bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 12808: Use of Intra-Aortic Balloon Pump in COVID-19 Patients With Cardiogenic Shock and Associated Mortality Risk
Authors: Memon Rahat A , Ramphul Kamleshun , Kumar Nomesh , Dhaliwal Jasninder , Sombans Shaheen , Ravalani Abhimanyu , Bawna Fnu , Ramphul Yogeshwaree , Lohana Petras
Published: December 2023

Introduction:
While some past studies have hinted that intra-aortic balloon pump (IABP) may not influence mortality in cardiogenic shock(CS) patients, the impact and the predictors of its use among COVID-19 admissions with CS are unknown.

Methods:
We analyzed COVID-19-positive adults from the 2020 National Inpatient Sample hospitalized between April 1st, 2020, and December 31st, 2020. The presence of CS and the use of IABP were identified. Factors influencing the preference of IABP in CS cases were evaluated via logistic regression models.

Results:
We found 9665 COVID-19 patients with CS, and 430 patients (4.4%) necessitated the use of IABP. COVID-19 patients with CS requiring IABP were younger (mean age 61.38 years) than those not using IABP(mean age 66.28 years). IABP use was less likely to involve adults with prior MI (aOR 0.549, p=0.031), ages ≥60 years (aOR 0.574, p<0.01), hypertension (aOR 0.638,p<0.01), obesity (aOR 0.474, p<0.01), events of acute kidney injury (aOR 0.626, p<0.01), weekend hospitalizations (aOR 0.724, p<0.01), or females (vs. Males, aOR 0.759, p=0.02). However, higher odds of IABP use in CS were seen among those with complete AV block (aOR 5.581, p<0.01) and smokers (aOR 1.427, p<0.01). No racial differences in use were seen and those covered with private insurances were likelier to use IABP than Medicare-insured patients (aOR 2.077, p<0.01). The mortality rate among CS patients using IABP was 3.0%, while those not using IABP had a worse outcome (mortality rate 6.9%, aOR mortality in IABP users vs. non-users 0.458, 95% CI 0.369-0.569, p<0.01).

Conclusions:
Our study shows that COVID-19 adults with CS using IABP were younger and had a lower mortality rate. Factors such as past MI, ages ≥60 years, hypertension, obesity, AKI, female sex, and weekend hospitalizations were linked with fewer use. At the same time, those with complete heart block, Private insurance forms, and smokers were more likely to use IABP in CS.
Abstract 12812: Temporal Trends of Calcium Modification Therapies in Chronic Total Occlusion Percutaneous Coronary Intervention
Authors: Kostantinis Spyridon , Rempakos Athanasios , Simsek Bahadir , Karacsonyi Judit A , Allana Salman S , Alexandrou Michaella , Davies Rhian , gorgulu sevket , Alaswad Khaldoon , Basir Mir B , Khatri Jaikirshan , Poommipanit Paul , Choi James , Ybarra Luiz , Bagur Rodrigo , Reddy Niranjan , Soylu Korhan , Yildirim Ufuk , PATEL MITUL P , Mahmud Ehtisham , Azzalini Lorenzo , Kearney Kathleen , Elguindy Ahmed M , Abi Rafeh Nidal , GOKTEKIN OMER , Mastrodemos Olga , Rangan Bavana V , Sandoval Yader , Burke M Nicholas , Brilakis Emmanouil S
Published: December 2023

Introduction:
Various techniques with different mechanisms of action are presently available for the modification of coronary calcium in chronic total occlusions (CTOs).

Hypothesis:
We sought to examine the temporal trends in the use of calcium modification therapies in a large multicenter CTO percutaneous coronary intervention (PCI) registry.

Methods:
We analyzed data from 13,079 CTO PCIs performed in 12,799 patients at 46 US and non-US centers between 2012 and 2023. Calcification was assessed by angiography as mild (spots), moderate (involving ≤50% of the reference lesion diameter), or severe (involving >50% of the reference lesion diameter).

Results:
Moderate or severe calcification was present in 6,094 CTOs (46.6%). Among CTO lesions with moderate or severe calcium, one or more calcium modification techniques was used in 1,006 cases (16.9%); rotational atherectomy (7.2%, n=434), laser atherectomy (3.4%, n=203), intravascular lithotripsy (IVL) (3.4%, n=200), scoring balloon (3.0%, n=178), cutting balloon (1.8%, n=109), orbital atherectomy (1.5%, n=91), and Chocolate balloon (Teleflex, 0.3%, n=15). Over time, the use of calcium modification techniques for lesions with moderate to severe calcification increased from 2.5% in 2012 to 25.7% in 2023 (p for trend <0.001), with a significant increase in the use of IVL (from 0.6% in 2020 to 16.6% in 2023; p for trend <0.001) (Central Illustration). In the last 2 years (2021-2023), IVL was the most commonly used calcium modification technique followed by rotational atherectomy.

Conclusions:
The use of calcium modification techniques for calcified CTO lesions increased over time, with a significant increase in the use of IVL in the last years.
Abstract 12824: Quantitative Autonomic Testing ‘Early’ and ‘Late’ After Recovery From Acute COVID-19 Illness
Authors: Mascarenhas Lorraine , Kohno Ritsuko , McDonald Dana , Colburn Shaun , Benditt David G
Published: December 2023

Background:
Cardiovascular (CV) autonomic dysfunction (AD) is a known potential complication following acute COVID-19 illness and may contribute to persistent symptoms, such as fatigue and postural intolerance. However, the quantitative assessment of CV AD after an acute COVID-19 infection is largely unexplored.

Objective:
Compare CV autonomic testing in patients presenting ‘early’ and ‘late’ after an acute COVID-19 illness.

