bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 13635: Blunted Vascular Endothelial Function in Black Females: Examining the Impact of Psychosocial Stress Exposure versus Internalization and Coping
Authors: Martin Zachary T , Aldaas Iman O , Cardenas Natalia , Kolade John O , Merlau Emily R , Vu Joshua , Brown Kyrah K , Brothers Robert M
Published: June 2023

Introduction:
Among females in the United States, Black females suffer from the highest rates of hypertension, coronary artery disease, and total cardiovascular disease (CVD) mortality. Vascular endothelial dysfunction precedes overt CVD and predicts CVD risk and has been reported in this population, but this is not always a consistent finding. Although psychosocial stress from numerous sources likely contributes to this disparity, the precise pathways and mechanisms remain incompletely understood. A growing literature suggests that internalization and coping may be more important than exposure to stressors alone. Therefore, we examined the relationship between endothelial function (brachial artery flow-mediated dilation, FMD) and psychosocial stress exposure (adverse childhood experiences, ACEs; past week discrimination, PWD) versus internalization/coping (John Henryism Active Coping Scale, JHAC12; Giscombe Superwoman Schema Questionnaire, G-SWS-Q). We hypothesized that 1) FMD would be blunted in Black relative to White females and 2) among Black females, internalization and maladaptive coping would exhibit a stronger negative relationship with FMD than exposure to stressful experiences alone.

Methods:
Twelve Black (21 ± 3 yr) and 8 White (25 ± 6 yr) healthy females underwent standard FMD testing. Black participants completed the ACEs, PWD, JHAC12, and G-SWS-Q inventories. Higher scores indicated greater stressor exposure or endorsement of the internalization/coping constructs.

Results:
Brachial artery FMD was lower in Black relative to White females (4.93 ± 3.10 vs 8.58 ± 1.62%;
p
< .01). Neither ACEs (
r
= -.10,
p
= .75) nor PWD (
r
= -.24,
p
= .45) were associated with FMD. JHAC12 scores were (
r
= -.61,
p
= .02) and SWS scores tended to be (
r
= -.39,
p
= .11) negatively associated with FMD. Among the SWS subscales, SWS-Resistance to Being Vulnerable (
r
= -.51,
p
= .04) and SWS-Intense Motivation to Succeed (
r
= -.54,
p
= .04) were negatively associated with FMD.

Conclusion:
These preliminary data indicate that 1) brachial artery endothelial function is blunted in young Black females and 2) reduced vascular function in Black females may be due more to internalization and maladaptive coping than exposure to stressful experiences alone.
Abstract 13637: Advanced Multimodality Imaging of Atrial Baffle Leak After the Senning Operation
Authors: Kollar Sarah E , Udine Michelle , Krishnan Anita , Loke Yue-Hin , Ito Seiji
Published: June 2023

Description of Clinical Presentation
We present a 40-year-old male with dextro-transposition of the great vessels and history of a Senning repair as an infant and a transvenous dual-chamber pacemaker at 7 years of age for sinus node dysfunction. Advanced imaging, including cardiac computed tomography (CT) and cardiac magnetic resonance (CMR), were performed as routine testing to evaluate the baffle and ventricular function.

Diagnostic Testing and Their Most Important Findings:
An ECG-gated cardiac CT demonstrated multiple defects between the systemic and pulmonary venous baffle (1A). CMR demonstrated a severely dilated right ventricle with moderately depressed systolic function, mild tricuspid valve insufficiency, and a moderately dilated, hyperdynamic left ventricle (LV). Advanced 4D flow confirmed a pulmonary to systemic blood flow ratio of 2.8:1, with large left-to-right shunt corresponding to the defects noted on CT (1B). There was no evidence of systemic or pulmonary venous baffle obstruction. 3D transesophageal echocardiography (echo) demonstrated multiple deficiencies in the septal/posterior atrial flap (1C). A stenotic, bicommissural pulmonary valve with moderate flow acceleration was also noted. 3D modelling from the CT/CMR data further clarified the location of the baffle leaks relative to pacemaker leads (1D). Cardiac catheterization confirmed these findings of large left-to-right shunt.

Learning Points from this case:
Atrial switch patients have a significant risk for baffle leaks, which can be challenging to identify. Advanced imaging including CT, CMR, 3D modeling, 3D echo, and cardiac catheterization are complimentary in the diagnosis of baffle leaks and can guide therapeutic options.
Abstract 13645: Transcutaneous Vagus Nerve Stimulation Restores the Cardiac Phenotype in Heart Failure With Preserved Ejection Fraction by Modulating the Immune Cell Profile
Authors: Farhat Kassem , Niewiadomska Monika , Morris Lynsie , Bland Sarah , Whyte Seabrook , Barber Rylee , Sample Karlie , Zimmerman Kurt A , Stavrakis Stavros
Published: June 2023

Introduction:
A proinflammatory state plays a central role in heart failure with preserved ejection fraction (HFpEF) but the role of specific immune cells remains unclear. Transcutaneous vagus nerve stimulation (tVNS) modulates immune responses via the cholinergic anti-inflammatory pathway, which involves acetylcholine-dependent activation of α7 nicotinic acetylcholine receptors (α7nAchR) on macrophages.

Hypothesis:
tVNS reverses the HFpEF phenotype by reducing resident macrophage number and pro-inflammatory cytokine production in an acetylcholine-α7nAchR-dependent manner.

Methods:
We induced HFpEF in male C57BL/6 CCR2-RFP mice with nitric oxide synthase blocker (L-NAME) and a high-fat diet for 5 weeks. C57BL/6 CCR2-RFP mice fed with standard chow diet served as controls (n=7). We randomized the mice to sham, or tVNS with or without the α7nAchR inhibitor methyllycaconitine (MLA) (n=6 in each group) for 4 weeks, followed by euthanasia. Cardiac macrophages were analyzed using flow cytometry. Resident macrophages were further subdivided based on MHC2 and CCR2 expression.

