bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 18595: Predictors of Prolonged Post-Operative Stay in Patients Undergoing Coronary Artery Bypass Grafting: The Impact of Multi-Disciplinary Quality of Care Protocols, a Single Center Experience From the Middle East
Authors: Aljabery Yazan , Manla Yosef , Thiab Sama , BHATNAGAR GOPAL , Darr Umer
Published: December 2023

Background:
Prolonged postoperative stay (POS) in patients undergoing CABG is associated with increased cost, inefficient utilization of resources, and poor quality of care (QOC). We aim to identify predictors of prolonged POS and evaluate the overtime impact of multidisciplinary team (MDT) QOC protocols on POS at a newly established tertiary care center.

Methods:
A total of 1168 consecutive patients undergoing isolated CABG between 2015-2022 were evaluated. POS was identified as prolonged (>6 days) and short (≤ 6 days). Short vs. prolonged stay groups were compared by appropriate testing methods. Predictors of prolonged POS were determined by multivariable logistic regression. Trends in prolonged POS were determined using Joinpoint Software to calculate the average annual percentage change (AAPC).

Results:
Overall, 44.3% (517/1168) of patients had prolonged POS. Patients in the prolonged POS group were older (59.1±10.5 vs. 56.3± 9.5, P<0.001), more likely females (16.6% vs. 9.7%, P<0.001), and had a higher burden of hypertension (88.1% vs. 81.9%, P=0.004), and diabetes (74.8% vs. 62.7%, P<0.001). The prolonged POS group featured worse ejection fraction, higher serum creatinine, and more frequently required preoperative intra-aortic balloon pump insertion
(Table)
. On multivariable logistic regression, age, female gender, NYHA class ≥II, history of diabetes, preoperative creatinine level, preoperative EF, and preoperative IABP placement were independent predictors of prolonged POS
(Figure A)
. Between 2015-2022, more QOC protocols were initiated, with a 67% relative reduction in the proportion of patients with prolonged POS (85.7% to 28.3%), with an AAPC of -12.8, 95% CI [-16.3, -9.2], P<0.001
(Figure B).

Conclusion:
Initiating MDT QOC protocols was associated with a reduction in POS among patients undergoing CABG. Identifying predictors of prolonged POS can help in timely planning of milestones aimed at eliminating unnecessary POS.
Abstract 18597: Is Sleep Disordered Breathing Optimized in Patients With Bradycardic Rhythm Disorders Prior to Pacemaker Implantation? - A Retrospective Observational Study and a Quality Improvement Project
Authors: Rajak Kripa , Halder Anupam , Sharma Gautam Seema , Amirian Aslan , Calderon Barahona Gabriela , Bobrysheva Hanna , Wert Yijin , Atrash Anas , Ramesh Navitha
Published: December 2023

Introduction:
Obstructive sleep apnea (OSA) is associated with cardiovascular (CV) morbidity and mortality ranging from asymptomatic bradycardia to sudden death. Studies have shown that sleep-related bradyarrhythmias, decrease with continuous positive airway pressure (CPAP) and are unlikely to develop symptomatic bradycardia in the long-term. AHA/ACC/HRS recommends to evaluate and treat suspected or documented conduction disorder during sleep including patients who have received or are being considered for permanent pacemaker (PPM).

Objective
We aim to examine the number of sleep studies and CPAP performed and address the barriers of under-diagnosis and treatment with post intervention quality improvement initiative.

Methods:
We performed retrospective analysis of patients >18 years admitted for elective PPM placement from 01/10/2021-01/01/2023. Categorical variables were reported as number and percent and numerical variable was reported as mean. Multiple logistic regression was used to identify predictors for compliance and sleep study prescription. All statistical analyses were performed with SAS software, version 9.4.

Results
Of 423 patients, mean age was 78.1 years, 56.50% were males, 96.9% were Caucasians and mean BMI was 30.1 kg/m
2
. Only 34.75 % (N= 147/423) received sleep study. 93.2% (N=137/147) were diagnosed with OSA and 82.9% (N=122/137) were treated with CPAP. Only 63.1% were compliant with CPAP. Males were more complaint with CPAP [OR 3.13 (95% CI 1.36-7.18, p=0.0072)]. Mean BMI at OSA diagnosis was 33.7 kg/m
2
and 30.1 kg/m
2
at PPM implantation. Weight loss was noted but most patients remained obese. Males, age ≥80 and obesity were significant predictors to get sleep study. After study outcomes, we adopted a standardized algorithm for risk assessment, incorporated EHR reminder and educated doctors. The intervention is currently ongoing.

Conclusion
Data on underutilization of sleep study helped us to work with administration to produce a protocol for screening high risk patients. Treating sleep apnea not only alleviates apnea-related symptoms but also improves CV outcome by avoiding unnecessary pacemaker implantation and minimizing unnecessary health care cost. If effective, this strategy can be a model for other hospitals.
Abstract 18625: Mechano-Transcriptomic Interaction Mediates Spatial Variations in Early Vascular Fibrosis
Authors: Roustaei Mehrdad , Cavallero Carmen S , Cho Jae Min M , Vu Khoa N , Hsiai Tzung K
Published: December 2023

Background:
The spatiotemporal variations of wall shear stress (WSS) modulate vascular genomics and function. Despite the advances in imaging modalities and computational modeling, the link between local hemodynamics and genetic pathways underlying atherosclerosis development remains elusive. We hypothesized that differential WSS patterns in the aorta modulate fibroblast gene expression in response to high fat diet (HFD) leading to vascular stiffness.

