bluuebunny/crossref_metadata_2025 huggingface dataset:
The COVID-19 Pandemic Challenged Nurse Managers’ Daily Leadership Work: A Qualitative Study
Authors: Ahlqvist Annika , Nurmeksela Anu , Kvist Tarja
Published: December 2023

Aim. To explore and describe nurse managers’ experiences of how the COVID-19 pandemic affected their leadership work. Background. As frontline leaders in healthcare, the work of nurse managers was dominated by the global COVID-19 pandemic in recent years. Method. Semistructured interviews were carried out during autumn 2021 at a Finnish university hospital. Twelve nurse managers participated in video call interviews, and the data were analysed by inductive content analysis. Results. Four main categories of COVID-19 effect on the nurse managers’ leadership work were identified: increased work requirements; changes in work content; crisis communication; and human resources. The main categories included a total of 14 subcategories. Conclusion. The complexity and range of nurse managers’ leadership work during the pandemic were emphasized. Nurse managers performed several important tasks that ensured ongoing delivery of healthcare services. Flexibility, ability to solve problems, capacity to tolerate uncertainty, pressure and rapidly evolving situations, excellent crisis communicational skills, and an ability to address the diverse needs of their staff were key competencies that nurse managers relied on during this period. Implications for Nursing Management. Nurse managers’ experiences of COVID-19 can inform practice, policies, nursing, and nursing leadership education in relation to future crises.
The Salivary Microbiome and Predicted Metabolite Production Are Associated with Barrett's Esophagus and High-Grade Dysplasia or Adenocarcinoma
Authors: Solfisburg Quinn S. , Baldini Federico , Baldwin-Hunter Brittany , Austin George I. , Lee Harry H. , Park Heekuk , Freedberg Daniel E. , Lightdale Charles J. , Korem Tal , Abrams Julian A.
Published: December 2023

Background:

Esophageal adenocarcinoma (EAC) is rising in incidence, and established risk factors do not explain this trend. Esophageal microbiome alterations have been associated with Barrett's esophagus (BE) and dysplasia and EAC. The oral microbiome is tightly linked to the esophageal microbiome; this study aimed to identify salivary microbiome-related factors associated with BE, dysplasia, and EAC.

Methods:

Clinical data and oral health history were collected from patients with and without BE. The salivary microbiome was characterized, assessing differential relative abundance of taxa by 16S rRNA gene sequencing and associations between microbiome composition and clinical features. Microbiome metabolic modeling was used to predict metabolite production.

Results:

A total of 244 patients (125 non-BE and 119 BE) were analyzed. Patients with high-grade dysplasia (HGD)/EAC had a significantly higher prevalence of tooth loss (P = 0.001). There were significant shifts with increased dysbiosis associated with HGD/EAC, independent of tooth loss, with the largest shifts within the genus Streptococcus. Modeling predicted significant shifts in the microbiome metabolic capacities, including increases in L-lactic acid and decreases in butyric acid and L-tryptophan production in HGD/EAC.

Conclusions:

Marked dysbiosis in the salivary microbiome is associated with HGD and EAC, with notable increases within the genus Streptococcus and accompanying changes in predicted metabolite production. Further work is warranted to identify the biological significance of these alterations and to validate metabolic shifts.

Impact:

There is an association between oral dysbiosis and HGD/EAC. Further work is needed to establish the diagnostic, predictive, and causal potential of this relationship.
Figure S1 from Immunologic Signatures of Peripheral Blood T Cells Reveal the Outcome of p53MVA Vaccine and Pembrolizumab Treatment in Patients with Advanced Ovarian Cancer
Authors: Kos Ferdynand J. , Frankel Paul , Cristea Mihaela , Eng Melissa , Tinsley Raechelle , Dempsey Shannon , Ruel Nora , Stewart Daphne , Dellinger Thanh H. , Diamond Don J.
Published: December 2023

Gating Strategy for TEM and TEF
FIGURE 2 from Immunologic Signatures of Peripheral Blood T Cells Reveal the Outcome of p53MVA Vaccine and Pembrolizumab Treatment in Patients with Advanced Ovarian Cancer
Authors: Kos Ferdynand J. , Frankel Paul , Cristea Mihaela , Eng Melissa , Tinsley Raechelle , Dempsey Shannon , Ruel Nora , Stewart Daphne , Dellinger Thanh H. , Diamond Don J.
Published: December 2023

Activation of peripheral blood CD8+ T cells in immunologic R but not in immunologic NR during p53MVA/pembrolizumab treatment. The immune response of p53-specific CD8+ T cells from PBMC, as determined by flow cytometric analysis, is compiled for 18/28 evaluable in correlative studies patients (R: n = 6; NR: n = 12; A), as well as is shown for 1 representative R patient (B) and 1 NR patient (C). Frequencies of activated CD8+ TEM and TEF cells are shown in D and E, respectively. R patients normalized CA-125 serum levels to <30 U/mL by week 6 of treatment (F and G) in contrast to NR patients who exhibited gradual increase of CA-125 (F and H). *, P < 0.05, unpaired two-tailed t test except for two-tailed paired t test in F comparing NR Pre versus NR Wk+6 and R Pre versus R Wk+6 (whiskers indicate 5–95 percentiles).
FIGURE 1 from Immunologic Signatures of Peripheral Blood T Cells Reveal the Outcome of p53MVA Vaccine and Pembrolizumab Treatment in Patients with Advanced Ovarian Cancer
Authors: Kos Ferdynand J. , Frankel Paul , Cristea Mihaela , Eng Melissa , Tinsley Raechelle , Dempsey Shannon , Ruel Nora , Stewart Daphne , Dellinger Thanh H. , Diamond Don J.
Published: December 2023

