Citations

Background: Heavily calcified coronary bifurcation lesions present significant challenges during percutaneous coronary intervention, particularly during atherectomy due to the risk of side branch occlusion from plaque shift. We describe the "Double Guiding Catheter Technique" to minimize side branch closure and wire damage to non-atherectomy vessels during bifurcation orbital atherectomy (OA). Case: A 74-year-old male with a recent NSTEMI presented for elective coronary artery revascularization. A coronary angiogram revealed non-obstructive left coronary arteries and a dominant right coronary artery (RCA) with heavily calcified stenosis at the bifurcation of the right posterolateral (RPL) and right posterior descending (RPD) branches. After placing temporary transvenous pacing and inserting sheaths in the right radial and right femoral arteries, both the RPL and RPD were wired with coronary guidewires. Using a coronary microcatheter, the wire in RPL was replaced with a ViperWire guidewire for OA, while the microcatheter in RPD served as guidewire protection. OA of RPL was successfully performed with the Diamondback 360° OA system (Cardiovascular Systems Inc), followed by multiple dilatations with non-compliant balloons and placement of two drug-eluting stents in the distal RCA to RPL and RPD, achieving good angiographic and IVUS results. Discussion: The Double Guiding Catheter Technique has been described in a few case reports of heavily calcified left main coronary bifurcation atherectomy which is limited to relatively proximal lesions due to the need to pass a second wire to a non-atherectomy vessel outside a guide extension catheter for the main branch. This is the first reported case of OA using this technique in the right coronary artery and a relatively distal part of the coronary artery. The primary advantage of this technique is eliminating the need to withdraw one of the two wires, which can be challenging when recrossing the side branch. The microcatheter can safely protect the other branch wire during atherectomy. Conclusion: By maintaining both wires with a protective microcatheter, OA of coronary bifurcation stenosis can be successfully achieved, potentially reducing the risk of wire transection.

Background: Catheter ablation (CA) is an effective treatment for atrial fibrillation (AF), but many patients experience recurrence post-intervention. Evaluating left atrial strain (LAS) to measure LA reservoir strain (LASr), conduit strain (LAScd), and contractile strain (LASct) could help predict AF recurrence, especially in patients with no evident signs of severe LA myopathy. Goal: This study aims to assess the prognostic value of pre-ablation LAS in both paroxysmal AF (paAF) and persistent AF(peAF) in patients with no evident signs of severe LA myopathy. Methods: This retrospective study encompassed AF patients who underwent their first CA procedure at Mayo Clinic Arizona from October 2018 to February 2022 and had a LAVI <40 ml/m2 and LVEF >55%. Transthoracic echocardiography parameters, including the three LAS phases, were collected using TOMTEC software on the closest date before the CA procedure. Receiver operating characteristic (ROC) curve analysis was used to evaluate the capability of LAS to detect patients with AF recurrence after CA from those without recurrence. Results: Out of 335 AF patients who underwent CA during the study period, 40 cases had LAVI <40 ml/m2 and LVEF >55% (72.5% male; mean age 69.2 ± 8 years). Of these, 15% (6/40) experienced recurrence, while 85% (34/40) maintained sinus rhythm. The mean values of LASr, LAScd, and LASct for all patients were 16.82, 11.23, and 6.87, respectively. ROC analysis indicated that the area under the curve (AUC) for LASr, LAScd, and LASct was 0.582, 0.502, and 0.710, respectively. (Graph 1A, Table 1A) LASct was the only parameter associated with AF recurrence (AUC: 0.71). Additionally, we developed a novel marker termed LAVI-LASct by combining LAVI and LASct values, which demonstrated improved discrimination with an ROC value of 0.74 (Graph 1B). Conclusions: LASct demonstrated predictive capability for AF recurrence in patients with no severe LA dilation and preserved LVEF, potentially due to its ability to detect early atrial dysfunction preceding visible structural changes or myocardial pathology. The addition of LAVI values provided better discrimination for the ROC model. Further research is needed to confirm the clinical relevance of LAS in AF patients undergoing ablation.

