bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 12599: Pushing the Boundaries of Heart Transplantation in a Patient With Giant Cell Myocarditis and Pulmonary Embolism
Authors: Ranard Lauren S , Brener Michael , Masoumi Amirali , Kaku Yuji , Takeda Koji , Fried Justin A , Uriel Nir , Griffin Jan
Published: April 2024

A 47-year-old woman with a remote history of hormone receptor positive breast cancer presented to our hospital with dyspnea and malaise. She was hypotensive and had an S3 gallop with cool extremities. Electrocardiogram demonstrated atrioventricular dissociation with a wide underlying ventricular escape. Transthoracic echocardiography revealed a left ventricular ejection fraction of 15% and severely depressed right ventricular function with normal biventricular dimensions.She emergently went for temporary transvenous pacemaker placement and a right heart catheterization with endomyocardial biopsy. This revealed elevated biventricular filling pressures (central venous pressure = 16 mmHg; pulmonary capillary wedge pressure = 19 mmHg) and a low cardiac index (2.0 L/min/kg
2
).Her hemodynamics deteriorated despite inotropes and an intra-aortic balloon pump, prompting escalation to veno-arterial extracorporeal membrane oxygenation. She was initiated on pulse dose steroids for 3 days, followed by a slow taper. Over the course of 24 hours, she had worsening right ventricular function and developed episodic ventricular tachyarrhythmias requiring recurrent defibrillation. She was escalated to CentriMag biventricular support. The endomyocardial biopsy revealed severe giant cell myocarditis with >25% destruction of the sampled myocardium. After an expedited transplant committee review, the patient was listed for heart transplantation (HT).Three days after HT listing, she developed acute hypoxemia and profound hypotension. CT angiography of the chest identified multiple pulmonary emboli (PE), including a centrally located thrombus causing partial obstruction of the right pulmonary artery. Despite this complication, the patient proceeded to a combined pulmonary embolectomy and HT. She was discharged home from the hospital post HT and at 10-week follow-up demonstrated excellent functional rehabilitation.Although PE is a relative contraindication for heart transplantation, the reversible nature of her pathology and the benefit of avoiding time-dependent pulmonary vascular remodeling favored early transplantation. PE in HT recipients is far less well characterized and has important implications for management and prognosis.
Abstract 12603: Impaired Coronary Flow Reserve in Athletes With Long-Term Cardiovascular Symptoms After COVID-19
Authors: Clark Daniel E , Hughes Sean G , M Dendy Jeffrey M , Crum Kimberly , Dixon Debra , George-Durrett Kristen , Gregory Justin M , Phillips Neil J , Stein Elliot J , Tran Lena E , Wassenaar Jean W , Austin Eric D , Soslow Jonathan
Published: April 2024

Introduction:
Cardiovascular symptoms post-acute sequelae of SARS-CoV-2 infection (CV-PASC) have been increasingly recognized, but the underlying pathobiology is unclear. Endothelial and cardiac pericyte ACE2 receptors are important targets of SARS-CoV-2, resulting in virally-induced endothelial activation, which may adversely affect the coronary microvasculature and impair myocardial performance. We hypothesized that athletes with CV-PASC have microvascular and subclinical myocardial dysfunction.

Methods:
We compared 15 athletes with CV-PASC with 7 control athletes without prior COVID-19 using regadenoson stress cardiac magnetic resonance (CMR). All athletes participated in >6 hours of endurance activities per week. We analyzed CMR volumes, function, global circumferential strain (GCS), late gadolinium enhancement (LGE), and coronary flow reserve (CFR) by coronary sinus method. Values presented as median [IQR].

Results:
CMR in CV-PASC athletes occurred 102 [66,123] days post-SARS-CoV-2 infection. There were no differences in chamber volumes, function, or LGE between groups. One CV-PASC athlete had acute myocarditis (7%). CV-PASC athletes had decreased CFR compared with control athletes (
Figure 1
). Multiple CV-PASC participants had CFR below the 95% CI of the controls and reported normal values from the literature (2.9 and 2.5, respectively). GCS was worse in CV-PASC athletes at the base (-23.7% [-21.6,-26.4] vs -31.1% [-27.3,-33.0], p=0.01), mid-LV (-21.5% [-18.5,-22.8] vs -28.5 [-25.4,-29.9], p=0.008), and apex (-27.1% [-24.1,-29.9] vs -30.6% [-27.8,-38], p=0.07), though the apex did not reach statistical significance.