Results:
HFpEF mice exposed to sham developed hypertension, diastolic dysfunction, increased heart weight normalized to tibia length, and left ventricular fibrosis compared to the control mice, while tVNS restored these parameters towards the control values. MLA partially reversed the protective effect of tVNS in these parameters. Flow cytometry data revealed a significant increase in resident macrophages in HFpEF sham compared to control hearts, mainly driven by the MHC-/CCR2- subtype (F). Notably, tVNS restored the numbers of resident macrophages to the control levels, while MLA partially attenuated this effect (Figure).

Conclusions:
tVNS improves the cardiac phenotype in HFpEF mice by modulating cardiac resident macrophages, in an acetylcholine-α7nAchR-dependent manner.
Abstract 13646: APOL1 Nephropathy Risk Variant Alters Macrophage Metabolism
Authors: Wright Matthew , Liu Esther , Garcia Valerie , Lin Jennie
Published: June 2023

The common G1 and G2 variants in the APOL1 gene, specific to patients with African ancestry, increase the risk of developing chronic kidney disease and stroke. These variants also confer a survival benefit against African trypanosomiasis, but the effects of G1 and G2 variants on macrophage function remain unclear despite their role in innate immunity. Crucial to both innate immunity and tissue homeostasis, macrophages can promote cardiometabolic disease if dysregulated. Others have shown that metabolic changes can alter macrophage phenotype and function, and the G1 and G2 variants have been linked to mitochondrial dysfunction in epithelial cells. We therefore hypothesize that APOL1 risk variants promote cardiometabolic disease traits by altering macrophage metabolism and, thus, function. To test our hypothesis, we established CRISPR-Cas9 genome-edited induced pluripotent stem cell (iPSC) lines with the G0/G0 (major allele) genotype and the G1/G1 genotype on isogenic backgrounds. We then differentiated these iPSC lines into macrophage-like cells (iPSDMs) and evaluated their phenotype and function at baseline and under stimulation with 5 - 50 ug/mL interferon-γ, a potent inducer of APOL1 expression. We measured inflammatory markers via QPCR and ELISA, mitochondrial oxygen flux with the Agilent Seahorse XF Analyzer, and intracellular hydrophilic metabolites via LCMS. We found that G1/G1 iPSDMs express higher levels of pro-inflammatory markers and exhibited lower basal respiration as well as lower ATP production compared to G0/G0 controls. Because APOL1 risk variants have been linked to defective autophagy and ER stress, we treated the G1/G1 iPSDMs with rapamycin (autophagy inducer) or TUDCA (ER stress inhibitor) but found that they did not abrogate these genotype-specific differences in metabolic flux. Upon examination of metabolomics profiles of G1/G1 vs G0/G0 iPSDMs, differentially abundant metabolites were enriched for SMPDB pathways including spermidine biosynthesis (needed for anti-inflammatory reprogramming), gluconeogenesis, Warburg effect, homocysteine degradation, and fatty acid oxidation. Taken together, G1/G1 iPSDMs exhibit metabolic differences that may contribute to their proinflammatory phenotype.
Abstract 13651: Adipose Tissue Resolvin Biosynthesis is Abrogated by High Fat Diet-Induced Adrenergic Deficiency
Authors: Hellmann Jason , Pena Calderin Ernesto H , Lynch Will G , Zheng Jing-Juan , Sansbury Brian E , Spite Matthew R , Bhatnagar Aruni , Hill Bradford G
Published: June 2023

Diet-induced chronic inflammation in adipose tissue (AT) is associated with systemic insulin resistance. Conversely, exercise (Exe) protects against the development of chronic inflammation and insulin resistance. Our lab recently showed that exercise promotes inflammation resolution through adrenergic stimulation of specialized proresolving mediators (SPMs). In this study, we sought to determine if the proresolving benefits of exercise were dietary dependent. When compared with sedentary controls (Sed), mice exposed to 4 wk of Exe display elevated AT expression of SPM biosynthetic enzyme
Alox15
(Sed 1.12±0.18 vs. Exe 1.68±0.13 relative expression,
n
=5-7), SPM levels (Sed vs. Exe; RvD1 156.7±12.02 vs. 223.0±24.71; 17
R
-RvD1 354.0±35.86 vs. 534.4±98.92; RvD4 31.31±6.93 vs. 123.1±30.69; and 17
R
-RvD3 2.92±1.08 vs. 8.20±1.70 pg/g,
n
=5-7), and anti-inflammatory macrophages (F4/80
+
CD301
+
; Sed 17.5±3.2 vs. Exe 40.9±4.5 %F4/80
+
,
n
=4-6). These changes were dependent upon diet as short duration feeding with high fat diet (60% kcal from fat; HFD) abrogated the proresolving effect of exercise when compared with low fat diet (10% kcal from fat; LFD) controls. Interestingly, exercise-induced epinephrine (Epi) production in LFD-fed mice (Sed 147.2±24.4 vs Exe 312.5±60.9 ng/mL) was inhibited by HFD (Sed 121.1±22.7 vs. Exe 140.0±16.8 ng/mL). HFD feeding resulted in diminished expression of the Epi biosynthetic enzyme phenylethanolamine N-methyltransferase (PNMT) in adrenal glands when compared with LFD fed animals (protein expression: LFD 1.0±0.25 vs. HFD 0.36±0.15,
n
=4). These results suggest that the proresolving effects of exercise in adipose tissue are dietary and adrenergic dependent.
Abstract 13656: Symptoms and Outcomes Are Not Related to Regurgitant Severity in Guideline Directed Mitral Valve Surgery
Authors: Uretsky Seth , Biederman Robert W , Han Yuchi , Jacob Ron M , Choi Andrew D , Martin Edward T , Langer Michael , Sultan Ibrahim , Cavalcante Joao L , Shah Dipan J , Tong Matthew , Wolff Steven , Guglielmo Marco , Pontone Gianluca
Published: June 2023

Introduction:
The purpose of this study was to assess symptoms in patients undergoing class I/IIa ACC/AHA guideline directed lone mitral valve surgery.

