bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 9445: Using Latent Class Analysis to Identify Antihypertensive Adherence Trajectories: The BETTER-BP Trial
Authors: Grant Eleonore V , Qian Kun , Adhikari Samrachana , Guttierez Yasmin , Shimbo Daichi , Levy Natali , Fonceva Anamarija , Dodson John A
Published: June 2023

Introduction:
Adherence to antihypertensive medications remains low in many patients. In this context, the BETTER-BP randomized trial was designed to test whether providing small financial rewards for medication adherence with a text message-based lottery system improves adherence and lowers blood pressure. In this preliminary analysis we characterized adherence trends from baseline to 6 months in BETTER-BP through 12/2021.

Methods:
Participants were recruited from two safety-net clinics in New York City (Bellevue Hospital and NYU-Brooklyn FHC). There were 101 participants with six months of complete adherence data. Mean weekly adherence was recorded through an Adheretech electronic monitoring device. Latent class mixed methods analysis was used to determine categorizable adherence trajectory trends over six months. We then investigated factors (age, sex, insurance status, comorbidity burden, depression, self-efficacy) that predicted category membership. The analysis remained blinded to treatment arm given that full enrollment was not yet complete.

Results:
Three distinct adherence trajectories were determined: (1) High, persistent adherence (n=53), (2) Gradually declining adherence (n=33), and (3) Early declining non-adherence (n=15). In a multivariable analysis, only self-efficacy (based on the medication adherence self-efficacy scale [MASES]) had a significant (p=0.02) association with adherence, with mean MASES scores of 81.4, 76.3 and 72.1 for clusters (1), (2) and (3) respectively.

Conclusions:
In this preliminary analysis, we found that the majority of participants had high persistent adherence, and that those with high self-efficacy were more likely to be members of this category. These results will need to be confirmed at trial completion (target sample N = 435).

Figure 1. Mean participant adherence trajectory clusters over six months.
Abstract 9472: Effects of Social Determinants of Health on ICD Shocks, Hospitalizations, & Mortality in the First Year After an ICD
Authors: Streur Megan M , Auld Jonathan P , Frazier Elizabeth , Chang Wei-Lun , Choupani Fatemeh M , Liberato Ana C , kwan ka yee , Zheng Tao , Thompson Frances Elaine , Dougherty Cynthia M
Published: June 2023

Introduction:
Disparities in the receipt of an implantable cardioverter defibrillator (ICD) have been reported. African Americans (AA), women, and those with lower SES are less likely to receive an ICD and more likely to report poor outcomes after ICD implant. The
purpose
of this study was to determine if social determinants of health (SDOH) were associated with the number of ICD shocks experienced, all cause hospitalization, or mortality in the first year following receipt of an initial ICD.

Hypothesis:
SDOH (age, race, biological sex, annual income, employment, education, rural vs urban locale) are related to total ICD shocks, all cause hospitalization, and mortality in the first year after an initial ICD.

Methods:
301 patients who received an initial ICD (58% primary prevention, 42% secondary prevention) were followed for 1 year. Patients were 64
±
2 years old, 91% Caucasian, 4% AA, 2% Am Indian (AI), 2% Latinx, 74% male, 87% urban , 65% retired-disabled, 45% household income < $50K, and 48% high school education or less. ICD shocks, hospitalizations, & deaths were verified using the EMR. Descriptive statistics, correlations, and multivariate logistic regression were used to examine for SHOD related disparities in health outcomes over 1 year.

Results:
There were
no
significant associations between SDOH and ICD shocks, all cause hospitalization, or mortality over 1 year.
ICD shocks
: 34 patients (11.3%) had at least 1 ICD shock over 12-months of follow-up. The number of ICD shocks was higher for those who engaged in hazardous drinking (25%: 5% women, 20% men, p=0.03), and those who received an ICD for secondary prevention (primary 8.4%, secondary 15.4% (p=0.04) at baseline..
Hospitalization
: 95 patients (31.6%) were hospitalized over the 12 months of follow-up.
Mortality
: 9 (3%) deaths (67% cardiac related) were recorded over the 12 months, with no associations found between SDOH and mortality.

Conclusions:
SDOH were not associated with the incidence of ICD shocks, all-cause hospitalization, or mortality in the first year after receipt of an initial ICD. SDOH influences on access to receipt of an initial ICD may have contributed to the observed outcomes post-ICD.
Abstract 9501: Single-Cell Transcriptomic Analysis and Patient-Specific iPSCs Reveal Dysfunctional Coronary Arterial Endothelial Cells in Hypoplastic Left Heart Syndrome
Authors: Yu Zhiyun , Zhou Xin , Liu Ziyi , PastranaGomez Victor , Liu Yu , Guo Minzhe , Tian Lei , Nelson Timothy J , Wang Nian , Mital Seema , Chitayat David , Wu Joseph C , Rabinovitch Marlene , Wu Sean M , Snyder Michael , Miao Yifei , Gu Mingxia
Published: June 2023

Introduction:
Hypoplastic left heart syndrome (HLHS) is a severe form of single ventricle congenital heart disease characterized by the underdeveloped left ventricle. Early serial postmortem examinations revealed a high rate of coronary artery abnormalities in HLHS fetal hearts (e.g., thickened wall and kinking arteries). However, the intrinsic defect in HLHS coronary vessels and its genetic basis remain unclear.

Methods:
We profiled human fetal heart with an underdeveloped left ventricle (ULV) and induced pluripotent stem cells derived endothelial cells (iPSC-ECs) from HLHS patients at single-cell resolution.
CD144
+
/
NPR3
-
vascular ECs were selected and classified as venous, arterial, and late arterial populations. To study the arterial EC phenotypes, we generated iPSC-arterial ECs (AECs, CDH5
+
CXCR4
+
NT5E
-/low
) derived from 3 HLHS patients and 3 age-matched controls, and evaluated their functionalities including cell cycle regulation, angiogenesis, and inflammatory response.

