bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 17200: PAD Raising Awareness in Sacred Environments “Praise”
Authors: Thomas Victoria , Butler Marjorie , Brewer LaPrincess C , Liu DanDan , Sohn Ine , Shardelow Emily , Aday Aaron W , Beckman Joshua A
Published: December 2023

Introduction:
Atherosclerotic peripheral artery disease (PAD) leads to a great burden of cardiovascular and limb-related morbidity and mortality in African Americans (AA) compared to White Americans. Medical center partnerships with churches may be an effective method to improve PAD awareness and detection in the AA community.

Hypotheses:
We hypothesized that implementing a medical educational program in partnership with churches would increase PAD familiarity and identify participants with undiagnosed PAD.

Aims:
To determine (1) PAD familiarity before and after a one-time educational intervention and (2) the prevalence of PAD in older, church-going Nashville residents.

Methods:
Using a community-engaged research (CER) model, we partnered with 5 churches to enroll participants ≥ 50 years of age. Participants were given a 16-point pre- and post-educational program assessment to determine baseline and post-intervention PAD knowledge. Pre- and post-intervention scores were compared using Wilcoxon signed-rank test. Ankle-brachial index (ABI) testing was used to screen for PAD (ABI < 0.9).

Results:
We enrolled 120 participants (mean age [SD]: 64.67 [8.33] years, 74% women, 80% AA). The prevalence of PAD was 10.83%. Pre-intervention PAD awareness was low (mean score (MS): 10.89 [4.24]) and improved significantly post-intervention in all participants (MS: 13.88 [2.76; p=2 x 10
-12
). Participants without PAD (ABI ≥ 0.9-1.39) (MS: 10.81 [4.28] vs. 13.91 [2.79]; p= p=4 x 10
-11
) and with indeterminate status (ABI>1.4) (MS [SD]: 10.00 [5.03] vs. 14.10 [1.73; p=0.01) showed significant improvement in PAD awareness pre vs post intervention. Participants with PAD (ABI <0.9) (MS: 12.15 [3.26] vs. 13.46 [3.26; p=0.40) did not have significant improvement in their awareness scores.

Conclusions:
The PRAISE study demonstrates an effective CER partnership with churches as a method to increase PAD awareness and early detection of PAD, specifically among AAs.
Abstract 17201: Referral Patterns and Clinical Outcomes in Patients With Severe Aortic Stenosis
Authors: Vakilpour Azin , Levin Michael , Anyanwu Emeka , Denduluri Srinivas , Lee Jennifer N , Sharkoski Tiffany , Adusumalli Srinath , Vidula Mahesh K , Lopez-Mattei Juan , Chittams Jesse , Jones David B , Hartwell Carlton , Bolooki Michael , Bourque Jamieson , Scherrer-Crosbie Marielle
Published: December 2023

Introduction:
Once aortic stenosis (AS) becomes severe, close clinical follow-up by cardiac specialists and timely aortic valve replacement (AVR) are necessary to optimize patient outcomes. Discrepancies exist in the care of AS.

Hypothesis:
Provider specialty impacts referral for AVR after an initial echocardiogram (echo) revealing severe AS, with greater referral by cardiac specialists vs. non-cardiologists.

Methods:
Patients were identified based on an echo finding of new severe AS from Jan 2019 to Dec 2022 in an academic health system and were compared based on the ordering provider’s specialty (cardiology or cardiac surgery specialist vs. non-cardiologist). The primary endpoint was the rate of AVR after the initial echo. Univariable and multivariable logistic regression were used to identify characteristics associated with referral for AVR.

Results:
The study cohort included 2,131 patients: 630 (30%) were referred to echo by a non-cardiologist, 992 (46%) by cardiology, and 509 (24%) by cardiac surgery specialists (Table). Patients referred to echo by non-cardiologists were older, more frequently Black, and more symptomatic, with a lower rate of vascular diseases and a higher rate of heart failure and kidney disease. Thirty-four percent of patients referred by non-cardiologists, 62% of patients referred by cardiology and 81% of patients referred by cardiac surgery specialists underwent AVR at a median time of 58, 64 and 24 days after their echocardiogram, respectively (P<0.001). Echo referral by cardiology (OR: 2.76, P<0.001), echo referral by cardiac surgery (OR: 7.50; P<0.001), age (OR: 0.96, P<0.001), Black race (OR: 0.60, P<0.001), presence of >=2 CV risk factors (OR: 1.99, P<0.001), and >=2 comorbidities (OR: 1.54, P=0.001) were independent factors associated with AVR.

Conclusion:
Provider specialty impacts referral to AVR after an echo with new severe AS despite baseline characteristic adjustment, with higher AVR rates by cardiac specialists.
Abstract 17218: CES1 Deficiency is Associated With Metabolic Reprograming and Endothelial Dysfunction in Pulmonary Arterial Hypertension
Authors: Agarwal Stuti , Heo Lyong , Chakraborty Ananya , Auer Natasha , Swaminathan Gowri , Liu Lichao , West James , Suresh Karthik , Nair Ramesh , Rabinovitch Marlene , Nicolls Mark , Morisseau Christophe , Hammock Bruce D , Lafyatis Robert , Kawut Steven M , Zamanian Roham , Dejesus Vinicio A
Published: December 2023

Introduction:
PAH is associated with loss of pulmonary microvessels & vascular remodeling. Metabolic reprogramming(MR) characterized by high glycolysis & reduced FAO is hallmark feature of PAH linked to oxidative stress, endothelial cell(EC) dysfunction & reduced angiogenesis. BMPR2 gene mutations promote MR; however, due to low penetrance, alterations in other genes are likely necessary for PAH development. We found Carboxylesterase 1 (CES1) is an ER enzyme involved in lipid metabolism & cellular detoxification with a potentially important role in MR & EC dysfunction in PAH.

