bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 12491: Impact of Augmented Treatments on Physical Activity Outcomes in a Sequential Multiple Assignment Randomized Trial
Authors: Halloway Shannon , Daniel Manju , Wilbur Joellen , Schoeny Michael , Kitsiou Spyros , Johnson Tricia J , Vispute Sachin , Buchholz Susan
Published: December 2023

Background:
Nearly half of women do not meet aerobic physical activity (PA) guidelines. Despite proven efficacy of PA interventions, response varies. Little is known about when treatment should be augmented. The Working Women Walking Program is a Sequential Multiple Assignment Randomized Trial testing two initial treatments (Fitbit vs. Fitbit+text messages) for eight weeks and two augmented treatments (personal calls vs. group meetings) added at eight weeks for non-responders to the initial treatments.

Aims:
We aim to compare the two augmented treatments among non-responders to the initial treatments on PA after 34 weeks of the program.

Methods:
Participants (
N =
301; women ages 18-70) were randomly assigned to an initial treatment of either Fitbit (
n
= 149) or Fitbit+text messages (
n
= 152). Both groups received a Fitbit and PA prescription (increase daily steps by ≥600 above baseline). Response to treatment was defined as (a) wearing the Fitbit 10 hours per day 3 of 7 days weekly in weeks 6-8 and (b) reaching a step goal ≥600 steps above baseline for 2-3 weeks in weeks 6-8. Non-responders were randomly assigned to an augmented treatment with personal calls (
n
= 72; 50.7%) or group meetings (
n
= 70; 49.3%). Objective PA was assessed with the waist-worn ActiGraph accelerometer (≥4 days with one weekend day and ≥10 hours daily wear time) at baseline and 34 weeks to assess daily steps and minutes of light and moderate-vigorous intensity PA (MVPA). Self-report PA was measured with the International PA Questionnaire to assess daily MVPA and walking.

Results:
Across all PA measures, there were no significant differences between augmented treatments (personal calls vs. group meetings). Overall, both treatments showed non-significant increases in objective PA, including steps (
d
= .15;
p
= .30), light PA (
d
= .11;
p
= .39), and MVPA (
d
= .22;
p
= .15), but showed significant increases in self-report PA, including (
d
= 1.02;
p
< .001) and walking (
d
= .73;
p
= .30).

Conclusion:
In this sample of working women who were non-responsive to an initial PA treatment (Fitbit or Fitbit+texts), augmenting with personal calls or group meetings did not yield a difference in PA outcomes. Next, we will explore participant characteristics that may differentiate response to augmented treatments.
Abstract 12499: The Incidence and Predictor of Persistent Iatrogenic Atrial Septal Defect in Patients Who Underwent Catheter Ablation
Authors: Kamada Hiroyuki , Iriki Yasuhisa , Yoshimoto Issei , Ninomiya Yuichi , Miyata Masaaki , HAMAMOTO YUKI , Horizoe Yoshihisa , Ikeda Yoshiyuki , Ohishi Mitsuru
Published: December 2023

Background:
The left atrium approach for atrial fibrillation (AF) ablation requires an atrial transseptal puncture that may cause an iatrogenic atrial septal defect (iASD).

Aims:
This study aims to investigate the incidence and predictor of iASD in patients who underwent catheter ablation.

Methods:
This retrospective study included 639 patients (489 male; 60.2 ± 10.7 years) who underwent initial catheter ablation for AF between May 2005 and June 2018. All patients received preoperative transesophageal echocardiography (pre-TEE), preoperative transthoracic echocardiography (pre-TTE), and TTE one day after the procedure (post-TTE). TTE 6 months after the procedure (6M-TTE) was performed in 533 patients. The iASD incidence after 6 months, pre-procedure characteristics, and methods were evaluated.

Results:
Patent foramen ovale (PFO) was diagnosed in 6.6% (42/639) using pre-TEE and detected in 26.2% (11/42) using pre-TTE. Of the 533 patients who underwent 6M-TTE, 497 had no PFO using pre-TEE. iASD was observed in 59.6% (296/497) using post-TTE and 4.6% (23/497) using 6M-TTE. In the multivariate analysis, the total diameter of sheath through the septum (OR 1.21, p < 0.001) or two sheaths placed through a single puncture (OR 4.26, p = 0.001) was the independent risk factor on iASD incidence in 6M-TTE. iASD was more likely to occur in cryoballoon ablation using a larger sheath than radiofrequency catheter ablation.

Conclusions:
iASD was not a rare complication. A larger sheath diameter or two sheaths placed through a single puncture might be associated with the incidence of iASD. Careful procedural considerations might be required for patients with hemodynamic deterioration by iASD.
Abstract 12591: 12,13-dihome and Noradrenaline Are Associated With the Occurrence of Acute Myocardial Infarction in Patients With Type 2 Diabetes Mellitus
Authors: Cao Ning
Published: December 2023

Introduction:
Acute myocardial infarction (AMI) is the most prevalent cause of mortality and morbidity in patients with type 2 diabetes mellitus (T2DM). However, strict blood glucose control does not always prevent the development and progression of AMI.

Aims:
Therefore, the present study aimed to explore potential new biomarkers associated with the occurrence of AMI in T2DM patients.

Methods:
A total of 82 participants were recruited, including the control group (n=28), T2DM without AMI group (T2DM, n=30) and T2DM with initial AMI group (T2DM+AMI, n=24). The untargeted metabolomics using LC-MS analysis was performed to evaluate the changes in serum metabolites. Then, candidate metabolites were determined using ELISA method in the validation study (n=126/T2DM group, n=122/T2DM+AMI group).