Methods:
CV autonomic testing was undertaken in symptomatic patients presenting ‘early’ (0-10 months) and ‘late’ (11-20 months) after an acute COVID-19 illness. Findings were compared to autonomic testing results in healthy control subjects. Measures included i) heart rate (HR) and blood pressure (BP) responses during active standing (AS), ii) time to BP nadir and recovery during AS, iii) Valsalva ratio (VR), and iv) respiratory sinus arrhythmia (RSA). Unpaired student t-test was used to compare findings (mean ± SD) in post-COVID patients to controls. A p-value of <0.05 was statistically significant.

Results:
Control (n=82, mean 33 years, 87% female), ‘early’ (n= 37, mean 38 years, 89% female) and ‘late’(n=18, mean 43 years, 72% female) groups were similar in age and sex. Compared to controls, VR was abnormally low in both the ‘early’ and ‘late’ groups (‘early’ 1.5 and ‘late’ 1.4 vs. controls 1.7, both p<0.03) (
Table
). Other autonomic measures did not differ significantly from controls. However, compared to the ’early’ group, the ‘late’ group exhibited a trend toward more marked AD (
Figure
).

Conclusion:
Patients presenting ‘early’ and ‘late’ after an acute COVID-19 illness exhibit similar severity of autonomic disturbance. Potentially, the ‘late’ group experienced more severe COVID illness leading to delayed referral for troublesome AD symptoms. Nonetheless, our findings suggest that abnormal CV AD findings may persist without apparent improvement for lengthy periods (up to 20 months in this study) after acute COVID-19 infection.
Abstract 12827: Daylight Savings Time Practice and the Rate of Adverse Cardiovascular Events in the United States: A Probabilistic Assessment in a Large Nationwide Study
Authors: Dikilitas Ozan , Satterfield Benjamin A , Van Houten Holly , Yao Xiaoxi , Gersh Bernard J
Published: December 2023

Introduction:
Previous studies have shown inconsistent changes in the rates of adverse cardiovascular events after daylight savings time (DST) transitions. In this large-scale, U.S.-based nationwide study, we sought to investigate the association of DST transitions with the rates of adverse cardiovascular events.

Methods:
The study cohort included 36,116,951 unique individuals from de-identified administrative claims data of the OptumLabs Data Warehouse®. There were 74,722 total adverse cardiovascular events during the week of DST transition and the control weeks (two weeks prior and after) in spring and autumn of 2015-2019. We used Bayesian hierarchical Poisson regression models to estimate the event rate ratios (ERR) representing the ratio of composite adverse cardiovascular event rates (acute myocardial infarction, stroke, cardiogenic shock, cardiac arrest, and sudden death) between DST transition weeks and control weeks.

Results:
Our results showed an average increase of 3% [95% uncertainty interval; -3% to 10%] and 4% [-2% to 12%] in the rate of adverse cardiovascular events during Monday and Friday of the spring DST transition week, respectively. The probability of spring DST transition being associated with a moderate-to-large increase in the event rates (ERR>1.10) was estimated to be <6% for Monday and Friday, and <1% for the remaining days. During autumn DST transition, the probability of any decrease in adverse cardiovascular event rates was estimated to be <46% and a moderate-to-large decrease in the event rates to be <4% across all days of the week.

Conclusions:
Spring DST transition week had a suggestive association with a minor increase in adverse cardiovascular event rates on Monday and Friday. The probability of this association to be of clinically meaningful magnitude was estimated to be very low. We did not observe any evidence suggestive of a change in adverse cardiovascular event rates immediately following autumn DST transition. Taken together, our findings, based on a large, diverse cohort from across the United States, suggest that DST transitions are unlikely to significantly impact the rate of cardiovascular events.
Abstract 12849: Assessing Cardiovascular Toxicity in Cancer Treatment: Validation of the Heart Failure Association and International Cardio-Oncology Society Tool Using Prospective Registry Data
Authors: Shibata Tatsuhiro , Nohara Shoichiro , Morikawa Nagisa , Shibao Kodai , Fukumoto Yoshihiro
Published: December 2023

Introduction:
Cancer treatment-related cardiovascular toxicity (CTR-CVT) is a growing concern in patients undergoing anticancer therapy. The Heart Failure Association (HFA) and International Cardio-Oncology Society (ICOS) risk assessment tools have been proposed for the baseline cardiovascular (CV) risk stratification of patients with cancer. This study examined the incidence of adverse CV events associated with cancer treatment in clinical practice, also using the HFA-ICOS risk assessment tool.

Methods:
This single-center, prospective, observational study was conducted at Kurume University Hospital between October 2016 and August 2021 in patients aged ≥20 years with hematologic malignancies or breast cancer who were receiving anticancer agents. CV assessments were performed at enrollment and every 6 months until February 2022, with additional assessments for suspected CV adverse events. The primary endpoint was adverse CV event as defined by Common Terminology Criteria for Adverse Events (CTCAE) v4.0 grade ≥2, and the secondary endpoints were all-cause and CV death.

Results:
Of the enrolled 486 patients, adverse CV events occurred in 24.5% of patients with leukemia, 15.8% of patients with malignant lymphoma, 38.1% of patients with multiple myeloma, and 18.0% of patients with breast cancer, respectively. Kaplan-Meier curves of the primary endpoint and heart failure (HF)/ left ventricular (LV) dysfunction stratified by HFA-ICOS risk assessment group have shown the significant worse events in high/very high-risk group, in which the hazard ratios in the high/very high-risk group compared to the low-risk group were 2.34 (95% CI 1.48-3.71, p<0.001) in the primary endpoint and 3.57 (95% CI 1.70-7.51, p<0.001) in HF/LV dysfunction. There was no significant difference in the event risk between the low- and moderate-risk groups. CV death occurred in 4 patients (0.8 %) during follow-up.