Hypothesis:
Symptoms in patients undergoing guideline directed mitral valve surgery and are not associated with the severity of mitral regurgitation (MR).

Methods:
In this prospective multicenter study, 93 patients with a Class I/IIa indication for isolated mitral valve surgery were evaluated. Each patient had a cardiovascular magnetic resonance (CMR) exam prior to surgery and 3 to 5 months following surgery. The presence or absence of symptoms was determined by the treating physician. Symptoms were quantified using the Kansas City Cardiomyopathy Questionaire (KCCQ).

Results:
There were 55 (59%) patients who were symptomatic preoperatively. Based on CMR regurgitant volume, 30%, 39%, and 31% had mild, moderate, or severe MR, respectively. Among those with mild, moderate, and severe MR, the percentage of patients who were symptomatic at baseline did not differ significantly and the severity of symptoms as quantified by the KCCQ did not differ significantly (Figure1A). Post-surgical improvement in the percentage of patients with symptoms and the KCCQ score did not differ based on baseline MR severity (Figure1B). Patients who were symptomatic before surgery reported the greatest improvement in KCCQ symptom score following surgery compared to those who were asymptomatic at baseline (17 ± 25 vs. -0.4 ± 17, p<0.001).

Conclusions:
In a multi-center study of patients undergoing ACC/AHA class I/IIa indication for surgery for MR there was no of correlation between MR severity and symptoms. These findings question the assumptions that severity of MR is associated with worse symptoms prior to surgery and those with severe MR benefit the most from mitral valve surgery. The lack of correlation between MR severity, symptoms, and outcomes is concerning and it suggests symptoms may be often misattributed to MR.
Abstract 13664: Cardiovascular Mortality in Brazil During the COVID-19 Pandemic: Comparison Between Underlying and Multiple Causes of Death
Authors: Nascimento Bruno R , Passaglia Luiz G , Pinheiro Pedro C , Ribeiro Antonio L , Brant Luisa C
Published: June 2023

Introduction:
COVID-19 has impacted cardiovascular disease (CVD) mortality worldwide due to avoidance of healthcare, health system collapse, and the direct CV effects, but detailed data from Brazil are still scarce. We aimed to evaluate the impact of COVID-19 pandemic on CVD mortality, stratified by age, sex and region of Brazil, comparing underlying (UC) and multiple causes (MC) of death.

Methods:
Ecological, time series study analysing CVD age-standardized death rates, from epidemiological weeks (EW) 10/2020 to 11/2021, using data from the Mortality Information System (SIM-SUS). CVD was defined as in ICD-10 Chapter IX, and considered if reported as UC or MC of death (UC + other causes reported in any line of death certificate) in separate analyses. Observed was compared to expected data (mean for the same EW of 2017-2019). Risk ratios (RiR) were analysed and 95% confidence intervals calculated.

Results:
Age-standardized CVD mortality rate as UC of death in the pandemic was 165.9 (95% CI 165.5 - 166.3)/100,000 inhabitants, similar to the expected: (165.6; 95%CI 165.2 - 166.2)/100,000, with a RiR=1.00; 95% CI 1.00 - 0.93). There was an increase in out-of-hospital mortality (18%) (RiR=1.18; 95% CI 1.17 - 1.19) and in deaths with ill-defined CVD causes (43%) (RiR=1.43; 95%CI 1.42 - 1.44), particularly in the out-of-hospital setting (51%). The increase in out-of-hospital deaths was more pronounced in the North (RiR=1.33; 95% CI 1.30 - 1.36) and Center West (RiR=1.26; 95% CI 1.23 - 1.30), regions with less prepared health systems. Conversely, in MC of death analysis, there was a 10% increase in CVD mortality (observed: 243.2 (95% CI 242.7 - 243.7), expected: 221.6 (95% CI 221.1 - 222.1)/100,000, RiR=1.10 (95% CI 1.09 - 1.10), noticeably in the out-of-hospital setting (19%). Steeper increasing trends also occurred in the North region (RiR=1.16; 95% CI 1.15 - 1.17), and in individuals ≥60 years (RiR=1.11; 95% CI 1.10 - 1.11), and among men (RiR=1.11; 95% CI 1.11 - 1.12) vs. women (RiR=1.08; 95% CI 1.08 - 1.09).

Conclusions:
During the pandemic, CVD mortality as UC of death remained stable in Brazil, contrasting with an increase when MC were considered. Higher out-of-hospital mortality, exacerbation of existing CVD by COVID-19, and competing causes of death may have contributed.
Abstract 13695: Is There Utility of Fetal Echocardiogram for Isolated in vitro Fertilization Pregnancies?
Authors: Allen Catherine C , Zhang Xiao , Kiley Allie , Srinivasan Shardha
Published: June 2023

Introduction:
Risk of congenital heart disease (CHD) for in vitro fertilization (IVF) pregnancies is higher than the general population, though other factors may be involved. IVF is an indication for fetal echocardiogram (FE), however there is center variation to perform FE without a secondary indication if the anatomy ultrasound (AU) is normal. We aim to assess the number of new CHD diagnoses following normal AU in IVF-only pregnancies.

Hypothesis:
We hypothesize that there is minimal benefit to a FE in IVF-only pregnancies with a normal AU and may result in overutilization of resources.

Methods:
Retrospective chart review from 2016-2021 of all IVF pregnancies with and without a secondary indication for FE at our center. Those without FE during the COVID-19 pandemic were included to assess postnatal CHD detection. Patients were classified as IVF-only if they had a normal AU and no secondary indication for FE; all others classified as IVF+other. Maternal and fetal demographics, AU, FE, and postnatal echo (post-echo) data was obtained.