Methods:
We performed ultrasound-based 4-D+time moving boundary computational fluid dynamics (CFD) on the aorta of
Ldlr
-/-
mice fed a normal diet (ND) or HFD during 4 weeks. B-mode images (Vevo 3100) of the aortic arch were used to reconstruct a 3-D model of the lumen structure by revolving the vessel wall around the centerline in the aorta and the branches. Computational domain reconstruction was followed by image registration to generate a moving boundary model. WSS contours and velocity profiles were acquired by solving Navier-Stokes equations using svFSI code. The longitudinal strains along the outer curvature of the aortic arch over several cardiac cycles were measured, and the changes were compared with the effects of HFD. Mouse aortas were processed for single cell RNA sequencing and analyzed using the Scanpy package.

Results and Conclusion:
Our analysis of transcriptomics profiles revealed increased Acta2 and Postn expression in the myofibroblast subclusters, suggesting myofibroblast differentiation in response to HFD in the aortic arch. This was confirmed and localized to the lesser curvature of the aortic arch through Periostin immunostaining. We found that the increase in Postn and Acta2 is associated with reduced arterial strain or increased arterial stiffness measured in the aortic arch. In parallel, CFD analysis demonstrated that an elevated WSS along the outer curvature vs. low WSS and disturbed flow along the inner curvature in early diastole results in differential gene expression to regulate myofibroblast differentiation and modulates vascular stiffness.
Abstract 18626: Cardiac Malformations in a Pheochromocytoma and Paraganglioma Syndrome: Reconsidering the Origins of Structural Cardiovascular Disease
Authors: Nazari Matthew A , Rosenblum Jared S , Wang Herui , Sirajuddin Arlene , Bradley Andrew , Cole Yasemin , Jha Abhishek , Arai Andrew E , Pacak Karel , Zhengping Zhuang
Published: December 2023

Introduction:
Structural cardiovascular (CV) disease and heart failure in patients with pheochromocytoma/paraganglioma is thought to develop from catecholamines and hypertension. A syndrome of polycythemia, catecholamine-releasing paragangliomas, and resultant hypertension caused by pathogenic mosaic variants in
hypoxia-inducible factor 2-alpha (HIF2A
or
EPAS1
) was described.

Hypothesis:
We hypothesized this syndrome may have both developmental and secondary causes of structural CV disease.

Methods:
We evaluated CV structure and function in syndromic patients (n=10), hypertensive pheochromocytoma patients without a known syndrome (n=29), and polycythemic patients (n=29) using cardiac magnetic resonance imaging (MRI) and contrast-enhanced computed tomography (CT) and compared their findings to normal volunteers. We also evaluated the mouse model via vascular casting and subsequent micro-CT or
ex vivo
14 tesla MRI at embryonic, post-natal, and adult stages. We tested affected tissue from the mouse model for the genetic variant.

Results:
Compared to normal volunteers, hypertensive pheochromocytoma, and polycythemic patients, syndromic patients had enlarged left and right atrial appendages relative to respective atria (LAA/LA ratio 0.18 ± 0.04 p<0.001; RAA/RA: 0.20 ±0.10 p=0.005) [
Table
]. We observed similar abnormalities in the mouse model and confirmed the genetic variant in the affected cardiac tissue (
Figure
).

Conclusions:
This study identifies a signature for distinguishing primary from secondary causes of CV disease in patients with pheochromocytoma and paraganglioma using an atrial appendage to atrial volume ratio.
Abstract 18640: Universal Interpretation of Electrocardiograms as Plain Language Using Deep Learning
Authors: Vaid Akhil , Nadkarni Girish N
Published: December 2023

Introduction:
Deep learning models have shown promise in diagnosing diseases using electrocardiogram (ECG) data. However, each condition currently requires a separate model, which increases computational burden and operational complexity while decreasing overall clinical utility.

Objective:
Development of a unified modeling approach that allows for the interpretation of any ECG as plain language.

Methods:
We extracted ECG data from five facilities within the Mount Sinai Health System in New York City using the GE MUSE system. These data contained raw ECG waveforms, as well as cardiologist-confirmed diagnoses situated as plain language. Waveform data were plotted to images, and available diagnoses were allotted unique identifiers using Natural Language Processing. We also considered echocardiographically derived parameters such as left ventricular ejection fraction, valvular disease, and hypertrophic cardiomyopathy which were available for a subset of these patients as additional diagnostic endpoints to create a list of diagnoses per ECG.We created an end-to-end transformer based neural network consisting of a pre-trained vision transformer for extracting features from the ECG joined to a generative transformer for predicting associated diagnostic text. Model performance was evaluated by checking for concordance between predicted and actual diagnoses.

Results:
A total of 8.5 million ECGs were used for pre-training the feature extracting vision transformer. A total of 152 diagnoses were embedded with this corpus of data within the ECG file. We analyzed 406,000 echocardiogram reports to generate additional diagnostic labels for pathologies mentioned above. The model correctly predicted all diagnoses for 86.7% cases, and at least one correct diagnosis for 96.2% cases.

Conclusions:
A unified deep learning model can effectively interpret a broad range of disease conditions from ECG and echo data. Such an approach can speed up physician workflows, and allow for easier screening for conditions not normally diagnosed from the ECG. Future work will focus on extending the vocabulary of the model.
Abstract 18643: An Index to Measure Inequity-Health Equity Index for Guideline Directed Medical Therapy Among HFrEF
Authors: Yan Xiaowei , Shen Zijun , Lane Rashon , Azar Kristen
Published: December 2023

Background:
Heart failure affects 6.2 million adults in the US with 50% five-year mortality. Effectiveness of guideline-directed medical therapy (GDMT), composed by four different medications, has been established to reduce morbidity and mortality for heart failure with reduction ejection fraction (HFrEF), and with strong incremental impact of number of GDMT medications. Despite immense positive evidence, < 5% of patients with HFrEF are on the appropriate target doses of all 4 GDMTs, and there is substantial disparity of GDMT use among race/ethnic groups or socio-economical levels. However, the study to quantify the inequity of GDMT prescription is lacking.

