bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 13534: Trends, Predictors, and Outcomes of Maternal Shock From the National Inpatient Sample 2009-2019
Authors: Zghyer Fawzi , Rasheed Ahmed Daniyaal , Patel Harsh P , Kwapong Yaa A , Boakye Ellen , Dani Sourbha , Blumenthal Roger , Sharma Garima
Published: June 2023

Introduction:
Maternal shock is an important contributor to severe maternal morbidity and mortality. Although there is some data on hypovolemic shock in pregnancy, the literature on maternal shock is remarkably limited.
Methods:
Data from the National Inpatient Sample with delivery hospitalizations from 2009 to 2019 were used for the data extraction. Diagnosis codes from the International Classiﬁcation of Diseases, 9
th
and 10th Revision for common cardiovascular disease (CVD) conditions, adverse pregnancy and fetal outcomes, and delivery complications including shock, were used. Multivariable logistic regression was performed to assess the predictors and outcomes associated with maternal shock.

Results:
A total of 41,573,217 delivery hospitalizations were analyzed, of which 13,217 were complicated by maternal shock. The trend of maternal shock was seen to rise from 20 to 45 per 100,000 hospitalizations over the study period (Fig 1A). Traditional cardiovascular risk factors and diseases (e.g., hypertension and heart failure) were significant predictors of maternal shock(Fig 1B). The presence of coagulopathy (Odds Ratio [OR]: 16.2, 95% CI: 15.4-17.0) and peripheral arterial disease (OR: 6.4, 95% CI: 4.9-8.2) were strong predictors of maternal shock. All-cause in-hospital mortality (3.82%), pre-eclampsia (10.78%) and cardiac arrest (5.69%), (all p <0.001), were adverse outcomes that were significantly associated with maternal shock.
Conclusions:
Overall, the trend of maternal shock was seen to increase more than 2-fold per 100,000 hospitalizations over the 10-year study period. Patients hospitalized for delivery with co-morbid CVD conditions such as heart failure, coagulopathy, and peripheral arterial disease are at an increased risk of developing maternal shock and must be monitored more closely. Subsequent research should focus on characterizing the types of shock and treatment strategies in this population.
Abstract 13548: Impact of Guideline-Directed Statin Intervention for Primary Prevention in Patients With Diabetes Mellitus
Authors: Muluk Pallavi , Zhu Jianhui , Thoma Floyd W , Hay Eli , MARROQUIN Oscar C , Makani Amber , Agarwala Anandita P , Aiyer Aryan , Nasir Khurram , Mulukutla Suresh R , Saeed Anum
Published: June 2023

Background:
The 2018 ACC/AHA Guidelines suggest patients with diabetes mellitus should receive moderate-high intensity statin therapy for primary prevention of ASCVD. We investigated diabetic and non-diabetic patients to evaluate the magnitude of benefit of guideline-directed statin intervention (GDSI) in each cohort.

Methods:
Primary prevention patients were categorized into diabetes (HbA1c>6.5%) and no-diabetes and stratified based on 10-year ASCVD risk (Borderline [5%-7.4%], Intermediate [7.5-19.9%], or High [>20%]). GDSI prior to first event was determined to be moderate to high intensity statin therapy for moderate and high-risk groups. Mean (±SD) time to start/change to GDSI was calculated from first interaction in health care. Cox regression assessed HRs of myocardial infarction (MI), stroke, and mortality with statin use.

Results:
Among 282,298 patients, 253,491 were non-diabetic and 28,807 had diabetes. Among diabetic patients at intermediate and high-risk, about 50% received GDSI initially, which rose to about two-thirds at 5y. In fully adjusted models, no statin use showed a higher risk of MI, stroke, and mortality compared to GDSI in all patients
(Table).
Compared to non-diabetics, diabetics on no statin versus GDSI had a higher risk of mortality and stroke in both intermediate risk [HR
mortality
2.18 (1.79-2.65) vs 1.58 (1.45-2.72); all p<0.01] and high risk [HR
mortality
1.81 (1.58-2.07) vs 1.41 (1.26-1.57); all p<0.01] groups
(Table).
Interaction analysis for mortality was significant (p<0.001) by diabetes status. Low statin vs GDSI did not significantly increase risk of ASCVD, except for mortality in the high-risk diabetes group.

Conclusions:
Significant gaps remain in achieving GDSI, and diabetic patients not treated with GDSI have a higher risk for adverse outcomes, specifically mortality, than non-diabetics. We must develop more aggressive measures to achieve GDSI in all patients, particularly those at highest cardiovascular risk.
Abstract 13552: Associations Between Food Security and Social Determinants of Health With Dietary Intakes- A Pilot Study
Authors: Diallo Ana F , Bolden Tiara , Karimian Sogand , Russell Sally , Talegawkar Sameera
Published: June 2023

Introduction:
Food insecurity remains prevalent in the United States and has disproportionately affected those living in poverty or experiencing financial hardships. Social determinants of health (SODH) influence food security; yet, little is known on which aspects of the built environment influence the most food insecurity and dietary intake, especially among minority groups living in urban food deserts. We conducted a pilot study to examine the association between individuals’ dietary intake, food insecurity and other SODH measures among individuals residing in an urban food desert.

Methods:
We recruited 45 adults, residing in the targeted study area. Following consent, participants completed surveys to measure sociodemographic and health status, dietary intake, social determinants of health (food insecurity, perceived neighborhood safety, healthy food environment, perceived discrimination). All demographic and survey data were examined graphically and summarized descriptively. Analysis of variance was used to examine associations between dietary data and SODH measures.

Results:
Overall, ~78% of the participants were African American, female (80%), 53 years old on average. More than 50% lived in a household with a yearly income below $12,000. Education level and neighborhood safety were the major SODH influencing dietary intake. Majority of participants were food insecure and 54% reported not feeling safe in their neighborhood. The effect of food insecurity was significant on the average intake of processed meat (F = 4.72, p = .036), fast food (F= 4.384, p= .042) and whole grains (F= 4.573, p= .038). The effect of education level on average intake of processed meat was significant, F = 3.59, p=.02. Lastly, neighborhood safety significantly influenced the average intake of processed meat (F= 3.593, p= 0.022).