Hypothesis:
Loss of CES1 leads to EC dysfunction through MR, lipotoxicity & oxidative stress & serves as a genetic modifier of BMPR2 in ECs

Methods:
Healthy/PAH ECs & lung tissues were obtained from transplants and commercial sources. Healthy ECs were transfected with siRNA/plasmid to knockdown/overexpress CES1. Mitochondrial & ER structure & function was assessed by confocal microscopy & proteomic assays. Metabolic flux in ECs was analyzed using the SeahorseXF. CES1 HET KO mice exposed to normoxia and hypoxia were studied & lungs were processed for scRNA-seq.

Results:
CES1 mRNA/protein expression was reduced in PAH ECs & lung vascular lesions. Compared to controls, siCES1 ECs have high apoptosis,reduced angiogenesis,increased ROS,mitochondrial fragmentation & ER stress. Lipid staining of siCES1 PMVECs demonstrates cytoplasmic lipid droplet accumulation correlating with reduced FAO and switch to glycolysis. Restoring CES1 expression reverses MR, reduces ROS & improves functional status of siCES1/PAH ECs. CES1 is a downstream target of BMPR2 under NRF2 transcriptional regulation & its loss exacerbates MR & dysfunction associated with BMPR2 loss that improves via CES1 restoration. Hemodynamic & scRNA-seq studies show that hypoxic CES1 HETKO mice develop more severe PH & demonstrate dysregulation of genes in key metabolic & angiogenic pathways.

Conclusions:
CES1 is essential for maintenance & repair of the pulmonary endothelium & acts as a key modifier of BMPR2 signaling. Limitations of current therapies to reverse EC dysfunction and prevent small vessel loss warrant therapeutic interventions that can restore CES1 expression and serve as a novel treatment approach for PAH.
Abstract 17224: Macrophage Expressed CD36 Promotes Plaque Vulnerability in Atherosclerosis
Authors: Gissler Mark Colin , Mwinyella Timothy , Morguet Cynthia , Heitlinger Simon , Li Xiaowei , Horstmann Hauke , Marchini Timoteo , Willecke Florian , Westermann Dirk , Wolf Dennis
Published: December 2023

Introduction:
Atherosclerosis is characterised by a chronic lipid-driven inflammation that accounts for the majority of deaths worldwide. CD36 is an immunoregulatory scavenger receptor at the interface of lipid metabolism and inflammation that is critically involved in atherogenesis. However, due to the lack of cell-specific animal models the exact role of CD36 on macrophages in atherosclerosis remains unknown to date.

Research Question:
Here, we aimed to study the role of macrophage expressed CD36 in atherogenesis.

Methods:
To screen for a potential role of macrophage expressed CD36 in atherosclerosis we assessed CD36 gene expression across different leukocyte populations in scRNAseq data from atherosclerotic LDLR-/- mice. To evaluate the role of macrophage expressed CD36 in atherogenesis, we generated tamoxifen inducible macrophage (CX3CR1)-specific CD36-deficient mice on a LDLR-/- background. To interrogate a potential role of CD36 in human atherosclerosis, human atherosclerotic plaques were studied by scRNAseq.

Results:
Analysis of murine scRNAseq data identified macrophages as the main CD36 expressing cell type. In line, CD36 protein expression in aortic cell suspensions from LDLR-/- mice was significantly higher in macrophages compared to B and T cells as assessed by flow cytometry. Notably, macrophage-specific CD36 deficiency substantially reduced lesional necrotic core area after 16 weeks of high cholesterol diet feeding indicating ameliorated plaque vulnerability. In vitro, macrophage-specific CD36 deficiency reduced ROS production and oxLDL uptake. Similar to our observations in mice, cellular CD36 expression was highest in human macrophages/monocytes. Pathway analysis revealed that CD36-expressing macrophages exhibited a more pro-inflammatory gene signature than CD36-negative macrophages. Finally, unstable carotid plaques displayed a significantly higher CD36 expression compared to stable lesions.

Conclusion:
All in all, our data indicates a pro-inflammatory role of macrophage expressed CD36 in murine and human atherosclerosis. These findings suggest that targeting CD36 on macrophages may represent a potential target for anti-atherosclerotic therapy.
Abstract 17231: Importance of Intra Plaque Hemorrhage During Carotid Artery Revascularization
Authors: Wiley Karlo A , Anker Allison , Sanina Cristina , Kozdag Gold Guliz
Published: December 2023

Introduction:
The American Heart Association currently estimates that every 3 minutes a person dies from a stroke. Carotid artery stenosis, a major risk factor for new and recurrent strokes, can be treated with carotid artery revascularization. Vascular emboli released during this procedure are non-invasively detected by transcranial doppler (TCD) ultrasound as micro embolic signals (MES). In this study we aim to show the relationship between carotid plaque characteristics and MES rates that were detected by TCD-monitoring throughout the stages of the carotid artery revascularization procedures.

Methods:
Before elective carotid revascularization 30 patients (mean age 72±8 years; 16 males, 14 females) underwent 3-T MRI. After localization of the carotid bifurcation using phase contrast imaging, Time-of-Flight, 3D T1 weighting, transverse T1 and T2 weightings and proton density sequences were acquired. The different plaque components: lipid core, intraplaque hemorrhage, calcification and the characterization of the fibrous cap were assessed. While 20 patients underwent carotid endarterectomy (CEA), 10 patients had carotid artery stenting (CAS). CES was divided into 9 stages: 1- Pre-procedure, 2- Dissection, 3- IC clamp, 4- Shunt placement, 5- Shunt open, 6- Endarterectomy, 7- Clamped, 8- IC opened, 9- Post-procedure. Similarly, CAS was divided into 9 stages: 1- Pre-procedure, 2- Arch-carotid angiography, 3- Wire insertion, 4- Filter deployment, 5- Pre-dilation, 6- Stent deployment, 7- Post-dilation, 8- Final angiography, 9- Post-procedure. Patients were monitored continuously with TCD to detect pre-procedural, intra-procedural and post-procedural MES rates.