Introduction: Menopause is known to be associated with myocardial infarction (MI). However, the association between menopause age and MI onset in a nationally representative population remains unknown. Objective: To examine the correlation between age of menopause and age of MI onset in the general population and the association between early menopause (onset of menopause ≤ 40 years old) and early onset of MI (onset of MI ≤ 40 years old). Methods: A cross-sectional study was conducted using a population from the 2017-2020 National Health and Nutrition Examination Survey (NHANES). The questionnaire collected self-reported data on the participants' menopause age and their age of first MI. The relationship between these two parameters was analyzed by multivariate linear and logistic regression analyses. Multivariate analysis was adjusted for race, age, body mass index (BMI), smoking status, diabetes mellitus (DM), hypertension, and dyslipidemia status. Results: Among 2,200 postmenopausal females, 90 (4.1%) have had MI. The study involved 85 postmenopausal females who reported both menopause age and MI onset, with a mean ± SD age of 55 ± 13 years. This study found a significant association between menopause age and MI onset. After adjusting for confounders, it was found that every 1-year increase in the age of menopause will delay the onset of MI by 0.28 years, with a 95% CI of 0.013 to 0.552 (Table 1A, Graph 1A, Graph 1B). Additionally, early menopause carries an almost significantly increased risk of 2.11 times (95% CI: 1.00, 4.45) for early-onset MI. After adjusting for confounders, the magnitude of the association was lower and not statistically significant, but the direction remains (OR (95% CI): 2.08 (0.87, 4.95)). However, after stratification with comorbidities, DM status was identified as an effect modifier, with early MI significantly observed in patients with DM in both univariate and multivariate analyses, with OR (95% CI) of 3.03 (1.10, 8.37) and 4.88 (1.26, 18.96), respectively (Table 2A). Conclusion: This study demonstrated a positive association between menopause age and MI onset in a generally representative population. This suggests that prolonged estrogen exposure due to late menopause may delay the onset of MI. Additionally, early menopause was associated with early MI onset in the DM population. Further longitudinal studies are required to examine the potential mechanisms involved in menopause onset and MI onset.

Background: There is suspicion that estrogen may protect against atherosclerosis. Women who experience menarche earlier, and thus have earlier estrogen exposure, might develop atherosclerosis later. The relationship between menarche age and the onset of angina pectoris, a symptom of coronary artery disease, remains unknown. Goal: This study aims to find the correlation between menarche age and the onset age of angina pectoris, and the association between early menarche (onset of menarche ≤ 10 y/o) and early onset of angina pectoris (onset of angina pectoris ≤ 40 y/o). Methods: A cross-sectional study using a population from the 2017-2020 National Health and Nutrition Examination Survey (NHANES). The question collects self-reported data on onset of menarche and onset of angina pectoris. The relationship between menarche age and age in onset of angina pectoris was analyzed by linear and logistic regression analysis. Multivariate analysis adjusted for race, age, body mass index (BMI), smoking , diabetes mellitus (DM), hypertension, and dyslipidemia status. Results: Among 4,816 females who reported their menarche age, 88(1.8 %) have had an angina pectoris. The study involved 82 females who reported both the age of menarche and the age of onset of angina pectoris. The mean ± SD of the age at menarche and the age at onset of angina pectoris was 12.53 ± 1.79 y/o and 51.66 ± 15.16 y/o, respectively. The study found a significant association between the menarche age and the age at onset of angina pectoris. After adjusting for confounders, we found that every 1-year increase in the age of menarche will delay the onset of angina pectoris by 1.43 years, with a 95% CI of 0.01 to 2.86.(Table 1A,Graph 1A-1B) We also found that early menarche has a significantly increased risk 2.8 times (95%CI: 1.3, 6.2) of early onset of angina pectoris.After adjusting for confounders, the association became even stronger. The odds ratio (OR) increased to 3.3 (95%CI: 1.4, 8.0), indicating that women with early menarche were 3.3 times more likely to experience early angina pectoris compared to those with later menarche.(Table 2A) Conclusion: In contrast to our hypothesis, age at menarche is positively associated with onset of angina pectoris. The earlier onset of menarche is linked to the earlier onset of angina pectoris. We suspected that factors beyond estrogen levels may contribute to this unexpected finding. Additional studies are needed to examine the cause of this correlation.

