bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 17652: Association Between Ventricular Arrhythmias and Myocardial Fibrosis in Patients With Chagas Disease Without Known Cardiomyopathy
Authors: Gulhar Radhika , Jiang Michael , Hayase Justin , Malik Aneeq
Published: December 2023

Introduction:
Chagas disease (CD) is an important cause of cardiomyopathy, arrhythmias and sudden death. The presence of myocardial fibrosis detected by late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMR) in these patients has been correlated with an increased prevalence of ventricular arrhythmias. The incidence of ventricular arrhythmias in patients with CD without established cardiomyopathy has not been well described.

Hypothesis:
We aim to evaluate if there is an association between LGE on CMR and incidence of ventricular arrhythmias in patients with CD but without cardiomyopathy.

Methods:
Patients treated at a Chagas disease center of excellence were retrospectively analyzed for ambulatory rhythm monitoring (Holter and/or 14-day patch monitor) and CMR data. Significant ventricular arrhythmias were defined as either a PVC burden >/=1% or non-sustained ventricular tachycardia (NSVT) ≥4 beats. A Fisher exact test was used to compare categorical variables.

Results:
There were 191 patients treated between 12/2014 and 8/2022 available for analysis. Of these, 46 patients with CD and no prior history of cardiomyopathy received both ambulatory rhythm monitoring and CMR. There were 16 male and 30 female patients with average age of 52.2 ± 11.5 years, and LV ejection fraction of 58.8% ± 14.2%. Of the 46 patients, 15 (32.6%) were found to have LGE on cMRI while 31 (67.4%) had no evidence of LGE. Within the patients with LGE, 8/15 (53.3%) were found to have significant ventricular arrhythmias. Of the patients without LGE, only 7/31 (22.6%) were determined to have significant ventricular arrhythmias (p = 0.038).

Conclusions:
These data suggest that for patients with CD without cardiomyopathy, the presence of LGE on CMR is independently associated with incident ventricular arrhythmias detected on ambulatory rhythm monitoring. Whether these findings indicate increased risk of sudden cardiac death requires further study.
Abstract 17673: Sudden Cardiac Death as the First Manifestation of Heart Disease
Authors: Chugh Harpriya , Uy-Evanado Audrey , Aziz Habiba , Sargsyan Arayik S , Nakamura Kotoka , Reinier Kyndaron , Chugh Sumeet S
Published: December 2023

Background:
Clinical risk stratification is most challenging in the subgroup of individuals who present with sudden cardiac death (SCD) as the first manifestation of heart disease (SCD-FM) and there is a lack of current era population-based data.

Hypothesis:
Occurrence of SCD-FM SCD differs by ethnicity and access to health care.

Methods:
Consecutive out-of-hospital cases of SCD attended by emergency medical services were ascertained prospectively from a large ongoing population-based study in the Southwest US (population ~ 850K, 2015-2022) using an established multi-source ascertainment and adjudication process. A detailed review was conducted of the lifetime clinical record and available autopsy data, for each individual. SCD-FM cases were defined as SCD with no prior heart disease diagnosis. We calculated annual age-standardized incidence of overall SCD and SCD-FM per 100,000 residents using US census data. Ethnicity-stratified incidence of SCD-FM was calculated. Occurrence of all health care visits prior to SCD was evaluated.

Results:
From a total of 2681 SCD cases (age 71 ± 16, female 35%) age adjusted incidence of SCD was 40[38-41] per 100,000 out of which SCD-FM was 15[14-16] per 100,000 (n=1019 (38%), age 67±18, female 33%). There was no difference in SCD-FM incidence between Hispanic and non-Hispanic residents (15 [13-17] vs 15 [14-17], p=0.84). Individuals younger than 65 yr were more likely to have SCD-FM compared to those older than 65 yr (50% vs 33%, p <0.001). We observed that 91% of SCD-FM had visited healthcare providers and 3% had cardiac evaluations performed.

Conclusion:
A significantly higher proportion of SCD-FM were age <65 but the proportion of SCD-FM did not differ by ethnicity. The vast majority of SCD-FM (91%) underwent health care visits prior to SCD but cardiac evaluations were rare (3%). These findings highlight the need to discover and develop user-friendly, cost-effective pre-screening methods to reduce SCD-FM in the general population.
Abstract 17675: Association Between Obesity and Heart Failure and Related Atrial Fibrillation: Patient-Level Data Comparisons of Two Cohort Studies
Authors: Lee Young Shin , Yang Pil-sung , Jang Eunsun , Kim Daehoon , Yu Hee Tae , Kim Tae-Hoon , Uhm Jaeson , Sung Jung-Hoon , Pak Hui-Nam , Lee Moon-Hyoung , JOUNG BOYOUNG
Published: December 2023

Introduction:
Differences in obesity-mediated association between heart failure (HF) and HF-related atrial fibrillation (AF) among Asians and Europeans was evaluated.

Methods:
Using the Korean National Health Insurance Service-Health Screening (K-NHIS-HealS) cohort and U.K. Biobank, we included 395,173 Korean and 477,214 UK adults aged 40-70 without previous HF who received check-ups. The incidence and risk of HF was evaluated in relation to different body mass index (BMI).

Results:
The proportion of obese individuals was significantly higher in the UK Biobank (24.2%) compared to the K-NHIS-HealS cohort (2.7%, P<0.001). During the follow-up period of 7.3 and 11.7 years, 684 and 3,183 subjects in the K-NHIS-HealS cohort and UK Biobank, respectively, developed HF. The incidence of HF and HF-related AF was higher in the UK than in Korea across all BMI categories, even after age and sex adjustment. For obese individuals, the age- and sex-adjusted incidences of HF were 0.50 and 1.16 in Korea and the UK, respectively. The risk of HF was notably higher in the British population compared to Koreans, with adjusted hazard ratios of 1.81 (95% CI, 1.30-2.53) and 2.20 (95% CI, 1.98-2.45) in obese participants (P for interaction<0.001). After adjusting for clinical variables, a 5-unit increase in BMI was associated with a 52% greater risk of HF-related AF in the UK Biobank cohort (P<0.001), but not in the Korean NHIS-HealS cohort (P=0.275).