Results:
Revealed by single cell RNA-seq and subsequent gene ontology analysis, ULV late arterial EC population showed significant defects in EC development, proliferation, angiogenesis, and Notch signaling compared to the control. Consistently, HLHS iPSCs exhibited impaired AEC differentiation judged by the reduced CXCR4
+
NT5E
-/low
AEC progenitors. Mature HLHS iPSC-AECs showed reduced angiogenesis and enhanced G0/G1 cell cycle arrest with downregulated cell cycle-related genes (e.g.,
Ki67, CCND1/2
). Healthy human aortic smooth muscle cells exhibited abnormal proliferation and synthetic phenotypes when co-cultured with HLHS iPSC-AECs. Additionally, NOTCH pathway genes (e.g.,
DLL4, HEY1, GJA5
) were suppressed in both ULV AECs and HLHS iPSC-AECs. HLHS
de novo
variant
KMT2D
directly regulated the transcription of NOTCH targeted genes involved in arterial development and proliferation via H3K4me2. Intriguingly, the treatment of NOTCH ligands (Jag1, Dll1) significantly improved the proliferation of HLHS AECs.

Conclusions:
Our study revealed that HLHS coronary AECs were dysfunctional in angiogenesis, proliferation, and EC-SMC interaction. KMT2D-NOTCH signaling may contribute to the impaired development and proliferation of HLHS AECs.
Abstract 9536: The Influence of Social Determinants of Health and Race on Pediatric Heart Transplant Outcomes
Authors: Amdani Shahnawaz , Asante-Korang Alfred , Kirklin James K , Zhao Hong , Cantor Ryan , Schold Jesse , Azeka Estela
Published: June 2023

Introduction:
While traditional registry-based analyses have outlined that Black children have worse post-heart transplant (HT) outcomes, it is not entirely clear if such differences persist after accounting for social determinants of health (SDOH).

Hypothesis:
After accounting for SDOH, Black children from distressed communities will continue to have worse post-HT outcomes compared to White children.

Methods:
All children in the Pediatric Heart Transplant Society (PHTS) database that underwent HT in the U.S. from January 2010 - December 2020 were included. Recipient zip codes from PHTS and the Scientific Registry of Transplant Recipients databases were used to create a pediatric specific community risk score for each transplanted recipient. Lower risk communities (quartiles 1 and 2) were labelled

prosperous

and the higher risk (quartiles 3 and 4) as

distressed

communities. The effects of community risk and self-identified race on post-HT rejection, cardiac allograft vasculopathy (CAV) and graft loss were evaluated unadjusted and after adjusting for donor and recipient risk factors.

Results:
Of 3680 children transplanted, 1911 (51.9%) lived in prosperous and 1769 (48.1%) in distressed communities. Unadjusted analysis revealed that Black children from distressed communities had higher rejection (p=0.0013), CAV (p=0.0011) and graft loss (p<0.0001)
(Figure)
. In multivariable adjusted analysis, Black children from distressed communities experienced increased rejection (HR 1.33, 95%CI 1.03-1.71), CAV (HR 2.06, 95%CI 1.21-3.51) and graft loss (HR 1.66, 95%CI 1.12-2.46), while white children did not experience increased rejection (HR 0.99, 95%CI 0.86-1.14), CAV (HR 0.95, 95%CI 0.69-1.32) or graft loss (HR 1.17, 95%CI 0.92-1.48).

Conclusions:
This study found that SDOH independently affects post-HT outcomes for Black, but not White children. More studies will be necessary to identify the root causes to be able to address these racial disparities.
Abstract 9544:
PRDM16
Loss in 1p36 Deletion Syndrome is Associated With Worse Cardiovascular Outcomes: A Multi-Institutional Registry Study
Authors: Kramer Ryan J , Fatahian Nima , Chan Alice , Mortenson Jeffrey , Osher Jennifer , Sun Bo , Parker Lauren E , Rosamilia Michael , Atkins Sage L , Rosenfeld Jill A , Birjiniuk Alona , Jones Edward , Howard Taylor S , Allen Hugh D , Kim Jeffrey J , Scott Daryl A , Lalani Seema , Rouzbehani Omid T , Hathaway Marissa A , Cohen Jennifer L , Asaki Yukiko , Martinez Hugo R , Boudina Sihem , Landstrom Andrew P
Published: June 2023

Introduction:
1p36 deletion syndrome can confer a predisposition to pediatric-onset cardiomyopathy. 1p36 deletion breakpoints are variable and can delete
PRDM16
, a cardiac transcription factor. Early studies suggest
PRDM16
loss may underlie cardiomyopathy in patients with 1p36 deletion; however, the prognostic impact of
PRDM16
loss is unknown.

Hypothesis:
Deletion of
PRDM16
in 1p36 deletion syndrome (“
PRDM16
deleted”) is associated with the development of cardiomyopathy and adverse cardiovascular outcomes.

Methods:
This registry study included Duke University Hospital, Texas Children’s Hospital, Primary Children’s Hospital, & Le Bonheur Children’s Hospital. Standard descriptive statistics and Kaplan-Meier estimates were generated. The composite primary outcome was freedom from death, cardiac transplantation, or ventricular assist device (VAD) implantation. A cardiac-specific conditional
Prdm16
knockout mouse (
Prdm16
cKO) was generated. Echocardiography, qPCR, and fibrotic staining were performed at 29 weeks.