Clinical response of patients with ovarian cancer treated with p53MVA and pembrolizumab. Relative changes in tumor sizes derived from radiological evaluations (A) show that 3/28 PR patients had a decrease of 76.4%, 93.3%, and 59.5% in tumor burden (irRECIST). Twenty-one of 28 patients had at least baseline and one subsequent measurement. OS and PFS are shown in B. The numbers above the X-axis in B show numbers of patients at risk at the given timepoint after the start of treatment for OS and PFS. Two patients remain progression-free at 28 and 33 months.
Fundus Autofluorescence Patterns in Subretinal Hemorrhages Associated with Neovascular Age-Related Macular Degeneration
Authors: Nawrocka Zofia Anna , Nawrocki Jerzy
Published: December 2023

Introduction: Submacular hemorrhage (SMH) is a vision-threatening complication of neovascular age-related macular degeneration (AMD). The exact treatment scheme is not established yet. The aim of the current study was to describe surgical results and fundus autofluorescence (FAF) patterns after pars plana vitrectomy (ppV) + subretinal tissue plasminogen activator (tPA) + anti-vascular endothelial growth factor (VEGF) and intravitreal tPA + anti-VEGF + sulfur hexafluoride (SF6) tamponade and to compare them to intravitreal tPA + anti-VEGF + SF6 in the treatment of SMH in the course of AMD. Materials and Methods: We performed FAF imaging in patients with a previous SMH in the course of AMD with a duration of <60 days treated with vitrectomy with subretinal anti-VEGF and tPA and intravitreal anti-VEGF, tPA, and SF6 administration (group 1) or intravitreal tPA + anti-VEGF + SF6 (group 2). In all eyes, a throughout ophthalmic examination, fluorescein angiography, and spectral domain optical coherence tomography (SD-OCT) were done for diagnosis. SD-OCT was performed monthly during treatment. Results: Three FAF patterns were observed in both groups. Pattern one (normal autofluorescence) was observed in 5/18 in group one and 5/21 group two. Pattern two was observed in 6/18 in group one and 7/21 in group two. Pattern three was noted in 7/18 in group one and 5/21 in group two. Improvement in visual acuity was statistically significant for both groups: 0.01 Snellen (2.0 logMAR) to 0.11 Snellen (0.96 logMAR) in group one (p = 0.019) and 0.11 Snellen (0.96 logMAR) to 0.33 Snellen (0.48 logMAR) in group two (p = 0.0007). Central retinal thickness also decreased with statistical significance for both groups (p < 0.05). Conclusion: FAF patterns did not depend on the treatment used, but solely on the duration of SMH before treatment. SMH if not treated prompt enough might cause long-standing photoreceptor and retinal pigment epithelium defect, which is represented by hypo- and hyperautofluorescence. Performing a subretinal injection of tPA and anti-VEGF does not cause any defects associated with the injection site. That might be associated with previous local internal limiting membrane peeling, which reduces the injection pressure. Not only prompt treatment of SMH but also further continuation of anti-VEGF treatment is mandatory to maintain vision.
ВПЛИВ СУЧАСНИХ ҐАДЖЕТІВ НА ЗДОРОВ’Я ДІТЕЙ ТА ПІДЛІТКІВ
Authors: Петрик Н. С. , Федорів О. Є.
Published: December 2023

Мета: дослідити основні проблеми впливу ґаджетів на здоров’я дітей та підлітків.

Матеріали і методи. У дослідженні брали участь 80 школярів середнього та старшого підліткового віку (11–17 років, з них 43 дівчини та 37 хлопців) Кам’янківської ЗОШ I–III ступенів Тернопільського району Тернопільської області.

Результати. У результаті дослідження встановлено, що 40 % дітей та підлітків не контролюють час проведення з телефоном, 92,5 % школярів використовують ґаджети кожного дня. Учні в переважній більшості використовують різні ґаджети для користування соціальними мережами та для спілкування з друзями по мобільному зв’язку та в Інтернеті. Значно рідше ґаджети використовуються для читання електронних книг та навчання.

Із проведеного нами анкетування видно, що майже половина учнів часто полюбляє грати в комп’ютерні ігри (47,5 %), у той час майже 24 % дітей та підлітків відповіли, що практично ніколи не грають у комп’ютерні ігри. 50 % дітей та підлітків відповіли, що батьки не забороняють їм грати в комп’ютерні ігри, що звичайно не може не засмучувати. Про деяку ґаджетозалежність свідчить і те, що велика кількість опитаних учнів відповіла, що вони часто відкладають виконання домашніх завдань, щоб пограти за комп’ютером або телефоном (55 %).

Також ми з’ясували, що 30 % дітей та підлітків часто втомлюються, занадто довго граючи в телефоні або комп’ютері, 37,5 % – втомлюються часто, однак майже 24 % дітей сказали, що не втомлюються ніколи.

Висновки. У результаті дослідження ми встановили, що великий відсоток учнів не контролює час, який вони витрачають на телефон. Понад 90 % дітей та підлітків використовують ґаджети кожного дня, що було абсолютно очікувано. Найбільше діти та підлітки полюбляють користуватися соціальними мережами, однак дуже мало учнів використовують ґаджети для навчання. Майже половина опитаних учнів грає в комп’ютерні ігри. Ще один негативний висновок ми отримали в результаті анкетування про те, що 63 % батьків ніколи не забороняють дітям грати в комп’ютерні ігри.
ОСОБЛИВОСТІ ЕПІДЕМІОЛОГІЧНОГО ПРОЦЕСУ ПРИ ЛЕПТОСПІРОЗІ В ТЕРНОПІЛЬСЬКІЙ ОБЛАСТІ
Authors: Паничев В. О. , Пасєка Л. Г. , Маціпура С. В. , Безрукий М. Є. , Заставна Т. Ю. , Костюк О. А. , Годована Н. І. , Бурда Т. В.
Published: December 2023

Мета: проаналізувати особливості епідеміологічного процесу при лептоспірозі в Тернопільській області.

Матеріали і методи. У межах дослідження проаналізовано дані ДУ «Тернопільський обласний центр контролю та профілактики інфекційних хвороб Міністерства охорони здоровʼя України» за період 2018–2022 рр. щодо захворюваності, смертності від лептоспірозу. Використано епідеміологічний та статистичний методи дослідження.

