac anatomy. Methods: A retrospective cohort study of fetuses with HLHS or normal cardiac anatomy confirmed by fetal echocardiogram between 1/1/13 – 12/31/22 was performed, excluding multiple gestation pregnancies. Fetal echocardiograms were assessed by an independent reviewer who obtained RV, PV and tricuspid valve annulus dimensions, and PV flow velocities. Nomograms were created for both HLHS and normal cohorts. The association between gestational age and PV velocity, PV annulus, RV diameter and tricuspid valve annulus was assessed and compared between groups using linear mixed models. Results: There were 290 total fetal echocardiograms for 177 patients with HLHS compared against 408 normal fetuses. [MG1] PV velocities were higher for patients with HLHS compared to normal cardiac anatomy throughout gestation (p < 0.001). In addition, the PV velocity increased more rapidly with gestational age for the HLHS (+0.02 m/s/week) group compared to those with normal cardiac anatomy (+0.01 m/s/week) (p=0.019) (Figure 1). Similarly, the RV dimension grew more rapidly with gestational age for those with HLHS (+3.2% cm/week) compared to those with normal cardiac anatomy (+2.5% cm/week) (p<0.001) (Figure 2). Lastly, the tricuspid valve annulus grew more rapidly with gestational age for patients with HLHS (+2.6% cm/week) compared to those with normal cardiac anatomy (+2.3% cm/week) (p=0.010) (Figure 3). While the PV annulus size increased with gestational age, there was not a significant difference in growth between the two groups (p=0.119). Conclusions: In fetuses with HLHS, the PV velocity, RV size and tricuspid valve size increase at a rate greater than normal somatic growth. These nomograms help identify expected RV size, tricuspid valve size and PV velocities for fetuses with HLHS and any who may deviate from the norm.

Abstract 4126893: Feasibility and Acceptability of a Nurse-Pharmacist Post-Discharge Telehealth Model of Care for Heart Failure Patients

Background: Suboptimal medication management is common in patients with heart failure (HF), particularly during transitions-of-care. To date, there are few studies assessing the feasibility of a nurse-pharmacist post-discharge telehealth service for medication optimisation in patients with HF. We performed a feasibility study to determine service uptake and acceptability, and ability to identify medication-related issues for HF patients as they transition from hospital to home. Methods: HF patients were referred to an existing post-discharge telehealth service and offered medication reconciliation and education in addition to their usual care; a service we termed ‘MedRec’ (MR). Primary outcomes were feasibility, measured through recruitment and successful MR completion, and acceptability, measured by an investigator-developed survey. Secondary outcomes were medication-related issues detected during MR. Results: A total of 100 HF patients were offered a post-discharge MR. Mean age of patients was 68.5 ±14.2 years, and mostly male sex (62%). Pharmacist MRs were requested by 80% of patients. In total 62 MRs (77.5%) were performed; 9 patients declined MR during follow-up and an additional 9 patients were uncontactable. Mean time to MR following nurse referral was 10.98 ±9.74 days. Drug-related toxicity or adverse effect presentation was identified in 25 (40.3%) MR recipients at the time of consultation and subsequently required general practitioner follow-up. Medication compliance issues were detected by the pharmacist in 13 (20.9%) patients; forgotten doses being the most common concern. Undertreated medical conditions, such as symptomatic HF and chronic pain, were identified in 12 (19.3%) MR recipients. Medications prescribed without any apparent indication were found in 8 (12.9%) patients. Drug or disease management information was requested by 35 (56.4%) MR recipients. A total of 35 (56.5%) post-MR surveys were successfully completed. All participants who completed a post-MR survey agreed that a post-discharge telehealth MR was an acceptable form of education provision. Engagement with a pharmacist MR was perceived to ease anxiety associated with understanding medication-related changes and empowered greater medication self-management. Conclusions: A post-discharge nurse-pharmacist telehealth service is a feasible and acceptable model of care. Inclusion of a routine MR post-discharge may be an effective means of maintaining continuity of care for HF patients.

Abstract 4125093: Association of Systemic Inflammatory Index and Systemic Inflammatory Response Index with Major Adverse Cardiovascular Events in Patients with Acute Coronary Syndrome Who Had Primary Percutaneous Coronary Intervention

Introduction: Inflammation plays an important role in the pathogenesis of coronary artery disease and Acute Coronary Syndrome (ACS). Inflammatory indicators such as neutrophil count and monocyte count potentially may predict patients’ outcomes and prognosis in ACS. White blood cells count is an affordable and accessible way to assess the systemic immune response. Considering their multidirectional effect on atherosclerosis, new inflammatory biomarkers integrating various leukocyte subgroups have been proposed to calculate the systemic inflammatory response index (SIRI) and systemic inflammatory index (SII). Aim: The aim of this study was to assess the association between the systemic inflammatory response index (SIRI) and Systemic inflammatory index (SII) at admission with major adverse cardiovascular events (MACE) 30-days after Primary Percutaneous Coronary Intervention (PPCI) among patients with Acute Coronary Syndrome (ACS) at one referral hospital in Jordan. Method: A Prospective design was used to assess and follow 150 adults presented with ACS and received PPCI at one referral hospital in Jordan. Data was collected from patients and their medical records during hospital stay using a structured data collection form. The MACE was assessed 30-days after PPCI through phone calls with patients and confirmed from medical records. Results: The study included 150 patients with ACS, 82.7% (n= 124) of them were males. The mean age of patients was 57.68 (SD= 11.19) years. Types of ACS include stable angina 5.3% (n=8), unstable angina 24% (n=36), NSTEMI 28.7% (n=43), and STEMI 24% (n=36). All patients had interventional PCI with balloon and stent insertion. The mean of SIRI was 24.45 (SD=25.49) and the mean of SII was 663.30 (SD= 403.75). Rate of MACE as composite outcome 30-days after PPCI as 24.7% (n=37). The most MACE was unplanned repeat revascularization (n=14, 38% of MACE). Significant association between SIRI and SII, and MACE was found SIRI:(Χ 2 (2)> = 12.63, p = 0.001), SII:(Χ 2 (2)> = 4.23, p = 0.03) . Conclusion: The SIRI and SII are inflammatory biomarkers that should be studied as potentially predictors of MACE among patients presented with ACS.