Conclusions:
This pilot case-control study found CV-PASC athletes had reduced CFR and associated subclinical myocardial dysfunction as assessed by GCS compared to control athletes. These findings suggest coronary microvascular dysfunction related to endothelial injury may mediate CV-PASC symptoms.
Abstract 12607: Long-Term Outcomes of CABG versus Medical Therapy: A Systematic Review and Meta-Analysis of 34350 Patients With Ischemic Heart Diseases
Authors: Nso Nso , EMMANUEL KELECHI , Nassar Mahmoud , Zirkiyeva Milana , Choudhary Khushal , Enoru Sostanie , Rizzo Vincent , MUNIRA MOST S , Marmur Jonathan , Radparvar Farshid
Published: April 2024

Background/Aim:
Medical therapy (MT) and coronary artery bypass graft (CABG) are valuable treatment options for patients with ischemic heart diseases (IHD). However, their negative outcomes in the long-term are poorly investigated. Therefore, we conducted this meta-analysis to determine the long-term effects of both interventions.

Methods:
Till Nov 27, 2020, nine databases were searched for original articles investigating MT versus CABG in patients with IHD. Primary outcomes included mortality, survival, revascularization/additional treatment, event-free survival (incidence of cardiovascular (CV) mortality, myocardial infarction (MI), or refractory angina), cerebrovascular accidents (CVA), and acute MI. Secondary outcomes included imaging findings, such as left ventricular ejection fraction (LVEF). Cochrane’s revised tool (Version II) and ROBINS-I tool were used to assess the risk of bias of randomized and non-randomized intervention studies, respectively.

Results:
Fifteen studies were included in the systematic review, while twelve studies (34350 patients) were analyzed. CABG was associated with a significant reduction in all-cause mortality (OR=0.61; 95%CI: 0.45-0.83) and significant improvement in survival (OR=2.45; 95%CI: 1.61-3.73). The risk of acute MI (OR=0.44; 95%CI: 0.23-0.85) and the need for revascularization/additional treatment were significantly lower in the CABG group. No significant differences were noted as regards CV mortality (OR=0.64; 95%CI: 0.34-1.17), CVA (OR=1.45; 95%CI: 0.56-3.75), event-free survival (OR=0.86; 95%CI: 0.22-3.39), and LVEF (OR=-0.21; 95%CI: -1.48-1.6). Eleven studies had low risk, and four studies had a high risk of bias.

Conclusions:
Compared to medical therapy alone, CABG offers better long-term outcomes in terms of fewer mortality rates, higher survival rates, and limited need for revascularization or additional treatment.
Abstract 12611: Demographics and Readmissions of Patients With Congestive Heart Failure and Adverse Social Determinants of Health
Authors: Mohandas Appesh N , Rodin Holly , Vickery Katherine D , Shroff Gautam R
Published: April 2024

Background:
Safety Net Community Hospitals (SNCH) account for 1/3 of all US inpatient admissions. The congestive heart failure (CHF) population at our SNCH has high rates of adverse social and behavioral determinants of health (SBDH), but this high-risk population is not well represented in randomized clinical trials of CHF. We sought to determine whether differences in prescriptions of guideline-directed medical therapy (GDMT) for CHF explained worse outcomes in individuals with CHF and adverse SBDH.

Methods:
We performed a retrospective review of patients diagnosed with CHF (using ICD codes) in 2018, 2019 at Hennepin Healthcare, a SNCH in downtown Minneapolis. We obtained baseline demographics, comorbidities, insurance status, and outcomes from electronic health record. We compared these variables among those without and with adverse SBDH (homelessness, incarceration, substance abuse) using paired t-tests.

Results:
CHF patients with at least 1 adverse SBDH were more likely to be younger, male, black, with higher prevalent mental illness (Table). They were less likely to have commercial insurance or Medicare, more likely to have Medicaid. The prescription for GDMT for each of the individual categories was high; prescription patterns of GDMT were statistically similar or superior for CHF patients with vs. without adverse SBDH. Patients in SNCH with adverse SBDH had significantly higher hospitalizations and emergency department (ED) visits compared to those without adverse SBDH.

Conclusions:
CHF patients with adverse SBDH are demographically different from those without adverse SBDH. CHF in the presence of ≥1 adverse SBDH is associated with significantly higher rates of hospitalization and ED visits, without significant differences in prescriptions of GDMT for CHF. The disproportionate demographic burden of adverse SBDH in SNCH as well as causes underlying worse outcomes in CHF patients with adverse SBDH need further research.
Abstract 12644: Clinical Features and Outcomes by Systemic Ventricle Morphology in Adult Fontan Patients
Authors: Hong Jessica M , Yogeswaran Vidhushei , Anigwe Christopher , Moon-Grady Anita J , Harris Ian S , kouretas peter , Mahadevan Vaikom S , Agarwal Anushree
Published: April 2024

Introduction:
Single ventricle physiology is commonly encountered in patients after Fontan palliation. However, limited data exists on the differences in clinical characteristics and long-term outcomes in adults with systemic left ventricular morphology (SLV) compared to systemic right ventricular morphology (SRV).