Results:
The results showed that 146 differential serum metabolites were identified among the control, T2DM and T2DM+AMI, Moreover, 16 differentially-expressed metabolites were significantly altered in T2DM+AMI compared to T2DM. Furthermore, three candidate differential metabolites, 12,13-diHOME, noradrenaline (NE) and estrone sulfate (ES), were selected for validation study. Serum levels of 12,13-diHOME and NE in T2DM+AMI were significantly higher than those in T2DM. Multivariate logistic analyses showed that 12,13-diHOME (OR, 1.491; 95% CI, 1.230-1.807,
P
<0.001) and NE (OR, 8.636; 95% CI, 2.303-32.392,
P
=0.001) were independent risk factors for AMI occurrence in T2T2DM patients. The area under receiver operating characteristic (ROC) curve (AUC) were 0.757 (95% CI:0.697-0.817,
P
<0.001) and 0.711(95% CI:0.648-0.775,
P
<0.001), respectively. The combination of both significantly improved the AUC to 0.816 (95% CI:0.763-0.869,
P
<0.001).

Conclusions:
12,13-diHOME and NE may lead to understanding the possible metabolic alterations associated with AMI onset in T2DM population and serve as promising risk factors and therapeutic targets.
Abstract 12623: Leadless Pacemaker Insertion is Safe in Pulmonary Hypertension Patients
Authors: Harb Ahmad , Harb Amjad , Salah Abdelraouf , Al Kalaji Bilal , Petryshyn Yuliana , Dwaram Amulya Reddy , Khabsa Mariam , Battikh Naim , Muhyieddeen Amer , Dutta Aman , Orji Richard , Gill Jashan
Published: December 2023

Introduction:
Compared to conventional single-chamber pacemakers, leadless pacemakers (LPM) had a higher risk of pericardial effusion and/or perforation, but decreased risk of other delayed device related complications. Pulmonary hypertension patients often have higher pressures in the adjacent right ventricle, possibly increasing the risk of perforation and pericardial complications.

Methods:
The National Readmission Database years 2017 to 2020 were queried for the patients who underwent LPM placement with the ICD10 code (02HK3NZ). Patient comorbidities were identified using the appropriate ICD10 codes. Multivariate logistic regression was used to compare outcomes in patients with and without pulmonary hypertension, adjusting for patient comorbidities shown in Table 1.

Results:
We identified 26,084 patients who underwent LPM placement, 4114 (15.77%) of whom had pulmonary hypertension. There was no statistically significant difference in the primary outcomes of 30-day readmission (aOR 1.01, p 0.37, 95% CI 0.936 - 1.193), or mortality (aOR 0.973, p 0.82, 95% CI 0.769 - 1.232).

There was no difference in the composite outcome of pericardial complications (aOR 0.729, p 0.17, 95% CI 0.462 - 1.149) which included hemopericardium, tamponade, or the need for pericardiocentesis. However, patients with pulmonary hypertension had a higher risk of postprocedure bleed (aOR 1.182, p 0.036), hemothorax (aOR 2.493, p 0.003), and cardiogenic shock (aOR 2.447, p<0.001). Rest of the outcomes shown in Table 2.

Conclusions:
Leadless pacemaker insertion appears to be safe in pulmonary hypertension patients, although patients seem to be at increased risk for bleeding complications.
Abstract 12628: Effects of Temperature and Humidity on Cerebrovascular Disease Hospitalization in a Super-Aging Society
Authors: Yoshida Toshiya , Doi Shunichi , Yoneyama Kihei , Kawagoe Yasuhito , Nakai Michikazu , Yoko Sumita , Ishibashi Yuki , Izumo Masaki , Tanabe Yasuhiro , Harada Tomoo , Akashi Yoshihiro J
Published: December 2023

Introduction:
Cerebrovascular disease is known as one of the leading causes of death and disability in the elderly worldwide. Although weather was reported as predictor with cardiovascular disease, it was few evidence with cerebrovascular disease in Japan.

Hypothesis:
The weather is correlate with cerebrovascular disease hospitalizations.

Methods:
The Japanese registry of all cardiac and vascular diseases database includes patients with cardio-cerebrovascular disease who required hospitalization and constitutes a nationwide dataset in Japan. This study included 4,998,541 consecutive patients with cardio-cerebrovascular disease requiring hospitalization were admitted between 2015 and 2019. We investigated the relationship between cerebrovascular disease hospitalization and temperature, or humidity.

Results:
Data were collected from 606,807consecutive patients with cerebrovascular disease admitted. In this study population, the median age was 75.0 (66.0-83.0) years and 55.8% of subjects were male. The mean weather temperature and humidity 1 day before cerebrovascular disease hospitalization were 17.2 °C and 69%, respectively. Multilevel mixed-effects linear regression models showed the association of temperature and humidity with cerebrovascular disease hospitalizations after adjusting for air pollution, hospital, and patient demographics. Lower mean temperatures and humidity <70% or humidity ≧70% are associated with an increased incidence of cerebrovascular disease hospitalization (coefficient, -1.442 [-1.473 to -1.411] per °C, p<0.001, coefficient, -0.084 [-0.112 to -0.056] per%, p < 0.001, and coefficient, 0.136 [0.103 to 0.168] per %, p < 0.001, respectively).

Conclusions:
Lower mean temperatures and extremely lower or higher humidity are both associated with an increased incidence of cerebrovascular disease hospitalization in the aging society of Japan.
Abstract 12680: Analysis of the Impact of Cardiovascular Disease on the Early Post-COVID Period Based on the ACTIV SARS-CoV-2 International Registry
Authors: Sugraliyev Akhmetzhan , Aimakhanova Galiya , Gordeychuk Elizaveta , Bashkinov Roman , Arutiunov Aleksandr
Published: December 2023

Introduction:
Cardiovascular disease (CVD) is a leading cause of mortality worldwide. The early post-hospitalization period following COVID-19 infection is critical due to high incidences of rehospitalization and deaths.

Aim:
To study the impact of CVD on the first 3 months after hospitalization for COVID-19.

