bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 11876: Impact of Online Continuing Medical Education on Advancing Physician Knowledge and Confidence Around Dual-Pathway Inhibition for Patients With Peripheral Artery Disease
Authors: Harris Margaret , Sendaydiego Anne , Lacouture Michael , Capparelli Catherine , Kolluri Raghu , Patel Manesh R , Aronow Herbert D
Published: December 2023

Background:
Patients with PAD are at risk for MACE and MALE. Antithrombotic therapy, including DPI can improve patient outcomes. Physicians who care for patients with PAD may require education to improve knowledge and confidence around employing newer treatments.

Purpose:
This study was conducted to determine if online CME could improve physician knowledge and confidence of advances in DPI for the treatment of patients with PAD.

Methods:
The educational program consisted of a 15-minute online video-based rapid-fire discussion between 2 experts that launched March 24, 2021-March 24, 2022. Data were collected from participants on March 24, 2022. Four multiple choice questions were used; 3 assessed knowledge and 1 determined confidence with Likert-type scale. Endpoints were assessed using a repeated-pair design with pre-/post-assessment. A paired samples t-test was conducted on overall average number of correct responses for physician knowledge, and a McNemar’s test was conducted at the question level (significance level,
P
< .05) for confidence.

Results:
855 physicians completed the pre-/post-assessment out of 3,825 total physician learners (22%). Physician specialties included general cardiology (28%), vascular cardiology (15%), vascular surgery (15%), other surgery (20%), and primary care (22%). Overall, significant improvements were seen in knowledge of medical treatment for PAD (P<.001), data for the use of factor Xa inhibition to treat PAD (P<.001), and confidence in selecting antithrombotic therapy (P<.001) (Table). Gains in knowledge and confidence were highest amongst vascular specialists compared with non-vascular specialists (Table).

Conclusion:
This study demonstrates the effect of a 15-minute online video-based CME discussion between 2 expert faculty on knowledge and confidence among providers caring for patients with PAD related to advances in antithrombotic therapy. Continued gaps were identified for future educational targets.
Abstract 11905: Real-World Clinical Impact of High-Sensitivity Troponin for Chest Pain Evaluation in the Emergency Department
Authors: Martin Jacob A , Saxena Archana , Akindutire Olumide , Genes Nicholas , Gollogly Nathan , Smilowitz Nathaniel R , Quinones Camacho Adriana
Published: December 2023

Background:
The impact of high-sensitivity cardiac troponin (hs-cTn) implementation on clinical practice in emergency departments in the United States is not well characterized.

Research Questions:
We sought to assess the effect of hs-cTn on length of stay, hospital admissions, and utilization of cardiac testing and consultations.

Methods:
Adult patient visits to the emergency department (ED) for chest pain with ≥ 1 troponin result were identified in electronic health record data from a large academic health system encompassing one suburban hospital and two urban hospitals including a quaternary referral center. Patients were included 15 months before and 11 months after the implementation of hs-cTn on April 6, 2022. Associations between hs-cTn implementation and clinical metrics were evaluated using both univariable and multivariable linear models.

Results:
Among 27,313 unique patients, there were 17,267 and 14,809 encounters before and after the implementation of hs-cTn, respectively. Using hs-cTn, a greater proportion of patients were discharged from the ED (59.5 % vs. 64.9 %, p <0.0001), and total length of stay (
Figure 1
) was shorter (6.6 h, IQR 3.9 - 29.5 vs. 6.0 h, IQR 4.0 - 27.1, p = 0.039). Similar results were observed in urban vs. suburban settings and in quaternary care vs. lower levels of care. There were lower rates of cardiology consults (-1.2 per 100 patient visits, adjusted odds ratio [OR]: 0.91, 95% confidence interval [CI]: 0.86 - 0.97), echocardiograms (-2.8 per 100 patient visits, adjusted OR: 0.86, 95% CI: 0.82 - 0.91), stress tests (-1.9 per 100 patient visits, adjusted OR: 0.74, 95% CI: 0.67 - 0.81), and coronary angiograms (-2.0 per 100 patient visits, adjusted OR: 0.77, 95% CI: 0.70 - 0.83) after hs-cTn implementation.

Conclusions:
In real-world data, implementation of hs-cTn was associated with a higher rate of discharges from the ED and shorter total length of stay with small reductions in utilization of cardiac testing.
Abstract 11932: Discharge Dichotomy: Lack of Appropriate Discharge Follow Up in ST-segment Elevation Myocardial Infarction With Non-Obstructive Coronary Arteries (STE-MINOCA) Patients
Authors: Makkapati Shreya , Venuti Morgan , Ross Anika , Ibe Oby , Yu Daohai , LU XIAONING , Islam Sabrina , Gannon Michael
Published: December 2023

Introduction:
Readmission after acute myocardial Infarction is a challenge in health care. Guidelines recommend early follow-up as those who do not have established follow-up are 10 times more likely to be re-hospitalized. This allows for close review of cardiac symptoms and medications. While there is substantive data about early follow up in the obstructive ST-Segment Elevation Myocardial Infarction (STE-Obstructive) populations improving readmission rates, there are minimal guidelines regarding follow up for STE-MINOCA patients.

Hypothesis:
Does time to post-discharge outpatient care impact rate of readmission between STE-Obstructive and STE-MINOCA patients?

Methods:
A single center, retrospective cohort study analyzed demographics and discharge pathways of patients meeting STEMI criteria who underwent coronary angiography. Discharge medications, follow up appointment, and readmissions were examined. Simple and multiple logistic regression analyses were used to explore the association between discharge pathways and clinical factors in two STEMI populations.

Results:
377 of 433 patients survived discharge with a median age of 59. Of those who survived, 63.9% were male, 44.3% Black, 30.2% Hispanic, and 82.7% had government-issued insurance. STE-Obstructive patients had significantly higher rates of follow up (p=0.0006) and earlier than STE-MINOCA patients (p=0.052) (Table 1). Despite differences in follow up, readmissions for cardiovascular issues were not significantly different between the STE-MINOCA and STE-Obstructive patients. Of note 64% of STE-MINOCA patients who were readmitted did not have follow up prior to readmission.

