bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 13163: Clonal Hematopoiesis Risk Score is Associated With All-Cause and Cardiovascular Mortality in Older Adults: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Saadatagah Seyedmohammad , Uddin Md Mesbah , Weeks Lachelle D , Niroula Abhishek , Ru Meng , Takahashi Koichi , Bradley Steven , Yu Bing , Bick Alexander G , Ebert Benjamin L , Platz Elizabeth A , Natarajan Pradeep , Ballantyne Christie M
Published: December 2023

Introduction:
Clonal hematopoiesis of indeterminate potential (CHIP) is common in older adults, but the prognostic significance is unknown. We studied the prevalence of CHIP and its mortality in older adults and investigated whether the CHIP risk score (CHRS) -tool to predict hematologic malignancies (HM)- is associated with mortality in this population.

Method:
In ARIC cohort, CHIP was identified using exome sequencing, and CHRS scores were calculated using demographic, blood parameters, and molecular features. Individuals with CHIP were categorized into low- (CHRS≤9.5), intermediate- (9.5<CHRS<12.5), and high-risk (CHRS ≥12.5) groups. The primary outcome was all-cause death, and secondary outcomes were death from HM and cardiovascular disease (CVD).

Results:
In 3871 participants without a history of HM (aged 75.7 ± 5.2 years, 58.5% female, 23.1% Black), we identified 938 (24.2%) with CHIP, of whom 562 (59.9%) were low risk, 318 (33.9%) intermediate risk, and 58 (6.2%) high risk by the CHRS. During a median follow-up of 7.13 years, 570 (19.4%) deaths occurred in participants without CHIP and 128 (22.8%), 93 (29.2%), and 33 (56.9%), in the CHRS groups, respectively. Using multivariable competing risk regression, the hazard ratio HR (95% confidence interval) for all-cause mortality was 1.09 (0.90-1.32,
P
= 0.35), 1.13 (0.90-1.42,
P
= 0.29), 2.57 (1.75-3.77,
P
<0.001), for low-, intermediate-, and high-risk CHIP, respectively. (
Fig. 1A
) Compared to those without CHIP, in the high-risk CHIP, the HR of death from HM (6 deaths of 58, 10.3%) was 25.92 (8.04-83.57,
P
<0.001) and from CVD (12 of 58, 20.7%) was 2.97 (1.59-5.53,
P
<0.001). (
Fig. 1B
).

Conclusions:
CHIP can be identified in one-fourth of older adults, and most were low-risk and had the same survival. However, individuals with high-risk CHIP face not only an elevated risk of death from HM but also a threefold higher risk of death from CVD. The latter was the most common cause of death in this group. Funding: NHLBI, NCI, NPCR
Abstract 13186: Factors Associated With Dysglycemia and Type 2 Diabetes Mellitus Onset in Familial Hypercholesterolemia
Authors: Maia Flavia C , Miname Marcio H , Maia Kleisson A , Chacra Ana P , Rocha Viviane Z , Mizuta Marjorie , Jannes Cinthia Elim , Krieger Jose E , Pereira Alexandre , Santos Raul D
Published: December 2023

Introduction:
Familial hypercholesterolemia (FH) is an autosomal dominant monogenic disorder characterized by high blood LDL-C and cardiovascular disease (CVD). Type 2 diabetes mellitus (T2DM) is an independent cause of CVD and there is evidence that FH is associated with a lower frequency of its development. On the other hand, lipid lowering therapy (LLT) may increase T2DM risk.

Goals:
Evaluate the risk of dysglycemia and T2DM development in a cohort of molecularly proven FH individuals.

Methods:
This is a prospective analysis of a population enrolled on a genetic cascade screening program evaluated from March 2011 to January 2022. FH diagnosis was confirmed by molecular testing of variants in
LDLR, APOB and PCSK9.
Dysglycemia and T2DM diagnoses were done according to the ADA Criteria or use of any antidiabetic drugs.

Results:
790 FH patients were included (age 45.5±15.0 years, 56.8% female, baseline LDL-C 198±74 mg/dL), 96.6% had
LDLR
variants. The prevalence of T2DM was 13.3% and 67.4% were taking LLT at baseline . There were 206 (26%) new cases of T2DM or dysglycemia after a median 51-month follow-up . In multivariate Cox regression analysis age (HR:1.026, CI95%: 1.014-1.038, p=0.000) , body mass index (HR: 1.062, CI95%: 1.035-1.090, p=0.000) and current smoking (HR: 2.005, HR: 1.337-3.008, p=0.001) were independently associated with T2DM and dysglycemia, while metformin use was associated with a lower risk (HR: 0.147, CI95%: 0.076-0.284, p=0.000). History of previous CVD, use of lipid lowering therapy at baseline, high intensity LLT , or type of molecular defect were not associated with higher T2DM/dysglycemia risk.

Conclusions:
In this cohort of molecularly proven FH subjects, T2DM affected more than 1 in 10 people at baseline. Previous CVD and classical risk factors but neither molecular defects nor lipid lowering therapy were associated with T2DM/dysglycemia onset.
Abstract 132: The Effect of Social Determinants on Cardiac Arrest and Pre-Arrest Care Patterns
Authors: Dillan Meghan , Curtis Kristen , Wilson Lance D , Piktel Joseph S
Published: December 2023

Background:
More than 300,000 people experience out-of-hospital cardiac arrest (OHCA) and only 11% of patients survive to discharge, calling for a focus on prevention. Understanding the impact of social determinants of health (SDOH) on OHCA, including access to care pre-cardiac arrest (CA) can improve outcomes.

Aims:
To 1) determine the incidence of CA in a large national database across demographics and 2) characterize the CA patient population’s access to care pre-arrest based on SDOH.

Hypothesis:
SDOH will have a significant effect on CA incidence and access to pre-arrest care.

