bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 13836: Factors Associated With a Complicated Hospital Course in Patients With Spontaneous Coronary Artery Dissection: A Report of the iSCAD Registry
Authors: Alkhalfan Fahad , Wood Malissa , naderi sahar , Leon Katherine , Gibson C M , Chi Gerald C , Grodzinsky Anna , Gornik Heather L , Wells Bryan J , Lewey Jennifer , Taylor Angela , Kadian Dodov Daniella , Hess Connie N , Henkin Stanislav , Lindley Kathryn , Morris Gretchen , Orford James L , Tam Lori , Kumbhani Dharam J , Norris Samuel , Reyes Cassandra , Vitarello Clara , Kim Esther S
Published: June 2023

Introduction:
Spontaneous coronary artery dissection (SCAD) is a cause of acute coronary syndrome in younger patients. Though associated with lower short and long-term mortality, there is still a need to identify the subset of patients who are at a higher risk of adverse events or a more complex hospital course.

Methods:
Using data from the iSCAD Registry, a multicenter registry of patients with SCAD, univariate and multivariable logistic regression models were created to assess the association between factors related to the index admission and a complicated hospital course. A complicated hospital course was defined as the occurrence of either a recurrent myocardial infarction (MI), cerebrovascular accident (CVA), a new arrhythmia, heart failure requiring diuretics, ≥ 2 angiograms performed, or a hospital admission of more than 5 days. The multivariable logistic regression model was developed using a backward selection approach with exit criteria set at p >0.2. Patients presenting with cardiac arrest were excluded.

Results:
Of the 414 patients included, 159 patients (38.4%) had a complicated hospital course: 76 patients had a prolonged admission, 27 had a recurrent MI, 1 had a CVA, 39 had an arrhythmia, 13 had heart failure requiring diuretics and 72 had ≥ 2 angiograms in the index admission. The final model showed that patients who had structural complications related to MI, fibromuscular dysplasia (FMD), or a history of cardiomyopathy were more likely to experience a complicated hospital course
(Table).
Finally, patients on anticoagulation were at a higher risk of having the composite outcome but this may be secondary to the indication for anticoagulation.

Conclusions:
The presence of structural complications related to MI, a diagnosis of FMD, or a history of cardiomyopathy were associated with an increased risk of a complicated hospital course related to SCAD. Identification of risk factors for a complex inpatient stay may help to tailor the acute care of SCAD patients.
Abstract 13841: Prevalence and Impact of Recreational Cannabis Use on Acute Ischemic Stroke and Related Mortality in Elderly (≥65 Yrs) Peripheral Vascular Disease Patients: A Population-Based Analysis in the US (2016-2019)
Authors: Desai Rupak , Bansal Prerna , Chintalapalli Patta Harika Varma , BRERETON Brian , George Blessy , Raju Athul Raj , Jnaneswaran Geethu , Merugu Bhavyasri , Jasti Jaswanth , Nunez Frailyn , Anil Peethambar Gowri
Published: June 2023

Background:
Considering preliminary reports suggesting associations between peripheral atherosclerotic disease (cannabis arteritis) and acute ischemic stroke (AIS) with cannabis use disorder (CUD), we sought to study the burden and impact of CUD on AIS risk and outcomes in the elderly with PVD.

Methods:
The National Inpatient Sample (2016-2019) was used to identify geriatric PVD admissions with vs. without CUD . We compared the burden and risk of AIS admissions with vs. without CUD and subsequent in-hospital mortality using adjusted multivariable regression analyses.

Results:
Of 5,115,824 total geriatric admissions with PVD (50.6% males, 77.5% white), 21,405 had CUD. The prevalence of DM was lower in the CUD cohort (19.7% vs 33.7%) with comparable rates of HTN and smoking between groups [Table 1]. Concomitant drug use was higher in CUD vs non-CUD cohort. There was AIS period prevalence of 5.2% in CUD vs 4.0% in non-CUD cohorts (p<0.001). Among geriatric PVD patients, CUD was associated with higher odds of AIS hospitalizations aOR 1.34 (95%CI 1.18-1.52, p<0.001) without a statistically significant difference in subsequent all-cause in-hospital mortality (aOR 0.71, 95%CI 0.36-1.37, p=0.302). Elderly PVD patients with HTN (aOR 1 .73) predicted higher risk of AIS, however, interestingly, concomitant tobacco use disorder revealed a paradox protective effect while assessing the predictors of AIS in elderly PVD patients with CUD (aOR 0.58 95CI 0.42-0.79, p<0.001).

Conclusions:
There is a 34% risk of AIS in Geriatric PVD patients with CUD even after controlling for CVD risk factors and drug abuse. Future studies are warranted to explore and confirm the observed smoker’s paradox.
Abstract 13845: Atrial Fibrillation in Patients With Biopsy-Proven Cardiac Al Amyloidosis; A Cancer Center Experience
Authors: Wanna Charles , Black Christopher , Niku Adam , Song Juhee , Fatakdawala Mariya , Yarrabothula Akshitha , Irizarry-Caro Jorge , Miller Chase , Yusuf Syed W , Palaskas Nicolas L , Iliescu Cezar , Durand Jean-Bernard , Mouhayar Elie , Banchs Jose , Karimzad Kaveh , Deswal Anita M , Koutroumpakis Efstratios
Published: June 2023

Introduction:
Atrial fibrillation (AF) is common in cardiac amyloidosis and often symptomatic. Commonly used therapeutics may be poorly tolerated. Patients with cardiac AL amyloidosis carry a high risk of stroke and bleeding, making anticoagulation challenging. This study examined the incidence of AF, treatment patterns, and incidence of thrombotic or bleeding complications.

Methods:
Patients with endomyocardial biopsy-proven cardiac AL amyloidosis treated at a tertiary cancer center between 6/2011 and 6/2020 were identified. Demographic and clinical data were abstracted. Outcomes included the development of AF, stroke and bleeding. Severe bleeding was defined as intracranial bleeding, hemorrhagic pericardial tamponade, or bleeding requiring endoscopic investigation.

