bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 14636: The Effects of Celecoxib on Endothelial Function in Healthy Volunteers; A Double Blind, Placebo Controlled Randomised Trial
Authors: Vaja Ricky , Ferreira Plinio , Collins Peter , Rickman Matthew , Punjabi Prakash P , Kirkby Nicholas , Mitchell Jane
Published: June 2023

Introduction:
Non-steroidal anti-inflammatory drugs (NSAIDs), which work by blocking cyclooxygenase (COX)-2 can increase cardiovascular risk by up to 30% after 2 weeks of use and in animal models augments thrombosis. However, the effect of NSAIDs and loss of COX-2 on endothelial function and blood flow remains incompletely understood. A plausible explanation is inhibition of COX-2 affects endothelial function by inhibiting prostacyclin and/or reducing endothelial nitric oxide synthase (eNOS) activity/expression. We hypothesised that COX-2 inhibition with celecoxib will impact on endothelial function.

Methods:
Healthy male volunteers aged between 18 to 40 were randomised 1:1 to receive either celecoxib (200 mg twice daily) or matching placebo for 7 days. The primary outcome was change (Δ) in endothelial function assessed using the EndoPAT device. Participants were given a home blood pressure machine and diary as a secondary outcome measure. Participants and outcome assessors were blinded to the intervention.

Results:
Between June 2021 and January 2022, 44 participants were randomised of which 40 participants completed the study (20 allocated to each arm) and were included in the final analysis. Baseline characteristics were similar between the groups. Compared to placebo, there was a significant increase in augmentation index (AI) following celecoxib use: Δ 6.2; (95% CI 0.05 to 12.4) p:0.048. There was no difference in log reactive hyperaemia index (LnRHI): Δ -0.092; (95% CI -0.31 to 0.12) p:0.39, systolic blood pressure: Δ -3.5; (95% CI -9.9 to 3) p:0.28, or diastolic blood pressure: Δ 4.7; (95% CI -1.8 to 11.1) p:0.15
(Figure)
.

Conclusion:
In healthy male volunteers, 7 days of treatment with celecoxib significantly increased augmentation index which is a surrogate for vascular stiffness and an independent predictor of cardiovascular risk. Further clinical and mechanistic studies are required to elucidate how COX-2 inhibition impacts on augmentation index.
Abstract 14674: Identifying CXCL12 as a Potential Marker for AF Subset Classification Based on Bioinformatic Tools
Authors: Yang Lingzhi , Huang Wei , Chen Yunwei
Published: June 2023

Introduction:
An improved understanding of the pathogenesis of AF and atrial substrate remodeling is necessary for development of novel therapeutic approaches and new management strategies.

Hypothesis:
CXCL12 could be involved in the regulation of AF inflammatory microenvironment and have the potential to be a marker for AF subset classification.

Methods:
In this study, we utilized the Robust Rank Aggregation method to integrate AF microarray datasets. Potential compounds were identified by mining the Connectivity Map database. Functional modules and closely-interacted clusters were identified using WGCNA analysis and PPI network, respectively. Biological functions were further analysed. Moreover, a reliable Machine Learning-based diagnostic model was constructed and visualized to clarify the diagnostic features of these genes.

Results:
Differentially expressed genes were identified. We showed that mitogen-activated protein kinase and epidermal growth factor receptor inhibitors were likely to mitigate AF based on Connectivity Map analysis. Four genes were identified as hub genes.
CXCL12
was shown to play an important role in regulation of local inflammatory response and immune cell infiltration.

Conclusions:
Key genes involving in the pathogenesis of AF were identified. The biological features of
CXCL12
in AF were investigated using integrative bioinformatics tools. The results suggested that
CXCL12
might be a biomarker that could be used for distinguishing subsets of AF, and indicated that
CXCL12
might be an important intermediate in the development of AF by increasing the infiltration of mast cells, neutrophils, and γδ T cells, and reducing infiltration of regulatory T cells. A reliable Machine Learning-based diagnostic model was constructed. Our work improved understanding of the mechanisms of AF predisposition and progression, and identified potential therapeutic avenues for treatment of AF.
Abstract 14720: Marked Increase in Mitochondria Degradation in Engineered Heart Tissue During Reperfusion
Authors: Nager Mireia , Bhujabal Zambarlal , Bowitz Larsen Kenneth B , Kalstad Trine B , Myrmel Truls , Birgisdottir Asa B
Published: June 2023

Introduction:
Engineered heart tissue (EHT) consisting of beating cardiomyocytes differentiated from human inducible pluripotent stem cells (hiPSCs) has the potential to recapitulate molecular and functional features of the human heart. Cardiac homeostasis is dependent on lysosomal removal of damaged mitochondria through selective autophagy (mitophagy). The level of mitophagy and cardioprotective impact during ischemia and reperfusion remains elusive and demands further investigation.

Objective:
To assess mitophagy during ischemia-reperfusion simulation in human EHTs.

Methods and results:
A hiPSC line was genetically modified using CRISPR/Cas9 knock-in to insert a fluorescent tag (mCherry or EGFP) on
Translocase of the Outer Mitochondrial Membrane 20
(
TOMM20)
gene resulting in hiPSCs with fluorescent mitochondria. The hiPSCs were differentiated to cardiomyocytes that were embedded in a fibrin hydrogel between two flexible silicone posts to generate EHTs. The EHTs (21 days or older) were subjected to 90 min of ischemia simulation followed by 120 min of simulated reperfusion with and without the lysosomal inhibitor Bafilomycin A1 (BafA1) to measure flux. Time-matched control EHTs remained in normal conditions (with and without BafA1). The EHTs were fixed and sections were immunostained with the lysosomal marker LAMP1A and analyzed by confocal microscopy. Co-localization of fluorescent mitochondria and stained lysosomes was observed after 120 min of reperfusion. To further assess this co-localization we used proximity ligation assay (PLA), an antibody-based assay allowing verification of close proximity (within 40 nm) of two proteins resulting in a single fluorescent signal (PLA dot). We performed the assay using anti-TOMM20 and anti-LAMP1A antibodies to localize mitochondrial content within lysosomes. Notably, there was a significant increase in the number of PLA dots in response to 120 min of reperfusion in the presence of BafA1 (3.41±0.56 fold vs. control, p<0.01; n=4), indicative of induced mitophagy flux.