Results:
Intraplaque hemorrhage was observed in 18 patients (60%). Patients with intra plaque hemorrhage had more MES during carotid artery dissection/arch-carotid angiography (p=0.028) and IC clamping/wire insertion (p=0.009) compared to patients without intra plaque hemorrhage in the pre-procedural stage.

Conclusions:
Carotid plaques with intra plaque hemorrhage is associated with higher MES during carotid artery revascularization procedures.
Abstract 17249: Epidemiology of Wolff-Parkinson-White Syndrome Among Acute Care Recipients in California
Authors: Teraoka Justin T , Tang Janet J , Noubiap Jean Jacques , Dewland Thomas A , Marcus Gregory M
Published: December 2023

Introduction:
Wolff-Parkinson-White syndrome (WPW) is a congenital heart disease associated with life-threatening arrhythmias. However, little is known about the epidemiology of WPW in the general population.

Goals:
To describe the frequency, predictors, and management associated with WPW among California residents.

Methods:
We used Ambulatory Surgery, Emergency Department, and Inpatient data from the California Department of Health Care Access and Information to identify California residents receiving hospital care between January 1, 2005 to December 31, 2020. Demographics were ascertained from the database. Rurality was determined using the CDC Urban-Rural Classification. Diagnoses and procedures were identified using clinical diagnostic codes. Two multivariable logistic regression models were used to 1) assess the association between patient characteristics and WPW in the entire cohort and 2) examine the odds of undergoing an electrophysiology study (EPS)/ablation among those with WPW. All models were adjusted for sex, rurality, race/ethnicity, and median income.

Results:
Among 31,414,813 individuals (53% female, 53% non-White, 3% rural), 19,866 (0.06%) had WPW. After multivariable adjustment, those who were female, non-White, or residing in a lower income county had lower odds of having a diagnosis of WPW. Among those with WPW, those who were female, Black, Native Hawaiian/Pacific Islander, or residing in a lower income county were less likely to undergo EPS/ablation. Hispanics and Asians with WPW were more likely to undergo an EPS/ablation than non-Hispanic Whites (Figure).

Conclusions:
There are substantial differences in both the diagnosis and treatment of WPW by patient characteristics. Whether, or to what degree, these are due to biological differences, the clinical presentation, access to care, or willingness to undergo interventions is deserving of future research.
Abstract 17266: Associations of Life’s Essential 8 With Phenotypic Age in a Nationally Representative Cohort of US Adults
Authors: Hosalli Rahul , Dinh Vanessa , Makarem Nour
Published: December 2023

Introduction:
Phenotypic age (PhenoAge), a new biomarker-based biological aging measure, captures morbidity and mortality risk in the general population. Associations of cardiovascular health (CVH), based on the enhanced Life’s Essential 8 (LE8) framework, with PhenoAge and phenotypic age acceleration (PhenoAgeAccel) have not been evaluated.

Hypothesis:
Higher CVH will be associated with lower PhenoAge and PhenoAgeAccel in US adults.

Methods:
Participants were 6,593 men and women from the 2015-2018 NHANES (mean age: 47y, 50% female, 6% Asian, 10% Black, 16% Hispanic, 64% White). The overall and component CVH scores were calculated using the LE8 framework. PhenoAge was computed from nine biomarkers and chronological age. PhenoAgeAccel was the difference between PhenoAge and chronological age, with higher positive values indicating faster biological aging. Survey-weighted multivariable linear models were used to evaluate the overall and component CVH scores in relation to PhenoAge and PhenoAgeAccel.

Results:
Participants with high CVH had negative PhenoAgeAccel, while those with low CVH had positive PhenoAgeAccel (-4.20 vs. 2.36; p<0.01). Each 10-unit increase in the LE8 score was associated with lower PhenoAge (β(95%CI): -4.82 (-5.28, -4.36)) and PhenoAgeAccel (β(95%CI): -1.80 (-1.98, -1.62)). Those with high vs. low CVH had lower PhenoAge (β(95%CI): -17.15 (-18.98, -15.33)) and PhenoAgeAccel (β(95%CI): -6.08 (-6.76, -5.41)) (p-trend<0.001). Being in the highest vs. lowest tertile of all LE8 metrics was associated with negative PhenoAgeAccel (p-trend<0.01) (Table). Further, being in the highest vs. lowest tertile of the physical activity, BMI, glucose, blood lipids, and blood pressure scores was related to having lower PhenoAge (p-trend<0.05).

Conclusions:
CVH is inversely associated with PhenoAge and PhenoAgeAccel with evidence of a dose-response relation. Improving CVH may decelerate biological aging and reduce associated morbidity.
Abstract 17285: Impact of Baseline Yellow Plaque Assessed by Coronary Angioscopy on 11-month Vascular Response After Stent Implantation
Authors: Tsujimura Takuya , Ishihara Takayuki , Mizote Isamu , Nakamura Daisuke , Okamoto Naotaka , Shiraki Tatsuya , Naoki Itaya , Takahara Mitsuyoshi , nakayoshi takaharu , Iida Osamu , Hata Yosuke , Nishino Masami , Ueno Takafumi , Nakatani Daisaku D , Hikoso Shungo , Nanto Shinsuke , Mano Toshiaki , Sakata Yasushi
Published: December 2023

Background:
In-stent yellow plaque (YP) evaluated by coronary angioscopy (CAS) 1 year after stent implantation is associated with the future adverse cardiac event. However, the impact of baseline YP on vascular response has not been fully investigated.

Methods:
This was a sub-analysis of the Collaboraiton-1 study (multicenter, retrospective, observational study). A total of 88 lesions from 80 patients with chronic coronary syndrome who underwent percutaneous coronary intervention with polymer-free biolimus A9-coated stent or durable-polymer everolimus-eluting stent implantation were analyzed. Optical coherence tomography (OCT) and CAS were serially performed immediately and 11 months after stent implantation. YP was defined as the stented segment with yellow or intensive yellow color assessed by CAS. Neoatherosclerosis was defined as a lipid or calcified neointima assessed by OCT. Neointimal coverage (NIC) over the stent was classified into 4 grades by CAS: grade 0, stent struts fully visible; grade 1, stent struts bulging into the lumen, although covered; grade 2, stent struts embedded in the neointima, but translucently visible; and grade 3, stent struts fully embedded and invisible. OCT and CAS findings at 11 months were compared between the lesions with baseline YP (YP group) and those without YP (Non-YP group).