Results:
Out of 43 patients with cardiac AL amyloidosis, 51% were diagnosed with AF during the follow up period (median 4.2 years (95% CI, 2.8-8.6)). Of those, 41% were women and 73% were white. Median age was 65.5 years (61-70). No significant demographic differences were identified between patients with and without AF. Beta-blockers were initiated in 86% and continued for more than 3 months in 59% of patients. Amiodarone was initiated in 50% and continued for more than 3 months in 18%. Treatment with digoxin and diltiazem were less common (27% and 14%, respectively). Pulmonary vein isolation was performed in 14% of patients. Anticoagulation (AC) was used in 59% of patients with AF and 19% of patients without AF for a different indication. Bleeding was common; 23% of AF patients reported an episode of severe bleeding, 60% of whom were on AC, in comparison to 19% in patients without AF, 50% of whom were on AC. Stroke was diagnosed in 14% of patients with AF, 67% of whom received AC, compared to 14% of patients without AF, 33% of whom received AC.

Conclusions:
Although AF is common (51%) in patients with cardiac AL amyloidosis, treatment with rate or rhythm control strategies is challenging. Many patients do not tolerate treatment for more than 3 months. While a significant number did not receive AC, there was a substantial risk of severe bleeding (1/4) and stroke (1/7). Given improved survival with newer therapies for AL amyloidosis, a greater focus on improving management of AF and outcomes is needed.
Abstract 13846: Shared Curriculum Delivery Gaps Among Advanced Heart Failure and Transplant Cardiology Fellowship Programs
Authors: Beasley Michael H , Windish Donna
Published: June 2023

Introduction:
Nearly 4,000 heart transplants and more than 5,000 LVAD implants were performed in the US in 2021. Medical care for these patients is performed by Advanced Heart Failure and Transplant Cardiology (AHFTC) physicians. Variations in faculty expertise and patient pathology exist between training programs, and some may be unable to provide a curriculum addressing all recommended competencies during the one-year-long fellowship. This study is a targeted needs assessment identifying gaps in curriculum delivery among US AHFTC fellowship programs.

Methods:
50 medical knowledge competencies were selected from the 2017 ACC/AHA/HFSA/ISHLT/ACP Training Statement on Advanced Heart Failure and Transplant Cardiology. AHFTC fellowship programs were identified using the AMA’s FREIDA website. A survey was published on Qualtrics. An anonymous link was emailed to all program directors (PDs), while PDs and program coordinators (PCs) were asked to help distribute the survey to current fellows.

Results:
17 PDs and 11 fellows completed the survey. The most common areas where little to no training was reported to be provided were: role of lung transplantation in patients with pulmonary arterial hypertension (68%), pathophysiology of cardiac dysfunction associated with portal hypertension (61%), and conditions that may impact mechanical circulatory support strategies in adult patients with congenital heart disease (58%). Respondents most requested a moderate to a significant amount of more training in the following areas: appropriate treatment of patients with each type of pulmonary hypertension (63%), pharmacology of medications available to treat pulmonary arterial hypertension (58%), and role of lung transplantation in patients with pulmonary arterial hypertension (53%). (The information reported is as of June 12, 2022. Data collection is ongoing.)

Conclusions:
Common gaps in curriculum delivery among US AHFTC fellowship programs appear to exist. The most desired area for additional instruction involves different aspects of the management of pulmonary hypertension. A focused centralized curriculum could be developed to teach these concepts, thereby better preparing AHFTC fellows to care for these types of patients in the future.
Abstract 13939: Catecholamine-Induced Cardiomyopathy and Limb Ischemia in Pheochromocytoma
Authors: Lim Jayoung , Cho Hyoung-won , Kang Si-hyuck
Published: June 2023

Case Presentation:
A 40-year-old woman who was 4 weeks pregnant presented with nausea and vomiting. Blood pressure (BP), heart rate, and temperature were 180/104 mmHg, 85 beats/min, 36.1℃ (96.98 ℉), Hypoxemia and mild pulmonary edema were observed. Echocardiography showed severe left ventricular dysfunction and normal dimension with ejection fraction < 10 %. As BP was decreased despite inotropic agents with aggravated hypoxemia, deteriorated acute kidney injury, mechanical ventilation, venous arterial extracorporeal membrane oxygenation (VA-ECMO), and continuous renal replacement therapy were initiated. Coronary angiography revealed normal coronary arteries and the possibility of myocarditis was low because endomyocardial biopsy showed rare inflammatory infiltration. After a few days, other parameters including cardiac function were improved and VA-ECMO was stopped, however, ischemic signs of the right lower leg progressed. To rule out rhabdomyolysis and compartment syndrome, CT angiography was done and about 4.9 cm sized left adrenal mass was found (A). The results of catecholamines are as follows: plasma metanephrine, 1862.6 (< 98.6 pg/mL); normetanephrine, 993.8 (< 164.9 pq/mL); 24hr urine metanephrine, 1396.2 (36~229 mcg/24hr); normetanephrine, 835.8 (95~650 mcg/24hr). A diagnosis of pheochromocytoma was made and left adrenalectomy was done, Pheochromocytoma was demonstrated in biopsy. Unfortunately, due to severe vasoconstriction and rhabdomyolysis, her right leg was not completely recovered, so amputation was done below knee (B).