Methods:
Retrospective review of medical records from a tertiary medical center for 2010-2018 identified 191 Fontan patients ≥ 18 years of age for whom ventricular morphology data was available.

Results:
Of 191 patients, 62 (32%) had SRV and 129 (68%) had SLV. Mean age was 28.9 ± 9.1 years and mean age at the time of Fontan palliation was 6.4 ± 6.7 years. Patients with SLV were older (30.9 ± 9.6 years vs. 24.7 ± 6.0 years) and more likely to have classic atriopulmonary connection (17% vs. 2%). Differences in adverse outcomes by ventricular morphology are shown in the figure. After adjusting for age, patients with SRV were more likely to have atrioventricular valve regurgitation (adjusted odds ratio 3.42, 95% confidence interval 1.56-7.52, p=0.002). There were no significant age-adjusted differences between SRV and SLV patients for NYHA class, arrhythmia/pacemaker placement/implantable cardioverter-defibrillator (ICD) placement, heart failure hospitalization, thromboembolic complications, cirrhosis, protein-losing enteropathy, Fontan revision, or death. Data from cardiac catheterization, cardiopulmonary exercise testing, and liver function tests showed no significant differences.

Conclusion:
Adverse outcomes among adult recipients of the Fontan procedure did not differ significantly based on ventricular morphology. Further multicenter studies will be necessary to understand finer differences in SRV and SLV pathophysiology and eventually the impact of ventricular modeling on long term outcomes as the adult Fontan population continues to age.
Abstract 12649: Associations Between Diet Adherence Scores and Cardiac Structure and Function in the Hispanic Community Health Study/Study of Latinos
Authors: Flomenbaum David , April-Sanders Ayana , Lee Un Jung , Kaplan Robert , Mossavar-Rahmani Yasmin , Ostfeld Robert , Sotres-Alvarez Daniela , Mattei Josiemer , McClain Amanda , Daviglus Martha L , Kansal Mayank M , Van Horn Linda , Shook-Sa Bonnie , Rodriguez Carlos
Published: April 2024

Introduction:
The Alternative Healthy Eating Index (AHEI) and Dietary Approaches to Stop Hypertension (DASH) diets are associated with improved cardiovascular outcomes. We assessed associations between adherence to these diets and measures of left ventricular (LV) structure and function from the Echocardiographic Study of Latinos (Echo-SOL) ancillary study.

Hypothesis:
We hypothesized that increased adherence to AHEI or DASH diets would be associated with better cardiac structure and function.

Methods:
Cross-sectional baseline data from two 24-hour dietary recalls were used to calculate AHEI and DASH adherence scores among 1818 adults (57% female, mean age 56 ± 0.17) with complete echocardiographic assessments. Adherence scores were calculated based on decile of each food group for each score, with higher scores signifying higher adherence (AHEI: 0-110, DASH: 0-80). Associations between adherence scores and echo outcomes were analyzed via simple linear regression as well as ANOVA across quintiles of each score. All analyses were weighted to account for complex survey design.

Results:
Mean ± SE diet scores were 49.9 ± 0.32 for AHEI and 43.2 ± 0.33 for DASH. Higher AHEI scores were associated with better ejection fraction (EF) (1.1% per 10-point increase, p < 0.01) and higher left atrial volume index (1.6 ml/m
2
per 10-point increase, p < 0.01). Higher DASH scores were directly associated with EF (0.3% per 10-point increase, p < 0.01) and inversely associated with LV mass (-4.4g per 10-point increase, p < 0.01). In quintile analysis, better global longitudinal strain was seen across increasing quintiles of AHEI score
(Figure).