Conclusion:
We observed a marked increase in lysosomal degradation of mitochondria in EHTs during reperfusion. The functional impact on EHTs during ischemia and reperfusion needs further research.
Abstract 14731: Form and Function: 4D Flow Derived Hemodynamic Parameters in the Ascending Aorta is Reflective of Transverse Aortic Arch Dilation in Patients With Single Ventricle Physiology
Authors: Ghosh Reena M , Elbaz Mohammed , Nallamothu Thara , Jones Andrea , Rychik Jack , Harris Matthew A , Partington Sara , Biko David , Whitehead Kevin , Fogel Mark A
Published: June 2023

Introduction:
Reconstructed aortas in patients with single ventricle (SV) can dilate progressively over time, possibly due to abnormal flow patterns. Four-dimensional (4D) flow cardiac magnetic resonance imaging (CMR) can assess advanced hemodynamic parameters. This study utilizes 4D flow CMR to assess the association between ascending aorta (AAo) 4D flow dynamics of vorticity, viscous energy loss (EL) and kinetic energy (KE) with arch anatomy in SV patients.

Methods:
This was a retrospective single center study of all patients with SV who underwent 4D flow CMR from June 2021-present. Vorticity, KE and EL were calculated over the segmented three-dimensional AAo, and values were normalized to cardiac index (CI). Cross-sectional areas of the aortic root, AAo and transverse aorta were indexed to body surface area. Linear regression was used to determine associations between hemodynamic parameters and arch anatomy.

Results:
20 pts met inclusion criteria; 5 were excluded due to incomplete datasets. The remaining 15 pts had a median age of 57 months (IQR 31;117.5). Ten (66%) had a systemic RV, 13 (86%) had a reconstructed aorta and 40% were after the Fontan operation. Peak and mean vorticity in the AAo were positively associated with transverse arch area. Additionally, there was a positive association between both total EL and EL index, and transverse arch area. (see table)

Conclusions:
Higher vorticity and EL in the AAo are associated with and reflective of higher transverse arch areas (i.e. dilation) in SV pts. In depth research in a prospective, longitudinal cohort is warranted to better understand this relationship and the geometry relative to hemodynamics. Furthermore, correlation of 4D flow metrics with clinical outcomes may provide novel insights into modifiable risk factors in this patient population
Abstract 14755: Left Ventricular Three-Dimensional Speckle Tracking Echocardiography Predicts Adverse Clinical Outcomes in Heart Transplant Patients
Authors: Zhu Shuangshuang , Li Yuman , Xie Mingxing , Zhang Li
Published: June 2023

Background:
The prognostic value of 3D-GLS in HT recipients has not been evaluated. This study explored the long-term prognostic significance of 3D-GLS in HT recipients.

Methods:
The study comprised 296 consecutive patients who underwent HT between January 2015 and December 2019 at Union Hospital in Wuhan, China. All subjects underwent comprehensive transthoracic two-dimensional (2D) and 3D echocardiographic examinations. Patients were followed until January 1st, 2022. Major adverse cardiac events (MACE) were defined as a composite of heart failure hospitalization, re-transplantation and death.

Results:
After a median follow-up of 3.3 years, 53 HT patients experienced MACE. Patients with MACE displayed significantly impaired 2D-GLS and 3D-GLS compared with those without MACE. Kaplan-Meier analysis showed that the risk of MACE increased significantly with worsening tertiles of 2DGLS and 3DGLS (both log-rank p < 0.001). Area under the curve for 3D-GLS was larger than that in 2D-GLS for MACE prediction. On multivariate Cox proportional hazards regression, 2D-GLS and 3D-GLS were independently associated with the MACE after adjustment for diabetes, history of rejection, hemoglobin, brain natriuretic peptide (BNP), and LV ejection fraction. In addition, 3D-GLS provided incremental prognostic value over 2D-GLS. Continuous net reclassification improvement analysis showed an improvement of + 23.3% was noted in the accuracy of classification between 3D-GLS and 2D-GLS.

Conclusion:
In heart transplant recipients, 3D-GLS is an independently predictor of MACE. These findings support the potential of 3D-GLS to identify higher risk HT patients.
Abstract 14756: Outcomes of Cardiac Co-Morbidities in Renal Transplantation: A National Population-Based Cohort Study
Authors: Hussain Bilal , Kasinath Vivek , Abdi Reza , Paul Timir K
Published: June 2023

Background

Cardiovascular disease (CVD) is common and associated with higher mortality in end-stage renal disease patients, but its impact on mortality from renal transplantation has not been studied formally. Our aim was to investigate the impact of CVD on the mortality of renal transplant recipients at the time of transplantation.

Methods

The National Inpatient Sample 2016-2019 was analyzed to identify a patient cohort admitted for renal transplantation with a diagnosis of a cardiovascular diseases using ICD-10 codes. The prevalence of various cardiac co-morbidities and their effect on mortality in renal transplant recipients were evaluated. A multivariate logistic regression model was used to analyze the in-hospital mortality rates.