Conclusions:
Obesity was associated with increased risk of HF and HF-related AF in both populations. The higher incidence in the UK population was likely because of the higher proportion of obese individuals.
Abstract 17687: Left Ventricular Unloading in Pulmonary Hypertension With Impella 5.5 as a Bridge to Heart Transplantation
Authors: Lee Moses , Jackson Samuel , Watson Andrew D
Published: December 2023

A 59 year-old male with a history of triple-vessel coronary artery bypass graft surgery, ischemic cardiomyopathy with an implantable cardioverter defibrillator, pre- and post-capillary pulmonary hypertension, severe mitral regurgitation, paroxysmal atrial fibrillation, diabetes mellitus, hypertension was referred for transplant evaluation in the setting of cardiogenic shock despite inotropic support. His initial right heart catheterization showed RAP 21 mmHg, RVP 91/9 mmHg, PAP 88/31 mmHg with a mean of 50 mmHg, PCWP 22 mmHg, PVR 6.6 Wood units, SVR 857 dynes, and CO 4.85 l/min/CI 2.59 l/min/m
2
by thermodilution. His hospital course was complicated by acute renal failure requiring continuous renal replacement therapy. Inotropic support could not be weaned on multiple attempts, and pulmonary and wedge pressures remained significantly elevated despite a trial of inhaled nitric oxide. The patient underwent Impella 5.5 placement to assess the hemodynamic response of unloading the left ventricle. A repeat right heart catheterization showed a RAP 1 mmHg, RVP 42/1 mmHg, PAP 48/13 mmHg with a mean of 26 mmHg, PVR 2.3 Wood units, SVR 829 dynes, and CO 6.75 l/min/CI 3.74 l/min/m
2
by thermodilution. Measurements were obtained with Impella 5.5 at P-8 level, milrinone 0.2 mcg/kg/min, treprostinil 4 ng/kg/min, epoprostenol 1 mg every 6 hours, and sildenafil 10 mg in morning and afternoon and 15 mg in evening. The patient underwent successful heart and kidney transplantation. Post-transplantation right heart catheterization showed persistent pre-capillary pulmonary hypertension with normal filling pressures and CI. His pulmonary hypertension was managed with sildenafil 40 mg three times daily and ambrisentan 10 mg daily. This case demonstrates favorable hemodynamic effects of left ventricular unloading using Impella support with significant reduction in pulmonary vascular pressure to reach candidacy for heart transplantation.
Abstract 17689: Distal Ventricular Pacing for Drug-Refractory Mid-Cavity Obstructive Hypertrophic Cardiomyopathy: A Randomized, Placebo-Controlled Trial of Personalized Pacing
Authors: Malcolmson James , Hughes Rebecca , Husselbury Tim , Khan Kamran , Learoyd Annastazia E , Lees Martin , Wicks Eleanor , Smith Jamie , Simms Alexander , Moon James , Lopes Luis , O’Mahony Constantinos , Sekhri Neha , Elliott Perry M , Petersen Steffen E , Dhinoja Mehul B , Mohiddin Saidi A
Published: December 2023

Introduction:
Patients with refractory symptomatic left ventricular (LV) mid-cavity obstructive (LVMCO) hypertrophic cardiomyopathy (HCM) have extremely limited therapeutic options. Hypothesis: We hypothesized that site-specific-pacing would induce regionalized contractile dyssynchrony to reduce LVMCO gradients and improve symptoms.

Methods:
Symptomatic-drug-refractory LVMCO patients were recruited for a randomized blinded trial of personalized prescription of pacing (PPoP). Multiple LV and apical RV pacing sites were assessed during invasive hemodynamic study. Patient-specific optimal pacing site and atrioventricular (AV) delays were selected on basis of LVMCO gradient reduction and pacing parameters. Patients were randomized to 6 months active or back-up pacing in cross-over design. Primary outcome examined invasive gradient change with PPoP. Secondary outcomes assessed quality of life and exercise.

Results:
A total of 17 patients were recruited; 16 met primary endpoints. Baseline NYHA was 3±0.6 despite medical therapy. Hemodynamic effects were assessed during pacing at RV apex and a mean of 8 LV sites (range 4-16). Optimal PPoP was achieved via LV pacing in 14 (88%) patients and RV apex in 2. Mean baseline gradient 80±29 mmHg fell to 31±21 mmHg with PPoP (p<0.0001). Cardiac vein perforation occurred in one case, and 15 patients entered into cross-over; 2 withdrawals occurred during cross-over (myocardial infarction, persistent atrial fibrillation). Of the 13 completing cross-over, 9 (69%) chose active pacing as their preferred setting. PPoP was associated with better 6-minute walking test performance (329±100 vs 286±106 meters, p=0.018); other outcome measures also indicated benefit with PPoP.

Conclusions:
In a randomized placebo-controlled trial, PPoP reduces obstruction and improves exercise performance in severely symptomatic LVMCO patients. A personalized approach to pacing site selection is a key component of this novel therapy.
Abstract 17705: BAG5 Plays a Critical Role in the Regulation of Cellular Oxidative Stress and Heart Function
Authors: Gupta Manish K , Ciccone Pierce , Mukker Avni , Hong Kim , Kimura Yuka , de Lima Isabela Beatriz
Published: December 2023

Introduction:
Molecular chaperone and co-chaperone play important roles in maintaining cardiac function by regulating cellular proteostasis and reducing oxidative stress during hypertrophy. Bcl2 binding proteinBAG5 belongs to Bcl-2 associated anthanogene (BAG) family and acts as a co-chaperone to HSP70. Genetic mutation of BAG5 induces dilated cardiomyopathy and arrhythmia. However, the molecular mechanism of BAG5 in heart function is unclear. In this study, we explore the regulatory role of BAG5 in heart function.