Results:
Baseline YP was detected in 37 lesions (42%). OCT findings at 11 months showed that the incidence of neoatherosclerosis was significantly higher in YP than Non-YP groups (11% versus 0%, P=0.028) and mean neointimal thickness tended to be lower (104±43 μm versus 120±48 μm, P=0.098). CAS finding at 11 months demonstrated that dominant and minimum NIC grades were significantly lower (Figure) and maximum yellow color grade was significantly higher in YP than Non-YP groups.

Conclusions:
Baseline YP affected the incidence of neoatherosclerosis as well as poor neointimal coverage at 11 months after stent implantation.
Abstract 17298: Deep Learning Electrocardiogram Detecting Acute Coronary Occlusion in Myocardial Infarction Presenting Without ST-Elevation
Authors: Herman Robert , Meyers Harvey P , Smith Stephen W , BERTOLONE DARIO TINO , Demolder Anthony , Boza Vladimir , Vavrik Boris , Martonak Michal , Perl Leor , Hatala Robert , Wojakowski Wojciech , Bartunek Jozef , Barbato Emanuelle
Published: December 2023

Introduction:
One third of Non-ST-elevation myocardial infarction (NSTEMI) patients present with an acutely occluded culprit coronary artery (OMI), associated with poor short and long-term outcomes due to delayed identification and consequent delayed invasive management.

Hypothesis:
We sought to develop and validate an artificial intelligence (AI) model detecting OMI on single standard 12-lead electrocardiograms (ECGs) and compare its performance to existing standard criteria.

Methods:
An AI model was developed using 18,616 ECGs from 10,692 unique contacts (22.9% OMI) of 10,543 patients (age 66±14 years, 65.9% males) with acute coronary syndrome (ACS) from an international cohort. This AI model was tested on an international test set of 3,254 ECGs from 2,263 unique contacts (20% OMI) of 2,222 patients (age 62±14 years, 67% males) and compared with STEMI criteria and annotations of ECG experts in detecting OMI on 12-lead ECGs using sensitivity, specificity, predictive values and time to OMI diagnosis. OMI was based on a combination of angiographic and biomarker outcomes.

Results:
The AI model achieved an area under the curve (AUC) of 0.941 (95% CI: 0.926-0.954) in identifying the primary outcome of OMI, with superior performance (accuracy 90.7% [95% CI: 89.5-91.9], sensitivity 82.6% [95% CI: 78.9-86.1], specificity 92.8 [95% CI: 91.5-93.9]) compared to STEMI criteria (accuracy 84.9% [95% CI: 83.5-86.3], sensitivity 34.4% [95% CI: 30.0-38.8], specificity 97.6% [95% CI: 96.8-98.2]) and similar performance compared to ECG experts (accuracy 91.2% [95% CI: 90.0-92.4], sensitivity 75.9% [95% CI: 71.9-80.0], specificity 95.0 [95% CI: 94.0-96.0]) (
Figure 1
).

Conclusions:
The present novel ECG AI model demonstrates superior accuracy in detecting acute OMI when compared to the STEMI criteria. Its external and international validation suggests its potential to improve ACS patient triage with timely referral for immediate revascularization.
Abstract 17310: Epsins Promote Atherosclerosis Through Vascular Smooth Muscle Phenotypic Modulation
Authors: Wang Beibei , Cui Kui , Dong Yunzhou , Zhu Bo , Wu Hao , Bhattacharjee Sudarshan , Singh Bandana , Wang Donghai , Wong Scot , Cowan Douglas B , Chen Hong
Published: December 2023

Hypothesis:
VSMC play crucial roles in atherosclerosis via phenotypic switching. The trans-differentiation of VSMC into other cell types might contribute to atherosclerotic lesion development, progression, and the subsequent diseases such as myocardial infarction or stroke. Epsins, a family of endocytic adaptors, are crucial for atherosclerosis development and progression; yet, the role of epsins in VSMC phenotypic modulation is unknown.

Methods and Results:
To decipher the role of VSMC epsins in regulating atheroma development and progression, we created WT and SMC-specific inducible epsin1/2 double knockout (SMC-iDKO) mice on ApoE
-/-
background fed a western diet. Using single-cell RNA-seq analysis, we found VSMC and EC population significantly changed in SMC-iDKO/ApoE
-/-
mice compared to ApoE
-/-
mice. Using immunofluorescent and FACS analysis, we observed that both VSMC and EC marker genes expressions were up-regulated in DKO-VSMCs indicating that DKO-SMCs were maintaining their SMC phenotype and may further trans-differentiating into ECs via a process called MEndoT, mesenchymal to endothelial transition. Given the critical role of KLF4 in regulating VSMCs phenotype during atheroma progression, we observed diminished KLF4 expression in DKO-SMCs compared to WT treated with oxLDL. Furthermore, we found that epsins interacted with KLF4 with Epsin-UIM domain and their interaction improved KLF4 stability and promoted KLF4 to transfer into nuclei. In this study, we found that epsins were highly expressed and positively correlated with the lesion severity in VSMCs in atherosclerotic. Using immunofluorescent and Oil Red O stainings, we observed reduced lipid accumulation, lesion size and macrophage infiltration but elevated VSMCs in the cap of lesions in SMC-iDKO/ApoE
-/-
mice compared with ApoE
-/-
mice.