Results

Analysis of 142,333,352 patients revealed that 84,525 (0.059%) were admitted for renal transplantation, of whom 32.5% had cardiac co-morbidities. Mean age of these patients was 57 years, and 66% were males. 19% of these patients had ischemic heart disease, 15.9% had heart block, 8.1% had heart failure, 7.1% had atrial fibrillation, 7.6% had congenital heart disease (CHD), 3.4% had pulmonary hypertension, 2.7% had ventricular arrhythmia, 2.5% had non-rheumatic valvular heart disease (NRVHD), 1.3% had chronic rheumatic heart disease (CRHD), 0.05% had pericarditis, and 0.018% had infective endocarditis. In patients undergoing renal transplant, CVD was associated with more than four times higher likelihood of mortality (OR 4.77, CI 2.84-8.03, p=0.00). Pericarditis (OR 31.56), ventricular arrhythmia (OR 13.9), heart failure (OR 5.4), heart block (OR 5.0), atrial fibrillation (OR 2.64), pulmonary hypertension (OR 2.54), and ischemic heart disease (OR 1.7) were also associated with significantly higher mortality (p<0.05). CHD, NRVHD, CRHD, and infective endocarditis had no significant association with mortality.

Conclusions

The prevalence of CVD in renal transplant recipients is 32.5%, and it is associated with over four-fold higher odds of mortality. Other cardiac co-morbidities associated with increased mortality following renal transplantation are ischemic heart disease, heart failure, atrial fibrillation, ventricular arrhythmia, heart block, pericarditis, and pulmonary hypertension
Abstract 14760: Troponin Leak in Sepsis: Does it Correlate With Hemodynamics?
Authors: Varrias Dimitrios , Nagraj Sanjana , Alhuarrat Majd Al Deen , Krishnan Suraj , Sasidharan Anika , Vikash Sindhu , Kharawala Amrin , SAFIRIYU ISRAEL , Cerna Luis , Gulani Perminder , Alvarez Miguel , Faillace Robert
Published: June 2023

Introduction:
Although several studies have demonstrated that elevated troponin predicts mortality in septic patients, data concerning the independent risk factors predisposing to higher chance of troponin leak are conflicting.

Hypothesis:
In this study we aim to identify predictors of troponinemia and lactatemia in the setting of sepsis and more specifically to clarify how hemodynamics affect these biomarkers.

Methods:
This is a retrospective cohort study on patients admitted to the intensive care units with severe sepsis. A total of 354 patients were included. Elevated admission troponin-T and lactate were defined as ≥0.01ng/mL and 2.5mmol/L respectively. Modified shock index defined as heart rate/mean arterial blood pressure (MSI) was used as a surrogate of hemodynamic instability. Linear regression models where generated to examine multi variate associations and Cox regression models were used for mortality outcomes. Analysis was done using STATA I/C 16.1.

Results:
The only independent predictor of elevated troponin in the setting of septic shock was pre-existing coronary artery disease (Coef.= 6 [1.9 - 10] p = 0.001). Troponin was not associated with mean arterial pressure (MAP) nor Modified Shock Index (Heart rate/MAP). On the other hand, elevation of lactate was significantly associated with Modified Shock index (Coef.=1.7 [CI 0.4 - 3] p= 0.001) and history of Diabetes (Coef.=1.2[0.04-2.3] p= 0.04). In a Cox regression modeling assessing for predictors of mortality in septic shock, lactate levels were strongly associated with death (OR= 1.17 [1.12-1.2] p= 0.0001) followed by male sex (OR= 1.8 [1.02-3] p=0.04) and Modified Shock Index (OR=1.5 [1.23-3.2] p=0.03) but troponin leak failed to show any correlation with mortality.

Conclusions:
Troponin leak is associated only with pre-existing CAD, not associated with hemodynamics and does not predict mortality.
Abstract 14785: Predictors of In-Hospital Mortality in Coronary Artery Aneurysm Patients: An Insight From the National Inpatient Sample Database
Authors: Ghumman Ghulam Mujtaba , Shah Jay , Al-Dabbas Maen , Khan Muhammad Shayan , Luthra Kritika , Khan Amir , Ahsan Muhammad , Singh Heminder , Taleb Mohammed , Ali Sohail
Published: June 2023

Background:
There is limited literature on the mortality outcome of coronary artery aneurysms (CAA). The purpose was to study the baseline characteristics, associated co-morbidities, and in-hospital mortality in CAA patients using the Healthcare Cost and Utilization Project National Inpatient Sample database.

Methods:
The Healthcare Cost and Utilization Project administrative longitudinal database contains encounter-level information on inpatient stays, emergency department visits, and ambulatory surgery in all U.S. hospitals. We performed a cross-sectional analysis on 10230 patients diagnosed with CAA during hospitalization from January 2016 to December 2018. The primary outcome was in-hospital mortality.

Results:
Of the total patient population, 10230 patients were found to have CAA. All patients with ages ≥ 18 were included in the study (8660). Hypertension, diabetes mellitus, and peripheral vascular disease were predominant co-morbidities. The observed overall in-hospital mortality was 2.9% (251 patients out of 8660). The highest mortality was observed in patients with acute myocardial infarction (adjusted odds ratio: 80.9; 95% confidence interval: 51.9 to 126.1; p-value < 0.01). The age group >80 years had higher mortality when compared to the age group <40 years (adjusted odds ratio: 9.1; 95% confidence interval: 2.9 to 29.3; p-value < 0.00). Smoking (adjusted odds ratio: 46.6; 95% confidence interval: 31.3 to 69.2; p-value < 0.01) and peripheral vascular disease (adjusted odds ratio: 4.0; 95% confidence interval: 2.7 to 6.0; p-value < 0.01) also had a significant impact on mortality (Table 1,2).

Conclusion:
Our analysis showed higher mortality in CAA with increasing age and in patients who developed acute myocardial infarction, with smoking and peripheral vascular disease also having a significant impact.
Abstract 14809: Longitudinal Trends in the Incidence of Covid-19 in Acute Myocardial Infarction Patients
Authors: Bansal Agam , Reed Grant W , Menon Venu , Krishnaswamy Amar , Kapadia Samir R , Khot Umesh N
Published: June 2023

Introduction:
Existing studies have reported association between acute myocardial infarction (AMI) and risk of fatal outcomes in COVID-19 patients. However, impact of Omicron COVID-19 variant on the incidence of AMI has not been studied. We aimed to ascertain longitudinal trends in incidence of COVID-19 in AMI patients with a focus on the Omicron period.