Methods:
An international registry "ACTIV SARS-CoV-2" (NCT04492384) was established to characterize the course of COVID-19 in the Eurasian region and included 7 countries. The presented subanalysis used data of patients hospitalized during the acute phase of COVID-19. The post-COVID period was assessed based on telephone surveys of the patients 3 months (n=3099) after recovery.

Results:
79.8% of patients required unscheduled medical care in the first three months post-recovery from SARS-CoV-2 infection, with 11.8% necessitating rehospitalization. Decompensation of various CVDs was the most common reason for unscheduled medical care (Table 1).

The presence of CVD in people who had COVID-19, significantly increased the likelihood of death in the first 3 months after discharge from the infectious diseases hospital (OR 4.93; 95% CI 2.53-10.8; p<0.001).

The predominant causes of death were cardiovascular events, such as acute heart failure (22.4%; n=13), acute coronary syndrome (10.3%; n=6), acute cerebrovascular accident (10.3%; n=6), pulmonary embolism (3.4%; n=2), in addition to end-stage chronic kidney disease (5.2%; n=3).

Conclusions:
Analysis of data from the "ACTIV SARS-CoV-2" registry showed that CVD may be a risk factor for a more severe course of the early post-COVID period. Moreover, cardiovascular conditions were the leading cause of unscheduled healthcare encounters and death in the first 3 months after recovery from COVID-19, which may underscore the contribution of this infection to decompensation of CVD.
Abstract 12698: Myocardial Infiltration of the Epicardial Adipose Tissue in Human Heart Failure
Authors: Viveiros Anissa , Brown Kemar J , Chen Huachen , Zhang Anran , Khoramjoo Mobin , Kim Yuri , Seidman Jonathan G , Seidman Christine E , Oudit Gavin Y
Published: December 2023

Introduction:
The epicardial adipose tissue (EAT) is adipose tissue that is contiguous with the myocardium without barrier. However, there is a fundamental gap in knowledge for the EAT’s role in health and disease.

Methods:
We employed single-nucleus RNA sequencing (snRNAseq) and molecular techniques to phenotype human EAT procured from patients with heart failure (HF) secondary to dilated cardiomyopathy (DCM) and ischemic heart disease (IHD). EAT was harvested from the right and left ventricles (RV and LV) of 10 healthy control (CTRL) donors ((median age: 54.0 (interquartile range [IQR]: 49.0-57.9) years; 5 [50.0%] males; median BMI: 25.0 ([IQR]: 24.5-28.2) kg/m
2
), 32 DCM patients ((median age: 55.0 (interquartile range [IQR]: 48.0-60.7) years; 16 [50.0%] males; median BMI: 26.1 ([IQR]: 23.0-30.3) kg/m
2
) and 22 IHD patients ((median age: 57.5 (interquartile range [IQR]: 52.5-64.5) years; 13 [59.1%] males; median BMI: 27.2 ([IQR]: 25.1-30.7) kg/m
2
). HF patients were age (p=0.668 (DCM); p=0.172 (IHD)), sex (p>0.999 (DCM); p=0.712 (IHD)), and BMI (p=0.711 (DCM); p=0.515 (IHD)) matched to CTRL.

Results:
There was a significant expansion of EAT over the LV (mean EAT thickness in CTRL: 1.11mm, DCM: 2.75mm (p=0.002) and IHD: 3.31mm (p<0.001)) and the RV (mean EAT thickness in CTRL: 2.24mm, DCM: 5.57mm (p=0.029) and IHD: 5.11mm (p=0.065)) in HF. There was only a regional expansion of EAT over the LV of IHD patients. Data were analyzed using one-way ANOVA with Tukey’s
post hoc
test. Histological staining revealed myocardial EAT infiltration in HF, which was absent in CTRL. Nuclei isolated from EAT and adjacent myocardium were then subjected to snRNAseq. The transcriptional signature of HF intramyocardial adipocytes closely resembled unique cell states and gene expression identified in the EAT, suggesting infiltration by the EAT. By contrast, myocardial adipocytes in CTRL tissue were distinct from the EAT. The adipocytes in the interventricular septum, which lacks contiguous EAT, were similar in HF and CTRL.

Conclusion:
The proximity of the EAT confers a unique position to directly modulate the myocardium. As such, targeting pathogenic EAT expansion and infiltration may be critical to the development of novel therapeutic strategies in HF patients.
Abstract 12701: Safety and Tolerability of Angiotensin Receptor Neprilysin Inhibitor Initiation in High-Risk Acute Myocardial Infarction Relative to Drug Initiation Setting: A Subgroup Analysis of the PARADISE-MI Trial
Authors: De Pasquale Carmine , Claggett Brian , Jering Karola , McMurray John J , Mann Douglas L , Granger Christopher , Kober Lars , Lewis Eldrin F , Maggioni Aldo Pietro P , Rouleau Jean L , Solomon Scott , Steg Philippe G , van der meer peter , Braunwald Eugene , Pfeffer Marc A
Published: December 2023

Background:
The initiation of blood pressure lowering pharmacologic agents during an acute myocardial infarction (AMI) can be challenging. The PARADISE MI trial randomised AMI patients with LV dysfunction and/or pulmonary congestion to either sacubitril/valsartan or ramipril within 7 days of presentation. At the physician’s discretion, drug initiation occurred in the inpatient (IP), day of discharge (DD), or outpatient (OP) setting.

Objectives:
To explore the safety and tolerability of sacubitril/valsartan versus ramipril when initiated in AMI in the IP, DD or OP care setting.

Methods:
Efficacy (cardiovascular death or incident heart failure), safety and tolerability were compared across initiation settings, and by randomization to either sacubitril/valsartan or ramipril.