Conclusions:
In conclusions, we demonstrated an unexpected role of epsins in regulating phenotypic switching by repressing SM-contractile and EC marker genes expression through an epigenetic regulatory mechanism. Our data suggest that epsins may be a therapeutic target for treating occlusive vascular diseases, and uncover regulatory pathways for therapeutic targeting of SMC transitions in atherosclerotic cardiovascular disease.
Abstract 17351: Structural Racism and 3-month Postpartum Blood Pressure in a Mulitethnic Prospective Cohort
Authors: Janevic Teresa , Lee Alison , Howell Frances , Burdock Micki , Nowlin Sarah , Maru Sheela , Boychuk Natalie , Oshewa Oluwadamilola , Monterroso Maria , McCarthy Katharine , Rodriguez Alva , Cabrera Camila , Lewey Jennifer , Howell Elizabeth , Levine Lisa
Published: December 2023

Introduction:
Postpartum hypertension is a leading cause of racial inequities in maternal morbidity and mortality.

Research Question:
Is racial-economic segregation, a proxy for structural racism, associated with differences in postpartum blood pressure (BP) in Black, Hispanic and Asian (“Global Majority”) birthing people?

Methods:
We used data (n=369) from the coronaVirus Impact on Birth Equity (VIBE) Study, a prospective cohort in Philadelphia and New York City, 2022-2023. We measured racial-economic segregation by the Index of the Concentration of Extremes (ICE) using zipcode. Participants completed the Gendered Racial Microagressions (GRM) in Obstetrics Scale, and reported postpartum BPs through a text-messaging platform for 90 days. We used mixed-effects linear regression with repeated measures to estimate associations between ICE and postpartum systolic and diastolic BP (SBP, DBP). We adjusted for prepregnancy BMI, race-ethnicity, age, parity, and prepregnancy hypertension. We tested effect modification by hypertensive disorders of pregnancy (HDP) and GRM.

Results:
Participants were 10.3% Asian, 38.0% non-Hispanic Black, 38.2% Hispanic, and 13.6% other; 26.0% had HDP, 70.7% lived in high concentration poor, Black neighborhoods (highest quartile of ICE), and 37.6% experienced GRM. People in poor, Black neighborhoods had a higher 90-day postpartum mean SBP (120.6 mmHg) than those in other neighborhoods (116.4 mmHg, difference (β)=4.2, 95% confidence interval(CI)=1.7, 6.8; adjusted difference (aβ) = 2.1, 95% CI=0, 4.2). DBP did not differ (73.8 vs. 73.1 mmHg, β =0.8, 95%CI=-1.1, 2.6; aβ=0.1, 95% CI=-1.9, 1.6). Associations did not vary by HDP but were heightened for participants in poor, Black neighborhoods who experienced GRM vs. those in other neighborhoods who did not experience GRM (SBP: β = 6.2, 95%CI= 2.8, 9.6; aβ = 4.2, 95%CI = 1.3, 7.1; DBP: β = 2.1, 95%CI= 0.5, 4.7; aβ = 1.1, 95%CI = -1.3, 3.6).

Conclusions:
Racial-economic segregation is associated with higher postpartum BP over a 90-day period in Global Majority people, and further heightened in those who experienced GRM. Interventions to disrupt structural racism, including segregation, and eliminate GRM in obstetric care may improve postpartum health inequities.
Abstract 17360: Epstein Barr Virus in the Heart: A Case of Infectious Mononucleosis Causing Myopericarditis
Authors: Acharya Sameer , Schuchardt Brett , Rogner Jaimie , Duke Jessica , vaughan maurice
Published: December 2023

Introduction:
The most common causes of myopericarditis are Coxsackie B followed by Coxsackie A, Echovirus, and Poliovirus. However, Epstein Barr Virus (EBV) may uncommonly cause myopericarditis and can mimic acute coronary syndrome (ACS).

Case:
A 19-year-old healthy non-smoker male presented with acute onset of central, positional chest pain preceded by a 5 day-long course of viral prodromal symptoms including sore throat. EKG showed inferolateral ST segment elevations (Figure 1). HS-Troponin T was markedly elevated (initial; 988, 1 hour; 1171). He was started on ibuprofen and colchicine for suspected myopericarditis. TTE showed LVEF 50% with borderline mild posterior and lateral wall hypokinesis with no pericardial effusion (Figure 1). Although, the presentation and PR depression were consistent with pericarditis, focal wall motion abnormality led to consideration of right or circumflex CAD such as coronary dissection. This was ruled out by coronary angiogram (Figure 2). Cardiac MRI demonstrated the epicardial pattern of gadolinium enhancement consistent with myopericarditis (Figure 2). Subsequently, patient tested positive for IgG (6.4) and IgM (3.2) [normal range 0.8 to 1.1] against EBV Capsid Antigens with unremarkable remaining viral panel results. His symptoms improved significantly with ibuprofen and colchicine. He was also treated with metoprolol succinate and lisinopril due to reduced ejection fraction.

Conclusions:
Cardiac complications from EBV infection are uncommon. Sometimes, the EKG with pericarditis can mimic ACS warranting an invasive test. Therefore, clinicians must maintain a high level of suspicion for myopericarditis resulting from EBV.
Abstract 17364: Lysyl Oxidase Inhibition Induces Acute Aortic Dissection Through Activation of Focal Adhesions and Mammalian Target of Rapamycin Signaling in Mice
Authors: Zhou Zhen , Guan Pujun , Sarkar Ripon , Li Zhouxuan , Guo Dongchuan , Duan Xue Yan , Kwartler Callie S , Milewicz Dianna M
Published: December 2023

Introduction:
Defective genes that predispose to acute aortic dissections (AADs) suggest that maintenance of aortic integrity requires mature extracellular matrix (ECM) and intracellular homeostatic contraction of smooth muscle cells (SMCs). Focal adhesions (FAs) link the ECM to SMC contractile units, and we sought to determine the role of SMC FA signaling in a mouse model in which AADs are induced by disrupting ECM with a lysyl oxidase inhibitor, β-aminopropionitrile (BAPN).