Discussion:
Pheochromocytomas are catecholamine secreting tumors derived from chromaffin cells in the adrenal medulla. Catecholamine-induced vasoconstriction, microvascular hypoxia, muscle ischemia, direct toxic effects are considered to contribute to cardiomyopathy and limb ischemia in rare situations. Timely clinical suspicion, prompt diagnosis, and therapeutic intervention are critical.
Abstract 13967: Association Between Artificial Intelligence Identified Radiographic Pulmonary Vascular Injury and Cardiac Structure and Function in Patients With
Chronic Obstructive Pulmonary Disease
Authors: Duus Lisa S , Andersen Ditte , Nielsen Anne B , Sivapalan Pradeesh , Ulrik Charlotte S , Lapperre Therese , Browatzki Andrea , San Jose Estepar Ruben , Nardelli Pietro , Jensen Jens-Ulrik Staehr , San Jose Estepar Raul , Biering-Srensen Tor
Published: June 2023

Background

Early recognition of cardiac dysfunction in patients with chronic obstructive pulmonary disease (COPD) may prevent future cardiac impairment and improve prognosis. Artificial intelligence (AI) using neural networks on Computed Tomographic (CT) imaging provides a measurement of loss of small vessel volume, as a surrogate of pulmonary vascular injury, and a compensatory increase in large vessel volume. This study investigated pulmonary vascular alteration in patients with COPD and its association with cardiac structure and function assessed by echocardiography.

Methods:
We studied 205 prospectively enrolled patients with COPD with an available CT scan and echocardiogram. AI algorithms calculated the small - and large vessel fraction as respectively the vascular volume in small vessels (5-10 mm
2
) and large vessels (20-90 mm
2
), indexed to total intrapulmonary vessel volume. Univariable and multivariable linear regressions were conducted, and standardized ß-coefficients were calculated. The multivariable model was adjusted by CT reconstruction kernel (spatial resolution).

Results:
In the unadjusted model, we found that loss in small vessel fraction and increase in large vessel volume were associated with higher left ventricular (LV) mass, LV diastolic dysfunction, and inferior vena cava dilatation. Small vessel fraction was also associated with right ventricular remodeling, while large vessel fraction was associated with higher pulmonary pressure. After adjustment, all measures remained significantly associated, except for tricuspid annular plane systolic excursion which did not. Measures of LV mass and right atrial pressure displayed the greatest associations with pulmonary vascular damage.

Conclusion:
We found that pulmonary vascular damage assessed by loss in small vessel fraction and increase in large vessel fraction, as assessed by AI on CT imaging, may negatively affect cardiac structure and function in patients with COPD.
Abstract 13968: The Alteration in Hepatic Inner Mitochondrial Membrane Fusion Affects Lipoprotein Metabolism and Liver Fat Accumulation
Authors: Da Dalt Lorenzo , Moregola Annalisa , Uboldi Patrizia , Norata Giuseppe Danilo
Published: June 2023

Introduction:
in liver, mitochondria continuously undergo biogenesis, fusion, fission and mitophagy, and thus participate to the regulation of energy metabolism, calcium homeostasis and lipid metabolism.

Hypothesis:
test the role of selective deletion of a key protein involved in inner mitochondrial membrane fusion (OPA1) in hepatocytes on mitochondrial function and lipid metabolism.

Methods:
liver selective OPA-1 deficient mice (Opa1LKO) were generated by crossing OPA-1 flox/flox mice with albumin-CRE+ mice. Opa1LKO and OPA1 flox/flox (controls) mice were fed a high fat diet for 20 weeks and then in vivo metabolic responses, liver and fat characteristics and proteomic signature were profiled.

Results:
Opa1LKO mice fed with HFD display reduced weight and weight gain compared to controls. Opa1LKO presented a significant reduction in fasting glycaemia as well as improved glucose tolerance and insulin tolerance compared to Opa1 WT. Moreover, plasma cholesterol levels and cholesterol distribution in lipoprotein fractions was reduced in Opa1LKO compared to Opa1 WT and the same was true for triglycerides. In vivo metabolic cages experiments revealed a reduced oxygen consumption and increased respiratory exchange rate in Opa1LKO compared to Opa1WT.Liver OPA1 deficiency limited lipid accumulation in the liver compared to Opa1 WT. Moreover, the liver from Opa1LKO mice presented an increased prevalence of smaller LD compared to Opa1 WT suggesting that diminished lipid accumulation and smaller LDs could be associated to changes in liver morphology and structure. In parallel Opa1LKO presented smaller adipocytes both in VAT and in SCAT compared to Opa1 WT. Interestingly, proteins involved in bile acids synthesis and transport were reduced in Opa1LKO liver compared to Opa1 WT, in parallel also proteins involved in lipoproteins uptake, lipoprotein synthesis (MTTP) and apolipoproteins (apoA-I, apoA2, apoB) were reduced.

Conclusion:
Our data suggest that the impairment of mitochondrial fusion could rewire liver metabolism and leads to cholestasis. This could be the consequence of altered bile acid synthesis, due to impaired mitochondrial activity, which results in reduced lipid absorption and limited liver lipid accumulation under HFD conditions.
Abstract 13986: Efficacy and Safety of Cangrelor in Patients Undergoing PCI After Cardio-Pulmonary Resuscitation and/or Cardiogenic Shock. Results of the CAN-SHOCK Registry
Authors: Zeymer Uwe , Geisler Tobias ,   CAN-SHOCK Investigators
Published: June 2023

Background.
Cangrelor is an intravenous P2Y12 inhibitor with an immediate onset of action and a short half-life. Its use seems especially attractive in patients who cannot swallow oral drugs, e.g. after CPR or in cardiogenic shock.
Purpose.
To determine the efficacy and safety of the intravenous P2Y12 inhibitor cangrelor undergoing PCI after prehospital cardiopulmonary resuscitation (CPR) and/or cardiogenic shock (CS) in real life.