Results:
66 individuals met the inclusion criteria of 1p36 deletion syndrome and at least one clinical encounter. Among individuals with
PRDM16
deleted, 37.9% developed cardiomyopathy versus 4.3% of individuals with
PRDM16
not deleted (p=0.09). The most common cardiomyopathies in individuals with
PRDM16
deleted were LVNC (27.6%) and DCM (13.8%). Individuals with
PRDM16
deleted had a 65% probability of developing systolic dysfunction by age 18. Notably,
PRDM16
deletion was associated with a significantly increased risk of death, cardiac transplant, or VAD (p=0.04) versus those with
PRDM16
not deleted.
Prdm16
cKO mice exhibited an increased risk of mortality (p=0.05) and decreased ejection fraction (p<0.01).
Prdm16
cKO mice demonstrated significantly increased cardiac fibrosis (p<0.0001), and
Tgf-β
and
Nppb
mRNA were significantly upregulated (p<0.05).

Conclusions:
PRDM16
deletion as part of 1p36 deletion syndrome confers a significantly increased risk of cardiac mortality. Murine models of cardiomyocyte
Prdm16
loss demonstrate an increased risk of mortality and cardiomyopathy development. Patients with 1p36 deletion syndrome should be assessed for cardiac disease, particularly those with
PRDM16
deletions.
Abstract 9551: Extracorporeal Membrane Oxygenation for Covid-19 in Children: A Systematic Review and Meta-Analysis
Authors: Watanabe Atsuyuki , Yasuhara Jun , Karube Takaharu , Watanabe Kae , Shirasu Takuro , Takagi Hisato , Takagi Hisato , Sumitomo Naokata , Lee Simon , Kuno Toshiki
Published: June 2023

Introduction:
In the wake of the COVID-19 pandemic, extracorporeal membrane oxygenation (ECMO) has been widely used to treat severe acute respiratory distress syndrome (ARDS) in adults. However, the indications, complications, and outcomes of ECMO in children with COVID-19 remain unelucidated. We conducted a systematic review and meta-analysis to investigate the characteristics and outcomes of ECMO use in children with COVID-19.

Methods:
PubMed and EMBASE databases were searched in March 2022 without language restrictions, and studies involving children (aged≤18) with COVID-19 who received ECMO were included. Two investigators extracted data and assessed the risk of bias independently. Mortality, successful weaning rate, and complications related to ECMO were synthesized by a one-group meta-analysis using a random-effect model.

Results:
We included 18 observational studies, 4 case series, and 22 case reports encompassing 110 children with COVID-19 requiring ECMO. The median age was 8 years (range: 10 days to 18 years), and the median body mass index was 21.4 kg/m
2
(range: 12.3-56.0). The most common comorbidities were obesity (11% [7/63]) and congenital heart diseases (11% [7/63]), while 48% (30/63) were previously healthy. The major indications were multisystem inflammatory syndrome in children (52% [47/90]) and ARDS (40% [36/90]). Seventy-one percent (56/79) received venoarterial-ECMO. The median ECMO runtime was 7 days (range: 3-71). The mortality rate was 26.6% (95% confidence interval [CI] 15.9-40.9), and the successful weaning rate was 77.0% (95% CI 55.4-90.1). ECMO-related complications, including stroke, acute kidney injury, pulmonary edema, and thromboembolism, were seen in 37.0% (95% CI 23.1-53.5).

Conclusions:
This meta-analysis demonstrated relatively favorable outcomes of ECMO for COVID-19 in children. Our findings will contribute to establishing the evidence of ECMO and serve as a guide to managing children with severe COVID-19.
Abstract 9553: Sirtuin1 Aggravates Hypertrophic Heart Failure Caused by Pressure Overload via Shifting Energy Metabolism
Authors: Krause-Hauch Meredith , Le Van , Zoungrana Linda Ines I , Wang Hao , Iglesias Migdalia , Ren Di , Li Ji
Published: June 2023

Introduction:
Sirtuin1 (SIRT1) serves as a deacetylase to regulate cardiac substrate metabolism during physiological and pathological conditions. The alteration in metabolic homeostasis plays a critical role in hypertrophic heart failure.

Hypothesis:
Cardiomyocyte SIRT1 modulates substrate metabolism to regulate cardiac remodeling during pressure overload-induced heart failure.

Methods:
The inducible cardiomyocyte specific Sirt1 knockout (icSirt1
-/-
) and its wild type littermates (Sirt1

f/f

) C57BL/6J mice were subjected to transverse aortic constriction (TAC) surgery to induce pressure overload. The cardiac functions were evaluated with echocardiography and electrocardiography measurements.

Results:
The pressure overload by TAC induces upregulation of cardiac SIRT1 in Sirt1

f/f

but not icSirt1
-/-
mice. The cardiac contractile dysfunctions caused by TAC-induced pressure overload occurred in Sirt1

f/f

but not in icSirt1
-/-
mice. Intriguingly, Sirt1

f/f

heart showed a drastic reduction in systolic contractility and electric signals during post-TAC surgery, whereas icSirt1
-/-
heart demonstrated significant resistance to the pathological stress by TAC-induced pressure overload as evidenced by no significant changes in systolic contractile functions and electric properties. The Seahorse data revealed that TAC-induced pressure overload causes a decrease in basal respiration and ATP generation, as well as reduced OXPHOS (oxidative phosphorylation) integrity of mitochondria in Sirt1

f/f

but not in icSirt1
-/-
cardiomyocytes. The targeted proteomics showed that the pressure overload trigged downregulation of the SIRT1-associated IDH2 (isocitrate dehydrogenase 2) that result in an increased oxidative stress in mitochondria. Moreover, a significant alteration in substrate metabolism was observed in Sirt1

f/f

but not in icSirt1
-/-
heart in response to TAC-induced pressure overload stress.

Conclusions:
SIRT1 interferes metabolic homeostasis through regulating mitochondrial IDH2 during pressure overload. Inhibition of SIRT1 activity benefits cardiac functions under pressure overload-related pathological conditions. SIRT1 antagonism could be a pharmacological approach for hypertrophic heart failure patients.
Abstract 9558: Twenty Five-Year Trends of Serum Cholesterol Levels and Incidence of Atrial Fibrillation: The Kuakini Honolulu Heart Program
Authors: Anzai Tagayasu , Grandinetti Andrewg , Katz Alan , Hurwitz Eric , Yan Yan Wu , Masaki Kamal
Published: June 2023

Introduction:
Several studies have indicated high cholesterol is paradoxically associated with low prevalence of atrial fibrillation (AF). However, the etiology is uncertain. One potential explanation might be the different trends in serum total cholesterol (TC) between AF and non-AF groups.