Abstract Background Short sleep is linked to increased acute myocardial infarction (MI) risk.However, the association of weekend-to-weekday sleep patterns with MI in a nationally representative population remains unknown. The goal is to investigate how weekday and weekend sleep durations affect myocardial infarction (MI) in the general population, and if longer weekend sleep can offset insufficient weekday sleep's effects. Methods A cross-sectional study utilized data from the 2017-2020 NHANES to examine the relationship between sleep patterns and MI. Participants self-reported their average sleep durations on weekdays (1) and weekends (2), along with the calculated weekend-to-weekday sleep duration ratio (SDR) (3). Logistic regression models, adjusting for various factors, including demographics and comorbidities, were employed to analyze the association. Those with SDR &gt; 1 had more weekend sleep, while an SDR = 1 indicated equal sleep durations. Results The study involved 9,205 adult participants, with a mean ± SD age of 68.8 ± 10.8 years and 30.7% being female. Among them, 4.65% (428 patients) had a history of MI. The mean ± SD of weekday and weekend sleep hours was 7.6 ± 1.7 and 8.3 ± 1.8 hours, respectively. For weekday sleep duration, after univariate analysis, individuals compared to those in Q1 were statistically significant 0.72 times less likely in Q2 and 1.4 times more likely in Q4 to experience MI . While MI was 0.76 times less likely to occur among participants in Q3, it was not statistically significant (95% CI Q2: 0.54, 0.96; Q4: 1.05, 1.76; Q3:0.57, 1.00). After adjusting, participants only in Q3 were statistically significant 0.71 times less likely to develop MI.(Q3: 95% CI 0.51, 0.99). For weekend sleep duration, the univariate analysis showed that individuals in Q2, Q3, and Q4 were significantly less likely to experience MI (OR = 0.63, 0.67, and 0.69; 95% CIs: 0.48-0.82, 0.51-0.87, 0.53-0.90, respectively) After adjusting, only participants in Q2 were statistically significant less likely to develop MI (OR = 0.71; 95% CI 0.52 - 0.96). For the weekend-to-weekday sleep duration ratio (SDR), after univariate analysis, individuals were statistically significant 0.54 times less likely, and 1.5 times more likely to experience MI in those whose SDR is more than 1, and those whose SDR equals 1, respectively (95% CI SDR &gt; 1: 1.14, 1.98; SDR = 1: 0.39, 0.72). After adjusting, participants with SDR more than 1 were statistically significant 0.69 times less likely to develop MI. Conclusions Moderate sleep durations on weekdays (in Q3), weekends (in Q2), along with SDR more than 1, were negatively linked with MI in a general population. This implies that sleep durations on both weekends and weekdays have comparable associations with MI. Additionally, full recovery sleep on weekends following sleep-deprived weekdays, might reduce MI risk. Further studies are needed to explore impact of weekend and weekday sleep patterns on MI.Histogram and Margins plotTable of Odd ratios