Conclusions:
Findings from this pilot study confirm the importance of examining neighborhood contextual factors such as SODH in relation to food insecurity and diet. A better understanding of the relationships between dietary intake and SODH have important implications for clinical practice, behavioral interventions and policies aiming to decrease diet-related health disparities.
Abstract 13553: Remote Monitoring of the Haemodynamic Response to Clinically Indicated Therapeutic Escalation and Clinical Worsening Events in Patients With Pulmonary Arterial Hypertension
Authors: Middleton Jennifer T , Binmahfooz Sarah , Zafar Hamza , Patel Junaid , Giri Dharshan , Battersby Christian , Toshner Mark , Reddy Ashwin , Lewis Robert , Condliffe Robin , Elliot Charlie , Hameed Abdul , Charalampopoulos Athanasios , Thompson Alfred , Kiely David G , Rothman Alex M
Published: June 2023

Background
Hospital-based assessment of haemodynamics, exercise capacity and right heart function/strain are used for risk-stratification to aid clinical decision making and guide treatment in patients with pulmonary arterial hypertension. Advances in haemodynamic and cardiac monitoring now provide the capacity to remotely measure physiological parameters that relate to mortality from a patient’s home. We sought to examine remote monitored physiology in the time preceding and following increase in standard of care therapy and clinical worsening events in patients with pulmonary arterial hypertension.
Methods
Between January 2020 and October 2021 22 patients with WHO functional class III PAH and a hospitalisation in the preceding year were implanted with a pulmonary artery pressure monitor (CardioMEMS, Abbott) and an insertable cardiac monitor (LinQ, Medtronic) (FITPH 19/YH/0354). Remote data and clinical events were reviewed in a multidisciplinary team identifying 18 increases in therapy and 13 worsening events. For each parameter baseline was set at the 30-days preceding the event and daily data analysed as change from baseline. Statistical significance was determined using Wilcoxon matched pairs and One-way ANOVA with Dunnett’s correction as appropriate.
Results
Following clinically indicated increase in therapy improvements in field walk test, WHO functional class and NT-proBNP were observed (p<0.05) with mean time to follow up of 5.1 months. Remote monitored mean pulmonary artery pressure and total pulmonary resistance were reduced and cardiac output and physical activity increased compared to baseline at day 7, 4, 22 and 42 respectively (p<0.05). Clinical worsening events led to deterioration in field walk test, WHO functional class and NT-proBNP (p<0.05). Remote monitored mean pulmonary artery pressure and total pulmonary resistance were increased and cardiac output and physical activity reduced 10 days prior to a clinical worsening event (p<0.05).
Conclusion
Remote haemodynamic and cardiac monitoring may provide a means for early, remote evaluation of clinical efficacy and early identification of clinical worsening in patients with pulmonary arterial hypertension.
Abstract 13559: Altered Nucleotide Biosynthesis is a Prominent Metabolic Feature of Cardiac and Liver Aging
Authors: Kurlawala Zimple , Fulghum Kyle , Cassel Teresa , Brittian Kenneth R , Zheng Jing-Juan , Pena Calderin Ernesto , Fan Teresa W , Lorkiewicz Pawel , Hellmann Jason L , Nystoriak Matthew A , Hill Bradford G
Published: June 2023

Introduction:
The heart is particularly vulnerable to age-related dysfunction, with left ventricular hypertrophy and diastolic dysfunction developing in late life. In this study, we used deep network tracing to elucidate the effects of aging on glucose metabolism in the heart and peripheral tissues of a mouse model of late-life cardiac dysfunction.

Hypothesis:
Aging processes in the heart are mediated through altered nucleotide metabolism.

Methods:
Young (12–16 wk,
n
=6) and aged (80–84 wk,
n
=6) male C57BL/6J mice were subjected to treadmill exercise capacity tests and echocardiographic measurements. To delineate the effects of age on
in vivo
glucose metabolism, we delivered
13
C
6
-glucose to mice via a liquid diet and analyzed
13
C enrichment and the relative abundance of metabolites in the heart, liver, and skeletal muscle by ion exchange chromatography-mass spectrometry.

Results:
Compared with young mice, aged mice had lower exercise capacity (257.3 vs. 394.2 meters distance,
p
=0.0002 and 0.9 vs. 1.4 kg/m work,
p
=0.07), which was associated with a 1.3–fold increase in left ventricular mass (
p
=0.0006) and longer isovolumetric relaxation time (IVRT: 12.3 vs. 14.1 ms,
p
=0.03). Although no significant differences in
13
C enrichment were found for metabolites in the glycolysis and tricarboxylic acid cycle pathways, we found 1.2- to 1.5-fold difference in
13
C enrichment (
p
<0.05) in purine (AMP, ADP, ATP and GMP, GDP, GTP) and pyrimidine (UMP, UDP, UTP, uridine, orotidine) metabolites. Additionally, aged hearts had 2.4-fold higher levels of the pyrimidine precursor N-carbamoyl L-aspartate. Similar changes were detected in the pyrimidine metabolite pool in aged liver, but not skeletal muscle.

Conclusions:
These data indicate that altered nucleotide biosynthesis is a prominent metabolic feature of cardiac and liver aging and could provide novel insights into age-related decrements in cardiovascular health.
Abstract 13560: System Gene Regulatory Network-Based Drug Repurposing Combined With Preclinical Molecular Imaging Identifies Anti-Atherosclerotic Properties of Auranofin
Authors: Amadori Letizia , Calcagno Claudia , Kaur Ravneet , Chong Peik Sean , sajja swathy , Shamailova Roza , Naidu Sonum , Soler Raphael , Faries Christopher , Ghotbi Adam A , Readhead Ben , Dudley Joel , Fayad Zahi A , Bjorkegren Johan , Giannarelli Chiara
Published: June 2023

Introduction:
The identification of new treatments for atherosclerosis (ACVD), a common complex disease, is a daunting task because sets of genes, rather than individual genes, control cell functions. Using systems genetics, our team identified gene regulatory network (GRN42) that is active in the human atherosclerotic arterial wall and is involved in the regulation of foam cell formation.