Hypothesis:
Significant inequity exists in the GDMT prescription among HFrEF.

Aims:
We derived a health equity index (HEI) for GDMT prescription for HFrEF patients to provide administrators with an assessment tool for evaluating disparity of GDMT use at a large healthcare system covering diverse geographic areas and population in northern California.

Methods:
HEI for GDMT (3+ GDMT medications) is estimated by ratio of observed-to-expected values. The number of expected patients with 3+ GDMT medication level was derived from a weighted average of subpopulation distribution of the 3+ GDMT prescription for each race/ethnicity and medium income race/medium income level within the population catchment area. Observed 3+ GDMT use was captured from the medication order data in the EHR. HEI > 1.0 represents existence of health inequity. We applied this method to the whole HFrEF population, and then to each of geographic area where the race/ethnicity and medium income level vary significantly.

Results:
Among 45,222 HFrEF patients 24.6% had 3+ GDMTs, varying from 19% to 29% in 6 geographic areas. The HEI for the whole HFrEF population was 1.33. Further analysis revealed that highest disparity occurred at East Bay area (Oakland area) (1.67), serving large proportion of non-Hispanic Black patient population, and lowest at Palo Alto area (1.27).

Conclusion:
HEI for GDMT reflects disparity in receiving adequate care for HFrEF population. Substantial disparity was observed in different geographic areas, implying the priority of delivering equitable care to HFrEF should start with the area with highest disparity.
Abstract 18645: Phenylacetylglutamine Causes a Pathologic Hyperinflammatory State and Enhances Atherosclerosis Through the ß2-Adrenergic Receptor in Diabetes
Authors: huang lu , Zhang Jinyan
Published: December 2023

Background:
Type 2 diabetes (T2DM) affects billions of patients and has a pathophysiologically important inflammatory component. Macrophage plasticity in diabetes is impaired, and remains in a persistent proinflammatory state; yet currently, the cause of the inflammatory state is unknown. Phenylacetylglutamine (PAGln) is an amino acid metabolism end product that rises in T2DM patients and is associated with incident major adverse cardiovascular events. However, the role of PAGln in the inflammatory component of T2DM remains unknown.
Purpose:
Here, we aim to identify blood-based systemic factors for pathologic inflammation status and risk of atherosclerosis as they are highly reproducible at low cost and search for effective and safe agents to attenuate diabetic inflammatory complications.

Methods:
In vivo, phenylacetylglutamine was dissolved in normal saline and injected in mice daily (ip). The levels of PAGln were analyzed by liquid chromatography-mass spectrometry. The effect of PAGln on atherosclerosis progression was analyzed by Ldlr-/- mice, followed by a Western diet feeding for 12 weeks. In vitro, primary mice bone marrow-derived macrophages (BMDMs) and haematopoietic stem cells (HSCs) were treated with phenylacetylglutamine (100 uM) for the indicated time.

Results:
In vivo, increased immune cells and inflammatory macrophages were detected in PAGln-treated mice blood, spleens, bone marrow, and arteries. In vitro, PAGln leads to macrophage M1 polarization. The result of bone marrow transplantation on Ldlr-/- mice further confirmed the effect of PAGln on the central immune system of mice. Besides, the negative effects of PAGln could be rescued by ß-blockers.

Conclusion:
Our study unravels a novel mechanism by which PAGln accelerates atherosclerosis progression and causes pathologic inflammation by activating the ß2-adrenergic receptor. The negative effect of PAGln could be rescued by carvedilol (ß blocker). Thus, our recognition of chronic inflammation in diabetes needs to be revised, and understanding these mechanisms can inform alternative treatment strategies and refine atherosclerosis repair therapies for diabetic patients.
Abstract 18671: Cardiac Magnetic Resonance Radiomics Characterization of Myocardial Extracellular Matrix in Dilated Cardiomyopathy
Authors: Amyar Amine , Nakamori Shiro , Fahmy Ahmed S , Ngo Long H , Ishida Masaki , Nakamura Satoshi , Omori Taku , Moriwaki Keishi , Fujimoto Naoki , Imanaka-Yoshida Kyoko , Sakuma Hajime , Dohi Kaoru , Manning Warren J , Nezafat Reza
Published: December 2023

Introduction:
Current CMR sequences cannot discriminate between different myocardial extracellular space (ECS), including collagen, non-collagen, and inflammation. We sought to investigate if CMR radiomics analysis can distinguish between non-collagen and inflammation from collagen in dilated cardiomyopathy (DCM).

Methods:
132 DCM patients were scheduled for an invasive septal biopsy and underwent CMR at 3T incorporating native and post-contrast T1 mapping and late gadolinium enhancement (LGE). The radiomic features were computed from the mid-septal myocardium, near the biopsy region, on native T1, extracellular volume (ECV) map, and LGE images. Principal component analysis was used to reduce the number of calculated radiomic features to five. These features were then used in a regression model to discriminate between non-collagen and collagen ECS. Biopsy samples were used to quantify ECS, myocardial fibrosis, and inflammation.

Results:
Four histopathological phenotypes were identified as normal (G1, n=20), non-collagenous ECS expansion (G2, n=49), collagenous ECS expansion (G3, n=42), and severe fibrosis (G4, n=21). G2 was associated with the highest risk of myocardial inflammation (65%). While native T1 and ECV provided high diagnostic performance in differentiating G4 (AUC= 0.90 and 0.90), their performance in differentiating between G2 and G3 decreased (AUC= 0.59 and 0.55, respectively). Integration of ECV radiomics provided better discrimination and reclassification between G2 and G3 (AUC= 0.79, net reclassification index 0.83; 95% CI 0.45-1.22, p<0.001). A similar trend was observed with the addition of native T1 radiomics and LGE radiomics.