Conclusions:
This study showed that 16-38% of patients with hematologic malignancies and breast cancer developed CTR-CVT during follow-up, in which high/very high-risk patients were well predicted by the HFA-ICOS risk assessment tool. The monitoring and managing CV risk factors are essential for safe cancer therapy.
Abstract 12851: Severe Right and Left-Sided Multi-Valvular Carcinoid Heart Disease Associated With Ovarian Carcinoid Tumor
Authors: Troy Jordan Y , Rashid Sana , Bharucha Ronak , Cimato Thomas R , Fernandez Stanley F
Published: December 2023

Carcinoid tumors are neuroendocrine neoplasms that secrete vasoactive substances, primarily serotonin, and have an incidence of approximately 2 in 100,000 people. Up to 60% of carcinoid tumors result in carcinoid heart disease (CHD), and unlike other carcinoid tumors, ovarian carcinoid tumors can involve the heart without liver metastasis. By bypassing the liver, ovarian carcinoid tumors can result in CHD in the absence of liver metastasis. We present a rare case of a 40-year-old female who presented in cardiogenic shock requiring inotropic support with echocardiographic evidence of preserved left ventricular systolic function (LVEF 50-55%) and multiple retracted leaflets that exhibited poor coaptation resulting in severe mitral regurgitation, torrential tricuspid regurgitation, and moderate-to-severe aortic regurgitation. Her left heart catheterization revealed non-obstructive coronary artery disease. A non-contrast CT torso revealed an isolated large septated left ovarian cystic mass (7.1x5.2 x7.1cm) without any other mass or lesion. In the setting of an elevated CA-125 (536units/mL, normal 0-35units/mL) and 24-hour urinary 5-HIAA (12.1mg, normal 2-9mg) with a normal CEA, CHD was suspected as the most likely diagnosis given the isolated ovarian mass and severe valvular disease. She underwent triple valve surgery in which valvular pathology revealed myxoid degeneration. Her post-operative course was complicated by multi-organ failure requiring multiple inotropes and V-A ECMO shortly thereafter, but the patient unfortunately passed away. While there are a few documented cases of CHD from ovarian carcinoid (less than 0.5% of cases) and left-sided CHD (less than 10% of cases), this is the first documented case, to our knowledge, describing severe right and left-sided CHD associated with a suspected ovarian carcinoid tumor.
Abstract 12866: Increased Left Ventricular Mass Has Greater Association With Fat Free Mass Than Fat Mass in Black and White Females
Authors: Sill Jordan , Woo Jessica G , Urbina Elaine M
Published: December 2023

Introduction:
Increased left ventricular mass (LVM) is a risk factor for adult CV disease and is associated with increased body mass including obesity. The effects of different measures of body composition on LVM in young adulthood are not well described.

Goals/Aims:
Utilizing an existing longitudinal data set of black and white female young adults, we aimed to determine the contribution of various types of body composition measures to increased LVM.

Methods:
Data from the National Growth and Health Study, a study of racial differences in the development of obesity, including dual energy X-ray absorptiometry (DEXA), MRI, and echocardiogram (collected at ages 24-27) were analyzed. Logistic regression was conducted and receiver-operator characteristic (ROC) curves compared to assess the contribution of fat mass by DEXA (FM), fat-free mass by DEXA (FFM), subcutaneous adipose tissue mass by MRI (SAT), and visceral adipose tissue mass by MRI (VAT) towards the development of LVH (defined as LVMI ≥ 38.6 g/m
2.7
). Multiple linear regression analyses were performed to assess for contributions to LVMI.

Results:
550 women were included in the analysis (52.6% Black, mean age 24.9 ± 0.7 years at baseline). Using logistic regression, FM, FFM, SAT, and VAT were significantly associated with LVH (p < 0.0001 for all), adjusting for SBP, DBP, and race. The ROC for FFM is greater than FM, SAT, and VAT (0.849 vs. 0.832, 0.813, and 0.788 respectively). In linear regression, FFM and DBP were significant contributors to LVMI. Black race was a significant predictor of LVH in the visceral fat model. There were no other significant racial differences.

Conclusions:
FFM had the greatest association with LVM, confirming previously published data. While the contribution of FFM towards the development of LVH was greater than that of FM and BP, FM and BP are modifiable risk factors and thus targets for clinical intervention.
Abstract 12874: Risk of Ischemic Heart Disease in Young Women With Dysmenorrhea: A Cross-Sectional Study on Electronic Health Records
Authors: Alleva Eugenia , Shaw Leslee J , Bottinger Erwin P , Kahlil Susan , Rodrigues Jovita , Ensari Ipek
Published: December 2023

Introduction:
Ischemic heart disease (IHD) incidence is increasing among young individuals, particularly women. Suboptimal primary prevention due to risk underestimation is thought to contribute to this trend. Non-traditional risk factors, such as stress and female-specific factors, are often overlooked but offer an opportunity to improve risk stratification. Dysmenorrhea is the most prevalent menstrual complaint, and associated with increased stress and autonomic dysfunction. To date, contribution of dysmenorrhea to cardiovascular disease risk has not been investigated.

Hypothesis:
Dysmenorrhea is associated with increased risk of IHD before 50 years of age.

Methods:
We extracted a cohort of 30,554 women with dysmenorrhea and 25,350 controls from Mount Sinai data warehouse as shown in Fig 1. For statistical analysis we performed full propensity score matching on demographic and clinical covariates, followed by weighted logistic regression with IHD before age 50 as a binary outcome. We then investigated IHD subtypes (angina, acute myocardial infarction (AMI), AMI complications, chronic IHD) in separate regression models, and evaluated the inclusion of menstrual abnormalities (MA) and endometriosis as additional covariates in the models (vs other covariates only).

Results:
Dysmenorrhea was associated with a significant increase in the OR for overall IHD, angina and chronic IHD (Table 1), independently from MA or endometriosis.