Conclusions:
STE-MINOCA patients had longer time to follow up and less follow up than STE-Obstructive patients. Readmission rates between the two groups were similar. Further studies are required to explore the role of earlier follow up in STE-MINOCA clinical trajectory.
Abstract 11953: Aortic Stenosis Severity, Symptom Status, and Long-Term Outcomes
Authors: Solomon Matthew D , Leong Thomas K , Garcia Elisha , Lange David , Mishell Jacob , mcnulty edward J , Philip Femi , Rassi Andrew , Demaria Anthony N , Nishimura Rick A , Go Alan S , Ambrosy Andrew P
Published: December 2023

Introduction:
The relationship between aortic stenosis (AS) severity, AS-related symptoms, and clinical outcomes is poorly understood.

Research Question:
Does a history of AS-related symptoms at the time of diagnosis affect clinical outcomes including death and AS-related hospitalization?

Methods:
Using a combination of natural language processing algorithms and administrative codes, we ascertained physician-assessed AS, AS severity, and AS-related symptoms (chest pain, acute coronary syndrome, syncope, presyncope, orthopnea, dyspnea, PND, and worsening heart failure) in the year prior or up to 60 days after an initial AS diagnosis among 602,821 adults with echocardiograms in a large, integrated health system from 2010-2019. We examined multivariable associations between AS severity and recent AS-related symptoms for the outcomes of death and AS-related hospitalizations using Cox models.

Results:
Among 40,333 patients identified with incident AS, the majority had recent AS-related symptoms (mild: 80%, mild-moderate: 77%, moderate: 77%, moderate-severe: 85%, and severe AS: 87%). Patients with recent symptoms were older (mean [SD] age 78 [10] vs 75 [11] years; p<0.01), more likely female (51% vs 47%; p<0.01), and had a higher comorbidity burden. In unadjusted analyses, symptom status was a strong discriminator of risk over a median (IQR) of 2.2 (0.8-4.3) years of follow-up (
Figure
). After multivariable adjustment, AS-related symptoms remained strongly associated with death and AS-related hospitalization across the spectrum of AS severity, with moderate symptomatic patients having risk similar to severe asymptomatic patients.

Conclusions:
The majority of patients diagnosed with AS have recent and/or active AS-related symptoms, which is associated with a significantly increased risk of adverse outcomes. Incorporating symptom status across the individual grades of AS may improve risk stratification beyond AS severity alone.
Abstract 11962: Breaking Down the Relationship Between Atrial Fibrillation Class and Risk of Embolic Stroke: Beyond CHADSVASC Score
Authors: Alziadin Nmair , alhalaseh saleh , Maraey Ahmed , Alwarawrah Zaid , T Raju Apoorva , Mann Sabrina A , Al Wahadneh Omar
Published: December 2023

Introduction:
Atrial fibrillation (AF) is recognized as a risk factor for stroke. To evaluate the risk of stroke in AF patients, the CHADSVASC score is commonly utilized. However, the correlation between AF classification and the risk of embolic stroke beyond the CHADSVASC score remains unclear.

Methods:
We analyzed data from 488,790 admissions with embolic stroke, out of which 133,429 had atrial fibrillation, between 2016-2020 to examine the association between AF class and risk of embolic stroke. The CHADSVASC score was computed for each patient, with risk factors being assigned point values ranging from 0 to 2 based on their association with embolic stroke. Patients were categorized into one of four AF classes, namely paroxysmal, persistent, long-standing persistent, or permanent.

Results:
Patients with persistent, long-standing persistent, and permanent AF had a higher risk of embolic stroke compared to those with paroxysmal AF, even after adjusting for CHADSVASC score (OR: 3.15, 95% CI: 3.08-3.22, P=0.000, 3.48, 95% CI: 3.26-3.71, P=0.000, 3.56, 95% CI: 2.84-4.47, P=0.000, OR: 3.21, 95% CI: 3.12-3.30, P=0.000).

Conclusion:
Based on our study findings, it can be concluded that nonparoxysmal atrial fibrillation is associated with a higher risk of embolic stroke compared to paroxysmal atrial fibrillation , regardless of the CHADSVASC score. Therefore, patients diagnosed with persistent, long-standing persistent, and chronic AF should receive enhanced monitoring and more proactive management strategies to effectively mitigate the risk of embolic stroke.
Abstract 11964: The Effect of Endothelin-1 on Angiotensin II-Induced Renal Injury
Authors: Niida Tomiharu , Isoda Kikuo , Ohtomo Fumie , Akita Koji , Kitamura Kenichi , Kadoguchi Tomoyasu , Minamino Tohru
Published: December 2023

Introduction:
Hypertension (HT) and kidney disease is increasingly recognized as a global public health problem. Angiotensin II (AngII) induces endothelin-1 (ET-1), and ET-1 is a key mediator of kidney fibrosis.

Hypothesis:
Inhibition of ET-1 may contribute to modulation of HT and renal injury induced by angiotensin II.

Methods:
In addition to wild-type (WT) mice, we also used IL-1 receptor antagonist-deficient (IL-1Ra
-/-
) mice that were prone to AngII-induced renal inflammation, because WT (C57BL) mice were genetically resistant to renal injury in response to AngII. Both mice were infused with AngII (1000ng/kg/min) using subcutaneous osmotic pumps for 14 days.

