bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 13447: Superior Vena Cava Isolation From the Right Atrial Posterior Wall: A Case Series
Authors: Gianni Carola , Mohanty Sanghamitra , Trivedi Chintan , Bai Rong , Al-Ahmad Amin , Burkhardt J D , Gallinghouse G J , Hranitzky Patrick M , Horton Rodney P , Sanchez Javier E , Di Biase Luigi , Natale Andrea
Published: April 2024

Introduction:
Superior vena cava (SVC) isolation is a common ablation strategy to address non-pulmonary vein triggers in patients with paroxysmal and non-paroxysmal AF. SVC isolation with circumferential ablation might be difficult to achieve because of the phrenic nerve (PN) location in its anterolateral aspect.

Hypothesis:
It is possible to isolate the SVC sparing its anterolateral aspect given the presence of preferential conduction from the posterior wall of the right atrium (RA) to the SVC.

Methods:
Consecutive patients in which SVC isolation ablating in the RA posterior wall. RF ablation was started in the septal aspect of the SVC-RA junction and it was continued posteriorly-inferiorly in sites of early activation (relative to the SVC) until electrical isolation was obtained. The distance between the SVC-RA junction and the site of SVC isolation was measured with 3D electro-anatomical mapping.

Results:
85 patients were included in the analysis. 27% were females, with a mean age of 66 ± 10 years, 21% had paroxysmal AF, 42% persistent AF, 36% longstanding persistent AF. The procedure was a repeat ablation in 58% of the cases, with a mean procedure time of 124 ± 38 minutes.

Acute SVC isolation was achieved in 98%. Mean distance of isolation from the SVC-RA junction was 19.9 ± 5.1 mm (range 10.2-32.1 mm).

At follow-up, we observed 2 (2%) transient PN injuries. After this, we began performing PN mapping in the PW, which precluded complete SVC isolation in 1 case (see Figure 2).

Conclusions:
SVC isolation can be achieved without circumferential ablation by targeting sites with early activation (relative to the SVC) in the RA posterior wall.
Abstract 13512: Chemokines and Carotid Intima-Media Thickness in a European Population at High Risk for Cardiovascular Events: Results From the IMPROVE Study
Authors: Moreno Velasquez Ilais , Malarstig Anders , Strawbridge Rona J , Baldassarre Damiano , Veglia Fabrizio , Leander Karin , Silveira Angela , Rauramaa Rainer , Smit Andries J , Giral Philippe , Mannarino Elmo , Tremoli Elena , Humphries Steve E , Lindén Anders , Hamsten Anders , de Faire Ulf , Gigante Bruna
Published: April 2024

Background:
Experimental studies indicate that two archetype chemokines circulating in the blood, IL-8 and GRO-α, are critical for atherogenesis. However, their association with measures of subclinical atherosclerosis has not been investigated.

Hypothesis:
Here we test the hypothesis that circulating IL8 and GRO-α protein are associated with the carotid artery intima media thickness (c-IMT) in a large European multicenter study:
the c-IMT and c-IMT Progression as Predictors of Vascular Events in a High Risk European Population (

IMPROVE

) study
.

Methods:
IMPROVE study participants (n=3,703), recruited in 5 European Countries (Sweden, Finland, the Netherlands, France and Italy), had at least three cardiovascular (CV) risk factors but not prevalent CV diseases. C-IMT measures (mm) (c-IMT
mean
, c-IMT
max
and c-IMT
mean-max
) were recorded at baseline. Each measurement represent the average of 8 (4 left and 4 right) carotid segments. IL8 and GRO-α were measured in plasma from 3,452 participants (women, n=1,784; men, n=1,668) using the Olink ProSeek CVD array I and expressed in arbitrary units. We evaluated the association, expressed as beta coefficient (β) and 95% confidence intervals (CI), between chemokines and c-IMT using median regression. Models were adjusted by sex, age, body mass index, hypertension, diabetes, current smokers, hypercholesterolemia and latitude.

Results:
Higher levels of IL8 and GRO-α were observed in participants from Northern Europe as compared to those from Southern Europe [IL8: 50 (41-62) vs 36 (28-49) and GRO-α 108 (70-176) vs 42(22-95)]. At multivariable analysis only in men, levels of IL8 were positively associated with c-IMT measures: c-IMT
mean
[1.0 x 10
-4
(6.5 x 10
-5
-1.4 x 10
-4
), p<0.01], c-IMT
max
[(6.5 x 10
-4
,(4.8 x 10
-4
-8.2 x 10
-4
), p<0.01] and c-IMT
mean-max
[1.7 x 10
-4
, (1.3 x 10
-4
-2.2 x 10
-4
), p<0.01]. No corresponding association was observed for GRO-α and c-IMT measurements.

Conclusions:
The chemokine IL8, but not GRO-α, was associated with baseline c-IMT in men at high risk of CV events. Furthermore, our results suggest the presence of a European north-to-south gradient in chemokine levels. New studies are warranted to disentangle potential differences between IL8 and CV risk across sexes.
Abstract 13797: Effects of Resveratrol Supplementation on Walking Performance in Peripheral Artery Disease: A Randomized Clinical Trial
Authors: McDermott Mary , Leeuwenburgh Christiaan , Ferrucci Luigi , Guralnik Jack M , Sufit Robert , Tian Lu , Zhao Lihui , Stein James , Gao Ying , Anton Stephen , De Cabo Rafael , Criqui Michael
Published: April 2024

Introduction:
Resveratrol, a phenol found in red wine and grape skin, has been associated with longevity in animals and with improved endothelial function and mitochondrial activity in humans without cardiovascular disease. Resveratrol supplement sales exceed 30 million dollars per year. Recent evidence suggests that lower resveratrol doses may have greater benefits.

Hypothesis:
In a randomized trial, we hypothesized that 125 mgs and 500 mgs of resveratrol, respectively, would improve walking performance in people with lower extremity peripheral artery disease (PAD), compared to placebo.

