bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 13507: Outcomes Among Coronary Artery Disease Patients Hospitalized for Left Ventricular Assist Device Implantation: A United States Population-Based Cohort Study
Authors: Casipit Bruce Adrian , Idowu Abiodun , Al Sudani Hussein , Casipit Carlo , Lo Kevin Bryan , Khraisha Ola , Amanullah Aman M
Published: December 2023

Introduction:
Coronary Artery Disease (CAD) is a significant cause of morbidity and mortality among the general population. Previous studies suggested that significant CAD increased the risk for adverse outcomes including acute coronary syndrome and ischemic cardiomyopathy, which if severe enough warrants advance therapeutic options including implantation of a left ventricular assist device (LVAD). However, there is paucity of data exploring the in-hospital outcomes of patients with CAD admitted for LVAD implantation.

Hypothesis:
CAD does not impact outcomes in patients undergoing LVAD implantation.

Methods:
A retrospective cohort study using the National Inpatient Sample 2018-2020 database. Patients aged
>
18 years with known CAD admitted for LVAD placement were identified in the database. Multivariate logistic regression analysis was used to adjust for potential patients' and hospital level confounders. Outcome of interest were in-hospital mortality, ST-Elevation Myocardial Infarction (STEMI), LVAD thrombosis and ischemic stroke among patients with CAD hospitalized for LVAD implantation.

Results:
We identified a total of 76,757 patients admitted for LVAD implantation in the years 2018-2020, of which 55.93% (n= 42,930/76,757) had CAD. The overall mortality rate among patients admitted for LVAD implantation was 27.47% (n=21,080/76,757). Among those with concomitant CAD, the mortality rate was significantly higher at 28.93% (12,263/42,930, P=0.00). Using a stepwise survey multivariable logistic regression model that adjusted for patient and hospital level confounders, concomitant CAD among LVAD recipients was found to be an independent predictor of overall in-hospital mortality (aOR 1.24; 95% CI (Confidence Interval), 1.14-1.36; p<0.001) but did not increase the risk of STEMI (aOR 1.48; 95% CI, 0.98-1.34; p=0.09), LVAD thrombosis (aOR 1.04; 95% CI, 0.51-2.14; p=0.91) and ischemic stroke (aOR 0.76; 95% CI, 0.38-1.39; p=0.33).

Conclusions:
Among hospitalized patients for LVAD implantation, concurrent CAD increased the risk for in-hospital mortality but did not increase the risk for STEMI, LVAD thrombosis and ischemic stroke. Prospective studies with control of potential confounders may better delineate these associations.
Abstract 13510: Clinical Characteristics and In-Hospital Outcomes of Patients With Myocardial Infarction With Non-Obstructive Coronary Arteries in Japan -Lessons From the Real-World Database of JAMIR-
Authors: Onuma Sho , Takahashi Jun , Shiroto Takashi , Godo Shigeo , Hao Kiyotaka , Honda Satoshi , Kensaku Nishihira , Kojima Sunao , Takegami Misa , Itoh Tomonori , Watanabe Masafumi , Takayama Morimasa , Sumiyoshi Tetsuya , Kimura Kazuo , Yasuda Satoshi
Published: December 2023

Background:
A certain percentage of patients with acute myocardial infarction (AMI) do not have significant stenosis and they are termed as "myocardial infarction with nonobstructive coronary arteries (MINOCA)”. However, there were few studies representing MINOCA patients in the era of coronary intervention, in Asia in particular.

Aims:
We aimed to elucidate the clinical characteristics and in-hospital outcomes of patients with MINOCA in Japan by using a real-world database.

Methods:
The Japan Acute Myocardial Infarction Registry (JAMIR) is a nationwide, real-world multi-center registry study. We retrospectively analyzed 22,236 AMI patients (68±13 years, female 23.4%) enrolled in the JAMIR between 2011 and 2016.

Results:
Of those, 286 patients (1.3%) were diagnosed as MINOCA following coronary angiography and the remaining 21,950 patients (98.7%) were inevitably as myocardial infarction with obstructive coronary artery disease (MI-CAD). MINOCA patients were characterized by younger age, higher prevalence of women, fewer coronary risk factors, lower rate of ST-elevation AMI, lower Killip classes, and lower peak creatinine phosphokinase levels as compared to those with MI-CAD. In-hospital all-cause mortality was not different between MINOCA and MI-CAD groups (5.2% vs. 5.7%, P=0.82, OR adjusted by age and sex 1.06; 95%CI [0.63-1.80]), meanwhile non-cardiac mortality was significantly higher in the MINOCA group (4.2% vs. 1.6%, P<0.01, adjusted OR 3.14; 95%CI [1.74-5.68]) (
Figure A
). Importantly, non-cardiac mortality increased with age in the MI-CAD group, whereas this did not apply in the MINOCA group (
Figure B
).

Conclusions:
The large-scale real-world database JAMIR demonstrated high prevalence of non-cardiac death in MINOCA, which indicate a clinical significance of comprehensive evaluations concerning underlying pathophysiological mechanisms of myocardial injury, especially in the younger patient group.
Abstract 13514: Unfavorable Neurological Outcomes With Incremental Cardiopulmonary Resuscitation Duration in Cardiac Arrest Brain Injury: A Systematic Review and Meta-Analysis
Authors: Mondal Avilash , Bollu Bhaswanth , Shafi Nimra , Parmar Poojan , Kali Abeera , Dong Qiming , Mylavarapu Maneeth , DADANA SRIHARSHA , Khan Muhammad Hassan , Shanker Srija , butt Samia , Desai Rupak
Published: December 2023

Introduction:
Duration of Cardiopulmonary resuscitation (CPR) affects neurological outcomes. Data on its decremental effect on neurological outcomes haven’t been explored before

Methods:
PubMed, Scopus and Google Scholar were searched for relevant studies until May 2023 using relevant keywords. Odds of good neurological outcomes were studied. Binary random-effects models were used to estimate pooled odds ratios (OR) and 95% confidence intervals (CI). Leave one out sensitivity analysis was performed. Heterogeneity was assessed using I2 statistics. For outcomes showing moderate or high heterogeneity, subgroup analyses were performed for follow-up duration or type of study. A p<0.05 was considered statistically significant.