Conclusions:
The radiomic features extracted from native T1, ECV, and LGE provided incremental information that may improve our capability to discriminate non-collagenous ECS from collagen and could be useful for detecting subtle chronic inflammation in DCM patients.
Abstract 18692: Relationship Between Fasting Time on Ketogenic Diet and Myocardial Glucose Suppression in Patients Referred for Cardiac Sarcoidosis Evaluation on FDG-PET Imaging
Authors: Bhattaru Abhijit , Vidula Mahesh K , Selvaraj Senthil , Rojulpote Chaitanya , Bravo Paco E
Published: December 2023

Introduction:
FDG-PET imaging is standard for assessing myocardial inflammation for cardiac sarcoidosis (CS). Preparation with the ketogenic diet (KD) is required to suppress physiologic myocardial glucose uptake (MGU), thereby highlighting pathologic MGU. Incomplete physiologic myocardial glucose suppression (MGS) continues to limit FDG-PET. The effect of fasting time (FT) on MSG remains unexplored.
Goal:
To identify if FT is an independent predictor of MGS following a KD in patients undergoing FDG-PET imaging.

Methods:
We prospectively included 442 consecutive patients (59.2 ± 10.9 yrs, 39% female, 55% white) who underwent 590 FDG-PET scans for the evaluation of CS after following a KD at our institution between 2021 and 2023. Time from last meal to FDG injection was documented in all patients. Serum BHB levels were measured in 516 scans. FDG PET images were classified as 1) diagnostic (complete MGS) when there was either no MGU (negative) or multifocal uptake (positive), or 2) nondiagnostic (incomplete MGS) when there was either diffuse left ventricular or nonspecific uptake.

Results:
The KD was followed for 1, 2 or ≥3 days in 127 (22%), 61 (10%), and 402 (68%) of cases respectively. FDG-PET scans were interpreted as the following: 436 (74%) negative; 109 (18.3%) positive; 13 (2.2%) diffuse; 32 (5.4%) nonspecific uptake. Patients on the KD for only 1 day had higher rates of MGS with increased FT (β = 0.33 ± 0.11, p <0.01); this correlation did not hold true for patients on KD for 2 days (β = -0.005 ± 0.09, p = 0.96) whereas, patients on the KD for 3 or more days showed lower rates of MGS with increased FT (β = -0.18 ±0.07, p<0.01) (
Figure 1
). When adjusting for BHB level, the correlation between MGS and FT held true (1 day: β = 0.35 ± 0.13, p <0.01; 2 days: β = 0.26 ± 0.28, p = 0.35; 3 days: β = -0.17 ± 0.07, p = 0.02).

Conclusion:
Fasting time appears to be most beneficial in patients following the KD for 1-day only. Patients following the KD for 2 days or longer may not require overnight fasting.
Abstract 18707: Concomitant Occurrence of Takotsubo Cardiomyopathy and Posterior Reversible Encephalopathy Syndrome: An Uncommon Encounter With Shared Pathophysiology
Authors: Gudiwada Mohan Chandra Vinay Bharadwaj , Treminio Quezada Miguel , Lukan Abdulkareem , Singh Pooja , Sahni Ankit , Baddi Ajay
Published: December 2023

CASE PRESENTATION:
A 61-year-old African American woman presented in an unconscious state after a seizure. She was febrile, tachycardic, tachypneic alongside elevated lactate, leukocyte counts, and procalcitonin levels. Initial high-sensitivity troponin I was notably raised at 4,217 ng/l, with ekg revealing a new onset left bundle branch block (LBBB). Patient was intubated and needed pressor support. Echocardiogram revealed hypokinesis in the basal-mid left ventricle, with a significantly decreased ejection fraction (EF) of 40%. Chest imaging showed a consolidation in the left lower lobe, and Hemophilus influenzae was identified in the sputum culture. A subsequent lumbar puncture yielded elevated leukocytes and proteins, suggesting a secondary meningitic process.

DISCUSSION:
She was started on antibiotic therapy for pneumonia and meningitis. LV hypokinesis was thought to be due to Takotsubo cardiomyopathy (TTC) or myocardial infarction. Although uncommon LBBB can be seen in TTC. Her clinical presentation, echocardiogram findings further points her LBBB and troponinemia towards TTC than Myocardial infarction. Patient was managed conservatively. Neuroimaging later on revealed restricted diffusion in bilateral occipital and parietal lobes, consistent with Posterior Reversible Encephalopathy Syndrome (PRES). A delayed coronary angiogram after clinical stabilization ruled out obstructive atherosclerotic disease. Weakness and ataxia improved over the course. EF at discharge was 80%.This case illustrates the possibility of concomitant TTS and PRES, conditions hypothesized to arise following intense physical or emotional stress, in this case, likely triggered by pneumonia and meningitis. This clinical scenario underscores the importance of awareness and understanding of these two entities and their potential for simultaneous presentation, providing valuable insights for clinical decision-making in such complex cases.
Abstract 18731: Connexin 43 Hemichannels Contribution to Ischemia-Reperfusion-Induced Hyperpermeability
Authors: Burboa Pia , Duran Walter , Lillo Gallardo Mauricio A
Published: December 2023

Introduction:
Ischemia-reperfusion (I-R) injury is a significant complication in vascular surgery or organ transplantation. I-R injury involves intracellular Ca2+ overload, nitric oxide (NO), oxidative stress. I-R injury increases endothelial vascular hyperpermeability leading to tissue edema and damage mediated by endothelial Ca2+ increase. The role of Ca2+ permeable channels in I-R is not defined. Connexin (Cx) proteins form hemichannels, allowing the exchange of molecules between intracellular and extracellular spaces. The Cx43 isoform is highly expressed in endothelial cells (EC). Endothelial Ca2+ increase promotes NO-dependent Cx43 S-nitrosylation. However, whether Cx43 hemichannels are involved in I-R-induced hyperpermeability is unknown.