Results:
Systolic blood pressure in IL-1Ra
-/-
mice significantly increased compared with WT mice (197±5 vs 169±9 mmHg, p<0.05). Furthermore, renal preproendothelin-1 mRNA expression and serum levels of ET-1 were also significantly higher in IL-1Ra
-/-
mice (p<0.05). Immunostaining revealed that ET-1 was elevated in glomeruli and tubules in the cortex of IL-1Ra
-/-
mice compared with WT mice (Figure upper panels: ET-1 staining), indicating elevated ET-1 might contribute to glomerular injury (Figure middle panels: PAS staining) and intratubule fibrosis (Figure lower panels: Elastica Masson staining) detected in the histological analysis. Finally, we investigated whether pharmacological inhibition of ET receptors could prevent AngII-induced renal injury in IL-1Ra
-/-
mice. Bosentan significantly decreased AngII-induced HT, and protected renal injury in IL-1Ra
-/-
mice. On the other hand, treatment of hydralazine, an antihypertensive agent, did not suppress renal damage in AngII-infused IL-1Ra
-/-
mice in spite of improvement of HT.

Conclusions:
Our results indicate that inhibition of ET-1 might protect AngII-induced renal inflammation beyond an antihypertensive therapy, suggesting that we might be required to develop new strategies for blocking ET-1 to prevent hypertensive renal injury.
Abstract 11969: Association Between Blood Lead Levels and Silent Myocardial Infarction in the General Population
Authors: Mostafa Mohamed A , Abuessa Mohammed A , Soliman Mai , Ahmad Muhammad I , Soliman Elsayed Z
Published: December 2023

Background:
While the connection between environmental lead exposure and cardiovascular disease (CVD) is well-known, the association with silent myocardial infarction (SMI) remains unexplored.

Aims:
Our objective was to examine if there is a connection between higher blood lead levels (BLL) and increased prevalence of SMI in the general population.

Methods:
This analysis included 7,283 (mean age 56.1±2.52 years, 52.5% women, 49.8% Whites) participants from the Third National Health and Nutrition Examination Survey who were free of CVD. Graphite furnace atomic absorption spectrophotometry was used to measure blood lead levels (BLL). SMI was defined as the presence of electrocardiographic evidence of myocardial infarction (MI) without a prior history of MI. Multivariable logistic regression analysis was used to examine the cross-sectional association between baseline BLL and SMI.

Results:
Participants with higher levels of BLL had a higher prevalence of SMI (SMI prevalence 0.4%, 0.9% and 2.4% across BLL tertiles). In a multivariable-adjusted model, the highest BLL tertile was associated with over three times the odds of SMI compared to the first tertile, with an odds ratio of 3.42 (95% CI: 1.76-6.63). There was a 9% increase in the odds of SMI for every 1 μg/dL increase in BLL (Table). This association was consistent across subgroups stratified by median age, sex, and race.

Conclusion:
Higher BLL levels are associated with a higher likelihood of SMI in the general US population. These results underscore the ongoing need for efforts to minimize lead exposure among the general public.
Abstract 11983: Biomarker Profile of Patients With Atrial Fibrillation and Heart Failure With Preserved Ejection Fraction or Reduced Ejection Fraction: Insights From the ARISTOTLE Trial
Authors: Pol Tymon , Lindbäck Johan , Alexander John H , Granger Christopher , Lopes Renato D , Siegbahn Agneta G , Wallentin Lars C , Hijazi Ziad
Published: December 2023

Introduction:
Heart failure with preserved ejection fraction (HFpEF) is a poorly understood entity with phenotypic differences to heart failure with reduced ejection fraction (HFrEF). To shed light on the potential pathophysiological difference between HFrEF and HFpEF, multiplex screening of plasma proteins was performed.

Methods:
From the ARISTOTLE trial with atrial fibrillation (AF) patients, 562 patients with HFrEF and 562 with HFpEF at randomisation were included. Heart failure status at baseline was defined according to systolic left ventricular function; for HFrEF ≤40% and for HFpEF >40%. Plasma samples were analysed with conventional immunoassays and OLINK proximity extension assay panels; CVDII, CVDIII and the inflammation panel. Associations between biomarkers and HF subtype was evaluated with Wilcoxon–Mann–Whitney test with Bonferroni-Holm adjustment for multiplicity.

Results:
Out of 269 biomarkers, 53 biomarkers differed between the HF subtypes. After adjustment for multiplicity, nine biomarkers had the strongest associations with difference between HFrEF and HFpEF (Figure). In HFrEF, the proteins levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP), brain natriuretic peptide (BNP), cardiac troponin-T (cTnT-hs), renin, growth differentiation factor-15 (GDF-15), angiotensin-converting enzyme 2 (ACE-2) and interleukin-6 (IL-6) were higher than in HFpEF, whereas levels of stem cell factor (SCF) and leptin were higher (Figure) in HFpEF.

Conclusions:
HFrEF was more strongly associated with elevated markers of cardiorenal dysfunction, the renin-angiotensin-aldosterone system and oxidative stress/inflammation while HFpEF was more strongly associated with higher levels of adipose tissue metabolism and vasculogenesis and tissue repair proteins. These findings add valuable knowledge to the understanding of the underlying differing biological mechanisms in the HF subtypes HFrEF and HFpEF in an AF population.
Abstract 11986: Erythropoietic Response After Intravenous Iron in Heart Failure With Reduced Ejection Fraction With or Without Background Treatment With Sodium-Glucose Co-Transporter 2 Inhibitors
Authors: Matias Paula , Marques Pedro , Vieira Joana T , Vasques-Novoa Francisco , Sharma Abhinav , Mavrakanas Thomas A , Frioes Fernando , Ferreira Joao P
Published: December 2023

Introduction:
Intravenous (IV) iron increases hemoglobin/hematocrit and improve outcomes in patients with heart failure with reduced ejection fraction (HFrEF) and iron deficiency. Sodium glucose co-transporter 2 inhibitors (SGLT2i) also increase hemoglobin/hematocrit and improve outcomes in HF by mechanisms linked to nutrient deprivation signaling, and inflammation/oxidative stress reduction. The effect of IV iron among patients using SGLT2i has not yet been studied.