Results:
A total of 349,027 cardiac arrest patients (mean age: 70.2 years; males: 56.5%) from four studies were included in the meta-analysis. Of them the initial rhythm was shockable in 11% (38,465/349,027) and non-shockable in 88.97% (310,562/349,027) of the population. Odds of having favorable neurologic outcomes were OR 0.32 (95% CI 0.10-1.01, p=0.05) for 6-10-minute(n=14,118), OR 0.10 (95 %CI 0.02-0.64,p=0.02) for 11-15 min(n=43885), OR 0.05 (95% CI 0.01-0.36, p<0.01) for 16-20 minutes(n=66,174), OR 0.04 (95% CI 0.01-0.21, p< 0.01) for > 20 min(n=181,262) and OR 0.03 (95% CI 0.00-1.55, p=0.08) for > 30 minutes (n=66,461) when compared to patients receiving CPR for < 5 mins (n=6420).(Fig.1)

Conclusions:
Steady decremental odds of favorable neurological outcomes were seen with every five minutes of increase in CPR duration with a statistically significant decline seen in CPR duration of 11-15 mins onwards
Abstract 13525: Plateletcrit: A Novel Risk Predictor of Acute Myocardial Infarction
Authors: Tasneem Samia P
Published: December 2023

Introduction:
Platelets are crucial in the pathogenesis of acute coronary syndrome (ACS). Naïve platelets are larger in size and have higher thrombotic activity compared to smaller platelets. The plateletcrit (PCT), representing the total platelet mass, may emerge as a marker of prothrombotic state in ACS patient.

Hypothesis:
Increased PCT is associated with higher risk of acute MI in young patients (≤40 years).

Aim:
To find out PCT levels in young AMI patients.

Methods:
A hospital-based case-control study at Dhaka Medical College Hospital, Bangladesh were carried out. 50 young newly diagnosed AMI (both STEMI & NSTEMI) patients presented to CCU and 50 age- and sex-matched healthy controls were studied. Platelet indices i.e., PCT, Mean platelet volume (MPV) and platelet count were measured upon admission. The correlation between PCT, clinical and laboratory parameters were examined with Pearson Spearman analysis. Multivariate logistic regression was used to evaluate the role of PCT in predicting AMI. Receiver operating characteristic (ROC) curve analysis was done to obtain the optimal cut off for significant variables. 95.0% confidence interval and
p
<0.05 were considered statistically significant.

Results:
In AMI patients, the mean platelet count, mean PCT and mean MPV were 258 х 10
3
/μl, 0.30% and 11.09fl, respectively. In the control population, the mean platelet count, mean PCT and mean MPV were 245х10
3
/μl, 0.26% and 10.29 fl, respectively. PCT showed the most significant association with AMI with odds ratio 3.89, followed by an OR of 2.38 for MPV. PCT showed higher sensitivity and specificity (84.8% and 67.2%, respectively) in comparison to MPV (66% and 68%, respectively) (
p
<0.001 vs 0.003). There was a significant positive correlation between PCT and serum troponin-I level.

Conclusion:
Patients with higher PCT was at higher risk of AMI and myocardial damage. This routine inexpensive and readily available PCT may be of value as a complementary marker in early AMI.
Abstract 13571: Endothelial Jagged1 in Vascular Calcification Induced by Chronic Kidney Disease
Authors: Guo Qunying , Lee Tae Hoon , Liang Ming , Huang Fengzhang , Truong Truong , Mitch William E , Cheng Jizhong
Published: December 2023

Introduction:
Chronic kidney disease (CKD)-induced vascular calcification (VC) is a dire complication with high incidence, while its pathogenesis has not been fully elucidated.

Hypothesis:
We hypothesized that endothelial Jagged1 prevents vascular smooth muscle cell from osteoblast trans-differentiation thus alleviates CKD induced vascular calcification.

Methods:
We have generated a CKD mouse model by 5/6 nephrectomy followed by high phosphate diet (HPiD). CKD-induced VC were determined in Jagged1 EC specific KO and Notch3 KO mice. Co-culture of EC with vascular muscle cells (VSMCs) was performed to study the mechanism.

Results:
Endothelial Jagged1 expression was decreased in calcified arteries from CKD patients
vs
. normal arteries. Knockout of EC Jagged1 significantly induced artery calcification and decreased the mice survival rate
vs.
WT CKD mice. There was decreased expression of VSMC contractile markers and Notch3, and increased expression of ossification markers in calcified arteries from endothelial Jagged1 KO CKD mice. Furthermore, overexpression of EC Jagged1 significantly prevented artery calcification. In EC
Jag1 OE
/Notch3 KO CKD mice, KO Notch3 partially blocked the protective effects on VC by Jag1 OE. In co-culture experiments, KO of Jagged1 in ECs enhanced transdifferentiation of VSMCs into osteoblast cells after high-phosphate (HPi) treatment, while overexpression of Notch3 alleviated calcium deposition induced by HPi. Silencing Hes1 in VSMC led to remarkably increased Runx2 expression and more severe calcification in response to HPi treatment.

Conclusions:
Jagged1 expression in ECs controls CKD-induced VC. Down-regulation of EC Jagged1 impairs VSMC Notch3 activation, thus induces VSMC transdifferentiation and VC through Notch target Hes1.
Abstract 13572: Electrocardiographic Aging Derived From Artificial Intelligence is Associated With the Risk of Early- and New-Onset Atrial Fibrillation: A Multi-National Cohort Study
Authors: Cho Seunghoon , Eom Sujeong , You Seng Chan , Yu Hee Tae , JOUNG BOYOUNG
Published: December 2023

Background:
The application of artificial intelligence (AI) algorithms to ECG provides promising age prediction methods. We investigated whether the age discrepancy between AI-predicted age from ECG (AI-ECG age) and chronological age, known as the AI-ECG age gap or electrocardiographic aging (ECG-aging), could predict atrial fibrillation (AF) risk.