Hypothesis:
There are different 25-year trends in TC levels in older men with vs. without incident AF during the 25-year period.

Methods:
We used data from the Kuakini Honolulu Heart Program, a longitudinal cohort study since 1965. Participants were 3,741 Japanese-American men living in Hawaii who participated in the 4th exam cycle. TC level was repeatedly measured at baseline (mid-life, ages 45-68 years) and after 25 years (late-life, ages 71-93 years). The amount of TC reduction between mid- and late-life was categorized into quartiles. AF was diagnosed by 12-lead ECG at mid- and late-life. We excluded participants who were diagnosed with AF at mid-life (prevalent cases).

Results:
AF incidence was 4.4% over 25 years. Mid-life TC levels were similar between those with incident AF vs. those without (218.6±36.0mg/dl vs 218.6±35.4mg/dl, p=0.91). However, in those with incident AF, the drop in TC levels between mid- and late-life was significantly larger than in those without AF (-39.4±35.8mg/dl vs -27.9±38.0mg/dl, p<0.001) (Fig1). Moreover, after multivariable adjustment, there was a biological gradient between AF incidence and reduction of TC levels over 25 years (P for tend p<0.001). As a result, the group with incident AF showed significantly lower late-life TC levels compared with the non-AF group (179.7±32.9mg/dl vs 190.3±33.0mg/dl, p<0.001) at late-life (Fig1).

Conclusions:
Incident AF over 25 years was associated with a greater decrease in serum TC levels between mid- and late-life. The paradoxical associations between AF prevalence and low TC levels might be explained by the different trends in drop from mid- to late-life TC between those with vs. without incident AF.
Abstract 9559: Isolated Functional Tricuspid Regurgitation: Importance of Atrial Fibrillation and Right Atrial Remodeling and Prognostic Significance
Authors: KWAK SOON GU , Lim Jaehyun , Choi You-Jung , Park Jun-bean
Published: June 2023

Aim:
We aimed to identify the risk factors for progression from mild tricuspid regurgitation (TR) to significant isolated functional TR (FTR) in relation to atrial fibrillation (AF) and assess its prognostic implications.

Background:
Isolated FTR is an increasingly recognized type of TR, but little is known about the determinants and outcomes.

Method:
We retrospectively studied 833 patients who had mild TR at baseline echocardiography and underwent follow-up echocardiography at least 1-year apart. Significant TR was defined as ≥moderate TR. Isolated FTR was defined as TR with no overt cause. Patients were stratified by the baseline AF. The Mantel-Byar test was used to compare the clinical outcomes according to significant TR progression.

Result:
Of 833 patients with mild TR, 291 patients (34.9%) had AF. During the median 4.6 years, significant TR developed in 35 patients, including 33 isolated FTRs, which were markedly higher in patients with AF than in those without (11.0%
vs.
0.6%,
P
<0.001). In Cox analysis, AF was a strong risk factor for isolated FTR progression (adjusted hazard ratio: 7.97, 95% confidence interval: 2.26–28.12,
P
=0.001). Among AF patients, those who developed significant isolated FTR had a larger baseline right atrium (RA) area (23.8
vs.
19.1 cm
2
,
P
<0.001) and area ratio of RA to right ventricle at end-systole (3.0
vs.
2.3,
P
<0.001) than those who did not. These parameters were also independent predictors of isolated FTR progression. The 10-year cumulative major adverse cardiovascular event was significantly higher after isolated FTR progression than before or without progression (79.8%
vs.
8.6%, Mantel-Byar
P
<0.001).

Conclusion:
In patients with mild TR, significant isolated FTR developed predominantly in AF patients. RA enlargement, especially with a higher RA to right ventricle end-systolic area ratio, was a strong risk factor for isolated FTR progression in AF patients. Patients with significant isolated FTR conferred poor prognosis.
Abstract 9610: Endothelial Function and Coronary Arterial Imaging in Youth-Onset Type 2 Diabetes: Evidence for Early Vascular Aging Compared to Age-Matched Peers
Authors: Abd-Elmoniem Khaled , Villalobos-Perez Alfredo , Edwan Jehad , Matta Jatin , Dietsche Katrina , Dixon Sydney , Feeley Jenna , Stagliano Michael , Mabundo Lilian , Gharib Ahmed M , Chung Stephanie T
Published: June 2023

Introduction:
Youth-onset type 2 diabetes (Y-T2D) may be associated with accelerated vascular aging, but the tempo and mechanisms are unknown. Non-invasive cardiac MRI coupled with ex-vivo experiments to assess endothelial function are ideal for assessing risk in young adults. Plasma exosomes are pro-inflammatory extra-cellular vesicles that may modulate endothelial dysfunction.

Methods:
We hypothesized that Y-T2D would have endothelial dysfunction compared to healthy age-matched peers measured by right coronary wall thickness (CWT) and coronary and brachial artery dilation during isometric handgrip exercise using a 3.0 Tesla cardiac MRI. In a subset of 4 Y-T2D, we isolated, characterized, and incubated plasma-derived exosomes in human coronary artery epithelial cells (HCAECs) compared to control cells.