Methods:
Observational retrospective cohort study using Epic Cosmos, a large deidentified electronic health database with 186 million patients. IRB approval was not required. Inclusion criteria was ED visit for CA (ICD-10-CM: I46). Patient demographics included age, gender, race, ethnicity, social vulnerability index (SVI, a composite measure with greater SVI representing more adverse SDOH). The primary outcome was CA incidence between demographic groups, reported as odds ratios (ORs). The secondary outcome was incidence of prior visits within 30 days within each demographic group. Significance was determined using Chi-squared analysis.

Results:
There were 201,846 ED visits for CA between April 20, 2020, and April 19, 2023 (0.11% incidence). For all ages, the odds of CA were greater in the highest SVI quartile compared to the lowest (OR 1.84, p<0.001). Black patients had higher odds of CA than White patients (OR 1.65, p<0.001). In the cohort of patients with an ED visit for cardiac arrest, 9.1% had a prior ED visit within 30 days, and 9.1% and 6.0% had an office or specialty care visit, respectively. Patients with a higher SVI had a greater incidence of ED visits (10.2% vs. 7.8%, p<0.001), but a lower incidence of office visits (8.1% vs. 9.9%, p<0.001) and specialty visits (5.2% vs. 6.8%, p<0.001) pre-arrest. Similarly, Black patients had more ED visits (11.6% vs. 8.6%, p<0.001) than White patients, but less office visits (8.5% vs. 9.8%, p<0.001) and specialty visits (5.6% vs. 6.5%, p<0.001).

Conclusions:
The SDOH have a significant impact on the risk of CA and s pre-arrest care patterns. Targeting interventions to address community and individual SDOH can lead to prevention of OHCA.
Abstract 13220: Independent Effects of Baseline Pulse Wave Velocity versus Advancing Age on Changes in Arterial Stiffness Over Time
Authors: Basker Gayathri , Thangaraja Keerthana , Gao Fei , Tan Ru S , Lee Gina S , Cheng Charmaine , Ewe See H , Teo Loon Yee , Koh Angela S
Published: December 2023

Introduction:
While arterial stiffness (AS) is a known marker of vascular ageing that prognosticates cardiovascular disease (CVD), prospective analyses of AS evolution alongside chronological age are necessary to understand factors that drive progressive AS. Using pulse wave velocity (PWV) we investigated the impact of baseline factors in predicting PWV changes over a 5-year period.

Hypothesis:
We hypothesized that certain baseline factors in older Asian adults are predictive of PWV trajectories later in life independent of chronological age.

Methods:
Participants without CVD from a community-based cohort had their clinical risk factors collected prospectively, and PWV (m/s) measured using a cuff-based oscillometric pulse wave analysis machine at baseline and 5-year timepoint.

Results:
This analysis included 159 participants (41.5% women, mean age 67.7 ± 10.2 years). ΔPWV (2.19 ± 2.25), the 5-year change in PWV, was associated with baseline PWV (β = -0.687, p < 0.001), age (β = 0.084, p < 0.001), hypertension (β=0.763, p = 0.033), weight (β = -0.042, p = 0.018) and waist circumference (β = -0.045, p = 0.018). Gender, body mass index, dyslipidemia, diabetes mellitus and lifetime smoking status were not significantly associated with ΔPWV. ΔPWV was independently associated with baseline PWV (β = -1.17, 95% CI -1.65 - -0.70, p < 0.001) and age (β = 0.144, 95% CI 0.09 - 0.20, p < 0.001) adjusting for weight, waist circumference and hypertension, with insignificant interaction between baseline PWV and age (p = 0.431). Participants with increases in PWV after 5 years, compared to those without PWV increase, had lower PWV (8.52 ± 1.81 vs 11.10 ± 2.44) at baseline.

Conclusions:
Baseline PWV was associated with changes in AS over a 5-year period independent of age and clinical risk factors. The inverse relationship between baseline PWV and ΔPWV may suggest plateauing of PWV increases at higher baseline PWV levels. In addition, high baseline PWV may not predict worsening of AS later in life.
Abstract 13255: Cardiac and Generalized
SGLT2
Deficiency Does Not Protect Against Development of Heart Failure With Reduced Ejection Fraction in Mice
Authors: Berger Justin H , Matsuura Timothy R , Bowman-Cornelius Caitlyn , Lai Ling , Leone Teresa , Patel Jiten , Callaway Russell , Arany Zoltan , Kelly Daniel P
Published: December 2023

Sodium-glucose cotransporter 2 inhibitors (SGLT2i), originally designed for the treatment of diabetes, exert profound cardiovascular benefit and are now the standard-of-care in all forms of heart failure (HF). The mechanism of their benefit in HF is unknown. We hypothesized SGLT2i act via an on-target, extra-cardiac mechanism to promote ketosis and improve myocardial energetics. Generalized- (gKO) and cardiac-specific (csKO) SGLT2 knockout mice were generated by breeding SGLT2 floxed mice with EIIa or αMHC Cre recombinase lines, respectively. While csKO grew and developed normally, gKO mice were slightly smaller compared to WT littermates. There was no baseline cardiac phenotype in either group. The gKO mice exhibited profound glucosuria, decreased fasting serum glucose and augmented fasting ketosis compared to controls, and comparable in magnitude to the metabolic effects of 14 days of treatment with empagliflozin (Empa, 50mg/kg/day orally) in WT mice. Targeted metabolomic analysis of gKO and Empa-treated WT mice identified increased circulating and myocardial levels of the ketone body 3-hydroxybutyrate (1.9-2.3x, p<0.01), along with an increase in a subset of tricarboxylic acid cycle intermediates and C4-OH, a ketone oxidation by-product. Empa treatment in WT mice following trans-aortic constriction with apical myocardial infarction (TAC/MI) improved LV dysfunction and pathological remodeling at 6 weeks (left ventricular ejection fraction (EF) 36±6 vs 28±9, p<0.03; tibia length-normalized biventricular weight 9.6±0.4 vs 11.3±1.6, p<0.001). In contrast, csKO and gKO mice subjected to TAC/MI had no difference in EF, strain, ventricular hypertrophy or dilation compared to WT controls. In conclusion, generalized SGLT2 deficiency phenocopies the metabolic effects of SGLT2i treatment but neither gKO nor csKO afford cardiac protection in an established HF model. These results suggest an off-target mechanism for beneficial effects of SGLT2i in HF.
Abstract 13259: Large-Scale Plasma Proteomics Identifies C1QTNF1 as a Potential Causal Risk Factor for Aortic Stenosis
Authors: Shelbaya Khaled A , Lamberson Victoria , Yang Yimin , Dorbala Pranav , Buckley Leo , Claggett Brian , Skali Hicham , Dufresne Line , Engert Jamie C , Yang Ta-Yu , Thanassoulis George , Floyd James S , Austin Thomas , Bortnick Anna E , Kizer Jorge R , Costade Freitas Renata Caroline C , Singh Sasha A , Aikawa Elena , Ballantyne Christie M , Hoogeveen Ron C , Yu Bing , Coresh Josef , Matsushita Kuni , Shah Amil M
Published: December 2023