Methods:
We developed an AI-ECG age prediction model using a single-center dataset (1,533,042 ECGs from 689,639 participants) and validated it using five independent, multi-national datasets (637,177 ECGs from 230,838 participants). The AI-ECG age gap was calculated in two cohorts from South Korea and the UK. Based on this age gap, participants were classified into two study groups: Normal ECG-aging (Normal EA, age gap <7 years) and Early ECG-aging (Early EA, age gap ≥7 years). We assessed the predictive capability of ECG-aging for early- and new-onset AF risk.

Results:
In two cohorts followed up for 5.9±3.7 and 3.0±1.6 years with 37,208 and 40,989 participants, respectively, the mean AI-ECG age with mean age gap was 47.4±12.4 (-0.1±6.0) and 68.4±7.8 (4.7±8.7) years, respectively. The early EA group was associated with increased risk of new-onset AF with HR of 1.86 (95% confidence interval, 1.46-2.38) and 1.88 (1.54-2.29), and early-onset AF with OR of 2.23 (1.79-2.77) and 1.52 (1.34-1.73), compared to the normal EA group in each cohort, respectively. Furthermore, there was an increased risk of both early- and new-onset AF with an increasing AI-ECG age gap.

Conclusions:
ECG-aging derived from the AI model was associated with the risk of early- and new-onset AF, indicating its potential as a risk predictor for AF in primary prevention.
Abstract 13577: Burden of Cardiometabolic Risk Factors and Vascular Health
Authors: Hamo Carine , Schlamp Maria Florencia , Drenkova Kamelia , Jindal Manila , Fadzan Maja , Akinlonu Adedoyin , Goldberg Ira J , Garshick Michael , Berger Jeffrey
Published: December 2023

Introduction:
Cardiometabolic risk factors (diabetes, obesity, and hypertension) are highly prevalent and contribute to cardiovascular disease (CVD). Endothelial dysfunction often precedes CVD development. Direct brachial vein endothelial cell (EC) harvesting enables the examination of vascular health via assessment of EC gene expression.

Hypothesis:
We hypothesized that individuals with greater cardiometabolic risk would demonstrate a more pro-inflammatory EC transcriptome.

Methods:
Adult participants without CVD underwent EC harvesting followed by RNA sequencing. We categorized individuals by number of risk factors (hypertension, diabetes, obesity) as 0 through 3. To evaluate the association between risk factor burden and outcome transcripts, we performed multivariable linear regression, adjusting for age, sex, and race/ethnicity.

Results:
Among 18 individuals (mean age 47 ± 14, 44% female, and 61% white), 17%, 44%, 28%, and 11% had 0,1,2, and 3 prevalent risk factors, respectively. EC RNA sequencing revealed 588 differentially expressed transcripts (p-adj <0.05) with 585 upregulated, 3 downregulated, and excellent clustering (
Fig. a, b
). Gene ontology enrichment analysis demonstrated enriched and upregulated pathways of T-cell activation (NES = 2.22, p<0.001), leukocyte differentiation (NES= 2.16, p<0.001), and platelet aggregation (NES= 1.66, p=0.03) and downregulated pathways of endothelial cell proliferation (NES= -1.68, p=0.03). (
Fig. c
) Select upregulated genes (log 2FC >3, p-adj<0.05) included VCAM1, CEACAM1, ADAM 17, and CD99L2, with a graded increase in mean normalized counts with increasing number of risk factors. (
Fig. d
)

Conclusions:
We demonstrate a proinflammatory, pro-adhesive, and pro-coagulant EC transcriptome associated with increased cardiometabolic risk factor burden offering insight into potential mechanisms linking cardiometabolic risk factors with the development of CVD.
Abstract 13595: Sex-Specific Burden of Peripheral Arterial Disease Across the United States: Analysis of the Global Burden of Disease 1990-2019
Authors: Janus Scott E , Chami Tarek , Hajjari Jamal , mously haytham , Badhwar Anshul , Al-Jammal Mustafa , Chahine Nicole , Li Jun , DEO SALIL , Al-Kindi Sadeer
Published: December 2023

Background:
Peripheral arterial disease is a ubiquitous disease that varies in terms of morbidity and mortality due to biologic sex, including the impact of traditional and non-traditional risk factors and sex-specific conditions that adds complexity and contributes to the existing disparities. Thus, understanding the sex-specific trends of PAD in the United States population is critical for developing targeted interventions. We sought to analyze the burden of PAD in male and female patients across the US from 1990 to 2019.

Methods:
Using the Global Burden of Disease (GBD) study data from 2019, we performed an analysis of the burden of PAD from 1990-2019, across US states. The GBD defined PAD based on studies that used symptom-based criteria and expressed the burden of PAD as the age-standardized prevalence and disability adjusted life years (DALYs) rates. We additionally estimated the regional relative change in DALYs.

Results:
In 2019, there were 5.4 million males and 7.1 million females with PAD in the US. Absolute PAD prevalence and DALYs increased in both sexes between 1990 and 2019, figure. The 2019 age-standardized prevalence of PAD (per 100,000) in the US in 2019 was 2,124 (95% Uncertainty Interval (UI): 1905-2354), and 2,302 (95% UI: 2,079-2,522) for females. Between 1990 and 2019, females had higher increase in age-standardized PAD DALYs compared with males (13.8% vs 5.5%). Significant state-level geographic variance was noted in age-standardized prevalence of PAD in both sexes (2-fold difference between lowest and highest state), figure.