Hypothesis:
VEGF-induced hyperpermeability causes increased NO-mediated Cx43 S-nitrosylation and opening of endothelial Cx43 hemichannels, leading to Ca2+ entry and exacerbating reperfusion damage.

Methods:
We used VEGF as I-R related pro-inflammatory agonist. Using primary cultures of mesenteric endothelial cells, we tested Cx43 hemichannel activity by ethidium uptake and Ca2+ influx with Fluo-4 indicator. We evaluated hyperpermeability in vitro and in vivo

Results:
Results indicate that VEGF stimulation increased hemichannel activity in EC, associated with a rapid rise of Ca2+ influx. Both hemichannel activation and Ca2+ increase were abolished by treatment with specific Cx43 blocker (Gap19) or blocking NO production with NG-monomethyl-L-arginine (LNMMA). Cx43 inhibition blunted VEGF-induced hyperpermeability both in vitro in primary EC culture and in vivo mouse mesenteric vascular bed. To further understand the participation of NO-mediated S-nitrosylation in the VEGF-induced hyperpermeability, we replaced cysteine 271 by serine to create a Cx43C271S mouse that fails to cause S-nitrosylation of Cx43. We demonstrated that this knockin mouse exhibits a decrease in VEGF-stimulated hyperpermeability in vivo.

Conclusions:
These results indicate that Cx43 hemichannels activation is critical to VEGF (I-R inflammatory environment)-induced hyperpermeability and the S-nitrosylated Cx43 is a key regulator in I-R damage. AHA support: # 932684 and #23DIVSUP1054931
Abstract 18753: Dynamic Phenotypic Transition of Smooth Muscle Cells During Human Ascending Thoracic Aortic Disease Progression: From Compensation in Aortic Aneurysm to Decompensation in Aortic Dissection
Authors: Li Yanming , Zhang Chen , Vasquez Hernan , Li Yang , Chakraborty Abhijit , Rebello Kimberly , Xu Samantha , Zhang Lin , Sawada Hisashi , Zhou Zhen , Chen Rui , li yumei , Saeys Yvan , eisenberg steven , Lu Hong S , Cassis Lisa A , Coselli Joseph S , Daugherty Alan , Milewicz Dianna M , Shen Ying H , Lemaire Scott A
Published: December 2023

Introduction:
Although ascending thoracic aortic aneurysm (ATAA) and ascending thoracic aortic dissection (ATAD) share common pathologic features of aortic degeneration, the specific elements that lead to rapid disease progression in ATAD remain poorly understood. We examined the molecular and cellular dynamics in smooth muscle cells (SMCs) of aortic tissues from ATAA and ATAD patients and further examined mechanisms in a mouse model.

Methods:
Single-cell RNA sequencing (scRNA-seq) analyses were performed in ascending aortic tissues from individuals without aortic disease (n=8), patients with ATAA without dissection (n=9), and patients with acute ATAD (n=9). Further, scRNA-seq and scATAC-seq were performed in ascending aortic tissues from mice infused with angiotensin II (AngII) or control mice; scRNA-seq analyses were performed on SMC-specific
Tgfbr2
-/-
mice.

Results:
Six SMC subtypes were identified in human aortic tissues. Cluster proportion and trajectory analyses indicated a profound SMC transition from contractile in control to extracellular matrix (ECM)-contractile phenotype in ATAA, however, was reduced in ATAD tissues. Instead, ATAD showed significant SMC transition to inflammatory phenotype. Consistently, many genes in ECM organization and muscle contraction, collectively termed compensatory response, were upregulated in ATAA but downregulated in ATAD tissues compared with controls, whereas inflammatory response and cell death pathway genes were significantly upregulated in ATAD compared with control and ATAA tissues. Cell-cell interaction, regulatory network, and motif analysis suggested that TGF-beta-MEF2C signaling contributed to the induction of the ECM-contractile SMC phenotype. MEF2C
+
SMCs exhibited the capacity of transition towards ECM-producing SMCs in both mouse and human aorta. SMC-specific
Tgfbr2
-/-
mice showed compromised SMC transition to ECM-producing phenotype.

Conclusions:
Our study reveals SMC phenotypic transitions to ECM-producing SMCs in ATAA and to inflammatory and pro-death SMCs in ATAD, which represent a compensatory response in ATAA and a decompensatory status in ATAD. TGF-beta-MEF2C, a novel regulatory axis, promoted the compensatory response in SMCs of the ascending aorta.
Abstract 18771: Gender, Geographic and Subspeciality Differences in Mentorship in Cardiology: Results of the Global Mentorship Survey
Authors: Cader Aaysha , Gulati Martha , Burgess Sonya , Oliveros Estefania , Robledo Kristy , Alasnag Mirvat , Park Ki , Castelletti Silvia , rao sarita Y , Morice Marie-Claude , Ortega Rebecca , Mehran Roxana , Banerjee Shrilla
Published: December 2023

Introduction:
Mentorship is valued among cardiologists for career advancement globally.

Hypothesis:
We investigated differences in mentorship characteristics, trends and needs based on gender, continent of practice and cardiology subspeciality.