Background:
Despite the increasing prevalence of aortic stenosis (AS) and associated morbidity, limited data exist regarding circulating risk factors for AS development.

Methods:
Among Atherosclerosis Risk in Communities study participants with available proteomics (Somascan v4) at study Visit 5 (2011-13; n=4,899; age 76 ± 5 years, 57% women), we used multivariable linear regression to evaluate the association of 4,877 plasma proteins with peak aortic valve (AV) velocity and AV dimensionless index. We then tested their associations, when assessed at study Visit 3 (1993-95; n=11,430; age 60 ± 6, 54% women), with incident AV-related hospitalization post Visit 3 (median follow-up 22, IQR 14 - 25 years) using multivariable Cox PH regression. For the resulting candidate proteins, we tested associations with incident adjudicated AS in the Cardiovascular Health study (CHS) and assessed for potentially causal effects on AS and AV peak velocity using two sample Mendelian Randomization (MR). pQTLs were obtained from 3 previously published European studies, summary statistics for AS from the recently completed TARGET GWAS, and summary statistics for AV peak velocity from an ARIC GWAS.

Results:
We identified 52 plasma proteins with consistent associations with AV peak velocity, AV dimensionless index, and incident AV hospitalization. Of these 52 proteins, genetic instrumental variables (IVs) for MR analysis were available for 42. After multiple testing correction, a multi-SNP IV for C1QTNF1 demonstrated a potential causal effect on AS, such that higher genetically determined levels of C1QTNF1 associated with greater odds of AS. That same multi-SNP IV also demonstrated concordant MR association with peak AV velocity. C1QTNF1 was also associated with AS events in CHS (Figure).

Conclusion:
Large-scale proteomics in a longitudinal community-based cohort identifies C1QTNF1, an adiponectin paralog associated with inflammation, as a potential novel risk factor for AS.
Abstract 13300: Recovery From Acute Cardiac Events in Lower-Socioeconomic Status Patients: Physical and Psychological Outcomes Over Time
Authors: Gaalema Diann , Khadanga Sherrie , Savage Patrick , Katz Brian , Middleton William , Higgins Stephen , Ades Philip
Published: December 2023

Introduction:
Participation in cardiac rehabilitation (CR) reduces morbidity, and mortality, while improving quality of life following major cardiovascular events. Patients with lower-socioeconomic status (SES), such as those enrolled in Medicaid, are much less likely to attend and complete CR, despite being at increased risk for recurrent cardiovascular events.

Methods:
A secondary analysis was performed on a randomized controlled trial in which 130 individuals enrolled in Medicaid, with a CR-qualifying cardiac event, were randomized 1:1 to receive financial incentives for completing CR sessions or to usual care. Participants were assessed on clinical and cognitive outcomes soon after discharge as well as at 4 months, and 1 year following entry. The current analyses focused on how outcomes changed over the three timepoints. Outcomes included changes in psychological measurements (depressive/anxious symptoms, quality of life), body composition (waist circumference, body mass index), and fitness (peak VO2/METS). Mixed model repeated measures analyses of variance were used to test for main effects while controlling for sex, smoking status, age, and qualifying diagnosis.

Results:
Lower-SES patients entering CR had remarkably low levels of fitness and high rates of psychological issues. Fitness improved between intake and 4-months, and gains were maintained through one year (p<0.001) (Table 1) however gains were less in females and those who completed fewer sessions of CR. Body composition measurements significantly worsened between 4-months and 1-year (p<0.03). Psychological measures did not improve in the year following the event.

Conclusion:
While fitness improved in lower-SES patients, especially among those who completed more sessions of CR, psychological symptoms were elevated and did not improve. Future research should seek to understand how we can better serve this population, especially in the area of psych symptoms.
Abstract 13306: Substantial Variation in the Rate of Coronary Artery Disease Among Ontario Immigrants
Authors: Nouraei Hirmand , Qiu Feng , Porter Joan , Madan Mina , Wijeysundera Harindra C , Shah Baiju , Sud Maneesh , Abdel-Qadir Husam M , Haldenby Olivia , Ko Dennis T
Published: December 2023