Conclusions:
Dysmenorrhea might be an important risk factor for early IHD. The risk appears to be largest for angina and chronic IHD. Further research can investigate dysmenorrhea as a predictor of future IHD risk.
Abstract 12905: Epicardial and Intramyocardial Fat as Predictors of Ventricular Arrhythmia in Ischemic and Non-Ischemic Cardiomyopathy
Authors: Mojarrad Sani Maryam , Sung Eric , Engels Marc , Trayanova Natalia , Wu Katherine C , Chrispin Jonathan
Published: December 2023

Background:
Sudden cardiac death from ventricular arrhythmia (VA) is a global concern. While emerging evidence suggests a role for myocardial fat in the development of VA among ischemic (ICM) and non-ischemic cardiomyopathy (NICM) patients, the volume and distribution of epicardial adipose tissue (EAT) and intramyocardial fat (IMF) linked to VA remain underexplored.

Objective:
To evaluate the predictive value of LV tissue heterogeneity, EAT, and IMF volumes in assessing the risk of VA in ICM and NICM patients.

Methods:
Patients enrolled in the PROSE-ICD registry, who underwent contrast-enhanced computed tomography were included. The designated endpoint was ventricular arrhythmia, defined as appropriate ICD shock or sudden arrhythmic death. IMF volume (voxels between -180 and -5 HU), EAT volume (voxels between -200 to -50 HU), and myocardial fat tissue heterogeneity (defined as the magnitude of change between nearby voxels) were calculated. Logistic regression models were employed to assess the association between explanatory variables and outcome.

Results:
98 patients (47 ICM, 51 NICM) were included with a mean follow up time of 5.6±3.4 years. Participants’ mean age was 56±13.2 years, and 66% were male. LV tissue heterogeneity (per HU/mm) was associated with VA incidence (OR = 1.11; P < 0.01) in the ICM cohort, whereas EAT and IMF volume were associated with VA in the NICM subgroup [(OR = 1.12; P < 0.01), and (OR = 1.21; P = 0.01), respectively]. Even after adjusting for various covariates, LV tissue heterogeneity in the ICM group and EAT in the NICM group maintained a significant association with VA.

Conclusion:
In ICM, increased fat distribution heterogeneity is associated with VA, while in NICM, increased IMF and EAT volume are linked to a higher risk for VA. These findings suggest that LV tissue heterogeneity and EAT volume offer valuable prognostic insights in cardiomyopathy patients, indicating that the contribution of fat to VA depends on the underlying substrate.
Abstract 12926: Characteristics of Tafamidis-Treated Patients With Mixed Phenotype Transthyretin Amyloidosis: A Real-World Study in the Medicare Fee-for-Service Population
Authors: Chung Haechung , Prasad Sapna , Swarup Sameer , Benjumea Darrin , Crowley Aaron , Alvir Jose M , Angeli Franca S , Sounthonevat Cindi
Published: December 2023

Introduction:
Transthyretin amyloidosis (ATTR amyloidosis) is highly heterogeneous, characterized by predominantly cardiac, predominantly neurologic or mixed phenotypes. Diagnosis of mixed phenotype is often delayed, due in part to fragmented care. Research based on administrative claims data has improved knowledge of the disease, but investigation of the mixed phenotype has been limited by deficiencies in ICD diagnosis codes.

Hypothesis:
Proxy algorithms can be used to identify and characterize mixed phenotype ATTR amyloidosis in Medicare patients.

Methods:
This noninterventional, retrospective, observational cohort study was conducted using de-identified patient data from the US Medicare database (Jan 1, 2016-Dec 31, 2021). Based on literature review and clinician consultation, 3 distinct proxy algorithms were developed to select 3 cohorts of tafamidis-treated patients with possible mixed phenotype ATTR amyloidosis (
Figure
). Baseline patient characteristics were analyzed descriptively.

Results:
In 1,243 patients, mean (SD) age ranged from 76.0 (6.3)-79.5 (6.5) y, and 68-83% were men. Comorbidity burden was similar across cohorts (Charlson comorbidity indices: 1.6 [0.9]-1.7 [1.0]). The most common cardiovascular comorbidities were hypertensive diseases, arrhythmia, conduction disorders and LVH; the most common noncardiovascular comorbidities were cataracts, chronic and acute kidney disease, constipation and diabetes (
Table
).

Conclusions:
In this real-world study, proxy algorithms helped identify and characterize mixed phenotype ATTR amyloidosis in Medicare patients. Additional research is needed to further validate these algorithms.
Abstract 12931: Development of Novel Targeted, Membrane-Coated Polymer Hybrid Nanoparticles for Endothelial Repair Following Balloon Angioplasty in Rat Carotid Artery Model
Authors: Ramasubramanian Lalithasri , Bahatyrevich Nataliya , Hao Dake , Pivetti Christopher , Loll Emma G , Paxton Zachary J , Gidda Siraj S , Kumar Priyadarsi , Farmer Diana L , Panitch Alyssa , Wang Aijun
Published: December 2023

Background:
Coronary and peripheral arterial disease remains one of the leading causes of death worldwide. Treatments include balloon angioplasty, stent placement, or bypass grafting, all of which damage the endothelium and increase the risk of thrombosis or intimal hyperplasia. Thus, there is a critical need for rapid reendothelialization following these treatments. Endothelial progenitor cell-derived (EPC) extracellular vesicles (EVs) containing proangiogenic microRNAs, such as miR126, is one of the natural mechanisms of vascular repair. However, the translational application of EVs is limited by low EV yield, functional heterogeneity, and difficult tissue targeting.

Hypothesis:
We hypothesize that EV-inspired hybrid nanoparticles can improve reendothelialization and modification with a specific collagen binding peptide SILY can target vascular injury.

Aims:
(1) Engineer and characterize a SILY modified hybrid EPC membrane coated nanoparticles (SILY-ENPs) containing a miRNA-126-loaded poly-lactic-co-glycolic acid core (miR126-PLGA)
in vitro
. (2) Test the therapeutic efficacy of the SILY-ENPs in an
in vivo
rat carotid balloon angioplasty model.