Results:
Y-T2D (n=14, 40% female, age 19.4±1.3y, BMI 38±9kg/m
2
, mean±SD) compared to peers (n=16, 40% female, age 22.9±2.6 y, BMI 23±3 kg/m
2
) had higher HbA1c (6.5 ± 1.2 vs 5.0 ± 0.5%), C-reactive protein (6.5±8.3 vs. 3.1±2.0 mg/L), systolic blood pressure (130±14 vs. 114±11 mmHg, all
P
<0.05) but similar LDL-cholesterol and triglycerides. Y-T2D had greater CWT (1.34±0.13 vs. 1.22±0.13 mm,
P
=0.02) and impaired arterial dilation (Figure 1A). HCAECs incubated with Y-T2D exosomes induced phenotypic changes of endothelial dysfunction: reduced expression of phosphorylated endothelial nitric oxide synthase (peNOS), increased expression of endothelial membrane ICAM-1 and phosphorylation of pERK(1/2) (Figure 1B).

Conclusion:
Accelerated vascular aging in Y-T2D was associated with paradoxical exercise-induced coronary artery vasoconstriction and peripheral endothelial dysfunction despite young age and the absence of traditional risk factors such as severe hyperglycemia, frank hypertension, or dyslipidemia. Plasma exosomes should be explored in the pathogenesis of endothelial dysfunction and early vascular aging in Y-T2D.
Abstract 9689: Impact of Epinephrine Administration Route on the Outcomes of Cardiac Resuscitation of Acute Myocardial Infarction Patients With Cardiac Arrest in the Cardiac Catheterization Laboratory (iCPR Study)
Authors: Haq Ayman , Aldujeli Ali , Tecson Kristen M , Lickunas Karolis , Unikas Ramunas , Hamadeh Anas , Brilakis Emmanouil S
Published: June 2023

Objectives:
To compare the efficacy peripheral intravenous (IV), central IV, and intracoronary (IC) administration of epinephrine in acute myocardial infarction (AMI) patients with cardiac arrest in the cath lab.

Methods:
Prospective, two-center cohort pilot study of AMI patients with cardiac arrest in the cath lab. Patients who received mechanical circulatory support, primary fibrinolysis, anti-arrhythmic/vasopressors prior to cardiac arrest, or those with prior CAD or a cardiac arrest that lasted < 60 seconds were excluded. Outcomes included return of spontaneous circulation (ROSC), stent thrombosis, and survival-to-discharge with a favorable neurological outcome.

Results:
158 patients were enrolled (Table 1). After adjusting for age and initial cardiac rhythm, the peripheral IV route had 5.5-fold lower odds (OR: 0.18, 95% CI: 0.07-0.49,
p
= 0.0007) of achieving ROSC compared with the central IV route, while the IC route had a similar odds compared to the central IV route (
p
= 0.9516). Among those who achieved ROSC, the IC route had a higher odds for stent thrombosis compared to the central IV route (OR: 5.7, 95% CI: 1.9-17.2,
p
= 0.0022), but not the peripheral IV route (
p
= 0.1277). The adjusted odds of achieving survival-to-discharge with a favorable neurological outcome were higher in the IC route compared to the peripheral IV route (OR: 7.8, 95% CI: 2.2 – 27.0,
p
= 0.0013), and similar in the IC and central IV routes (
p
= 0.0585) (Table 2).

Conclusions:
Epinephrine administration via central IV has a higher odds achieving ROSC than via peripheral IV and a lower odds of stent thrombosis than via the IC route in patients with AMI who suffer from cardiac arrest during PCI.
Abstract 9692: Sex Differences in Cardiovascular Outcomes of SGLT-2 Inhibitors in Heart Failure Randomized Controlled Trials: A Systematic Review and Meta-Analysis
Authors: Rivera Frederick , Golbin Jem Marie , Ansay Marie Francesca M , Rocimo Aubrey Melody R , Alfonso Pia Gabrielle I , Ong Bradley Ashley G , Taliño Marianne Katharina , De Luna Deogracias , McCullough Peter A , Santos Volgman Annabelle
Published: June 2023

Background:
Randomized controlled trials (RCTs) of sodium-glucose transporter-2 inhibitors (SGLT-2is) have proven to be effective in decreasing major adverse cardiovascular events (MACE) in patients with heart failure. A recently published meta-analysis showed that the use of SGLT-2i among women with diabetes resulted in less reduction in MACE vs. men. This study aims to determine sex differences in MACE in patients with chronic heart failure.

Methods:
We systematically searched the medical database until April 30, 2022, and retrieved all the RCTs using SGLT-2is with specified CV outcomes. We used PRISMA, Preferred Reporting Items for a Review and Meta-analysis. We pooled the hazard ratio (HR) of MACE in both sexes, did a meta-analysis, and analyzed the odds ratio (OR) of MACE based on sex. Statistical analysis was completed with the use of Cochrane Review Manager (RevMan) version 5.4. Results of the pooled hazard ratio (HR) and the 95% confidence interval (CI) were made based on intention-to-treat analysis.

Results:
Figure 1 shows the results of the meta-analysis of 4 RCTs conducted with SGLT-2is (n=20725) vs. placebo. MACE was significantly lower in males and females taking SGLT-2is (men - HR 0.76; 95% CI 0.69 to 0.83; p=0.00001; women - HR 0.72; 95% CI 0.63 to 0.83; p=0.00001). Pooled data from three of the RCTs (n=7233) revealed a greater reduction in MACE in females vs. males (OR 1.32; 95% CI 1.14 to 1.53; p=0.0002).

Conclusion:
SGLT-2is reduce the risk of MACE in patients with heart failure, regardless of sex. However, the benefits were more pronounced in females, contrary to the meta-analysis of SGLT-2is in patients with diabetes. This finding may reflect an actual sex difference due to physiologic or behavioral factors or can be due to inadequate statistical power. More sex-based RCTs may help establish these sex differences in cardiovascular outcomes.
Abstract 9709: Impact of Ventricular Assist Device Use on Pediatric Heart Transplant Waitlist Mortality: Analysis of the SRTR Database
Authors: Butto Arene , Wright Lydia , Mao Chad Y , Dyal Jameson , Garcia Richard , Mahle William T
Published: June 2023

Introduction:
Children in need of heart transplant (Tx) have a high risk of death on the Tx waitlist due to scarcity of donor organs. Studies of previous eras have shown that ventricular assist devices (VADs) reduce waitlist mortality. We sought to determine whether a survival benefit for VAD patients persists in the current Tx allocation system.