Результати. У Тернопільській області щорічно реєструються випадки захворювання на лептоспіроз. Епідемічна ситуація щодо лептоспірозу в різних кліматичних регіонах Тернопільської області має свої особливості. Досліджено, що епідситуація щодо лептоспірозу в центральному регіоні Тернопільської області найбільш неблагополучна. Фактично, циклічність захворюваності на лептоспіроз у Тернопільській області відсутня. У структурі захворілих переважали сільські жителі. Оцінено захворюваність на лептоспіроз серед професійно-побутових груп, вікову структуру захворілих. Досить високий рівень реєстрації лептоспірозу спостерігається в червні – липні – 10,5–18,7 %. За середньобагаторічними показниками переважали антропургічні вогнища (55,1 % від загальної кількості) над природними (32,7 %). Відповідно, захворюваність найвища в антропургічних вогнищах (від 3 випадків у 2021 р. до 10 – в 2019 р.).

Висновки. Тернопільська область є ендемічною щодо захворюваності на лептоспіроз. Епідситуація характеризується як нестійка, оскільки захворюваність населення є стабільно високою і перевищує середні державні показники.

У регіоні встановлено прямий зв’язок між рівнем захворюваності людей на лептоспіроз і ступенем інфікованості мишоподібних гризунів лептоспірами.
ПЕДАГОГІЧНІ ПОГЛЯДИ ПАВЛА БІЛЕЦЬКОГО-НОСЕНКА
Authors: Гаврищак І. І. , Проців О. Я.
Published: December 2023

Статтю присвячено реконструкції та інтерпретації творчого феномену П. Білецького-Носенка задля доведення його історико-культурної, суспільно-національної та науково-естетичної значимості. Задля об’єктивної оцінки різножанрову і політематичну спадщину П. Білецького-Носенка проаналізовано з урахуванням складних соціально-політичних реалій епохи, що сформували його як особистість, митця, педагога-новатора, громадянина – активного і конструктивного члена суспільства, визначили його національну позицію. Залучення біографічного дискурсу і використання хронологічного методу аналізу дали змогу простежити особистісну й творчу еволюцію автора, специфіку формування його естетичних та національно-моральних поглядів, які реалізовувалися в оригінальних творах і перекладах та переспівах, етнографічних працях і завершилися написанням граматики та укладанням словника української мови.
Fragmentos da Amazônia
Authors: Martinho Fernando
Published: December 2023

Ensaio fotográfico sobre o universo amazônico. Imagens que capturam detalhes ou fragmentos da região amazônica, sua atmosfera, cultura e ancestralidade.
Abstract 103: Quantitative Analysis of Apparent Diffusion Coefficients to Predict Neurological Prognosis in Cardiac Arrest Survivors: An Observational Derivation and Internal-External Validation Study
Authors: Yoon Jung A A , Park Jung Soo , Yeonho You , Changshin Kang , Jin Hong Min , In Yong Nam , Lee Byungkook , Ahn Hong Joon , Jeong Won Joon , Kim Yong Hwan , Jeong Hye Seon
Published: December 2023

Aim:
Our study aimed to develop apparent diffusion coefficient (ADC) values and thresholds to predict poor outcomes in out-of-hospital cardiac arrest (OHCA) survivors by quantitatively analyzing ADC values in brain MRI.

Methods:
This observational study utilized prospectively collected data two tertiary academic hospitals. The derivation cohort comprised 70% of patients randomly selected from one hospital, whereas the internal validation cohort comprised the remaining 30%. The external validation cohort used data from the other hospital. MRI data were restricted to scans conducted at 3T within 72-96 h after OHCA. We analyzed the % voxels of ADC thresholds (percentage of voxels below ADC thresholds per total voxel [PV]) at 50-step intervals ranging from 200 to 1200 х 10
-6
mm/s. Poor neurological outcomes were defined as cerebral performance categories 3-5 at 6 months after OHCA.

Results:
In total, 448 brain MRI scans were evaluated, including a derivation cohort (n=224) and internal/external validation cohorts (n=96 and 128, respectively). The PV values of 500, 550, 600, 650 and 700 х 10
-6
mm/s were determined using the area under the curve (AUC) and demonstrated better performance than higher values in predicting poor neurological outcomes across the derivation (AUC 0.90-0.91), internal validation (AUC 0.87-0.91), and external validation cohorts (AUC 0.91-0.92), showing similar performance levels. A PV of 600х10
-6
mm/s predicted a poor outcome with 100% specificity at a threshold of >13.2% in the derivation cohort, with a sensitivity of 74% (95% CI 66-81) at 100% specificity. In both the internal and external validation cohorts, when using the same threshold, a specificity of 100% corresponded to sensitivities of 75% (95% CI 63-85) and 78% (95% CI 66-87), respectively (Figure).

Conclusions:
Quantitative analysis of ADC values in brain MRI is a promising tool for predicting poor neurological outcomes in OHCA survivors, with high sensitivity at a specificity of 100%.
Abstract 11400: Coronary Artery and Carotid Artery Plaques in Patients With Heterozygous Familial Hypercholesterolemia
Authors: Tada Hayato , Usui Soichiro , Sakata Kenji , Kawashiri Masa-aki , Takamura Masayuki
Published: December 2023

Background:
Little is known regarding the formation coronary and carotid plaques and their impact on cardiovascular disease in patients with familial hypercholesterolemia (FH).

Objectives:
We aimed to determine 1) when coronary and carotid plaques develop, 2) if the development of coronary and carotid plaques are correlated and 3) if these plaques are associated with major adverse cardiac events (MACEs).

Methods:
This was a retrospective review of 622 patients with heterozygous FH at Kanazawa University Hospital, assessed coronary and carotid plaque scores using coronary computed tomography and carotid ultrasound within 1 year. Spearman correlation coefficients were assessed among variables. Risk factors for MACEs were determined using the Cox proportional hazard model.