Immigrants constitute a substantial proportion of the population in Western Europe and North America. Although prior studies have suggested that a "healthy immigrant effect" exists, little is known about the extent and variation of stable obstructive coronary artery disease (CAD) among immigrants. We evaluated the association of country of origin and the rates of stable CAD among immigrants. We assembled a cohort of immigrants and non-immigrants who received elective cardiac catheterization in Ontario, Canada, between April 1, 2012 and March 31, 2021. Immigrants were categorized by their country of origin into 7 regions: Africa, Caribbean, Latin America, Western Countries, East Asia, South Asia, and Middle East. Our main outcome was the rate of obstructive CAD (left main stenosis ≥50% or major epicardial vessel stenosis ≥70%). Multivariable logistic regression analyses adjusting for age, cardiac risk factors, and socioeconomic status was used to study the association of country of birth with presence of CAD. The study included 208,363 non-immigrants and 36,139 immigrants: 13,503 from South Asia, 6,839 from Western Countries, 5,036 from East Asia, 4,374 from the Middle East, 2,481 from Latin America, 2,320 from Caribbean, and 1,586 from Africa. Obstructive CAD was found in 47.1% of immigrants and 47.4% of non-immigrants. Immigrants from South Asia had the highest rate of obstructive CAD at 53.7% and those from the Caribbean had the lowest rate at 32.5%. South Asian men and women had the highest odds of obstructive CAD compared to non-immigrants (Figure). Despite the conventional belief that immigrants have better health status, we found that immigrants in Canada had higher odds of obstructive CAD than non-immigrants. In addition, significant variation exists among patients by country of origin even after accounting for the traditional cardiac risk factors.
Abstract 13310:
TTN
Variants and Arrhythmic Risk Among Countywide Sudden Deaths: From the San Francisco Postmortem Systematic Investigation of Sudden Cardiac Death Study
Authors: Yee Matthew , Eik David , Kinkead Brielle , Wojciak Julianne , Devine W. Patrick , Connolly Andrew , Feng Jean , Moffatt Ellen , Tseng Zian H
Published: December 2023

Background:
Titin, encoded by
TTN
, is a sarcomeric protein necessary for normal cardiac and skeletal muscle function. Truncating variants in the A-band are a frequent cause of isolated and familial dilated cardiomyopathy (DCM) in living cohorts. Whether variants outside of the A-band confer arrhythmic risk remains unclear. We investigated the yield and distribution of
TTN
variants in a postmortem study of presumed sudden cardiac deaths (pSCDs) in San Francisco County.

Methods:
From 2/1/2011 to 12/31/2017, the Postmortem Systematic Investigation of Sudden Cardiac Death study performed complete autopsies on 889 incident deaths (age 16-90) meeting World Health Organization criteria for SCD (pSCD). Using clinical records, autopsy findings, and family history, we performed deep phenotyping to adjudicate underlying arrhythmic “SAD” (potentially rescuable with defibrillation) or non-arrhythmic “non-SAD” (tamponade, overdose, etc.) cause of pSCD. We performed clinical whole exome testing on cases with next of kin consent.

Results:
Of the 322 pSCDs tested (196 SAD, 126 non-SAD), we detected 5 truncating/splice variants located in non-A-band regions (p=0.03 vs. none found in the A-band) in 4 cases, all SAD. No truncating/splice variants were detected in 47 cases with autopsy evidence of DCM (cardiomegaly and short axis > 3.5cm). Overall, 89 cases had at least 1
TTN
variant of uncertain significance (VUS): 61 (68.5%) SADs and 28 (31.5%) non-SADs, with a trend towards more
TTN
VUSs among SADs (p =0.10). A total of 110 VUSs were found: 10 (9.1%) in the Z-disc, 38 (34.5%) in the I-band, 50 (45.5%) in the A-band, and 12 (10.9%) in the M-band.
TTN
VUSs clustered similarly throughout the gene in SADs and non-SADs.

Conclusion:
In this 7-year postmortem genetic study of unselected countywide sudden deaths using autopsy to adjudicate arrhythmic cause, we found
TTN
truncating/splice variants in non-A-band regions were associated with SAD and a trend toward association with SAD among
TTN
VUS carriers. In contrast to living cohorts with diagnosed DCM, no cases meeting autopsy criteria for DCM had a truncating/splice variant. Since non-survivors (i.e., SCDs) are underrepresented in DCM cohorts, our results suggest a potential role for non-A band
TTN
variants in arrhythmic risk.
Abstract 13332: Assessment of Myocardial Oxygenation Response to Vasoactive Breathing Maneuvers in Patients With Repaired Dextro-Transposition of the Great Arteries an OS-CMR Study
Authors: Guerrero Carlos E , Moukarzel Mayssa , Kodaira Masaki , Therrien Judith , Hillier Elizabeth , Marelli Ariane J , Friedrich Matthias
Published: December 2023

Introduction:
Long-term outcomes of patients with repaired Dextro-transposition of the great arteries (D-TGA) by arterial switch operation (ASO) are excellent. However, studies have suggested impaired myocardial blood flow reserve. Oxygen-sensitive cardiac magnetic resonance (OS-CMR) with vasoactive breathing maneuvers (BM) offers a contrast-free tool for evaluating myocardial oxygenation.

Hypothesis:
Evaluate myocardial oxygenation reserve and microvascular function in repaired D-TGA post-ASO using OS-CMR with BM.

Methods:
In this single-center study, we analyzed OS-CMR images (basal and mid-left ventricular slices) of 9 D-TGA post-ASO patients (mean age 29 ±6.52yrs, 33.3% females) and 10 healthy participants (mean age 33 ±8.9 yrs, 40% females) who completed the BM. The BM consisted of free breathing, then hyperventilation, causing vasoconstriction, then breath hold, causing vasodilatation. End-systolic OS-CMR signal intensity (SI) was measured at baseline, after hyperventilation (closest to 0 sec of breath hold), and at closest to 30 sec of breath hold. Changes in SI (ΔSI) in % were calculated in response to the different periods and compared using independent samples t-test.

Results:
In the D-TGA cohort, the coronary response to hyperventilation was abnormal compared to healthy subjects (5.8±19.9% vs -15.1±13.3%, p=0.01). No difference was observed in ΔSI% during breath hold (mean TGA:3.0±10.5% vs mean healthy:5.7±6%, p=0.5). No differences were observed in mid-slices for either period.