Hypothesis:
We hypothesized that BAG5 is an important Co-chaperone of cardiomyocytes and regulates heart function through the regulation of cellular proteostasis and oxidative stress.

Method:
We have generated adenovirus to overexpress and knockdown the BAG5 protein in cardiomyocytes. Additionally, we have generated BAG5 knockout mice to test the effect of BAG5 deficiency on cardiac function. Further, we have conducted a proteomics study to explore the role of BAG5 in heart function. Additionally, we tested the role of BAG5 in isoproterenol-induced cardiac hypertrophy.

Results:
Our results show that deficiency of BAG5 induces cellular hypertrophy and induction of cellular autophagy. Cardiac function analysis by echocardiography shows that the knockdown of BAG5 compromises heart function. Further, a protein interaction study shows that BAG5 participates in several critical heart signaling, including mitochondrial oxphos and glutathione-mediated regulation of oxidative stress. Additionally, we found that the knockdown of BAG5 worsens heart function during isoproterenol treatment.

Conclusion:
Our study shows a novel function of BAG5 and BAG5 can be exploited in treating cardiac hypertrophy and reducing oxidative stress.
Abstract 17709: ICD-10 Codes Have Low Sensitivity and Suboptimal Positive Predictive Value for Identifying Cases of Pulmonary Embolism With Cor Pulmonale in Electronic Healthcare Records
Authors: Bejjani Antoine , Khairani Candrika D , Lo Ying-Chih , Jimenez David , Barco Stefano , Mahajan Shiwani , Caraballo Cesar , Secemsky Eric A , Klok Erik , Hunsaker Andetta , Aghayev Ayaz , Muriel Alfonso , Hussain Mohamad A , Appah-Sampong Abena , MOJIBIAN HAMID , Lu Yuan , Lin Zhenqiu , Aneja Sanjay , Khera Rohan , Goldhaber Samuel , Zhou Li , Monreal Manuel , Piazza Gregory , Krumholz Harlan M , Bikdeli Behnood ,   PE-EHR+
Published: December 2023

Introduction:
The International Classification of Diseases, 10
th
revision (ICD-10) codes were updated in 2015 to include designation of pulmonary embolism (PE) with
cor pulmonale
. These codes can be advantageous to identify higher-risk patients with PE for research or quality improvement. However, the validity of these codes is unknown.

Methods:
We reviewed patient data from Mass General Brigham (MGB) health system (01/2016-12/2021). Patients were randomly selected from 3 groups: Patients with Principal discharge diagnosis codes for PE, patients with secondary discharge diagnosis of PE, and patients with no PE codes. Accuracy of codes for PE with cor pulmonale were assessed with reference to manual review by 2 independent physicians using pre-specified criteria. Weighted estimates were obtained by considering the total number of hospitalizations.

Results:
1,712 patients were included (age: 60.6±17.8 years, 52.3% female). Chart review found 865 patients with PE, of whom 360 (41.6%) had PE with cor pulmonale according to predefined clinical criteria. Of these 360 PE patients, 358 (99.4%) had ICD-10 codes for PE. However, only in 36 (10.1%) cases, the specific cor pulmonale codes were used. There were 24 additional cases with ICD-10 codes for PE with cor pulmonale in whom the diagnosis was not confirmed per manual review. Sensitivity and specificity for PE with cor pulmonale codes in Principal-or-secondary position were 10.0% and 98.2% (Table, panel A). The positive predictive value (PPV) for PE with cor pulmonale in Principal-or-secondary discharge position was 63.2% in the weighted sample (Table, panel B).

Conclusions:
ICD-10 codes for identification of acute PE with cor pulmonale have excellent specificity, but very poor sensitivity and suboptimal PPV. These results are informative for investigators who may use such ICD-10 codes for research or quality improvement purposes.
Abstract 17726: Nonischemic Cardiomyopathy in Patients With Coronary Artery Disease
Authors: Bawaskar Parag , Thomas Nicholas , Ismail Khaled , Guo Yugene , Chhikara Sanya , Athwal Pal , Ranum Alison , Jadhav Achal , Hooker Abel , Nadkarni Ishan , Frerichs Dominic , Velangi Pratik , Ergando Tesfatsiyon , Akram Hassan , Shenoy Chetan
Published: December 2023

Introduction:
Randomized trials in obstructive coronary artery disease (CAD) have largely shown no prognostic benefit from revascularization. While there are several potential reasons for the lack of benefit from coronary revascularization, an underexplored possibility is the presence of coexisting nonischemic myocardial pathology.

Aim:
We aimed to investigate the prevalence and prognostic significance of nonischemic cardiomyopathy (NICM) in CAD.

Methods:
We studied a large cohort of consecutive patients with obstructive CAD on coronary angiography who had cardiovascular magnetic resonance imaging (CMR) from 2004 to 2020 for clinical indications. CMRs were analyzed for this study for the presence and type of cardiomyopathy. Patients with normal left ventricular ejection fraction and no late gadolinium enhancement (LGE) were classified as having no cardiomyopathy. Ischemic cardiomyopathy (ICM) was defined by ischemic LGE or extensive hibernating myocardium in the absence of LGE. NICM was defined by nonischemic LGE, absence of LGE without hibernating myocardium, or morphological abnormalities of NICM such as left ventricular hypertrophy. The study endpoint was a composite of all-cause death or hospitalization for heart failure.