Results:
These scores were significantly correlated (Spearman’s r=0.82;
p
<0.001 in males and Spearman’s r=0.87;
p
<0.001 in females). We observed 132 MACEs during the median follow-up period of 13.2 years. Coronary and carotid plaque scores were significantly associated with the occurrence of MACE (hazard ratio: 3.33; 95% confidence interval: 1.88-4.78;
p
<0.001, hazard ratio: 2.24; 95% confidence interval: 1.28-3.20;
p
<0.001, respectively). The regression equations between age and the coronary and carotid artery plaque scores, respectively, were Y=0.358X-9.44 and Y=0.146X-3.68 in males, and Y=0.330X-11.76 and Y=0.121X-3.60 in females (
p
<0.001 for all).

Conclusion:
Coronary and carotid plaque scores were significantly correlated, and both were independently associated with MACEs. Based on the regression equations, the average age of onset of coronary and carotid artery plaque developments, respectively, were 26 and 25 years old in males and 35 and 30 years in females.
Abstract 11402: Impact of the Severe Familial Hypercholesterolemia Status on Atherosclerotic Risks
Authors: Tada Hayato , Sakata Kenji , Usui Soichiro , Kawashiri Masa-aki , Takamura Masayuki
Published: December 2023

Background and aims:
Risk of atherosclerotic events substantially vary even among patients with familial hypercholesterolemia (FH) with extremely high risk based on life-long exposure to elevated LDL cholesterol. We aimed to examine impact of the severe FH status defined by the International Atherosclerosis Society (IAS).

Methods:
The data of patients with FH (N = 1,050, male = 490) who were admitted to Kanazawa University Hospital between 2000 and 2020 and who were followed-up were retrospectively reviewed. The number of MACEs, including mortality associated with cardiovascular disease, acute coronary syndrome, and ischemic heart disease requiring coronary revascularization per 1,000 person-years, was calculated. In addition, hazard ratio was calculated using Cox proportional model.

Results:
Overall, we identified 545 patients (51.9 %) with severe FH in this population. The median follow-up duration was 12.6 years. In total, 171 MACEs were recorded during the follow-up period. We found that severe FH was significantly associated with MACE (hazard ratio = 6.48, 95% confidence interval = 2.56 - 10.40,
P
= 1.2 х 10
-5
). The event rates per 1,000 person-years for in the primary prevention group (non-severe FH and severe FH) were 0.0 and 15.6, respectively. The event rates per 1,000 person-years in the secondary prevention group (non-severe FH and severe FH) were 2.0 and 32.3, respectively.

Conclusion:
Patients with severe FH exhibited significant higher risks in primary as well as secondary prevention settings. This simple criterion provides us useful information to identify patients with even higher risk who may need further managements.
Abstract 11649: Serum Adiponectin Levels Correlate With Atrial PPARγ and TGFβ1 mRNA Expression in Patients Receiving Cardiac Surgery: Involvement of PPARγ on Atrial Fibrotic Remodeling
Authors: Nakajima Takafumi , Nakajima Toshiaki , HARUYAMA AKIKO , Fukuda Taira , Minami Kentaro , Sakuma Masashi , Obi Syotaro , Abe Shichiro , SHIBASAKI IKUKO , Fukuda Hirotsugu , Toyoda Shigeru
Published: December 2023

Introduction:
The peroxisome proliferator-activated receptor gamma (PPAR
γ)
plays important roles in regulating processes related to fibrogenesis. On the other hand, adiponectin, a marker for PPARγ activity, is a hormone involved in maintaining energy homeostasis, and exerts anti-profibrotic effects in various organs. However, the roles of PPARγ and adiponectin on atrial fibrotic remodeling are still unknown.

Hypothesis:
We investigated the association of serum adiponectin levels and atrial gene expression of adiponectin, PPARγ and fibrosis-related genes in cardiovascular surgery patients including heart valve disease.

Methods:
Atrial mRNA expression levels including adiponectin and PPARγ were analyzed by real-time reverse transcription polymerase chain reaction (RT-PCR) in 59 cases (sinus rhythm (SR) 24 patients, atrial fibrillation (AF) 35 patients) in which left atrium (LA) tissues were removed from the appendage during surgery. The immunohistochemical studies were used to identify the protein expression. The serum levels of adiponectin were measured by ELISA.

Results:
The immunohistochemical staining showed the expression of adiponectin, PPARγ and PPARα. The significant correlations were observed among the mRNA expression levels of extracellular matrix (ECM) (COL1A1, COL3A1, fibronectin) and the fibrosis-related genes such as TGFβ1, TIMP1, MMP2, NOX2, CTGF and PDGFD attributed to the fibrosis of myocardium. The mRNA expression level of PPARγ, but not PPARα, positively correlated with that of the ECM and the fibrosis-related gene expression level. The mRNA expression level of adiponectin also positively correlated with that of ECM. Patients with AF had higher atrial expression level of adiponectin, PPARγ, COL1A1 and TGFβ than those with SR. Serum adiponectin levels significantly correlated with atrial mRNA expression level of PPARγ and TGFβ1. Patients with AF had serum higher levels of adiponectin than those with SR.

Conclusions:
Atrial PPARγ and adiponectin associate with atrial fibrotic remodeling in cardiovascular surgery patients. Serum adiponectin levels correlate with atrial PPARγ and TGFβ1 mRNA expression, and might have potential utility as a biomarker in atrial fibrotic remodeling.
Abstract 11662: Efficacy And Safety Outcome Of Intravenous Vernakalant For Recent-onset Atrial Fibrillation: A Systematic Review And Meta-analysis
Authors: Idowu Abiodun , Mohibur Rahman , Nguyen Matthew , Casipit Bruce Adrian , Bolaji Olayiwola , Al madani Mohammad , Khraisha Ola
Published: December 2023

Introduction:
Vernakalant hydrochloride is a relatively new atrial-selective antiarrhythmic approved in >40 countries to pharmacologically cardiovert patients with recent-onset atrial fibrillation (ROAF). Due to safety concerns, it is yet to be approved in the USA.

Objectives:
To determine the effectiveness and safety of vernakalant in patients with ROAF.