Methods:
In the RESveratrol To improve outcomes in Older people with PAD (RESTORE) trial, people age 65 and older with PAD were randomized to one of three groups: 500 mgs resveratrol, 125 mgs of resveratrol, and placebo. The trial was double-blinded. The primary outcome was change in six-minute walk distance at 6-month follow-up. Secondary outcomes were changes in maximal and pain-free treadmill walking distance and brachial artery flow-mediated dilation (FMD).

Results:
66 PAD participants were randomized (mean age- 74.4 ±6.7 years, mean ankle brachial index- 0.67±0.18). The study population included 21 (31.1%) females and 33 (50%) blacks. The table shows results. P values are relative to the placebo group.

Conclusions:
These results suggest that resveratrol should not be prescribed to improve walking performance or cardiovascular health in people age 65 and older with PAD.
Abstract 13804: Differential Outcome of Medical Therapy Compared With Percutaneous and Surgical Coronary Revascularization in Individuals With Chronic Kidney Disease at Low, Medium, or High Cardiovascular Risk
Authors: Herzog Charles A , Li Shuling , Natwick Tanya , Solid Craig , Charytan David M
Published: April 2024

Introduction:
Comparisons of medical therapy (MT) and percutaneous (PCI) or surgical coronary revascularization (CABG) for the treatment of coronary artery disease (CAD) in the setting of chronic kidney disease (CKD) have suggested that MT is inferior, but may be confounded by failure to adequately account for baseline cardiovascular disease (CVD) risk and by the nihilistic definition of MT as absence of revascularization rather than active titration of MT.

Hypothesis:
MT is superior to revascularization in CKD pts at low CV risk but PCI and CABG are superior to MT when CV risk is high.

Methods:
The 20% Medicare sample was used to identify pts in 2007-2012 with CKD, assess outcomes, and define risk groups: Low risk: angiography or stress testing in the absence of prior CVD; Medium risk: stress test or angiography with prior CVD history; High risk: admission for acute coronary syndrome (ACS). PCI and CABG were defined on the basis of procedures within 60 days of risk group entry. MT included non-PCI/CABG pts with addition of new CV medication during the same time frame. R
esults:
For low risk pts 1000 had PCI, 571 CABG, and 6848 MT. For medium risk 1751 PCI, 718 CABG and 9670 MT pts. For high risk 4542 PCI, 1481 CABG and 8287 MT pts. All-cause mortality rates increased across risk groups, consistent with excellent performance of our classification metric. Mortality rates per hundred pt years were lowest with MT in the low risk group—PCI 9.1, CABG 8.9, MT 8.1--and medium risk groups—PCI 13.5, CABG 14.6, MT 13.2. In contrast, survival was markedly better with CABG or PCI in high risk pts—PCI 18.4, CABG 13.1, MT 33.5 (
Table
).

Conclusions:
The relative benefits of MT and coronary revascularization in the setting of CKD vary according to pre-treatment CV risk. For pts at low or moderate risk, MT, PCI, and CABG have similar survival. In contrast, revascularization, particularly CABG, is associated with markedly improved survival (and higher ESRD rate) compared to MT after ACS.
Abstract 13849: Enhancing Anti-thrombotic Efficacy but Reducing Hemorrhage: Comparison and Combination Use of a Novel Integrin Outside-in Signaling Inhibitor With Current Anti-platelet Drugs
Authors: Cui Yujie , Pang Aiming , Shen Xiang , Stojanovic Aleksandra , Du Xiaoping
Published: April 2024

Introduction and Hypothesis:
Current anti-platelets drugs cause excessive bleeding. We have developed a novel anti-platelet drug, M3mP6, which selectively inhibits integrin outside-in signaling but not ligand binding to integrin αIIbβ3. Here we test the hypothesis that M3mP6 may synergistically enhance anti-thrombotic effects of current anti-platelet drugs but reduce risk of hemorrhage.

Methods and Results:
One time bolus injection of M3mP6 (10 uMol/kg,15 min) has superior anti-thrombotic effect compared to high doses of clopidogrel (4 mg/kg, oral, 2 hours), and very high doses of aspirin (36 mg/kg, i.p., 1 hour), using a FeCl
3
-induced occlusive carotid artery thrombosis model in mice. However, unlike the high doses of clopidogrel and aspirin, M3mP6 did not affect bleeding using a tail bleeding time model. We found that M3mP6 was comparable with the loading doses of ticagrelor (3 mg/kg) and cangrelor (30 μg/kg) in anti-thrombotic efficacy. However, ticagrelor or cangrelor cause dramatically increased hemorrhage, which is in contrast to M3mP6’s lack of bleeding side effect. To mimic hemorrhage during intravascular/surgical procedures, we designed a carotid artery puncture model of surgical hemorrhage. Cangrelor caused dramatically excessive bleeding even treated with a hemostatic pad. In contrast, M3mP6-treated mice are not different from control. Importantly, M3mP6 exerts synergistic anti-thrombotic effects when used together with current anti-platelets drugs, without further increases in bleeding. Furthermore, when M3mP6 was used in combination with a reduced dose of cangrelor, the anti-thrombotic effect was significantly more potent than high dose cangrelor, but hemorrhage was greatly reduced.

Conclusions:
M3mP6 is potentially a superior new anti-platelet drug, ideal for patients with bleeding risk, and also for greatly enhancing anti-thrombotic effects of current anti-platelet drugs while reducing hemorrhage.
Abstract 13852: Improved Long-Term Survival With Repeat Coronary Bypass Surgery Compared to Percutaneous Coronary Intervention After Previous Surgical Revascularization a 20 Year Experience
Authors: Greiten Lawrence E , Schaff Hartzell V , Stulak John M , Said Sameh M , Greason Kevin L , Daly Richard C , Joyce David L , Maltais Simon , Lahr Brian D , Heins Courtney N , Dearani Joseph A , Lerman Amir , Locker Chaim
Published: April 2024

Introduction:
We compared outcome of repeat CABG (RCABG) and PCI in patients with previous CABG.

Hypothesis:
RCABG may improve survival versus PCI.