Results:
A total of 556 maternal and 628 fetal patients from IVF pregnancies were included; 401 fetuses were IVF-only with a FE, 116 were IVF-only with no FE, the remaining were IVF+other. There was no complex CHD (CCHD) in either IVF-only groups, the FE group detected several minor findings, and the no FE group detected three small septal defects on post-echo (Table 1). The probability of a normal postnatal evaluation in IVF-only with a normal FE was 94% and with no FE was 96%. Minor variations found on FE triggered additional testing (71 total FE in 43 fetuses) and detected a few minor CHD, none requiring intervention.

Conclusions:
Given low-risk for CCHD in IVF-only pregnancies, there is minimal benefit to a FE in the setting of a normal comprehensive AU and raises questions of cost vs. benefit of FE. This may impact future recommendations for indications for FE in the setting of IVF-only without added risk factors for CHD.
Abstract 13713: Myocarditis and Coronary Vasospasm in a Patient With Antiphospholipid Syndrome and MINOCA
Authors: Ravipati Goutham , Marcus Mason , Okwara Jeomi
Published: June 2023

Background
: The prevalence of MINOCA in patients with antiphospholipid syndrome (APLS) is estimated to be 20%. Frequent causes in this population include coronary vasospasm, microcirculatory dysfunction and takotsubo cardiomyopathy.

Objective
: This case reveals myocarditis and coronary vasospasm as newly described complications of APLS associated MINOCA and illustrates the use of CMR to differentiate ischemic injury from myocarditis in this population.

Case
: A 40-year-old female presented with two-days of left-sided, substernal, pleuritic, and radiating chest pain associated with dyspnea. Admission ECG showed 0.5mm ST elevations in the inferior leads with ST depression in aVL. She had an initial high sensitivity troponin of 1531 ng/L, NT-proBNP of 18,357 pg/mL, baseline creatinine of 1.53 mg/dL, platelets of 95,000/μL, hemoglobin of 8.4 g/dL, and a subtherapeutic INR of 1.1 on warfarin. An emergent catheterization showed no coronary artery disease or evidence of SCAD. TTE showed hypokinesis of inferior and lateral walls with an LVEF of 45% and CTA chest ruled out pulmonary embolism. The patient’s admission was complicated by rising troponins to a peak of 9790 ng/L, oliguric renal failure requiring continuous renal replacement therapy, and fever. Patient was medically managed for presumed myocardial infarction and repeat TTE two days after catheterization showed a recovered LVEF of 59%. CMR showed a transmural infarct of the basal and inferior walls with signs of microvascular obstruction and diffuse patchy late gadolinium enhancement of the LV midwall, consistent with myocarditis. An infectious workup for myocarditis was negative. Patient was discharged home on warfarin, aspirin, and amlodipine.

Conclusion
: MINOCA is more common in patients with APLS, although coronary vasospasm and myocarditis have not been described in the same patient. CMR is useful to differentiate the etiology of ischemic injury following successful diagnosis of MINOCA.
Abstract 13737: An Electronic Health Record-Based Algorithm to Optimize Secondary Prevention Using Lipoprotein(a), Apolipoprotein B, Cholesterol, and Myocardial Infarction Diagnosis: ABCDs Prevention Program
Authors: Johnson Trent B , Yang William , MacFarlane Zane , Martin Seth S , Marvel Francoise A
Published: June 2023

Background
:

According to the 2022 American Heart Association Heart Disease and Stroke Statistics, coronary heart disease remains the leading cause of death attributable to cardiovascular disease (CVD). In 2016 only ~1 in 4 Medicare beneficiaries who were eligible for cardiac rehab (CR) participated. We explored the use of cardiovascular biomarkers and electronic health records (EHRs) to facilitate the early identification of patients at high risk for CVD.

Methods
:

The EHR algorithm uses a combination of cardiovascular biomarkers and ICD diagnosis codes to automatically identify and refer patients to select secondary prevention programs: (1) traditional CR, (2) lipid clinic, (3) virtual CR (Corrie Health Program). In order to determine program eligibility our model uses criteria of lipoprotein(a) >70 nmol/L, apolipoprotein B >90 mg/dL, low-density lipoprotein cholesterol >150 mg/dL, triglycerides >200 mg/dL
,
and/or a diagnosis of ST-elevation myocardial infarction (MI) or non-ST-elevation MI as depicted in Figure 1. Lipid biomarker cutoffs were defined to maximize sensitivity for familial hyperlipidemia.

Results
:

In a test environment 90% of patients deemed eligible by the algorithm received appropriate referrals to traditional, virtual (Corrie) CR and lipid clinics. The algorithm is currently being used in both inpatient units and outpatient clinics at Johns Hopkins Hospital and Johns Hopkins Bayview. Sixty-six percent of the orders placed increased referrals to CR and lipid clinic and 33% of the orders placed increased referrals to virtual cardiac rehab.

Conclusions
:

Building an EHR-based algorithm to individualize CVD prevention using cardiovascular biomarkers and diagnoses may increase early identification and intervention on high-risk patients.
Abstract 13759: Gender Differences in the Relationship Between Health Rating and Disruption of Medical Care in Atherosclerotic Disease Populations Due to COVID-19
Authors: Kesiena Onoriode , Allahverdiyeva Aysha , Kumar Navin , Singireddy Shreyas , Seffah Kofi D , Braunstein Jacob , Rizvi Mehdi , Hagan Kobina , Olokunlade Temitope , Hyder Syed , Mszar Reed , Mossialos Elias , Sharma Garima , Nasir Khurram
Published: June 2023

Introduction:
The COVID-19 pandemic reportedly disrupted access and delivery of healthcare across diverse populations. We evaluated gender differences in the relationship between health rating and the disruption of medical care in patients with atherosclerotic diseases (ASCVD) due to COVID-19.

Methods:
This was a cross-sectional study of 2,678 adults with ASCVD using the 2020 National Health Interview Survey data. Health status was rated as fair/poor, good, and very good/excellent. Medical care disruption due to COVID-19 were based on reports about a delayed medical care or not getting medical care at all due to COVID-19. Multiple logistic regression was used in this analysis with demographic, cumulative social risk, and comorbidities controlled for.