Results:
Among 3,027 patients (mean age 65 years, 24% women), 18% had no cardiomyopathy, 65% had only ICM, and 17% had NICM. Of those with NICM, 38% also had ICM (dual cardiomyopathy). At a median follow-up of 4.7 years, 1,112 patients experienced the study endpoint. On Kaplan-Meier analysis, patients with NICM had a higher cumulative incidence of the study endpoint compared with no cardiomyopathy and ICM (log-rank P<0.001 for both comparisons). On multivariable regression analyses, NICM was associated with a greater risk for the study endpoint-hazard ratio (HR) 1.77; 95% confidence interval (CI) 1.43-2.19; P<0.001 compared with no cardiomyopathy and HR 1.27; 95% CI 1.09-1.47; P=0.003 compared with ICM, after adjustment for potential confounders.

Conclusions:
NICM was identified in 1 in 6 patients with CAD and was associated with worse long-term outcomes compared with no cardiomyopathy and ICM. In patients with obstructive CAD, coexisting NICM may contribute to the lack of prognostic benefit from revascularization.
Abstract 17729: When Do Black and White Patients Die After Coronary Artery Bypass Surgery: Insights From the United States Veterans Health Administration
Authors: Raghunathan Karthik , Bartholomew Alex , Wackerle Harold , Pepin Marc , Barbeito Atilio , Ohnuma Tetsu , Cobert Julien , JohnBull Eric , Mehta Sachin , Mamoun Negmeldeen , Treggiari Miriam , Grecu Loreta , Krishnamoorthy Vijay , Bartels Karsten , BRYAN WILLIAM E
Published: December 2023

Introduction:
Black patients continue to have disproportionately higher rates of death after Coronary Artery Bypass Graft (CABG) procedures. Data are needed to guide interventions to eliminate inequity. We examine race-related differences in when death occurred after CABG by comparing the proportions of 1-yr mortality occurring within versus after the first 30-days.

Hypothesis:
When compared with White patients, 1-yr mortality after isolated CABG among Black patients is significantly more likely to occur within the first 30-days postoperatively.

Methods:
Using comprehensive death ascertainment files in the most extensive integrated health system in the US, the Veterans Health Administration (VHA), we extracted 30-day and 1-year mortality data after isolated CABG (defined using procedural codes) between January 2006 and December 2015 (follow-up through to December 2016). We classified patients as non-Hispanic Black versus White. We compare 1-yr mortality and the proportions of 1-yr mortality occurring within the first 30-days. We examine trends over the 10-year period.

Results:
Among 14743 White versus 1545 Black veterans who underwent isolated CABG over the 10-year period, 589 versus 85 had died within 1-yr (4% versus 5.5% respectively, p<0.05). The proportions who died within the first 30-days was significantly lower among White when compared with Black veterans, 31.7% versus 36.5%, p<0.05. Over the 10-year period, the difference between races in when patients died grew substantially (Figure) whereas race-related differences in 1-yr mortality decreased (Figure).

Conclusions:
While racial disparities in death after CABG are well known, we present the first study showing differences in when death occurs within 1-yr. Using accurate nationwide data, we found that Black patients who died within 1-yr after isolated CABG increasingly died within the first 30-days.
Abstract 17738: Cardiac MRI vs Coronary Angiography in Stable Coronary Artery Disease: A Head-to-Head Comparison
Authors: Nagpal Sagar , Pokhriyal Sindhu , bhandari Pooja , jbara manar , Patel Suyog
Published: December 2023

Introduction:
Coronary angiography has been the gold standard invasive procedure for diagnosing and treating coronary artery disease (CAD). However, it poses risks and complications. In contrast, cardiac MRI offers non-invasive tools for early detection and diagnosis of CAD, presenting an alternative to angiography with fewer associated risks.

Hypothesis:
Our study aims to investigate if MRI can replace invasive procedures in stable CAD, reducing the need for such procedures while maintaining comparable diagnostic outcomes to coronary angiography.

Methods:
An extensive literature search was conducted, involving PubMed and Google Scholar databases up to February 2023. After careful evaluation, four clinical trials (CARMENTA, CE-MARC, MR INFORM, and MR Impact 2) comparing MRI and angiography in stable coronary artery disease were included in our study. Animal studies, expert opinions, literature reviews, and studies without reported MRI outcomes were excluded.

Results:
In the MR INFORM trial, among 221 patients with significant CMR-detected ischemia, 184 had confirmed angiographic lesions, while 35 did not. There were no significant differences in major adverse cardiovascular events or angina-free status at 1 year between the CMR and angiogram groups. The CE MARC 2 trial involving 752 patients reported a sensitivity of 86.5% and a specificity of 83.4% for multiparametric CMR, with a positive predictive value (PPV) of 77.2% and a negative predictive value (NPV) of 90.5%. The CARMENTA trial demonstrated a significant reduction in invasive coronary angiograms with CMR as the initial evaluation (87% vs. 100%), without significant differences in outcomes or the detection of obstructive coronary artery disease compared to computed tomography angiography. In the MR Impact 2 trial, CMR exhibited a sensitivity of 75% (±7%) and a specificity of 59% (±8%). The PPV, NPV, and accuracy for CMR were 70% (±5%), 65% (±5%), and 68% (±5%), respectively.

Conclusions:
CMR shows promise in diagnosing coronary artery disease, correlating well with angiography and reducing invasive procedures without significant outcome differences. Further research is needed to assess its clinical utility, highlighting its potential role in practice.
Abstract 17760: Conversion of Dicom ECG Images to Tabular Format for Building Large Language Model in Diagnoses and Disease Progression of Cardiovascular Conditions
Authors: Kar Sujoy , jallepalli Shivkumar , Potla Bharath , Haranath Sai Praveen P , Reddy Sangita
Published: December 2023

Introduction:
DICOM Electrocardiography (ECG) images from individuals are routinely stored at the institutional PACS server, including normal and abnormal findings.

Hypothesis:
The study’s objective is to create a database of ECGs as per Standard Communication Protocol (SCP) and to build an accurate Large Language Model (LLM) across different cardiovascular conditions

Methods:
DICOM ECGs are retrieved, anonymized and labelled to convert the signals to (x, y) coordinates with the help of PyDicom libraries. The tabular format is then stored with lead definition and dimensions of duration and amplitude, metadata, clinical conditions, and textual diagnoses.