Conclusion:
The burden of PAD is increasing in the US owing to the aging population. The absolute prevalence of PAD is higher in women compared with men in the US. Over the past 3 decades, there has been a more significant increase age-standardized PAD DALYs in women as compared with men. Future studies are needed to investigate and target these disparities.
Abstract 13612: Association Between B-Type Natriuretic Peptide and Inferior Vena Cava Diameter as a Measure of Hypovolemia in Cancer Patients
Authors: Qarajeh Raed , Le Amy Tu Trinh , Wilder Bart , Sharma Akash , Golemi Lolita , Okwuosa Tochukwu
Published: December 2023

Introduction:
Hypovolemia is frequently seen in cancer patients due to catabolism, cachexia, and decreased oral intake. However, volume status assessment in this population is often difficult due to competing comorbid conditions such as edema. Elevated B-type natriuretic peptide (BNP) is an established biomarker of myocardial wall stress in patients with hypervolemia. We sought to determine if very low BNP could be an objective marker of hypovolemia in cancer patients

Hypothesis:
In cancer patients undergoing treatment, is low BNP level (<10 pg/mL) associated with small inferior vena cava (IVC) diameter (< 1.4 cm) - an established marker of hypovolemia on transthoracic echocardiography (TTE)?We hypothesize that BNP <10 pg/mL is associated with small IVC as a marker of hypovolemia in cancer patients.

Methods:
We conducted a retrospective study (N=91) with solid malignancies, undergoing chemo- and/or radiation therapy (RT), divided into 3 groups based on BNP values in pg/mL: low (BNP <10), normal (BNP 10-100) and high (BNP>100). Retrospective data were obtained between 2016-2023 from Rush University Medical Center Cardio-Oncology Registry. IVC measurements by 2 medial trainees (Cohen’s intraclass correlation coefficient = 0.87, p < 0.01) were acquired from formal TTEs obtained within 1 week of BNP measurements. Linear regression was used to calculate the adjusted means (for age, sex, BMI, blood pressure, creatinine, RT, TSH) of the 2 measured IVC diameters per datapoint. Mean difference in IVC diameters was compared between the 3 BNP groups.

Results:
The population mean age was 59.99 ± 12.19, 67% women. Adjusted mean IVC measurements were 1.89cm, 1.55cm, and 1.26cm for the high, normal, and low BNP groups respectively. The mean difference in IVC diameters between high and low BNP groups was 0.628 ±0.164 cm (p<0.01).

Conclusions:
In cancer patients undergoing treatment, very low BNP (<10pg/mL) was associated with small IVC as a marker of hypovolemia. In this group of patients, BNP measured with routine lab data is a readily available tool to identify individuals with hypovolemia where other measures of volume status such as physical exams might be uncertain.
Abstract 13623:
In Silico
Comparison of Pressure Head Loss for Outflow Variations of a Novel LVAD Accessory Compared to Generic LVAD Pump Outflow
Authors: Osypka Anna , Meissner Florian , Ozturk Deniz , Vestner Heiko , Costa Galbas Michelle , Czerny Martin , Bothe Wolfgang
Published: December 2023

Introduction:
Left ventricular assist device (LVAD) implantation is a treatment option for end-stage heart failure, requiring a sternotomy. A novel accessory, redirecting the outflow via the left ventricular apex into the ascending aorta, allows for LVAD implantation via left thoracotomy. Pressure distribution within accessory designs is unknown. Our goal was to compare three different outflow designs with a generic LVAD outflow (Control) to optimize the accessory’s outflow design.

Hypothesis:
We hypothesize that the LVAD accessory leads to higher pressure head loss than Control and that there are relevant differences among varied designs.

Methods:
Volume models of the LVAD accessory variations (A–C) and Control were created using computer aided design. Computational fluid dynamics (CFD) was used to simulate blood flow through the accessories and generic outflows. A verification study was performed to optimize numerical parameters. Pressure head loss (mmHg) was calculated for each outflow while changing the LVAD flow rate continuously (2–7 L/min). Pressure loss was compared by mean differences (MD).

Results:
Pressure head loss increased with higher LVAD flow rate among all groups. Addressing the accessories’ outflow designs, Design B revealed the lowest increase in pressure loss revealing a mean slope of 2.3 mmHg/L/min compared to 4.6 and 3.0 for Design A and C. Referring to a flow rate of 5.5 L/min, a common flow rate among clinical LVAD patients, and comparing pressure head loss with Control, we found an additional pressure loss of 15.5, 6.4 and 8.3 mmHg in Design A, B and C, respectively.

Conclusion:
There is a trade off between fitting the outflow design to the cardiac geometry and the pressure head loss. Continued optimization of the LVAD accessory could allow minimally invasive LVAD implantation with minimal changes in LVAD performance. Potential compromise between improved design and performance renders CFD an important tool for medical device development.
Abstract 13625: Laboratory Markers of Effective Endogenous Fibrinolysis in Intermediate-High-Risk Pulmonary Embolism
Authors: Mihalovic Michal , Robert Petr , Odvodyová Denisa , Malinicova Ivana , Pilikova Katerina , Karpisek Michal , Jarkovsky Jiri , Motovska Zuzana
Published: December 2023

Introduction:
Unselected therapy with fibrinolysis in intermediate risk-pulmonary embolism (iPE) is associated with an unacceptable risk of bleeding. Early identification of iPE patients on anticoagulant therapy with ineffective endogenous fibrinolysis (eFL) could optimize treatment-strategy. Aims: The study aims to determine markers of (in)effective eFL in intermediate-risk PE initially on anticoagulant therapy with UFH.

Methods:
In course of 24 months, iPE patients were enrolled in the prospective study. At admission, and every 24 hours until day 5, levels of 6 selected markers of eFL (i.e., PAI-1 and tPA active assay and total antigen, TAFI, and PAP) were determined. Upon arrival and following a span of 36 hours,defined i) Clinical (heart rate >100 bpm and spontaneous oxygen saturation <90%), ii) Echo (D-shape, RVd/LVd from PLAX>0.7, RV/RA >30mmHg), and iii) CT (RV/LV>0.9) variables were obtained. An (un)successful therapy was assessed by one point for each clinical, Echo and CT criteria, as at least one parameter from initially altered has adjusted at 36 hours. We performed correlation of laboratory markers with the dynamics of clinical and imaging characteristics.

