bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 14349: Relationship Between Obesity and Youth Athletes’ Physical Activity and Exercise-Related Symptoms
Authors: Qiu Grace , Riley Joshua M , Dikdan Sean , Johnson Drew , Shipon David
Published: December 2023

Introduction:
Pediatric obesity has significant impacts on the development of many medical comorbidities into adulthood. While studies have identified the negative effects of obesity on exercise performance and cardiovascular health, the effects of obesity on youth athletes are less studied.

Hypothesis:
Obesity in youth athletes is associated with decreased activity levels and increased exertional cardiac symptoms.

Methods:
The HeartBytes National Youth Database produced by Simon’s Heart, a nonprofit organization that organizes sports pre-participation examinations (PPEs) of adolescents, was used for this study. This database contains demographic, exercise-related symptoms, and electrocardiogram data obtained during Simon’s Heart PPEs. BMI values were converted to age- and gender-adjusted percentiles, with obesity defined in accordance with CDC definition BMI ≥ 95th percentile. A chi-squared test with odds ratios (OR) and 95% confidence intervals (CI) were used to evaluate obesity outcomes.

Results:
Of the 7363 patients in the HeartBytes database with BMI data, the majority were male (60.7%) and White (83.3%). The median age was 15.0 years old (interquartile range 13.5-16.5). Youth athletes within the normal weight range (5th-85th percentile) had higher exercise participation rates in comparison to those who were underweight, overweight, or with obesity (p<0.0001 for each). Athletes with obesity were more likely to have exertional symptoms (OR: 1.63 [CI: 1.36-1.96]; p<0.0001), specific symptoms of easily fatigued (OR: 3.00 [CI: 2.38-3.79]; p<0.0001) and dyspnea (OR: 1.69 [CI: 1.37-2.10]; p<0.0001), compared to those without obesity. Athletes with obesity were more likely to have hypertension (OR: 5.35 [CI: 2.00-14.30]; p=0.0002), high cholesterol (OR: 3.84 [CI: 2.51-5.86]; p<0.0001), and ECG T-wave inversion changes (OR: 2.19 [CI: 1.10-4.33]; p=0.022) than those without obesity. No association was found between obesity and diabetes.

Conclusions:
In this dataset from a national registry of PPEs, obesity in youth athletes is associated with decreased physical activity and exertional symptoms. Further study is needed to elucidate the cause-effect relationship of these findings.
Abstract 14370: Educate: A Randomized Controlled Trial of Education Curriculum Assessment for Teaching Electrocardiography
Authors: Kashou Anthony H , Noseworthy Peter A , Beckman Thomas , Anavekar Nandan S , Cullen Michael W , Angstman Kurt , Sandefur Benjamin , Shapiro Brian P , Wiley Brandon , Kates Andrew , Sadhu Justin , Thakker Prashanth , Huneycutt david , Braisted Andrew , Smith Stephen W , Baranchuk Adrian , Grauer Ken , O'Brien Kevin , Kaul Viren , Gambhir Harvir , Knohl Stephen , Restrepo Daniel , May Adam
Published: December 2023

Background:
Gaps in ECG interpretation competency among medical professionals exist, with a need for practical, evidence-based, and accessible learning solutions. We conducted an international, prospective, randomized controlled trial to assess the effectiveness of web-based, self-directed ECG learning.

Methods:
A total of 1206 diverse medical learners and professionals underwent an initial test, followed by random assignment to one of four groups: (i) online question-bank (questions), (ii) online lectures (lectures), (iii) online, question-bank and lectures (hybrid), or (iv) no resources (control). After 4 months, a post-test was administered to evaluate the overall change in performance.

Results:
Of all participants, 863 (72%) completed the trial. After the 4-month follow-up, all three online, self-directed intervention groups (questions, lectures, and hybrid) showed significant improvement in overall performance (P<0.001), while the control group did not (P=0.544). The questions, lectures, and hybrid interventions demonstrated score improvements of +11.4% (95% CI, 9.1-13.7; P<0.001), +9.8% (95% CI, 7.8-11.9; P<0.001), and +11.0% (95% CI, 9.2-12.9; P<0.001) respectively, compared to +0.8% (95% CI, -1.2-2.8; P=0.544) for the control group. These improvements were consistent across medical professional groups
(Figure 1)
.

Conclusions:
Web-based, self-directed learning resources effectively improved ECG interpretation proficiency for diverse medical learners and professionals.
Abstract 14386: High Sensitivity Troponin: Implementation Before Education
Authors: Chebaya Philip , Banerjee Sanchari , Anand Nicholas , Zafar Hiba , Weinberg Andrew , Smith Kevin , Phogat Vishal , Olonoff Danielle
Published: December 2023

Introduction:
Troponin T is strong indicator of Acute Myocardial Injury, however, concerns regarding its sensitivity have led to the inception of high sensitivity troponin (hscTn). The use of hscTn in clinical practice allows for an increased negative predictive value, which in turn can expedite triage and disposition of patients presenting with Acute Coronary Syndrome. The ACC/AHA have developed algorithms to provide a road map to aide in the interpretation of hscTn values and their indications. However, the understanding of the interpretation of test is integral hscTn in guiding management.

Hypothesis:
Evaluate if the implementation of hscTn within our hospital system decreased the amount of inappropriate diagnostic testing and admissions.

Methods:
A total of 602 patients consisting of two patient groups seen in our emergency department with the chief complaint of chest pain were studied. The troponin T group consisted of patient admitted between Jan 2021 to June 2021 (n=246) and the hscTn group between July 2021 - December 2021 (n=356). Baseline demographic and clinical comorbid characteristics were compared between both groups. Notable outcomes of interest were rates of admission as well as cardiac testing. Analysis was performed using T test for continuous variables and Chi squared test for categorical variables.