Methods:
We included all hospitalized patients from March 2020 to January 31
st
, 2022 at all Cleveland Clinic hospitals in the U.S. who had an ICD-10 code I21 representing AMI. Data was obtained using Slicer Dicer. Primary outcome was longitudinal trends in incidence of COVID-19 in AMI patients and secondary outcome was the incidence of COVID-19 in Omicron as compared with previous waves. Hospitalisations were stratified based on following periods: stay at home order [03/2020-05/2020]; pre-vaccination [06/2020-01/2021]; post-vaccination but before delta wave [02/2021-06/2021]; delta wave [07/2021-08/2021]; and Omicron wave [12/2021-01/2022]. Trends over study period were assessed using Mann-Kendall test. Comparison of outcomes across different COVID-19 pandemic periods was performed using the chi-square test.

Results:
Total of 14908 hospitalizations were identified. Overall incidence rate of COVID-19 in AMI patients was 7.62% (1137/14908). From March 2020 until January 31
st
, 2022, there has been a significant increase in incidence rate of COVID-19 in AMI patients from 0.83% to 29.92%, p=0.006. Incidence rate of COVID-19 in AMI during the Omicron period (25.7% (322/1252)) was significantly higher compared with the stay at home order (2.3%), pre-vaccination (8.2%), post-vaccination (4.3%), and delta wave (3.7%), p<0.001. Furthermore, incidence of COVID-19 in AMI patients decreased post-vaccination period until emergence of Omicron variant.

Conclusions:
There has been a significant increase in the incidence of COVID-19 amongst the AMI patients which is attributed to the emergence of Omicron variant.
Abstract 14817: Machine Learning Computer Vision for Point of Care Decision Support of Echocardiographic Identification of Hypertrophic Cardiomyopathy
Authors: Vemulapalli Sreekanth , Kong Fanjie , Alenezi Fawaz , Giczewska Anna , Kang Lillian , Chiswell Karen , Henao Ricardo , Wang Andrew
Published: June 2023

Introduction:
Hypertrophic cardiomyopathy (HCM) has an estimated prevalence of 1/500 but remains underdiagnosed. Echocardiography is the primary diagnostic modality but requires recognition of varied patterns of hypertrophy. Point of care tools to facilitate improved identification of HCM are needed.

Methods:
We identified 400 study cases of HCM in adults meeting professional society guideline diagnostic criteria from 2000-2020 at Duke University Medical Center. 900 study controls matched on age, sex, year of echo, and ejection fraction were also identified. Multi-vendor echocardiographic examinations performed within 12 months of initial diagnosis were used to train a convolutional neural network (CNN) to identify HCM. The model consisting of a 18-layer deep R(2+1)D residual network was developed on 60% of the data (training), 20% of the data (validation) was used to select model hyperparameters and to monitor for overfitting, and the remaining 20% (test) was used for performance estimation. CNN performance was evaluated by the receiving operating characteristic (ROC) and precision-recall curve and their summaries, namely, area under the ROC (AUROC) and average precision (AP,
i.e.
, average positive predictive value). We report performance characteristics at the study level.

Results:
Among 400 HCM cases and 900 controls, the median age was 65, with 48.1% male. Hypertension was present in 44.9%, with heart failure in 16.3% and Atrial Fibrillation in 12%. Median EF was 55% with 14.5% having an EF < 50%. Median diastolic dimension was 4.4 cm and moderate or severe MR was present in 8.4%. Study-level AUCROC for the CNN was 0.853 and the average precision was 0.698 (Figure 1).

Conclusion:
A machine learning CNN is able identify study-wise HCM with an AUC of 0.853. Further work will be necessary to ensure explainability of results and similar multi-institutional performance as a point of care tool for the echocardiographic identification of HCM on diagnostic rates.
Abstract 14836: Drug-Coated Balloon Angioplasty of
De Novo
Native Coronary Arteries Allows Favorable Vessel Healing With Regards to Vasomotor Function
Authors: Kim Sunwon
Published: June 2023

Background:
Pre-stent era witnessed the presence of abnormal vasomotion at balloon-injured coronary segments, leading to fatal vasospasm. Drug-coated balloon (DCB) angioplasty is fundamentally the same procedure that was performed in the pre-stent era, except for antiproliferative drug being delivered. We evaluated whether
de novo
native coronary lesions treated using DCB are prone to vasospasm and how they respond to ergonovine and nitrate.

Methods and Results:
Among 132 DCB angioplasty recipients, 89 patients underwent ergonovine provocation test at 6-9 months follow-up. Within-subject ergonovine- and nitrate-induced diameter changes were compared among the three different sites: DCB-treated vs. angiographically normal vs. segment showing prominent vasoreactivity (spastic). None of 132 patient experienced clinically refractory vasospastic angina during follow-up. Ergonovine induced vasospasm in seven patients; all cases were multifocal spasms either involving(n=2) or sparing DCB-treated segments(n=5). No patient showed focal spasms that exclusively involved DCB-treated lesions. Among patients with vasospastic features, DCB-treated segments showed less vasoconstriction than did the spastic counterparts (p<0.001). 35.5% of DCB-treated segments showed constrictor-resistance during ergonovine provocation. A total of 274 segments including 110 DCB-treated lesions were analyzed to assess vasomotor function. Most of the analyzed segments were constricted and dilated significantly after ergonovine and nitrate administration (both, p<0.001). Vasomotor function, defined as a combined constrictor and dilator response, was comparable between DCB-treated and angiographically normal segments (p=0.173), while significant differences were observed against spastic counterparts (p<0.001).