Hypothesis:
We hypothesize that HFrEF patients with iron deficiency treated with IV iron with a background treatment including a SGLT2i will have an increase erythropoietic response comparing to SGLT2i non users.

Methods:
Retrospective, single-center analysis of HFrEF patients with iron deficiency treated with IV iron using (n=60) and not using (n=60) SGLT2i, matched for age and sex. The primary outcome was the difference in absolute hemoglobin change (before
vs
after IV iron administration) between SGLT2i users and nonusers. The main secondary outcomes were the difference in hematocrit and iron biomarkers (total iron, ferritin and trasnferrin saturation) changes between SGLT2i users and nonusers.

Results:
Mean age was 73±12 years, 48% were men, with more than 65% of patients having chronic kidney disease and anemia. After adjustment for all baseline differences, SGLT2i users experienced a greater increase in hemoglobin and hematocrit compared to SGLT2i nonusers: hemoglobin +0.57 g/dL (95%CI 0.04-1.10, p=0.036) and hematocrit +1.64% (95%CI 0.18-3.11, p=0.029). No significant differences were noted for iron biomarkers or any of the secondary outcomes.

Conclusion:
Combined treatment with IV iron and background SGLT2i was associated with a greater increase in hemoglobin and hematocrit than IV iron without background SGLT2i. These results suggest that in HFrEF patients treated with IV iron, SGLT2i may increase the erythropoietic response.
Abstract 11988: Understanding Ethnic Differences in the Risk of Cardiovascular Events and Mortality Among Immigrants in Canada
Authors: Sebastian Sneha Annie , Padda Inderbir , Sethi Yashendra , Khan Ubaid , Johal Gurpreet
Published: December 2023

Introduction:
Immigrants make up the largest share of the population in Canada, and one in four Canadians has come to the country as an immigrant. The high level of immigration has resulted in significant ethnic diversity in Canada, and each presents with a cardiovascular disease (CVD) risk profile unique to their ethnicity and country of birth.

Methods:
We performed a literature search of 6 electronic databases, including the grey literature sources of conferences, reports, theses, and dissertations from January 2000 until May 25, 2023. We included pertinent English language literature that summarized the evidence on ethnic differences in CVD risk and mortality among immigrants of the following ethnic groups in Canada: South Asian (East Indian, Pakistani, Sri Lankan), Chinese, Black, Latin American, Southeast Asian (Vietnamese, Cambodian, Malaysian), West Asian (Iran, Afghan), Arab, Korean, Japanese, and Filipinos.

Results:
Of the 9968 studies identified, 47 studies formed the basis of the review. Four overarching themes of CVD risk were found, comprising individual characteristics, ethnic differences, gender-related risks, and duration of residence in Canada. Among the different ethnic groups, South Asians had the greater risk of cardiovascular events, in which males had a striking difference in mortality of (42%) compared to females (29%), whereas East Asians had the least risk. No significant difference in the incidence of CVD was reported with the duration of residence between varied ethnic groups. However, East Asians showed a notable exception, with an increase in the incidence of CVD after 10 years of stay in Canada by 40% and 60% among males and females, respectively.

Conclusions:
Ethnic inequalities in CVD attributes to a combination of modifiable and non-modifiable risk factors, and this disparity in CVD incidence can be tackled by targeting interventions according to ethnic differences in risk profiles.
Abstract 12010: Duration of Postoperative Atrial Fibrillation After Coronary Artery Bypass Graft Surgery is Associated With Poor Perioperative Outcomes
Authors: Qin Haokai , Xie Enzehua , Peng Zhan , Yang Xiubin , Hua Kun
Published: December 2023

Background:
Postoperative atrial fibrillation (POAF) is one of the most common complications after coronary artery bypass graft surgery (CABG). It has long been associated with poor perioperative outcomes, but few studies have been carried out regarding the effect of POAF duration on those outcomes.

Research Questions:
Does prolonged duration of POAF have an adverse effect on perioperative outcomes of CABG?

Methods:
This retrospective cohort study examined CABG patients enrolled at Beijing Anzhen Hospital from January 2018 to September 2021. We compared POAF duration ≥48 hours patients with POAF duration <48 hours patients. Primary outcomes examined were in-hospital mortality, stroke, acute respiratory failure (ARF), acute kidney injury (AKI), as well as significant gastrointestinal bleeding (GIB); secondary outcomes were postoperative length of stay (LOS), intensive care unit (ICU) stay. Associations between primary outcomes and POAF duration were determined using logistic regression and restricted cubic spline analyses.

Results:
Out of 11 848 CABG patients, 3604 (30.4%) had POAF; 1131 (31.4%) of POAF patients had it for duration ≥48 hours. ARF (adjusted odds ratio [OR]: 2.96, 95% confidence interval [CI]: 1.47 - 6.09), AKI (adjusted OR: 2.37, 95% CI: 1.42 - 3.99), and significant GIB (adjusted OR: 2.60, 95% CI: 1.38 - 5.03), but not in-hospital mortality (adjusted OR: 1.56, 95% CI: 0.92 - 2.65) or stroke (adjusted OR: 1.29, 95% CI: 0.70 - 2.33) was associated with POAF duration ≥48 hours. These findings were still applicable, even after conducting propensity score matching and inverse probability of treatment weighting analyses.

Conclusions:
POAF duration longer than 48 hours was independently associated with poorer perioperative recovery from CABG, with respect to the occurance of AFR, AKI and GIB, as well as longer postoperative LOS and ICU stay. However, it was not associated with greater in-hospital mortality or stroke occurrence. All these findings suggest that postoperative monitoring of POAF and positive intervention after detection could optimize post-CABG patient outcomes.
Abstract 12016: Rare Variants in
APOE
Gene Are Associated With Disease-Onset and Outcomes of Hypertrophic Cardiomyopathy
Authors: Huang Qiya , Zhang Channa , Lu Minjie , Bo Xiaochen , Wang Jizheng , song lei
Published: December 2023

Introduction:
Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiovascular disease and may lead to tragic outcomes such as sudden cardiac death and heart failure. Previous studies have shown that HCM patients undergo significant lipid-related metabolic reprogramming. But whether lipid gene variants affect the diagnosis and prognosis of HCM patients remains unclear.