Results:
Compared to IP, both DD and OP groups had fewer poor prognostic characteristics. Furthermore, serious adverse events were less frequent in the DD and OP compared to IP cohorts. The efficacy of sacubitril/valsartan on the primary outcome did not vary. Although overall adverse event rates were similar within initiation setting cohorts, systolic BP was lower with sacubitril/valsartan, regardless of initiation setting. The increased relative risk of hypotension with sacubitril/valsartan was similar across initiation settings.

Conclusion:
In this analysis of the PARADISE-MI trial based on drug initiation setting, sacubitril/valsartan reduced BP compared to ramipril. However, the clinical setting of drug commencement did not impact adverse event or tolerability signals between sacubitril/valsartan and ramipril.
Abstract 12710: The Role of Cellular Senescence in Aortic Dissection
Authors: Nakao Eichi , Aoki Hiroki , Majima Ryohei , Hashimoto Youhei , Shibata Ryo , Hayashi Makiko , Ohno Satoko , Furusho Aya , Nishida Norifumi , Hirakata Saki , Fukumoto Yoshihiro
Published: December 2023

Background:
Aortic dissection (AD) is a catastrophic disease with high mortality and serious complications, and its molecular pathogenesis is largely unknown. The importance of inflammation in AD has been reported. Recently we found that cell proliferation precedes the inflammatory response in AD. Cell proliferation causes cellular senescence that induces inflammatory response, however, role of cellular senescence in AD has not been elucidated.

Objective:
We investigated if cellular senescence contributes to AD pathogenesis in mouse AD model.

Methods and Results:
A mouse AD model was created by continuous infusion of beta-aminopropionitrile and angiotensin II (BAPN+AngII) for 14days. BAPN+AngII infusion induced senescence markers from day 3, before AD onset, and persisted until day14. Senescent cells, as demonstrated by the expression of senescence-associated beta-galactosidase, were evident in intimal endothelial cells, medial smooth muscle cells, adventitial macrophages, and fibroblasts. To examine role of cellular senescence in AD, we orally administrated ABT263 known as “senolytics” that eliminates senescent cells. ABT263 treatment reduced the expression of the senescence markers. The AD mortality of ABT263 group was 35%, which was lower than that of vehicle group(66.7%, P < 0.05 by log-rank test). The severity of AD, as assessed by the lesion length in vehicle group was 33.2 ± 3.1mm, whereas that in ABT263 group was 24.6 ± 1.8mm (P < 0.05). Transcriptome analysis revealed that ABT263 treatment suppressed the immune and inflammatory response in the aorta before AD onset. Quantitative RT-PCR confirmed that ABT263 treatment prevented the induction of p21Cip1, interleukin-6 and several chemokines. Bioplex analysis of mice’s serum showed that ABT263 decreased inflammatory molecules in mice’s serum compared to vehicle group. Moreover, aortic smooth muscle cells(SMCs)remained contractile phenotype in ABT263 group, whereas BAPN+AngII reduced the phenotype in vehicle group.

Conclusions:
Elimination of senescent cells prevented AD progression and death in mice. ABT263 suppressed the inflammatory response and contributed to retain the SMCs phenotype. Cellular senescence represents a potential predictor and a therapeutic target for AD.
Abstract 12719: The Association of High Vitamin B12 With Mortality Risks and Related Metabolisms Among Hypertensive Population
Authors: Cao Tianyu , Liu Lishun , Huang Xiao
Published: December 2023

Background:
The association of high serum vitamin B12 (B12) with mortality risks is not well studied, and its independence from related metabolites needs to be disentangled. This study aims to explore the association of high serum B12 levels with all-cause mortality and its interaction with serum folate and plasma total homocysteine (tHcy) among Chinese adults with hypertension.

Methods:
This large observational study obtained data from the China Stroke Primary Prevention Trial (CSPPT), a multi-center RCT. The study sample consisted of 9,695 hypertensive adults who were not exposed to B vitamin supplements at baseline and during follow-up. The primary outcome was all-cause mortality, and the secondary outcome was cardiovascular mortality. Patients were stratified by B12 tertiles, and previously published cutoffs: B12 < 299.52 pg/ml included patients with circulating B12 deficiency and sub-optimal deficiency; B12 < 349.69 pg/ml with concomitant elevated tHcy determines B12 metabolic deficiency; B12 ≥ 349.69 ng/ml refers to those who are free from both circulating and metabolic B12 deficiency.

Results:
During the median follow-up time of 4.5 years, 284 deaths occurred. Compared to individuals with lower B12 levels, those with elevated B12 showed increased risk of all-cause mortality (hazard ratio (HR), 1.41 95%CI 1.07-1.85) and cardiovascular mortality (HR, 3.01; 95% CI 1.30-7.01). The association between elevated B12 and all-cause mortality risk appears robust in all tested subgroups. After excluding those with potential B12 metabolic deficiency, elevated B12 remains significantly and independently associated with all-cause mortality (HR, 1.36 95%CI 1.05, 1.76) and cardiovascular mortality (HR, 2.44 95%CI 1.15, 5.18). The Bayesian kernel machine regression results showed that higher B12 is associated with increased all-cause mortality risk independent of baseline folate and tHcy.

Conclusion:
Among Chinese adults with hypertension, elevated B12 levels is associated with increased risk of all-cause mortality, independent of baseline folate, tHcy, and other traditional risk factors. These findings, if further confirmed, have important implications for nutritional counseling and clinical recommendations on B vitamin therapy.
Abstract 12724: High Health-Related Quality of Life Among Survivors of Out-of-Hospital Cardiac Arrest: A Nationwide Survey From 2001-2019
Authors: Yonis Harman Gailan Hassan , Sørensen Kathrine Kold , Bøggild Henrik , Bundgaard Ringgren Kristian , Malta Hansen Carolina , Granger Christopher B , Folke Fredrik , Christensen Helle Collatz , Jensen Britta , Andersen Mikkel Porsborg , Joshi Vicky , Zwisler Ann-Dorthe , Torp-Pedersen Christian , Kragholm Kristian
Published: December 2023

Background:
Survival after out-of-hospital cardiac arrest has increased over the past two decades. However, little is known about the health-related quality of life of long-term survivors.