Methods:
From 1993 through 2009, 3,058 patients underwent revascularization after previous CABG. RCABG patients (n=530) were grouped by the use of arterial grafts (n=396), or saphenous vein grafts (SVG; n=134). At previous CABG, 37% of RCABG patients received IMA graft. PCI patients (n=2,528) were grouped into balloon angioplasty (BA; n=491), bare metal stent (BMS; n=1,267), and drug-eluting stent (DES; n=769). PCI patients were further stratified by the treated target into native coronary artery (n=1,637), bypass grafts (n=674), or both (n=216). Propensity score analysis matched 287 patients.

Results:
RCABG had increased 30-day mortality compared with PCI (HR=3.92; 95% CI, 2.25-6.84;
P
<.001) in multivariable analysis, while in propensity matched analysis it did not (
P
=.09). Overall survival, however, was greater for RCABG compared with PCI in multivariable analysis (HR=0.70; 95% CI, 0.59-0.83;
P
<.001), as well as in propensity matched analysis (10-year survival rates were 52% vs 37%, respectively [
P
=.005]). Compared with RCABG, PCI involving bypass grafts had increased mortality (HR, 1.39; 95% CI, 1.09-1.78;
P
=.008), whereas PCI targeting only the native coronaries did not (HR, 1.12; 95% CI, 0.85-1.47;
P
=.43); BMS patients had increased mortality (HR, 1.34; 95% CI, 1.06-1.68;
P
=.013), but DES did not (HR, 1.28; 95% CI, 0.77-2.12;
P
=.35). At RCABG, 318 patients (60%) received an IMA graft and late survival was similar to those receiving SVG; The use of IMA in previous CABG was associated with improved survival (HR=0.82; 95% CI, 0.72-0.92;
P
<.001].

Conclusions:
Long-term survival after previous CABG is improved with RCABG compared to PCI, especially when PCI involves bypass grafts. There is no difference in long-term survival between RCABG using arterial grafts vs SVG only if IMA is used in either previous or RCABG.
Abstract 13871: Does Compliance With a Global Cpr Quality Benchmark Predict Survival From Out-Of-Hospital Cardiac Arrest?
Authors: Cheskes Sheldon , Schmicker Rob , Morrison Laurie , Rea Tom , Grunau Brain , Drennan Ian , Leroux Brian , Vaillancourt Christian , Schmidtt Terri , Koller Allison , Kudenchuk Peter , Aufderheide Tom , Herren Heather , Vilke Gary , Flickinger Kate , Charleston Mark , Straight Ron , Jasti Jamie , Christenson Jim ,   Resusctiation Outcomes Consortium Investigators
Published: April 2024

Background:
Measures of chest compression fraction (CCF), compression rate, compression depth and pre-shock pause have all been independently associated with improved outcomes from out-of-hospital (OHCA) cardiac arrest. However, it is unknown whether compliance with a global CPR quality benchmark, incorporating the aforementioned metrics, can predict OHCA survival.

Methods:
We performed a secondary analysis of prospectively collected data from the Resuscitation Outcomes Consortium Cardiac Arrest Epistry database. As per the 2015 American Heart Association (AHA) guidelines, high quality CPR was defined as CCF > 0.8, chest compression rate 100-120/minute, chest compression depth 50-60 mm and pre-shock pause< 10 seconds. To derive a global CPR quality benchmark, we created multiple models employing combinations of CPR metrics to assess relationships between CPR compliance and survival to hospital discharge. Multivariable logistic regression models controlling for age, gender, witnessed status, bystander CPR, location, presenting rhythm and site were used to assess the relationship between compliance with a global CPR quality benchmark, survival to hospital discharge and neurologically intact survival with MRS < 2.

Results:
We analyzed CPR process data from 35,445 defibrillator records collected over a 4 year time frame ending in June 2015. Of the 35,445 records, 19,568 (55.2%) included compression depth. For the primary model (CCF, rate, depth), there was no improvement in survival from OHCA comparing resuscitations that met no CPR quality benchmarks (reference) to those who met all CPR quality benchmarks (OR 0.89; 95% CI: 0.47, 1.70) and those who met some of the CPR quality benchmarks (OR 0.71; 95% CI: 0.45, 1.13). Models combining CCF, rate, depth and pre-shock pause yielded similar results for both shockable and non- shockable presenting rhythms when controlling for Utstein variables.

Conclusions:
When modeled in combination and adjusting for other predictors of survival, a global CPR quality benchmark using the current AHA guidelines was not associated with improved survival from OHCA. Unmeasured confounders, unknown combinations of optimal CPR quality metrics or possible interactions may explain our study findings.
Abstract 13927: Allosteric Activation of PP2A Inhibits Experimental Abdominal Aortic Aneurysm
Authors: Zhang Chao , Dong Nianguo , Narla Goutham , Lin Zhiyong
Published: April 2024

Introduction:
In abdominal aortic aneurysms (AAA), recent studies strongly implicate the kinase, Mitogen-activated protein kinase (MAPK) as an essential contributor to its pathogenesis. Upregulation of Protein phosphatase 2A (PP2A) activity has been shown to be of significant therapeutic value, however pharmaceutically tractable approaches to directly activate PP2A remain elusive in AAA disease.

Hypothesis:
In light of the potential phosphatase effects PP2A can exert on MAPK protein targets, we hypothesized that PP2A activation by small molecule activators of PP2A (SMAPs) might mitigate AAA progression.

Methods:
Oral administration of the small molecule activator of PP2A, termed DT-1154, was performed for 4 weeks in apolipoprotein E-null (ApoE-/-) mice concomitant with subcutaneous Angiotensin II infusion. Human abdominal artery tissue as well as abdominal artery tissue from Ang II-infused ApoE-/- mice (+/- DT-1154) were examined by PCR, Western blotting and IHC.

Results:
To examine its activation state, Phosphorylated-PP2A (Y307) was stained in human and murine AAA tissues, with an increased phospho-PP2A signal indicating less cellular phosphatase activity. Examination of these tissues indeed revealed increased phosphorylation of PP2A compared to control non-AAA tissues indicating a marked reduction of PP2A activation. This strongly suggests that compromised PP2A activation can drive AAA formation. Oral administration of DT-1154 also resulted in significantly reduced AAA incidence and aortic dilation in these pro-AAA ApoE-/- mice. Finally, mechanistic studies indicated that blockade of ERK1/2 and NF-kB signaling by DT-1154 contributed to its effects in ameliorating AAA progression.