Methods:
C57BL/6J wild-type mice at postnatal day 21 (P21) were exposed to BAPN to induce AADs. All aortas were visually inspected at necropsy or tissue harvest. Proximal aortas were harvested for single-cell RNA sequencing (scRNAseq) at P35 and for immunoblot analyses at P24 and P35. Echocardiography, tail-cuff blood pressure, and histopathology analyses were performed on surviving mice at P49.

Results:
MELD analysis of scRNAseq data identified SMC clusters as the top altered cell type in BAPN-treated aortas. KEGG pathway analysis identified activated FA, along with Rho/ROCK and mTOR signaling, in the BAPN-treated SMC cluster. Immunoblots confirmed increased phosphorylation of FAK, MYPT1, mTOR, p70S6K, and S6RP in BAPN-treated aortas, and FAK inhibition blocked Rho/ROCK and mTOR pathways. Pharmacological inhibition of mTOR with rapamycin significantly rescued BAPN-induced AAD deaths (9% vs. 50%, p=0.001) without altering blood pressure, aortic enlargement, or aortic medial elastic fiber degeneration. Immunoblot analyses confirmed dramatic decrease of mTOR, p70S6K, and S6RP phosphorylation levels in BAPN aortas with rapamycin treatment. Administration of a ROCK inhibitor, Y-27632, significantly augmented type A AAD incidence (p=0.04) without altering blood pressure in BAPN mice, and immunoblot analyses identified increased mTOR signaling as early as P24 in BAPN plus Y-27632-treated aortas compare with BAPN group.

Conclusions:
Activation of FA and downstream mTOR signaling triggers AAD when the ECM is disrupted by BAPN, and mTOR inhibition significantly attenuates these deaths. FAs also activate Rho/ROCK, which is protective. These findings support that preventing mTOR signaling or augmenting Rho/ROCK signaling are therapeutic targets to prevent AADs.
Abstract 17368: Burden of Cardiovascular Diseases in Haiti: Implications for Low-Income Countries
Authors: Yan Lily D , Sufra Rodney , St Sauveur Reichling , Jean-Pierre Marie Christine , Macius Youry , Apollon Alexandra , Malebranche Rodolphe , Theard Michel , Pierre Gerard , Devieux Jessy , Lau Jennifer , Mourra Nour , Roberts Nicholas , Rasul Rehana , Nash Denis , Lee Myung Hee , Kwan Gene F , Safford Monika M , Adrien Laure , Alfred Jean Patrick , Deschamps Marie , Severe Patrice , FITZGERALD Daniel W , Pape Jean , Rouzier Vanessa , Mcnairy Margaret
Published: December 2023

Introduction:
Although 80% of global cardiovascular disease (CVD) burden occurs in low- and middle-income countries, data from Black populations in these settings are scarce. We estimated the baseline prevalence of CVD using data from the population-based Haiti Cardiovascular Disease Cohort.

Methods:
Among urban Haitian adults ≥18 years, we collected data on demographics, health behaviors, psychosocial measures, anthropometrics and clinical exams including imaging and laboratory data at enrollment from 2019-2021. Prevalent cases of CVD were adjudicated using approaches guided by US and international cohorts. Multivariable Poisson regressions assessed relationships between risk factors and prevalent CVD.

Results:
Among 3,003 participants, median age was 40 years, 58.1% were female, and 70.2% reported income of <$1/day. The most common risk factors were elevated blood pressure (30.4% hypertension, 23.0% prehypertension) and obesity (17.2%). Age-adjusted prevalence of CVD was 14.7% (95%CI 13.3%, 16.5%). Heart failure was the predominant disease with an adjusted prevalence of 11.9% (95%CI 10.5%, 13.5%), followed by stroke (2.4% [95%CI 1.9%, 3.3%]), angina (2.1% [95%CI 1.6%, 2.9%]), MI (1.0% [95%CI 0.6%, 1.8%]), and TIA (0.4% [95%CI 0.2%, 1.0%]). Of all heart failure, 80% had preserved ejection fraction, with a median age of 57 years. Heart failure was associated in a dose-response relationship with hypertension, and with obesity, diabetes, chronic kidney disease, depression, and stress.

Conclusions:
The burden of CVD in urban Haiti is primarily early-onset heart failure, with low prevalence of ischemic heart disease, challenging current global assumptions. These findings highlightunderscore the urgent need for local population-based epidemiologic data on cardiovascular disease and risk factors to inform health policy, planning and promotion.
Abstract 17373: The Effect of a Multi-Level Nurse-Led and M-Health Intervention on Medication Adherence Among Adults with Uncontrolled Hypertension in the ADHINCRA Study
Authors: Appiah Nana Kwasi , Ogungbe Oluwabunmi V , Hinneh Thomas , Metlock Faith , Dennison Himmelfarb Cheryl R , Cooper Lisa A , Carson Kathryn , SARFO FRED S , Appiah Lambert T , Commodore-Mensah Yvonne
Published: December 2023

Introduction:
Poor adherence to antihypertensive therapy is a major contributor to poor cardiovascular outcomes for patients diagnosed with hypertension (HTN). However, multifaceted patient centered interventions may improve medication adherence and HTN control.

Objective:
To examine the impact of the nurse-led, multi-level, m-health intervention on medication adherence in adults with uncontrolled HTN in the ADHINCRA study in Ghana.

Methods:
Using a cluster randomized controlled pilot trial design, four hospitals were randomized to the intervention arm and enhanced usual care (EUC) arm; 120 participants in each. We estimated HTN medication adherence using the Hill-Bone Medication Adherence Scale (Range, 9-36), higher scores indicate better adherence. A logistic regression model was used to estimate dichotomized adherence score (low and high adherence) as a function of the treatment group over time.