Background: Although BP is associated with kidney outcomes, its clinical significance in living kidney donors (LKD) is unknown. We aim to examine the association between pre-donation BP and the risk of kidney function decline in LKD. Methods: A retrospective cohort study using OPTN/SRTR including adult LKD, who underwent donation between 6/1972 and 9/2022, was utilized to examine the association of quartile (Q) of pre-donation SBP and DBP with time-to-event of ≥35% decline in post-donation eGFR from pre-donation eGFR by multiple Cox regression. Results: Of 174,311 adult LKD, mean±SD age was 41±12 years and 60% were female. Mean pre-donation SBP and DBP were 122±13 and 74±9 mmHg, respectively. Mean pre-donation SBP in Q 1, 2, 3, and 4 were 106±6, 117±2, 126±3, and 140±9 mmHg, respectively and the corresponding DBP were 62±5, 71±2, 78±2, and 86±5 mmHg, respectively. The median (IQR) of pre-donation eGFR was 91 (75, 111) mL/min/1.73 m2. Median(IQR) eGFR at immediate post-donation, 6-, 12-, and 24-months post-donation were 50 (40, 62), 54 (44, 67), 55 (45, 68), and 57 (47, 70) mL/min/1.73 m2, respectively. Out of 38,780 LKD with post-donation eGFR data at 6, 12, or 24 months, 31,054 had the event of ≥35% decline in post-donation eGFR from pre-donation eGFR with a median time to follow-up of 6.77 months(IQR 5.93, 12.67). The incidence rate of the event was 0.08 person-months. Compared to patients with SBP in Q 1, those with SBP in Q 2, 3, and 4 had a significantly increased risk for the event(HRSBP Q2,3,4 1.05, 1.08, and 1.15; P <0.001 – 0.003) but only patients with DBP in Q 3 and 4 had a significantly increased risk for the event (HRSBP Q3,4 1.04 and 1.09). After adjusting for age, gender, race/ethnicity, U.S. citizenship, education level, history of pre-donation HTN, diabetes, pre-donation BMI, DBP, and urine protein:creatinine ratio, there was a J-shaped association between pre-donation SBP and post-donation eGFR decline and only patients in the Q 2 became significantly associated with lower the risk for the event (HR 0.87, 95%CI 0.76, 0.99; Fig1). The pre-donation DBP – post-donation eGFR association was similar to the SBP – eGFR association but there was no statistically significant in all Q (Fig2). There was no effect-measured modifier for all covariates. Conclusions: Pre-donation SBP in a normal range(113 - 120 mmHg) is associated with the lowest risk for a post-donation eGFR decline. BP control in the normal range should be achieved for potential LKD.

Background: Hypertension is well known for its association with cardiovascular events and arthritis. However, epidemiological data on the direct relationship between heart failure and arthritis in hypertensive patients is limited. This study examines the hypothesis that arthritis increases the risk of heart failure among patients with hypertension. Additionally, the effect of gender on these outcomes was assessed. Method: In our study, we analyzed data from 6,789 adults with hypertension aged 18 to 80 years, sourced from the National Health and Nutrition Examination Survey (NHANES) for the years 2017-2018. Arthritis was defined based on participants’ self-reported diagnosis by a doctor. We utilized logistic regression to explore the relationship between arthritis and the presence of heart failure across three different models. The first model included heart failure alone, the second model included age, gender, education, race, body mass index (BMI), smoking, and drinking, and the third model additionally included coronary artery disease and stroke. Result: The prevalence of heart failure among individuals with both arthritis and hypertension stands at 6.0%. Investigation into gender reveals a notable prevalence in males at 8.2% compared to 4.5% in females [Fig 1]. The analysis revealed a positive correlation between the two conditions across the entire population, with correlation coefficients of 2.38 (95% CI: 1.68-3.37), 1.61 (95% CI: 1.11-2.34), and 1.51 (95% CI: 1.01-2.25) for the three models, respectively. Specifically, in males, there was a notably increased association in the first and second models, with correlation coefficients of 2.77 (95% CI: 1.76-4.35) and 1.69 (95% CI: 1.05-2.74), respectively. Conversely, among females, a significant association was observed only in the first model, with a correlation coefficient of 2.24 (95% CI: 1.29-3.89) [Fig 2]. Conclusion: A robust positive correlation between arthritis and heart failure was observed in hypertensive U.S. patients. Gender was found to be a factor influencing this relationship, with males having a higher risk and prevalence of heart failure compared to the overall population.

Despite advances in ablative therapies, outcomes remain less favorable for persistent atrial fibrillation often due to presence of non-pulmonary vein triggers and abnormal atrial substrates. This review highlights advances in ablation technologies and notable scientific literature on clinical outcomes associated with pursuing adjunctive ablation targets and substrate modification during persistent atrial fibrillation ablation, while also highlighting notable future directions.