Conclusions:
These studies demonstrate a role of PP2A in AAA etiology and implicate that activation of PP2A may serve as a novel strategy to limit human AAA progression.
Abstract 13937: Electrocardiography-Derived Respiratory Rate Detects Clinical Deterioration in Acute Care Patients With Cardiovascular Disease
Authors: Moss Travis J , Clark Matthew T , Calland James Forrest , Enfield Kyle B , Kim Gina , Lynch Michelle A , Blatt Marc I , Lake Douglas E , Moorman J Randall
Published: April 2024

Introduction:
Clinical deterioration resulting in ICU transfer occurs in 4 to 5 of every 100 acute care admissions. Early Warning Scores (EWS) identify high risk patients, but rely on intermittent assessments. Continuous ECG not only provides heart rate (HR) and rhythm, but can also estimate respiratory rate (RR).

Hypothesis:
Continuous ECG data improves the predictive validity of EWS prior to acute deterioration leading to ICU transfer or unanticipated death.

Methods:
Among floor patients admitted with continuous ECG, we identified those with deterioration resulting in ICU transfer or unanticipated death. We analyzed 60 patient-years of ECG data and applied previously validated methodologies for detection of atrial fibrillation (AF) and estimation of RR. We evaluated the predictive validity of common EWS and compared them to models that incorporate ECG data. We excluded observations after DNR/DNI orders or transitions to comfort care. We calculated the fold change in mortality, and the predictive validity (C-statistic).

Results:
From 8,033 consecutive admissions, we identified 544 instances of clinical deterioration in 508 admissions. Admissions with events had a 50-fold increase in mortality (19.8% vs 0.4%) despite unexpected deaths accounting for only 6% of all events. We analyzed the 274 deteriorations that had ECG data in the 24-hours leading up to events. EWS had C-statistics ranging from 0.63 to 0.70. A model using only ECG-derived measurements had a C-statistic of 0.67 and the strongest predictors included RR, HR, and AF. Addition of the ECG-only model to the best EWS improved its C-statistic to 0.72.

Conclusions:
Continuous ECG data improves the ability of intermittent EWS to identify the highest risk patients up to 24-hours in advance of acute clinical deterioration.
Abstract 13949: Biomarkers for Prediction of Atrial Fibrillation in European Cohorts
Authors: Schnabel Renate B , Niiranen Teemu , Gianfagna Francesco , Vishram Julie K , Ojeda Francisco M , Costanzo Simona , Soederberg Stefan , Vartiainen Erkki , Donati Maria Benedetta , Pasterkamp Gerard , Hughes Maria , Kontto Jukka , Bobak Martin , Schillert Arne , den Ruijter Hester M , Mathiesen Ellisiv , König Wolfgang , König Wolfgang , König Wolfgang , Blankenberg Stefan , de Gaetano Giovanni , Joergensen Torben , Kuulasmaa Kari , Salomaa Veikko , Iacoviello Licia , Zeller Tanja
Published: April 2024

Introduction:
Blood-based biomarkers are objective tools to assess susceptibility for atrial fibrillation (AF).

Hypothesis:
Whether novel biomarkers improve risk prediction based on clinical risk factors and N-terminal pro B-type natriuretic peptide (Nt-proBNP) remains to be shown.

Methods:
In individuals from two European community studies (N=32,318) we examined 11 circulating biomarkers representing lipids (total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, lipoprotein(a), apolipoprotein A1, apolipoprotein B), inflammation (C-reactive protein), renal function (cystatin C), myocardial damage (high sensitivity assayed troponin I (hsTnI)), and vitamin D in relation to incidence of AF in addition to clinical risk factors and Nt-proBNP. Multivariable-adjusted Cox regression models were computed for models comprising classical cardiovascular risk factors and biomarkers. Net reclassification improvement (NRI) was computed.

Results:
The median age was 53.2 (interquartile range 44.0, 62.9) years, age range 24.1-97.6 years, 51.9% women. Over a median follow-up of 4.9 years N=893 AF cases occurred. In multivariable-adjusted models there was evidence for an association between one standard deviation increase in biomarker for total cholesterol (hazard ratio (HR) 0.90, 95% confidence interval (CI) 0.83-0.97;P=0.0042), LDL cholesterol (HR 0.89, 95% CI 0.82-0.96; P=0.0015), apolipoprotein B (HR 0.89, 95% CI 0.83-0.96; P=0.0033), cystatin C
1/3
(HR 1.19, 95% CI 1.11-1.28; P<0.001), hsTnI
1/3
(HR 1.09, 95% CI 1.04-1.13;P<0.001), besides Nt-proBNP (HR 1.99, 95% CI 1.86-2.13;P<0.001). Only Nt-proBNP increased the C-index markedly to 0.872 (95% CI 0.844-0.901) compared to the model based on clinical risk factors C-index 0.836 (95% CI 0.809-0.863). Similarly, only Nt-proBNP improved reclassification (NRI 0.219, 95% CI 0.159-0.279).

Conclusions:
Several known and novel biomarkers including blood lipids (total and LDL cholesterol, lipoprotein B), hsTnI and cystatin C are related to incident AF in large European cohorts. None proved to be superior to Nt-proBNP in C-statistic and net reclassification analyses. A possible benefit in the clinical application of Nt-proBNP for AF risk prediction needs to be shown.
Abstract 14013: E-selectin-targeted Novel Nano Polymers Stabilize Atherosclerotic Plaque and Improve Cardiac Remodeling
Authors: Tsoref Olga , Amit Uri , Landa Natalie , Kain David , Rosenboim-Cohen Osnat , Tyomkin Dalia , David Ayelet , Leor Jonathan
Published: April 2024

Introduction:
Inflammation is implicated in the initiation and progression of cardiovascular disease. Endothelial activation with up-regulation of E-selectin adhesion molecules stimulates leukocyte infiltration leading to atherosclerotic plaque growth, plaque vulnerability and acute myocardial infarction.