Results:
The mean (SE) age was 67.1 (0.4) and 42.8% were females. The distribution of the health rating of each gender by medical delay is shown in figure 1. Females who rated their health as fair/poor were more likely to delay care due to COVID when compared to those who rate their health as excellent [AOR 2.09 (95% CI 1.03, 4.24) p=0.040]. Males who rated their health as fair/ poor [AOR 1.50 (95% CI 0.85, 2.63) p=0.161] or good [AOR 1.27 (95% CI 0.75, 2.19) p=0.385] were not more likely to delay care due to COVID-19 when compared to those with an excellent health. Female who rated their health as fair/poor were more likely to not get care due do COVID-19 [AOR 2.35 (95% CI 1.14, 4.75) p=0.021]. However, males who rated their health as fair or poor [AOR 1.37 (95% CI 0.68, 2.74) p=0.375] or good [AOR 1.05 (95% CI 0.52, 2.11) p=0.887] were not more likely to not get care due to COVID-19 when compared to those with an excellent health rating.

Conclusion:
Among females, a fair/poor health rating was associated with either a delay or failure to get medical care. This can further worsen the gender disparity among ASCVD populations. Measures are needed to address this growing problem.
Abstract 13775: Novel Risk Model of Quantitatively Predicting Recurrence of Atrial Fibrillation After the Cox-Maze IV Procedure
Authors: Song Long , Jiang Zenan , Tan Haoyu , Zhang Hao , Liu Liming
Published: June 2023

Introduction:
This study developed a novel risk score model for quantitative prediction of the rate of atrial fibrillation (AF) recurrence after the bipolar radiofrequency Cox-maze IV procedure (CMP-IV) in patients with AF and chronic valvular disease.

Methods:
We enrolled 408 consecutive patients who underwent the CMP-IV concomitant with valve surgeries in our hospital between 2014 and 2021. We randomly divided the cohort into two groups. A ‘development cohort’for model generation (204 patients; 50%) and a ‘test cohort’for model validation (204 patients; 50%) were calculated by Kaplan-Meier survival curve analysis and receiver operating characteristic curve analysis.

Results:
The median follow-up was 3.5 (interquartile range: 0.9-6.8) years. The 1-, 3-, 5- and 6-year rates of freedom from AF recurrence in the entire cohort were 91.3%, 87.1%, 80.9% and 76.3%, respectively. Risk factors for AF recurrence examined by multivariate Cox regression analysis included preoperative AF duration >4.4 years, postoperative neutrophil/lymphocyte ratio >9.23, anteroposterior diameter of left atrium >51mm before discharge and AF rhythm at discharge(panel A). Points were assigned to each risk factor according to its hazard ratio. A novel risk score model was developed with a range up to 13 points(panel B). High score (≥7) predicted significantly higher rates of AF recurrence after the CMP-IV than low score (0-3) and medium score(4-6) did in both development cohort(panel C) and test cohort(panel D). The area under the receiver operating characteristic curve of the novel risk model score at 1-, 3- and 5-year was 0.72, 0.80 and 0.89 (95% confidence interval: 0.49-0.95, 0.70-0.90 and 0.81-0.96) respectively in the test cohort(panel E).

Conclusions:
Surgeons should be cautious to apply the CMP-IV in patients with high model score due to higher risk of AF recurrence.
Abstract 13776: Alpha 1-Acid Glycoprotein is Involved With Neutrophil Nets in COVID-19
Authors: Mestriner Fabiola , Campos Lígia C , Franco Francisco Daniely , Couto Ariel , Fraga-Silva Thais F , Flora Dugaich Vinicius , D Avila Mesquita Carolina , Milani Elizabete R , Martins Ronaldo , Corsi Carlos , Michelon Jessyca , Vasconcelos Jociany , Vasconcelos Tauana F , Petroski Bruno , Couto Daniel M , Jordani Maria CecÃlia , da Costa Rafael M , Menengueti Mayra G , Evora Paulo Roberto B , Tostes Rita C , Bonato Vania L , Martins Maria A , Ribeiro Maurício S , Becari Christiane
Published: June 2023

Introduction:
Orosomucoid also named Alpha-1 Acid Glycoprotein(AGP) is a major acute-phase protein and is increased in response to systemic injury and inflammation. AGP has been described as an inhibitor of neutrophil migration on sepsis, particularly its immunomodulation effects. The AGP biological functions are not understood in Coronavirus disease 2019 (COVID-19).

Hypothesis:
We hypothesize that plasmatic AGP is upregulated in severe Covid-19 patients and is involved in the regulation of netosis. Therefore, we sought to investigate the role of AGP in plasmatic from COVID-19 severe infection patients and neutrophils infected with Severe Acute Respiratory Syndrome Coronavirus-2 (SarsCov-2).

Methods:
Epidemiological data and AGP, interleukin-6 (IL-6), C-reactive protein (PCR), lactate, and other laboratorial parameters were measured in blood samples from 52 subjects hospitalized in the ICU with clinically SarsCov-2 infection confirmed by RT-PCR. To evaluate the role of AGP in netosis in neutrophils, blood samples from health patients (n=13) were collected, and neutrophils were separated and infected with Sars-Cov-2 (Moi=1). Those neutrophils were treated with AGP (10μg/ml) or vehicle for 18 hours and netosis was analyzed by flow cytometry (n=10) and immunofluorescence (IF; n=10). Early and late netosis, respectively, were characterized by negative or positive FVS and positive Sytox. The neutrophil extracellular traps (NETs) were investigated by myeloperoxidase (MPO), neutrophil elastase (NE), and DAPI by IF and quantified Netquant/Matlab software. This study was approved by Ethics Committee -CAAE: 30816620.0.0000.5440.