Purpose:
We conducted a nationwide survey to examine the long-term quality of life of out-of-hospital cardiac arrest survivors from 2001-2019.

Methods:
The study included all out-of-hospital cardiac arrest patients from the Danish Cardiac Arrest Registry between 2001-2019 who were alive in October 2020. Health-related quality of life was evaluated using the EuroQol health questionnaire (EQ-5D), SF-12 Health Survey (SF-12), and Hospital Anxiety and Depression Scale (HADS).

Results:
Of the 4,545 survivors, 2,552 (56.1 %) completed the survey. Respondent and non-respondent age was comparable (67 vs. 68 years). The median EQ-index score for survivors who had been alive for 0-1 year was 0.8 (Q1-Q3: 0.7-1.0), while survivors who had been alive for 15-20 years had a median EQ-index score of 0.9 (0.8-1.0). These scores were comparable to a Danish reference population, whose mean EQ-index score was 0.9 (SD: 0.16).

Mean standardized SF-12 physical health score was 40.6 (SD: 12.7) for 0-1 year survivors vs. 44.4 (SD: 11.8) for >15-20-year survivors, and the SF-12 mental health score was 53.1 (SD: 8.4) vs. 54.1 (SD: 8.7), respectively. Both scores were comparable to a Danish reference population.

In terms of symptoms of anxiety, 73% of survivors who had been alive for 0-1 year reported a normal score (score ≤ 8), compared to 89.3% of survivors who had been alive for 15-20 years. For symptoms of depression, the percentages were 79.7% and 87.5%, respectively (Figure 1).

Health-related quality of life was similar for survivor groups >1-2, >2-4, >4-6, >6-8, >8-10, and >10-15 years after arrest.

Conclusion:
Short-term as well as long-term survivors of out-of-hospital cardiac arrest generally reported high health-related quality of life after the event, regardless of the time elapsed since the arrest.
Abstract 12747: Adaptive Coping, Resilience, and Cardiovascular Stress Reactivity in Women With Takotsubo Syndrome
Authors: Ouaddi Sara , Gathright Emily , Burg Matthew , Keirns Natalie , Breault Christopher , Tripolone Janice , Abbott Jinnette , Salmoirago-Blotcher Elena
Published: December 2023

Introduction:
Takotsubo Syndrome (TS) is often triggered by acute stressful events. While excessive stress reactivity is associated with worse cardiovascular (CV) outcomes, its role and that of possible stress response moderators in TS are poorly understood.

Goals/Aims:
To explore whether adaptive coping and resilience affect CV reactivity in TS patients.

Hypothesis:
Negative psychological functioning will be associated with greater CV reactivity.

Methods:
Prospectively enrolled women with TS (per Mayo criteria) completed coping (Brief-COPE) and resilience (Brief Resilience Scale) measures at enrollment (scores categorized as “high” or “low” using a median split) and a standardized stress reactivity protocol 2 weeks later. Systolic blood pressure (SBP) and diastolic BP (DBP) (mmHg) were measured every 5 min during Baseline (10 min), Mental Stress (10 min), and Recovery (20 min) using an automated BP cuff. SBP and DBP change from baseline to peak stress and 5 min into recovery were compared between low vs. high coping and resilience groups, respectively, using t-test statistics; p < 0.05 was considered significant.

Results:
Patients (n=29; mean age 64.1 ± 8.8 years) with low (vs high) adaptive coping showed a smaller stress response (SBP: 15.9 ± 22.2 vs. 28.3 ± 19.2, p= 0.13; DBP: 8.1 ± 17.8 vs 21.8 ± 23.4, p= 0.11) and slower recovery (SBP -12.0 ± 7.0 vs -23.5 ± 19.3, p = 0.12; DBP -3.4 ± 17.6 vs -18.5 ± 22.1, p=0.07). Similar, non-significant responses were noted for the low (vs high) resilience group at peak stress (SBP: 18.8 ± 22.9 vs 27.9 ± 18.7, p= 0.28; DBP: 13.0 ± 20.9 vs. 16.9 ± 23.6, p=0.67) and recovery (SBP: -13.4 ± 17.4 vs -24.7 ± 19.3, p= 0.15; DBP: -5.3 ± 18.4 vs -18.3 ± 23.8, p= 0.16, Figure 1).

Conclusion:
Consistent with recent evidence in other populations, negative psychological functioning was associated with blunted CV reactivity in women with TS. Further investigation in fully powered studies is needed to confirm these novel, exploratory findings and their prognostic value.
Abstract 12754: The Forgotten Circulation: Lymphovascular Malformation Presenting as a Complex Mediastinal Mass in a Young Adult
Authors: Suero-Abreu Giselle A , Parakh Anushri , Sung Lily L , Ghoshhajra Brian , Neilan Tomas G , Defaria Yeh Doreen , Hung Yin P , Cameron Danielle B , Bloom Jordan P
Published: December 2023