Methods:
We systematically searched PubMed, EMBASE, Ovid MEDLINE, and CENTRAL from inception to December 2022 for studies that compared intravenous vernakalant to another drug(s) or placebo in patients with ROAF (onset ≤7 days). The pre-specified efficacy endpoint was conversion to sinus rhythm within 90minutes of administering interventions. Safety outcome of interest was mortality rate. Random-effects model meta-analysis was performed on extracted quantitative data.

Results:
886 patients got vernakalant, 353 received placebo, and 401 got an antiarrhythmic agent. Vernakalant was significantly superior to placebo (conversion rate: 49.5% vs 6.2%, OR: 14.94, 95% CI: 7.18-31.07, P<0.001, I
2
: 49%), Flecainide (72.3% vs 53.8%, OR: 2.44, 95% CI: 1.46-4.06, p<0.001, I
2
: 0%), Amiodarone (55.7% vs 8.5%, OR: 17.42, 95% CI: 7.75-39.13, p<0.001, I
2
: 0%), but not Ibutilide (62.4% vs 47.3%, OR: 1.77, 95% CI: 0.61-5.08, p=0.29, I
2
: 67%) in efficacy endpoint. In the vernakalant group, there was significantly lower incidence of ventricular arrhythmia (OR:0.65, 95% CI: 0.45-0.95, p=0.027) but higher incidence of bradycardia (OR:8.58, 95% CI: 4.69-15.67, p<0.0001) and dysgeusia (OR:14.51, 95% CI: 7.03-29.95, p<0.0001). No significant difference in mortality rate between vernakalant and other groups combined (OR: 2.51, 95% CI: 0.26-24.21, p=0.427).

Conclusions:
This hypothesis-generating study showed that intravenous vernakalant, though associated with a higher incidence of bradycardia and dysgeusia, is superior to placebo, Flecainide, and Amiodarone not Ibutilide in converting ROAF to sinus rhythm.
Abstract 11679: The Crucial Role of Estrogen-Related Receptor in Human Cardiomyocyte Maturation
Authors: Sakamoto Tomoya , Batmanov Kirill , Kelly Daniel P
Published: December 2023

During the developmental transition from fetal to adult, the heart undergoes dramatic mitochondrial and sarcomeric maturation. This process is partially reversed during development of heart failure. We have identified the nuclear receptors, estrogen-related receptor (ERR) α and γ, as critical transcriptional regulators of energy metabolic and sarcomeric genes during postnatal maturation of mouse heart. Here, we aimed to define the transcriptional mechanisms involved in ERR-mediated maturation in human cardiomyocytes. Genomic interrogation with published datasets revealed that approximately 50% of super-enhancer regions (SEs) overlapped with ERRγ peaks in human-induced pluripotent stem cell-derived cardiac myocytes. Intersection of the ERRγ cistrome with a published H3K27ac Hi-ChIP dataset from human hearts identified over 3,000 ERR-containing enhancer-promoter loops, which are associated with genes related to cardiac contractile function. These results highlighted the essential role of ERR in cardiomyocyte enhancer function. Among the SEs defined by mediator complex deposition, we found that both ERRα and γ occupied the enhancer region flanking the
MYH6/MYH7
cluster, a well-characterized locus for fetal to adult developmental switching. Targeting ERR recruitment on the enhancer using catalytically-dead Cas9-KRAB or proteolysis targeting chimeric (PROTAC) strategies resulted in the reversal of
MYH6/7
switching. RNA-sequencing analysis following PROTAC treatment revealed that deactivation of ERRα resulted in downregulation of a wide array of genes encoding cardiac structural proteins, particularly adult-type ventricular sarcomeric proteins. Additional cistrome analyses demonstrated that PROTAC treatment resulted in decreased ERRα peak signals on cardiac structural genes, including enhancer regions directing
MYH6/7
transcription consistent with the observed gene expression changes. In summary, ERR signaling is essential for the transcriptional program of structural maturation in human cardiomyocytes. This process likely involves establishing proper cardiac chromatin architecture. These results support a novel therapeutic strategy of utilizing ERR activators to reverse fetal shifts in failing hearts.
Abstract 11748: A Retrospective Observational Study Exploring Real-World Diagnostic Workup of Patients With Wild-Type Transthyretin Amyloid Cardiomyopathy and/or Light Chain Amyloidosis
Authors: Sounthonevat Cindi , Alvir Jose , Feron Patrick , Crowley Aaron , Benjumea Darrin , Chen Yong , Chung Haechung
Published: December 2023

Introduction:
Light chain (AL) and transthyretin amyloidosis are the most common forms of cardiac amyloidosis. Despite having similar presentation, the prognosis and treatment pathways are distinct, placing importance on accurate diagnosis.

Aim:
Assess the real-world diagnostic workup for AL in patients with AL, wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM), or both (AL+ATTRwt-CM).

Methods:
A retrospective study of Optum EHRs from Jan 2019-Dec 2021. Diagnostic workups in the 24 months prior to first diagnosis (index date) were assessed in mutually exclusive patient cohorts (aged ≥18 years) with AL (ICD10: E85.81 not E85.82), ATTRwt-CM (ICD10: E85.82 not E85.81), or AL+ATTRwt-CM (both ICD10 codes).

Results:
Of 49,466,996 patients in the database, 996, 526, and 31 met criteria for the AL, ATTRwt-CM, and AL+ATTRwt-CM cohorts, respectively (
Table
). Notable proportions of patients had no relevant workups (40%, 24%, and 23%) or no AL workups (40%, 29%, and 23%). Across cohorts, 54% (AL), 35% (ATTRwt-CM), and 61% (AL+ATTRwt-CM) received a workup for AL only, and >60% had 1-3 types of AL workup. Among patients tested with the serum-free AL assay (n=681), serum (n=460), or urine (n=286) immunofixation (IF) methods, ≥60% were in the AL cohort; ≤36% were in the ATTRwt-CM cohort and ≤4% in the AL+ATTRwt-CM cohort (
Figure
).