Results:
Study population consists of 44 patients, 22 men, mean (SD) age 60 (18.3) yr., first (38), repeat (6) PE. Plasminogen activator inhibitor-1 (PAI-1) active assay showed the most promising results. The cut-off for unsuccessful therapy from AUC for PAI-1 was ≥65 U/ml. Mean (IQR) levels of PAI-1 on day 1 were 119 U/ml (27.1 - 155.8) and were significantly higher on day 1 (p=0.019) and day 2 (p=0.055) in those with/without adjustment of initial pathological findings. PAI-1 elevation was associated with unsuccessful restoration of clinical, Echo and CT parameters at 36 hours (Table1). Overall Tx failure was associated with elevated PAI-1 (p=0.011).

Conclusions:
PAI-1 active assay could help us in identifying patients who would benefit from early indicated therapeutic fibrinolysis.
Abstract 13627: Atrial Fibrillation is Associated With Worse Outcomes in Saddle Embolus of Pulmonary Artery Without Cor-Pulmonale
Authors: Dwaram Amulya Reddy , Petryshyn Yuliana , Harb Ahmad , Swarna Siri Chandana , Koorapati Gowthami , Harb Amjad , Dominic Paari
Published: December 2023

Background:
Pulmonary embolism (PE) is a common form of venous thromboembolism that could be potentially fatal. Atrial fibrillation (AF) is the most common arrhythmia, which may lead to thromboembolic complications. They are distinct medical conditions, but PE may lead to AF through right-sided pressure overload. AF, in turn, might lead to right atrial thrombus formation and, thereby, PE. AF can be seen as a presenting sign during early phase or later during recovery from PE.

Methods:
This is a retrospective cohort study in which we queried the National Inpatient Sample database between 2016 and 2019 to identify hospitalizations (age 18 and older) with a principal diagnosis of Saddle embolus of pulmonary artery without acute cor-pulmonale. The cohort was divided into patients with and without AF as a secondary diagnosis. The primary outcome was in-hospital mortality. The secondary outcomes were cardiogenic shock, acute respiratory failure, length of stay, and total hospital charges. All statistical analyses were performed using weighted values.

Results:
During the study period, there were 58,285 hospitalizations with a principal diagnosis of Saddle embolus of pulmonary artery without acute cor-pulmonale. Among them, 5800 (11%) had a diagnosis of AF. Baseline characteristics are shown in Table 1. After adjusting for all significant baseline characteristics, patients admitted with concomitant AF had higher in-hospital mortality (6.6% vs 3.7%; aOR 1.88, 95% CI:1.46 - 2.42, p < 0.0001), cardiogenic shock (5.9% vs 2.0%; aOR 3.04, 95% CI: 2.3 - 4.0, p < 0.0001), acute respiratory failure (4.2% vs 2.7%; aOR 1.65; 95% CI: 1.14 - 2.15), increased length of stay (7.59 vs 5.44 days p < 0.0001), total hospital charges ($100,756 vs $ 69,396 p < 0.0001)

Conclusions:
This study demonstrates that AF is associated with increased mortality, cardiogenic shock, acute respiratory failure, length of stay, and total hospital charges in saddle embolus of pulmonary artery without cor- pulmonale
Abstract 13631: Desmoplakin Cardiomyopathy in Pediatric Patients - A Distinct, Underrecognized Cohort of Arrhythmogenic Cardiomyopathy
Authors: Choi Nak Hyun , Cherny Sara , Berul Charles I , Goodyer William R , Howard Taylor , Joong Anna , Liberman Leonardo , Silver Eric S , Villa Chet , Lee Teresa , Zuckerman Warren
Published: December 2023

Introduction:
Arrhythmogenic cardiomyopathy is a spectrum of diagnoses including the historically recognized arrhythmogenic right ventricular cardiomyopathy. More recent literature describes predominately left ventricular (LV) or biventricular (BiV) involvement. Variants in the desmoplakin (
DSP)
gene commonly cause LV and BiV phenotypes, though data in children are sparse.

Hypothesis:
Pediatric patients (pts) with
DSP
mutation have predominantly LV or BiV disease and may present with early onset malignant arrhythmia.

Methods:
We performed a multicenter, retrospective cohort study of pts <21 years with pathogenic or likely pathogenic
DSP
variants from 6 tertiary referral children’s hospitals. We describe clinical variation in
DSP
probands (PBs), the first affected family member prompting genetic testing due to clinical history, as compared to genotype-positive family members (FMs) <21 years of age diagnosed by familial cascade screening.

Results:
We identified 34 pts; 12 (35%) were PBs and 22 (65%) were FMs. Median age at genetic diagnosis was 13.3 and 12.3 years for PBs and FMs, respectively. Four PBs had LV-predominant disease; 6 had BiV disease (table 1). The most common initial diagnosis for PBs was myocarditis and dilated cardiomyopathy. ECG abnormalities were common in PBs (75%) and included left axis deviation, inferolateral T-wave inversion, and low QRS complex amplitude. The LV ejection fraction (EF) on echo was 48% and 65% for PBs and FMs, respectively. Eight PBs underwent MRI and 6 had late gadolinium enhancement involving the LV only, while 2 had BiV involvement. Six PBs underwent ICD implantation and 2 received appropriate ICD therapy (LVEF 25% and 41%). Two PBs had cardiac transplantation.

Conclusion:
Pediatric
DSP
-cardiomyopathy has predominantly LV or BiV involvement and may be misdiagnosed as myocarditis or dilated cardiomyopathy. Probands in particular, may present with early malignant ventricular arrhythmias and significant LV dysfunction.
Abstract 13659: Prevalence of Diagnosed Atrial Fibrillation in the United States
Authors: Noubiap Jean Jacques , Tang Janet J , Teraoka Justin T , Dewland Thomas A , Marcus Gregory M
Published: December 2023

Background:
A study done in 1996-1997 predicted that there would be 3.3 million people with atrial fibrillation (AF) in the United States in 2020. However, contemporary estimates of AF prevalence in the US are lacking. Therefore, we estimated the minimum age-, sex-, and race-stratified prevalence of diagnosed AF in California, and the number of people with diagnosed AF in US.