A 20-year-old transgender male presented with one week of intermittent shortness of breath and chest pain. He reported dizziness and increasing pain when playing the trumpet. His exam was unremarkable, but chest X-ray showed mediastinal widening and opacification of the retrosternal space (Fig. 1A). Chest CT showed a well-defined centrally enhancing prevascular mediastinal mass abutting the superior vena cava (SVC) and right heart (Fig. 1B). He was referred to a thoracic surgeon for evaluation. Subsequent chest CT venography and MRI demonstrated a progressively enhancing, part-solid and cystic mass with dilated veins draining into the SVC and a phlebolith. Due to imaging and clinical features, including a low probability of malignancy given negative tumor markers, lymphovascular malformation was favored over other possibilities such as thymoma, germ cell tumor, sarcoma, or Kaposiform hemangioendothelioma. After multidisciplinary discussions between cardiology, radiology, cardiothoracic and pediatric surgery, and a review at a dedicated vascular anomalies center, the consensus was for close surveillance. A 6-week follow-up MRI showed no significant change, but given increased dyspnea and chest pain, the decision was made to proceed with surgical resection via median sternotomy. The tumor was densely adherent to the right phrenic nerve, pericardium, and SVC but was excised completely without complications (Fig. 1C). Pathology confirmed a benign vascular malformation with lymphatic and venous components (Fig 1D). This diagnosis is more common in the pediatric population but a rare cause of dyspnea and chest pain in a young adult. This case illustrates the value of multimodality imaging and multidisciplinary collaboration among adult and pediatric subspecialists in the diagnosis and treatment of a rare, complex mediastinal mass in a young adult patient.
Abstract 12782: Serial Cerebral Hemodynamic Monitoring in Patients With HeartMate 3 Left Ventricular Assist Devices
Authors: Favilla Christopher G , Carter Sarah , Atluri Pavan , Reehal Navpreet , Genuardi Michael
Published: December 2023

Introduction:
Left ventricular assist device (LVAD) implantation improves cardiopulmonary hemodynamics and vital organ perfusion, but cerebral blood flow is not routinely measured despite the clinical significance of neurologic complications. We aimed to quantify the short and long-term impact of LVAD on cerebral hemodynamics by serially monitoring patients before and after LVAD implantation.

Hypothesis:
We hypothesize that LVAD implantation improves dynamic measures of cerebral blood flow: cerebral autoregulation (CA) and cerebrovascular reactivity (CVR).

Methods:
20 patients with advanced heart failure with planned LVAD implantation participated in serial cerebral hemodynamic monitoring: (1) <72-hours pre-implant, (2) <72-hours post-implant, (3) 14-days post-implant, and (4) 90-days post-implant. Cerebral blood flow velocity was measured at each visit by transcranial Doppler. CA, quantified by
Mx index
, characterized the relationship between blood pressure and cerebral blood flow. CVR quantified the cerebral hemodynamic reserve, based on the response to a hypercapnic stimulus (5% inhaled CO
2
).

Results:
As compared to the pre-implant assessment, no change was noted in absolute cerebral blood flow velocity (
Figure 1a
). However, CA improved immediately post-implant (0.47 vs 0.26; p=0.0007), at 14-days (0.47 vs 0.33; p=0.007), and at 90-days (0.47 vs 0.31; p=0.03),
Figure 1b
. Pre-implant CVR was not significantly altered at 14-days (1.14 vs 1.70, p=0.25) but improved at 90-days (1.14 vs 2.11, p=0.03),
Figure 1c
.

Conclusions:
Despite no change in cerebral blood flow velocity, LVAD implantation improves dynamic measures of cerebral blood flow, CA and CVR. Future studies should include longer follow-up and correlate post-LVAD cerebral hemodynamics with clinically meaningful neurologic endpoints such as stroke and cognitive decline.
Abstract 128: Gender Differences in Out-of-Hospital Cardiac Arrest Incidence, Characteristics, and Prehospital Outcome in Qatar
Authors: Awad Emad , Azizurrahman Adnaan , Mortada Bothina , Gholami Nooreh , Bukhari Asma , Farhat Hassan , Henri Jean Alinier Guillaume , Rumbolt Niki , Morris Timothy , Shami Rakan
Published: December 2023

Introduction:
Research on gender differences in OHCA incidence, characteristics, and outcomes is lacking in the Middle East. We evaluated gender differences in adult non-traumatic OHCA by incidence, characteristics, and achieving prehospital ROSC in Qatar.

Methods:
We analyzed data obtained from Hamad Medical Corporation on adult, non-traumatic, EMS-attended OHCA in Qatar (2017-2022). We calculated the annual incidence of OHCA and ran descriptive statistics for OHCA characteristics for the full cohort and by gender. This was followed by multivariable logistic regression to examine association between gender and ROSC, adjusting for variables known to be associated with ROSC.

Results:
We included 4306 OHCA patients, 79.8% were males. The annual incidence of OHCA was 27.4 per 100,000 population. The annual incidence was higher in males than females (30.1 per 100,000 population vs. 20.4 per 100,000 population). Males had higher proportions of OHCA cases in public locations, receiving bystander CPR, and having an initial shockable rhythm. No significant difference was detected in crude ROSC. The adjusted analysis, however, demonstrated that male gender was associated with greater odds of ROSC (OR 1.38, 95% CI 1.15 - 1.66). This advantage of ROSC in males was observed in the full cohort and in subgroups with shockable and unshockable rhythms.

Conclusion:
Approximately 717 adult patients suffer non-traumatic OHCA in Qatar annually, with a higher occurrence in males. OHCA characteristics were disadvantageous for females. Male gender was associated with greater odds of achieving ROSC, highlighting the need for additional gender-specific research in pre-OHCA care in Qatar.
Abstract 12818: Clinical Significance of Myocardial Perfusion in Dilated Cardiomyopathy and Hypokinetic Non-Dilated Cardiomyopathy
Authors: Kosuge Hisanori , Hachiya Shoko , Fujita Yasuhiro , Hida Satoshi , Satomi Kazuhiro
Published: December 2023

Introduction:
Dilated cardiomyopathy (DCM) is characterized by left ventricular (LV) systolic dysfunction with LV dilatation. Hypokinetic non-dilated cardiomyopathy (HNDC) characterized by LV dysfunction without LV dilatation is proposed as a new category of DCM. Microvascular dysfunction in DCM is associated with the degree of LV dysfunction. However, the association between myocardial perfusion and clinical spectrum of DCM has not been elucidated.

Hypothesis:
We assessed the hypothesis that myocardial perfusion is correlated with the clinical spectrum of DCM.