Methods:
An anonymous online survey was distributed globally to cardiologists, current and prospective cardiology trainees, collecting demographic data, mentoring experiences and best mentorship practice. Categorical variables were compared by Pearson's Chi-squared test.

Results:
A total 1210 responses, 51% women, 49% men, 0.3% non-binary, with most (33%) from Europe. 57% received mentorship, with no gender differences. Australians (82%) and North Americans (68%) were most likely to receive mentorship, South Americans (43%) and Africans (42%) least likely. Access to mentorship was the most common challenge (70%). Most valued mentor characteristics were trustworthiness, supportiveness and constructive feedback. Mentor ethnicity was deemed irrelevant by majority. More women than men considered their mentors’ gender relevant and placed more importance on work-life balance (p=0.03) and mentoring in pregnancy (p<0.001). Among mentee objectives, professional networking & resource-sharing were most important goals for both genders. Skill development via mentorship was important for both genders but more proceduralists valued this compared to non-proceduralists (53% vs 47% p=0.03). Lack of dedicated time, lack of training/understanding of mentorship and poor communication were key barriers to effective mentorship in both genders. More women than men considered gender differences as a barrier to good mentorship (10% vs 4.4%, p<0.001), Australians and Europeans perceived lack of time, North Americans perceived lack of goal-setting and failure to sponsor as barriers. There was global interest in a mentorship training programme, more among women than men (95% vs 89%, p<0.001).

Conclusions:
Mentorship is a valued for career and professional development, despite global variations in access to mentors. Most female cardiologists felt mentorship was beneficial to advise work life balance and during pregnancy. Mentoring training needs to be made available globally within cardiology.
Abstract 18780: Prognostic Value of Cardiovascular Magnetic Resonance Feature Tracking Strain in Patients With Suspected Cardiac Sarcoidosis
Authors: Guo Yugene , Chhikara Sanya , Bawaskar Parag , Athwal Pal , Markowitz Jeremy , Von Wald Lisa , Roukoz Henri , Shenoy Chetan
Published: December 2023

Background:
Cardiac sarcoidosis (CS) is associated with a high risk of ventricular arrhythmia (VA) and heart failure (HF). Cardiovascular magnetic resonance imaging (CMR) is often used for the diagnosis and prognostication of suspected CS. Small studies have shown promise for ventricular strain as a marker of adverse outcomes in suspected CS.

Aim:
We aimed to investigate the prognostic value of CMR global longitudinal strain (GLS) in patients with suspected CS.

Methods:
Using a retrospective cohort design, we studied consecutive patients with histologically proven sarcoidosis who underwent CMR for the evaluation of suspected CS from 2004 to 2021. Feature-tracking GLS was assessed for the left and right ventricles (LV and RV). Kaplan-Meier and Cox proportional hazards regression analyses were used to determine the association between GLS, and VA and HF composite endpoints.

Results:
Among 557 patients (mean age 54 years, 47% women), the median LVGLS was -14.8% and the median RVGLS was -16.2%. Over a median follow-up of 5.8 years, 39 patients reached the VA endpoint, and 63 reached the HF endpoint. On Kaplan-Meier analyses, patients with either LVGLS or RVGLS worse than the median had a higher estimated cumulative incidence of both endpoints compared with patients with GLS better than the median (log-rank P<0.001 for all comparisons). On multivariable regression analyses, LVGLS was not associated with the VA endpoint [hazard ratio (HR) 0.93 per 1% worsening; 95% confidence interval (CI) 0.83-1.05; P=0.25], but RVGLS was independently associated (HR 1.13 per 1% worsening; 95% CI 1.02-1.25; P=0.015) in a model that included the extent of late gadolinium enhancement (LGE) and the presence of the high-risk CMR phenotype. Neither LVGLS (HR 1.08, 95% CI 0.98-1.12; P=0.11) nor RVGLS (HR 1.04, 95% CI 0.96-1.13; P=0.31) were independently associated with the HF endpoint in a model that included age, pulmonary hypertension, and the high-risk CMR phenotype.

Conclusions:
In patients with suspected CS, RVGLS was independently associated with long-term VA but not HF outcomes, while LVGLS was not independently associated with either. Research is warranted into the role of CMR RVGLS to aid clinical decision-making regarding implantable cardioverter-defibrillators.
Abstract 18784: Impaired Left Atrial Strain is a Risk Factor for New-Onset Atrial Fibrillation
Authors: Sherer Jason , Dahan Shani , Plakht Ygal , Al-Alusi Mostafa , Khurshid Shaan , Lubitz Steven A , Ellinor Patrick T , Van Kampen Antonia , Hung Judy
Published: December 2023

Introduction:
Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting millions of individuals. Left atrial (LA) strain, a measure of LA function and remodeling, holds potential as a prognostic indicator for AF development. We aimed to examine whether LA strain is associated with new onset AF.

Methods:
We performed a nested case-control study within an electronic health record-based longitudinal cohort of primary care patients from a multi-institutional healthcare system spanning 2001 to 2018. Cases included patients who developed new-onset AF during a follow-up period of 7.3 years and had undergone transthoracic echocardiography (TTE) within three years of the follow-up start. Several LA strain parameters were compared between the case and control groups, including Peak Atrial Longitudinal Strain (PALS), Left Atrial Conduit Strain (LACS), and Peak Atrial Contraction Strain (PACS).

Results:
The study included 216 patients who developed AF during follow-up each matched with a corresponding age- and sex-matched control without AF. The AF group had significantly lower PALS (25.9 ± 8.9 vs. 34.3 ± 10.4, p<0.001) and LACS (13.6 ± 5.2 vs. 19.9 ± 7.6, p<0.001) compared to the non-AF group. Subgroup analyses of AF patients, stratified by the time to AF development, revealed more substantial differences between the AF and non-AF groups when the initial TTE was conducted closer to the onset of AF. Specifically, when the TTE was performed within 2 years prior to AF onset, the disparities in LA strain parameters were more pronounced compared to TTEs conducted between 2-5 years prior or beyond 5 years prior to AF onset.