Hypothesis:
A network-driven drug repurposing approach combined with rigorous preclinical validation will identify new uses for existing drugs to treat ACVD.

Methods:
We developed a GRN42-based computational drug repurposing pipeline to infer new uses for existing drugs. Selected compounds were screened by measuring their ability to inhibit foam cell formation
in vitro
using THP-1-derived macrophages. The
in vivo
efficacy was validated in ApoE-/- mice fed a western diet by histology and in atherosclerotic rabbits using histology and non-invasive
18
F-FDG PET-MR imaging.

Results:
30 candidate compounds were predicted to influence the function of GRN42 and 5 were selected for
in vitro
screening based on their prediction scores (Figure 1A). As expected, vitamin D reduced cholesteryl esters accumulation in foam cells. Auranofin, and FDA-approved drug for rheumatoid arthritis reduced foam cell formation. As predicted methyl-fasudil had no effect, while nicardipine and flutamide increased foam cell formation (Figure 1B). Auranofin reduced plaque burden in ApoE-/- mice (Figure 1C) and in rabbits reduced lipid accumulation (Figure 1D) and inflammation shown as reduced
18
F-FDG uptake in the arterial wall (Figure 1E).

Conclusions:
Our results provide robust evidence that a GRN-based computational drug repurposing approach, when combined with robust preclinical validation using translational molecular imaging, can successfully identify new uses of existing drugs for the treatment of ACVD.
Abstract 13586: In Patients With Left Bundle Branch Block, QRS Duration is a Stronger Predictor of Left Ventricular Hypertrophy and Dilation Than QRS Voltage
Authors: DeBauge Ashley , Fairbank Tyan , Harvey Christopher J , Ranka Sagar , Jiwani Sania , Sheldon Seth H , Reddy Madhu , Beaver Timothy A , Noheria Amit
Published: June 2023

Introduction:
ECG criteria for left ventricular (LV) hypertrophy in absence of left bundle branch block (LBBB) rely on QRS amplitudes. ECG correlates of LVH in setting of LBBB are not well established. We sought to evaluate quantitative LBBB ECG predictors of echocardiographic LV measurements [LV mass, end-diastolic volume (EDV), end-systolic volume (ESV), ejection fraction (EF)].

Hypothesis:
QRS duration (QRSd) is a better predictor of LV hypertrophy than QRS amplitudes.

Methods:
We included adult patients with typical LBBB having ECG and echocardiogram performed within 3 months of each other in 2010-2020. Digital 12-lead ECGs were processed to reconstruct orthogonal X, Y, Z leads using Kors matrix. Amplitudes and voltage-time-integrals (VTIs) from all 12 leads, X, Y, Z leads and 3D (root-mean-square) ECG, and QRSd were evaluated. We used age, sex and BSA-adjusted linear regressions to predict LV measurements, and separately generated ROC curves for identifying LV abnormalities.

Results:
We included 413 patients (53% women, age 73±12 yr). Among all the ECG variables, QRSd was most strongly correlated with all 4 LV measurements (all p<0.00001, see Table 1a showing QRSd compared to VTI and amplitude from 3D QRS). Table 1b shows area under ROC curves to identify LV abnormalities. QRS duration ≥150 ms in women had sensitivity 56.3%, specificity 64.4% for LVMi >95 g/m
2
and sensitivity 62.7%, specificity 67.8% for LVEDVi >61 mL/m
2
. QRS duration ≥160 ms in men had a sensitivity 63.1%, specificity 72.1% for LVMi >115 g/m
2
and sensitivity 58.3%, specificity 74.5% for LVEDVi >74 mL/m
2
.

Conclusions:
In patients with LBBB, QRS duration ≥150 in women and ≥160 in men is a superior predictor of adverse LV remodeling esp. eccentric LV hypertrophy/dilation. The weak correlation of QRS amplitude with hypertrophy may be due to the dominant effect of electrical dyssynchrony on voltage, and the heterogeneous effects of fibrosis, infiltrative cardiomyopathy, epicardial fat and LV dilation.
Abstract 136: The Effect Of Mechanical Chest Compression Device On Survival After Out-of-hospital Cardiac Arrest According To Patient Transport Interval: A Multicenter Observational Study
Authors: Kim Jooyeong , Moon Sungwoo , Park Jong-Hak , Ahn Sejoong , Cho Hanjin , Song Juhyun , Jin Kim S
Published: June 2023

Objectives:
This study aimed to investigate the effect of mechanical chest compression device (MCPRD) on patients with OHCA according to patient transport interval (PTI). We hypothesized that MCPRD is effective on survival with prolonged PTI compared with manual chest compression (non-MCPRD).
Methods:
This cross-sectional multicenter observational study used the Korean Cardiac Arrest Research Consortium registry data from 2015 to 2019. Emergency medical service (EMS) treated OHCAs presumed of cardiac etiology without return of spontaneous circulation (ROSC) at scene were included. Exposure was prehospital MCPRD use and PTI. The main outcome was survival to admission. PTI was categorized into three groups; short PTI for 0-5 minutes, intermediate for 6-10 minutes and long PTI for over 10 minutes, respectively. Multivariable logistic regression was performed to estimate the adjusted odds ratios (AORs) and its’ corresponding 95% confidence intervals (95% CI) for the effect of MCPRD compared with manual compression on outcome. Interaction of PTI on the effect of MCPRD on outcome were tested. To control for selection bias and confounding factors, propensity score (PS) matched cohort was extracted. PS score for each patient to receive MCPRD was estimated using a multivariable logistic regression model. To reduce the standard error of MCPRD on outcomes, a two-to-one propensity score matched cohort was extracted.
Results:
For unmatched cohort,

a total of 3,530 patients were eligible and after PS matching, a total of 2,049 patients were eligible for the analysis. The MCPRD was applied at 19.3% of all unmatched cohort. After adjusting for potential confounders, the AOR of MCPRD for survival to admission was 1.36 (95% CI 1.07-1.72) for unmatched cohort and 1.37 (95% CI 1.06-1.78) for PS matched cohort. Interaction according to PTI on the effect of MCPRD was significant at prolonged PTI on both cohorts; AOR 1.60 (95% CI 1.06-2.42) for unmatched cohort and AOR 1.60 (95% CI 1.06-2.42) for PS matched cohort, respectively.