Conclusions:
DCB-treated lesions were not vulnerable to vasospasm and some segments showed rather spasm-resistance. DCB angioplasty allowing favorable vessel healing facilitated restoration of vasomotor function achieving level comparable to angiographically normal segments as early as 6 months after index procedure. This study supports the safety of DCB-only strategy in treating
de novo
native coronary lesions.
Abstract 14842: Concordance Between the Various Cardiovascular Risk Scores: Six Months Results of the Randomised Clinical Trial Evaluating Whole-Body Digital Twin Technology Enabled Precision Nutrition for Remission of Diabetes
Authors: Shamanna Paramesh , Mohammed Jahangir , Mohamed Maluk , Poon Terrence , Dharmalingam Mala , Vadavi Arun , Keshavamurthy Ashok , Bhonsley Suchitra , Thajudeen Mohamed , Mohammed Sarah , Joshi Shashank
Published: June 2023

Introduction:
The Twin Precision Treatment (TPT) intervention uses the Whole-Body Digital Twin Platform, with AI and the Internet of Things, to integrate multi-dimensional data to give precision nutrition and health recommendations via the TPT app and by coaches

Methods:
We compared the differences between the cardiovascular (CV) risk scores: (ASCVD (atherosclerotic cardiovascular disease) risk score, QRISK, and Framingham risk score (FRS) in the TWIN intervention arm (T) (n=203) and control group (C) (n=80) along with the changes in glycemic and extra glycemic parameters

Results:
Mean age (years) in T and C was 43.4 (±8.2) and 50.9 (±10.6); respectively. Mean duration of diabetes (years) in T and C was 3.7 (±2.6) and 4.7 (±2.8); respectively. There was a significant reduction in all three risk scores in T arm with glycemic and other extra glycemic parameters (Table). In the intervention arm, the mean difference in the ASCVD score (%) from baseline to 180 days was comparable in the group that achieved remission (AR) (n=170) -5.3 (±5.7, 95% CI -6.2 to -4.4) and the group that did not achieve remission (DAR) (n=33) -3.9 (±4, 95% CI -5.3 to -2.5) (p=019 ns). Similarly, the mean difference in the QRISK score (%) from baseline to 180 days was comparable in AR -3.3 (±5.1, 95% CI -4.1 to -2.5) and DAR -5.1 (±6.7, 95% CI -7.6 to -2.7), (p=0.07 ns). Mean difference in the FRS (%) from baseline to 180 days was comparable in AR -9.2 (±7.4, 95% CI -10.4 to -8.1) and DAR -7.4 (±6.9, 95% CI -9.8 to -4.9), (p=0.18 ns). On day 180 Kappa agreement between ASCVD and QRISK was 0.32, between QRISK and FRS was 0.63, and between ASCVD and FRS was 0.43.

Conclusions:
The significant reduction in all three CV risk scores at three months was sustained at six months. TPT yields a significant reduction in cardiovascular risk across the three risk scores and is independent of the achievement of remission of diabetes. TPT, apart from achieving diabetes remission, has independent benefits for the reduction of cardiovascular risk.
Abstract 14845: Evaluation of Heart Failure With Preserved Ejection Fraction in Patients With Symptomatic Atrial Fibrillation by Invasive Assessment of Left Atrial Compliance
Authors: Ariyaratnam Jonathan P , Mishima Ricardo , McNamee Olivia P , Kadhim Kadhim I , Emami Mehrdad , Lau Dennis , Gallagher Celine , Elliott Adrian , Sanders Prashanthan
Published: June 2023

Background:
Atrial fibrillation (AF) and HFpEF are both associated with left atrial (LA) cardiomyopathy. We hypothesise that HFpEF is common in patients with symptomatic AF due to the presence of LA cardiomyopathy involving reduced LA compliance (LAC).

Methods:
Consecutive patients with AF and preserved left ventricular (LV) function were prospectively recruited. Gold-standard diagnosis of HFpEF was undertaken by invasive assessment of LA pressure; participants had ‘AF-HFpEF’ if baseline mean LA pressure (mLAP) was >15mmHg and ‘early AF-HFpEF’ if mLAP exceeded 15mmHg only after 500mls fluid challenge. LAC was assessed by monitoring atrial pressures and LA size during infusion of 15mL/kg normal saline over 8 minutes. Transmural LAC was calculated as ΔLA diameter/Δ(LA pressure - RA pressure). All participants were also studied with resting and exercise echocardiography, electrophysiology (EP) study, cardiopulmonary exercise testing and AF Symptom Severity questionnaires.

Results:
Of 105 participants, 49 (46.7%) had AF-HFpEF, 26 (24.8%) had early AF-HFpEF and 30 (28.6%) had no HFpEF. AF-HFpEF was associated with increased BMI (p=0.03) and higher prevalence of hypertension (p<0.01). AF-HFpEF was associated with lower transmural LAC compared to those with no HFpEF (1.36±0.45 vs 3.32±0.46, p=0.01). As shown in the table, participants with AF-HFpEF also displayed reduced LA mechanical function at rest and during exercise, LA electrical remodelling, reduced cardiorespiratory fitness and increased AF symptom burden.

Conclusions:
HFpEF is common in patients with symptomatic AF and is associated with increased BMI and hypertension. AF-HFpEF is characterized by a global LA cardiomyopathy involving reduced LAC, reduced LA mechanical function and LA electrical remodelling. Diagnosis of HFpEF in patients with AF may identify those with increased symptom burden, reduced exercise capacity and increased risk of stroke. (Trial registration: ACTRN12620000639921)
Abstract 14851: Risk Factors and Clinical Effects of Leaflet Thrombosis After Transcathether Aortic Valve Replacement
Authors: Bak Minjung , Park Sung-ji , CHOI KIHONG , Kim Jihoon , Park Taek Kyu , Kim Eun Kyoung , Kim Sung Mok , Choi Seung-Hyuk
Published: June 2023

Introduction:
The incidence of leaflet thrombosis is higher in TAVR than in SAVR; however, knowledge regarding the risk factors of leaflet thrombosis in TAVR is limited.