Methods:
California’s Department of Health Care Access and Information databases were used to identify adults aged ≥ 20 years who received care in an ambulatory surgery unit, emergency department, or inpatient hospital in California between January 01, 2005, and December 31, 2019. AF was defined based on ICD-9 and ICD-10 codes. We estimated the cumulative number of people diagnosed with AF in California from 2005 to 2019 and accounted for interim mortality using social security death index data. We applied age- and sex-specific AF prevalence data in California to census information on the US population to estimate the number of people with diagnosed AF in US.

Results:
The estimated population prevalence of diagnosed AF in adults in California was 2.04% in 2019. It was higher in males than females (2.42% vs 1.73%, p < 0.0001), and in Whites (3.82%) compared to Blacks (2.10%), Asian (1.13%), Hispanic (0.93%), < 0.0001. This prevalence increased with age, from 0.04% in the 20-24 age group, to 21.48% in those aged ≥ 85 years. After accounting for deaths, there was an estimated 657,584 people with diagnosed AF in California at the end of 2019. We estimated that at least 5,955,806 people (53.0% males) had AF in the US in 2019. The number of males with AF was higher than females in all age groups, except in those aged ≥ 80 years. The number of affected people increased with age, from 8,074 in those aged 20-24 years, to 1,416,282 in those aged ≥ 85 years.

Conclusion:
The prevalence of diagnosed AF in the US is higher than previously estimated. More efficient prevention and treatment strategies are needed to curb the burden of AF in the US.
Abstract 13661: In-Hospital Outcomes, Rates of Development of Complete Heart Block and Rates of Pacemaker Placement in TAVR and SAVR Cases: A 5-year Nationwide Inpatient Sample Analysis
Authors: Desai Spandan , Roma Nicholas , Ferraro Bruce , Shah Kashyap , Durkin Michael
Published: December 2023

Introduction:
Complete Heart Block (CHB) is a commonly observed post-procedural complication associated with Transcatheter aortic valve replacement (TAVR) and Surgical aortic valve replacement (SAVR). Since 2016, limited data exists on In-hospital outcomes of TAVR and SAVR cases and rates of development of CHB.

Methods:
National Inpatient Sample 2016-2020 was used to identify and group TAVR and SAVR cases using appropriate ICD codes. Logistic regression was used to compare baseline characteristics and in-hospital outcomes.

Results:
590,615 patients underwent aortic valve replacement (AVR) from 2016-2020, of which 49.6% were TAVR and 50.4% were SAVR. The most common diagnosis for AVR in both groups was nonrheumatic trileaflet aortic stenosis (AS) (86.6% in TAVR group and 53.5% in SAVR group, p<0.001). In TAVR cases, development of CHB was more common (8.9%-vs-7.2%, p=0.235) along with increased need for transvenous pacing (16.6%-vs-8.7%, p=0.010) and permanent pacemaker placement (9.4%-vs-6.4%, p<0.001). An upward trend in CHB occurrence and pacemaker placement (PPM) was noted in the TAVR group as shown in Image 1. TAVR group was observed to have higher rates of acute myocardial infarction (MI) (14.5%-vs-12.8%, p=0.074). SAVR group had higher rates of cardiogenic shock (8.10%-vs-2.20, p<0.001) and in-hospital mortality (3.6%-vs-1.30%, p=0.02).

Conclusions:
Over the past few years, CHB has been more commonly observed with TAVR as compared to SAVR, necessitating increasing use for PPM placement. Despite these trends, in-hospital mortality and complications are lower with TAVR procedure.
Abstract 13686: An Implementation Science Informed, Patient Activation Intervention for Depression Treatment in Coronary Heart Disease Patients: Impact on Clinician Referral and Prescribing Behaviors
Authors: Moise Nathalie , Dimaond Meredith E , Genao Kiara , Mizhquiri Barbecho Jennifer , Onyilofor Chinelo , Ospina Nohora , Rome Danielle , Shaw Kaitlin , Simantiris Samantha , Ye Siqin
Published: December 2023

Intro:
Implementation strategies are integral to addressing gaps in AHA depression treatment guidelines in coronary heart disease (CHD) patients.

Methods:
From 2019 to 2023, we randomized 12 Columbia University affiliated primary care and cardiology clinics to timing of receiving a multi-level intervention. We enrolled separate pre and post EHR eligible patients/site (≥21 years old, English or Spanish speaking, CHD ICD10 and upcoming cardiologist/PCP
index
visit) with Patient Health Questionnaire(PHQ)9≥10 and not seeing a psychiatrist. Pre-implementation patients and their providers/sites received usual care. Post-implementation, a theory-informed intervention included problem-solving meetings for mental health social workers (MHSW), cardiologist/PCP [“provider”] education and a patient psychoeducation, activation, and treatment selection tool (with patient treatment preferences sent to MHSW/providers via EPIC). Blinded physicians extracted index visit pre vs. post provider behavior (i.e., documented CHD risk factor or mental health counseling, therapy/cardiac rehab referral, and/or antidepressant prescribing vs. none). We conducted a pre-post analysis using descriptive statistics and thematically analyzed any MHSW/provider responses to EPIC reports.

Results:
Of 10,625 EHR eligible CHD patients; 1759 patients were screened, 304 (16.5%) eligible and 253 (82.9%) enrolled; 52.0% were female, 56.1% Hispanic, 14.6% Black; mean age was 67.8 years old, PHQ9 13.1. Overall, all (n=71) intervention providers received EPIC messages with 67.8% of patients selecting ≥1 treatment; 29.7% of reports prompted a MHSW/provider response (themes:
thinking, talking,
action)
; more cardiologists acknowledged receipt/relayed plans than PCPs as did providers caring for commercially insured (vs. Medicaid) patients; 25% of providers optimized treatment pre- vs. 40% post-implementation.

Conclusion:
A multi-level strategy centered around patient activation may marginally improve provider guideline adherence. Key limitations are pre-post design and descriptive analyses without adjustment for temporal trends. Our ongoing study will adjust for temporality and examine impact on depressive symptoms and patient behavior.
Abstract 13693: Left Atrial Sarcoma Mimicking Myxoma in Embolic Stroke
Authors: Qureshi Abdul Moiz , Manan Haris , Goulding Avedisian Taylor , Malozzi Christopher , Omar Bassam
Published: December 2023

Background:
Myxomas cause about 0.5% of strokes. Cardiac sarcomas are rare, may mimic myxomas, and are also associated with stroke. Imaging can provide clues to diagnosis.