Methods and Results:
Whole-exome sequencing was performed in 985 patients with HCM and 759 non-HCM controls to search for lipid gene variants. The
APOE
rare variants were more prevalent in patients with HCM than controls (odds ratio, 4.91, P < 0.001). Patients with
APOE
rare variants have higher left ventricular outflow tract gradient (LVOTG) (71.0 VS 38.0 mmHg, P = 0.035), higher triglycerides (1.59 VS 1.32 mmol/L, P = 0.051) and lower lipoprotein a (65.5 vs 113 mg/L, P = 0.076) in peripheral blood.
APOE
carriers also had elevated free fatty acids in 290 surgically resected myocardial tissue lipidomics data (P = 0.008). With a median follow-up time of 5.10 years, HCM patients with
APOE
rare variants were more likely to experience cardiovascular death (adjusted HR 4.8, P = 0.001) and all-cause death (adjusted HR 3.5, P = 0.008).

Conclusion:
Our cohort data indicated that rare variants of
APOE
are associated with altered lipid metabolism in peripheral blood as well as myocardial tissue, increased LVOTG, and greater risk of HCM disease-onset as well as poor prognosis. We proposed that
APOE
might be associated with HCM and that its contribution to myocardial hypertrophy through lipotoxicity may be an emerging mechanism for HCM pathogenesis and progression.
Abstract 12019: The Psychometric Performance of the Kansas City Cardiomyopathy Questionnaire-12 in Symptomatic Obstructive Hypertrophic Cardiomyopathy
Authors: Sauer Andrew J , Sherrod Charles F , Gosch Kensey L , Arnold Suzanne V , Reaney Matthew , Zhong Yue , Lam Jenny , Wyrwich Kathleen W , Spertus John A
Published: December 2023

Background:
A treatment goal for obstructive hypertrophic cardiomyopathy (oHCM) is to reduce symptom burden and improve health status, which can be measured with the 23-item Kansas City Cardiomyopathy Questionnaire (KCCQ-23). While the KCCQ-23 has been validated in oHCM, the shorter 12-item version (KCCQ-12) is more feasible in clinical care but has not been validated.

Hypothesis:
The construct validity, reliability, and responsiveness of the KCCQ-12 will support its use for patients with oHCM.

Aims:
To validate the psychometric performance of the KCCQ-12 in patients with oHCM and its interpretability categorized by Patient Global Impression of Change (PGIC).

Methods:
The psychometric properties of the KCCQ-12 and domains were tested in 196 participants with symptomatic oHCM from the EXPLORER-HCM trial. Construct validity was assessed against clinical and patient-reported standards using Spearman Correlation coefficients. Reliability was assessed by Cronbach’s alpha (> 0.70). Test-retest reliability was determined using intra-class correlation (ICC) coefficient (good correlation being ICC > 0.70) and paired t-tests of clinically stable patients (defined as no change in PGIC from baseline to 6 weeks and no change in Patient Global Impression of Severity from 18-30 weeks). Responsiveness and interpretability were assessed within categories of the 6-week PGIC.

Results:
KCCQ-12 domains and summary scores had moderate to strong correlations with most clinical standards (NYHA class, exercise duration, pVO
2
) and patient-reported scales (Table 1). The KCCQ-12 showed strong internal and test-retest reliability (Table 2). All KCCQ-12 scores demonstrated significant and proportional changes of different magnitudes of clinical change delineated by the PGIC (Table 3).

Conclusion:
The KCCQ-12 demonstrates good psychometric performance for patients with oHCM and can be confidently used to monitor the health status of patients with oHCM in clinical practice.
Abstract 12053: Diagnostic Utility of SGLT2 Inhibitors to Facilitate Myocardial Glucose Suppression During Evaluation of Myocardial Inflammation
Authors: Selvaraj Senthil , Vidula Mahesh K , Rojulpote Chaitanya , Clancy Caitlin , Rossman Milton , Goldberg Lee R , Pryma Daniel A , Bravo Paco E
Published: December 2023

Background:
The non-invasive cornerstone for evaluating cardiac sarcoidosis (CS) remains
18
F-FDG-PET. However, FDG-PET requires suppressing physiologic glucose uptake to highlight pathologic uptake. Short term ketogenic diet (KD) is standard-of-care, yet inadequate suppression occurs in 10-20% which can mimic CS patterns. Ketone metabolic markers strongly predict appropriate glucose suppression, and therefore the ketogenic-SGLT2i may facilitate suppression.

Methods:
We prospectively evaluated 494 scans from 388 unique patients undergoing evaluation for CS. FDG-PET images were classified as diagnostic (negative or positive for CS-related inflammation) or non-diagnostic (diffuse or non-specific uptake). We used mixed effect linear regression (accounting for clustering at the participant level), adjusting for age, race, sex, days of KD, heart failure (HF), and diabetes mellitus.

Results:
Mean age was 59.0±10.1 years, 63% were male, 29% were Black, 21% were repeat scans, and 14% were on SGLT2i. SGLT2i use was associated with male sex, features/treatment for HF and diabetes, and higher hemoglobin and ketone levels (
Table
, p<0.05 for all comparisons). Diagnostic scans were more frequently achieved in the SGLT2i group (98.6%) vs. non-SGLT2i group (92.0%) (unadjusted beta-coefficient 6.6%, 95%CI 0.0-13.1%, p=0.049; multivariable-adjusted 8.0%, 1.3-14.6%, p=0.019). Adjusting for log-transformed BHB eliminated this relationship (beta-coefficient 4.7%, p=0.17), though hemoglobin adjustment did not (beta-coefficient 7.9%, p=0.038). There were no interactions by days of KD, HF, sex, race, or diabetes (p-interaction>0.05 for all comparisons).