Hypothesis:
Novel E-selectin-targeted polymers, with or without dexamethasone, can prevent plaque progression and adverse cardiac remodeling in atherosclerosis prone ApoE deficient ApoE
(-/-)
mice.

Methods and Results:
To target and modulate cardiovascular inflammation we used novel N-(2-hydroxypropyl)-meth-acrylamide polymers conjugated with peptides that bind E-selectin with high affinity, with and without dexamethasone 1mg/kg (P-ESBP-Dex, P-ESBP). Five-month-old ApoE
(-/-)
mice were fed a high-fat diet (HFD) for 8 weeks. Plaque growth was assessed by vascular ultrasound (US) 4 and 8 weeks after onset of HFD. We used a novel software application designed to measure in-vivo vessel wall anatomy and motion in small-animal models. Following the baseline vascular US, mice were randomized to 4 treatment groups: P-ESBP-Dex, P-ESBP, free dexamethasone or saline, delivered by 4 weekly intraperitoneal injections. Left ventricular remodeling and function were assessed by echocardiography in parallel to the vascular US. We found that both P-ESBP and P-ESBP-Dex selectively targeted atherosclerotic lesions, and reduced wall thickness of the ascending aorta. Furthermore, compared with saline controls, P-ESBP significantly decreased the area of necrotic core in the aortic plaques (74.2±5.9 mm2 vs. 34.7±15.5 mm2, p<0.05). Notably, the addition of dexamethasone to P-ESBP did not improve their therapeutic effect. Finally, P-ESBP attenuated left ventricular diastolic and systolic dilatation, compared with controls.

Conclusion:
E-selectin binding polymers reduce the growth of atherosclerotic lesions, contribute to plaque stability and prevent adverse cardiac remodeling in ApoE
(-/-)
mice. We suggest a novel nanomedicine-based therapy for atherosclerosis, unstable plaque, and to prevent adverse cardiac remodeling.
Abstract 16587: Comparison of Risk Profile for New-Onset Atrial Fibrillation Between Young and Elderly
Authors: Yang Pil-sung , Jang Eunsun , Yu Hee Tae , Kim Tae-Hoon , Uhm Jae-Sun , Pak Hui-Nam , Lee Moon-Hyoung , Joung Boyoung , Kim Joung-Youn
Published: April 2024

Introduction:
The atrial fibrillation (AF) is heterogeneous in pathophysiology based on individual patient characteristics. A number of risk factors are associated with an increased risk for the development of AF. The aim of our study is to identify the effects of widely known risk factors for AF, on the incidence of AF according to age in general population and to find out its clinical implication.

Methods:
We analyzed 506,209 patients (≥18 years) without AF or valvular heart disease from the Korean National Health Insurance Service-National Sample≥ Cohort (NHIS-NSC) between 2009 and 2013. Total population is divided into two groups: “young” whose age is less than, and the “elderly,” as those older than 60.

Results:
Of the 3,416 (0.7%) cases of AF occurring during follow-up periods of 46.2 ± 15.1 months, 1664 (0.4%) were in young age and 1752 (2.6%) were in elderly age group (p<0.001). In a multivariate Cox regression analysis, age, male gender, hypertension and heart failure were related with increased risk of AF in both group. In addition, in young age group, risk of new-onset AF incidence was increased by diabetes mellitus (HR 1.26, 95% CI 1.05-1.52, p=0.014), current or former smoking (HR 1.20, 95% CI 1.02-1.42, p=0.028), and obesity (HR 1.36, 95% CI 1.21-1.54, p<0.001). In elderly age group, chronic obstructive pulmonary disease (HR 1.46, 95% CI 1.21-1.75, p<0.001) and chronic renal disease (HR 1.23, 95% CI 1.06-1.42, p=0.007) increased the risk of new-onset AF.

Conclusions:
There was a difference in the pathogenesis of AF between young and elderly. In young age group compared to elderly age group, modifiable risk factors had a greater impact on the incidence of new-onset AF. Therefore, clearly defined management strategies to prevent and tackle this arrhythmia according age is required.
Abstract 16612: The Feasibility, Safety, and Value of a Virtual Cardiac Implantable Electronic Device Wound Check
Authors: Marzec Lucas N , Guigli Rebecca , Hamer Mika , Sauer William H , Meyer Martha , Baringer Connor , Gritz Mark , Ho P Michael , Sandy Lisa , Matlock Daniel , Allen Larry A
Published: April 2024

Introduction:
In-person wound checks are standard of care for patients implanted with cardiac implantable electronic devices (CIEDs), which include pacemakers and implantable cardioverter-defibrillators. However, in-person wound checks burden patients, providers, and health systems. A virtual wound check may be a safe alternative, but the feasibility, safety, and costing savings of a virtual CIED wound check are unknown.

Methods:
We performed a single-center pilot study of a virtual wound check following CIED implantation. Eligible patients included those implanted with a CIED and scheduled for an in-person wound check at our center, and who had a smartphone or digital camera and internet access. Virtual wound checks consisted of 1) patients taking and uploading a digital photograph of their wound, and 2) a phone conversation with a CIED nurse regarding signs and symptoms of wound complication. The safety of a virtual wound check as compared to an in-person wound check was assessed by examining the agreement between virtual and in-person wound checks regarding wound abnormalities detected and recommended treatments. The value of a virtual wound check was assessed with time-driven activity-based costing (TDABC), a micro-costing approach in which time is assigned to each task in both the virtual and in-person wound checks.

Results:
We enrolled 67 of 76 (88.2%) eligible patients, of whom 50 (74.6%) completed a virtual wound check. No abnormality was seen in either virtual or in-person checks for 42 (62.7%) patients. An abnormality was seen in the virtual but not in-person wound check in 5 patients, and in the in-person but not virtual wound check in 5 patients. Pocket swelling was detected in 6 patients during virtual wound checks, and 7 during in-person wound checks. Erythema was detected in 1 patient during an in-person wound check that was not detected during a virtual wound check. The overall agreement was 71.4%. All complications that led to a clinical action (i.e. prescription of antimicrobial drugs, placement of pressure dressing) were detected in both the virtual and in-person wound checks. TDABC analysis demonstrated virtual visits used an average of 5 minutes less of provider time, and a total cost savings of $153.