Hypothesis:
In this study, the incidence and risk factors for leaflet thrombosis after TAVR and its effects on clinical course were investigated.

Methods:
176 patients who underwent TAVR from January 2015 to October 2020 were enrolled. Follow-up MDCT was performed between 3 months and 2 years after TAVR in 94 patients. Among the 94 patients, leaflet thrombosis occurred in 20 patients, and risk factors were analyzed by comparing clinical factors, echocardiographic parameters, 4D-MDCT information, and angiographic data between thrombosis group and no thrombosis group. Clinical outcome was defined as the composite of all-cause death, stroke, HF admission, redo AVR, and major bleeding after detection of leaflet thrombosis.

Results:
Indexed mean SOV diameter, AV calcium volume, and post-procedure EOAi were predictive of leaflet thrombosis with AUC value of 0.670 (95% CI 0.546 - 0.795,
P
-value = 0.020), 0.695 (95% CI 0.541 - 0.850,
P
-value = 0.012), and 0.665 (95% CI 0.548 - 0.782,
P
-value = 0.031), respectively. In echocardiography performed at the time of follow-up CT, the value of AV max velocity and AV mean pressure gradient were higher in the thrombosis group and the EOAi and Doppler velocity index values were lower in the thrombosis group than in the no thrombosis group. All the median echocardiographic values in both groups were within normal range. All patients with leaflet thrombosis were in subclinical status and half changed medication after detection. Clinical outcome was not significantly different between the two groups (log-rank
P
-value = 0.26).

Conclusions:
Larger indexed SOV diameter, higher AV calcium volume, and smaller post-procedure AV EOAi were risk factors for leaflet thrombosis after TAVR. Subclinical leaflet thrombosis has a benign course when properly managed.
Abstract 14862: Development and Validation of a Phenomapping Tool to Identify Patients With Diuretic Resistance in Acute Decompensated Heart Failure: A Multi-Cohort Analysis
Authors: Segar Matthew W , Khan Mohammad S , Patel Kershaw , Butler Javed , Ravichandran Ashwin , Ravichandran Ashwin , Walsh Mary N , Willett Duwayne , Fonarow Gregg C , Drazner Mark H , Mentz Robert J , Hall Jennifer L , Farr MaryJane , Hedayati Susan , Yancy Clyde W , Allen Larry A , Tang Wai Hong W , Pandey Ambarish
Published: June 2023

Introduction:
Individuals presenting with acute decompensated heart failure (ADHF) have varying response to diuretic therapy and short- and long-term prognosis.

Hypothesis:
If machine learning can risk stratify patients with ADHF and identify subgroups at risk for diuretic resistance.

Methods:
Participants with ADHF from the ROSE-AHF and CARRESS-HF clinical trials were included (n=451) and clustered using multivariable finite-mixture models based on diuretic efficiency (fluid output over first 72 hours per total intravenous loop diuretic dose). Differences in diuretic efficiency, in-hospital length of stay, and in-hospital mortality were assessed using linear and logistic regression models. Phenogroups were externally validated in trial (DOSE/ESCAPE, ATHENA-HF) and real-world (GWTG-HF) cohorts.

Results:
Clustering identified 3 phenogroups. Participants in phenogroup 1 (n=271, 60%) had worse diuretic efficiency [median(IQR) = 11.6(6.6-17.9) mL/mg) compared with phenogroups 2 (n=145, 32%) and 3 (n=35, 8%) [median(IQR) = 16.3(11.2-23.9) and 20.2(12.3-49.9) mL/mg, respectively; p<0.001]. An integer-based risk score to predict phenogroup 1 (lowest diuretic efficiency) was created: BAN-ADHF (
Fig.
). Net urine output was 2600 vs. 1090mL per 24 hours in patients with scores of 5 and 15, respectively (
Fig
). In the external validation cohorts, participants with scores ≥11 vs. <11 had significantly lower global well-being, higher natriuretic peptide levels on discharge, longer length of stay, and higher risk of in-hospital mortality.

Conclusions:
We developed and validated a phenomapping strategy and risk score for individuals with ADHF and differential response to diuretic therapy, which was associated with length of stay and mortality.
Abstract 14867: Examining Effects of a Physical Activity Intervention on Exercise Capacity and Cardiovascular Function Among Patients With Lymphoma and Breast Cancer Undergoing Treatment
Authors: Lucas Alexander R , Costa Juliana , Brubaker Peter H , Mihalko Shannon L , Vaidya Rakhee , Seegars Mary Beth , Jordan Jennifer H , Marshall Alexandra , Via Jeremy O , Franco Robert L , Ladd Amy , Dagostino Ralph , Hundley William G
Published: June 2023

Introduction.
Patients receiving serial outpatient infusion treatment for lymphoma or breast cancer (BC) with potentially cardio-toxic chemotherapeutic regimens may experience declines in left ventricular ejection fraction (LVEF) and exercise capacity. This study sought to determine if a physical activity intervention (PAI) administered during cancer treatment could attenuate deterioration of exercise capacity and LVEF.

Methods.
Across two NCI funded cancer centers, we randomized (2:1) 34 participants to a home-based PAI or healthy living education intervention (HLI) within 6 weeks of initiating curative therapies for stage I-IV Hodgkin’s, non-Hodgkin’s lymphoma, or stage I-III BC (NCT01719562). Training programs were tailored by treatment and functional status and adapted for remote delivery during COVID-19. Exercise capacity was determined via cardiopulmonary exercise test (peak VO
2
[ml/kg/min]) and LVEF (%) was determined by magnetic resonance imaging at baseline, 3, and 6 months. Separate linear mixed-effects regression models controlling for baseline values examined changes in peak VO
2
and LVEF by time and treatment group.