Results:
Admission rates were significantly increased in the hscTn group in comparison to the regular troponin group with proportions of 60.3% vs 39.7% respectively (p < 0.001). An 11 percent increase in inpatient cardiology consultation of the total visits occurred within the hscTn group vs the regular troponin group. When evaluating admitted patients, based on AHA guidelines for significant hscTn findings only 2% of those patients who were admitted met the criteria.

Conclusions:
The introduction of hscTn troponin within our hospital did not appear to decrease chest pain admissions regardless of its improved sensitivity and specificity. In contrast, rates were increased even when elevation was not significant, this may not be due to the test's efficacy but instead to the lack of education on its indications.
Abstract 14388: Meta-Analysis of Randomized Controlled Trials Comparing Immediate vs Staged Complete Revascularization in Patients With Acute Coronary Syndrome
Authors: Singh Sahib , Tantry Udaya , Bliden Kevin , Garg Aakash , Gurbel Paul
Published: December 2023

Introduction:
Complete revascularization with percutaneous coronary intervention (PCI) has been shown to improve clinical outcomes in patients with acute coronary syndromes (ACS) and multivessel disease (MVD). In order to address the conflicting results reported with respect to the timing, we aimed to perform a meta-analysis of the available randomized controlled trials (RCTs).

Methods:
Online databases were searched for RCTs comparing immediate to staged complete PCI in patients presenting with ACS. The primary outcomes of interest were major adverse cardiovascular events (MACE), all cause death, myocardial infarction (MI), cardiovascular death, stent thrombosis, target lesion revascularization (TLR), target vessel revascularization (TVR), cerebrovascular events and bleeding at the longest available follow up. Pooled risk ratios (RR) and 95% confidence intervals (CI) were calculated using a random-effects model.

Results:
Three RCTs with a total of 2,261 patients, with 1,131 in the immediate PCI group and 1,130 in the staged PCI group were included. The mean age was 67 years, 79% of patients were men and the mean duration of follow up was 1 year. The immediate PCI group compared to staged complete PCI was associated with a significant reduction in MI (RR 0.50, 95% CI 0.31-0.83, p = 0.007) (Figure 1) and TVR (RR 0.58, 95% CI 0.41-0.80, p = 0.001). There were similar risks of cardiovascular death (RR 1.15, 95% CI 0.55-2.42, p = 0.71), TLR (RR 0.88, 95% CI 0.17-4.65, p = 0.88), cerebrovascular events (RR 0.87, 95% CI 0.41-1.82, p = 0.71), all-cause death (RR 1.30, 95% CI 0.48-3.50, p = 0.61), MACE (RR 0.70, 95% CI 0.48-1.02, p = 0.06), stent thrombosis (RR 0.89, 95% CI 0.36-2.22, p = 0.81) and bleeding (RR 0.65, 95% CI 0.18-2.41, p = 0.52) between the two groups.

Conclusions:
Complete PCI of the culprit and non-culprit vessels during the index procedure (immediate) significantly reduces the risk of MI and TVR when compared with staged PCI.
Abstract 14394: Complete Atrioventricular Block in a Young Patient With Alport Syndrome: A Case Report
Authors: Zhou Zuoyi , ZHANG Long , Gong Yanjun , Li Jianping
Published: December 2023

Background:
Atrioventricular block (AVB) in young adults is rare, and the etiologies and mechanisms in most cases remain uncertain. Alport syndrome is a heterogeneous, hereditary disorder characterized by nephropathy, hearing loss, and ocular abnormalities. Complete AVB has never been reported in Alport syndrome patients with normal kidney function.

Case report:
A 20-year-old male patient was admitted to hospital with “asymptomatic bradycardia for years”. On admission, the patient’s blood pressure was normal and electrocardiogram (ECG) showed third-degree AVB with atrial rate of 63 bpm and ventricular rate of 36 bpm. He was diagnosed with Alport syndrome at the age of 10. Genetic testing at that time showed single nucleotide variants (c.2372T>C, c.2072T>G) and deletion (c.1781-1949(Exon25)) in
COL4A5
gene. During the subsequent 10-year follow-up, the patient was presented with consistent hematuria and proteinuria, but his renal function has never been found impaired. He denied other medical history as well as family history of arrhythmia. Laboratory tests indicated hypoproteinemia, hyperuricemia, hyperlipidemia, and hyperhomocysteinemia. The 24-hour ambulatory ECG revealed a heart rhythm consisting of sinus rhythm with second-degree AVB (2:1 downward transmission) and complete AVB with junctional escape. The mean ventricular rate was 36 bpm (ranged 25-60 bpm). Neither echocardiography nor cardiac magnetic imaging with delayed gadolinium enhancement found any significant abnormality. We then did whole exome sequencing (WES), which did not identify specific pathogenic variant (Table1). 3mg atropine was admitted to the patient for an atropine test to rule out the possibility of vagally mediated AVB and the pacemaker implantation was then performed.

Conclusion:
We report a case of complete AVB with unknown etiology in a young patient with Alport syndrome.
Abstract 14403: Echocardiographic Predictors of Phenotype Development in Hypertrophic Cardiomyopathy Mutation-Carriers
Authors: Canciello Grazia , Borrelli Felice , Todde Gaetano , Chen Suet Nee , Santoro Ciro , PERILLO ERRICO FEDERICO F , Ordine Leopoldo , Esposito Giovanni , losi Maria-Angela , Lombardi Raffaella
Published: December 2023

Introduction:
Hypertrophic cardiomyopathy (HCM) is a hereditary disease characterized by unexplained left ventricular (LV) hypertrophy (LVH). Genetic family screening of probands identifies mutation carriers (Gen+) without phenotype (Phen-), who require clinical follow-up.

Hypothesis:
Identification of early phenotype signs may facilitate clinical management of Gen+/Phen-. We assessed if echocardiography LV global longitudinal strain (GLS) and strain rate (SR) may predict LVH development in Gen+/Phen- HCM.