Abstract 4138350: Candidemia in Patients with Left Ventricular Assist Device-A Case Series

Introduction: Candidemia is rare but associated, have significant morbidity and mortality. Outcomes are not well-characterized in patients with left ventricular assist devices (LVADs). With an increasing number of patients living with LVADs, we sought to characterize risk factors to help optimize outcomes for this high-risk population. Methods: We retrospectively reviewed records of 97 patients who underwent LVAD implant between January 2012 to May 2024 at Indiana University Health, Indianapolis Indiana. Demographic and clinical data were extracted. Candidemia was defined as a positive blood culture with candida species. Result: We identified three patients with candidemia, with an overall attack rate of 3.09%. All patients had a HeartMate III (HM3) at the time of infection. The mean age of patients was 40.3 years (Range 29.0 – 58.0 years) and mean BMI was 35.7 kg/m 2 (Range, 30.0 – 42.0 kg/m 2 ). One patient grew Candida auris and Candida tropicana, the other patient grew Candida auris and the third patient grew Candida globrata. All patients had an automatic implantable cardiac defibrillation, a peripherally inserted central catheter line, and right heart failure. Two patients had driveline infections (one fungal, one bacterial) while one patient developed LVAD endocarditis with a right ventricular outflow tract vegetation. Two patients had persistently positive blood cultures despite treatment with a multi-drug anti-fungal regimen (Flucytosine, Amphotericin B and micafungin) and expired. The third patient initially cleared her blood cultures after treatment with IV micafungin only but was re-admitted with muti-organ failure and expired. Summarily, all patients with candidemia died with a mortality rate of 100%. None of the patients were candidates for heart transplantation. Average survival from the time of diagnosis of candidemia was 5 months (Range 1.0 – 11.0 months). RHF, chronic DL infection and high BMI were associated with candidemia in our series. Conclusion: Candidemia in LVAD patients, while less common than bacterial infections, carry high mortality without cardiac transplantation (100% mortality in our cohort). Its rare occurrence makes it challenging to identify reversible risk factors, leading to poor survival. Multicenter registries are needed to fully elucidate these risk factors and determine effective treatment strategies.

Abstract 4145890: P-Wave Parameters on 12-Lead Electrocardiogram after Catheter Ablation: A Comparison between Pulsed Field Ablation and Cryoablation

Background: Catheter ablation (CA) is a well-established treatment for atrial fibrillation (AF). The most popular current methods of CA include radiofrequency ablation (RFA) and cryoablation (CRYO) which are thermal methods of ablation known to affect the autonomic nervous system through ablation of cardiac ganglionated plexi (GP). Pulsed[SC1] -field ablation (PFA) is a newer method of CA with demonstrated efficacy that preferentially affects cardiac cells and spares surrounding structures such as GP through irreversible electroporation which does not lead to chronic fibrosis like RFA or CRYO. Elevations in the marker the marker P terminal force (PTF) have been associated with AF/stroke and have been known to correlate with atrial fibrosis, and higher PTF after cryoablation for patients with paroxysmal AF has been associated with an increased risk of recurrence. The differences in P-wave parameters pre and post PFA have not been studied. Objective: To investigate the differences in P-wave parameters after PFA and compare them to CRYO. Methods: We identified 40 patients who underwent PFA (20 patients) or CRYO (20 patients) for paroxysmal AF and compared P-wave parameters including duration and amplitude in leads aVF, V1 and the PTF calculated as the duration x amplitude of the terminal negative component of the P-wave in V1. Data were obtained from 12-lead electrocardiograms obtained pre and post ablation. Results: The mean age of patients in our study was 61 with 75% male and 33% on antiarrythmics. We noticed a significant reduction in PTF for patients who underwent CRYO (54 mVmS at baseline compared to 36.8 mVmS after CRYO, p = 0.04) and no significant reduction in PTF for patients who underwent PFA (46 mVmS at baseline compared to 38 mVmS after PFA, p = 0.27). There was also a significant increase in HR after CRYO (65 bpm at baseline compared to 78 bpm after CRYO, p=0.01) and no significant change in HR after PFA (61 bpm at baseline compared with 60 bpm after PFA, p=0.8). There was no statistical difference in both groups looking at aVF or total V1 duration or amplitude pre and post ablation. Conclusions: CRYO leads to a significant change in PTF after ablation while PFA does not, consistent with the notion that PFA does not lead to fibrosis and PTF is not a useful marker for measuring risk of recurrence of AF post PFA.