Methods:
EPC plasma membranes were isolated from umbilical cord blood EPCs and conjugated with SILY using copper-free Click chemistry. Membrane fragments were coextruded with miR126-PLGA to form SILY-ENPs. Particles were characterized
in vitro
for collagen and platelet binding and angiogenic function.
In vivo
function was tested in a rat carotid balloon angioplasty model.

Results:
SILY-ENPs were found to have increased collagen binding and decreased platelet activity. Delivery of miR126 cargo slightly improved pro-angiogenic protein expression and increased rates of reendothelialization. However, SILY-ENPs were found to stimulate hyperplasia as an adverse side-effect.

Conclusions:
SILY-ENPs exhibited target specificity, decreased platelet activity, and increased rates of reendothelialization, but increased intimal hyperplasia. This technology represents a novel EV inspired nanoplatform which can be tailored for treating various diseases by altering the cargo or membrane coating.
Abstract 12961: Heart Failure Redesign Across a Newly Integrated Health System
Authors: Rasmusson Kismet , Miller Jenna , Goss Jeffrey , Alharethi Rami , Husa Ruchika , Lum Corey , Koceja Vicki , Graham Kaley , Springer Jennifer , Ketterling Theresa , Phillips Merrilee , Evans Reuben , Willis Carrie , Longman Susan , Payne Simon
Published: December 2023

Introduction:
Heart Failure (HF) challenges are magnified when healthcare mergers and expansions occur requiring significant integration of operational and clinical effort. With enterprise support, we brought HF teams together from a newly merged system to 'redesign' HF care aiming to provide high level, consistent, evidence-based, patient-centered care in a novel, adaptive model where such roadmaps do not exist.

Hypothesis:
Integrated care across a large network can be patient centered, of high value, with a proper framework.

Methods:
Representatives from 3 distinct, newly aligned regions of Intermountain Health completed a care redesign program aimed to integrate HF services. Current processes, tools, education were evaluated then mapped to identify barriers and most impactful areas to guide redesign.

Results:
Over 6 months, 45 multidisciplinary HF specialists met weekly. Current state was mapped for 9 markets across 3 regions reaching >38,089 patients. Baseline data revealed areas for improvement: readmissions, mortality, advanced care planning, transitions in care. 141 barriers were identified, 39 of high impact, 15 are the primary focus; includes increasing access to stage-based care, implementing a guideline-directed referral pathway and providing market-specific resources. 4 teams built an operating system to support a new HF standard (image). Elements culminated in a consistent care path across the HF Stages for the newly formed enterprise. Implementation is underway; outcomes will be forthcoming.

Conclusion:
Building HF care across a large healthcare organization takes both clinical and operational leadership through shared learning. With a vision and framework this redesigned system aims to increase ease and access while providing high quality, patient-centered, consistent care regardless of location. Attention to high areas of opportunity requires operational prioritization, subject matter expertise, and resource support.
Abstract 13004: Blockade of Endothelial to Mesenchymal Transition (EndMT) by an AP-1 Inhibitor Attenuates Atherosclerosis in Diabetes
Authors: Khan Waheed , Aziz Misbah , Jandeleitdahm Karin A
Published: December 2023

Background:
Atherosclerotic cardiovascular disease is the leading cause of death in individuals with diabetes. Endothelial to mesenchymal transition (EndMT) is characterized by endothelial transformation to a mesenchymal like cellular state. EndMT-mediated endothelial cell dysfunction is known to be involved in cardiovascular complications of diabetes including atherosclerosis. Gene expression changes occur when endothelial cells transition to mesenchymal cells. These transcriptomic changes are regulated by multiple factors including transcription factors (TFs). Although, previous studies have implicated the role of EndMT in atherosclerosis, the role of AP-1 TF complex in EndMT in diabetes induced atherosclerosis is not known.

Methods:
Single cell transcriptomic (SCT) analysis of diabetic aorta in atheroprone Apoe
-/-
mice was performed using 10X Genomics platform.
In vitro
model mimicking diabetes-induced EndMT was established in human aortic endothelial cells (HAECs) using high glucose (25mM) and TNF-
α
± a small molecular inhibitor of AP-1, T-5224. RNA and ChIP (chromatin Immunoprecipitation) sequencing was performed. Moreover, Apoe
-/-
mice made diabetic with streptozotocin, were treated with T-5224 (30 mg/kg daily for 5 weeks) in a 10-week intervention study.

Results:
SCT analysis of aorta identified increased expression of AP-1 members cFOS and Junb in diabetic endothelial cells in Apoe

-/-

mice. These genes were also upregulated in the HAECs-based
in vitro
EndMT model. Interestingly, AP-1 inhibition by T-5224 attenuated EndMT
.
RNA and ChIP sequencing identified several AP-1 target genes including Col1A2, Col4A1, TGFB, THBD, INSR, PIK3R3 (FDR <0.05, Log2 fold change (2x)) that were common to many enriched pathways including “leukocyte trans-endothelial migration” and “AGE-RAGE signaling pathways in diabetic complications” directly relevant to EndMT in diabetes. Importantly, T-5224 treatment blocked EndMT resulting in reduced atherosclerosis in diabetic Apoe

-/-

mice.

Conclusion:
This study identified the AP-1 inhibition with T-5224 as a novel treatment for the first time for the diabetes induced EndMT and atherosclerosis.
Abstract 13012: Impact of End-Stage Renal Disease on Short-Term Outcomes Among Adults Undergoing Percutaneous Mitral Valve Repair
Authors: Dhaliwal Jasninder S , Memon Rahat A , Aggarwal Shruti , Ramphul Kamleshun , Kumar Nomesh , Sakthivel Hemamalini
Published: December 2023

Introduction:
Patients with end-stage renal disease (ESRD) are predisposed to multiple complications following invasive and non-invasive procedures. With the recent introduction of percutaneous mitral valve repair (PMVR), there needs to be more data on ESRD patients' outcomes following such procedures. Our analysis aims to bridge data via national hospitalization records.