Results:
In the pilot study, 1308 ECGs from individuals with different age (<45 & >45 years), gender (male & female), binary clinical categories (normal & abnormal) and heart rate (<90 & >90 per min) are selected for analysis and modeling. The DICOM image signal reproducibility following conversion (Figure 1 & 2) shows Cross Correlation Percentage of 0.85 (0.76 - 0.94) (Figure 3). An eXtreme Gradient Boosting (XGBoost) model (6) was trained to predict above variables. The results (Figure 4) show AUC highest for predicting binary clinical categories (normal vs abnormal) at 0.81 (0.7 - 0.9) and lowest for predicting age (<45 & >45 years) at 0.6 (0.46 - 0.7). The accuracies in the leads also show similar trend. The limitations include reproducibility of results in Lead VIII, IX and XI, which are sub average and hence being retrained with optimizers. These are initial results with relatively smaller database where multiclass disease or condition classifications are not performed.

Conclusions:
To conclude, the methodology possesses opportunities to improve the model with Deep Learning and Entity Disambiguation Techniques (NLP) to build Large Language ECG Models for cardiovascular diagnoses and disease progression trajectories.
Abstract 17802: Racial Disparities in the Association of Pre-Pregnancy Cardiometabolic Risk Factors With Adverse Pregnancy Outcomes
Authors: Sun Kevin M , Boyer Theresa , Avula Vennela , Choi Eunjung , Vaught Arthur J , Ndumele Chiadi E , Michos Erin D , Coresh Josef , Ogunwole Michelle , Hays Allison , Minhas Anum S
Published: December 2023

Background/Hypothesis:
Racial and ethnic disparities and worsened poor pre-pregnancy cardiometabolic health are individually recognized to increase risk for adverse pregnancy outcomes (APOs). However, the interaction of race and ethnicity with pre-pregnancy cardiometabolic factors in relationship with APO risk is less well understood.

Aims:
To evaluate racial and ethnic disparities in the risk association of cardiometabolic factors with APOs in a national population.

Methods:
We analyzed Natality Data from the National Vital Statistics System of the National Center for Health Statistics between 2016-2017. We used multivariable logistic regression to estimate adjusted odds of APOs (preterm birth, gestational diabetes, and pregnancy-induced hypertension) with pre-pregnancy cardiometabolic factors: chronic hypertension, obesity, and diabetes, stratified by race and ethnicity. Population attributable fractions (PAFs) were calculated to assess the proportion of APOs attributable to pre-pregnancy cardiometabolic risk factors.

Results:
Among 7,460,633 births, presence of pre-pregnancy hypertension, obesity and diabetes were differentially associated with APO risk by race and ethnicity (Table 1). Overall, non-Hispanic Black women had the greatest incidence of preterm birth (16.7%), while American Indian/Native women had the greatest incidence of pregnancy-induced hypertension (10.1%) and gestational diabetes (12.6%).

Conclusion:
There is heterogeneity by race and ethnicity in the association of pre-pregnancy cardiometabolic factors with APOs. Non-Hispanic Black and American Indian/Native women have the overall greatest burden of most APOs, including preterm birth, pregnancy-induced hypertension, and gestational diabetes. Targeted preventive efforts, with consideration of stressors for individual racial and ethnic groups, should be undertaken to improve cardiometabolic health prior to conception to lower risk of APOs.
Abstract 17811: Biomarkers Are Superior to Left Atrial Strain Predicting Outcomes in a Multi-Ethnic HFpEF Population
Authors: Csecs Ibolya , Wengrofsky Aaron , Pina Pamela , Majmuda Ushma , Mangeshkar Shaunak , Gongora Carlos , Schenone Aldo L , Slipczuk Leandro , Garcia Mario J
Published: December 2023

Introduction:
In heart failure with preserved ejection fraction (HFpEF) atrial mechanics play an important role in diastolic dysfunction, and impaired atrial function is related to increased levels of atrial biomarkers such as NT-proBNP. We studied the predictive value of atrial function assessed by speckle-tracking strain and compared it to biomarkers in a multiethnic HFpEF population.

Methods:
We studied 237 consecutive patients who were admitted with acute decompensated heart failure and EF > 50. The average age was 78±11, 69% of patients were female, and 36% (n=86) were non-Hispanic Black (NHB); 30% (n=71) Hispanic; 21% (n=50) non-Hispanic White (NHW) and 13% (n=30) Other. Left ventricular (LV), atrial (LA), and right atrial (RA) volumes, ejection fraction, and global longitudinal strain (GLS) were measured. During a two-year follow-up, heart failure readmissions and death were registered.

Results:
Most patients (n= 202) had an abnormal LA-EF of < 45% and abnormal RA-EF <46% (n=205). During a follow-up period of 2 years, 55 patients died, 28% Hispanic, 20% NHB, 20% NHW, and 17% Other. LA-GLS was impaired in all HFpEF patients (13.5+8.2) and was not associated with event-free survival (Figure) in the entire cohort or in any race/ethnicity subgroups. However, increased NT-proBNP (1,200 pg/mL) was associated with worst outcomes (p < 0.01) (Figure).

Conclusions:
In a multiethnic HFpEF cohort, LA function was universally impaired but had no prognostic value. In contrast, elevated NT-proBNP at hospital discharge predicted recurrent hospitalization and death.
Abstract 17819: Latent Class Analysis of Heart Health in a Marginalized Black Community
Authors: Oakley Linda D , Kuo Wan-Chin , Voland Rick P , Olson-Williams Hannah , Kunkul Fatih , Brown Roger L
Published: December 2023

BACKGROUND
Mounting evidence associates Black American’s experiences of chronic stress with younger age hypertension (HTN) onset, higher prevalence rates, and poorer treatment outcomes. Epigenetic research findings attribute these trends to DNA methylation, commonly referred to as stress related premature biological aging. Guided by the current American Heart Association (AHA) Science Statement on heart health, this health equity study aims to examine positive Black identity as a measure of positive psychological health in Black adults.