Methods:
We identified 16 Gen+/Phen- (25% women; age 20±11 years). Echocardiogram was performed at baseline, when no phenotype was evident, and repeated yearly. The end of follow up was the HCM diagnosis date in subjects who developed HCM (FU-Phen+) and the last visit date in those who didn’t develop HCM (FU-Phen-). Mitral inflow peak E and A velocities and Tissue Doppler E’ and A’ peak velocities were measured. LV GLS and SR-peak during isovolumic relaxation (SRIVR) were calculated offline independently by two investigators blind to the clinical data.

Results:
GLS and SRIVR were not age-dependent (p=0.08 and 0.55, respectively), whereas E/E’ ratio was directly related to age (p=0.011). During follow-up (8±5 years, interquartile range 5-10 years) 5 subjects became FU-Phen+. At baseline, FU-Phen+ compared to FU-Phen- were older and had higher maximal wall thickness, higher EF, less negative GLS and lower SRIVR (Table). Abnormal baseline GLS, despite a normal EF, and reduced SRIVR indicate reduced systolic deformation and covert diastolic dysfunction which may be caused by disarray preceding LVH and fibrosis.

Conclusions:
This is the first HCM preclinical study to compare at baseline HCM Gen+/Phen- subjects who will develop to those who will not develop LVH. We identified sensitive, easily obtainable, age- and load-independent echocardiographic predictors of phenotype development in HCM gene carriers who may undergo early preventive treatment.
Abstract 14415: Aortic Strain and Stiffness in Patients With Turner and Marfan Syndrome: Non-Invasive Phenotyping of Aortic Biomechanical Properties
Authors: Iguidbashian John , Carroll Adam , Stone Matthew , Mitchell Max B , Jaggers James , Chatfield Kathryn , Khanna Amber , Jacobsen Roni , Barker Alexander J , Schafer Michal , Reece T B
Published: December 2023

Introduction:
Turner and Marfan Syndromes (TS and MFS) are hereditary connective tissue disorders with increased risk of aortic aneurysm and rates of dissection. Prior studies suggest that TS and MFS have increased aortic stiffness when compared to healthy controls but comparative phenotyping of central aortic stiffness between the two syndromes has not yet been performed.

Hypothesis:
Non-invasively derived aortic biomechanical properties will differ between MFS and TS patients.

Methods:
Patients underwent cardiac MRI to evaluate central aortic strain and stiffness. Circumferential strain was evaluated using relative area change (RAC) for both the ascending and descending aorta and longitudinal aortic strain (LAS) was measured in the ascending aorta. Stiffness was evaluated using pulse wave velocity (PWV) and by wave-intensity analysis derived backward compression wave (BCW) ratio measuring stiffness of arch and abdominal vessels.

Results:
Patients with TS (N=53, mean age: 17.2±5.4) and MFS (N = 22, mean age: 17.8±6.2) had similar ascending aortic size and z-score. When compared to TS, MFS patients had reduced RAC in both ascending (33 vs 16%, P < 0.05) and descending aorta (24 vs 14%, P < 0.01) (Figure). PWV was increased in MFS in both ascending (4.0 vs 3.0 m/s, P < 0.01) and descending aorta (3.8 vs 4.7 m/s, P < 0.01). LAC was reduced in MFS patients as well (14 vs 8%, P < 0.01). Lastly, MFS had increased BCW ratio for arch vessel stiffness (0.11 vs 0.26, P < 0.01) with no difference in abdominal vessels (0.35 vs 0.36, P = NS).

Conclusion:
In contrast to TS, MFS patients have comparably increased stiffness and reduced compliance throughout the central aorta including aortic arch vessels. These differences are in parallel with clinical observations describing higher rate of aortic events throughout the entire aorta in patients with MFS. Our results might also be critical given the increasingly dominant role of biomechanical indices in the risk assessment for aortic events.
Abstract 14425: Independent Predictors of ECG Interpretation Proficiency in Healthcare Professionals
Authors: Kashou Anthony H , Noseworthy Peter A , Beckman Thomas , Anavekar Nandan S , Cullen Michael W , Sandefur Benjamin , Boswell Christopher L , Angstman Kurt , Shapiro Brian P , Wiley Brandon , Kates Andrew , Huneycutt david , Braisted Andrew , Kerwin Scott , Beard John , Young Brian , Rowlandson Ian , Baranchuk Adrian , O'Brien Kevin , Knohl Stephen , May Adam
Published: December 2023

Background:
Accurate ECG interpretation is vital, but variations in skills exist among healthcare professionals. This study aims to identify factors contributing to ECG interpretation proficiency.

Methods:
Survey data and ECG test scores from participants in the EDUCATE Trial were analyzed. The dependent variable was the test score for interpreting 30 12-lead ECGs. Independent variables included non-modifiable factors (physician status, clinical experience, patient care impact) and modifiable factors (weekly interpretations, training hours, expert supervision frequency). Bivariate and multivariate analyses generated the Comprehensive Model (all factors) and Actionable Model (modifiable factors only).

Results:
Among 1206 participants, there were 72 (6.0%) primary care physicians, 146 (12.1%) cardiology fellows-in-training, 353 (29.3%) resident physicians, 182 (15.1%) medical students, 84 (7.0%) advanced practice providers, 120 (9.9%) nurses, and 249 (20.7%) allied health professionals. Physicians accounted for 571 (47.3%) of participants, while 453 (37.6%) were non-physicians. Bivariate analysis showed associations between test scores and multiple variables
(Table 1)
. In the Comprehensive Model, scores were independently associated with weekly interpretations (9.9 score increase; 95% CI 7.9-11.8; P<0.001), physician status (9.0 score increase; 95% CI 7.2-10.8; P<0.001), and training hours (5.7 score increase; 95% CI 3.7-7.6; P<0.001). In the Actionable Model, scores were independently associated with weekly interpretations (12.0 score increase; 95% CI, 10.0-14.0; P<0.001) and training hours (4.7 score increase; 95% CI 2.6-6.7; P<0.001). The Comprehensive and Actionable Models accounted for 18.7% and 12.3% of the variance in test scores, respectively.