Methods:
The CAN-SHOCK registry included patients undergoing PCI for acute myocardial infarction after CPR. Baseline characteristics, procedural features, and in-hospital outcomes were centrally collected and analysed. The primary endpoint was the incidence of stent thrombosis and/or myocardial reinfarction until 48 hours after PCI.
Results.
A total of 303 patients were included in 10 centers in Austria and Germany. The inclusion criteria were CPR before PCI (n=169, 55.8 %), cardiogenic shock (n=68, 22.4 %) and CPR and cardiogenic shock (n=59, 19.5 %). The baseline characteristics, in-hospital procedures and outcomes are listed in the table.
Conclusions.
In this large multicentre registry cangrelor in patients undergoing PCI after CPR and/or CS cangrelor was effective in preventing stent thrombosis and re-infarction and associated with an acceptable bleeding rate.
Abstract 13987: Cost-Effectiveness of Direct Oral Anticoagulant vs Warfarin Among Atrial Fibrillation Patients With Intermediate Stroke Risk
Authors: Kim Jin-Bae , Kim Woo-Shik , Lee Young-Shin
Published: June 2023

Background:
Several studies have shown the cost-effectiveness of direct oral anticoagulants (DOACs), compared with warfarin, to prevent atrial fibrillation (AF) related complications. However, few have reported cost-effectiveness of DOACs in AF patients with intermediate stroke risk. Thus, we investigated the cost-effectiveness of DOACs vs. warfarin in non-valvular AF patients with intermediate stroke risk using national representative data.

Methods:
We identified 7,954 newly diagnosed non-valvular AF patients (≥18 years) with intermediate stroke risk (CHA2DS2-VASc score: 1 for men and 2 for women) using the national healthcare utilization data from August 1, 2016, to July 31, 2019. Annual incidence rate of AF-related composite outcomes (heat failure, myocardial infarction, ischemic stroke, intracerebral hemorrhage, and gastrointestinal bleeding) was estimated. Cost-effectiveness was estimated using a Markov chain model with the transition probability of 1 year. The willingness-to-pay (WTP) was set at $32,000 per quality-adjusted life-year (QALY) gained.

Results:
The total cost of warfarin, rivaroxaban, apixaban, dabigatran and edoxaban was $2,874, $5,761, $5,151, $5,761 and $5,851, respectively. The QALYs gained were 10.83, 10.95, 11.10, 10.49 and 10.99 years, respectively. The incremental cost-effectiveness ratio of rivaroxaban, apixaban, dabigatran and edoxaban was $29,743.99, $8,426.71, -$8,483.04 and $18,483.55, respectively. The WTP was set at $32,000. DOACs (except dabigatran) were more cost-effective compared with warfarin because they did not exceed the WTP in the base-case analysis.

Conclusion:
Our findings showed that DOACs were more cost-effective than warfarin in non-valvular AF patients with intermediate stroke risk.

Figure 1. Cost-effectiveness acceptability curve of Warfarin vs. DOACs in AF patients with intermediate stroke risk.
Abstract 14034: 30-day Readmission Rates of Cardiogenic Shock: A Nationwide Analysis of Inpatient Demographics and Clinical Outcomes
Authors: Amoateng Richard , Ahmed Ibrahim , Lander Matthew
Published: June 2023

Introduction
Cardiogenic shock (CS) is a common medical emergency that causes significant morbidity and mortality. Our aim was to characterize patient demographics and analyze the factors that increase the likelihood for CS readmissions.

Methods
This was a retrospective cohort study using the 2019 Nationwide Readmissions Database (NRD) database to identify admissions in adults with principal diagnosis of CS.

Results
The index CS admission cohort was 62.2% males, mean age 66.9 years. Of 146,254 index admissions with CS, 19,238 (20.4%) were readmitted. 30-day mortality rate (MR) of index admission was 35.4%, with a MR of 9.7% in those readmitted. The most common cause for readmissions was acute heart failure (26.7%). Patients with the lowest median household income, Medicare, and Medicaid insurance were more likely to be readmitted (1.10 OR 95% CI 1.04 -1.16, p <0.01, 1.17 OR 95% CI 1.11-1.24, p <0.001 and 1.27 OR 95% CI 1.12-1.86, p <0.001 respectively). Meanwhile, being in the highest median household income quartile (>75
th
) or having private insurance were protective against readmission. Acute MI patients were less likely to be readmitted (0.83 OR 95% CI 0.79 -0.87, p <0.001). Diastolic HF and CHF were associated with increased odds of readmission when adjusted for other comorbidities, age, and gender (2.52 OR 95% CI 1.09-5.83, p<0.031 and 2.15 OR 95% CI 1.01-4.57, p<0.046 respectively).

Conclusion
Readmission after CS is common, with high mortality. Risk factors for readmission include lower household income and Medicare/Medicaid insurance, and those that leave AMA after index cardiogenic shock admission have increased odds of readmission. Conversely, those with the highest median household income and with private insurance had a significantly lower rate of readmission. Additional research is needed to elucidate the contributing factors for this stark difference.
Abstract 14062: Longitudinal Rate of Change for Cardiac Magnetic Resonance Biomarkers Associates With Mortality in Duchenne Muscular Dystrophy
Authors: Soslow Jonathan H , Xu Meng , Starnes Joseph , GeorgeDurrett Kristen , Crum Kimberly , Raucci Frank J , Spurney Christopher , Hor Kan N , Cripe Linda , Husain Nazia , Gambetta Katheryn E , Buddhe Sujatha , Slaughter James C , Markham Larry W
Published: June 2023

Introduction:
Cardiomyopathy (CM) is the leading cause of death in Duchenne muscular dystrophy (DMD). Progression is variable. Multiple DMD-specific CM medications are in development, but there are no established outcome measures for therapeutic trials. Our prior work demonstrated an association between cardiac magnetic resonance (CMR) metrics and mortality, including left ventricular ejection fraction (LVEF), ventricular volumes, and native T1 mapping. The objective of this study was to determine whether longitudinal change in these metrics associates with all-cause mortality.