Methods:
We used de-identified data of adults(ages 18 and more) undergoing PMVR between 2016-2020 via the National Inpatient Sample. Patients were separated into two groups based on the presence of a diagnosis of ESRD. We excluded all other forms of Chronic kidney disease classifications from our control group. Differences in outcomes were studied via logistic regression models.

Results:
Between 2016-2020, a total of 24680 procedures of PMVR were performed in the United States that met our selection criteria. Among them, 1655 (6.7%) patients were reported with a diagnosis of ESRD, while 23025 (93.3%) were without any diagnosis of CKD or ESRD. Patients with ESRD consisted of a younger cohort (mean age 68.68 years) compared to the non-ESRD group (mean age 77.39 years, p<0.01). Furthermore, the ESRD group showed a higher mean Charlson Comorbidity Index Score (CCI) score (6.47) compared to the non-ESRD group (score of 2.20). Most procedures were conducted in Urban teaching centers (90.4% of non-ESRD patients and 93.4% of ESRD patients). ESRD patients recorded higher odds of sepsis (aOR 1.747, 95% CI 1.191-2.560, p<0.01), major bleeding (aOR 8.316, 95% CI 7.336-9.426, p<0.01), postprocedural respiratory failure (aOR 2.531, 95% CI 1.441-4.445, p<0.01), and mortality (aOR 2.109, 95% CI 1.513-2.940, p<0.01). The two groups showed no differences in acute myocardial infarction events (aOR 1.235, 95% CI 0.899-1.697, p=0.193) during their hospitalization for the procedure.

Conclusions:
Patients with ESRD experienced poorer outcomes following PMVR as they had higher odds of mortality, postprocedural respiratory failure, major bleeding, and sepsis. Thus, physicians must adequately address the potential complications with and without the procedure and closely monitor the post-operative progress.
Abstract 13031: Real World Outcomes of Prognostic Value of Platelet Function Testing for Five-Year Ischemic Events in Patients Undergoing Percutaneous Coronary Intervention: A Large-Scale Cohort Study
Authors: Li Yulong , Li Jiawen , Yan Kailun , Yang Yuejin , Yuan Jinqing , Zhao Xueyan
Published: December 2023

Introduction:
Individualized antithrombotic therapy guided by platelet function testing is a hot topic in current study. However, the prognostic value of platelet function testing for long-term ischemic events in percutaneous coronary intervention (PCI) population is still unknown.

Objective:
To investigate whether platelet function testing (reflected by adenosine diphosphate-induced platelet maximum amplitude [MA
ADP
] based on thromboelastogram) is associated with five-year ischemic events in patients undergoing PCI.

Methods:
10,724 consecutive patients undergoing PCI in 2013 were enrolled. The traditional cut-off point of MA
ADP
(47) and the optimal cut-off point of MA
ADP
(41.8) according to receiver operating curve were selected. The primary endpoint was cardiovascular death. The secondary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE), including death, myocardial infarction, ischemic revascularization, and stroke.

Results:
A total of 6,290 patients (mean age, 58.27 ± 10.30; male, 77.5%) who had both MA
ADP
results and completed follow-up were finally included. After five-year follow-up, 143 (2.3%) cardiovascular death and 1,410 (22.4%) MACCE occurred. According to the traditional cut-off point, multivariate COX regression analysis (Figure 1) showed no prognostic value of MA
ADP
for both cardiovascular death and MACCE (all
P
>0.05). As for the optimal cut-off point, multivariate COX regression analysis (Figure 2) showed that MA
ADP
≥ 41.8 was independently associated with cardiovascular death (HR=1.484, 95% CI: 1.043-2.111,
P
=0.028) and MACCE (HR=1.138, 95% CI: 1.018-1.272,
P
=0.023).

Conclusions:
Our study is the first to report that platelet function testing can help identify individuals at high risk of long-term ischemic events. We proposed a new cut-off point of MA
ADP
to assess the prognosis of ischemic events, and demonstrated that MA
ADP
≥ 41.8 was associated with five-year cardiovascular death and MACCE.
Abstract 13051: Profiling CD8+ T Cell Activation in Experimental Models With LDL-R Deficiency and in Patients With Familial Hypercholesteroleamia
Authors: Norata Giuseppe Danilo , Moregola Annalisa , Bonacina Fabrizia
Published: December 2023

Introduction and Hypothesis:
Familial Hypercholesterolaemia (FH) is a rare genetic disease characterized by elevated plasma cholesterol levels, xanthomas, overt atherosclerosis and premature cardiovascular death. HoFH and severe HeFH present an elevated inflammatory burden and poorly responsive to therapeutics such as anti-PCSK9 monoclonal antibodies. Therefore, innovative approaches to diagnose the severity of the disease and control the over-activation of the immune-inflammatory response in the arterial wall of FH patients should be studied to improve the management of this genetic disease. Here we profiled the activation of CD8+ T lymphocytes from experimental models and with patients with clinical diagnosis of FH.

Methods:
Immunophenotypic characterization of T cells from WT and LDLR KO mice was performed in vitro and in vivo coupled to proteomics and WB analysis on isolated T cells. CD8 T cell response in FH patients, carrying mutations in the LDLR gene, was profiled.

Results:
LDLR mRNA expression increased after in vitro activation of CD8, but not CD4 T cells, suggesting a different regulation of cholesterol homeostasis between T cell subsets. LDLR deficiency mainly affected CD8 T cell activation as demonstrated by reduced in vitro and in vivo proliferation and cytokine production after ovalbumin vaccination of LDL-R KO T cells compared to their wild type counterpart. The addition of LDL to serum free media increased CD8 proliferation in WT but not in KO CD8 T cells. Proteomic and WB analysis showed that this phenotype is the consequence of reduced mTORC1 activation and impaired lysosomal organization. The proliferation of CD8 T cells from FH patients was less pronounced compared to sex- and age-matched controls. In addition, CD8 T cells from FH vaccinated for seasonal influenza were tested in vitro with virus-derived peptides, showing a decreased granzyme production compared to CD8 from vaccinated controls.