Methods:
Thirty-six subjects (20 non-ischemic cardiomyopathy (NICM) patients and 16 control subjects, mean age: 59 ± 2 years) underwent CMR at 3T. Cine imaging, adenosine stress perfusion, T1 mapping, and late gadolinium enhancement were performed. NICM group was divided into DCM (n=10) and HNDC (n=10). Native T1 and extracellular volume fraction (ECV) were measured as an averaged values in the septum of 3 short-axis slices of base-to-apex LV myocardium. Myocardial perfusion reserve (MPR) was calculated as the ratio of stress/rest myocardial blood flow.

Results:
LV ejection fraction was significantly lower in NICM compared to control (29.2±1.6% vs. 56.6±1.5%, p<0.001). Native T1 and ECV were significantly higher in NICM compared to control (native T1: 1296±12ms vs. 1228±8ms, p<0.001, ECV: 32.9±1.7% vs. 27.3±0.62%, p<0.001), but they showed no significant differences between DCM and HNDC. MPR in HNDC was significantly higher than that in DCM (2.0±0.51 vs. 1.5±0.27, p=0.026), and comparable to that in control (1.9±0.11, p=0.717, Fig 1). MPR was negatively correlated with LV end diastolic volume index (r=-0.333, p=0.047, Fig 2), but MPR showed no significant correlations with native T1 and ECV.

Conclusions:
HNDC showed preserved MPR in contrast to impaired MPR in DCM. Myocardial perfusion may be a promising factor for the clinical spectrum of DCM.
Abstract 12825: Comparison of Workout Heart Rates in Obese and Non-Obese Individuals Using Wearable Devices
Authors: Eun Yong , Henry Terrence , Ayinla Raji , Raiszadeh Farbod
Published: December 2023

Introduction:
The impact of exercise on the body is influenced by various factors, including obesity. Existing research on how exercise affects heart rates of obese individuals, especially in a real-world, unsupervised setting, is limited. Our study aims to address this gap by comparing heart rates recorded during workouts in both obese and non-obese individuals using Fitbit data from the All of Us database.

Methods:
This study analyzed data from the "All of Us" Dataset v6, which included data from 258,188 individuals. ICD codes were used to identify people with obesity. A control group was generated using propensity score matching, accounting for age, gender, race, ethnicity, cigarette exposure, drug use, and Charlson Comorbidity Score. The heart rates during Fitbit-recorded workouts were analyzed for both the obesity cohort and the control group. The maximum and minimum heart rates for each workout session were averaged per individual, and the mean of these averages was compared between the two groups.

Results:
A total of 63,704 obese and 63,704 matched non-obese individuals were analyzed. Demographics for the two groups were not significantly different for variables used for matching. By recruiting available Fitbit workout data and after discarding erroneous data points, 160,248 workout records from 1,092 obese individuals and 142,065 records from 967 non-obese individuals were included in the study. The mean and the standard deviation (SD) of the average minimum and maximum heart rate for the non-obese group were 99.98 (SD=12.24) and 127.53 (SD=13.06), respectively, and for the obese group were 101.05 (SD=11.61) and 128.55 (SD=12.53), respectively (Figure 1).

Conclusion:
The heart rates, both maximum and minimum, during workouts were found to be higher in the obese group compared to the non-obese control group. This difference was statistically significant but small, and further research is warranted regarding the less-than-expected difference in heart rates.
Abstract 12832: Risk of Extreme Wet Climate Conditions and Racial/Ethnic-Specific Cardiovascular Mortality in Southwest United States
Authors: Majeed Haris , Majeed Hamnah , Singh Steve , Coles John
Published: December 2023

Introduction:
Coastal regions are highly vulnerable to extreme climate conditions, which are known to have effects on adult cardiovascular disease mortality (CVDM). Racial/ethnic (R/E) minority populations (ie Non-Hispanic (NH) Black) are known to have a greater incidence of CVDM compared to their NH White counterparts. Consequently, there is a need to document associations between climate extremes and R/E-specific CVDM.

Hypothesis:
Extreme wet conditions associated with CVDM should vary by R/E, where strongest increased risk is expected for minority populations.

Methods:
Population-based study using sex, age (45-84 years), and R/E-specific (NH White, Black, Asian, & Hispanic/Latino) CVD deaths [ICD-10 (I00-99)] from CDC for Southwest US (California, Arizona, New Mexico) from Jan 1999 to Dec 2020. Climate exposure categories (mild, moderate, extreme dry/wet) were based on Palmer Drought Severity Index (PDSI), which integrates temperature and precipitation. With population estimates, CVDM rates were associated with PSDI categories using negative binomial regression upon adjusting for diabetes, smoking prevalence, sex, trend, month, state, unemployment rate, and air pollution (PM
2.5
).

Results:
From 1999-2020, 1,307,418 (67.6% NH White, 16.1% Hispanic, 7.4% NH Asian, 8.9% NH Black) CVD deaths were recorded. CVDM was associated with a significant increased risk during extreme wet events (compared to extreme drought) only among NH Asian (adjusted rate ratio [RR] 1.08; 95% CI 1.06-1.09) and NH White (RR 1.02; 95% CI 1.01-1.025) in Southwest US (Figure). Insignificant interactions were observed between extreme wet and PM2.5 on CVDM by R/E.

Conclusions:
Extreme wet climate conditions were associated with an increased risk of CVDM among NH Asian and White adults. Both climate extreme events and R/E should be considered as predisposing risk factors for CVDM. Further studies are needed to assess such CVDM risk factors for other susceptible areas in the US.
Abstract 12872: Epigenetic Regulation of Vascular Smooth Muscle Cell Phenotypic Switch and Neointimal Formation by PRMT5
Authors: Zhu Ni , Guo Zhifu , Sun Jianxin
Published: December 2023

Rationale:
Phenotypic transition of vascular smooth muscle cells (VSMCs) from a contractile to a synthetic state is involved in the development of cardiovascular diseases, including atherosclerosis, hypertension, and post-angioplasty restenosis. Arginine methylation catalyzed by protein arginine methyltransferases (PRMTs) has been implicated in multiple cellular processes, however, its role in VSMC biology remains undetermined.