Results:
Among 240 participants, mean (±SD) age was 53 (±9.7) years; 117 men (49%). Mean (SD) adherence scores for intervention and EUC arms at baseline were 33.7 (2.9) and 33.2 (3.1) respectively. At month 12, the mean adherence score was 34.8 (1.8) in the intervention group and 34.3 (2.5) in EUC arm. Comparing baseline to month 6, the intervention arm had higher odds of adherence (Odds Ratio, OR, 1.85; 95%CI, 1.14-4.45) compared to EUC arm (OR, 1.74; 95%CI, 0 .91-3.31), and similarly for month 12, the intervention arm had higher odds of adherence (OR, 3.25; 95%CI, 1.68-6.27) compared to EUC arm (OR, 2.32; 95%CI, 1.19-4.52) (Figure 1).

Conclusions:
The ADHINCRA Study intervention resulted in greater improvement in medication adherence in the intervention than the EUC arm. Multi-level interventions should be integrated into clinical practice in Ghana to improve medication adherence.
Abstract 17389: Sex Differences in Aortic Dissection Outcomes in the Houston Aortic Collaborative Experience
Authors: Sandhu Harleen K , Miller Charles C , Lemaire Scott A , Preventza Ourania , Prakash Siddharth K , Mussa Firas , Oderich Gustavo , Coselli Joseph , Safi Hazim J , Estrera Anthony L , Afifi Rana O
Published: December 2023

Background:
Data on sex-related differences in presentation, management, and clinical outcome in acute aortic dissection (AAD) are sparse, especially for acute type A (AAAD) and acute type B (ABAD) subtypes.

Aims:
To determine the effect of sex on AAD presentation, management and outcomes in a large cohort of patients from two major aortic surgery centers.

Methods:
We retrospectively reviewed the two-institution clinical data of all consecutive patients treated for AAD from 2000 to 2022. Data were analyzed by univariate and multivariable methods for short- and long-term data using SAS 9.4. Cox multivariable analyses were restricted to 3 years’ follow-up to avoid violating the proportional-hazards assumption.

Results:
Overall, 1,855 patients treated for AADs with 1,109 AAAD and 746 ABAD. Median age was 60 years (IQR:50-70); 620 (33%) were women. Women were older (64 vs 58 yrs; P<.001), had lower baseline renal function (36% vs 26%, p<.001) and more genetically triggered aortic disease (11% vs 7%, P=.002). Clinical presentation is shown in Table. Women had fewer renal (17% vs 24%; P=.001), bleeding (10% vs 14%; P=.01), and GI (22% vs 26%; P=.048) in-hospital complications. 30-day mortality was not different between groups (12% vs 14%; P=.271). There was no significant difference in mid or long-term survival by sex overall, however, stratified analysis showed lower survival for women with AAAD, notably in the first 3 years (Figure). Among AAAD cases, absolute risk difference attributable to COPD in stratified analysis was 17% in women (p<.01), but numbers are small (n=63). Multivariable risk factors for 3 year mortality were female (HR 1.3, p<.016), GFR<60 (HR 1.4, p<.003), rupture (HR 2.0, p<.001), CAD (HR 1.8, p<.001), mesenteric MPS (HR 2.1, p<.001).

Conclusions:
Women with AAD presented at an older age with poor baseline renal function and had higher prevalence of genetic disease and ABAD. 3-year adjusted survival for women with AAAD was worse than men; COPD may modify risk by sex.
Abstract 17416: Epigenetic Regulation of Fibroblast Fate Transition in Cardiac Wound Healing
Authors: Asangwe Ngefor , Kraus Lindsay , Knight Thomas , Kubo Hajime , Khan Mohsin , Mohsin Sadia
Published: December 2023

Background:
Fibroblast transitioning between physiological and pathological states can define cardiac wound healing ability of the heart in response to stress. Preventing fibroblast activation and differentiation into myofibroblast formation can attenuate cardiac fibrosis and adverse cardiac remodeling. Changes in chromatin structure and accessibility are one of the essential drivers of gene expression/repression involved in myocardial injury. One such driver of chromatin remodeling is the group of polycomb proteins that alter expression of genes involved in cardiac wound healing including B cell specific Moloney murine leukemia virus integration site 1 (Bmi1), a component of the polycomb repressive complex 1 (PRC1). Bmi1 have been linked to self-renewal, proliferation, quiescence, and lineage commitment in many organs however, how Bmi1 can mediate fibroblasts states and mediate wound healing after cardiac injury is not understood.

Hypothesis:
Bmi1 mediates myofibroblast activation and transition, scar maturation, stability, and fibrotic responses by regulating histone marks after injury.

Methods and Results:
To establish the role of Bmi1 in cardiac wound healing, we developed an inducible knock out mouse model for Bmi1, which showed decrease in cardiac structure and function with maladaptive remodeling following myocardial injury. Bmi1 knockout (KO) mice showed significant decrease in ejection fraction and fractional shortening measured by echocardiography after cardiac injury. Concurrently, this significant decrease in heart function was associated with increased fibrosis and DNA damage analyzed using immunohistochemistry. Additionally, we found that the adult cardiac fibroblasts, isolated from the Bmi1 KO mice have increased expression of fibrotic genes including TGFβ, Acta2, and collagen using RTPCR analysis. Using single cell sequencing RNA and ATAC sequencing and cellular staining assays, we found significant changes in fibrotic signaling pathways of TGFβ. We found SMAD3 chromatin accessibility was increased with the loss of Bmi1 with the decrease in H2AK119Ub.

Conclusion:
Bmi1 mediates wound healing ability by regulating cardiac fibroblast transition after cardiac injury.
Abstract 17423: The Conundrum of Oxygen Delivery in Redo Cardiac Surgery: Prognostic Implications and Interactions With Major Predictors
Authors: Montella Antonio Pio , Rubino Antonino Salvatore , Golini Petrarcone Caterina , Palmieri Lucrezia , Galbiati Denise , De Santo Luca Salvatore , De Feo Marisa
Published: December 2023

Introduction:
Nadir oxygen delivery index (DO2i) during cardiopulmonary bypass (CPB) is a known independent predictor of Acute Kidney Injury (AKI) after routine cardiac surgery. Little is known about its prognostic role in the setting of redo procedures.