Results:
AGP increased in severe Covid-19 patients (p<0.05). A positive correlation between AGP with IL-6 and C-reactive protein (respectively, p=0.005, p=0.002) and a negative correlation between AGP and lactate (p=0.004) were found it. Together, AGP treatment downregulated early (35,7%) and late (43,5%) netosis in neutrophils infected with SarsCov-2. Confocal analysis by MPO, NE e DAPI showed NETs released by neutrophils infected with Sar-Cov-2 decreased when neutrophils were treated with AGP (p<0.05).

Conclusions:
Our data showed increased AGP in COVID-19 infection and contributed to netosis regulation.
Abstract 13815: SARS-CoV-2 and Plasmodium Falciparum Co-Infection A Lethal Combination to the Heart
Authors: Gonzalez Carta Karina A , Rojas Elirub , Terzic Carmen M , Mendoza Ivan , Mendoza Ivan
Published: June 2023

Introduction:
COVID-19 pandemic has had an unprecedented impact worldwide, co-infections with neglected tropical diseases like Malaria can occur and affect the heart.

Objective:
Describe a unique case of Malaria and SARS CoV2 infection occurring concurrently with cardiac complications.

Clinical Case:
A 69-year-old male, retired canoeing athlete, with well-controlled arterial hypertension, presented odynophagia, cough, and dyspnea on slight exertion for 2 days. On examination, O2 saturation was 91%, blood pressure 100/60 mmHg, regular heart rate of 110 bpm, positive PCR for SARS-CoV-2, elevated D-Dimer, and chest X-ray with evidence of viral pneumonia. He received supplemental oxygen, steroids, and paracetamol. Two days later, he presented with choluria, afternoon episodes of high fever preceded by chills and myalgia, and a thick blood smear showed Plasmodium falciparum (PF) trophozoites. Antimalarial treatment was started with primaquine 15mg, 20 mg of artemether, and 120 mg of Lumefantrine daily with the disappearance of fever until day 14 of onset of symptoms when he presented with acute heart failure (AHF) with a reduced ejection fraction of 45%. NYHA Class IV, arterial hypotension, sudden onset palpitations, and afternoon febrile episode. The electrocardiogram showed atrial fibrillation (AF) with a rapid irregular ventricular response of 120 bpm; The echocardiogram revealed a 7mm circumferential pericardial effusion, right ventricular dysfunction. Treatment with colchicine, enoxaparin, spironolactone, and bisoprolol was started. A new thick smear demonstrated the persistence of PF. A new antimalarial regimen was restarted, with the disappearance of the fever 48 hours after its onset, with the reversion of AF to sinus rhythm.

Discussion:
A unique case of concurrent COVID-19 and Malaria, which cause challenges to the heart and lead to cardiovascular complications.

Conclusion:
An exceptional case is presented, the coexistence of SARS-CoV-2 and PF infection-associated complications of myocarditis, pericarditis, new-onset AF, and AHF. This interaction should not go unnoticed, physicians’ awareness is key, and early diagnosis and treatment can be lifesaving, mitigate and offer the best chance of cure.
Abstract 13816: The Hypertension Care Cascade in 2019-21: A Nationally Representative Study of 1.9 Million Adults in India
Authors: Varghese Jithin Sam , Ali Mohammed K
Published: June 2023

Introduction:
Previous studies from India reported management of hypertension (diagnosed: 45%, treated: 13%) among adults 15-49 years, a fraction of those suffering from disease. This study aimed to provide nationally-representative estimates of (i) the proportion of all adults (18+ years) with prehypertension and hypertension (HTN), and (ii) the heterogeneity in their cascade of care by natal sex, age, and urbanicity.

Methods:
Using data from non-pregnant women (n = 959,468) and men (n = 935,829) in the National Family Health Survey-V (2019-21), we estimated the sex-specific prevalence of prehypertension and HTN (see footnotes of
Figure
), and among adults with HTN, the self-reported care cascade (ever screened, diagnosed, taking medication, under control defined by normotension). All estimates incorporated the complex survey design and were stratified by urban versus rural or by age group (18-39, 40-64, 65+).

Results:
Nationally, the prevalence of prehypertension and HTN were 19.1% (95%CI: 18.9,19.2) and 27.7% (95%CI: 27.5, 27.8) respectively. The prevalence of prehypertension was similar in urban areas (vs rural) among men (%; 23.2 vs 21.7) and women (%; 16.7 vs 16.1). Prevalence of HTN was higher in urban areas (vs rural) among men (%; 30.9 vs 27.2) and women (28.8 vs 26.2). Both prehypertension and HTN were higher with increasing age. Prevalence of screening in the total population was 56%, and was higher in urban areas, among women and higher with age. Among those with HTN, only 40%, 23%, and 10% being diagnosed, taking medication, and under control, respectively. Diagnosis, treatment and control were higher in urban areas, women, and older age groups (
Figure
).

Conclusions:
Despite the high prevalence of hypertension, there is a high unmet need at each step of care cascade nationally, especially in rural adults. Moreover, the prevalence of prehypertension is high in rural areas, and those under 40 years, requiring a comprehensive approach for prevention and management.
Abstract 13824: Lifestyle Management for Cardiac Health With Deep Learning of Biomechanical Dynamics
Authors: Gangadharan Kiirthanaa , Zhang Qingxue
Published: June 2023