Objective:
To determine the role of PRMTs in VSMC phenotypic switch and vascular remodeling after injury.

Methods and Results:
Our results show that PRMT5 is the most abundantly expressed PRMT in human aortic SMCs, and its expression is upregulated in platelet-derived growth factor (PDGF)-stimulated VSMCs, human atherosclerotic lesions, and rat carotid arteries after injury, as determined by western blot and immunohistochemical staining. PRMT5 overexpression inhibits the expression of SMC marker genes, and promotes VSMC proliferation and migration, while silencing PRMT5 exerts the opposite effects. Mechanistically, we found that PRMT5 overexpression led to histone di-methylation of H3R8 and H4R3, which in turn attenuates acetylation of H3K9 and H4, thus limiting recruitment of the SRF/myocardin complexes to the CArG boxes of SMC marker genes. Furthermore, both SMC-specific deletion of PRMT5 in mice and local delivery of lentivirus expressing shPRMT5 to rat carotid arteries significantly attenuated neointimal formation after injury. Likewise, pharmacological inhibition of PRMT5 by EPZ015666 markedly inhibited carotid artery ligation-induced neointimal formation in mice.

Conclusions:
Our results identify PRMT5 as a novel regulator in VSMC phenotypic switch and suggest that inhibition of PRMT5 may represent an effective therapeutic strategy for proliferative vascular diseases.
Abstract 12884: Impact of an Addiction Consult Team on the Management and Outcomes of Patients With Surgically Managed Drug Use Associated Infective Endocarditis
Authors: Marinacci Lucas X , Li Audrey , Tsay Annie , Kentoffio Katherine
Published: December 2023

Background:
Recurrent injection drug use is a major driver of poor long term outcomes in patients who undergo surgery for drug use associated infective endocarditis (DUA-IE). The effect of an inpatient addiction consult team (ACT) on this population is not well described.

Methods:
To assess the impact of an ACT on DUA-IE patients, we performed a single center retrospective review of all adults who underwent surgery for active DUA-IE and survived to discharge (DC) between 2012-2022 at a large academic teaching institution. An ACT was established in 9/2017. We compared measures of substance use disorder (SUD) care, readmission, reinfection, and death pre- and post- ACT implementation using logistic regression models.

Results:
The pre- and post-ACT groups were similar at baseline (Table 1). In a univariate analysis, post-ACT patients were more likely to receive medications for opiate use disorder (MOUD) pre-operatively, to receive MOUD at DC, and to have MOUD follow up appointments scheduled at DC. They were less likely to receive non-MOUD opiates at DC or to be readmitted at 30 or 90 days. Overall rates of SUD follow up care scheduled prior to DC were low. There were no differences in harm reduction measures, recurrent IE, or death. In a multivariate analysis, the association of the ACT with decreased 90 day readmissions remained significant (Table 2).

Conclusion:
Among surgically managed DUA-IE patients, ACT implementation was associated with improved metrics of SUD care and readmissions at 90 days, but not recurrent IE or death. Future efforts should focus on strengthening harm reduction interventions and ensuring SUD follow up to sustain longitudinal engagement in care.
Abstract 12915: Eye Tracking in the ECG: Exploring the Visual Behavior Patterns of Medical Students
Authors: Scherping Steven C , Doshi Samarth , Parcell Elena , Sridharan Mira , Shah Neeral , Brady William J , Soukoulis Victor
Published: December 2023

Introduction:
While a universal aspect of medical education, there are few validated teaching methods for ECG interpretation. Eye tracking technology applied to study visual patterns during ECG interpretation suggest that top performers localize the critical leads for diagnosis more effectively. No study, however, has analyzed visual behavior occurring within critical leads.

Research Question:
How does visual behavior of medical students within critical leads correlate with accuracy of ECG interpretation?

Aims:
We aimed to characterize the visual behavior of medical students interpreting ECGs to help inform future educational methods.

Methods:
36 fourth-year students from one medical school completed 9 cases while visual behavior was tracked via a Tobii Pro Nano eyetracker and analyzed with iMotions software. Cases included a vignette and 12-lead ECG followed by viewing up to three critical leads. We included five morphologic abnormalities (e.g. LBBB) and four arrhythmias (e.g. AVNRT). Accuracy was assessed via multiple choice questions after viewing the 12-lead ECG alone and again after viewing critical leads. Dwell time, the time spent focused on a given lead, and fixation count, the number of discrete focuses > 60 ms, were analyzed via Mann-Whitney U testing.

Data:
36.1% of students correctly interpreted all ECGs with morphologic abnormalities compared to 16.7% for arrhythmias. Within critical leads, there was a significant difference in average dwell time (2.62 vs 5.21 seconds (s), p <0.001) and fixation count (9.59 vs 16.5, p<0.001) between morphologic versus arrhythmia ECGs. Higher performers had decreased average dwell time and fixation count in critical leads compared to inaccurate interpreters for morphologic (2.39 vs 3.39 s, p=0.003; 8.92 vs 11.9 fixations, p<0.01) and arrhythmia (4.32 vs 7.04 s, p<0.01; 13.4 vs 22.7 fixations, p<0.01), respectively.

Conclusion:
Our study demonstrates that learners spend less focused time interpreting morphologic as compared to arrhythmia ECGs. Further, dwell times and fixation counts were lower amongst higher performers. Measurement of discrete visual behavior may provide a novel way to assess students’ pattern recognition skills and interpretation competency while also enhancing ECG didactic methods.