Conclusions:
Impaired left atrial strain is strongly associated with new-onset AF, particularly when measured 2 years prior to AF onset, indicating a higher risk of developing AF in the near future. Incorporating LA strain assessment into clinical decision-making can enhance the evaluation of individuals at risk for AF.
Abstract 18785: Prognostication of Neurological Outcomes in Cardiac Arrest Patients Based on Novel Serum Biomarkers
Authors: Maqsood Hamza , Abbas Fakhar , Jumani Laraib , Munir Maryam , Gulraiz Azouba , Raza Samina , Wazir Momna , Noor Nabeeha , Mehmood Saad , Saleem Hamza , Neelam FNU
Published: December 2023

Introduction and Hypothesis:
Patients with post-cardiac arrest syndrome (PCAS) rely on precise and timely diagnosis for good clinical outcomes. Our study sought to evaluate novel serum parameters' diagnostic and clinical efficacy in prognosticating neurological outcomes in post-cardiac arrest syndrome patients.

Methods:
345 patients with cardiac arrest treated with target temperature management were enrolled in this retrospective, multicenter study. Blood samples were drawn and evaluated at a period of 0, 1, 2, and 3 days. Samples were analyzed for conventional biomarkers; S100 calcium-binding protein (S-100B) and neuron-specific enolase, and for novel biomarkers; ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), glial fibrillary acidic protein (GFAP), neurofilament light chain (NFL), and tau load. Patients were followed up for neurological outcomes over 6 months period

Results:
328 patients completed the study in which the mean age was 68.4 years, and 23% were female. Normal values for NFL, UCH-L1, and tau proteins showed the highest sensitivity (91.8-96% of patients with poor neurological outcomes had abnormal values) and negative predictive value (90-94.5% with good neurological outcomes had normal values). Overall, all the novel biomarkers had independent statistically significant values for the diagnosis of clinical outcome (p<0.005). The area under the curves of the novel serum biomarkers was highest at 72 h post-cardiac arrest (0.913 for NFL, 0.88 for tau, 0.961 for GFAP, and 0.947 for UCH-L1).

Conclusions:
Our study concluded that low levels of novel serum biomarkers are associated with good neurological outcomes. The reliability of these novel biomarkers highlights that they should be included in baseline laboratory investigation for better prognostication of neurological outcomes in patients with PCAS.
Abstract 18787: Rural Intervention for Caregivers’ Heart Health: A Randomized Controlled Trial
Authors: Moser Debra K , Kang JungHee , Song MinKyoung , Chung Misook L
Published: December 2023

Background:
Informal caregivers are at greater risk for cardiovascular disease (CVD) than non-caregivers. This risk is higher for older caregivers who often have chronic illnesses, especially those living in a rural environment. Yet caregivers, particularly rural caregivers, are usually “hidden patients” in a caregiver-patient dyad as they commonly ignore their own health. We developed a CVD-risk reduction intervention (RICHH) that promoted self-care in the context of the demands of caregiving. Our aims were to test the impact of RICHH on adherence to CVD risk reduction behaviors and to determine whether age moderated intervention effects on outcomes.

Methods:
Rural informal caregivers (N=311; 76% female, age=55±14 years) at CVD risk were randomized to intervention or usual care groups. The intervention group completed a 12-week self-care intervention using video conferencing. Outcomes were assessed at 4 and 12 months. Adherence to CVD risk reduction behaviors and adherence to healthy diet was assessed using the Medical Outcome Scale-CVD Specific Adherence Scale and the Healthy Eating Index-2015 (HEI). Piecewise linear mixed-effect modeling determined intervention effects and age moderation.

Results:
Compared to the usual care group, adherence to CVD risk reduction behaviors increased in intervention at 4 months (b = 2.02, p < 0.001), and the improvement was maintained at 12 months (b = 4.17, p < 0.001; Figure). Total diet quality was improved in intervention versus control at 4-months (b = 0.95, p < 0.001) and was maintained at 12 months (b = 3.05, p = 0.024). Consumption of fruits, vegetables, and whole grains increased in intervention, while intake of sugar and saturated fats decreased. Age did not moderate intervention effects.

Conclusion:
The intervention was effective in improving adherence to CVD risk reduction behaviors, including heart-healthy eating, regardless of caregiver age, showing its effectiveness for all ages of caregivers.
Abstract 18794: Relationships Between Sex and Size and Morbidity and Mortality Among Patients Undergoing Cardiovascular Procedures
Authors: Birkmeyer Nancy J , Dauerman Harold L , Hassan Ansar , Devries James T , Ross Cathy S , Westbrook Benjamin M , Klemperer John D ,   the Northern New England Cardiovascular Disease Study Group
Published: December 2023

Background.
Recent large studies reported improvements in outcomes of cardiovascular procedures over time but have not benefited women.

Objective.
To explore the role that smaller physical stature may play in explaining differential outcomes of these procedures among men and women.

Methods. We used regional data (2003-17) to examine differences in in-hospital complications (bleeding, infection, stroke, low output failure, respiratory failure, RF), mortality and long-term survival among men and women of different body surface area (BSA) categories (<1.6, 1.6-1.7, 1.8-1.9, >=2) undergoing PCI (n=97,205), isolated CABG (27,128), or valve (17,414) while controlling for baseline age, comorbidity, disease severity, and year.