Results.
Demographics were similar between the two arms (PAI vs. HLI, 52.4 [16.3] vs. 56.8 [12.7] years of age [SD]; 69% vs. 75% white; and 57.7% vs. 50% female). Peak VO
2
increased at 3 (+1.15 ml/kg/min [CI: -1.46 - 3.77]) and 6 months (+3.88 ml/kg/min [CI: 0.79 - 6.96]) in the PAI arm, while the HLI arm increased slightly at 3- (+0.67 ml/kg/min [CI: -5.14 - 6.48]) but not 6 months (-0.83 ml/kg/min [CI: -5.99 - 4.33]). LVEF declined slightly at 3 months in the PAI (-2.29% [CI: -4.83 - 0.25]) but not HLI arm (3.05.% [CI: -2.49 - 8.60]), while at 6 months, the PAI arm had returned to baseline LVEF (-0.58% [CI: -4.30 - 3.14]) and the HLI arm declined slightly (-1.76% [CI: -7.23 - 3.71]).

Conclusions.
This pilot RCT suggests the importance and utility of home-based physical activity during cancer treatment in protecting against expected declines in exercise capacity and LVEF. These results

highlight the need for larger randomized trials that examine the effects of lifestyle interventions administered during treatment to improve quality of life and to support long term cardiovascular health in cancer survivors.
Abstract 14888: Arrhythmogenic Right Ventricular Cardiomyopathy-Brugada Syndrome Overlap: A Rare Clinical Entity
Authors: Sanku Koushik , Sriramoju Vindhya , bandarupalli tharun , Ramu Vijay
Published: June 2023

Introduction:
Arrhythmogenic right ventricular cardiomyopathy (ARVC) and Brugada syndrome (BS) are inherited disorders that predispose individuals to arrhythmic sudden cardiac death. ARVC is a heart muscle disorder of intercellular junctions resulting from mutations of desmosomal (DS) genes, often leading to heart failure, and monomorphic ventricular tachycardia (VT). BS is a channelopathy due to sodium channel mutations, usually presenting as polymorphic VT without cardiomyopathy.
Case presentation:
A 35-year-old male with history of migraines presented with syncope resulting in a fall. No family history of arrhythmias or sudden cardiac death. Initial EKG showed wide complex monomorphic VT. Repeat EKG (figure 1), revealed coved ST-segment elevations in V1, V2 consistent with Brugada type 1 pattern.

Emergent coronary angiography was unremarkable, and echocardiogram showed left ventricular ejection fraction of 55-60%, right ventricle (RV) outflow tract proximal diameter measured 3.5cm and normal RV function. An implantable cardioverter-defibrillator (ICD) was implanted for secondary prevention. Device interrogation on follow-up showed 11 shocks for recurrent episodes of monomorphic VT and patient was started on quinidine maintenance therapy. He remained symptom-free on subsequent visits. Genetic testing was positive for DSC2, DSP, and TMEM43 mutations associated with ARVC, but negative for genes associated with BS. Cardiac MRI results are pending.

Discussion:
Our patient has overlapping features of ARVC (genotype and monomorphic VT) and BS (EKG with coved ST elevations in V1, V2). Emerging evidence supports the theory that defects in DS proteins may affect the integrity of voltage-gated sodium channels in cardiac intercalated discs, leading to BS like phenotype.

Conclusion:
ARVC and BS could be related to the same disease spectrum, but further studies are required to understand pathophysiology, to guide treatment decisions.
Abstract 14896: A Study of the Relationship Between Big Five Personality Traits, Ultra-Processed Diet, and Obesity, and Implications for Cardiovascular Disease
Authors: Balhara Maria
Published: June 2023

Introduction:
The incidence of cardiovascular events is progressively higher with ultra-processed food consumption. With 7.5, 13, and 18 weekly servings, cardiovascular disease incidence is 8.1%, 12.2%, and 16.6% (Kouvari, 2021). However, the relationship between Ultra-processed Foods and Big Five personality traits in adolescents is understudied, despite ultra-processed foods now making up over 67% of adolescents' diets (Wang, 2021).

Methods:
The study collected the data for 342 participants aged 14-19 years in Florida, US. Consumption of ultra-processed food intake was calculated using a combined PIE score (Processed Intake Evaluation score, scale 0-100) averaged for different ultra-processed foods. Additionally, we collected data for each participant on personality domains using the Big-5 Inventory (Rammstedt, 2007).

Results:
The mean age of participants was 16.4±0.9 years, with 53% females. The participants’ personality was assessed on five dimensions- Neuroticism, Agreeableness, Conscientiousness, Extraversion, and Openness to new experiences. The ultra-processed food intake did not significantly differ between participants on Neuroticism and Extraversion dimensions and was elevated in high Conscientiousness participants characterized as hardworking and diligent (49.9 vs. 40.6, p<0.01) possibly due to the perceived convenience of ultra-processed food. A significantly lower intake of processed food was associated with participants who demonstrated high Agreeableness, characterized by a willingness to cooperate, empathize, and share (45.3 vs. 52.1, p<0.01). Also, participants with high Openness to New Experiences, characterized by curiosity, creativity, and a range of interests, were significantly less likely to consume ultra-processed foods (43.8 versus 50.1, p<0.01).

Conclusion:
Based on these results, Big Five personality constructs are significantly associated with adolescents' ultra-processed food intake. These findings support the inclusion of Openness and other Big Five personality factors in interventions aiming to curb obesity and ultra-processed food consumption among adolescents to mitigate risk factors and reduce the burden of cardiovascular disease.
Abstract 14926: VT LVAD Score and Survival Free From Ventricular Arrhythmias: The University of Michigan Experience
Authors: Larson John , Gondi Keerthi , Deshmukh Amrish , Cascino Thomas , Ghannam Michael , Bogun Frank , Pagani Francis D , Liang Jackson
Published: June 2023

Introduction:
Ventricular arrhythmias (VA) are a common complication after left ventricular assist device (LVAD) implantation and contribute to increased mortality. The VT LVAD Score was created to help stratify patients into four risk categories: Low Risk, Moderate Risk, High Risk, and Very High Risk.