Conclusions:
In Optum EHRs, >20% of patients diagnosed with ATTRwt-CM or AL+ATTRwt-CM, and 40% with AL, had no relevant workups. Due to clinical urgency, it is critical to rule out AL in patients with cardiac amyloidosis using the AL assay or IF. These findings highlight the need for better diagnostic pathways for patients with suspected AL or ATTRwt-CM.
Abstract 11810: Is the Presence of Statin Use Before Onset of Disease Associated With In-Hospital Mortality in Elderly Patients With Acute Myocardial Infarction?
Authors: Tabata Hiroyuki , Kanda Daisuke , Ohmure Kenta , Fukumoto Daichi , Shimono Hirokazu , Ito Nobuhiro , Ikeda Yoshiyuki , Ohishi Mitsuru
Published: December 2023

Introduction:
The effect of statin on preventing cardiovascular events is clear, and aggressive lipid-lowering therapy with statins is strongly recommended for patients with coronary artery disease including of acute myocardial infarction (AMI).

Hypothesis:
The relationship between in-hospital mortality of AMI and statin use before onset of AMI in the elderly patients is unknown, we thus assessed.

Methods:
The subjects were 207 consecutive AMI patients aged 65 years or older who underwent successful percutaneous coronary intervention (PCI) at Kagoshima university hospital between January 2015 and March 2021. We investigated the association between in-hospital mortality after PCI and baseline characteristics including Global Registry of Acute Coronary Events (GRACE) risk score, which is widely used for estimating mortality in AMI patients.

Results:
Twenty-three patients (11%) died in-hospital. The mortality rate was significantly lower in patients who were taking statins at presentation compared to those who were not (3% vs. 16%, p=0.002). Univariate logistic regression analysis of risk factors for in-hospital mortality revealed that statin use before onset of AMI, level of serum albumin, level of high sensitivity C-reactive protein (hs-CRP) and GRACE risk score were associated with in-hospital mortality. Multivariate logistic analysis models adjusted for age, statin use, level of serum albumin, level of hs-CRP, and GRACE risk score showed that statin use [Odd's ratio (OR): 0.13, 95% confidence interval (CI): 0.02-0.81, p=0.029] and GRACE risk score (OR: 1.04, 95% CI: 1.02-1.06, p <0.001) were independently associated with in-hospital mortality. The optimal cut-off on the receiver-operating characteristic curve of GRACE risk score for predicting in-hospital mortality was 160. In addition, multivariate logistic analysis models using GRACE risk score ≥160 and non-use of statin before the onset of AMI showed greater risk of in-hospital mortality (HR 19.24; 95% CI 6.62-55.94; p <0.001) after PCI as compared to patients with GRACE risk score <160 and statins use.

Conclusions:
In elderly AMI patients undergoing PCI, statin use before the onset of AMI was an independent risk factor for in-hospital mortality, as was the GRACE risk score.
Abstract 11917: Cardiometabolic Disease Staging and Major Adverse Cardiovascular Event Prediction in Two Prospective Cohorts
Authors: Howell Carrie R , Zhang Li , Mehta Tapan , Wilkinson Lua , Carson April , Levitan Emily B , Cherrington Andrea , Yi Nengjun , Garvey William T
Published: December 2023

Background:
Cardiometabolic risk prediction models that incorporate the presence and severity of metabolic syndrome traits to predict cardiovascular outcomes may help identify high-risk populations early in the progression of cardiometabolic disease.

Objective:
To examine whether a modified Cardiometabolic Disease Staging System (CMDS) - a validated diabetes prediction model - predicts major adverse cardiovascular events (MACE) in two prospective cohorts.

Methods:
We developed a predictive model using data accessible in clinical practice [fasting glucose, blood pressure, body mass index, cholesterol, triglycerides, smoking status, diabetes status, hypertension medication use] from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study using Bayesian logistic regression - with external validation in the Atherosclerosis Risk in Communities (ARIC) study - to predict MACE [cardiovascular death, nonfatal myocardial infarction, and/or nonfatal stroke]. Predictive performance was assessed using receiver operating characteristic (ROC) curves, mean squared errors, misclassification and area under the curve (AUC) statistics.

Results:
This analysis included 20,234 REGARDS participants who were enrolled at baseline (2003-2007) and had no history of stroke or myocardial infarction. Participants were a mean age of 64 years (SD 9.3), mostly female (58%), 41% were non-Hispanic Black, and 18% had diabetes. During a median 10-year follow-up, there were 2,695 incident MACE (13.3%). The CMDS development model in REGARDS for MACE had an AUC of 0.721; with an AUC of 0.737 in external validation (ARIC). Our CMDS model performed similarly to both the ACC/AHA 10-year risk estimate (AUC 0.721 vs 0.716) and the Framingham risk score (AUC 0.673).

Conclusions:
We found that the CMDS predicted the onset of major cardiovascular events with good predictive ability and performed similarly or better than two commonly known CVD prediction risk tools. These data underscore the importance of insulin resistance as a cardiovascular disease risk factor, and that CMDS can be used to identify individuals at high-risk for progression to CVD in order to enhance the efficacy and benefit/risk ratio for interventions for CMD prevention.
Abstract 11975: The Multi-Ethnic Association of Aortic Valve Calcium and Long-Term Risk of Incident Severe Aortic Stenosis: Multi-Ethnic Study of Atherosclerosis
Authors: Grant Jelani K , Jha Kunal , Marrero Natalie , Razavi Alexander C , Boakye Ellen , Anchouche Khalil , Dzaye Omar , Budoff Matthew , Shah Sanjiv J , Czarny Matthew J , Rotter Jerome I , Guo Xiuqing , Yao Jie , Blumenthal Roger S , Thanassoulis George , Post Wendy S , Blaha Michael J , Whelton Seamus P
Published: December 2023

Introduction:
Racial/ethnic differences exist in the prevalence and burden of aortic valve calcium (AVC) and in the incidence of aortic stenosis (AS). While AVC is strongly associated with the long-term risk for AS, whether this association differs by race/ethnicity remains uncertain.

Hypothesis:
There will be a similar absolute event rate for incident moderate to severe AS within AVC categories across race/ethnicity.