Results.
Smaller size was associated with worse outcomes among both men and women. In-hospital mortality rates were highest among the smallest men for CABG (5.1% versus 1.8% in largest men (OR=3.1; 95%CI=1.5-6.5; p=0.002)) and PCI (2.4% versus 1.1% (OR=2.5; 95%CI=1.4-4.3; p=0.002)) but not valve where smallest women had the highest mortality (9.3% versus 4.6% in the largest men (OR=2.3; 95%CI=1.7-3.2; p<0.001)). In-hospital complications were highest among smallest men for CABG (18% versus 13% (OR=1.5; 95%CI=0.9-2.3; p=0.100)) and valve (29% versus 26% (OR=1.2; 95%CI=0.7-2.1; p=0.502)) but highest among smallest women for PCI (5.9% versus 2.4% in the largest men (OR=2.7; 95%CI=2.3-3.1; p<0.001)). Long-term survival was worst among smallest men for CABG (HR=2.0; 95% CI=1.5-2.7; p<0.001) and PCI (HR=1.9; 95% CI=1.7-2.2; p<0.0001). Bleeding complications were significantly higher in smaller men (3.4% versus 1.6% (OR=2.2; 95%CI=1.4-3.6; p=0.001)) and women (4.8% versus 1.6% (OR=3.2; 95%CI=2.8-3.8; p<0.001)) undergoing PCI.

Conclusions.
Peri-operative devices and/or processes of care better tailored to the size of the patient might help to improve outcomes of cardiovascular procedures among women as well as smaller men.
Abstract 18805: Large-Scale Genome-Wide Association Study of Dilated Cardiomyopathy Identifies Genes and Pathways Contributing to Pathology
Authors: Zheng Sean L , Henry Albert , Ware James S , Lumbers Tom ,   HERMES Consortium
Published: December 2023

Introduction:
Dilated cardiomyopathy (DCM) is a primary heart muscle disease that has long been considered a Mendelian disorder, but recent evidence highlights the important role of common genetic variation. Better characterization of the genetic architecture will provide opportunities for improved diagnosis and risk stratification.

Methods:
We performed a GWAS meta-analysis of 14,256 DCM cases and 1,185,671 controls of European ancestry from 16 studies. To improve discovery power, we performed multi-trait analysis of GWAS (MTAG) with three genetically correlated cardiac imaging traits in 36,203 individuals. We performed gene-level burden analysis <0.1% for rare predicted truncating variants (PTV) with minor allele frequency <0.1% in prioritized genes against DCM and quantitative CMR traits in UK Biobank (UKB) and 100,000 Genomes Project (GeL). A polygenic score (PGS) generated using a Bayesian framework was assessed for association with the same outcomes in UKB participants.

Results:
We identified 80 independent genomic loci associated with DCM at a false discovery rate <1% in GWAS or at P < 5 x 10
-8
in MTAG, of which 65 were novel (
Figure
). We prioritized a single high-confidence gene at 61 loci, including established genes for Mendelian cardiomyopathies (
TTN
,
BAG3
,
FLNC
,
MYBPC3
,
FHOD3
,
ALPK3
). Rare variant analysis highlighted novel associations with DCM and quantitative traits for PTVs in
NEDD4L
and
MAP3K7
in UKB that were replicated in GeL. PGS was associated with DCM, with a 4-fold increased risk for those at the top centile compared to the median distribution. Penetrance of rare variants were higher for those in the top quintile of PGS compared to bottom quintile (7.3% vs. 1.7%,
P
<0.005).

Conclusion:
We have performed the largest DCM GWAS, resulting in 80 significant loci (65 novel). We identify novel DCM-causing genes and generate a PGS that associates with DCM and modulates penetrance in carriers of Mendelian disease-causing rare variants.
Abstract 18823: Outcomes With Pulmonary Artery Catheter Use in Cardiogenic Shock Patients
Authors: Thakker Ravi , Sunku Ramya L , Elbadawi Ayman , Iturrizaga Jose , Chatila Khaled , Albaeni Aiham , Jneid Hani , Khalife Wissam
Published: December 2023

Introduction:
Patients presenting with cardiogenic shock (CS) have a high mortality. Pulmonary artery catheter (PAC) is a well-known invasive tool for guiding escalation and de-escalation of treatments for CS patients. Despite this, paucity of data still exists in outcomes of PAC use in this critically ill population. In this systematic review of the current literature, we report outcomes in in-hospital mortality, length of stay (LOS), and mechanical circulatory support (MCS) use among patients with and without PAC implementation.

Methods:
A comprehensive search of the MEDLINE, Cochrane, and EMBASE databases was performed from inception to June 2023. Keywords used were “pulmonary artery catheter”, “PA catheter”, and “cardiogenic shock.” Studies without a control group (no PAC arm) were excluded. The endpoints were in-hospital mortality, LOS, and MCS use. Statistical analyses was performed using chi-squared test and t-test.

Results:
A total of 9 studies were identified for in-hospital mortality, 3 studies for LOS, and 7 for MCS. Among the 166,199 patients with PAC 49,983 died (30%) versus 391,399 among the 1,055,665 patients with no PAC (37%) (P=<0.001). The average LOS among the 2,808 patients with PAC was 3 days versus 10.4 days among the 19,224 patients with no PAC (P=0.09). MCS was used in 51,975 patients of the total 175,838 with PAC (29.6%) versus 323,738 patients of the total 1,179,528 with no PAC (27.4%) (P=0.09).

Discussion:
In this large systemic review we found statistically significant decrease in in-hospital mortality with PAC use. There was a numerical trend towards average LOS being lower among patients with PAC use although not statistically significant. MCS was utilized more in patients with PAC although not statistically significant. Further studies are needed to identify discrepancies in PAC guided treatment of CS patients.