Physical activities are of great values and, with appropriate principles, are reported to be clinically effective for rehabilitation from cardiac diseases. The physical activity-based lifestyle stimulation is thus highly promising to foster cardiac health management. Target the challenge that, the understanding of how different body locations contribute to the physical activity detection accuracy is still limited, we propose to leverage deep learning to investigate comprehensively seven body locations and six signal channels for each location. They are the chest, forearm, head, shin, thigh, upper-arm, and waist locations, and for each location, there are tri-axis acceleration signals and tri-axis gyroscope signals. In total there are forty-two combinations. The proposed convolutional neural network, when applied on each of the forty-two cases, yields a comprehensive comparison of these configurations in terms of physical activity type detection accuracy. Evaluated on fifteen subjects and six different physical activities, including climbing downstairs, climbing upstairs, jumping, lying, running/jogging, and walking, the determined optimal configuration is the chest location and the accelerometer axis-Y channel, with an accuracy of 95.1%. This study has not only maximized the physical activity detection accuracy through optimal configuration determination, but also deepened our understanding of how biomechanical dynamics are generated through different body locations and sensor channels. The research findings will greatly benefit cardiac health management.
Abstract 13829: Low Density Lipoprotein Receptor on the Immune Cells Influence the Atherosclerosis Progression in C57bl/6 Mice
Authors: Kanshana Jitendra S , Bustos Martha , NARAIN APOORVA , Nguyen Joshua , Doreswamy Kruthika , Kohan Alison B
Published: June 2023

Introduction:
Atherosclerosis is the leading cause of cardiovascular diseases (CVDs). Over the past three decades, the clinical focus has been reducing plasma lipids and other traditional risk factors to reduce cardiovascular mortality. More recently, the CANTOS trial showed that inflammation is a significant additional risk factor for CVDs. Regulatory T cells (Tregs) are well known to protect the aorta from the inflammatory burden, but clinically how to induce these cells is not known.

Hypothesis:
LDLr
is expressed on various immune cells, including Tregs. Recently, our lab found that modulating the lipid metabolism through
LDLr
in Tregs protects mice from colitis. Collectively, our data illustrate that
LDLr
plays an essential role in T cell homeostasis and function that may impact atherosclerosis progression. Therefore, our goal in this study is to test whether the absence of
LDLr
in immune cells alters the development of atherosclerosis.

Methods:
We used C57BL/6J male mice, which were lethally irradiated and transplanted with either
LDLr-/-
or
WT
bone marrow (BMT). To induce atherosclerosis, we blocked hepatic triglyceride clearance (antisense oligonucleotides) and fed mice with a high-fat diet for 12 weeks. We then collected blood and aorta to assess the extent of atherosclerosis.

Results:
Mice transplanted with
LDLr-/-
bone marrow have a lower percentage of T lymphocytes such as Th1 cells, Th1/Th2 hybrid cells, and pro-inflammatory M1 macrophages in the aorta compared to
WT
BMT aorta. Conversely,
LDLr-/-
BMT mice had a lower percentage of total Tregs but a significantly higher percentage of Tregs expressing the anti-inflammatory cytokine IL-10 and a lower percentage of Tregs co-expressing the pro-inflammatory marker T-bet compared to
WT
BMT aorta. Also,
LDLr-/-
BMT mice exhibited a 2-fold increase in plasma IL-10 compared to
WT
BMT plasma.

Conclusion:
Altogether, the current study's finding suggests that the loss of the
LDLr
in the immune compartment (bone marrow) can induce a significant change in the aortic immune cells and may be a future target for augmenting the protective Tregs population in CVD patients.
Abstract 13833: Arrhythmia Patterns in Patients Managed With and Without Tyrosine Kinase Inhibitors
Authors: Wei Chen , Fazal Muhammad , Kapoor Ridhima , Cheng Paul , Rogers Albert J , Perino Alexander C , Narayan Sanjiv M , Rhee June W , Baykaner Tina
Published: June 2023

Introduction:
Tyrosine kinase inhibitors (TKIs) are often used to treat hematologic malignancies. Ibrutinib, a Bruton’s TKI, has been associated with increased burden of treatment limiting arrhythmias. How this compares to arrhythmias in patients on non-ibrutinib TKIs or non-TKI therapy is unknown.

Hypothesis: We hypothesized that ibrutinib therapy would be associated with higher atrial and ventricular arrhythmia burden than non-ibrutinib TKI or non-TKI therapies in patients with hematologic malignancies.

Methods:
We performed a retrospective single center chart review of consecutive patients who received 14-day cardiac event monitors while on ibrutinib, non-ibrutinib TKIs, or non-TKI therapy for a hematologic malignancy between 2014-2021.

Results:
A total of 176 patients were included (ibrutinib=72, non-ibrutinib TKI=36, non-TKI=68; Figure A). The ibrutinib group had higher incidence of AF (n=32, 44%) and NSVT (n=31, 43%) than the non-ibrutinib TKI (AF: n=7, 19%, p=0.02; NSVT: n=8, 22%, p=0.03) and non-TKI group (AF: n=13, 19%, p=0.003; NSVT: n=14, 21%, p=0.006; Figure B). Rates of SVT, PAC burden, and PVC burden were not significantly different. Therapy was held in 25% (n=18) of patients on ibrutinib vs 5% (n=2) on non-ibrutinib TKIs. Average duration of TKI therapy was 32 months in the ibrutinib group vs 77 months in the non-ibrutinib group (p<0.001). Of note, the non-TKI group had significantly higher outpatient cardiology follow-up versus the TKI groups (p=0.048).

Conclusions:
In this large retrospective comparison of cardiac event monitors in patients with hematologic malignancies on ibrutinib, non-ibrutinib TKIs, or non-TKI therapy, those receiving ibrutinib had a higher incidence of atrial and ventricular arrhythmias and higher rate of treatment interruption due to arrhythmia burden but less cardiology follow-up. Further research is needed to optimize risk stratification, surveillance, and management of TKI-related arrhythmias.
Abstract 13857: Reduction of Infarct Size in Anterior ST Segment Elevation Myocardial Infarction (STEMI) With LAD Occlusion and LV Unloading Using a Micro-Axial Pump for 30 Minutes Before PCI: A Per Protocol Analysis of the STEMI DTU Pilot Study
Authors: Kapur Navin K , Moses Jeffrey , FARAZ HAROON , George Zachary , Iyer Vijay S , Kaki Amir , Karas Richard , Kimmelstiel Carey , Koenig Gerald , Madder Ryan D , Meraj Perwaiz M , MORELAND Jason A , Kim Raymond J , schreiber theodore , wohns david , Udelson James E , Stone Gregg , O'Neill William
Published: June 2023

BACKGROUND:
The STEMI-DTU pilot trial was the first exploratory study to identify that LV unloading and delaying reperfusion is safe and feasible in anterior STEMI without cardiogenic shock. We now report new findings in patients who met all protocol inclusion and exclusion criteria (per protocol cohort).