Conclusions:
Our findings suggest patients with D-TGA may have an impaired vasoconstrictor response to a hyperventilation maneuver. Further studies should explore the associated pathophysiology and potential impact on clinical management.
Abstract 13355: Acute Type A Aortic Dissection Surgical Repair in Octogenarians, Meta Analysis
Authors: K. Awad Ahmed , Hasan Mohammed Tarek , Rezq Hazem Salah , Aboeldahab Heba , Elkhashab Mohamed K. , Hamouda Salah Mahmoud , Elkersh Hassan , K. Awad Ayman , Nabeel Ambreen , Gardezi Syed Karam , Awan Rehmat Ullah
Published: December 2023

Aortic dissection is a serious medical condition that can lead to life-threatening complications. Type A aortic dissection (TAAD) is a subtype that occurs in the ascending aorta and is associated with increased morbidity and mortality rates. Surgical intervention is the standard of care for TAAD, but the optimal surgical approach for octogenarians remains a topic of debate. This meta-analysis aimed to investigate the long-term surgical outcomes of TAAD in octogenarians.

Electronic databases were searched from inception to September 20, 2022, to include any randomized clinical trials (RCT) and observational studies that compare TAAD in octogenarians versus TAAD in septuagenarians. The Mantel-Haenszel method was used to pool study estimates and calculate odds ratios (OR) with 95% confidence intervals (CI).

Twenty-seven observational studies comprising 18,057 participants were included in the meta-analysis. Surgical repair for TAAD in octogenarians had a lower risk of re-exploration (RR = 0.08), stroke (RR = 0.09), renal failure (RR = 0.09), respiratory failure (RR = 0.18), neurological complications (RR = 0.09), and bleeding (RR = 0.08), compared to septuagenarians. On the other hand, antegrade cerebral perfusion (RR = 0.39) and tracheostomy (RR = 0.11) were less likely to be used in octogenarians than in septuagenarians. In terms of surgical parameters, octogenarians had a significantly shorter cardiopulmonary bypass surgery time and systemic cardiac arrest time than septuagenarians (MD = -13.84 and -2.46), respectively.

Even though postoperative mortality rose dramatically with age, surgical care was associated with a significantly reduced inpatient mortality rate when compared to medical management. Octogenarians undergoing surgical repair for type A aortic dissection have a statistically significant difference in cardiopulmonary bypass surgery time, systemic cardiac arrest time, and 5-year survival rate when compared to septuagenarians.
Abstract 13356: Get the Strips: Bridging the Gap Between First-Responders and Hospital Care After Cardiac Arrest
Authors: Ashur Carmel , Kuo Kelby , Varosy Paul D , West John , Sandhu Amneet , Tumolo Alexis , Garg Lohit , Rosenberg Michael , Sabzwari Syed Rafay Ali , Barrett Christopher , Cerbin Lukasz , Zipse Matthew , Tzou Wendy , Aleong Ryan
Published: December 2023

Introduction:
Following a cardiac arrest, rhythm strips stored on an automated external defibrillator (AED) can help guide medical decisions, including the need for an implantable cardioverter defibrillator. However, this information is often lost or difficult to obtain in the transfer of patient care.

Objective:
Highlight the utility of obtaining AED rhythm strips and illustrate current practice and potential pitfalls from a first-responder’s perspective.

Methods:
Distributed a survey to emergency medical service (EMS) agencies in the Denver area.

Results:
A total of 25 EMS providers responded from Denver (28%) and the surrounding area (72%). Direct transfer of rhythm strips to hospitals after an arrest was felt to be either very important (20%) or extremely important (80%), while 24% responded that rhythm strips were unlikely to be transferred into a patient’s electronic medical record (EMR). Over half (52%) of respondents do not consider the possibility of an inappropriate shock or inappropriately withheld shock from an AED, while 88% recognized that the type of shockable rhythm affected medical decisions. Of the 18 who reported a system for uploading rhythm strips, half directly scanned paper rhythm strips while half uploaded data using a cloud-based software. Finally, 80% felt that a system of wireless transmission to an online server would improve transfer of rhythm strips to receiving hospitals. A rhythm strip obtained from an AED interrogation (Figure 1) showed an appropriate shock for polymorphic VT in an otherwise healthy 30-year-old male that did impact clinical decision making.

Conclusions:
Rhythm strips stored on an AED should be reviewed at the time of hospitalization as this information may affect medical evaluation. Despite first responder appreciation, there remain gaps in this process, with the use of direct wireless upload from an AED to a patient’s EMR offering a potential solution.
Abstract 13362: Proteomic Architecture of Frailty Across the Spectrum of Cardiovascular Disease
Authors: Perry Andrew , Zhao SHilin , Gajjar Priya , Murthy Venkatesh L , Lehallier Benoit , Miller Patricia , Nair Sangeeta , Neill Colin , Carr Jeffrey , Fearon William F , Kapadia Samir R , Kumbhani Dharam J , Gillam Linda D , Lindenfeld Joann , Farrell Laurie , Marron Megan M , Tian Qu , Newman Anne , Murabito Joanne , Gerszten Robert E , Nayor Matthew G , Elmariah Sammy , Lindman Brian R , Shah Ravi V
Published: December 2023

Introduction:
With an aging population, understanding how frailty affects treatment response is paramount to improve patient-centered outcomes.

Hypothesis:
We hypothesized that circulating proteomic correlates of frailty will identify novel pathways for therapeutic investigation and provide prognostic information.

Methods:
From a multicenter, prospective cohort of 809 participants (median age 83 years; 44% women) with symptomatic, severe aortic stenosis (AS) and systematic assessments of frailty, we measured >900 circulating proteins (Olink). We used principal component analysis (PCA) to define composite “axes” of 12 measures of frailty (Figure). Using ordinary and penalized regression (LASSO), we related proteins to both individual measures of frailty and the composite axes. Prioritized proteins were then examined for their relation with age and morbidity in external, published datasets. LASSO model coefficients were used to calculate protein “scores” of frailty, which were tested for their relation with all-cause mortality in the AS cohort and cause specific mortality in >1,800 participants from the Framingham Heart Study (FHS; mean age 55 years, 54% women).

Results:
PCA identified 3 axes of frailty (“patient reported outcomes”, “body composition” and “physical function”) that explained ≈49% of variance. Proteins related to axes of frailty were (1) related to inflammatory and metabolic phenotypes and (2) weakly related to age, in >35,000 community dwelling Icelanders (mean age 55±17 years). The protein score of physical function was associated with all-cause post-transcatheter aortic valve implantation (TAVI) mortality in the AS cohort (HR 0.68 [0.59-0.79]) and non-cardiovascular mortality in FHS (0.83 [0.75-0.91]).