Conclusions:
Being a physician is a non-modifiable predictor, while training and regular practice are modifiable predictors of ECG interpretation performance.
Abstract 14430: The Corcare Heart Function Optimization Protocol: A Structured Quality Improvement Intervention to Improve Goal Directed Targets for Patients With Reduced Ejection Fraction
Authors: Ricci Joseph A , Bozek Beverly , Aprile Maria , Ibrahim Siyam , Frisbee Stephanie J , Howlett Jonathan G , Kassam Saleem , McKelvie Robert , Poon Stephanie , Suskin Neville , Yan Andrew T , Aprile Luke , Goodman Shaun G
Published: December 2023

Introduction:
Reduced ejection fraction (REF) in patients is prevalent, utilizing substantial health care resources. Goal Directed Therapy (GDT) reduces hospitalization, morbidity, and mortality but use is suboptimal. Care in subspecialty clinics following discharge reduces readmission, but is not scaled for longitudinal care of the larger REF population. Canadian guidelines support integration of primary, specialist, and non-physician care in systems to improve outcomes.

Hypothesis:
A protocol-guided intervention will achieve high rates of GDT for REF patients in a community health care setting.

Goal:
To evaluate a pragmatic quality-of-care intervention to achieve GDT for REF patients and assess barriers to GDT.

Methods:
Patients referred for imaging and cardiology consultation at a community facility (Jan 1/15-Dec 31/22) were screened. Patients with LVEF <41% on echocardiogram were included if their cardiologist consented to study protocol GDT and were enrolled at the next scheduled, usual care cardiologist visit. 2 project nurses confirmed patient status and assisted GDT management using medical directives at 9 protocol-specified visits between usual care visits over 32 weeks. The primary target was achieving GDT or maximally tolerated GDT (>0 mg). A secondary endpoint, clinical inertia, was defined as not achieving GDT due to physician or patient choice.

Results:
864 patients (13 cardiologists) participated: median age 71 (28-102) years, diabetes 25%, hypertension 60%, atrial fibrillation 22%. At intake: NYHA class ≥2 (60%), EF <30% (45%), 30-35% (27%), 36-40% (29%), REF etiology ischemic (47%), non-ischemic (43%), mixed (10%). The majority achieved GDT in each class; inertia, not intolerance predominantly accounted for those who did not achieve GDT.

Conclusion:
This pragmatic community-based intervention achieved high rates of GDT that could improve longitudinal care for REF patients, and is potentially scalable and generalizable.
Abstract 14433: The Utility of Fibrinogen-Albumin-Ratio as a Prognostic Biomarker in Coronary Artery Disease Patients: A Comprehensive Meta-Analysis
Authors: Tanashat Mohammad , Hossam El Din Moawad Mostafa , Ramadan Alaa , Altobaishat Obieda , Abbas Abdallah , Shalaby Mahmoud , Elnagar Marwa , Hendawy Mohamed
Published: December 2023

Background:
Coronary artery diseases (CAD) are considered the leading cause of death and morbidity worldwide. The fibrinogen-to-albumin ratio (FAR), a novel inflammatory indicator, has been investigated to be associated with CAD. However, for CAD patients who received percutaneous coronary intervention (PCI), the predictive significance of the FAR is still unclear.

Objective:
This systematic review aimed to investigate the use of FAR as a prognostic biomarker for negative outcomes of CAD.

Methods:
Following the PRISMA guidelines, we searched PubMed, Scopus, and Web of Science for eligible articles mentioning the utility of FAR in the prognosis of CAD patients. In conducting our meta-analysis, a random effect model was used. The results were examined using a pooled adjusted hazard ratio or mean difference with a 95% confidence level. The Q statistics and I2 value were used to evaluate heterogeneity. A p-value of equal or less than 0.5 indicated statistically significant results and heterogeneity.

Results:
We included 21 studies in our meta-analysis after the screening process. Four studies with a total of 2813 participants reported that the pooled estimates of FAR revealed that CAD patients had higher values compared to non-CAD patients (SMD = 1.23 [0.45, 2.02]; P = 0.002). Our meta-analysis showed that high FAR level was statistically significant associated with increased all-cause mortality, cardiac mortality, and MACE as observed by hazard ratio. Using mean difference, high FAR values were associated with lower LVEF, higher SYNTAX score and no reflow.

Conclusion:
FAR can be utilized as a prognostic biomarker in CAD patients to predict poor outcomes.
Abstract 14437: Incidence and Inpatient Outcomes of Takutsubo Cardiomyopathy in the United States- An Analysis of the National Inpatient Sample
Authors: Hiltner Emily P , Kassotis John , Sethi Ankur
Published: December 2023

Introduction:
Takutsubo cardiomyopathy (TC) has been increasingly recognized as an acute cardiac syndrome characterized by typical wall motion abnormality patterns in the absence of epicardial coronary artery disease. It is unknown whether the incidence and mortality of this entity as characterized by race and gender have changed in recent years.

Methods:
The National Inpatient database (2009-19) was used to study trends in admissions and outcomes of TC over time. Survey estimation commands were used to determine weighted national estimates.

Results:
During the study period, the estimated incidence rate (IR) per million of hospital admissions for TC was found to increase with age and was higher for women than men in all age distributions (p<0.001). The increase in incidence continued well into older age groups, including patients 85 years and older (Figure). Men with TC were found to have higher rates of in-hospital mortality as compared to women (13.7% vs 7.4%, respectively), however there was no difference in in-hospital mortality when compared by race in both women and men (p=0.376 and p=0.406, respectively).