Conclusions:
A virtual CIED wound check is feasible, safe, and associated with cost-savings to health systems. Further work is needed to improve the processes of care for virtual CIED wound checks.
Abstract 16642: Hyperkalemia is Associated With Increased Short and Long-Term Mortality Among Unselected Cardiac Intensive Care Unit Patients
Authors: Brueske Benjamin , Sidhu Mandeep , Schulman-Marcus Joshua , Kashani Kianoush , Barsness Gregory , Jentzer Jacob
Published: April 2024

Introduction:
Studies have demonstrated an association between hyperkalemia and increased mortality in patients with myocardial infarction, but limited data exist regarding hyperkalemia and associated death among unselected cardiac intensive care unit (CICU) patients.

Hypothesis:
Hyperkalemia is associated with mortality in CICU patients.

Methods:
Historical cohort of 9,681 CICU patients admitted from January 2007 to December 2015 with serum potassium measured on admission. Hyperkalemia was defined as admission potassium >=5.0 mEq/L, normokalemia as admission potassium 3.5-4.9 mEq/L, and hypokalemia as admission potassium <3.5 mEq/L. Multivariate logistic regression was used to determine predictors of hospital mortality. Post-discharge survival was assessed using Kaplan-Meier analysis and Cox proportional hazards models.

Results:
Mean age was 67±15 years with 3,629 (36%) females and hospital mortality of 9%. Hyperkalemia occurred in 1,187 (12.3%), and hypokalemia occurred in 719 (7.4%). Compared to normokalemic patients, both hyperkalemic patients (unadjusted OR 2.85, 95% CI 2.40-3.39; P<.001) and hypokalemic patients (unadjusted OR 2.31, 95% CI 1.85-2.88; P<.001) were at increased risk of hospital mortality. After adjustment for illness severity and renal function, only hyperkalemic patients were at increased risk of hospital death (adjusted OR 1.35, 95% CI 1.07-1.69; p = 0.01), while hypokalemic patients were not (P = NS). Among hospital survivors, hyperkalemic patients had lower post-discharge survival by Kaplan-Meier analysis (P <0.001), while hypokalemic patients had similar survival compared to normokalemic patients (p = NS). After adjustment for illness severity and renal function, hospital survivors with hyperkalemia were at increased risk for post-discharge mortality compared with normokalemic patients (adjusted HR 1.16, 95% CI 1.05-1.28; p=.003).

Conclusions:
Hyperkalemia on CICU admission is associated with higher hospital and post-discharge mortality, independent of renal function and illness severity. This emphasizes the importance of potassium abnormalities as a risk predictor in patients admitted to the CICU.
Abstract 16656: How to Routinely Obtain One Billion Human Cardiomyocytes: A Large-Scale Systematic Expansion of Pluripotent Stem Cells and Differentiation Into Cardiomyocytes
Authors: Mesquita Fernanda C P , Hochman-Mendez Camila , Xi Yutao , Andersson Helen A , Morrissey Jacquelynn , Sampaio Luiz C , Taylor Doris A
Published: April 2024

Background:
Tissue engineering a human-sized whole heart requires recellularization of a scaffold with billions of cardiomyocytes, which are post-mitotic cells with limited expansion capability. Induced pluripotent stem cells (iPSCs) provide a new opportunity for cardiac tissue engineering, because iPSCs can be expanded and differentiated into cardiomyocytes. A closed cell culture system is an efficient clinically applicable tool that can be used to expand cells under controlled conditions. We used the Quantum Cell Expansion System (QES) as a human iPSC expansion platform.

Methods:
Human iPSCs were expanded 30-fold using the QES and karyotyped. The undifferentiated cells were characterized by RT-PCR, immunofluorescence and their ability to undergo spontaneous differentiation. After harvesting, iPSCs were differentiated into the cardiac lineage, and the cardiomyocytes were characterized by RT-PCR, immunofluorescence and flow cytometry. Action potential recordings were obtained through intracellular impalement (MultiClamp 700).

Results:
The QES provided the necessary environment for exponential iPSC growth, reaching 70.9x10e7 ± 20,75 x10e7 cells in less than 7 days (n=4), with a population doubling of 3.801 ± 0.1956. The cells kept a normal karyotype (46-XX), expressed pluripotency markers (OCT4, NANOG, LIN28, SOX2, REX1, DNMT3B, DPPA4, NODAL, TDGFb, TERT3, and GDF) and had characteristic staining for OCT4, SOX2, NANOG, SSEA4, TRA1-60, and TRA1-81. Spontaneous differentiation into ectoderm (NESTIN, TUBB3, and NEFH), mesoderm (MSX1, BMP4, and T) and endoderm (GATA6, AFP, and SOX17) lineages was detected by RT-PCR. Induction to the cardiac lineage was also characterized [cTNT+ by flow cytometry (with an efficiency of 74.2±6.3%, n=5) and immunohistochemistry, and MYH6, MYH7, MLC2a, MLC2V, KCNA5, KCNQ1, KCNJ3 by RT-PCR]. Electrophysiology analysis demonstrated that the action potential duration with 90% of repolarization (cAPD90) was 506.5 ± 27.99 mV and the beating rate of these cells was 39.08±1.8 bpm (n=31).

Conclusion:
QES maintains the stemness of iPSCs and is a promising platform to provide the high numbers of cardiomyocytes necessary to recellularize human-sized heart scaffolds.
Abstract 16679: Plasma Omega-6 Fatty Acids and the Risk of Cardiovascular Events in Patients After an Acute Coronary Syndrome
Authors: Zelniker Thomas A , Morrow David A , Mozaffarian Dariush , Guo Jianping , Im KyungAh , Sabatine Marc S , O’Donoghue Michelle L
Published: April 2024

Introduction:
Prior studies have shown an inverse correlation between plasma omega-6 fatty acids (Ω6-PUFA) content and the risk of CV events in primary prevention populations. The prognostic value of Ω6-PUFA in patients after an acute coronary syndrome (ACS) is less clear.