METHODS
Our community-engagement survey measured self-reports of: (1) environmental wellbeing, positive self-regard, spirituality, chronic stress, Black identity, anxiety, depression, anger, and five AHA essential cardiovascular health (CVH) factors: (2) physical activity, fruit, vegetables, smoking tobacco, and sleep. Multivariable linear regressions examined psychological health and CVH as predictors of systolic blood pressure. Latent class analysis (LCA), using ordinal indicators, assessed for latent sample profiles as statistical probabilities of similar responses and sample heterogeneity.

RESULTS
In a community sample (N=201) of Black adults (age M=46.7, SD=15.9), primarily female (N=141, 69.5%), increases in systolic blood pressure (Mean=134, SD=20.9) were associated with more chronic stress and less environment wellbeing; decreases were associated with less expressed anger. The LCA results show a four-class statistical solution with greater heterogeneity in spirituality, anger, anxiety, and depression. Among the four profiles, two theoretical latent classes for high and low systolic blood pressure were distinct. Low systolic blood pressure is associated with higher levels of environmental wellbeing, physical activity, and self-regard, both more and less spirituality, more positive Black identity, moderate anger, anxiety, and depression, and checking your BP.

CONCLUSION
In addition to emotion regulation, physical activity, and self-care, our findings support CVH promotion strategies in marginalized communities of Black Americans designed to reduce chronic stress, improve environmental wellbeing, and support positive Black identity.
Abstract 17823: Impact of the Type of Tricuspid Annuloplasty Ring Concomitant With Mitral Annuloplasty on Atrial Arrhythmia Behaviour and Pacemaker Implantation Rate, Fact or Fancy
Authors: Hassan Mohamed , Keller Daniel , Makhmetov Berikbol , Omerbasic Zulejha , Radakovic Dejan , Madrahimov Nodir , Leyh Rainer , Bening Constanze
Published: December 2023

Background:
Tricuspid valve repair has been advocated in patients undergoing mitral valve surgery who have not only preoperative severe TR but also for tricuspid annular dilatation (TAD) of >40 mm. We sought to analyze the impact of the type of tricuspid annuloplasty ring on the atrial arrhythmia behavior and the incidence of permanent pacemaker implantations in patients undergoing mitral valve annuloplasty.

Methods:
We performed a retrospective review of 408 patients underwent combined tricuspid and mitral valve annuloplasty in our institution between the years 2007 and 2014.Patients were 68,8 ± 10,7 years old, 67% male, 33% female. A total of 325 patients met the inclusion criteria; 201 received three-dimensional (3D) rigid ring (group 1) and 124 received ring annuloplasty with flexible bands (group2). The distribution of the preoperative and perioperative variables was similar.

Results:
There was no statistical difference in the incidence of high-grade heart conduction disorders lasting more than 3 days postoperatively (13.4% in group 1 and 12.9% in group 2; P = 0.89). Likewise, there was no difference in the

incidence of postoperative atrial fibrillation between the two groups (41.2% in group 1 and 37.1% in group 2; P = 0.45). On the other hand, there was statistical difference in the incidence of permanent pacemaker implantation between the two groups (12.9% in group 1 and 25.8% in group 2; P = 0.003). Likewise, there was difference in the incidence of sick sinus syndrome between the two groups (0.01% in group 1 and 16.1% in group 2; P < 0.00001).

Conclusion:
The need for permanent pacemaker implantation and the incidence of sick sinus syndrom may be increased after the use of flexible tricuspid annuloplasty ring in the setting of mitral valve surgery.Moreover, the present study found no association between the use of Flexible tricuspid annuloplasty ring and a higher incidence of postoperative atrial fibrillation or high-grade heart conduction disorders.Further large-scale randomized controlled studies are needed to elucidate the Impact of the type of tricuspid annuloplasty ring.
Abstract 17841: Early versus Late Anticoagulation for Ischemic Stroke Associated With Atrial Fibrillation: An Updated Systematic Review and Meta-Analysis
Authors: Akbar Usman , Anwar Rana Usman , Shamshad Talha , ALI AHMED , Umer Ahmed Muaaz , Waqas Muhammad , khan Muhammad Aslam , Vorla Mounica , Muhibullah - , Shafique Nouman , Mukhtar Sonia , khan Muhammad Adnan , Raza Munis , haider Ali , Dani Sourbha
Published: December 2023

Introduction:
The optimal timing for initiating oral anticoagulation in patients who have experienced ischemic stroke is debatable. We conducted an updated systematic review and meta-analysis on the outcomes of patients who received early oral anticoagulation (within <4 days) compared to those who received late oral anticoagulation (within 4-10 days) following the onset of ischemic stroke.

Methods:
We conducted a systematic literature search according to PRISMA guidelines to identify studies using the terms: “timing of anticoagulation,” “oral anticoagulants,” and “ischemic stroke.” After the screening, We extracted the data from 1980 to May 2023 in a data extraction sheet. We extracted data for three outcomes: Recurrent Ischemic Stroke (IS), Symptomatic Intracranial Hemorrhage (ICH), and all-cause mortality. We used a variance-weighted random-effects model to analyze early vs. late anticoagulation data, estimating event rates and odds ratios while assessing heterogeneity. Data were analyzed using RevMan software.