Conclusion
:

For patients with OHCA with PTI longer than 10 minutes, MCPRD use showed a significant survival benefit compared with manual chest compressions. Further studies are needed to evaluate the appropriate use of MCPRD in special situations.
Abstract 13609: Heterogeneous Populations of Cytotoxic CD4 T Cells Are Expanded in Atherosclerotic Plaques of Patients With Type 2 Diabetes
Authors: Das Dayasagar , Kaur Ravneet , Gildea Michael , Eberhardt Natalia , Fernandez Dawn , Amadori Letizia , sajja swathy , Shamailova Roza , Goldberg Ira J , Maldonado Thomas , Rockman Caron , Giannarelli Chiara , Berger Jeffrey , Fisher Edward
Published: June 2023

Introduction:
Atherosclerotic cardiovascular disease (ACVD) is the main cause of morbidity and mortality in patients with type 2 diabetes (T2D). ACVD is more severe and diffuse in T2D than in subjects with no diabetes (ND). Moreover, cholesterol reduction in T2D leads to less plaques resolution. While the role of macrophages in T2D plaque pathology has been investigated, no studies have systematically investigated the heterogeneity of CD4 T cells in human plaques.

Hypothesis:
Plaques of patients with T2D have a greater CD4 T cell heterogeneity and pathogenic phenotypes compared with plaques of ND subjects.

Methods:
To identify the specific T cell alterations in plaques we analyzed scRNA sequencing data of >80,000 plaque immune cells from 22 patients undergoing carotid endarterectomy with or without T2D (54.5% T2D).

Results:
Unbiased clustering of CD45+ cells identified a total of 24 immune cell clusters, including CD4 T cells that presented similar cell frequencies between T2D (~11%) and ND patients (~10%). CD4 T cells comprise 7 clusters: naïve, proliferating, central memory (CM), effector memory (EM), T regulatory (Tregs), cytotoxic (CTL), and gamma delta (γδ) T cells. CD4 CTLs expressed
GZMB, GNLY, PRF1
, and could be divided into
TRAC
+EM (cluster 9) and CTLγδ T cells expressing both
TRDC
and
TRGC2
(cluster 5). CTLγδ T cells were significantly expanded in T2D plaques (p=0.032), and expressed high levels of
GZMA
and transcription factors involved in T cell differentiation such as
RUNX
and
TBX21
. These CTLγδ T cells are enriched with sets of genes involved in T-cell activation, numerous pathways of apoptosis, cytotoxicity, chemotaxis and cytokine signaling (i.e.
IL1, IL2, IL9
).

Conclusions:
Our data show that plaques from patients with T2D are highly enriched in unique CTL/γδ T cells and suggest that their cytotoxic potential may contribute to the increased cardiovascular risk of subjects with T2D.
Abstract 13614: Why the Pulmonary Veins: Linking Atrial 4D Flow MRI Derived Biomechanics and Pulmonary Vein Electrical Remodeling
Authors: Nickel Andrew C , Johnson Cody J , Tran Brandon A , Fleeman Blake E , Kipp Ryan T , Modaff Daniel S , Wright Jennifer M , Glukhov Alexey V , Roldan Alzate Alejandro , Kalscheur Matthew M
Published: June 2023

Introduction:
Pulmonary veins (PV) often trigger atrial fibrillation (AF). However, the underlying mechanism is not completely understood and predicting who benefits from PV isolation (PVI) is imprecise. We propose that arrhythmogenic PV remodeling may be related to myocardial mechanical function. Flow-encoded cardiac magnetic resonance imaging (4D Flow MRI) based computational modeling enables assessment of left atrial (LA) hemodynamics and biomechanics. In this pilot study, 4D Flow MRI derived parameters were compared to invasive electroanatomic mapping (EAM) and hemodynamics to explore potential non-invasive evaluation of PV remodeling and arrhythmogenicity.

Methods:
Patients (5 female, 4 male, age 64±6.7 years) with paroxysmal or early persistent AF scheduled for PVI were enrolled. All patients underwent 4D Flow MRI prior to ablation (in sinus rhythm) and intraprocedural EAM (Carto) with atrial pacing under baseline conditions and after increasing LA pressure with a fluid bolus. Non-invasive measures included peak and average velocity (m/s) and net flow (ml/cycle) in each vein (n=36) and averaged for each patient. Apparent conduction velocities in the proximal, mid and distal portions of each vein were calculated under baseline and stretch conditions from EAM. Change in LA pressure per volume bolus, a measure of atrial stiffness, was compared to non-invasive parameters.

Results:
In patients with LA stiffness greater than median, peak velocities (0.77±0.12 vs. 0.62±0.24 m/s, p=0.26) and net flows were higher (17±2.0 vs. 14.0±2.4 ml/cycle, p=0.06). Patients with paroxysms of spontaneous arrhythmias during mapping had higher LA stiffness (11.5±5.7 vs. 7.6±5.3 mmHg/L, p=0.30). There was a significant correlation between non-invasive average velocity and apparent conduction velocity in the proximal portion of the vein (R=-0.36, p=0.03) and the suggestion of a correlation between increasing peak flow velocity and decreased apparent conduction velocity under stretch conditions compared to baseline (R=-0.24, p=0.16).