Conclusions:
SGLT2i facilitated diagnostic FDG-PET scans (number needed-to-treat 13-15), which was nearly universally achieved (99%), and may be mediated by their ketogenic effects. We demonstrate a novel diagnostic niche which may decrease inappropriate treatment, costs, and radiation.
Abstract 12075: Does Improvement in Food Insecurity Lead to Improvement in Weight and Waist Circumference?
Authors: Ardoin Tiffany W , Mercante Donald
Published: December 2023

Purpose:
The Food Insecurity and its Sequelae on Health (FISH) Research Study measures the impacts of the Geaux Get Healthy Clinical Program (GGH) on food insecurity and metabolic health. GGH is an 8-week program that provides community members with food insecurity nutrition/cooking education and access to resources. We have already shown that this program improves food security scores from enrollment to completion of the program with continued improvement at 6 months with USDA Adult Food Security Survey Module scores of 6.9 to 4 to 2.7 respectively
1
. We proposed that improvements in food insecurity with GGH would also translate into sustainable improvements in weight and waist circumference.

Methods:
Eligible participants included patients who qualified for the GGH Program ages 18-65, were English-speaking and without audiovisual deficits. Upon enrollment, participants met with the Health Specialist, again at 8-12 weeks, and again at 6 months. At each visit, participants completed validated surveys which included food security scores and vital signs were obtained.

Results:
At the time of this analysis, a total of 118 participants were enrolled. Participants’ mean BMI was 34.89 kg/m
2
(
SD
=9.20). 66% of enrollees had diabetes (37%) or pre-diabetes (29%) and 56% of enrollees had hypertension. Of those who completed the study (n= 57), the mean weights were 92.2 kg at initial visit; 86.1 kg at 8 weeks; and 91.2 kg at 6 months. The mean waist circumferences were 42.26 in at initial visit; 40.2 in at 8 weeks; and 41.06 in at 6 months. The Wilcoxon Signed Rank Test was used to analyze change in response over 2 timepoints. Significant improvement in means of both weight (
p
=0.011) and waist circumference (
p
=0.008) occurred from enrollment to program completion at 8 weeks. However, neither of these improvements were sustained.

Conclusions:
It appears that a program providing access to resources and education improves food security scores along with weight and waist circumference. Although food security score improvements persist, improvements in weight and waist circumference do not. This suggests that intense programs addressing food insecurity may not continue to improve metabolic health once the educational piece is over and only access to community resources remains.
Abstract 12097: Genetics of Cardiac Troponin
Authors: Sharma Pranav , Damrauer Scott M , Levin Michael
Published: December 2023

Introduction:
In the absence of coronary artery disease, observational studies suggest that myocardial injury may occurs because of drugs/toxins, infection, inflammatory disease, and malignancy, alongside commonly associated conditions such as heart failure, kidney disease, and hypertension, among others. The causes and optimal treatment for myocardial injury without ischemic heart disease remains an unmet need in cardiovascular medicine. We aimed to leverage genome-wide association studies (GWAS) to identify previously unreported risk loci for circulating troponin levels in the absence of ischemia, and Mendelian randomization (MR) to highlight causes of myocardial injury and identify potential targets for intervention.

Methods:
We performed a GWAS meta-analysis of circulating cardiac troponin I (cTnI) and T (cTnT) among up to 46,267 healthy ambulatory individuals using METAL. Using publicly-available GWAS of ~40 common cardiovascular risk factors such as lipids, blood pressure, and kidney function available from the IEU Open GWAS Project, we used Mendelian randomization (MR) to identify their potential causal association with circulating troponin. We primarily employed inverse-variance weighted MR; weighted median and weighted mode methods were applied as sensitivity analyses.

Results:
Our meta-analysis revealed three risk loci each for cTnI and cTnT, including a previously unreported signal on chromosome 3 (rs1706435) for cTnT. After accounting for multiple testing by controlling the false discovery rate (q < 0.05), MR identified 8 and 10 cardiovascular risk factors associated with elevated cTnI and cTnT, respectively. These factors included blood pressure, creatinine, classes of obesity, and waist circumference.

Conclusions:
This analysis identified a new risk locus for circulating troponin in the absence of ischemia. Our MR results provide human genetic evidence to support obesity and hypertension as important contributors to elevated circulating troponin, highlighting their potential role in myocardial injury.
Abstract 12119: Work Environment, Burnout, and Intent to Leave Current Job Among Cardiology Team Members: Results From the National Coping With COVID Survey
Authors: Mallick Sanjoyita , Shroff Gautam R , Linzer Mark , Douglas Pamela S , Sullivan Erin , Brown Roger , Karim Rehan
Published: December 2023

Introduction:
Burnout amongst cardiologists has nearly doubled since the COVID pandemic, but few data describe burnout or its relationship to work environment factors among cardiology team members.

Methods:
The National Coping with Covid (CwC) Survey included over 1300 cardiology healthcare workers (HCWs). We determined likelihood of burnout among different roles (physicians, advanced practice providers [APPs], nurses [RNs] and other clinical staff [OCS]). Multilevel logistic regression examined independent work life variables in predicting and mitigating burnout, and relationships of burnout to intent to leave current job.

Results:
The CwC Survey was completed by 1,396 cardiology HCWs (306 MD/ 173 APP/452 RN/ 105 OCS). RNs were most likely to report burnout (59% RNs, 56% OCS, 46% APPs, 40% physicians, p< 0.0001). Work overload was an independent correlate of burnout in all 4 groups, anxiety/depression due to COVID was meaningful in 3 groups, while childcare stress was not related in any group (adjusted Odds Ratios (aORs) 4-17, p’s < 0.005, Table). Feeling valued (FV) was associated with lower burnout in all groups except OCS. A sense of purpose was not significantly associated with lower burnout in any group, although there was a borderline association in physicians (aOR 0.53, p = 0.07). Intent to leave was common, and associated with burnout in all groups, especially APPs (r=0.66) and OCS (r=0.73, p’s < 0.01).