Methods:
Seventy-eight DMD subjects underwent 211 comprehensive CMR studies, including LVEF, indexed LV end diastolic and systolic volumes (LVESVi and LVEDVi), and native T1 mapping. To explore how the slope of CMR biomarkers affects mortality, multivariable linear regression was used to model age, mortality, and the interaction term of age and mortality on predictors of interest (LVEF, LVEDVi, LVESVi, native T1).

Results:
At baseline CMR, the median age was 12.5 years (range 7.4-27.5), and the median LVEF was 57%; 32 subjects (41%) had LVEF < 55%. LGE was present in 54 subjects (71%). Fifteen subjects (19%) died over a median follow up of 5 years (IQR 3.1,7). The slope of LVEF decline differentiated between subjects with and without mortality (p<0.001) (
Figure 1
). A steeper increase in LVEDVi and LVESVi also associated with mortality (p<0.001), while change in native T1 did not.

Conclusions:
DMD all-cause mortality is associated with the slope of progression of LVEF and ventricular volumes. Aggressive medical therapy to decrease the rate of progression may improve mortality in this patient population. In addition, a decrease in the rate of progression may serve as a valid surrogate outcome measure for therapeutic trials.
Abstract 14065: Functional and Structural Alterations in Stress-Related Neural Networks Implicated in Atherosclerosis
Authors: Gharios Charbel , Boukezzi Sarah , Shin Lisa , Murrough James , Chang Helena , Lun Ming Yin Y , van Leent Mandy , Osborne Michael , Tawakol Ahmed A , Fayad Zahi A
Published: June 2023

Introduction:
While a link between chronic stress and cardiovascular disease (CVD) is well established, the neurocircuit alterations underlying this association remain unclear. We leveraged advanced multimodal imaging to gain insights into neurocircuit alterations that associate with atherosclerosis.

Methods:
Individuals with posttraumatic stress disorder (PTSD), trauma-exposed controls without PTSD (TC), and healthy controls (HC) were prospectively enrolled. Participants underwent whole-body
18
F-fluorodeoxyglucose positron emission tomography/magnetic resonance (FDG-PET/MR) imaging. Stress-related neural network activity (SNNA) was assessed on PET as amygdala metabolic activity relative to regulatory (ventromedial prefrontal cortex [vmPFC]) activity. The structural integrity of the uncinate fasciculus, the major white matter tract connecting the amygdala to vmPFC, was assessed using diffusion tensor imaging (DTI). Atherosclerotic burden was assessed on MR as vessel normalized wall index and standard deviation (SD) of vessel wall thickness.

Results:
Of 91 participants (24 PTSD, 42 TC, 24 HC), 57% were female, and the median age was 37 years. Compared to controls, individuals with PTSD had higher SNNA (Fig 1A) and lower uncinate fasciculus integrity (Fig 1B). SNNA and uncinate fasciculus integrity were negatively correlated (r = - 0.30, p=0.008). Those with PTSD had higher ascending aorta normalized wall indices (p=0.018, adjusted for Framingham risk score). Notably, the SD of carotid wall thickness correlated positively with SNNA and negatively with uncinate fasciculus integrity (Fig 1C & D).

Conclusion:
These findings suggest that increases in the amygdala relative to vmPFC metabolic activity or disruptions of their structural interconnections may potentiate atherosclerosis. Interventions targeting this stress-related neural network may reduce adverse brain-heart interactions and related cardiovascular disease burden.
Abstract 14076: Myocardial Tissue Characterization and Strain by Cardiac Magnetic Resonance and Their Relationship in Pediatric Patients With Acute Myocarditis Within 2 Weeks of Presentation
Authors: Vaiyani Danish , Harris Matthew A , Whitehead Kevin K , Jones Andrea L , Biko David M , Partington Sara L , Restaino Kathryn M , Lin Kimberly Y , Fogel Mark A
Published: June 2023

Introduction:
Cardiac magnetic resonance (CMR) provides rich data on myocardial function, including indices such as strain, as well as tissue characterization. There is no published data on these values within 2 weeks of the diagnosis of myocarditis. We sought to describe these findings in children with acute myocarditis who underwent CMR early after presentation and determine relationships between these values.

Methods:
We retrospectively reviewed the clinical and imaging data of patients <21 years clinically diagnosed with acute myocarditis and underwent CMR within 14 days of presentation. Those who suffered cardiac arrest or with autoimmune disease, known cardiomyopathy or congenital heart disease were excluded. Strain was measured using CMR feature tracking. Spearman’s correlation was utilized. Significance was P <0.05.

Results:
85 patients underwent CMR at a median of 2 days following presentation (IQR 2 - 4) with median age 16.3 years (IQR 14.3, 17.5). Tissue characteristics, ventricular function and strain are listed in Table 1. 77 studies (90.6%) met Lake Louise criteria for myocarditis and 66 (77.7%) showed late gadolinium enhancement. Global circumferential (GCS) and longitudinal strain correlated with T2 values, biventricular ejection fractions, and peak brain natriuretic peptide (BNP); GCS also correlated with T1 values (Table 1, Figure 1).

Conclusions:
We present the first data on early strain and tissue characterization for myocarditis. Both global longitudinal and circumferential strain correlated with tissue characteristics and serum measures of acute injury. Strain imaging may be a sensitive marker of myocardial injury in patients with myocarditis.
Abstract 14077: Human Placental CDX2 Cells Are Multipotent and Differentiate Robustly to Cardiomyocytes
Authors: Vadakke-Madathil Sangeetha , Wang Bingyan , seyedmohammad saeed , Raedschelders Koen , Baljinnyam Erdenechimeg , Oniskey Micayla , Dekio Fumiko , Brody Rachel , Gelber Shari , Marro Samuele , Van Eyk Jennifer E , Sperling Rhoda , Chaudhry Hina W
Published: June 2023