Conclusions:
Circulating proteins capture frailty phenotypes that are weakly related to age, and provide prognostic information in both older adults undergoing TAVI and younger community dwelling adults.
Abstract 13381: Syncope as a Presentation of Waldenstrom Macroglobulinemia
Authors: garcia cruz Jian , Perez Rodriguez Julio , Kondapavuluru Roy , Cho Eunbee
Published: December 2023

Syncope as defined by ACC/AHA is defined as a symptom that presents with an abrupt, transient, complete loss of consciousness, associated with inability to maintain postural tone with rapid and spontaneous recovery without clinical features of other non-syncope causes of loss of consciousness, such as seizure, antecedent head trauma, or apparent loss of consciousness. Syncope is a common complaint treated in the emergency department and a major reason for hospital admissions. A rare etiology to this common symptom is Waldenstrom macroglobulinemia.

Case:
A 49-year-old man presented to the emergency department, referred for hypercalcemia. On review of records, the patient was noticed to have been seen previously in emergency visits for two episodes of syncope and recurrent anemia. The laboratory studies at the time of admission were remarkable for hemoglobin of 7.3, WBC of8.32, hematocrit of 28.5, MCV 77.2, platelets of 124,000. Complete metabolic panel showed a total protein of 13.1, calcium of 11.2 with an albumin of 1.6 and corrected sodium of 117. EKG demonstrated a sinus rhythm with left atrial enlargement and nonspecific T wave abnormalities. Echocardiogram demonstrated a LVEF of 60-65% with normal LV wall motion, posterior wall thickness, and septal wall thickness with grade 1 diastolic dysfunction. CT of the head was unremarkable. Further work up for recurrent microcytic anemia. Bone marrow biopsy was obtained which demonstrated a Waldenstrom macroglobulinemia. Further follow up revealed that the patient has not had any other syncopal episodes since initiation of treatment.

Conclusion:
Although current literature suggests a broad differential diagnosis for the symptom of syncope, Waldenström macroglobulinemia remains a rare etiology of syncope with an estimated incidence of 1000 to 1500 cases diagnosed per year. Waldenstrom macroglobulinemia can cause hyperviscosity syndrome in about 30 percent of the population with Waldentroms, which when severe and coupled with anemia and plasma volume expansion has been reported as arare cause of syncope. Syncope evaluation should be detailed with history and physical examination and hyper-viscosity syndromes, a medical emergency, should be considered as differential diagnosis of syncope.
Abstract 13383: Extracorporeal Membrane Oxygenation for COVID-19-associated Acute Respiratory Distress Syndrome: A Nationwide Analysis
Authors: Watanabe Atsuyuki , Malik Aaqib H , Aikawa Tadao , Briasoulis Alexandros , Kuno Toshiki
Published: December 2023

Introduction:
While extracorporeal membrane oxygenation (ECMO) has been used for patients with COVID-19-associated acute respiratory distress syndrome (ARDS), its benefit in the nationwide setting is unknown.

Aim:
To evaluate the association between the use of ECMO and outcomes of COVID-19-associated ARDS in the nationwide setting.

Methods:
Using the United States National Inpatient Sample in 2020, we identified adults hospitalized and mechanically ventilated for COVID-19 with ARDS and divided them into three groups according to the use of ECMO (i.e., no-ECMO, venovenous [VV]-ECMO, and venoarterial [VA]-ECMO). The primary outcome was in-hospital mortality, and the secondary outcomes were the length of hospital stay (LOS) and the total costs during hospitalization. We applied a multivariable logistic regression model for the primary outcome, adjusting for baseline characteristics and underlying comorbidities.

Results:
Of the total of 72,415 included patients, 68,795, 3,280, and 340 patients received no-, VV-, and VA-ECMO, respectively
(Table)
. The crude mortality was the highest in the no-ECMO group (59.8%; 41,110/68,795), followed by VA-ECMO (47.1%; 160/340), and VV-ECMO groups (44.8%; 1,470/3,280). LOS was the longest in VV-ECMO group, followed by VA-ECMO, and no-ECMO groups. Similarly, the total costs during hospitalization were the highest in VV-ECMO group, followed by VA-ECMO, and no-ECMO groups. After adjusting for the covariates, VV- or VA-ECMO was not associated with lower mortality compared to no-ECMO (adjusted odds ratio [95% confidence interval]: 0.98 [0.82-1.18] and 1.12 [0.62-2.04], respectively).

Conclusions:
In the nationwide setting, ECMO was not associated with improved mortality in patients with COVID-19-associated ARDS but was associated with longer LOS and higher costs. Future studies exploring the characteristics of suitable candidates for ECMO are warranted.
Abstract 13387: Transradial Intervention in Dialysis Patients Undergoing Percutaneous Coronary Intervention: A Japanese Nationwide Registry Study
Authors: Kuno Toshiki , Yamaji Kyohei , Aikawa Tadao , Sawano Mitsuaki , Ando Tomo , Numasawa Yohei , Wada Hideki , Amano Tetsuya , Kozuma Ken , Kohsaka Shun
Published: December 2023

Introduction:
Transradial intervention (TRI) for percutaneous coronary intervention (PCI) is used to reduce periprocedural complications. However, its effectiveness and safety for patients on dialysis are not well established. Hence, we aimed to investigate the association of TRI with in-hospital complications in dialysis patients undergoing PCI.

Hypothesis:
TRI reduces periprocedural complications for dialysis patients undergoing PCI.

Methods:
We included 52,639 patients on dialysis who underwent PCI using Japanese nationwide PCI registry data (2019-2021). Patients were categorized based on access site: TRI, transfemoral intervention (TFI), or other access site. Periprocedural access site bleeding complication requiring transfusion was the primary outcome and in-hospital death and other periprocedural complications were the secondary outcomes. Matched weighted analysis was performed for TRI and TFI.