Conclusions:
Burnout, common among cardiology HCWs, is highest in nurses. While work life variables related to burnout differ between role types, burnout is consistently associated with intent to leave practice. Leaders should recognize that burnout is prevalent among team members, may have different contributors, and has consequences for retention. To prevent burnout in cardiology, strategies such as workload reduction, mental health services and explicitly and effectively valuing workers should be implemented.
Abstract 12129: Using a Polygenic Risk Score to Account for Genomic Risk Factors in a Model to Detect Individuals With Dilated Ascending Thoracic Aortas
Authors: Depaolo John , Biagetti Gina , Judy Renae , Wang Grace , Iyengar Amit , Kelly John J. , Desai Nimesh D , Szeto Wilson Y , Bavaria Joseph E , Levin Michael , Damrauer Scott M
Published: December 2023

Background:
Ascending thoracic aortic dilation is a complex trait that involves modifiable and non-modifiable risk factors and can lead to thoracic aortic aneurysm and dissection. Clinical risk factors have been shown to predict ascending thoracic aortic diameter. Polygenic risk scores (PRS) are increasingly used to assess clinical risk for multifactorial diseases. The degree to which a PRS improves aortic diameter risk prediction is not known. In this study we tested the extent to which the addition of PRS to clinical prediction algorithms improves the prediction of aortic diameter.

Methods:
Training and validation cohorts comprised 6,790 Penn Medicine Biobank (PMBB) participants with clinical data linked to whole exome sequencing. Linear regression models integrated PRS weights derived from a large genome wide association study of thoracic aortic diameter in the UK biobank and were compared to the performance of the standard and a reweighted variation of the recently published AORTA Score.

Results:
The training cohort of 5,092 participants (56% male) had a median age of 61 years (IQR 52-70) with a mean ascending aortic diameter of 3.4 cm (SD 0.5). Compared to the AORTA Score which explained 29.1% (95% CI 27.9%-30.8%) of the variance in aortic diameter, AORTA Score + PRS (explained 29.7%, 95% CI 28.5%-30.9%), the reweighted AORTA score (explained 30.7%, 95% CI 29.4%-32.3%), and the reweighted AORTA Score + PRS (explained 31.5%, 95% CI 30.0%-32.8%) had superior performance. For the predictive ability to identify thoracic aortic diameter of ≥ 4 cm, the addition of a PRS to both the AORTA Score and the reweighted AORTA Score improved sensitivity at a range of model threshold values. The respective areas under the receiver operator characteristic curve for the AORTA Score + PRS (0.762, 95% CI 0.731-0.794) and reweighted AORTA Score + PRS (0.779, 95% CI 0.749-0.809) were greater than the standard AORTA Score (0.758, 95% CI 0.727-0.789) and reweighted AORTA Score (0.775, 95% CI 0.745-0.805).

Conclusions:
We demonstrated that inclusion of a PRS to the AORTA Score results in a small performance enhancement. Further investigation is necessary to determine if incorporation of genetics into clinical risk prediction improve outcomes for thoracic aortic disease.
Abstract 12134: The Utilization Rate of Intravenous Thrombolysis in Asian Countries: A Systematic Review and Meta-Analysis
Authors: Gajurel Bikram Prasad , Nepal Gaurav , Jaiswal Vikash , Ang Song Peng , Nain Priyanshu , Evbayekha Endurance O , Bohara Sujan , Shama Nishat , Ruchika FNU , Medina Jillian Reeze , Kharel Sanjeev , YADAV Dr. JAYANT KUMAR
Published: December 2023

Introduction:
Even though IV thrombolysis has been used for more than two decades, coverage remains inadequate. Asia, the region with the highest age-standardized incidence of ischemic stroke, has no regional data on IVT utilization at present.

Objective:
This study aimed to provide more accurate estimates of IVT usage for AIS in Asia.

Methods:
We performed a systematic literature search using PubMed, Embase, and Scopus for relevant articles from inception until 15th March 2023.

Results:
A total of 67 observational studies with a total of 778,046 patients with ischemic stroke were included in the final analysis. In terms of regional distribution of studies, East Asia was the most common (n=12), followed closely by Arab (n=18), Southeast Asia (n=15), South Asia (n=12) and lastly Central and North Asia (n=2). In terms of the income level stratified by GDP of these countries, 35.8 % of them were classified as high-income countries, 40.3% were of lower-middle income countries and the rest (23.9%) being upper-middle-income countries. Our pooled analysis of 67 Asian studies revealed an IV thrombolysis rate of 9.1%. We discovered substantial variation in the thrombolysis rate across Asia, with 11.3% receiving thrombolysis in HIC countries and only 8.1% in LMICs; far below the American Stroke Association's target rate of 50%.

Conclusion:
Patients with ischemic stroke in HIC countries, countries/hospitals with their own guidelines/protocols, living in urban areas, and receiving care in hospitals with a public-private partnership are more likely to receive thrombolysis, according to our findings. Improving thrombolysis rates throughout Asia would be greatly aided by reducing prehospital and hospital delays, enhancing local infrastructure and human resources, and educating the public about stroke.
Abstract 12151: Impact of Psychosocial Risk Factors on the Outcomes of Patients Undergoing Cather Ablation for Atrial Fibrillation
Authors: Agarwal Siddharth , Munir Bilal , Chaudhary Amna Mohyud Din , Sharma Vagisha , Krishan Satyam , Desimone Christopher V , Deshmukh Abhishek , Stavrakis Stavros , Po Sunny S , Al-Kindi Sadeer , Asad Zain Ul Abideen U
Published: December 2023

Introduction:
There is limited data on how psychosocial risk factors (PSRFs) affect the outcomes of patients undergoing atrial fibrillation (AF) ablation.