Methods:
In a multicenter, prospective, randomized safety and feasibility trial, we assigned 50 patients with anterior STEMI to LV unloading by using the Impella CP followed by immediate reperfusion (U-IR) versus delayed reperfusion after 30 minutes of unloading (U-DR). Cardiac magnetic resonance (CMR) imaging assessed infarct size normalized to the area at risk (IS/AAR) 3-5 days after PCI. Patients without CMR at 3-5 days (n=10; 5/arm), without PCI of a culprit LAD lesion (n=2; 1/arm) and without STEMI (n=5; 4 in U-IR, 1 in U-DR) were not per protocol and thus excluded from this analysis.

Results:
A total of 33 patients met all inclusion and exclusion criteria (U-IR n=15; U-DR n=18) with respective door-to-balloon times of 75±26 and 89±23 minutes (p=.10) and mean unload-to-balloon times of 10±5 and 34±3 (p<0.01). In the total cohort, IS/AAR was significantly associated with microvascular obstruction (MVO), 30-day IS normalized to total LV mass, 90 day LVEF, and 90dday LV end systolic volume with or without a delay to reperfusion (Table, R>0.5, p<0.005 for all). Despite longer symptom to balloon times in the U-DR arm (174±59 vs 228±78, p<0.01), IS/AAR was lower in the U-DR arm (62±16 vs 48±16, p=0.04) and remained significantly lower irrespective of the magnitude of precordial STE. MVO was significantly lower in the U-DR arm among patients with the highest precordial STE (Figure).

Conclusion:
A per protocol analysis of the STEMI-DTU Pilot trial identified a significant reduction in infarct size among patients with unloading and delayed reperfusion irrespective of precordial STE magnitude. These findings are currently under investigation in the STEMI-DTU Pivotal trial.
Abstract 13862: Trends in Complication Rates Post-Transcatheter Aortic Valve Replacement
Authors: Muthu Krishnan Anand , Zhang George , Sharma Toishi , Ittleman Frank , Lahoud Rony
Published: June 2023

Introduction:
Transcatheter Aortic Valve Replacement (TAVR) is a mainstay of treatment for aortic valve stenosis for patients. It is unclear if this has resulted in a significant change in post-procedural complications over time.

Hypothesis:
We hypothesised a reduction in major complication rates across our study period given the improvement in delivery systems.

Methods:
This is a nationwide temporal trends study utilizing the 2016-2019 National In Patient Sample (NIS) registry. Patients who underwent TAVR including those with major procedural complications (i.e: need for transfusion or permanent pacemaker implantation [PPMI]) were identified. The trends in overall complication rate and individual complication rates between 2016 to 2019 were analysed. Multivariate model was built to predict the factors influencing complications.

Results:
Between 2016-2019, 217,110 patients underwent TAVR of which 12.6% had atleast one major complication. Proportion of complications decreased significantly across the study period(see Fig 1). Overall, females had a 10% higher complication rate (aOR 1.1, p=0.002) mainly driven by bleeding with over a 50% need for transfusion (aOR 1.57, p<0.001) while having a 12% lower risk of PPMI (aOR 0.88, p=0.001). The Northeast region had a significantly higher complication rate driven by higher bleeding, with PPMI rate not differing geographically. Charlson comorbidity index (CCI) score was predictive of higher bleeding with a score of >3 having over a threefold risk (aOR 3.4, p<0.001).

Conclusions:
Our study shows that although there is a reduction in complication rate post-TAVR, the changes are uneven across different complications and population groups. More than 10% of patients were still experiencing a complication as recently as 2019. This could be a reflection of moving towards lower risk population, recent improvements in valve profile and implantation technique and a better understanding of predictors of PPMI.
Abstract 13871: Tamponade Physiology: To Tap or Not to Tap?
Authors: Al Sudani Hussein , Lo Kevin B , ali rafal , Hajnoczky Nora , Casipit Bruce , Paguio Joseph Alexander , Wattoo Ammaar , Ogunmola Isaac , Adekayode Christine , Akhtar Hamza , Bhargav Ruchika , Pressman Gregg S
Published: June 2023

Introduction:
Cardiac tamponade is often evaluated through echocardiography. However, not all patients with tamponade physiology develop clinical tamponade. Thus, we evaluated various echocardiographic and clinical factors as predictors of the need for intervention.

Methods:
A total of 264 patients with tamponade physiology were extracted from the echocardiographic database. We compared clinical and demographic factors among those who underwent intervention vs. conservative care. Factors with p value of <0.2 were included in a multivariable logistic regression model.

Results:
76% of these patients had moderate to large pericardial effusions, and their mean MAP was 92 mmHg. Half of these patients (n=134) had either pericardiocentesis or a pericardial window. Only 7 patients (3%) required a repeat pericardiocentesis.Intervention patients had more positive echocardiographic parameters (2 (1-3) vs 1.5 (1-2) p<0.001) and moderate to large pericardial effusions (90% vs 62% p<0.001). On multivariable logistic regression, uremic or CKD-related effusion was independently associated with less interventions OR 0.22; 95% CI (0.07-0.67) p=0.007 while systolic RA collapse, diastolic RV collapse, IVC plethora and tricuspid inflow variation were all independently associated with higher odds of pericardial intervention AUC of overall model 0.81, 95 percent CI [0.76-0.86].

Conclusions:
In this sample of patients with tamponade physiology on echocardiography, a model using a combination of echo and demographic parameters demonstrated good but not perfect discrimination in predicting the need for intervention. Clinical judgment remains important.