Results:
Here, 8,267 (15.7%) underwent TRI, 36,195 (60.2%) underwent TFI, and 8,177 (15.5%) underwent PCI from other access sites. Patients who received TRI were older and had lower rates of comorbidities than those who received TFI. Access site bleeding rate and in-hospital death were significantly lower in the TRI group (0.1% versus 0.7%, P<0.001; 1.8% versus 3.2%, P<0.001, respectively). After adjustment, TRI was associated with a lower risk of access site bleeding (odds ratio [OR] [95% confidence interval (CI)]: 0.19 [0.099-0.38]; P <0.001) and in-hospital death (OR [95% CI]: 0.79 [0.65-0.96]; P=0.02). Other periprocedural complications between TRI and TFI were not significantly different.

Conclusions:
In patients undergoing dialysis and PCI, TRI had a lower risk of access site bleeding and in-hospital death than TFI. This suggests that TRI may be safer for this patient population. Further investigation is necessary to promote the widespread utilization of TRI for patients on dialysis.
Abstract 13422: A Family With KCNH2 and SLC4A3 Mutation of Short QT Syndrome Inducing Frequent Sudden Death in Young Age
Authors: Fukue Noriko , Ueyama Takeshi , Kanemoto Masashi , Ohno Seiko , Akase Hideaki , Okuda Shinichi , Nakao Fumiaki , Ikeda Yasuhiro
Published: December 2023

Case report:
Short QT syndrome (SQTS) is an inherited disease characterized by abnormally short QTc intervals, which can lead to ventricular fibrillation(VF). However, the number of patients with SQTS are relatively low, and the optimal treatment for SQTS remains unclear. We experienced a family with SQTS inducing frequent sudden death of three sons. We identified KCNH2-H70Y in mother and three sons with QTc intervals 344, 300, 326, 322msec, respectively. Second son suffered cardiac arrest when he was 25-year-old. VF was recorded in the hospital, and the patient was successfully resuscitated. While recommended to implantable cardioverter defibrillator (ICD), oldest and third son suffered sudden death during nighttime sleep at their age 36 and 34. Functional analysis showed that cells expressing H70Y had significantly larger I
Kr
densities than WT. Also we identified SLC4A3 mutation in this family.

Conclusions:
Asymptomatic SQTS patients with family history may be recommended ICD implantation more strongly than class 2b. Registry studies of SQTS should be performed and solid guidelines should be established due to patients with poor prognosis of SQTS.
Abstract 13467: Artificial Intelligence Guided Coronary CT Angiography Impacts Care Beyond Conventional Assessment: The CERTAIN Trial
Authors: Nurmohamed Nick , Cole Jason H , Budoff Matthew J , Karlsberg Ronald P , Gupta Himanshu , Sullenberger Lance , Quesada Carlos , Rahban Habib , Woods Kevin , Uzzilia Jeffrey , Purga Scott , Aquino Melissa , Min James K , Earls James , Choi Andrew
Published: December 2023

Background:
Atherosclerosis imaging-quantitative CT angiography (AI-QCT) guided by artificial intelligence has demonstrated high diagnostic accuracy for assessment of coronary atherosclerosis, stenosis and ischemia (AI-QCT
ISCHEMIA
).

Methods:
CERTAIN was a multicenter study in 5 expert US centers prospectively recruiting 775 consecutive adult patients referred for CCTA. First, physicians were asked to complete an assessment of the patients’ diagnosis, additional imaging plan, intervention plan and medication management plan based on the conventional site assessment. Subsequently, coronary CT angiography (CCTA) exams were analyzed using AI-QCT, after which physicians were asked to repeat the assessment.

Results:
The 775 patients had a mean age of 64±12 years, 304 (39%) were female. Compared to site CCTA, AI-QCT analysis improved physician’s complete confidence two- to fivefold in every step of the care pathway (Figure). Overall, AI-QCT was associated with at least one clinical category change in over half (389; 50.2%) of patients compared to site CCTA interpretation, including CAD-RADS (304; 39.2%) and plaque burden (194; 25.2%). With implementation of AI-QCT, there was a 67% (43 vs. 14; p <0.001) reduction in patients planned for myocardial perfusion imaging and a 48% (163 vs. 85; p <0.001) reduction in patients referred for PCI or CABG compared to site CCTA.

Conclusion:
Implementing AI-QCT enabled a single-modality triple-aim assessment of stenosis, quantitative atherosclerosis and ischemia assessment through CCTA that improved physicians’ confidence, enhanced preventive medication uptake while it reduced the need for perfusion imaging and invasive testing.
Abstract 13478: Causes of Long-Term Mortality in Patients With Microvascular Obstruction Following ST-Segment Elevation Myocardial Infarction
Authors: Fisher Giselle , White Bethany , Okeson Brynn , Walser-Kuntz Evan , Traverse Jay H
Published: December 2023

Introduction:
The presence of microvascular obstruction (MVO) following ST-segment elevation myocardial infarction (STEMI) portends a poor prognosis and is associated with adverse left-ventricular (LV) remodeling and an increase in mortality in the subsequent year of follow-up. However, the long-term effects of MVO on mortality have not been previously described.

Methods:
We analyzed the long-term follow-up and cardiac MRIs of 475 patients (Average age = 60 years, 76% male) for the presence (n=337) or absence (n=138) of MVO at a single institution following STEMI and successful reperfusion with primary percutaneous intervention (PCI). Causes of death were determined from the patient's electronic medical record or death certificate.