Hypothesis:
We hypothesized that the presence of PSRFs affects the outcomes of AF ablation and tested this hypothesis using a nationally representative sample of the US population.

Methods:
The National Readmissions Database (NRD) was analyzed from 2016-2019 to identify patients ≥ 18 years old undergoing AF ablation. Patients were divided into two cohorts based on the presence or absence of ≥1 PSRF. PSRFs were divided into 5 domains including limited cognitive understanding, substance use, psychiatric disease, low socioeconomic status, and uninsured status. A multivariable logistic regression model was utilized to adjust for confounders.

Results:
Our cohort included 50,623 AF ablation procedures, of which 21,363 (42.2%) had ≥ 1 PSRF. On multivariable analysis, the presence of ≥ 1 PSRF was associated with higher odds of cardiovascular complications (adjusted odds ratio [aOR] 1.11; 95% confidence interval [CI]: 1.02-1.22; p=0.02), peripheral vascular complications (aOR:1.18; 95% CI: 1.01-1.38; p=0.04), pulmonary complications (aOR:1.16; 95% CI: 1.05-1.29; p<0.01) and neurological complications (aOR:1.42; 95% CI: 1.12-1.78; p<0.01), along with higher odds of 30-day all-cause readmissions (aOR:1.30; 95% CI: 1.19-1.43; p<0.01) and atrial fibrillation/flutter related readmissions (aOR:1.27; 95% CI: 1.08-1.50; p<0.01), 90-day all-cause readmissions (aOR:1.30; 95% CI: 1.20-1.40; p<0.01) and atrial fibrillation/flutter related readmissions (aOR:1.22; 95% CI: 1.06-1.41; p<0.01), and 180-day all-cause readmissions (aOR:1.35; 95% CI: 1.24-1.45; p<0.01) (Figure 1).

Conclusion:
In conclusion, our data suggest an association between PSRFs and worse in-hospital outcomes along with increased all-cause and arrhythmia-related readmissions in patients undergoing AF ablation.
Abstract 12166: Social Determinants of Health and Acute Interstage Outcomes: An NPC-QIC Analysis
Authors: Zielonka Benjamin , Bucholz Emily M , Lu Minmin , Bates Katherine , Hill Garick D , Pinto Nelangi M , Sleeper Lynn A , Brown David W
Published: December 2023

Introduction:
The interstage period after Stage 1 palliation (S1P) carries high morbidity and mortality. The impact of social determinants of health (SDOH) on acute interstage outcomes has not been well described.

Question:
How do SDOH affect interstage outcomes?

Methods:
Infants discharged after S1P in the National Pediatric Cardiology Quality Improvement Collaborative Phase 2 registry were analyzed. ZIP code-level Childhood Opportunity Index (COI), a composite metric incorporating 29 indicators, was used to classify patients into 5 COI levels. Birth and S1P characteristics were compared. The association between COI level and binary acute interstage outcomes was assessed using log-rank test and logistic regression with and without adjustment for race/ethnicity, interstage risk factors, and interstage duration.

Results:
There were 1837 patients from 68 centers. There were differences across COI levels in birthweight, proximity to a surgical center, area of residence, age and weight at S1P, S1P length of stay (LOS), and feeding mode at discharge (
Table
). Over 98% of patients in all COI levels had home monitoring. Death or transplant occurred in 101 (5%) patients with unplanned readmission in 987 (53%), ICU admission in 448 (24%), unplanned catheterizations in 345 (19%), and reoperation in 83 (5%). COI level was not associated with differences in interstage outcomes on logistic regression or log-rank test (
Figure)
.

Conclusions:
COI level is associated with differences in pre-operative status, feeding mode, and S1P LOS, but not acute interstage outcomes. The role of home monitoring programs in protecting against interstage disparities merits further investigation.
Abstract 12220: Intracavitary Left Ventricular Flow During Isovolumic Relaxation: Prevalence, Mechanism and Clinical Outcomes
Authors: Agdashian David , Meller Leo , Igata Sachiyo , Demaria Anthony N
Published: December 2023

Introduction:
Intracavitary flow (IVF) from LV base to apex during isovolumic relaxation (IVR) has been identified in patients with Grade I diastolic dysfunction (G1DD) associated with impaired relaxation. We examined the prevalence, mechanism, and outcomes of this phenomenon.

Methods:
Echocardiograms and medical records of 113 patients who met ASE criteria for G1DD without other cardiac abnormalities were reviewed. IVR was from relaxation onset to mitral opening. IVF was an apically directed signal with a defined envelope recorded by CW Doppler during IVR (Figure) confirmed by color Doppler. Global longitudinal strain was obtained in standard fashion using commercial equipment and analyzed for apical and basal segments.

Results:
IVF during IVR was present in 35 patients, absent in 27, and had inconclusive signals not meeting criteria in 51. The magnitude of reduction in apical strain was significantly larger in IVF patients than those without (-14% vs -5%, p = 0.04). This difference was present in both the lateral (-18% vs -7%, p = 0.04) and septal (-11% vs -1%, p = 0.05) segments. The rate of reduction in apical strain was also higher in the IVF group (0.318 strain fractions/sec vs 0.168, p = 0.03). No significant differences between groups existed for proportion of apical relaxation, change in strain between apex/base, proportion/magnitude/rate in basal strain. Patients with IVF during IVR had a non-significant trend for a higher death rate (23 vs 11%). There was no significant difference in hospitalization, heart failure, atrial fibrillation, CAD, or stroke.

Conclusions:
Apical intracavitary flow during IVR occurred in 31% of G1DD patients. Although mechanism is not fully defined, our data indicates that IVF during IVR is related to the magnitude and rate of apical relaxation. IVF during IVR may be of value in stratifying future risk in Grade I diastolic dysfunction patients but will require larger studies.