Conclusions:
Our findings may indicate a link between atrial hemodynamics, electrical remodeling and PV arrhythmogenicity. Additional studies are warranted to confirm and better define these findings.
Abstract 13620: Different Outcomes Influenced by Physical Frailty: A Comparison Between Women and Men With Heart Failure
Authors: Hays Sara , Lee Christopher S , Roberts Davis Mary , Gupta Nandita C , Hiatt Shirin O , Purnell Jonathan , Winters Kerri , Denfeld Quin E
Published: June 2023

Introduction:
Physical frailty is strongly related to adverse outcomes in heart failure (HF), including greater adverse clinical event risk and poor quality-of-life. In HF, women are more likely to be physically frail than men, but little is known about how this sex difference affects outcomes. The purpose of this study was to quantify sex differences in the associations between physical frailty and clinical and quality-of-life outcomes in HF.

Methods:
This was a prospective study of adults with NYHA Functional Class I-IV HF. A formal assessment of physical frailty was performed using the Frailty Phenotype Criteria; scores range from 0-5. Clinical characteristic data specific to the Seattle HF Model score (SHFM) were collected to account for the severity and treatment of HF. Clinical events (all-cause death, emergency room visit, or hospitalization for cardiovascular cause) over 12 months were adjudicated. Health-related quality-of-life was assessed using the Minnesota Living with HF Questionnaire (MLHFQ). Sex-stratified Cox regression analysis was used to examine associations between physical frailty and clinical events. Sex-stratified generalized linear modeling was used to examine associations between physical frailty and MLHFQ scores.

Results:
The sample (n = 115) was 63.5±15.7 years old, 49% women, and 29% had HF with preserved EF. After adjusting for SHFM scores, continuous physical frailty scores were significantly associated with time to first clinical event among men but not women. Specifically, for every one point increase in physical frailty score, there was a 46% higher risk of experiencing an event among men (HR = 1.46 [1.00, 2.11], p = 0.047) but not women (HR = 1.21 [0.81, 1.81], p = 0.36). After adjusting for SHFM scores, physical frailty was associated with 89% worse MLHFQ scores among women (p = 0.005) but was not significantly associated with MLHFQ scores among men (p = 0.14).

Conclusions:
This study demonstrates that physical frailty in HF may be predominantly associated with worse clinical event risk among men and worse quality-of-life among women.
Abstract 13627: Hepatic Venous Return to Lungs in Fontan is Dependent on Age-Dependent Caval Flow Ratio
Authors: Davee Jocelyn , Eickhoff Emily , Thatte Nikhil , Schulz Noah , S. Alemany Victor S , Nathan Meena , Hoganson David , Prakash Ashwin , Hammer Peter E , del Nido Pedro J , Rathod Rahul , Govindarajan Vijay
Published: June 2023

Introduction:
The Fontan procedure is performed between 2-4 years of age and is a palliative technique for patients born with single ventricle defects. The Fontan physiology is the result of a total cavopulmonary connection between superior and inferior vena cava (SVC and IVC) and the hepatic veins to the pulmonary arteries (PA). Maldistribution of hepatic blood flow to the lungs can result in the formation of pulmonary arteriovenous malformations (PAVM) and resulting cyanosis. Hepatic blood flow distribution (HFD) to right and left lungs is highly dependent on the local flow dynamics. We sought to investigate the impact of SVC-to-IVC flow ratio and age on HFD.

Methods:
SVC and IVC flow data measured by cardiac MRI (CMR) from 81 Fontan patients were collected to establish the relationship between SVC: IVC flow ratio vs. age. 3D Patient-specific computational fluid dynamics (CFD) modeling was performed for 5 patients who underwent Fontan procedure with an extracardiac conduit to quantify the HFD to the right and left PAs. We evaluated the dependency of HFD on SVC: IVC flow ratio by quantifying HFD to different SVC: IVC flow ratios (2, 1.0, and 0.5) for a given Fontan anatomy.

Results:
SVC: IVC flow ratio inverted at ~10 years of age (n=81, Figure A) indicating a clear shift to lower body predominance in overall caval flow. CFD analysis (n=5) showed that the shift in SVC-IVC flow had a significant effect on the HFD (Fig. B-F). Change in HFD was more substantial as SVC: IVC flow ratio shifted from 2 to 1 [~5-10 years] with an average % change of 21±6 compared to the HFD change that occurred for a shift of 1 to 0.5 [9±11 for ~10-20 years] (Fig. B-F).

Conclusion:
Well-balanced distribution of HFD is essential to prevent PAVMs and to ensure long-term efficacy of a Fontan. This study highlights how SVC: IVC flow ratios change over time and can impact HFD to PAs. Interventions to address HFD maldistribution should not be considered in isolation and should incorporate predictions of SVC: IVC changes over time.
Abstract 13633: Differences in Right and Left Ventricular Remodeling After Tetralogy of Fallot Repair in Patients With and Without Pulmonary Valve Replacement
Authors: Loss Karla , Wood John , Detterich Jon A , Durazo-Arvizu Ramon , Wiggins Luke M , Kantor Paul F
Published: June 2023

Background:
Pulmonary valve replacement (PVR) is required to address residual lesions after tetralogy of Fallot repair (rTOF). We wished to determine the progression of ventricular dilation after rTOF, using cardiac magnetic resonance (CMR) data in children, to determine age related RV and LV volume differences in patients who did or did not require PVR.

Methods:
Single center, retrospective longitudinal study, including 214 patients with rTOF who had primary repair before 24 months and at least one CMR performed from 2000-2020. During follow-up, 142 patients (66.3%) had PVR at median age 12 years (IQR 9-15.5). Linear mixed effect modeling was used to evaluate time-related changes in ventricular volumes by log-transformed age at CMR adjusted for sex and regurgitant lesion status. Patients were grouped as per need for PVR during follow-up.