Conclusions:
The incidence of TC has increased in both men and women of all races during the study period. There was no difference in in-hospital mortality amongst the different races, however men had higher in-hospital mortality when compared to women.
Abstract 14438: Loss of the ROR2 Tyrosine Kinase Receptor is Associated With Dysfunctional Angiogenesis in Pulmonary Hypertension via Inappropriate Focal Adhesion Activation and Disruption of the Endothelial Barrier
Authors: Mitra Ankita , Chakraborty Ananya , Zhong Brian , Agarwal Stuti , Heo Lyong , Nair Ramesh , Dunn Alexander R , Dejesus Vinicio A
Published: December 2023

Background:
Dysfunctional angiogenesis is a hallmark of pulmonary arterial hypertension (PAH), but its mechanisms are unclear. We recently demonstrated a key role for Wnt7a in lung angiogenesis. Wnt7a acts through ROR2, a Wnt pathway tyrosine kinase receptor. We elucidate how ROR2 controls angiogenic functions in pulmonary microvascular endothelial cells (PMVECs).

Hypothesis:
Loss of ROR2 activity is associated with PAH.

Methods:
Healthy and PAH PMVECs were obtained from explanted lungs. PMVECs were transfected with ROR2 siRNA/constructs, followed by functional and molecular studies. Focal adhesion (FA) activation and force generation was measured using FRET-based total internal reflection microscopy (TIRF). Mice with endothelial-specific conditional ROR2 KO (ROR2 ECKO) were phenotyped in normoxia and hypoxia.

Results:
ROR2 expression was found predominantly in the endothelium of healthy lung vessels but significantly reduced within PAH lesions. ROR2 knockdown (siROR2) reduced vascular sprouting comparable to PAH PMVECs. Interestingly, siROR2 and ROR2-deficient PAH PMVECs displayed increased fibronectin adhesion and hyperpermeability, which led us to look at focal adhesions (FA) and cell-cell junctions. Confocal and TIRF microscopy of siROR2 and ROR2-deficient PAH PMVECs revealed an increase in the FA number and force that inversely correlated with reduced VE-cadherin at cell junctions. However, transfection of a ROR2 construct in PAH PMVECs resulted in FAs activity normalization and junctional integrity accompanied by recovery of adhesion and permeability. Proteomic studies demonstrated that ROR2 interacts with Integrin b1 in focal adhesions, and its loss results in Integrin b1 activation, FA clustering, and high mechanical forces. In animal studies, we found that, compared to controls, ROR2 ECKO developed more severe pulmonary hypertension, right ventricular remodeling, microvascular reduction, and muscularization in hypoxia, which correlated with higher levels of integrin b1 activation and reduced VE-cadherin expression.

Conclusions:
ROR2 promotes PMVEC adhesion and barrier formation, and its loss is associated with dysfunctional angiogenesis. Restoring ROR2 could be a novel therapeutic strategy in PAH.
Abstract 14454: Catheter Ablation of Atrial Fibrillation Reverses Morphological Changes of the Mitral Valve and Ameliorates Atrial Functional Mitral Regurgitation
Authors: Nagaoka Kazuhiro , Mukai Yasushi , Yada Ryoko , kawai Shunsuke , Honda Nobuhiro , Ogawa Kiyohiro , Takase Susumu , Sakamoto Kazuo , Tashiro Hideki , Tsutsui Hiroyuki
Published: December 2023

Background:
We previously reported that atrial functional mitral regurgitation (A-FMR) occurs with morphological changes of the mitral valve and can be improved by catheter ablation (CA) of atrial fibrillation (AF). However, it is unclear whether the unique morphological changes in the time-course of AF persistence are reversible with sinus rhythm restoration with CA.

Aims:
The aims of this study were 1) to compare morphological differences among paroxysmal AF (PAF) w/o MR, non-paroxysmal AF (NPAF) w/o MR, and A-FMR, and 2) to examine changes in degree of MR and morphology of the mitral valve after CA in patients with A-FMR.

Methods:
This is a multicenter (4 hospitals in Fukuoka) retrospective observational study.
Protocol 1
: Eighty-four patients undergoing initial CA for AF (from 2010.January to 2021.May) were selected and divided into 3 groups after matching on age (68±8 y.o), sex (19 males), and body surface area (1.7±0,2 m
2
); PAF w/o MR, NPAF w/o MR, and A-FMR (n=28 in each group). A-FMR was defined as at least mild MR accompanying with NPAF, preserved LVEF (≧ 50%), and no evidence of valve degeneration and other structurally heart diseases.
Protocol 2
: Fifty-five patients with A-FMR (19 males, 71±9 y.o.) undergoing initial CA were enrolled. Clinical variables and echocardiographic parameters were analyzed.

Results:
In protocol 1, tethering angles of anterior and posterior mitral leaflet (AML and PML) were smaller in patients with A-FMR compared with PAF w/o MR (Table1). PML length was shorter in A-FMR than other groups (Table1). In protocol 2, the degree of MR was significantly reduced (Figure, p=0.0013) associated with reduction in MR vena contracta width and MR area (p<0.001) at 11±7 months after CA. Tethering angles of AML and PML were increased after CA (Table2).

Conclusion:
A-FMR occurs via unique morphological changes of the mitral apparatus along with AF persistence and can be improved by CA of AF with significant reversals of the morphological changes.
Abstract 14460: Impact of Carotid Artery Plaque Detection on Cardiovascular Disease Risk and the Importance of Age in the Multi-Ethnic Study of Atherosclerosis
Authors: Tattersall Matthew C , Hansen Spencer , McClelland Robyn , Korcarz Claudia E , Hansen Kristin , Post Wendy S , Shapiro Michael D , Stein James H
Published: December 2023

Background
Carotid artery plaque (CAP) predicts future atherosclerotic cardiovascular disease (ASCVD) events; however, its prevalence increases with age and differs by sex and race/ethnicity, so how its presence influences ASCVD risk in clinical settings is uncertain.