Results:
Our analysis included a total of 08 studies (n= 8119 patients). Early anticoagulation (<4 days) was associated with a lower risk of recurrent ischemic stroke, OR= 0.77(95% CI: 0.60- 0.99, I
2
= 21% ) as compared to late anticoagulation (4-10 days). However, there was no significant difference between the timing for symptomatic ICH, OR=1.27 (95% CI: 0.35- 4.64, I
2
= 0% ). Early anticoagulation was also associated with a reduction in all-cause mortality between the two patient groups. OR=0.63(95% CI: 0.43- 0.93, I
2
= 38% ).(Figure1)

Conclusions:
Early anticoagulation therapy may significantly reduce the recurrence of ischemic stroke and overall mortality with no significant impact on the risk of symptomatic ICH. More randomized control trials are needed to increase the robustness and reliability of these results.
Abstract 17851: Prevalence and Predictors of Early Left Ventricular Functional Recovery After Transcatheter Aortic Valve Implantation: The TAVI-NOR Study
Authors: Ali Abukar M , Wasim Daanyaal , Bleie Oyvind , Løland Kjetil H , Packer Erik J , Rotevatn Svein , Saeed Sahrai
Published: December 2023

Introduction:
Pre-intervention left ventricular (LV) ejection fraction (LVEF) in aortic stenosis (AS) patients has prognostic value. However, the hemodynamic changes early after TAVI (transcatheter aortic valve implantation) is not fully explored.

Hypothesis:
To what extent early functional recovery by a clinically significant increase (≥10%) in LVEF is achievable following TAVI, how it differs from baseline patient characteristics, and its potential prognostic impact.

Methods:
Between 2012 and 2019, 600 consecutive patients (age 81±6years, 49.3% females) with clinically significant AS underwent TAVI. Echocardiography was performed before and within 8 weeks after TAVI. Variables associated with <10% LVEF improvement were identified. End-points were ≥10% LVEF improvement and all-cause mortality.

Results:
From baseline to follow-up; 28% of patients achieved ≥10% LVEF improvement. A ≥10% LVEF improvement was observed in 25% of patients with normal baseline flow (indexed stroke volume ≥35ml/m
2
) versus 38% in low-flow (p=0.002). Impaired kidney function, higher blood pressure (BP), higher baseline LVEF and indexed stroke volume, and lower LV mass was more likely in patients with <10% LVEF. In a multivariate logistic regression analysis, higher baseline systolic BP (OR 1.02; 95% CI 1.01-1.03, p=0.004) and lower LV mass (OR 1.25; 95% CI 1.02-1.54, p=0.031), and new pacemaker implantation (OR 1.55; 95% CI 0.99-2.42, p=0.055) were associated with a higher risk, and baseline LVEF <50% with a lower risk (OR: 0.15; 95% CI: 0.09-0.25) for <10% LVEF improvement following TAVI, independent of CKD, baseline troponin T and NT-proBNP. In a univariate Cox regression model, <10% increase in LVEF in early phase after TAVI was not a significant predictor of mortality (HR 1.16; 95% CI 0.90-1.50, p=0.258).

Conclusions:
Clinically significant early LV functional recovery was evident in nearly one-third of severe AS patients, especially patients with reduced LVEF and more symptoms at baseline. Higher systolic BP, lower LV mass, and the need for new permanent pacemaker, were independently associated with a higher risk of not achieving early LV function recovery after TAVI. In long-term follow-up early LV functional recovery was not associated with all-cause mortality.
Abstract 17878: Clinical Profile, Procedure-Related Complications and Long-Term Outcomes in Men and Women With Aortic Stenosis Undergoing Transcatheter Aortic Valve Implantation: Insights From TAVI-NOR Study
Authors: Wasim Daanyaal , Ali Abukar , Bleie Oyvind , Løland Kjetil H , Herstad Jon , Saeed Sahrai
Published: December 2023

Introduction:
The incidence of aortic stenosis (AS) is increasing. If left untreated, AS progresses to clinical heart failure, reduced quality of life and functional capacity, and ultimately death.

Hypothesis:
Gender difference in survival benefits of transcatheter aortic valve implantation (TAVI) and frequencies of procedural complications.

Methods:
We included 600 consecutive, less selected, patients with symptomatic AS who underwent TAVI at our hospital. Clinical and echocardiographic data was analysed in SPSS. Data distribution was checked for normality. The inter-group comparison by Student’s t-test or chi square as appropriate. The association between gender and all-cause mortality assessed by Kaplan-Meier survival analysis with Log-rank test.

Results:
Mean age was 80.8±6.5 years of the study population. Women (49.3%) were older (82.2 ±5.3 years vs 79.5±7.3 years, p<0.001), had more severe AS and higher left ventricular ejection fraction and more often had basal septal hypertrophy. The prevalence of hypertension and use of antihypertensive medications were higher in women. The prevalence of diabetes mellitus, coronary artery disease, previous stroke, overall abnormal ECG, and atrial fibrillation was higher in men. The severity of symptoms, and prevalence of chronic kidney or lung diseases were comparable. The frequencies of procedure-related paravalvular leakage (PVL) ≥ grade II and endocarditis during follow-up were low, but significantly higher in men than women. No significant difference between genders in procedure-related access site dissection and pseudo-aneurysm, anaemia requiring blood transfusion, or new-onset renal failure. Need of permanent pacemaker implantation following TAVI was also comparable between genders. Mean event-free survival was 59±24 months for men and 66±25 months for women (p<0.001). Most apparent benefits was seen at 3-year follow-up where survival estimate for men was 84% and for women 92%.

Conclusions:
Results from TAVI-NOR study demonstrates that women with AS were older and had a higher burden of hypertensive heart disease, and showed a significantly better outcome. Men more frequently developed a significant PVL or endocarditis during follow-up.
Abstract 17910: Is Implantation of a Larger Edwards Sapien Transcatheter Pulmonary Valve Associated With Early Valve Failure? A Different Type of Patient-Prosthesis Mismatch
Authors: Headrick Andrew , Boucek Dana , Freestone Nancy , Boucek Matthew , Ou Zhining , Gray Robert , Jepson Bryan , Gallenberger Mikayla , Binka Edem , Martin Mary H
Published: December 2023

Introduction:
Transcatheter pulmonary valve replacement (TPVR) is an alternative option to address failing native and bioprosthetic pulmonary valves (BPV). TPVR has expanded to implantation in native right ventricular outflow tracts (nRVOT) and progressively smaller patients. We aim to define the relationship between valve-to-patient size ratio and early development of pulmonary insufficiency (PI).