Methods:
Using the Scientific Registry of Transplant Recipients database, we identified patients listed for primary Tx between 3/22/2016-9/1/2020. Characteristics at time of Tx listing were compared between VAD and non-VAD groups. Cox proportional hazards models were used to identify risk factors for one-year Tx waitlist mortality.

Results:
Among 5,054 total patients, 764 (15%) had a VAD at time of Tx listing. The VAD group was older, heavier, and had higher prevalence of cardiomyopathy, mechanical ventilation (MV), and impaired renal function. Unadjusted waitlist mortality was similar between the VAD and non-VAD groups (p=0.55, Figure), with the curves crossing ~90 days after listing. A multivariable Cox model showed infant age (HR 2.94, 95% CI 2.26-3.81), Black race (HR 1.59, 95% CI 1.33-1.90), congenital heart disease (HR 1.37, 95% CI 1.56-1.62), renal impairment (HR 2.62 95% CI 2.15-3.19), IV inotropes (HR 1.19, 95% CI 1.01-1.40) and MV (HR 2.58, 95% CI 2.13-3.13), were associated with one-year waitlist mortality. VAD use was not associated with mortality in the first 90 days after Tx listing (HR 0.87, 95% CI 0.65-1.18) but was protective for those waiting ≥90 days (HR 0.40, 95% CI 0.24-0.66).

Conclusions:
VADs reduce waitlist mortality in the current era, but only for those waiting ≥90 days after Tx listing. Potentially modifiable risk factors, including MV and renal impairment, are associated with mortality. These findings suggest that Tx listing without VAD may be a reasonable option if a short waitlist time is anticipated. However, VAD use may confer benefits, particularly for those expected to wait more than 90 days.
Abstract 9737: Association of Endogenous Sex Hormone Levels and Myocardial Fibrosis in Men and Post-menopausal Women: The Multi-Ethnic Study of Atherosclerosis
Authors: Chehab Omar , Shabani Mahsima , Varadarajan Vinithra , Wu Collin , Watson Karol E , Yeboah Joseph , Post Wendy S , Ambale-Venkatesh Bharath , Bluemke David A , Michos Erin D , Ac Lima Joao A
Published: June 2023

Introduction:
Endogenous sex hormone(ESH) imbalances have been linked to a higher risk of heart failure in men and post-menopausal women(PMW). However, experimental studies have found conflicting results regarding ESH' response to myocardial fibrosis(MF).

Hypothesis:
We hypothesize that at baseline, men and PMW with abnormal ESH profiles will have higher rates of MF measured by CMR T1 mapping and higher rates of myocardial scar detected by CMR during a ten-year follow up.

Methods:
A total of 1,276 men and 1,048 PMW were included in the MESA with ESH measured at baseline and had undergone CMR 10 years later. All analyses were stratified by sex and age groups (Table1A-B). Multivariable linear regression models were constructed to assess the associations of baseline ESH, ECV, and nativeT1 time. Multivariable logistic regression models were built to determine the associations of baseline ESH and myocardial scar among men.

Results:
Each 1-SD increment higher free and bioavailable testosterone in older men (≥65) was associated with 2.5% (p=0.008) and 1.0%(p=0.08) lower ECV, respectively, and 21.5%(p=0.03) and13.4%lower native T1(p=0.02). A 1-SD increment greater SHBG level was associated with 2%(p=0.01) higher ECV and 12% higher native T1 (p=0.08)(Table1A). Among post-menopausal women of 44-54 years, a 1-SD increment higher free testosterone was associated with 14% greater native T1 only; however, those between 55-64 years, a 1-SD increment higher total testosterone was associated with 9% lower native T1 (Table1B). Higher levels of estradiol in older men (≥65 years) were independently associated with a significantly higher odds of having a myocardial scar (OR:4.10,95%CI:1.35-12.40;p=0.01).

Conclusions:
Among older men, lower free testosterone and higher levels of estradiol were independently associated with CMR-defined interstitial MF and replacement fibrosis, respectively. There was no consistent association between ESH and interstitial MF among PMW.
Abstract 9777: Percutaneous Ambulatory Biventricular Support With Protekduo and Impella: A Community Hospital Experience
Authors: Patel Sankalp P , Solomon Brian J , Velamakanni Shona V , Navas Elsy V , Cubeddu Robert J , Cudemus Gaston A
Published: June 2023

Introduction:
With the advent of percutaneous MCS devices, like the Abiomed
®
Impella
TM
LVAD and Livanova
®
ProtekDuo
TM
RVAD, patients with biventricular failure necessitating ECLS can be transitioned to a fully ambulatory femoral-free BIVAD configuration.

Case:
A 60-year-old man presented with atrial fibrillation. He underwent TTE revealing EF <20%. After cardiac cath ruled out ischemic cause, he underwent TEE with plan for cardioversion. Upon induction, he suffered a PEA arrest and VA- ECMO support promptly ensued, per ECLS protocol, with b/l femoral cannulation. An Impella
TM
CP LVAD was also inserted to provide unloading and further support. After 2-days with b/l groin ECMO cannulation with femoral percutaneous LVAD, the patient awoke, displaying adequate urine output and following of basic commands. Transition was made from femoro-femoral cannulation to percutaneous right-IJ ProtekDuo
TM
RVAD attached to a Quadrox-i
®
oxygenator for ECMO support, along with transition of femoral Impella
TM
CP to a robust axillary Impella
TM
5.5 LVAD (Figure). This configuration decannulated the groins, permitting the patient to work with physical therapy.