Hypothesis:
We hypothesized that the impact of CAP detection on relative ASCVD risk declines with age.

Methods:
CAP was detected and quantified by ultrasound in adults free of clinical ASCVD at Exam 1 of the Multi-Ethnic Study of Atherosclerosis who were followed longitudinally for coronary death, myocardial infarction, angina, stroke, and ASCVD death. Cox proportional hazards models investigated associations of CAP and incident ASCVD events in subsets defined by age categories. These models were adjusted for confounders and an age*CAP interaction.

Results:
The 5198 participants were a mean (standard deviation) 61.8 (10.1) years old (53% female, 27% Black, 22% Hispanic, 12% Chinese) and experienced 880 ASCVD events over 14.3 (5.7) years. Prevalence of CAP and the age at which 50% of participants had detectable CAP differed by age, sex, and race/ethnicity, ranging from 13% in Chinese women <50 years old to 97% in Non-Hispanic White men 80-84 years old (Figure). CAP presence independently predicted ASCVD events (hazard ratio, 1.35, [95% confidence interval 1.17-1.57], p<0.001), however the strength of this association declined with increasing age (p
interaction
=0.029, Figure). CAP detection in younger individuals conferred higher relative ASCVD risk than in older participants who had higher absolute risk, regardless of CAP.

Conclusions:
Prevalence of CAP varies by sex and race/ethnicity. CAP becomes very common with increasing age and its relative association with future ASCVD events declines. These data can assist in guiding ASCVD risk assessment in younger adults and provide perspective for incidentally detected CAP on clinical imaging studies in older adults who have higher absolute ASCVD risk.
Abstract 14471: Can Administrative Claims Data Accurately Identify Low-Value Pre-Operative Cardiovascular Testing?
Authors: Klahr Rebecca , Wu Kelly , Smith Michelle , Han Jessica , Casale Paul N , Kini Vinay
Published: December 2023

Background:
Low-value care is defined as care where harms or costs outweigh the benefits. Low-value care services are often identified using administrative claims data, but the validity of claims-based measures may be limited due to the lack of clinical details. One example of a commonly-used claims-based measure of low-value care is pre-operative stress testing prior to low-risk surgery. Clinical practice guidelines recommend against routine testing since it provides no benefit, but testing may be clinically appropriate in patients with symptoms that warrant further investigation such as chest pain. AIM: To test the validity of a claims-based measure of low-value pre-operative stress testing against a gold standard of chart review.

Methods:
In this retrospective cohort study, we analyzed Medicare claims data linked to electronic health record data from a large accountable care organization. We applied a currently-used claims-based algorithm to identify patients who received a stress test within 60 days prior to a low-risk surgery (e.g., cataract surgery) in 2021. We then reviewed linked electronic health record data to assess the proportion of tests that were actually low-value or were misclassified (i.e., were clinically appropriate based on patient symptoms).

Results:
We identified 120 patients (median age 74, 50% female, 78% white) who underwent low-risk surgery and received a pre-operative stress test considered low-value by the claims algorithm. We excluded 35 patients who had insufficient data for chart review. Of the remaining 85patients, we found that 36 (42%) were confirmed low-value while 49 (58%) were actually clinically appropriate due to symptoms that prompted testing. The claims-based algorithm hada positive predictive value (PPV) of 42%.

Conclusions:
A commonly used claims-based measure for identifying low-value pre-operative CV testing misclassifies a substantial proportion of tests as low-value when they are clinically appropriate. This has significant implications for policy and practice, as it can erode trust in quality reporting systems and discourage clinically appropriate testing.
Abstract 14472: Identifying the Genetic Determinants of Early Heart Failure in Patients With Congenital Heart Disease
Authors: Bair Courtney A , Kurzlechner Leonie , George Ian , Monaco Gabrielle , Berkman Amy , Kreinbrook Judah , Moya-Mendez Mary E , dominguez Gonzalez carla , Gurumoorthi Manasa , BIDZIMOU MINU , Pace Leslie , Allen Andrew , Beckerman Ziv , Andersen Nicholas D , Turek Joseph W , Leong Martha Elisabeth , Hoffman Timothy , Li Jennifer S , Landstrom Andrew P
Published: December 2023

Introduction:
Heart failure (HF) is the most common cause of death in patients with congenital heart disease (CHD). Evidence suggests genetics play a role in HF predisposition. In particular, variants in cardiomyopathy-associated genes may be associated with HF and early mortality in CHD populations.

Goal:
Our goal is to leverage a large, well-curated, population-based cohort of individuals with CHD in North Carolina (NC) to determine the genetic underpinnings of HF in CHD.

Hypothesis:
We hypothesize that rare variants in cardiomyopathy-associated genes will be over-represented in CHD patients with HF compared to patients without HF.

Methods:
Patients were enrolled with inclusion criteria of 1) presence of CHD, 2) 2+ cardiac evaluations. Whole blood was collected for exome sequencing (ES). The presence of HF was defined as death, cardiac transplantation or listed for cardiac transplantation, VAD placement, ECMO cannulation, EF ≤ 40% on 2 images, or diagnosis of HF by a cardiologist and taking at least 1 HF medication. ES data was filtered for variants in cardiomyopathy-associated genes.

Results:
We have established NC-DEFINE: Determining the Genetic Basis of Heart Failure in Patients with CHD in NC, a prospectively enrolled cohort of patients with CHD for which ES data are available. We enrolled 138 CHD patients (mean age at enrollment [std dev]: 7.44+/-11.89 years; 40.6% female, 1.4% Asian, 23.9% Black, 6.5% Hispanic). About half (52.9%) have single ventricle physiology and 26% have HF. In a pilot ES cohort of 48 patients, there was an average of 524.2 variants/patient in cardiomyopathy genes of interest. After filtering out common and tolerated variants, 8 loss-of-function and 28 missense variants were identified and interpreted using ACMG criteria. Likely pathogenic or pathogenic (LPP) variants were found in 26.9% (7/26) of HF patients and 9.1% (2/22) of non-HF patients (
p
=0.15). The RR for having a cardiomyopathy-associated LPP variant and developing HF in the setting of CHD was 1.60 (95% CI 1.0-2.57).