81 Background: Recent data suggest an association between cardiovascular disease burden and biliary cancer patients. However, the outcomes of hospitalized patients for biliary-pancreatic malignancy with concurrent acute decompensated heart failure (ADHF) are not well understood. Therefore, our objective is to assess the impact of ADHF on patients hospitalized for biliary-pancreatic malignancy. Methods: We used the 2020 U.S. National Inpatient Sample (NIS) to study patients hospitalized for biliary tract and pancreatic malignancy with concurrent acute decompensated heart failure (ADHF) identified by ICD-10 CM codes. Adjusted odds ratios (aORs) for predefined outcomes were determined via multivariable logistic and linear regression analyses. The primary outcome examined was inpatient mortality, while secondary outcomes included complications related to various body systems. Results: We identified 43,009 patients with a primary discharge diagnosis of biliary tract and pancreatic cancer. The mean age was 68.5 years; 49.4% were female. Caucasians accounted for 68%, followed by Hispanics (13%). Of these, 6.27% (3,699/43,009) had a concurrent diagnosis of heart failure. In the survey's multivariable logistic and linear regression analysis, accounting for patient and hospital confounding factors, ADHF demonstrated significant associations with higher in-hospital mortality (aOR 1.63; 95% CI 1.09, 2.44, p = 0.015). In addition, a significant association between ADHF and various adverse in-hospital outcome was observed including prolonged mean length of stay (Beta 1.45; 95% CI 0.67, 2.24, p < 0.001), increased mean total hospital cost (Beta 3,757; 95% CI: 2,641, 36,630, p = 0.024), elevated risk of shock (aOR 2.75; 95% CI: 1.77, 4.26, p < 0.001), higher risk of sepsis (aOR 1.71, 95% CI: 1.09, 2.68, p = 0.018), increased risk of acute respiratory failure (aOR 3.18, 95% CI: 2.25, 4.51, p < 0.001), and heightened risk of acute kidney injury (aOR 1.57; 95% CI: 1.24, 1.99, p < 0.001). Conclusions: Among patients hospitalized for biliary-pancreatic malignancy, concurrent ADHF is linked to increased mortality risk and various in-hospital adverse complications. Additional long-term studies are required for a comprehensive understanding of this association.

80 Background: Disparities in health outcomes exist among racial and ethnic groups in the United States, notably in patients with colon cancer. Metastasis is the primary cause of cancer morbidity and mortality. However, data on the metastasis risks and clinical outcomes on hospitalized individuals with colon cancer is still limited. Therefore, we aim to assess the association between metastatic colon cancer and racial differences. Methods: We analyzed the 2020 U.S. National Inpatient Sample (NIS) to explore patients who have colon cancer as the primary diagnosis. Additionally, we identified evidence of metastasis, as recorded by ICD-10-CM. Adjusted odds ratios (aORs) for specified outcomes were calculated through multivariable logistic and linear regression analyses. The primary outcome was racial differences in organ metastasis and secondary outcomes included mortality and length of stay. Statistical significance was established at p-value of 0.05. Results: We identified 80,130 patients with primary diagnosis of colon cancer at discharge. The mean age was 67.4 years; 49.7% were female. Caucasians accounted for 69.3%, with African Americans at 13.3% and Hispanics at 8.2%. 15% of the patients had liver metastasis, whereas 22% had lung metastasis. In a multivariate analysis adjusting for patient, COVID-19, chemotherapy usage and hospital factors, African Americans had higher risk of lung metastasis (aOR 1.22; 95%CI (1.07, 1.40), p = 0.003), higher risk of liver metastasis (aOR 1.51; 95%CI (1.31, 1.74), p = 0.021) and longer length of stay (b = 0.95; 95%CI (0.56, 1.33), p = 0.001). Hispanics also had higher risk of lung (aOR 1.22, p < 0.05) and liver metastasis (aOR 1.24, p = 0.021). We observed an increase in risk of metastasis and mortality but non-statistically significant in some parameters and races, as shown in table provided. Conclusions: In conclusion, our study revealed that racial difference is associated with higher risk of metastasis, as well as other outcomes. To establish a causal relationship between races, metastasis, and mortality in patients with colon cancer, further longitudinal research is necessary. [Table: see text]