Results:
The infarct-related artery was more likely to be the LAD in patients with MVO and the RCA in patients without MVO. Patients with MVO had greater ischemic times (159 vs. 141 mins; p = 0.012) and were more likely to have TIMI 0 flow on presentation (71 vs 54%; p <0.002). Patients with MVO had greater infarct size by cardiac enzymes resulting in greater LV end-diastolic volume index (LVEDVI) (80 vs.75 ml/m2), LV end-systolic volume index (LVESVI) (39 vs 30 ml/m2) and LV mass (146 vs 134 g) and reduced LVEF (48 vs 58 %; all p < 0.01) by cardiac MRI performed 1-3 days following STEMI and PCI . During long-term follow-up a total of 56 patients with MVO died compared to 18 patients without MVO. Patients with MVO died sooner after STEMI (5.9 vs 7.8 years) and were more likely to die from cardiovascular causes such as progressive heart failure or sudden cardiac death (Table). LVEF before death was lower in the MVO group (46 vs 52%).

Conclusions:
There is significant long-term mortality associated with MVO following STEMI with the majority of patients dying from cardiovascular causes. In contrast, patients with STEMI without MVO rarely died from a cardiac etiology but from cancer and natural causes.
Abstract 13490: Sex Differences in the Association of Multi-Ethnic Genome-Wide Blood Pressure Polygenic Risk Score With Population Systolic Blood Pressure Trajectories
Authors: Shetty Naman , Pampana Akhil , Patel Nirav , Yerabolu Krishin , Patel Gnyata , Irvin Marguerite , Natarajan Pradeep , Lin Henry J , Guo Xiuqing , Rich Stephen S , Rotter Jerome I , Peng Li , Arora Garima , Arora Pankaj
Published: December 2023

Introduction:
Sex differences in the systolic blood pressure (SBP) trajectories have been described previously. However, the contribution of underlying genetic architecture to the sex associated differences in SBP trajectories has not been assessed.

Methods:
Multiancestry sex-specific SBP polygenic risk scores (SBP-PRS), accumulating 1.1 million variants each, were calculated in the participants of the ARIC, JHS, CARDIA, CHS, MESA, FHS, and JHS who underwent whole genome sequencing under the TransOmics for Precision Medicine Program. Based on the SBP-PRS, the cohort was stratified into low (<20
th
centile), intermediate (20
th
-80
th
centile), and high (>80
th
centile) genetic risk of SBP. For individuals on antihypertensive medications, SBP measurements were corrected by adding 15 mmHg. Multivariable adjusted restricted cubic splines were used to depict the non-linear relationship of SBP with age in each sex separately. Bootstrapping using 1000 samples was used to estimate the age and 95% CIs at which the sex-specific SBP trajectories crossed over in each SBP-PRS group.

Results:
In this study of 21,542 individuals (median age: 56 years; 56.0% females; 35.8% non-White individuals), the non-linear association of SBP with age varied by sex (P
interaction
: <0.001) and SBP-PRS groups (P
interaction
: 0.05). On stratifying by SBP-PRS, females had a higher age-related increase in SBP compared with males across the groups (p<0.001 in low, intermediate, and high SBP-PRS groups). The age at which the SBP in females surpassed that of males progressively decreased with increasing genetic risk of SBP [low: 66.7 (66.4-67.0) years, intermediate: 64.3 (64.1-64.6) years, high: 55.8 (54.4-57.1) years; p: <0.001]. In the high SBP-PRS group, the sex-associated differences in SBP trajectories were modest with females and males having nearly similar SBP values in old age.

Conclusion:
The underlying genetic architecture may contribute to sex difference of SBP trajectories.
Abstract 135: Identifying Optimal Mean Arterial Pressure in Cardiac Arrest Patients: Are Precision Medicine Approaches Feasible?
Authors: Beekman Rachel , Kim Noah , Kitlen Eva , Wira Charles R , Khosla Akhil , Sheth Kevin N , Petersen Nils H , Gilmore Emily J
Published: December 2023

Introduction:
Loss of cerebral autoregulation after cardiac arrest (CA) is associated with worse outcomes. A population-based mean arterial pressure (MAP) threshold, such as a post-resuscitation goal of ≥ 65 mmHg, may be insufficient to account for patient-specific factors, like autoregulatory failure. We investigated the feasibility of determining optimal MAP (MAP
OPT
) using regional cerebral tissue oxygen monitoring with near-infrared spectroscopy (NIRS).

Hypothesis:
Autoregulatory failure and MAP
OPT
can be identified in individual patients after CA.

Methods:
We prospectively enrolled adult comatose CA survivors undergoing invasive MAP and regional cerebral oxygen monitoring with NIRS in an ICU between April 2022 and May 2023. Tissue oxygenation autoregulatory index (TOx) was derived using a moving Pearson correlation coefficient of 30 consecutive, 10-second averaged values of MAP and tissue oxygen index signals. TOx ≥ 0.3 defined impaired autoregulation. MAP values were divided into bins of 5 mmHg for which each corresponding TOx was averaged. Parabolic curve fitting determined the MAP value with the lowest associated TOx value (MAP
OPT
).

Results:
Of 35 patients enrolled, 74.3% experienced out-of-hospital cardiac arrest with a mean (SD) age of 55.0 (13.9) years. Six (17.1%) patients survived to hospital discharge and 4 (11.4%) progressed to brain death. Monitoring was initiated at a median [IQR] of 14.9 [10.9 - 20.6] hours from CA for a duration of 47.5 [27.1 - 75.1] hours. The time spent with impaired autoregulation was 22.6 [18.4 - 31.6] % of the recording duration, corresponding to 10.1 [6.9 - 15.9] hours. MAP
OPT
could be identified in 33 (94.3%) patients and 47.7 [32.1 - 59.6] % of the recording duration. The average MAP
OPT
was <75 mmHg in 2 (6.1%), 75 - 85 mmHg in 14 (42.4%), and >85 mmHg in 17 (51.5%) patients. MAP
OPT
did not differ between survivors and non-survivors (mean (SD) 87.2 (9.6) vs. 88.2 (12.1) mmHg respectively, p=0.86).

Conclusion:
MAP
OPT
could be identified in all but two patients and calculated for half of the recording duration. Average MAP
OPT
was ≥ 75 mmHg in 94% of our cohort. Future studies are needed to evaluate whether targeting personalized physiologic thresholds influences outcomes.