Methods:
This single-center retrospective cohort study identified patients who underwent TPVR with a Sapien valve between 2014 and 2021. We collected demographic, anatomic, and pre- and post-TPVR echo data. Echo data were collected at four post-TPVR time points: prior to discharge, short-term (1-9 months), mid-term (9-18 months), and most recent study. The primary outcome was development of moderate or severe PI by mid-term follow-up. Valve size-to-body surface area (BSA) ratio was evaluated for correlation with the development of moderate or severe PI.

Results:
The cohort consisted of 187 patients; 79 (42.2%) underwent TPVR within the nRVOT (Table). Compared to patients with TPVR in a conduit or BPV, patients with a nRVOT were younger, had lower weight, and lower BSA. Moderate or severe PI post-TPVR was more common in patients in the nRVOT group (P-value < 0.001), occurring in 9 (11.5%) by mid-term follow-up, compared to 2 (1.9%) in a conduit or BPV. In the subset of patients with TPVR within the nRVOT, the development of moderate or severe PI was associated with a larger valve size-BSA ratio (OR=1.13, 95% CI: 1.03, 1.26, P-value=0.012).

Conclusions:
Development of moderate or severe PI following TPVR with a Sapien valve was rare in this cohort. Patients receiving a Sapien TPVR within the nRVOT with a large valve size-to-BSA ratio were more likely to develop early PI. The increased risk of early valve failure in these patients should inform counseling regarding expected longevity of the valve and may guide valve choice as more transcatheter valve options become available.
Abstract 17947: Mathematical Model of Cheyne-Stokes Respirations as an Educational Tool for Understanding Cardiorespiratory Interactions in Heart Failure
Authors: Balu Aniruddh , Balu Ramani
Published: December 2023

Background:
Patients with heart failure often develop Cheyne-Stokes Respirations (CSR): a breathing pattern characterized by alternating periods of hyperventilation and apnea. The cardio-respiratory interactions that result in CSR are complex and often difficult to understand for students learning cardiovascular physiology.

Aims:
We developed a mathematical model of CSR where cardiac output (CO), respiratory rate (RR) and arterial CO
2
(pCO
2
) can be manipulated to evaluate how periodic fluctuations in different physiological variables develop, thus providing a deeper understanding of cardiorespiratory interactions in heart failure.

Methods:
Our model consisted of 3 coupled differential equations. (1) pCO
2
is directly proportional to metabolic CO
2
production and inversely proportional to alveolar ventilation (V
A
). V
A
depends on RR, alveolar volume, and CO, with the interaction between CO and ventilation calculated by combining Fick’s principle and the Alveolar Gas Equation. (2) Changes in RR are modeled as a Hill function dependent on pCO
2
. (3) Finally, CO depends on pCO
2
, arterial O
2,
and RR. The model was propagated forward in time using Euler’s method. A graphical user interface allows users to easily manipulate variables and observe heart lung interactions.

Results:
Initial values for RR, CO, and PCO
2
resulting in stable, aperiodic breathing were 10 breaths/min, 6 L/Min, and 40 mmHg, respectively. Perturbing any of these values resulted in periodic fluctuations in RR, CO, and pCO
2
(Figure 1). A key insight of the model is that progressive decreases in CO induce more prominent oscillations in RR and pCO
2
and that pCO
2
directly influences CO.

Conclusions:
Our mathematical model of cardio-respiratory interactions allows users to easily manipulate physiological variables to graphically visualize how changes in CO and respiratory function give rise to CSR. This may enable students to obtain a deeper understanding of cardiovascular physiology.
Abstract 17950: Atrial Fibrillation Impacts Mortality, Length of Stay, Resources Utilization and Need for Endotracheal Intubation in Patients Who Were Submitted to C-section or Natural Delivery: A Nationwide Analysis 2016-2020
Authors: Carvalhais Ricardo , Rivera Frederick B , Mahfooz Kamran , Antia Akanimo , Taj Shiza Saher , Yan Linjie , Zhao Jiahe , Bostashvili Nikolozi , Priela Lia Veronique
Published: December 2023

Background:
Atrial fibrillation (AF) is rare during pregnancy but the data on its impact during delivery is scaring. In this study, we aim to analyze the impact of AF in patients who underwent delivery via Cesarean section (CS), natural spontaneous delivery (NSD) or instrumental delivery (ID).

Methods:
We obtained the data from the National Inpatient Sample from 2016-2020. Our primary outcome was in-hospital mortality. Secondary outcomes included length of stay, total hospital charges and respiratory failure requiring intubation. Primary and secondary outcomes were adjusted to variables that had a p-value<0.2 for that outcome. Results were considered statistically significant if p-value <0.05.

Results:
There were 17,785,980 deliveries who underwent CS, NSD or ID. Of this, 6,000 patients had the secondary diagnosis of atrial fibrillation. The population had a mean age of 29.13 years. (See table 1) Patient with AF had almost twenty times more change of dying compared to those without AF odds ratio (OR) 19.12, 95% Confidence interval (CI) 4.33 - 84.45, p<0.001. Furthermore, AF cohort stayed for one and a half day longer Coefficient 1.55, CI 1.16 - 1.94, p<0.001, had a higher hospital charge Coefficient 19294.05, CI 14658.17 - 23929.93 and had a higher rate of respiratory complications requiring intubation OR 15.86, CI 7.83 - 32.15, p<0.001. (See table 2)

Conclusion:
Atrial fibrillation has a substantial negative impact in inpatient outcomes on pregnant patients during delivery. Further research is needed to explore these disparities in maternal care.