Hypothesis:
We sought to assess the performance of the VT LVAD score at our institution.

Methods:
Consecutive patients who underwent LVAD placement from 2015-2019 were reviewed. VT LVAD scores were correlated with VA free survival (VA-FS). Only 1 patient was in the low-risk group and was excluded from analysis.

Results:
A total of 237 patients who underwent LVAD implant (age 57.9 ± 14.6 years, 180 male, 89 ischemic cardiomyopathy, 102 with prior VAs, 102 Heartmate 3) were included. Of the 5 variables included in the VT LVAD score, only prior VA was associated VA-FS (HR 3.09[1.89-5.03], p<0.001 (Figure 1A), log rank p=0.003, Figure 1D). There was a significant difference in VA-FS between moderate versus both high and very high-risk groups (p=0.033 and p=0.029 respectively) as well as moderate vs high/very high-risk combined (p=0.041, Figure 1B). The significant difference in VA-FS between moderate vs high/very high-risk score groups persisted among all patients with prior VA (p=0.04, Fig 1C). No other between-group differences in VA-FS were seen (Figure 1B and 1C, p>0.05 for all).

Conclusions:
Patients with a VT LVAD score of high or very high-risk had worse survival free from VA than patients with moderate-risk score, no other between group differences were noted. History of VA is a simple and powerful risk factor for late VA post LVAD.
Abstract 14935: Deep Learning Pipeline for Frailty Screening Using the 12-Lead Electrocardiogram
Authors: Afilalo Jonathan , Zhang Ding Yi , Tiwari Abhishek , Warrick Philip
Published: June 2023

Introduction:
The electrocardiogram (ECG) contains information about age-related changes in cardiovascular physiology, which have been linked with the frailty syndrome.

Hypothesis:
We sought to develop and validate a predictive model leveraging the 12-lead ECG to screen for frailty as defined by a prospective reference standard.

Methods:
We conducted a population-based cohort study using data from the Canadian Longitudinal Study of Aging (CLSA). From 2010-2015, the CLSA enlisted a diverse and multi-ethnic sample of community-dwelling adults 45-85 years of age. Comprehensive phenotyping was performed through interviews at participants’ homes and assessments at data collection sites. Frailty was quantified by the 110-item Frailty Index (FI) Composite, consisting of self-reported comorbidities, blood tests, physical performance tests, body composition tests, cardiovascular and pulmonary tests, cognitive and sensory tests. After dividing our sample into training (80%) and test (20%) sets, we developed an end-to-end deep neural network to predict the FI score based on the 12-lead ECG time series.

Results:
A total of 26,700 ECGs with paired FI scores were evaluated. For classification of FI quintiles, a bidirectional long short-term memory (BiLSTM) neural network with a cross-entropy loss function achieved a 5-fold mean area under the receiver operating characteristics curve (AUROC) of 0.70 and area under the precision-recall curve (AUPRC) of 0.36. Predictive performance was superior for classification of the first (most robust) quintile that had AUROC 0.79 and AUPRC 0.46, and the fifth (most frail) quintile that had AUROC 0.79 and AUPRC 0.56, as compared to the middle quintiles that had AUROC 0.60-0.69 and AUPRC 0.27-0.29.

Conclusions:
Our deep learning model can be used to screen for high or low levels of frailty based on the readily available 12-lead ECG. Additional research is underway to gain insights into other representations of the ECG signal and relative importance of the ECG features.
Abstract 14940: Neonatal Cardiac Mesenchymal Stem Cells Target ERK/MAPK Signaling Pathway to Ameliorate Oxidative Stress and Inflammation in Acute Kidney Injury
Authors: Sinha Anshuman , Boyd Riley M , Mishra Rachana , Ciolak Emily , Chen Ling , Kaushal Sunjay , Sharma Sudhish
Published: June 2023

Introduction:
Failure of multidrug therapy and the multifactorial nature of kidney injury has paved the path way regenerative medicine with over 45 clinical trials using stem cells-based therapy underway. Neonatal cardiac mesenchymal stem cells (nMSC) are one of the most potent stem cells due to their secretome. HYPOTHESIS: SOD2 and anti-inflammatory miRNAs (miR-214 & 95p) in paracrine secretions (secretome) of nMSC provides renoprotection in a rodent model of glycerol-induced AKI.

Methods:
nMSC were generated from neonatal myocardium using enzymatic digestion and antibodies-based selection. Secretome was collected by conditioning nMSCs for 72 hours in serum free basal medium. Human kidney cells (HKC) were used for
in vitro
anti-oxidation assays using cisplatin. THP-1 cells were used for anti-inflammatory assessment. CD1 mice were used for glycerol-induced AKI model. Mice were subjected to AKI via IM glycerol (9mg/kg). nMSC-derived secretome was intravenously administered immediately after, or 4 hours post-glycerol. Blood urea nitrogen (BUN) and creatinine were analyzed in serum. Cell survival/KIM1 was assessed by immunohistology/FACS. Other experiments utilized cisplatin toxicity in HKC.

Results:
Administration of nMSC secretome (5 or 10mg/kg) at the same time or 4-hours post-glycerol administration significantly reduced serum creatinine and BUN in a glycerol induced AKI animal model. Caspase-9 and KIM1 expression was significantly decreased in tubular cells as compared to placebo at a dose of 10mg/kg. KIM-1 was significantly downregulated as compared to placebo following nMSC-secretome administration. Western blot analysis of HKC treated with cisplatin in presence of nMSC-secretome showed significant reduction in NFkb and pERK expression (p<0.05) at 200 μg/ml of nMSC-secretome. IL-8 secretion from macrophages was significantly decreased by nMSC-secretome. Data showing the role of miR-210 in renoprotection will also be shown.

Conclusion:
nMSC and nMSC-derived secretome provide a renoprotective effect in the setting of glycerol-induced AKI. The mechanism of this effect is driven, at least in part, by a reduction in NfκB and pERK related signaling.