Conclusions:
LDLR plays a critical role in regulating the immunometabolic reprogramming of activated CD8 T cells by fuelling the cholesterol-lysosome-mTORC1 axis.
Acknowledgments:
This study is supported by a Grant from the Italian Ministry of Health: RF-2019-12370896
Abstract 13072: Safety and Efficacy of Lead Extraction at Time of Device Upgrade
Authors: Power John R , Patel Kavisha , Jacobs Kathleen , Pollema Travis , Ho Gordon , Birgersdotter-Green Ulrika
Published: December 2023

Introduction:
Patients with permanent pacemakers may require upgrade to ICD or CRT but there is no consensus on whether unused leads should be abandoned or extracted. Transvenous lead extraction (TLE) adds potential risk and can be complex in cases of complete venous occlusion. The safety and efficacy of TLE as a strategy to upgrade pacemakers has not been systematically explored and the impact of venous occlusion is unknown.

Aims:
1) Characterize the success and safety of TLE for the indication of pacemaker upgrade to ICD or CRT 2) Assess the effect of complete venous occlusion on outcomes

Methods:
A total of 50 patients underwent TLE for the sole indication of pacemaker upgrade at UCSD from January 2018 to January 2023. All patients completed preoperative cardiac TLE CT. In-hospital outcomes and procedural variables were collected by chart review. Association with venous occlusion was analyzed using McNemar and t-tests.

Results:
All 50/50 (100%) patients had successful TLE and successful device upgrade with CRT-D in 44/50 (88%) patients and DC-ICD in 6/50 (12%) patients. No complications occurred (conversion to open extraction, injury, tamponade). Preoperative CT showed complete venous occlusion in 14/50 (28.0%) patients. Median lead extraction fluoroscopy time was 6.0 minutes (IQR: 3.7-8.5). Laser extraction was required in 48/50 patients (96%), laser sheath upsizing in 4/50 (8.0%), conversion to mechanical sheath in 7/50 (14.0%), and telescoping sheaths in 1/50 (2.0%). Venous occlusion was not associated with different baseline characteristics, TLE techniques, or fluoroscopy time (Table 1).

Conclusions:
TLE in combination with pacemaker upgrade had excellent procedural success. Preoperative CT identified complete venous occlusion in 28% of patients, but this was not associated with technical difficulty, procedural success, or clinical outcomes. Further studies are required to assess the long-term impact of this lead management strategy.
Abstract 13074: Incremental Value of Abnormal Quantitative Myocardial Perfusion and Myocardial Infarction Using Cardiovascular Magnetic Resonance as Prognostic Markers in Type 2 Diabetes Mellitus
Authors: Sharrack Noor , Knott Kristopher D , Yeo Jian L , Kotecha Tushar , Brown Louise A , Porcari Aldostefano , Adam Robert D , Gulsin Gaurav , Thirunavukarasu Sharmaine , Chowdhary Amrit , Levelt Eylem , Moon James , McCann Gerry , Fontana Marianna , Kellman Peter , Munyombwe Theresa , Gale Chris P , Buckley David L , Swoboda Peter P , GREENWOOD John , Plein Sven
Published: December 2023

Introduction:
Abnormal myocardial perfusion and MI are each associated with cardiovascular events in individuals with diabetes mellitus (DM).

Hypothesis:
We hypothesised that, in patients with T2DM, CMR determined quantitative myocardial perfusion and MI are independent predictors of major adverse cardiovascular and cerebrovascular events (MACCE) and that the presence of both offers incremental prognostic value.

Methods:
A prospective multicentre cohort of individuals with T2DM and healthy controls underwent stress CMR with inline quantitative myocardial perfusion and late gadolinium enhancement (LGE). Adjusted cox proportional hazard models (adjusted for age, sex, LVEF, LV end diastolic volume (LVEDV) and LV mass quantified associations between quantitative myocardial perfusion and MI with MACCE (composite of all-cause death, MI, stroke, heart failure hospitalisation and coronary revascularisation).

Results:
A total of 572 participants with T2DM from four centres and 52 healthy controls were followed for a median of 851 (IQR 765-935) days, during which 82 (14%) participants accrued at least one MACCE, including 25 (4%) deaths. Presence of either CMR pathology was associated with increased MACCE (normal quantitative myocardial perfusion and no MI: 7% MACCE; abnormal quantitative myocardial perfusion or MI: 13% MACCE (adjusted HR compared with normal 2.06 (95% CI 1.07-3.97, p=0.03)); and both abnormal quantitative myocardial perfusion and MI was associated with the highest event rate: 28% MACCE (adjusted HR compared with normal quantitative myocardial perfusion and no MI 4.55 (95% CI 2.32-8.90, p<0.001)).

Conclusion:
In individuals with T2DM, the presence of either abnormal quantitative myocardial perfusion or MI is associated with MACCE and the presence of both offers strong incremental prognostic value.
Abstract 131: Sex-Based Differences in the Extracorporeal Cardiopulmonary Resuscitation Population for Out-of-Hospital Cardiac Arrest in the Minneapolis Metro Area
Authors: Dahiya Garima , Chahine Johnny , Gaisendrees Christopher , Jaeger Deborah C , Bartos Jason , Chiang Caleb , Gutierrez Alejandra , Hodgson Lucinda , Yannopoulos Demetris , Elliott Andrea M
Published: December 2023

Background:
Women constitute nearly 40% of out-of-hospital cardiac arrests (OHCA), receive less bystander CPR, and guideline-directed interventions such as post-arrest coronary angiography.

Aims:
To identify the presence of sex-based differences in utilization of extracorporeal cardiopulmonary resuscitation (ECPR) for refractory OHCA in the Minneapolis (MSP) metro area.