Methods:
Baseline plasma Ω6-PUFA (7 species) was assessed through thin liquid chromatography in a case-control population (203 CV deaths, 271 VT, 325 MI, 161 AF and 1,612 controls) from MERLIN-TIMI 36, a randomized trial of ranolazine versus placebo in patients hospitalized with ACS. Logistic regression models were adjusted for age and sex, and then BMI, hypertension, prior MI, prior HF, diabetes mellitus, smoking, eGFR, LDL, HDL, TG, statin use, index diagnosis and treatment arm.

Results:
After age and sex adjustment, higher plasma gamma-linoleic acid (GLA) content was associated with a 22% lower odds of CV death (OR
adj
0.78 per 1-SD, 95% CI 0.67-0.91). After further multivariable adjustment, higher plasma GLA remained significantly associated with lower odds of CV death (OR
adj
0.84 per 1-SD, 0.71-0.99)
[Figure]
. Patients with higher plasma GLA content had significantly lower odds of AF (OR
adj
per 1-SD 0.79, 0.66 -0.94) and tended to have lower risk of VT (OR
adj
per 1-SD 0.90, 0.78-1.03; OR
adj
top quartile versus lowest quartile: 0.67, 0.45-1.00). GLA was not significantly associated with the risk of MI (OR
adj
0.95, 0.83-1.08). Other Ω6-PUFA, including linoleic acid, were not consistently associated with CV events.

Conclusions:
Plasma gamma-linoleic acid content is significantly associated with the odds of CV death after ACS. Future research should examine whether dietary intake of GLA after ACS may help to attenuate CV risk.
Abstract 16718: Electronic Cigarette Aerosols Alter Cardiac Expression of Genes Key to Electrical and Structural Remodeling in Mice
Authors: Carll Alex P , Fulghum Kyle , Conklin Daniel J , Bhatnagar Aruni , Srivastava Sanjay
Published: April 2024

Background:
Electronic cigarette (e-cig) use has mounted. Some health authorities have even proclaimed e-cigs are profoundly safer than conventional cigarettes. However, e-cigs generate several potentially cardiotoxic constituents by heating their solvent vehicles propylene glycol (PG) and vegetable glycerin (VG) into aerosols to deliver nicotine and flavors.

Objectives:
To investigate the effects of chronic E-cig exposures, with or without nicotine, on cardiac gene expression compared to mainstream cigarette smoke (MCS).

Methods:
Healthy C57BL/6J male mice were exposed chronically (12 weeks, 3 hours/day) to e-cig aerosols from an equal-ratio mixture of PG and VG (PG:VG) with nicotine (36 mg/mL) or without nicotine, or to MCS, and compared to filtered air control group (Air). Hearts (n=8/group) were assayed by quantitative PCR for expression of genes associated with electrical and structural remodeling.

Results:
PG:VG exposure increased gene expression for a gap junction protein (connexin 43, 1.8-fold), voltage-gated potassium and sodium channels (K
v
4.3, 2.5-fold; Na
v
1.5, 1.6-fold), calcium sequestration protein (sarco/endoplasmic reticulum calcium ATP-ase, 1.4-fold), cytokines (TGFβ1, 1.8-fold; TNF-α, 3.8-fold), and collagen III (3.8-fold) relative to Air (all P < 0.05). Nicotine did not enhance PG:VG’s effects on gene expression relative to PG:VG-alone (all P > 0.05), and cigarette smoke did not significantly affect any of the transcripts assayed (all P > 0.05 vs. Air).

Conclusions:
E-cigs may induce cardiac electrical and structural remodeling via their primary vehicle ingredients and irrespective of nicotine or flavors. Such effects could precipitate fatal arrhythmia, stroke, and/or heart failure. Electronic nicotine delivery systems may pose cardiac risks distinct from conventional cigarettes.
Abstract 16791: Preliminary Evaluation of a Deep Learning Approach for Echocardiographic Screening for Rheumatic Heart Disease
Authors: Edwards Lindsay A , Feng Fei , Iqbal Mehreen , Fu Yong , Sanyahumbi Amy , Hao Shiying , McElhinney Doff B , Ling Xuefeng B , Luo Jiajia
Published: April 2024

Introduction:
Echocardiography-based screening for rheumatic heart disease (RHD) in asymptomatic children in resource-limited settings results in early diagnosis, which, in combination with effective secondary prevention, may reduce morbidity and mortality. Physician-led screening, however, is not feasible in much of the developing world. Automated echocardiographic diagnosis via a novel deep learning approach may obviate the need for a physician, enabling more widespread echocardiographic screening, early diagnosis, and improved outcomes. In this study, we hypothesized that a deep learning model is capable of identifying mitral regurgitation (MR) in appropriate views.

Methods:
Echocardiogram clips were labeled by clip for view and presence of MR. Using the computational ability of a Nvidia GTX1080TI graphics processing unit, training dataset clips were used to build two convolutional neural networks to perform the stepwise tasks of classifying the clips 1) by view and 2) by the presence/absence of MR in appropriate color Doppler views. We trained the views classification model using 1857 clips of all views and the MR detection model using 686 parasternal long axis, parasternal short axis, and apical four chamber color Doppler clips. We then evaluated the performance of our models using a test dataset. Results are reported as an F1 score (an F1 score of 1 suggests perfect accuracy of the model).

Results:

Figure 1. a) View Classification Model Learning Curve, b) MR Detection Model Learning Curve

Discussion:
Our results suggest that a deep learning model is capable of discerning MR on echocardiogram clips. This is an encouraging step toward automated diagnosis of RHD, which will enable less skilled echocardiogram operators to make a real-time diagnosis of RHD.
Abstract 16800: Sarcopenia in Advanced Systolic Heart Failure Patients Receiving Left Ventricular Assist Devices
Authors: Vest Amanda R , Coston Alexandra , Pellows Corinne , Yuen Nathan , DeNofrio Angelo , Kiernan Michael S , DeNofrio David , Couper Gregory S , Saltzman Edward
Published: April 2024

Introduction:
Sarcopenia is the age-related deterioration in skeletal muscle mass and function, which can be accelerated by chronic comorbidities. The prevalence in advanced systolic heart failure (HF) and impact on HF health status are currently uncertain. Sarcopenia diagnostic criteria from the Foundation for the National Institutes of Health (FNIH) and European Working Group on Sarcopenia in Older People (EWGSOP) have not been applied to HF cohorts.