Methods:
6,812 MESA participants underwent non-contrast EKG gated CT at MESA Visit 1 and AVC was quantified using the Agatston scoring method. Adjudication of incident moderate and severe AS was defined using standard clinical criteria. We assessed the association of AVC with the combined outcome of incident moderate-severe AS stratified by race/ethnicity. We calculated the event rate per 1,000 person-years and multivariate Cox proportional hazards with log-transformed AVC as a continuous variable.

Results:
The mean age was 62 years old and 47% of participants were women. Over a median follow-up of 16.7 years, there were 140 participants diagnosed with moderate AS (n=56) and severe AS (n=84). The prevalence of AVC >0 by race was 15.8% for White, 13.3% for Hispanic, 12.3% for Black, and 8.3% for Chinese participants. The rate of incident moderate-severe AS was similar across race/ethnicity when stratified by AVC, p for interaction=0.62 (Figure 1). Log-transformed AVC had a similar association with the long-term risk of moderate-severe AS regardless of race/ethnicity: White HR 1.83 (95% CI 1.63-2.05), Hispanic: HR 2.12 (95% CI 1.79-2.51), Black: HR 2.31 (95% CI 1.79-2.98), and Chinese: HR 2.14 (95% CI 1.30-4.41).

Conclusions:
The association between AVC and moderate-severe AS was similar across race/ethnicity. This suggests that previously observed differences in AS by race/ethnicity may be predominantly due to the differing prevalence of AVC.
Abstract 11978: Invasive Hemodynamic Changes Associated With Sodium Glucose Transporter-2 Inhibitors: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: Idowu Abiodun , Adebolu Olayinka , Casipit Bruce Adrian , Nriagu Bede , Evbayekha Endurance O , Lo Kevin Bryan U , Rangaswami Janani
Published: December 2023

Introduction:
Sodium-Glucose cotransporter-2 inhibitors (SGLT2i) have been shown to lower incident heart failure (HF) and HF hospitalizations, but the mechanism of benefits in relation to invasive hemodynamics remain unclear. This meta-analysis explores the central hemodynamic effects of SGLT2i.

Methods:
Using PRISMA guidelines, we systematically reviewed PubMed, Embase, CINAHL, Cochrane library, Ovid MEDLINE, and Google scholar from inception to April 2023 for randomized trials evaluating the effect of SGLT2i on central hemodynamics. Included patients were on guideline directed medical therapy and SGLT2i was added in the experimental group compared to placebo for 3-6 months. Rest and peak-exercise central hemodynamics was measured via right heart catheterization pre- and post-intervention. Random-effect model meta-analysis at 95% confidence interval (CI) was done using RevMan 5.4.

Results:
Out of 267 articles identified, 3 studies with a total of 145 patients were included in the meta-analysis. The mean age was 62.8
+
4.0 years, 70.0% were male and mean BMI was 31.9
+
2.2. Compared to placebo, SGLT2i were associated with reduction in weighted mean difference of pulmonary capillary wedge pressure (PCWP) by 2.71 (95% CI: -4.33 to -1.08, I
2
=2%, p = 0.001) and 4.17 (95% CI: -7.20 to -1.13, I
2
=0%, p = 0.007) mmHg at rest and peak exercise respectively. Similarly, SGLT2i reduced mean pulmonary artery pressure (mPAP) by 1.16 (95% CI: -3.00 to 0.69, I
2
=0%, p = 0.22) and 2.73 (95% CI: -5.63 to 0.18, I
2
=20%, p = 0.07) mmHg at rest and peak exercise respectively, however this was not statistically significant.

Conclusions:
SGLT2i significantly reduced PCWP at rest and peak exercise. Rest and peak exercise mPAP were also reduced compared to baseline but not statistically significant. This hypothesis-generating study offers mechanistic insights into the association of favorable hemodynamic effects underpinning to the HF benefits of SGLT2i.
Abstract 12070: An Implementation Study to Improve Statin Optimization in Primary Prevention Patients at a Resident Run Clinic in Rural US
Authors: Acharya Sameer , Senner Jillian , Ejaz Kanwal , Pokharel Yashashwi
Published: December 2023

Introduction:
Despite the benefit of statin in primary prevention of atherosclerotic cardiovascular disease (ASCVD), guideline-concordant statin use (statin optimization) remains low.

Methods:
We previously showed that among 325 consecutive 40-75 years old patients at baseline 35.4% did not have lipids ordered and 49.2% had lipid results unavailable over 3 years in electronic medical record (EMR). Using mixed-methods design, we previously identified provider and patient-related barriers; lack of automated ASCVD risk score reporting in EMR, insufficient clinic time and follow up visits. We identified and used several implementation strategies: 1) designed and disseminated a simplified process map and a guideline directed algorithm, 2) developed an automated ASCVD risk score reporting in EMR, 3) conducted telemedicine follow up, and 4) provided several refresher trainings/reminders. Now, we report two-year results among 354 consecutive patients with hypertension following the program adoption.

Results:
Mean age was 59.2 (61.9% male) and 50.6% were White patients and mean BMI was 30.2 (7.1). Compared with baseline, percentage of lipid labs ordering (64.6% vs 95.5%), lipid lab orders completion (78.6% vs 95.3%), ASCVD risk score assessment (3% vs 91%) and primary prevention statin optimization (34.6% vs 90.1%), all increased at 2 years (Table).

Conclusions:
Contextually appropriate implementation strategies can be helpful to address provider- and system-level barriers in cholesterol management and using statin for primary prevention.
Abstract 12100: Association Between Rheumatoid Arthritis and Cardiovascular Outcomes: A Systematic Review and Meta-Analysis
Authors: Jaiswal Vikash , Shama Nishat , Roy Poulami , Ang Song Peng , Mohamed Taha Amira , Sharma Akanksha , Halder Anupam , Agrawal Vibhor , Kalra Kriti , Khela Harpriya
Published: December 2023

Background:
Rheumatoid arthritis (RA) is an autoimmune disorder with a varying range of organs involved and leading to adverse outcomes. However, very little is known, with conflicting results about the association between RA and atrial fibrillation (AF) and the incidence of acute coronary syndrome (ACS).