Discussion:
Transition to groin-free configuration with percutaneous BIVAD apparatus implementing the ProtekDuo
TM
RVAD with Impella
TM
5.0/5.5 axillary LVAD has only been reported at a large cardiovascular institute in Germany. That case series highlighted how percutaneous ambulatory BIVAD allowed for rapid extubation, early mobilization, and minimal complications
1
. Herein, we demonstrated the first presumed community-hospital experience with this underreported mechanical circulatory support combination promoting a pathway to rehabilitation and eventual transplantation.

Conclusion:
This report showcases the feasibility of adapting percutaneous ambulatory BIVAD with a combined ProtekDuo
TM
/Impella
TM
groin-free apparatus in the community-hospital setting.
Abstract 9789: Geriatric Nutritional Risk Index Predicts Bleeding Event in Patients With Heart Failure
Authors: Sato Yu , Yoshihisa Akiomi , Nozaki Yuji , Ohara Himika , Sugawara Yukiko , Abe Satoshi , Misaka Tomofumi , Sato Takamasa , Oikawa Masayoshi , KOBAYASHI ATSUSHI , Yamaki Takayoshi , Nakazato Kazuhiko , Takeishi Yasuchika
Published: June 2023

Introduction:
The relationship between malnutrition and bleeding event has been unclear in patients with heart failure (HF).

Method and Results:
We evaluated the nutritional status of patients with HF (n = 2,044) using Geriatric Nutritional Risk Index (GNRI). The primary endpoint was composite bleeding event of hemorrhagic stroke or gastrointestinal bleeding. According to the survival classification and regression tree analysis, the accurate cut-off point of GNRI for predicting the primary endpoint was 106.2. We divided patients into two groups based on GNRI levels: the High GNRI group (GNRI ≥ 106.2, n = 606, 29.6%) and the Low GNRI group (GNRI < 106.2, n = 1,438, 70.4%), and compared patients’ characteristics and prognosis between the two groups. The Low GNRI group showed higher age (72.0 vs. 63.0 years, P < 0.001) and lower prevalence of male sex (56.9% vs. 64.5%, P = 0.001) than the High GNRI group. There were no differences in use of antiplatelet agents and anticoagulants between the groups. In laboratory data, levels of B-type natriuretic peptide were higher in the Low GNRI group (321.1 vs. 111.6 pg/mL, P < 0.001). Left ventricular ejection fraction was comparable between the groups. The Kaplan-Meier analysis demonstrated that bleeding event rates were higher in the Low GNRI group than in the High GNRI group (Figure, log-rank P < 0.001). The multivariable Cox proportional hazard analysis revealed that the Low GNRI was independently associated with bleeding events (hazard ratio 1.795, P = 0.047).

Conclusions:
Malnutrition assessed by GNRI predicts bleeding events in patients with HF.
Abstract 9792: Persistent Hypochloremia is Associated With Adverse Prognosis in Patients With Heart Failure
Authors: Nozaki Yuji , Yoshihisa Akiomi , Sato Yu , Ohara Himika , Sugawara Yukiko , Abe Satoshi , Misaka Tomofumi , Sato Takamasa , Oikawa Masayoshi , KOBAYASHI ATSUSHI , Yamaki Takayoshi , Nakazato Kazuhiko , Takeishi Yasuchika
Published: June 2023

Introduction:
Prognostic impact of persistent hypochloremia has been unclear in patients with heart failure (HF).

Methods & Results:
We recruited data of patients who were hospitalized for HF at least twice repetitively at our hospital from 2010 to 2021 (n = 309). Patients were divided into four groups based on the absence/presence of hypochloremia (< 98 mmoL/L) at discharge from 1st and 2nd hospitalization: Group A (patients without hypochloremia at 1st and 2nd hospitalization, n = 238), Group B (those with hypochloremia at 1st hospitalization and without hypochloremia at 2nd hospitalization, n = 25), Group C (those without hypochloremia at 1st hospitalization and with hypochloremia at 2nd hospitalization, n = 32), and Group D (those with hypochloremia at 1st and 2nd hospitalization, persistent hypochloremia, n = 14). We compared patients’ characteristics and prognosis after 2nd discharge. Group D showed highest age (Group D vs. Group A, B, and C; 75.5, 73.0, 63.0, and 74.5 years, respectively, P = 0.037) and highest prevalence of atrial fibrillation (92.9%, 46.6%, 44.0%, and 50.0%, P = 0.009) among the four groups. Levels of B-type natriuretic peptide were comparable among the four groups. In the Kaplan-Meier analysis, all-cause mortality and cardiac mortality were highest in the Group D compared to other groups (Figure, log-rank P < 0.001). The multivariable Cox proportional hazard analysis revealed that persistent hypochloremia was independently associated with all-cause mortality (hazard ratio 3.235, P < 0.001) and cardiac mortality (hazard ratio 3.069, P = 0.004).

Conclusions:
Persistent hypochloremia predicts poor prognosis in patients with HF.
Abstract 9796: Identification of an Optimal Blood Pressure by Images of Correction of the Pathological Mechanism by Hypertension: An Angiographic, Machine Learning Analysis and Application for Personalized Medicine
Authors: Nguyen Thach N , Hsu Che Wei , Ly Lan T , Le Thoa , PHAM THIEN , Vu Quang Phuc , Nguyen Nga , Nguyen DUC , Nguyen BAO , Ha Quang Dat , Huynh Duong , Aggarwal Sarthak , Mihas Imran , Vu LOC , Nguyen Cardy
Published: June 2023

Introduction:
As hypertension (HTN) is a strong risk factor of coronary artery disease (CAD), what is an optimal blood pressure (BP) which could preclude CAD?

Hypothesis:
In industrial piping, laminar flow preserves equipment service life while turbulent flow damages the inner surface of pipes and pumps. Based on the same hydraulic principles, our hypothesis is built on the observations that turbulent flow injures the intima and triggers atherosclerosis. In order to identify an optimal BP, at which BP level, could we evidence VISUALLY the abolishment of turbulent flow at the iliac artery as proof of correction of the injuring mechanism precipitated by HTN?