Results:
A total of 323 CMR from 201 patients performed before PVR were analyzed. The median age at first CMR was 9.4 years (IQR 5.9-12.3): 126 (62.7%) patients had one CMR, 34 (16.9%) had 2 and 41 (20.4%) had 3 or more. Prior to PVR there was steeper time-related RV dilation compared to non-PVR requiring patients: RVEDVi = 19.4 (CI 15.1 - 23.7) vs 2.8 (CI -2.5 - 8.2) ml/m
2
/log2year, p<0.001; RVESVi = 11.9 (8.9 - 14.8) vs 0.8 (CI -2.9 - 4.4) ml/m
2
/log2year, p<0.001. A time-related increase in LV volume also occurred in the PVR group compared to non-PVR: LVEDVi = 7.2 (CI 4.7 - 9.7) vs 1.5 (CI -1.6 - 4.6) ml/m
2
/log2year, p=0.005; LVESVi = 3.2 (CI 1.9 - 4.6) vs -0.4 (CI -2.1 - 1.3) ml/m
2
/log2year, p=0.001) (Figure 1). The factors associated with PVR were presence of regurgitant residual lesion, more prolonged QRS duration and transannular patch as surgical technique for TOF repair.

Conclusion:
Early and significantly increased progression of RV dilation and LV dilation are identifiable by CMR in patients destined to require PVR following rTOF. Early CMR surveillance may be indicated to permit early identification of progressive remodeling.
Abstract 13639: Bivalirudin versus Heparin in Patients With STEMI Undergoing PCI: Individual-Patient-Data Pooled Analysis of the 6 Major Randomized Trials
Authors: Bikdeli Behnood , Valgimigli Marco , Erlinge David , Kastrati Adnan , Steg Philippe G , Yaling Han , Stables Rod , Mehran Roxana , Frigoli Enrico , James Stefan K , patrick GOLDSTEIN , Li Yi , Shahzad Adeel , Schuepke Stefanie , Chen Shmuel , Mehdipoor Ghazaleh , Redfors Bjorn , Crowley Aaron , Zhou Zhipeng , Stone Gregg
Published: June 2023

Background:
Given differences in prior trial designs, the treatment tradeoffs between bivalirudin and heparin in patients with STEMI undergoing PCI remain uncertain. Study-level meta-analyses lack granularity to provide conclusive answers or assess subgroups.

Methods:
We performed an
individual-patient-data
pooled analysis from all 6 large (n>1000) RCTs of bivalirudin vs heparin in STEMI pts undergoing PCI (BRIGHT, EUROMAX, HEAT-PPCI, HORIZONS-AMI, MATRIX, and VALIDATE-SWEDEHEART). The primary efficacy outcome was the 30-day rate of all-cause mortality. Subgroup analyses were performed according to planned use of glycoprotein IIb/IIIa inhibitors (GPI), and administration of a post-PCI bivalirudin infusion.

Results:
A total of 15,254 patients with STEMI undergoing PCI were included (7,306 randomized to bivalirudin and 7,948 to heparin [43.6% with planned GPI use]). Thirty-day mortality was not significantly different between bivalirudin vs heparin (aHR: 0.80; 95% CI: 0.64, 1.01); 30-day cardiac mortality was reduced with bivalirudin (aHR: 0.72; 95% CI: 0.57, 0.91). There was a higher risk of 30-day MI (aHR: 1.29, 95% CI: 1.02, 1.64) and stent thrombosis (aHR: 1.42; 95 % CI: 1.05, 1.91) but lower risk of serious bleeding (aHR: 0.57 (0.47, 0.68) with bivalirudin vs heparin. At 1 year, net adverse clinical events were reduced with bivalirudin (aHR: 0.84; 95% CI: 0.77, 0.93) (Table). All-cause mortality was reduced with bivalirudin when a post-PCI infusion was used. A high-dose post-PCI infusion mitigated the 30-day MI and ST risks, irrespective of planned GPI use with heparin.

Conclusions:
In patients with STEMI undergoing PCI, procedural anticoagulation with bivalirudin did not reduce all-cause mortality. Cardiac mortality and serious bleeding were reduced with bivalirudin at the cost of increased rates of MI and ST. Full analyses will be presented at AHA 2022.
Abstract 13671: Predicting the Coronary Thrombosis Events Risk in Chinese Patients After Percutaneous Coronary Intervention With Drug Eluting Stents: Risk Model From PROMISE Trial
Authors: Song Ying , Xu Jingjing , Jiang Lin , Zhao Xueyan , Liu Fangchao , Zhang Zheng , Zhang Yongzhen , Su Shuhong , Guo Xiaogang , Wang Qingsheng , Feng Yingqing , Liu Zhenyu , Gao Runlin , Yaling Han , Yuan Jinqing
Published: June 2023

Introduction:
The accurate assessment of individual risk can be of great value to facilitate the prevention of recurrent coronary thrombosis events (CTEs) in patients after percutaneous coronary intervention (PCI) with Drug-Eluting Stents (DES). However, current prediction models in common use were often formulated in white populations and were of limit predicting value in Chinese patients. The current study is aimed at developing and validating a prediction model for recurrent CTEs from 2 contemporary Chinese cohorts of patients after PCI with DES. We formulated a CTEs prediction model from PROMISE trial, a
PR
ospective
O
bservational
M
ulticenter cohort of
I
schemic and h
E
morrage risk after PCI.

Hypothesis
We assessed the hypothesis that the PROMISE model was an effective tool for predicting 2-year CTEs risk in Chinese patients after PCI with DES.

Methods
7998 Chinese patients underwent DES-PCI from PROMISE trial with 2-year follow up were used as the derivation cohort to develop the PROMISE model. The external validation was evaluated in one independent Chinese cohort with 3824 participants. Cardiac death, myocardial infarction, definite and probable in-stent thrombosis were defined as CETs. We compared candidate variables between CETs and non-CETs groups. Backward selection with an entry criterion of p<0.05 were used to formulate the model. The model performance was assessed by discrimination C statistics and calibration χ2. We also assessed the internal and external validation.

Results
Over 2-year follow up in the derivation cohort, 151 patients developed CTEs. Five variables including, previous revascularization, baseline elevated cTNI, left ventricular ejection fraction, residual SYNTAX score after PCI and estimated glomerular filtration rate were finally involved in the PROMISE model. The C statistics of the model was 0.750(95% confidence interval, 0.700-0.799), and the calibration χ2 was 7.2(p=0.612). In the subsequent external validation, the PROMISE model had C statistics of 0.607 (95%CI,0.508-0.706) , and the calibration χ2 was 14.0(p=0.121).