Regenerative biology hinges on exploration of evolutionarily preserved healing mechanisms to maintain and restore homeostasis. CDX2 is one such conserved factor that regulates trophoblast stem cell differentiation in the placenta. We previously demonstrated that murine placental Cdx2 lineage cells are multipotent and restored cardiac function even in male mice after myocardial infarction. We have now isolated CDX2 cells from over 35 patients’ placentas and studied their properties. Using huCDX2 promoter-driven mCherry lentivirus, CDX2 cells were isolated and multi-omics analyses were carried out versus H9ES cells.
In vitro
cardiac and vascular differentiation was examined. CDX2 cells expressed HLAG (50.5%±5) and cytokeratin7 (95%±5) supporting a trophoblast progenitor identity. Bulk RNA-seq showed 1065 upregulated genes. Differentially expressed genes like
NKX2.5,
GATA4
, and
TBX5
attribute a cardiac committed progenitor feature to CDX2 cells. CDX2 cells downregulated pluripotency markers negating concerns of any undesirable proliferation. Whole-cell proteome of CDX2 cells revealed 252 unique proteins of which 73 were upregulated involving development and immune modulation including FGF, EFGR, and the Map kinase/ERK pathway crucial for cardiac development, in addition to unique cell surface proteins, which can be utilized in place of lentivirus for live-cell selection. When plated on neonatal murine cardiomyocyte feeders, CDX2 cells robustly differentiated into beating cardiomyocytes expressing cTnT and alpha-actinin. Using an alternate feeder-free method, we observed 80-90% cTnT expression in differentiated CDX2 cardiomyocytes. Additionally, CDX2 cells gave rise to endothelial lineage cells expressing vWF. CDX2 cells further formed tube-like structures on matrigel-based endothelial assays and demonstrated uptake of acetylated LDL suggesting functional endothelial generation. We further demonstrated that CDX2 cells can be passaged and significantly expanded
ex vivo
(50,000 to 1million cells), while retaining cardiovascular potential. These results bring us closer to translation as placenta-derived CDX2 cells may form the basis for a novel clinical approach to cardiovascular regeneration.
Abstract 14089: CT Analysis of Small Pulmonary Vessels and Its Association With Pulmonary Function Tests and Prognosis in Pulmonary Hypertension
Authors: Shahin Yousef , Tschirren Juerg , Kiely David , Swift Andrew J
Published: June 2023

Introduction:
The in vivo relationship between small pulmonary vessels (SPV) and pulmonary hypertension (PH) and its association with pulmonary function and prognosis in PH is not fully understood.

Hypothesis:
The morphological change in SPV volumes (SPVV) can be quantitatively estimated from CT pulmonary angiography (CTPA) in different subtypes of PH and is associated with pulmonary function metrics and prognosis in PH.

Methods:
: In this retrospective single center study performed from January 2008 to February 2018, quantitative CTPA analysis of total SPVV (TSPVV) (0.4-2mm vessel diameter) was performed using VIDA Diagnostics software (LungPrintTM, VIDA Diagnostics, Inc., Coralville, IA, USA).

Results:
1823 patients (mean (SD) age 69 (13) years, 65% females) were analysed. 1593 patients with PH (mPAP = 43 (13) mmHg) were compared to 230 patient controls (mPAP=20 (3) mmHg). Mean small vessel volumes at a diameter below 2 mm were lower in PAH and PH associated with left heart disease compared to controls (-4.3 (-8 to -0.1) ml for 1.6 mm vessels, p=.03 and -6.8 (-11 to -2) ml, p<.001, respectively). In patients with PH, the most significant positive correlation was noted with FVC%predicted (r=0.30-0.40, all p<.001). Median survival for TSPVV≤1.2mm greater than 50 ml was longer than TSPVV≤1.2mm less than or equal 50 ml (85 versus 71 months, 95% C.I 73-97, p=.02, respectively). Median survival for TSPVV>1.2mm greater than 135 ml was longer than TSPVV>1.2mm less than or equal 135 ml (88 versus 72 months, 95% C.I 73-98, p=.02, respectively). TSPVV≤1.2mm greater than 50 ml (HR 0.851, p=.02) and TSPVV>1.2mm greater than 135 ml (HR 0.839, p=.02) were significant predictors of mortality on univariate analysis. TSPVV≤1.2mm greater than 50 ml (HR 0.785, p=.04) was independent predictor of mortality on multivariate analysis in addition to age, Male gender, mRAP, PVR and SvO2.

Conclusions:
The morphological change in small vessels can be successfully quantified from CTPA in different subtypes of PH and is associated with pulmonary function metrics and prognosis in PH.
Abstract 141: Associations Between Sex Steroids And Cardiac Arrest Outcomes
Authors: Kotini-Shah Pavitra , Pobee Ruth , Buhimschi Irina , Karfunkle Benjamin , Granado Misha , Vanden Hoek Terry L , Li Jing
Published: June 2023

Introduction:
Sudden cardiac arrest (SCA) is one of the leading causes of death in both males and females although females tend to have better outcomes. While sex steroids influence cardiovascular disease, and low level of testosterone and high level of estradiol is associated with the risk of SCA, little is known about their changes after a cardiac arrest, and their association to outcomes. We sought to characterize the temporal trajectories in sex steroids (estrogens [estrone and estradiol], progesterone, and testosterone) in the post-return of spontaneous circulation (ROSC) phase and determine associations with survival and neurological outcomes.

Hypothesis:
Sex steroids and their temporal trajectories post-SCA are associated with survival and neurological outcomes.

Methods:
Plasma samples from SCA patients (n=65, 74% males) were collected at the University of Texas Houston between May 2018-March 2020 at four serial time points (0, 6, 24, 48h) post-ROSC. Quantitative sex hormone analysis was performed using LCMS. Data was analyzed by t-test, Chi
2
test and Generalized Estimating Equation (GEE) with p<0.05 indicating significance.