Objective:
We aim to evaluate the incidence of atrial fibrillation (AF), ACS, and other clinical outcomes among RA patients.

Methods:
We performed a systematic literature search using PubMed, Embase, and Scopus for relevant articles from inception until 10th April 2023. Primary clinical outcomes were AF. Secondary endpoints were acute coronary syndrome (ACS), stroke, and all-cause of mortality.

Results:
A total of 4,667,199 patients were included in the analysis, with 77460 (xy%) patients in the RA group and 4589739 patients in the NRA group. The most common Comorbidity includes hypertension among RA and NRA groups (27% vs. 6%), respectively. Pooled analysis of primary outcomes shows that RA groups of patients had significantly higher odds AF (OR, 1.17(95%CI: 1.11-1.23), P<0.00001, I2=34%) compared with NRA groups. Secondary Outcomes shows that the RA group of patients had significantly higher odds of ACS (OR, 1.37(95%CI: 1.23-1.53), P<0.00001) compared with the NRA groups. However, the likelihood of stroke (OR, 1.02(95%CI: 0.95-1.08), P=0.65), and all cause mortality (OR, 1.25(95%CI: 0.84-1.87), P=0.27, I2=91%) was comparable between both the groups of patients.

Conclusion:
Our study shows that RA groups of patients are at increased risk of having atrial fibrillation and acute coronary syndrome. However, mortality risk was comparable between both groups.
Abstract 12114: Advancing Heart Failure Knowledge and Therapies Through a Multicenter Registry and Innovative Platform for Extended Outpatient Hemodynamic Monitoring: The Hemodynamic Frontiers in Heart Failure (HF
2
)
Authors: Jordan Timothy , Munshi Kartik , Mcdermott Margaret , Muse Evan D , Abraham Jacob , guglin maya , Shah Hirak , Bhimaraj Arvind , Robinson Monique R , Khedraki Rola , McCann Patrick , Volz Elizabeth , Ashrith Guha , Jonsson Orvar , Bhatt Kunjan A , Sauer Andrew J , Bennett Mosi K , Benjamin Terrie A , Fudim Marat , Heywood J Thomas
Published: December 2023

Background:
Hemodynamic Frontiers in Heart Failure (HF
2
) is a multicenter research consortium of institutions with active remote pulmonary artery pressure monitoring programs that aims to promote research in this field. The consortium recently created a registry of patients with pulmonary artery hemodynamic (HD) monitors (HDM) to facilitate the research mission.

Goals/Aims:
HF
2
registry aims to collect demographic, clinical, laboratory, echocardiographic and HD data from HDM patients to create a test bed to advance scientific knowledge about ambulatory HD monitoring and quickly evaluate new therapies.

Methods:
HF
2
includes patients aged >18 who would have been implanted with a HDM as per FDA indications of NYHA Class III HF diagnosis with a prior hospitalization or patients with NYHA Class II or BNP elevation without hospitalization. HF
2
registry data warehouse rests through University of Kansas Medical Center (KUMC) and was approved by their institutional review board (IRB) board followed by local IRBs at participating institutions with required Data use agreements. Institutions report data into the electronic registry database using REDCap, housed at KUMC.

Results:
This initial data set includes 254 patients implanted from 2019 until May 2023. See Table 1 for initial demographic, comorbidity, laboratory, echocardiographic, and medication data. See Table 2 for HD measurements at time of implant.

Conclusion:
A real-world registry/test bed of patients with HDM can evaluate long-term outcomes in such patients, provide data in unique patient groups, and provide an opportunity to evaluate HD effects of new HF therapies in rapid turnaround cross over trials.
Abstract 12124: GlycA is Associated With Both Coronary Artery Calcium Incidence and Progression: ELSA-Brasil Cohort Analysis
Authors: Correa Fabiano Filho Ronaldo , Generoso Giuliano , Cardoso Rhanderson , Jones Steven R , Santos Raul D , Toth Peter P , Bensenor Isabela M , Lotufo Paulo A , Bittencourt Marcio
Published: December 2023

Introduction:
GlycA is an emerging systemic inflammatory marker and quantifies N-acetyl glucosamine within the glycan region of acute phase proteins. Elevated levels of GlycA, are associated with a higher risk for coronary artery disease (CAD). There is conflicting evidence on whether GlycA levels can predict subclinical CAD progression in healthy adults.

Hypothesis:
High GlycA levels can predict subclinical CAD progression in healthy patients.

Methods:
We included 2,690 participants from the ELSA-Brasil cohort without cardiovascular/chronic inflammatory disease not receiving statin therapy who had GlycA level measured and two interval coronary artery calcium score (CAC) assessments between 2010 through 2018. Multivariable regression models adjusted for demographics, lifestyle, comorbidities, and laboratory parameters were used to assess the consistency of GlycA levels and CAC incidence and progression (Berry definition). CAC incidence required that the first CAC = 0. CAC progression required that the first CAC > 0. Therefore, the presence of CAC incidence and progression were mutually exclusive.

Results:
The mean age of participants was 48.6 ± 7.7 years, 56.7% were female, 54.6% and 16.1% (429/2690) were White and Black, respectively. The mean CAC interscan period was 5.1 ± 0.9 years, the mean GlycA level was 414.7 ± 65 μmol/L, and the incidence of CAC was 13.1%. GlycA level odds ratio (OR) for CAC incidence was 1.002 (95% CI 1.0005-1.005, p = .016) adjusted for demographics, lifestyle, early (≤60 years) CAD family history, lipid panel, and comorbidities. The GlycA (≤p25 vs >p75) OR for CAC progression (Berry definition) was 1.77 (95% CI 1.07-2.96, p = .03) in a similar multivariable adjustment model.

Conclusions:
Higher GlycA levels were associated with CAC incidence and progression even after adjusting for multivariable risk factors in a healthy Brazilian cohort. GlycA may have potential to further stratify CAD risk in healthy patients.