Case:
A 53-year-old woman with diabetes, hypertension and prior strokes was admitted with new left hemiparesis. Computed tomography (CT) of the head revealed large middle cerebral artery infarct with petechial hemorrhages. Transthoracic echocardiogram (TTE; panel A) revealed large left atrial (LA) mass suspicious for myxoma protruding through the mitral valve. CT of the chest (panel B) revealed hilar adenopathy and LA mass concerning for myxoma or thrombus with stalk attachment to the right pulmonary vein (PV).

Decision-making:
Following heart team meeting decision was to remove the mass surgically given its embolic potential. Intraoperative transesophageal echocardiogram (TEE; panel C) revealed a large LA mass with multiple papillary protrusions and attachment via a stalk to the right lower PV. The mass was successfully removed and the patient recovered and was discharged. Follow up pathology returned as cardiac sarcoma.

Conclusion:
Pulmonary vein intimal sarcomas are rare tumors with poor prognosis, presenting early with chest pain, dyspnea and hemoptysis, or late with stroke. They can mimic myxomas and are therefore often diagnosed post-operatively. Preoperative diagnosis however is imperative to plan treatment and for prognostication. TEE and cardiac magnetic resonance imaging are the modalities of choice to diagnose sarcomas and evaluate extent of cardiac structure involvement.
Abstract 13695: Finerenone Added to RAS/SGLT2 Blockade for Non-Diabetic Chronic Kidney Disease. Results of a Preclinical Double-Blinded Randomized Controlled Trial
Authors: Zhu Zhihui , Anders Hans-Joachim
Published: December 2023

Introduction:
Dual inhibition of the renin-angiotensin system (RAS) plus sodium-glucose transporter (SGLT)-2 or plus the mineralocorticoid receptor (MR) demonstrated additive renoprotective effects in large clinical trials.

Hypothesis:
We hypothesized that triple therapy with a combination of RAS/SGLT2/MR inhibitors would be superior to dual RAS/SGLT2 blockade in attenuating CKD progression

Methods:
We performed a preclinical randomized controlled trial (PCTE0000266) in Col4a3-deficient mice with established Alport nephropathy. Treatment was initiated late (6 weeks of age) in mice with elevated serum creatinine and albuminuria and in presence of glomerulosclerosis, interstitial fibrosis and tubular atrophy. We block-randomized 40 male and 40 female mice to either nil (vehicle) or late onset food admixes of ramipril monotherapy (10 mg/kg), ramipril plus empagliflozin (30 mg/kg), or ramipril plus empagliflozin plus finerenone (10 mg/kg). Primary endpoint was mean survival.

Results:
Mean survival was 63.7 ± 10.0 days (vehicle), 77.3 ± 5.3 days (ramipril), 80.3 ± 11.0 days (dual), and 103.1 ± 20.3 days (triple), respectively. Sex did not affect outcome. Histopathology, pathomics, and RNA sequencing revealed that finerenone mainly suppressed the residual interstitial inflammation and fibrosis despite dual RAS/SGLT2 inhibition.

Conclusions:
This preclinical randomized controlled trial suggests that triple RAS/SGLT2/MR blockade may substantially improve renal outcomes in Alport syndrome and possibly other progressive chronic kidney disorders for synergistic effects on the glomerular and tubulointerstitial compartment, respectively.
Abstract 13708: Analyzing Outcomes of Atrial Septal Defect Closure in Patients With Ischemic Stroke and Thrombophilia
Authors: Cordova Sanchez Andres , Rawlley Bharat , Menezes Sherna , Morales Mejia Ana , Adames Ramos Kenneth , Pichs Armando , Chaudhuri Debanik
Published: December 2023

Introduction:
Evidence on outcomes of ASD closure after a stroke in patients with thrombophilia is limited.: We illustrate differences in long-term outcomes amongst patients diagnosed with a stroke and thrombophilia, who underwent ASD closure up to 3 months after the stroke versus those who did not.

Methods:
We queried the TriNetX research database to identify adult patients with thrombophilia and ASD who had an ischemic stroke from 2016 to 2021. Patients were divided into two groups: those undergoing percutaneous transcatheter ASD closure within 3 months of the stroke and those who received medical therapy only. Subgroup analyses was performed comparing ASD closure with patients who received either anticoagulation or antiplatelets, and of those with a specific diagnosis of PFO. Propensity score matching (PSM) was used to control for age, sex, hypertensive diseases, CKD, diabetes, dyslipidemias, ischemic heart disease, and tobacco use. Outcomes were measured from 1 month to 3 years after the index event and included all-cause mortality, new onset Atrial fibrillation/flutter, arterial embolism, and services associated with stroke/arterial embolism namely thrombolysis, thrombectomy, and imaging (CT, CTA, MRI, MRA) of head and neck.

Results:
Patients with thrombophilia undergoing ASD closure after a stroke had lower all-cause mortality compared to medical therapy [HR 0.35, 95%CI 0.165 - 0.764]. This association persisted on subgroup analysis comparing ASD closure to antiplatelet use only [HR 0.392, 95% CI 0.163,0.947] (Table 1).

Conclusions:
ASD closure was associated with lower mortality in patients with thrombophilia and ischemic stroke. There was no statistical difference in incidence of A.fib/flutter, arterial embolism, or services associated to stroke/embolism. There were no differences in outcomes in patients with a specific diagnosis of PFO.
Abstract 13714: Mortality Among Individuals With Prevalent Heart Failure and Low Socioeconomic Position
Authors: Perlick Alexa , Dixon Debra , Xu Meng , Lipworth Loren , Gupta Deepak K
Published: December 2023

Introduction:
Individuals of low socioeconomic position are at greatest risk for incident heart failure (HF). Few data exist, however, regarding factors associated with mortality among individuals with prevalent HF and low socioeconomic position.