Results:
There were no differences in demographic and clinical characteristics between males and females. Plasma estrogens peaked at 24 hours, whereas progesterone and testosterone peaked at 6 hours. Estrogens and testosterone were higher in males, while progesterone trended higher in females. Hormonal trajectories did not differ by survival, however, testosterone concentrations were lower in patients with good neurological recovery. Lower estradiol was associated with survival (β: -13.80, p=0.016) adjusting for sex, time, and age, while a lower testosterone was associated with good neurological recovery (β: -0.68, p=0.031) adjusting for time.

Conclusion:
Increased circulating sex steroid concentrations were observed in the post-ROSC phase after SCA. High levels of estrogens were associated with worse survival independent of sex, and lower testosterone levels were associated with better neurological recovery. A larger sample size and simultaneous measurement of cortisol will be important to better understand the role of sex hormones in outcomes after SCA.
Abstract 14111: Rhythm and Race: A Qualitative Assessment of Black Patients’ Experiences Living With Atrial Fibrillation
Authors: Mann Harnoor , Cameron Flor de Abril , Wasilewski Julia , Hamm Megan E , Ferry Danielle , Magnani Jared W , Johnson Amber E
Published: June 2023

Introduction:
Race-based disparities in atrial fibrillation/flutter (AF) outcomes have been well-documented, but few studies have investigated individuals’ experiences of living with AF, particularly among Black individuals.

Hypothesis: We aimed to identify themes regarding challenges Black patients experience in self-managing their AF.

Methods:
Three focus groups of four to six participants (sixteen in total) were recruited from the racial/ethnic minority participants in the Atrial Fibrillation Heath Literacy and Information Technology Trial (AFib-LITT). A tailored qualitative script was developed to assess the perspectives of participants in semi-structured focus groups. Audio recordings of focus group interviews were inductively coded using a descriptive approach to identify recurrent themes.

Results:
Participants were mostly male (62.5%) with mean age of 66.5 (range 40-78) years. Three themes emerged regarding 1) the physical and mental burdens of disease, 2) the need for interpersonal support systems, and 3) the importance of community understanding of AF. Focus group participants stated that the paroxysmal nature of the disease also created the sense that the disease was uncontrollable. The erratic nature of AF caused them to limit their physical exertion to prevent AF symptoms, thus skipping activities that were integral to their lives.

Conclusions:
Black patients found that the unpredictability of their AF symptoms led them to describe the disease as difficult to manage, but social and community support may serve as areas for future interventions. These social and behavioral themes highlight the need for tailored clinical strategies for AF self-management within a patient’s social context.
Abstract 14115: Multivariate Predictors of Long-Term Outcome From Ventricular Tachycardia Ablation in a Large Registry
Authors: Goyal Jatin , Deb Brototo , Le Menestrel Thomas , Chang Hui Ju , Tjong Fleur V , Rogers Albert J , Azizi Zahra , Ruiperez-Campillo Samuel , Feng Ruibin , Ganesan Prasanth , Baykaner Tina , John Roy , Perez Marco V , Perino Alexander C , Wang Paul J , Viswanathan Mohan N , Badhwar Nitish , Narayan Sanjiv M
Published: June 2023

Introduction:
It remains difficult to identify clinical risk predictors of long-term outcomes from VT ablation.

Hypothesis:
We hypothesized that analysis of detailed clinical and laboratory features in a large registry may enable prediction of long-term outcomes from VT ablation.

Methods:
623 consecutive patients enrolled in our VT ablation registry with 50 prespecified features included in this study. Ablation strategy was left to the discretion of each operator based on each clinical scenario, and included entrainment, activation mapping, substrate modification or a combination of these strategies. Patients were followed up for 3 years. Recurrent VT (>30 seconds, appropriate device therapy or repeat ablation) or death were determined by clinical follow-up plus natural language processing of device interrogation.

Results:
Follow-up was available in N=596 (age 58.7±14.8y, 32.3% female). The overall VT-free survival was 65.3% at 1Y and 50.4% at 3Y, and was lower in patients with cardiomyopathy, particularly if ischemic (Figure). There was substantial inter-patient variability. Multivariate predictors of 3-Y VT-free survival (Table) were heart failure and systolic dysfunction (Hazard Ratio [HR]: 2.01,
P
<0.0001), chronic kidney disease (HR: 1.70,
P
=0.0004), obstructive sleep apnea (HR: 1.36, P=0.0307), and serum sodium (HR: 0.89, P=0.0506) and calcium (HR: 0.85,
P
=0.0045). 1-Y predictors were similar.

Conclusion:
We identify novel clinical features of 1- and 3-year VT ablation outcomes in a large well characterized registry. These combinations of clinical and laboratory factors may guide procedural planning, and should be validated in other registries.
Abstract 14128: Impact of Sarcoidosis in Patients Undergoing Aortic Valve Replacement: Insight From National Readmission Database 2016-2019
Authors: Patel Kunal , Zala Harshvardhan , Majmundar Monil , kaur Avleen , Patel Vyoma , Doshi Rajkumar P , Toquica Gahona Christian , Watts Abi , Singh Heminder , Patel, MD Keval V , Dani Sourbha , Kalra Ankur
Published: June 2023

Introduction:

Limited data exist on the in-hospital and readmission outcomes in sarcoidosis patients after surgical or transcatheter aortic valve replacement (SAVR/TAVR).

Hypothesis:

Sarcoidosis can lead to cardiac conduction abnormalities and cardiomyopathy which can lead to poor outcomes after aortic valve intervention (AVI). We hypothesize that SAVR/TAVR in sarcoidosis patients has the worst outcomes.

Methods:
The NRD was queried for all sarcoidosis patients who underwent SAVR/TAVR from 2016-2019. Our outcomes of interest were in-hospital mortality, in-hospital complications, and 30-day readmissions for heart failure and pacemaker implantation. Clinical outcomes were modeled using logistic regression for binary outcomes and linear regression for continuous outcomes.