Conclusion
The PROMISE model had a good internal validation and moderate external validation and it was an effective tool for 2-year CTEs risk prediction in Chinese patients after PCI with DES.
Abstract 13686: HEART Score Predicts Coronary Artery Disease on Coronary Computed Tomography Angiography in the Emergency Department Only in Patients With Three or Greater Risk Factors
Authors: Masri Abdallah , Masri Abdelrahman , Malhotra Saurabh
Published: June 2023

Introduction:
HEART (History, Electrocardiogram, Age, Risk factors, Troponin) Score (HS) predicts MACE in patients presenting to the ED with chest pain. It was validated clinically but not radiologically. Coronary computed tomography angiography (CCTA) in the ED allows for rapid triaging of patients and carries prognostic value.

Objective:
study relationship between HS and the presence and severity of CAD on CCTA.

Methods:
In this retrospective cohort, we included patients undergoing CCTA in the ED for acute chest pain between January 2014 to July 2016. HS was calculated and classified as low-risk (score <=3) or high-risk (score >3). A certified specialist reviewed all CCTA studies and determined the presence and severity of CAD. Anatomic CAD was defined by coronary artery calcium score (CACS) >0 or the presence of any stenosis. Obstructive CAD was defined by CACS>100 or coronary stenosis >=50%. Multivariate regression analysis was performed to determine predictors of anatomic and obstructive CAD. We performed interaction analysis between HS and the presence of >=3 traditional CAD risk factors.

Results:
Of the 927 CCTA performed, 315 (34%) had anatomic CAD, 128 (14%) had obstructive CAD. Mean age was 51 years, 49% were males, mean HS was 2.6, and 71% of the cohort had a low-risk HS. High HS was associated with higher proportions of CAD only in patients who had >=3 traditional CAD risk factors [Fig 1]. Regression and interaction analyses showed that HS was an independent predictor of anatomic and obstructive CAD only in patient with >=3 traditional CAD risk factors [Fig 2].

Conclusion:
HS is a predictor of radiographic CAD on CCTA when performed in patients with >=3 traditional risk factors.
Abstract 13708: Il11 Causes Pulmonary Tissue Remodeling and Emphysematous Lung Disease in the Fbn1
C1041G/+
Mouse Model of Marfan Syndrome
Authors: Ng Benjamin , Xie Chen , Su Liping , Kuthubudeen Fathima Farzana F , kwek xiuyi , Yeong Daryl , Schafer Sebastian , Cook Stuart , Lim Wei-Wen
Published: June 2023

Introduction:
Marfan Syndrome (MFS) is an inherited connective tissue disorder caused by fibrillin-1 (FBN1) mutations that is associated with aortic disease. Lung abnormalities are common in MFS, but their pathogenesis is poorly understood. Here we studied IL11 in a mouse model of MFS (mMFS).

Methods:
We studied histological and molecular phenotypes in the lungs of
Fbn1
C1041G/+
(mMFS) mice, an established model of MFS. To identify IL11-expressing lung cell types, we studied 4- and 16-week-old
Fbn1
C1041G/+
:
Il11
EGFP/+
reporter mice lungs by immunohistochemistry. We studied the protective effects of IL11 inhibition in the lung by RT-qPCR, immunoblots and histopathology in two models: 1) 16-week-old IL11 receptor (IL11RA) knockout mMFS mice (
Fbn1
C1041G/+
:
Il11ra1
-/-
) and 2) administered IgG isotype control or anti-IL11RA (X209; 20mg/kg) antibodies twice weekly in mMFS mice between 4 to 24 weeks of age.

Results:
IL11 was upregulated in the lungs of mMFS mice, which exhibited progressive loss and enlargement of distal airspaces and increased extracellular matrix production. In the distal airways of young mMFS mice (4 weeks old), IL11 was specifically expressed in smooth muscle cells. In the older (16 weeks old) mMFS lungs, IL11 was expressed in smooth muscle cells, fibroblasts and type II alveolar epithelial cells. In mMFS mice, genetic (
Fbn1
C1041G/+
:
Il11ra1
-/-
mice) or pharmacologic (anti-IL11RA) inhibition of IL11 protected against emphysematous changes, pulmonary fibrosis and inflammation and was associated with reduced pulmonary ERK1/2 signaling and matrix metalloproteinase (MMP2 and MMP9) expression.

Conclusions:
IL11 causes pulmonary disease in mMFS. This adds to the recent finding that IL11 underlies aortic pathology in mMFS and provides a common disease mechanism across affected tissues in MFS. This has potential implications for treating multi-organ disease in MFS.
Abstract 13725: The Dose Difference of Carvedilol for Heart Failure Management Between Asian-Americans and Japanese Could Show No Difference in the Improvement of Heart Function
Authors: Maeda Makiko , Humber Douglas , Hida Eisuke , Ohtani Tomohito , Wang Guannan , Wu Tong , Hayashi Jun , Situ Jacinta N , Takeda Shiori , Okamoto Hiroshi , Takeda Toshihiro , Hori Masatsugu , Sakata Yasushi , Fujio Yasushi , Tsunoda Shirley
Published: June 2023

Introduction:
Carvedilol has improved cardiac mortality and morbidity for heart failure with reduced ejection fraction (HFrEF). The initial and target doses used in the Japanese randomized controlled trials (RCTs) were almost half of those in the USA leading to markedly lower recommended doses for HF management the in Japanese national guidelines compared to the USA.

Hypothesis:
Race may play a role in the optimal dose of carvedilol for HFrEF management.

Methods:
The international collaborative study was performed to compare the dose difference and the effect on heart functions, such as left ventricular EF (LVEF) and heart rate (HR), among Asian-Americans (AA), Caucasians (CA), and Japanese (JA) using real-world data. Each local ethics committee approved the study protocol at the University of California, San Diego (UCSD), the Osaka University Hospital (OUH), and the OU pharmaceutical sciences. The initial population at UCSD Health and OUH consisted of 1078 patients with HFrEF (≥ 20 years, EF<40%) treated with carvedilol (668 AA and CA and 410 JA). After inclusion/exclusion criteria, the study population consisted of 26 AA, 36 CA, and 96 JA.