Methods:
The Southern Community Cohort Study (SCCS) is a prospective observational study of 84,797 individuals of predominantly low socioeconomic position enrolled between 2002 to 2009 from 12 states in the southeastern US. Using Cox regression models, we examined demographic, social determinants, and clinical factors associated with 5-year all-cause mortality in a subset of 4,309 black or white adults with prevalent HF receiving Centers for Medicare and Medicaid Services at enrollment. Death was ascertained through linkage with the National Death Index and cohort follow-up.

Results:
Individuals with prevalent HF at SCCS enrollment were predominantly middle age (mean ~59 years), female (64%), black (70%), low income (75% <$15k/year), and low education (46% < high school). Over 5-year follow up, a total of 975 (23%) individuals died. Older individuals and men were at greater risk of death. Comorbidities such as history of myocardial infarction/coronary bypass, diabetes, hypertension, and smoking significantly associated with greater risk of death, as did lower physical activity and greater sedentary time. In contrast, social determinants such as race, income, education, and rural vs. urban residence did not significantly associate with mortality. Overall, body mass index (BMI) accounted for the greatest proportion of variance in the risk of death with a non-linear, predominantly inverse association (
Figure
).

Conclusions:
Among individuals of low socioeconomic position with prevalent heart failure residing in the southeastern US, clinical factors, particularly BMI, account for risk of mortality more so than social determinants.
Abstract 13717: Apixaban vs Warfarin for LVAD Anticoagulation
Authors: Soares Cullen , Desai Yash , Sorensen Erik , Dees Lynn , Hicks Albert J
Published: December 2023

Introduction:
Left ventricular assist devices (LVADs) are a therapy for the management of end stage heart failure. LVADs are typically managed with long-term therapeutic anticoagulation with warfarin to prevent thrombotic complications. Direct oral anticoagulants (DOACs) are easier to manage than warfarin for other medical conditions requiring therapeutic anticoagulation. There is limited data regarding DOAC safety in patients with LVADs.

Hypothesis:
There is no significant difference in outcomes for patients with LVAD when on DOAC compared to warfarin.

Methods:
In a single center retrospective analysis from February 2019 to May 2023, patients with LVAD who were switched to the DOAC apixaban (due to warfarin complications or compliance problems) were compared to patients who remained on warfarin. Overall survival, number of hospitalizations, bleeding and thrombotic complications were compared within/between groups.

Results:
72 patients were included. DOAC group vs warfarin group: n=12 vs 60, mean age = 52.5 vs 54.2 years; Male 75% vs 81.7%; black 66.7%; vs 58.3%. For DOAC group, 10 out of 12 were on warfarin prior to DOAC. Of these 10, incidence rates for bleeding related admissions were 4.2 per 1000 days on initial warfarin and 0.76 per 1000 days after switching to DOAC. Relative risk reduction of bleeding related admissions decreased by 81.9%. In the DOAC group, thrombosis related admissions on initial warfarin were 0, compared to 1 after switching to DOAC. When comparing DOAC and Warfarin groups, there were no statistically significant difference in bleeding or thrombotic complications (HR = 0.61; 95%CI= 0.21 to 1.46; HR= 0.74; 95%CI= 0.02 to 6.08, respectively) or mortality (HR = 0.44; 95%CI: 0.01 to 3.12). Incidence rates for bleeding related admissions were 0.98 per 1000 days and 1.59 per 1000 days, for DOAC and Warfarin, respectively. Incidence rates for thrombotic related admissions were 0.16 per 1000 days and 0.22 per 1000 days, for DOAC and Warfarin, respectively.

Conclusions:
There was no statistically significant difference in bleeding, thrombotic events, or mortality in LVAD patients receiving DOAC compared to Warfarin. Switching to DOAC improved bleeding rates in LVAD patients that suffered bleeding complications with Warfarin.
Abstract 13729: Subclavian Artery, Thoracic Aorta, and Coronary Artery Calcification, Age, Race/Ethnicity and Sex Distributions: The Multi-Ethnic Study of Atherosclerosis
Authors: Duprez Daniel A , Jacobs David R , Daniels Michael , Andrews Leah , Brumbach Lyndia , Denenberg Julie , Watanabe Kelly , Cornelissen Guillaume Germaine , Criqui Michael , Szklo Moyses , Allison Matthew A
Published: December 2023

Introduction:
Upper extremity atherosclerosis is typically localized in the subclavian arteries, although it is less prevalent and less often symptomatic than in the lower extremities. Subclavian artery calcification (SAC) is a metabolic consequence of subclavian artery atherosclerosis.

Hypothesis:
SAC is different in gender and in different ethnicties.

Aim:
We studied SAC, in comparison with coronary artery calcification (CAC) and descending thoracic aorta calcification (TAC) in the MESA study population.

Methods:
We quantified SAC, TAC, and CAC in MESA participants who had a chest CT in 2016-18 (N = 2756, mean age 68.3±9.2 years, 48% male, 27% Black, 13% Chinese, 22% Hispanic, 38% White). We characterized the distributions of SAC and TAC, relative to CAC, and examined their associations with age, race/ethnicity, and sex. Race and sex differences were studied separately using logistic regression, adjusted for age, for each vascular bed.

Results:
Prevalence of any SAC was 62%, TAC 60%, and CAC 69%. Among those with any calcification, N, median and 90th percentiles were SAC: 1704, 76, 534; TAC: 1655, 152, 2011; CAC 1896, 135, 1118. Pairwise correlations [ln(Agatston score + 1)] were SAC - TAC: 0.61, SAC - CAC: 0.48, TAC - CAC: 0.48. Correlations with age were 0.46 for SAC, 0.58 for TAC and 0.40 for CAC. SAC and TAC prevalences were similar for males and females, but CAC was more common in males (Table, p<0.05 for each race/ethnic group). Differences in prevalence varied by race, with small race differences for SAC, Chinese highest for TAC, and CAC highest for White (Table, groups with the same superscript within row do not differ significantly).

Conclusion:
In older adults, SAC and TAC occur almost as commonly as CAC. Calcification is moderately correlated between beds. The racial distribution is different for CAC than for SAC or TAC.