Conclusions:
We have established NC-DEFINE, a novel prospectively enrolled CHD cohort, to define the genetic architecture of HF in CHD. In a pilot ES cohort, we found enrichment of rare, LPP variants in cardiomyopathy-associated genes in patients with HF.
Abstract 14478: Electrocardiographic Predictors of Response to Sacubitril/Valsartan Therapy in Heart Failure With Reduced Ejection Fraction: A Retrospective Cohort Study
Authors: Shpigelman Jonathan , Blaine Ciara , Nugent Carol-Ann , Kiernan Louise , Cahir Caitriona , Mac Curtain Benjamin , Bachari Amir , Irfan Wadeed , O'Boyle Patrick , O'Neill James , Daly Michael
Published: December 2023

Introduction:
Sacubitril/valsartan (SV) therapy is currently recommended as first-line therapy in patients with heart failure and reduced ejection fraction (HFrEF) due to its significant clinical and prognostic benefit; however, not all patients respond to therapy and predictors of clinical response to SV remain under-studied.

Hypothesis:
Certain electrocardiographic (ECG) parameters may predict response to SV therapy in HFrEF patients.

Methods:
Retrospective analysis of a hospital heart failure registry was undertaken. Consecutive HFrEF patients (NHYA class II - III) on maximal-dose SV were studied. Response to SV was defined as ≥10% relative improvement in left ventricular ejection fraction (LVEF) at 3-months post-therapy. Pre-therapy ECGs were retrospectively analyzed for axes and standard wave and interval durations. Logistic regression was used to estimate odds ratios and 95% confidence intervals for associations between predictors and therapeutic response. For P-wave duration (PWD), the reference level was set to <100ms; for the remaining variables, reference levels were set as: (a) the normal range for ECG variables; (b) absence for bundle branch blocks; and (c) the other category for binary variables. Calibration and discriminative performance of the models were also assessed.

Results:
In the 102 patients studied, PWD 100 - 120ms, PWD >120ms, and QTc >460ms were independently associated with response to SV therapy: OR 18.00 (4.45 - 122.90), 5.00 (1.47 - 20.42), and 3.10 (1.18 - 9.22) respectively. A multivariate logistic regression model including these predictors, and adjusting for pre-therapy LVEF, was both highly selective (area under the ROC curve = .840) and well-calibrated (Hosmer-Lemeshow
p
= .973).

Conclusions:
Prolongation of both PWD and QTc interval on baseline ECG in HFrEF patients is predictive of therapeutic response to maximal-dose SV therapy and may indicate early cardiac remodeling that is highly amenable to reversal.
Abstract 145: Deploying Early Cooling at ICECAP Sites: A Barrier Assessment
Authors: Beekman Rachel , Kline Peyton , Yeatts Sharon D , Geocadin Romergryko , Silbergleit Robert , Meurer William J
Published: December 2023

Introduction:
Best practices for implementing early temperature control in comatose survivors of cardiac arrest have yet to be defined. We surveyed sites enrolling in the Influence of Cooling Duration on Efficacy in Cardiac Arrest Patients (ICECAP) trial to understand variability in temperature control practices and identify barriers to rapid induction of cooling.

Methods:
A 23 question electronic survey was sent to principal investigators at 68 active ICECAP sites. Participants were queried on temperature control practices and asked to upload institutional protocols.

Results:
Fifty-two sites (76.5%) responded to the survey. While 45 sites (86.5%) had an institutional temperature control protocol, only 33 (63.5%) had an emergency department (ED)-specific protocol. Intravascular cooling was available at 21 sites (40.4%). The most frequent barriers to early initiation of temperature control were clinical skepticism regarding the importance of early cooling (n=32, 35.9%), insufficient nursing availability (n=18, 20.2%), lack of access to a cooling device in the ED (n=17, 19.1%), inability to achieve target temperature despite rapid connection to a cooling device (n=17, 19.1%), and delay due to procedures or intensive care unit transfer (n=5 5.6%). ED average boarding time exceeded two hours in 23 sites (44.2%). Fourteen (28%) sites did not have institutional protocols for early sedation or paralysis to help rapidly lower core body temperature during induction of temperature control. Paralytics were infrequently used during the induction phase; at the majority of sites (n=30, 61.2%) paralytics were used less than 20% of the time. Activation in the ICECAP trial resulted in quality improvements to institutional cooling protocols (n=14, 26.9%), such as purchase of cooling devices for the ED, development of sedation or paralytic protocols, and educational initiatives to shorten the time to target temperature.

Conclusion:
Many of the identified barriers for rapid initiation of temperature control are modifiable. Nursing and provider education regarding the importance of early cooling and development of standardized sedation and paralytic protocols may be effective strategies to improve early cooling practices.
Abstract 14584: Differences in Pupillary Reflex Between Patients With Acute Heart Failure and Healthy Subjects. An Easy New Marker of Treatment Control in Heart Failure
Authors: Zamorano Margarita , Monteagudo Juan Manuel , Gonzalez Eduardo , Fernandez Santos Sara , Zhou Xu Qi-Heng , Rayo Isabel , Castillo Miguel , de la Villa Pedro , Zamorano Jose
Published: December 2023

Introduction:
In heart failure (HF), the sympathetic nervous system (SNS) is overactivated to try to maintain an adequate cardiac output. The pupillary reflex depends on the SNS and may be a new prognostic marker.

Hypothesis:
Pupillary reflex of patients with decompensated HF differs compared to controls, due to the hyperactivation of the SNS in acute HF. HF treatment may change pupillary reflex and may serve as a new marker of therapy.