Methods:
210 patients with uncontrolled HTN who underwent coronary intervention and a repeat diagnostic angiogram a few months later because of unstable angina were enrolled. At the end each coronary procedure, patients underwent iliac angiogram for deployment of closure device. In a new technique of dynamic angiography, the contrast was injected until the iliac artery was completely opacified. As the injection stopped, the blood flew down and displaced the contrast. The movements of the blood in white color above a black background could be clearly identified and analyzed. At the same time, Artificial Intelligence (Machine Learning algorithms) program had 2 models built on Python. Model 1 was based on U-net and Densenet-121 for vessel segmentation. Model 2 was used for classification and movement of flow. Model 2 was trained based on the convolutional neural network. The main measurements were the type of flow (turbulent), directions (antegrade versus retrograde) and presence of collision from slamming of the retrograde against antegrade flow.

Results:
At baseline, 98% patients had prolonged reversed flow with turbulence. At the 2nd iliac angiogram, if the systolic BP was <110mmHg, the rate of turbulence was 10%. If the systolic BP >130mmHg, the turbulence was present in 70% (p<0.05)

Conclusions:
With the uncontrolled BP imaged as collision at the iliac artery secondary to heightened distal vascular resistance, the abolishment of turbulence and return of laminar flow confirmed that the ideal systolic BP was <110mmH in the application of personalized medicine. Larger studies need to confirm the above result.
Abstract 9803: Randomized Comparison of a Radiofrequency Wire versus a Radiofrequency Needle System for Transseptal Puncture
Authors: Dewland Thomas A , GERSTENFELD Edward , Moss Joshua , Lee Adam C , Vedantham Vasanth , Lee Randall J , Tseng, MD Zian , Hsia Henry H , lee byron K , Wall Grace , Chang Kathleen , Yang Michelle , Marcus Gregory M
Published: June 2023

Introduction:
Transseptal puncture is a necessary component of many electrophysiology and structural heart procedures. A new technology utilizes a specialized introducer wire to cross the septum with radiofrequency (RF) energy, eliminating the need for a transseptal needle and wire/needle exchanges. The RF wire technique, however, has not been evaluated in a randomized trial.

Methods:
The Wire Instrumentation with Radiofrequency Energy to Impact Transseptal puncture (WIRE IT, NCT04645342) study was an investigator-initiated and designed trial that enrolled individuals ≥18 years of age undergoing double transseptal puncture for atrial fibrillation or left atrial flutter ablation. Participants were randomized to a transseptal approach with either a RF needle (NRG Transseptal Needle, Baylis Medical) or RF wire (Versacross RF Wire, Baylis Medical). The primary outcome was time to achieve first transseptal puncture. Timing was started at insertion of the guidewire into the short femoral vein sheath and was stopped once the transseptal sheath was positioned in the left atrium
and
the dilator and guidewire were removed. Secondary outcomes included second and combined transseptal puncture time, fluoroscopy time, number of equipment exchanges, and complications.

Results:
A total of 75 participants were enrolled between November 30, 2020 and February 2, 2022 (36 RF needle, 39 RF wire). No crossovers occurred. Randomization to the RF wire resulted in a statistically significant reduction in first transseptal time compared to the RF needle (Figure). Second and combined transseptal times and number of equipment exchanges were also reduced with the RF wire. One participant in the RF needle group experienced transient AV block due to mechanical trauma. There were no complications in the RF wire group.

Conclusions:
The RF wire technique resulted in faster time to transseptal puncture and fewer equipment exchanges compared to an RF needle with no difference in complications.
Abstract 9812: Abracadabra Alakazam: Sudden Invasion of the Pericardium by
Haemophilus Influenzae
Authors: Harmon Evan , Kiang Alan , Collier Patrick H , Jellis Christine L , Menon Venu
Published: June 2023

A 25 year old man presented with three days of cough, shortness of breath, and pleuritic chest pain. Initial vital signs in the ED were normal, and exam demonstrated tonsillar erythema without exudate. Labs revealed a leukocytosis of 18.9k/μL, D-dimer of 690 ng/mL, C-reactive protein of 5.7 mg/dL, and lactate elevated to 2.9 mmol/L. High-sensitivity troponin, NT-proBNP, and SARS-CoV-2 RT-PCR were all negative. Presenting electrocardiogram demonstrated PR elevation in aVR with diffuse ST-segment elevation in the inferior and anterolateral leads. Point-of-care echocardiogram demonstrated normal biventricular function without pericardial effusion. CTPA was negative for pulmonary embolism, and he was observed for presumed acute viral pericarditis. Fourteen-hours later, he became febrile to 38.3°C, tachycardic to 133 bpm, and hypotensive to 97/65 mmHg with diffuse abdominal pain. Repeat lactate was 9.0 mmol/L. This prompted an emergent CT scan which now showed a new large pericardial effusion and bilateral pleural effusions (
Panel A
). Repeat echocardiogram confirmed a large circumferential pericardial effusion with early signs of tamponade including right atrial inversion in late diastole (
Panel B
). Emergent pericardiocentesis yielded 560 mL of brown, purulent fluid (
Panel C
) with immediate improvement in hemodynamics. Bacterial gram stain and culture grew
Haemophilus influenzae
(
Panel D
). Immunodeficiency screening was negative. Transient severe biventricular systolic dysfunction was noted, consistent with sepsis-induced cardiomyopathy. He completed a targeted antibiotic course with partial recovery of his ejection fraction by discharge. Purulent pericarditis is rare in developed countries, and invasive
H. influenzae
in a young, immunocompetent adult is particularly unusual. This case illustrates the importance of early diagnosis and management of purulent pericarditis given its potential for rapid progression and high mortality.