Results:
Initial carvedilol dose (mg/day) (AA, 14.5 ± 11.9; CA, 19.1 ± 18.7; JA, 4.3 ± 4.2) and the dose at one year (30.9 ± 22.4; 34.5 ± 21.4; 11.2 ± 6.5) were significantly lower for JA compared to AA or CA (
p
< 0.05 vs JA, respectively). AA had the highest frequency of carvedilol discontinuation (%; AA, 10.7; CA, 2.6; JA, 6.5) and dose reduction (18.4, 10.7, 2.2) (
p
< 0.05, chi-square test). Clinical measurements of LVEF (%) measured before carvedilol initiation and after one year (before; 28.9 ± 8.8, 26.5 ± 8.0, 28.8 ± 7.4, after; 42.9 ± 11.1, 37.5 ± 15.3, 41.2 ± 13.1) and HR (beats/min) (before; 81.9 ± 19.0, 77.7 ± 13.5, 74.7 ± 10.9, after; 77.8 ± 10.6, 74.0 ± 12.5, 69.4 ± 9.4) showed no significant difference among the three groups. There were also no significant differences in event-free survival and in changes from baseline to 1 year in LVEF and HR, LVDd, or LVDs.

Conclusions:
JA patients exhibited similar effectiveness compared to AA and CA despite markedly lower carvedilol doses. Doses in AA were more similar to CA vs JA. Dose-deescalation may be an option in Asian HFrEF patients intolerable to high doses of carvedilol.
Abstract 13734: CardioNerds Narratives in Cardiology Tweetorials - Using Social Media to Elevate Discussions on Diversity and Inclusion
Authors: Kaur Gurleen , Desai Karan , Das Thomas M , Sharalaya Zarina , Nematollahi Saman , Ambinder Daniel , Ghobrial Joanna , Reza Nosheen , Berlacher Kathryn , Goyal Amit
Published: June 2023

Introduction:
Professional diversity is essential to addressing disparities in care but remains an unmet goal. The CardioNerds (a digital education platform) and Pennsylvania American College of Cardiology Chapter Narratives in Cardiology (NIC) multimodality series features faculty and trainees from underrepresented groups to share their professional and personal journeys with the aim to promote diversity and inclusion (D&I). We created tweetorials (linked tweets on Twitter) with each podcast episode and evaluated each tweetorial’s ability to enhance users’ comfort with conversations around diversity.

Methods:
Between June 2021-March 2022, 7 NIC tweetorials were released. We evaluated the scope of reach using impressions (tweet appears to users), engagements (user interacts with tweet), and training level of interacting users at one-month. We assessed change in Twitter users’ self-reported comfort in discussing D&I via poll question (Q1) at the beginning and end of the tweetorial: “I feel comfortable openly discussing or asking others about factors that make them different from myself⋯”. Users were also polled on “After reading this #CardsNarratives Tweetorial, I have a greater appreciation for diversity in cardiology” (Q2).

Results:
The 7 tweetorials had a total of 98,951 impressions and 2,717 engagements, with medical students or residents comprising 29% of interacting users. For Q1, there was a significant rise in the proportion of responders who answered “Agree” from 54% to 75% (ꭓ
2
=19.01, p <0.05). After reviewing a given tweetorial, 88% of respondents reported having a greater appreciation for diversity in cardiology (Q2).

Conclusions:
Evaluation of the NIC tweetorials demonstrates successful reach to a broad audience including pre-cardiology trainees. This early report shows that tweetorials can elevate D&I discussions and have the potential ability to positively impact users’ self-reported comfort with these topics.
Abstract 13739: Racial Disparities in Cardiac Arrest Deaths in the USA: 1999-2020
Authors: Chobufo Muchi Ditah , Rahman Ebad , Skaff Paulina , Mbome Yolande , Regner Sean , sattar yasar , balla sudarshan
Published: June 2023

Introduction:
Cardiac arrest(CA) is a strong predictor of death. Survival following CA depends on timely initiation of quality cardiopulmonary resuscitation and post CA care. Significant efforts have been made in the training of individuals at delivering CPR and improving post CA aimed at reducing mortality. To assess the impact, we set out to determine the trends in age adjusted mortality rates(AAMR, per 100,000 persons) and the average annual percentage change (AAPC, %) in the USA and by gender, race and Metro area from 1999 - 2020.

Methods:
Using the underlying causes of death (UCOD) database from the Centers for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiologic Research(1999-2020), we extracted all deaths with CA as UCOD using ICD-10 codes I46.0, I46.1, I46.9. AAMR was assessed using segmented regression models. STATA and Joinpoint softwares were used for analysis.

Results:
The CA related AAMR was 4.9 during the period 1999-2020. CA related deaths steadily declined from 7.7 in 1999 to 4.4 in 2020 with a statistically significant AAPC of -2.4%(95% CI -4.2 to -0.6). Ethnic specific AAMR were 8.7, 4.9, 2.8 and 3.4 for African Americans(AA), Whites, American Indian or Alaska Native and Asian or Pacific Islander, respectively. But for AA with an AAPC of -1.8%(CI -3.5 to 0.0), all other ethnic groups witnessed statistically significant decline in AAMR. AAMR were 5.3 and 5.5 for women and men, respectively. The AAPC were -2.7%(-4.5 to -0.8) and -2.5(-3.6 to -1.3) for women and men, respectively. The AAMR were 3.5, 5.6 and 8.1 for Large, Medium and Non-Metro areas, respectively, which all showed statistically significant decline.

Conclusions:
There has been a statistically significant decline in CA related AAMR in the USA from 1999-2020. Though AA harbor the highest AAMR, there has been no significant change in AAMR in the past two decades. Reasons for these racial disparities need to be investigated and addressed.