Aims:
The aim was to compare the difference pupillary reflex between patients with acute HF and controls that may offer a new and easy prognostic factor in such patients.

Methods:
107 pupillometry values of patients with decompensated HF were performed with NeuroOptics pupillometer prospectively and consecutively on admission and discharge, and compared with 42 pupillometry of controls.

Results:
HF patients have higher BMPD, higher MinPD and higher LC than controls.Patients with HF had higher BMPD and higher MinPD at admission vs. discharge (P<0.05). No significant differences were seen between HF patients at discharge and controls. It may be that pupillary reflex values reflect better disease control at discharge.

Conclusions:
Patients with decompensated HF have a higher BMPD and higher MinPD. Also, HF patients presented an improvement in pupillometric values at discharge and showed no differences compared to controls.This supports the hypothesis that patients with decompensated HF present a hyperactivation of the SNS that promotes mydriasis versus miosis. SNS activity is difficult to evaluate; the pupillary reflex can be a simple and useful tool to determine its status, establish prognostic, and could help to control therapeutic management.
Abstract 14586: Early Life Trauma Exposure and Subclinical Cardiovascular Disease Risk in Black Men and Women
Authors: Spikes Telisa , Mehta Puja , Pelkmans Jordan , Thorpe Roland J , Pemu Priscilla E , Taylor Herman A , Dunbar Sandra B , Quyyumi Arshed A
Published: December 2023

Introduction:
Childhood trauma is associated with a greater risk of developing hypertension in adulthood. Black individuals develop hypertension at younger ages, have more aggressive hypertension, and are more likely to experience childhood trauma compared to White individuals. Yet, the impact of childhood trauma on vascular stiffness in Black individuals remains less clarified; thus, we examined the association between childhood trauma and arterial stiffness in Black individuals.

Hypothesis:
Childhood trauma exposure will be associated with vascular dysfunction and this association may differ by sex.

Methods:
Childhood trauma exposure and vascular function were assessed in a cohort of healthy Black participants without known CVD [n=404] from a large metropolitan city. Childhood trauma was assessed using the Early Trauma Inventory short form [ETISR-SF] consisting of four-physical, sexual, emotional, and general-domains, with higher scores indicative of higher traumatic life events assessed before age 18 years. Outcomes of central augmentation index [CAIx] and carotid femoral pulse wave velocity [CfPWV] were measured as indices of wave reflections and arterial stiffness using applanation tonometry [Sphygmocor Inc.], and central pulse pressure [CPP] was calculated as the difference between the aortic systolic and diastolic blood pressures. Relationships between ETISR-SF and outcomes were assessed using multivariate-adjusted and sex-stratified linear regression models.

Results:
Mean age of the cohort was 53(SD=10.3), 61% women. Cumulative childhood trauma was associated with CAIx
β
=0.33%, 95%CI: 0.04,0.62 and CPP
β
=0.24mmHg, 95%CI:0.04,0.45, but not CfPWV
β
=-0.02m/s, 95%CI:-0.07,0.02 after adjusting for demographic, BMI, BP, lipids, glucose, clinical history, health behaviors, and depression. Significant traumaxSex interactions were identified for CAIx
P=0.01
and CPP
P=0.02
. Among women, childhood trauma was associated with higher CAIx
β
=0.32%, 95%CI: 0.04, 0.60 and CPP
β
=0.19 mmHG, 95%CI: -0.02, 0.41, but not in men.

Conclusion:
Exposure to childhood trauma is associated with measures of arterial stiffness in Black women, noting the detrimental effects of childhood trauma on future CVD risk in Black women.
Abstract 14599: A Pilot Rheumatic Heart Disease Screening Program Using Portable, Handheld Echocardiography in Rivas, Nicaragua
Authors: Min Sugi , Carrillo Bryan , Lopez Kimberly , Francisco Guido René , yeung michael , Espinoza Carlos , Lawlor Matthew
Published: December 2023

Introduction:
Portable, handheld echocardiography offers several advantages for rheumatic heart disease (RHD) screening in low-resource settings. Analyses of focused protocols using handheld echocardiography have yielded acceptable sensitivity and specificity for diagnosis of RHD, including in those performed by non-expert sonographers. Previous studies estimate high burden of RHD in Nicaragua. We conducted a pilot community-based RHD screening program using handheld echocardiography in Rivas, Nicaragua using contemporary RHD diagnostic criteria.

Methods:
Non-expert sonographers were trained using the GE Vscan Extend
TM
device and a simplified version of the 2012 World Heart Federation criteria for diagnosis of RHD. Referral criteria for complete echocardiogram included the presence of a mitral regurgitant jet of > 2.0 cm, aortic regurgitant jet > 1.0 cm, or any morphologic abnormality of the mitral or aortic valve, as well as left ventricular dysfunction or significant congenital heart disease. Participants were recruited by convenience-based sampling in communities throughout Rivas, Nicaragua. Participants were notified at the point-of-care of need for complete echocardiogram. All studies were overread asynchronously by expert readers for diagnostic accuracy.

Results:
Between March 2022 and April 2023, 494 screening echocardiographic studies were performed and evaluated for diagnostic accuracy. The median age was 36.3 years (IQR 19.2, 56.2), 22% of participants were <18 years of age, and 60% of participants were female. There were 17.6% of participants referred for complete echocardiogram at the point-of-care compared with 13.0% meeting referral criteria on expert review. Negative and positive predictive values for non-expert vs. expert assessment were 92.4% and 62.1%, respectively. Cohen’s kappa for inter-rater reliability was 0.338, suggesting fair agreement.

Conclusions:
This pilot program demonstrated the feasibility of a screening program for RHD in rural Nicaragua with non-expert sonographers. Lessons from this program are intended to inform future epidemiological studies to determine the population prevalence and longitudinal outcomes of RHD in this region.