Results:
We identified a total of 507,441 SAVR/TAVR hospitalizations of which 1429 were of sarcoidosis patients. Patients with sarcoidosis were younger (mean age 70.1 years vs 72.4 years) and had more women (48.3% vs 38.2%, p<0.001). In-hospital mortality occurred in 35 (2.5%) patients with sarcoidosis and in 13,367 (2.6%) patients without sarcoidosis. After SAVR/TAVR, the risk of in-hospital mortality in sarcoidosis patients was similar to patients without sarcoidosis (OR: 0.86, 95% CI 0.50 - 1.48, p = 0.58). Risks of stroke, cardiogenic shock, pacemaker implantation, paravalvular leak, AKI requiring dialysis, hemorrhage requiring transfusion, cardiorespiratory complications, need for cardiothoracic procedures, 30-day heart failure and pacemaker implantation readmissions were also similar in patients with and without sarcoidosis.

Conclusions:
Sarcoidosis is not associated with an increased risk of in-hospital mortality, in-hospital complications and 30-day readmissions for heart failure and pacemaker implantation. Thus, AVI is possibly not futile in sarcoidosis patients and future studies are necessary to understand the benefits of AVI in these patients.
Abstract 14149: High-Power, Low-Duration and Fluoro-Less Atrial Fibrillation Radiofrequency Ablation
Authors: Saleem Maryam , Nabavizadeh Pooneh , Athar Muhammad , Tam Wai , Costea Alexandru
Published: June 2023

Introduction:
High power radiofrequency ablation (RFA), a novel technique, is recently being employed for pulmonary vein isolation (PVI) for atrial fibrillation (AF). This study aimed to report our center’s procedural data and preliminary results of a high power RFA technique for AF without fluoroscopic guidance.

Methods:
Symptomatic AF patients were consecutively enrolled in this prospective observational study and underwent PVI. Ablation index (AI) was marginally used for at least 400 on the posterior wall and 500 on the anterior wall or 15 seconds total at 50 Watt ablation power, whichever came first. Contact-force catheter and esophageal temperature was used during the procedure. Post-ablation esophageal endoscopy was utilized. PVI was performed using CARTO and the ST SF D/F curve ablation catheter in a temperature-controlled mode.

Results:
PVI was achieved in all (n = 36, mean age: 68±11.3 years, female: 29%, CHADsVASc: 2.8±1.5, LA volume index:60.4±17.2 mL/m2). 29(80%) patients had paroxysmal AF. For left wide antral circumferential ablation (WACA); total duration was 7.4±11.3 min, total ablation sites were 49.9±11.2, average contact force was 9.97±2.2 g and average AI was 363.9±20.5. For right WACA total duration was 6.4±2 min, total ablation sites were 45.6±15.3, average contact force was 13.0±3.5 g and average AI was 403.6±32.9. WACA technique was employed for paroxysmal AF, additional ablation lines were targeted for persistent AF. For the entire flouro-less, 50W study population, average AI was 382.2±26.6, total ablation duration was 18.1±4.7 min, total ablation sessions were 118.4±33.4 and average temperature was 38.7±1.4 degree Celsius. During in-hospital follow-up no major complications such as death, stroke, tamponade, or atrio-esophageal fistula occurred.

Conclusions:
50 watts fluoro-less AF RFA is a safe and efficient procedure.
Abstract 14192: Effect of Aspirin Dosing in Patients Treated With P2Y12 Inhibitors for Secondary Prevention of Cardiovascular Events
Authors: Girotra Saket , Stebbins Amanda , Wruck Lisa M , Riley Danielle , Kripalani Sunil , Munoz Daniel , Effron Mark B , gupta Kamal , Whittle Jeffrey , Benziger Catherine , Zhou Li , Farrehi Peter M , Polonsky Tamar S , Ahmad Faraz S , Roe Matthew T , Rothman Russell , Harrington Robert A , Hernandez Adrian F , Jones William S
Published: June 2023

Background:
The ADAPTABLE was a pragmatic randomized controlled trial that found no difference between high dose vs low dose aspirin for secondary prevention of ischemic or bleeding events. Whether concomitant P2Y12 inhibitor therapy modifies the effect of aspirin dose on clinical events remains unclear.

Methods:
Participants in ADAPTABLE were stratified according to baseline use of clopidogrel or prasugrel (P2Y12 group). Ticagrelor was not permitted due to a black box warning with high dose aspirin. The primary
effectiveness
endpoint was a composite of myocardial infarction, stroke, or death and the primary
safety
endpoint was hospitalization for major bleeding. We used multivariable Cox regression to compare the relative
effectiveness
and
safety
of aspirin dose within P2Y12 and non-P2Y12 groups.

Results:
Of the 13,815 (91.6%) participants with available data, 3,051 (22.1%) were on a P2Y12 inhibitor at baseline (clopidogrel: 93.4%; prasugrel: 6.6%). P2Y12 inhibitor use was associated with higher risk of the primary effectiveness endpoint (10.86% vs. 6.31%; adjusted HR 1.44 95% CI 1.22-1.62) but was not associated with bleeding (0.53% vs. 0.95%; adjusted HR:1.42; 95% CI 0.91, 2.22). We found no interaction in the relative effectiveness and safety of high vs. low dose aspirin by P2Y12 inhibitor use (Table,
P interaction
0.09 and 0.73 for primary effectiveness and safety endpoint, respectively). Aspirin dose switching and discontinuation occurred in 28.6% of patients. Although this was more common in high dose vs. low dose aspirin, the above rates did not differ between the P2Y12 and non-P2Y12 groups.

Conclusion:
In this pre-specified subgroup analysis of a large, pragmatic trial, we found that the relative effectiveness and safety of high dose vs. low dose aspirin was not modified by baseline use of P2Y12 inhibitors. Decisions regarding aspirin dosing should be individualized based on clinical factors and patient preference, regardless of P2Y12 inhibitor use.