Methods:
Patients who met all eligibility criteria for the Minnesota Resuscitation Consortium (MRC) ECPR protocol between 2013-2021 were identified in the Cardiac Arrest Registry to Enhance Survival (CARES) registry. Patients who presented to the University of Minnesota (UMN) for the MRC ECPR protocol between 2014-2021 were identified. Arrest data, patient characteristics and mortality were compared between the sexes in both populations.

Results:
We identified 2790 OHCA patients through the CARES registry of whom 685 (24.6%) were women. There were 443 referrals to UMN for ECPR, of whom 87 (19.6%) were women. There were significantly more eligible women who arrested than those referred for ECPR (p =0.02). In the MSP metro area, women were more likely to suffer cardiac arrest at home (59% vs 66%, p<0.01), less likely to receive bystander CPR (42% vs 35%, p<0.01) and have greater time to professional CPR (6.3 vs 5.4 minutes, p<0.01). Among referrals for MRC ECPR protocol, there were no differences in arrest characteristics or age between men and women. Multivariate analysis for neurologically favorable survival showed female sex was associated with decreased survival in the community (p=0.03), but trended towards increased survival in the UMN ECPR cohort (p=0.08) (Figure 1).

Conclusion:
Women suffering from cardiac arrest have higher mortality and are less likely to be referred for ECPR. However, after referral for ECPR, sex is not associated with survival. Pre-hospital factors result in fewer women referred for ECPR and warrant further investigation to identify potential interventions.
Abstract 13116: Profiling the Role of Gut Microbiota-Derived Trimethylamine-
N
-Oxide in Cardiac Fibrosis — Evidence From a Primary Human in vitro Model
Authors: Agbaedeng Thomas A , Rao Sushma , Snel Marten , Noubiap Jean Jacques
Published: December 2023

Introduction:
The gut derived trimethylamine-
N
-oxide (TMAO) is correlated with increased atrial inflammation and fibrosis and associated with atrial fibrillation, heart failure, and stroke. However, the mechanisms mediating these links remain unresolved.

Hypothesis:
TMAO and its precursor metabolite L-carnitine (LCART) induce the transformation of atrial fibroblasts into pro-fibrotic phenotypes.

Aim:
To characterise the association between TMAO and cardiac fibrosis.

Methods:
Primary human cardiac (atrial) fibroblasts (hCFs) were sourced from healthy donors. hCFs were starved for 24 h and treated with PBS (control), 20 ng/mL transforming growth factor beta 1 (TGFβ1), 10 mM TMAO, or 1.0 mM LCART for 72 h (n=6 in each), then analysed by flow cytometry for α-smooth muscle actin (αSMA) expression. Unbiased proteomics was performed using LC-MS/MS to determine protein expression profile.

Results:
Analysis of αSMA expression revealed 3 hCF states: quiescent (Fbs), quiescent-to-myofibroblast (intermediate [Fbs-myoFbs]), and fully activated myofibroblast (myoFbs), (Fig-A). Compared to controls, there was no difference in the intermediate state after TGFβ1, TMAO, or LCART treatment (p=0.30). TMAO and LCART resulted in a significant induction of myofibroblast states compared to controls and TGFβ1 group. Unbiased proteomics identified 92, 65, and 43 proteins to be overexpressed and 84, 46, and 78 proteins downregulated following TGFβ1, TMAO, and LCART treatments (Fig-B). Both TGFβ1 and TMAO demonstrated shared enrichment for oxidative stress-regulated ferroptosis pathway (fold enrichment [FE] 31.8 and 22.2, p <.01 and 0.03); LCART showed enrichment for cell motility (FE 3.8, p=0.03).

Conclusions:
TMAO and its precursor L-carnitine are associated with activation of pro-fibrotic states, which may be due to oxidative stress and abnormal cell migration related mechanisms.
Abstract 13169: Different 90-day Readmission Outcomes Among Cardiogenic Shock Survivors Based on Their Index Hospitalization Etiology
Authors: Li Boyangzi , Wu Lingling , Olarte Neal , Alfonso Carlos , Katz Jason N , Jentzer Jacob C
Published: December 2023

Background:
Up to 70% of patients with cardiogenic shock (CS) will survive hospitalization, yet studies on the outcomes of CS survivors are scarce.

Hypothesis:
We hypothesized that CS survivors would be at high risk of rehospitalization, particularly CS without acute myocardial infarction (AMI) who may have chronic heart failure (HF).

Methods:
We used the Nationwide Readmissions Database (NRD) to examine adult patients who were discharged alive after an index CS admission from 2016-2019. We compared demographic and clinical features during the index admission and the readmission mortality rate between the AMI-CS versus non-AMI-CS groups. We analyzed the cumulative hazard for all-cause readmission within 90 days after index hospitalization using Kaplan-Meier curves.

Results:
We included 134,793 survivors of CS hospitalization from 2016 to 2019 who were discharged to home or a long-term facility, including 43.9% with AMI-CS and 56.1% with non-AMI-CS. The demographics and clinical features differed between the AMI-CS and non-AMI-CS groups, with more HF and non-cardiac comorbidities in the non-AMI-CS group. The non-AMI-CS patients were more likely to be readmitted after discharge, with a higher 90-day readmission rate compared to the AMI-CS group (31.6% vs 25.9%, p <0.001; Figure). During the readmission, the non-AMI-CS group had a higher rate of repeat CS presentation compared to the AMI-CS group (8.9% vs.. 6.1%, p < 0.001). In-hospital mortality during readmission was higher in the non-AMI-CS group (8.6% vs.7.2%, p < 0.001).

Conclusions:
Nearly one-third of CS survivors require readmission within 90 days after their index hospitalization. Non-AMI-CS patients have a higher re-admission rate after their index hospitalization and worse outcomes during readmission. This analysis identifies an unmet need and an important opportunity to improve long-term outcomes for CS survivors.