Hypothesis:
To define if Nadir DO2i is predictive of renal malperfusion in redo setting. Secondary outcomes were cardiac morbidity (composite of intra-aortic balloon pump or extracorporeal membrane oxygenation, use of continuous high dose inotropic support for at least 24 hours or autopsy evidence of heart failure), stroke and hospital mortality.

Methods:
All 398 consecutive patients (mean age of 62.1 ± 12.2 years, octogenarians 5.6%, female sex 47.4%, diabetes 20.1%, chronic kidney disease 31.2%, urgent/emergent status 26.2%, third-time sternotomy 9.8%; EuroSCORE II 10.5±11.2%) referred for a redo procedure (January 2011-January 2021) to a single tertiary care, university affiliated center were analyzed. The reliability of NadirDO2i to predict AKI was ascertained with AUC. The best cut-off was determined with the Youden index. The odds to incur in any of the predetermined outcomes was investigated with binary logistic regression. Interaction with known predictors of AKI (preoperative anemia, preoperative chronic kidney disease, older age, emergency status, baseline pathology, EuroSCORE II, need for CPB before sternotomy, blood transfusion during cardiopulmonary bypass) was also investigated.

Results:
Acute Kidney Injury (any grade) developed in 41.2 % (Risk 17.5%, Injury 8.0%, Failure 15.7%); cardiac morbidity developed in 53.2%, perioperative stroke in 2.8%. In-hospital mortality averaged 17.1%. Best Nadir DO2i predictor of AKI-Failure was 274 ml/min/m2 (AUC 0.644; 68.9% and 60.6% sensitivity and specificity, respectively). Same cut-off predicted cardiac morbidity and hospital mortality (OR 2.200, 95%CI 1.462-3.311 p=0.0002, and OR 4.677, 95%CI 2.577-8.488 p<0.0001, respectively). No interaction of Nadir DO2i emerged with predefined predictors.

Conclusions:
Nadir DO2i during cardiopulmonary bypass is independently associated with major postoperative morbidity and mortality in redo scenario and is not influenced by other nuances variables.
Abstract 17437: Estimated Lifetime Benefits of Combination Therapy With SGLT2 Inhibitors, GLP-1 Receptor Agonists, and Non-Steroidal MRAs in Patients With Type 2 Diabetes and Albuminuria
Authors: Neuen Brendon L , Perkovic Vlado , Bakris George L , Lambers Heerspink Hiddo , Vaduganathan Muthiah
Published: December 2023

Introduction:
Sodium glucose co-transporter 2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists (GLP-1RA), and the non-steroidal mineralocorticoid receptor antagonist finerenone all reduce cardiovascular events and mortality in patients with type 2 diabetes. However, the lifetime benefits of combination therapy with all three medications are not known.

Aim:
To estimate lifetime gains in cardiovascular event-free and overall survival with combination SGLT2i, GLP-1RA, and finerenone in patients with type 2 diabetes and albuminuria.

Methods:
We used individual participant data from the CANVAS and CREDENCE trials and trial-level data from 8 GLP-1RA trials and 2 finerenone trials (FIDELIO and FIGARO) to estimate the relative effects of combination therapy on cardiovascular and mortality outcomes. Using nonparametric age-based methods, we applied combined treatment effects to placebo treated patients with urinary albumin:creatinine ratio ≥30 mg/g in the pooled CANVAS and CREDENCE trials.

Results:
The aggregate hazard ratio comparing combination therapy versus conventional standard of care for major adverse cardiovascular events (MACE; nonfatal myocardial infarction, nonfatal stroke or cardiovascular death) was 0.65 (95% CI 0.55-0.76) (Figure). For a 50-year-old, estimated event-free survival from MACE was 18.0 years with placebo and 21.2 years with combination therapy (3.2 years gained, 95% CI 2.1-4.2; Figure). Estimated gains in survival free from hospitalised heart failure, cardiovascular death, and all-cause death with combination therapy in a 50-year-old person were 3.3 (95% CI 2.5-4.1), 2.2 (95% CI 1.2-3.1), and 2.5 years (95% CI 1.4-3.5) respectively, with benefits evident across all ages studied.

Conclusions:
Combination treatment with SGLT2i, GLP-1RA and finerenone in patients with type 2 diabetes and albuminuria is projected to afford clinically important gains in cardiovascular event-free and overall survival.
Abstract 17466: Impact of the Covid-19 Pandemic on Pediatric Cholesterol Screening Rates
Authors: Schwartz Jessica , Zhang Xiao , Peterson Amy L
Published: December 2023

Introduction:
Universal cholesterol screening during childhood has been recommended by the American Academy of Pediatrics since 2011, but most children remain unscreened. We hypothesized that the COVID-19 pandemic and subsequent disruptions in routine healthcare impacted pediatric cholesterol screening rates and may have disproportionately affected children based on race, ethnicity, socioeconomic status (SES), or rural/urban status.

Hypothesis:
The COVID-19 pandemic impacted pediatric lipid screening rates based on race, ethnicity, SES, and rural/urban status.

Methods:
The provider order placement rate (OPR) for a screening cholesterol panel was calculated for established patients 9-21 years old at a single institution pre-pandemic (3/18/2019-3/17/2020), mid-pandemic (3/18/2020-3/17/2021), late-pandemic (3/18/2021-3/17/2022), and post-pandemic (3/18/2022-12/31/2022). OPR was analyzed, including a chi-squared test, based on race, ethnicity, SES, rural/urban status, and the department of the visit.

Results:
Overall OPR fell over time and in both pediatric and family medicine specialties. There was a decrease in OPR across all race and ethnicity groups, though most did not reach statistical significance. Urban advantaged, urban, and rural underserved had a disproportionately larger decrease in OPR, though all groups had a lower OPR at the end of the study.

Conclusions:
The OPR decrease in late- and post-pandemic stages may be due to the pandemic. Though OPR differences existed between some rural/urban statuses and the ordering department pre-pandemic, these factors may have worsened these gaps. Future studies are needed to identify and address barriers to pediatric cholesterol screening.