Hypothesis:
We hypothesized that at the time of left ventricular assist device (LVAD) implantation systolic HF patients have prevalent sarcopenia, and that sarcopenia is associated with poorer nutritional and HF health status.

Methods:
We recruited 18 adults with systolic HF ±21 days from LVAD implantation. All underwent whole-body dual X-ray absorptiometry (DXA) to calculate appendicular lean mass (ALM). Subjects also underwent a 3-day food recall, Simplified Nutritional Appetite Questionnaire (SNAQ), Kansas City Cardiomyopathy Questionnaire (KCCQ) for HF health status, handgrip strength and blood testing. Sarcopenia was defined by 2 ALM criteria: FNIH – males <19.75kg, females <15.02kg; EWGSOP – males <7.26kg/m
2
, females <5.5kg/m
2
. Linear regression determined relationships between appendicular lean mass and age, weight, handgrip strength, KCCQ summary score, SNAQ score, 24-hour protein intake, and key blood variables, without/with adjustment for sex and height.

Results:
Sarcopenia was diagnosed in 5 subjects (28%) by FNIH criteria and an additional 5 (10 total, 56%) by EWGSOP criteria (Figure). There were unadjusted associations between lower appendicular lean mass and lower handgrip strength; higher SNAQ score (higher malnutrition risk); lower sodium; and lower hemoglobin. After adjustment for sex and height, lower lean mass remained associated with lower hemoglobin. Lower appendicular lean mass was also independently associated with higher (more favorable) KCCQ scores.

Conclusions:
As many as half of advanced systolic HF patients meet standard DXA criteria for sarcopenia. Lower appendicular lean mass is independently associated with lower hemoglobin but does not appear to be associated with poorer HF status.
Abstract 16813: Epidemiology and Microbiology of Central Line-Associated Bloodstream Infections in the Cardiac Intensive Care Unit
Authors: Schenone Aldo L , Mannan Zariyat , Chen Kevin , Klein Deborah , Cremer Paul , Fraser Thomas , Menon Venu
Published: April 2024

Introduction:
Extensive literature exists on the incidence, risk factors and impact of Central Line-Associated Bloodstream Infections (CLABSI) in the general ICU, but is lacking for the Cardiac Intensive Care Unit (CICU).

Hypothesis:
We describe the epidemiology and microbiology of CLABSI in patients admitted to a CICU.

Methods:
We retrospectively reviewed all critically-ill cardiac patients who met the definition for CLABSI while admitted at a Quaternary CICU between May-10 to Feb-18. Data on CLABSI rate per 1000 line days was only available since Jan 13. CLABSI data were collected prospectively by the Infectious Diseases Nurse Specialist. Patient demographics and clinical data were retrospectively collected using a predefined collection tool.

Results:
Out of approximately 21,070 individual CICU admissions within the study period, 46 patients met criteria for CLABSI with an average of 1.4 CLABSI per 1000 line days. The mean age was 67±11 years, 59% male with an observed in-hospital mortality of 39%. Most patients who developed CLABSI sustained a cardiac arrest (34%), cardiogenic shock (28%) or acute decompensated heart failure (24%). Line burden prior to CLABSI was estimated as a median of 2 (2-3 Q
1-3
) lines per patient. Most central lines were venous (86%) with jugular access predominance (76.5%) over femoral (22.5%). Inotropic, vasopressor and mechanical circulatory support was commonly encountered in this population. (Figure 1) Gram-positive cocci (64%) were the most common organism detected in blood cultures, but gram-negative bacilli represented a significant proportion (26%) of the implicated microbiology.

Conclusion:
A definition of CLABSI is met in the CICU mainly in the setting of cardiac arrest, cardiogenic shock and/or decompensated heart failure. The emergent placement of lines in hemodynamically unstable patients and the potential for gut translocation in this population may play a potential role and deserves further exploration.
Abstract 16899: Fully-Automated Left Ventricle Segmentation Using a Dilated and Adversarial Deep Learning Architecture
Authors: Yao Heming , Gryak Jonathan , Derksen Harm , Attili Anil K , Nallamothu Brahmajee K , Najarian Kayvan
Published: April 2024

Introduction:
Cardiovascular magnetic resonance (CMR) imaging is currently the gold-standard to analyze cardiac morphology and evaluate global and regional left ventricle (LV) function. Quantitative parameters such as ejection fraction (EF) and LV mass are important indicators for diagnosis and associated with morbidity and mortality. In practice, the manual or semi-automatic delineations of LV contours for function evaluation are time-consuming and prone to intra- and inter-observer variability. The objective of this study is to develop an accurate and fully-automatic LV segmentation method for CMR slices in short axis using deep learning techniques.

Methods:
In this study, we trained a model using the LV2011 training dataset, which contains 100 cases of patients with myocardial infarction from multiple MR scanner system using balanced steady-state free precession. We developed a novel fully convolutional network (FCN) with dilated convolutions for pixel-wise prediction. An adversarial network is added to enforce high-order consistency. Furthermore, a guided active contour model is deployed as a post-processing method that considers the intensity homogeneities and boundary smoothness of segmented components. The similarity between the automatic segmentation from our model and the manual segmentation are evaluated using Jaccard index and Hausdorff distance (HD).

Results:
On the LV2011 test dataset, our model achieved a Jaccard index of 0.77 and HD of 4.12 mm, outperforming existing fully-automatic methods. Examples of segmentation results are shown in Figure 1. The clinical parameter estimations also have high reliability. The correlations between the end-diastolic volume, end-systolic volume, EF, and LV mass, estimated from automatic segmentation and that from manual segmentation on the test dataset, are 0.99, 0.99, 0.93, and 0.96, respectively.

Conclusions:
Our results demonstrate that the proposed method obtains accurate segmentation and is robust over cases of high variability.