Conclusions:
Adherence to AHEI and DASH diets was associated with more favorable cardiac structure and function. Pre-heart failure (HF) is an independent risk factor for incident clinical HF development. These findings have important implications for HF prevention.
Abstract 12679: Clinical Applications and Comparison of the Oscar 2 and Spacelabs 90207 Ambulatory Blood Pressure Monitors (ABPMs) Using a Novel Dual Monitor Field Protocol
Authors: Lombardi Vincent P , Reichhold Patrick C , Cramer Jennifer L , Harkness Hannah P , DeBell Natalie J , Dietz Nicholas R , Pate Donald L
Published: April 2024

Background:
Our novel Dual Monitor Protocol and postural lab testing in 15 normotensives,15 hypertensives and 11 alcohol-dependents demonstrated that auscultatory ABPMs had problems assessing diastolic (DBP) and systolic pressures (SBP) with postural changes and misclassified up to 90% of DBPs and 20% of SBPs. Our lab studies of 11 normotensives and 4 hypertensives determined the oscillometric Oscar 2 and Spacelabs 90207 ABPMs overestimated SBP by ≥ 5 mm Hg for 87% (13/15) and 60% (9/15) of cases, respectively.
GOAL
. To apply our Dual Monitor Protocol in the field to compare values obtained by the Oscar 2 and Spacelabs 90207 ABPMs.

Hypothesis:
ABPMs will differ statistically and clinically depending upon the posture.

Methods:
A total of 9 field tests were conducted in 6 subjects either with 1 or 2 ABPMs. For dual monitor tests, ABPM clocks were synchronized and cuffs switched every 3 - 4 hr. Correction factors for each subject, specific to each ABPM and posture were used to adjust BPs from field tests.

Results:
All values = X ± SE,
mm Hg
. For 56 BPs over 24-hr in a normotensive, the Oscar overestimated observer-corrected SBPs by 8.7 ± 1.2 (135.5 ± 2.2
vs
126.8 ± 1.8, P < 0.001). For 101 simultaneous opposite arm BPs over 24 hr in a 66-yr old hypertensive, the Oscar was statistically (all P < 0.001) and clinically > Spacelabs for SBP (156.8 ± 1.2
vs
144.3 ± 0.9, Δ = 12.5 ± 1.0), MAP (118.8 ± 0.9
vs
110.7 ± 0.8, Δ = 8.1 ± 0.6) and DBP (99.8 ± 0.9
vs
95.2 ± 0.8, Δ = 4.6 ± 0.7). The Oscar overestimated (all P ≤ 0.001) the Spacelabs supine SBP (11.0 ± 1.7) and DBP (6.0 ± 0.7), seated SBP (10.8 ± 1.2) and DBP (3.5 ± 0.9) and standing SBP 16.4 ± 2.1) and DBP (5.5 ± 1.5). R was weakest for supine SBP (0.19, NS) and standing SBP (0.38, P < 0.05) and DBP (0.42, P < 0.05).

Conclusions:
These results are alarming despite our limited number of subjects. Oscar and Spacelabs ABPMs differ clinically and statistically and unlike auscultatory ABPMs are prone to significant SBP overestimation. To avoid SBP hypertensive bias and to obtain a more accurate representation of 24-hr BPs, values must be corrected for ABPM and Hg column lab postural Δs and converted to the phlebostatic axis. ABPM accuracy and reliability cannot be trusted until National and International validation protocols are revised to require multiple postural testing.
Abstract 12690: Outcomes of Tricuspid Valve Surgery in Patients With Septic Pulmonary Embolism From Drug-Associated Tricuspid Valve Endocarditis
Authors: Siddiqui Emaad , Alviar Carlos , Ramachandran Abhinay , Flattery Erin , Keller Norma M , Bangalore Sripal
Published: April 2024

Introduction:
Septic pulmonary emboli (PE) are a common sequela of drug-use associated infective endocarditis (DU-IE) of the tricuspid valve and is considered an indication for surgery.

Methods:
The Healthcare Cost and Utilization Project’s National Inpatient Sample was queried from 2008-2017 for adult patients hospitalized for septic PE with the diagnosis of DU-IE of the tricuspid valve. In-hospital outcomes of patients who underwent tricuspid valve operation (TVO) were compared with patients who did not. The primary outcome was perioperative major adverse cardiovascular events (MACE) defined as a composite of death, myocardial infarction (MI), stroke, cardiogenic shock, and cardiac arrest.

Results:
A total of 6,758 cases of DU-IE with septic PE were identified (mean age 32.2), of which 2,262 (33.6%) had a TVO during hospital admission. Patients who underwent a TVO had longer length of stay (32.3 vs 17.7, p<0.05), higher hospital costs ($97,486 vs $34,728, p<0.05), and more discharges to a long-term facility (33.7% vs 27.9%, p<0.05). MACE was significantly higher in patients undergoing TVO (12.5% vs 7.1%, p<0.05), which was driven by higher rates of stroke (5.0% vs 2.7%, p<0.05) and cardiogenic shock (4.8% vs 0.8%, p<0.05) but notably, a lower rate of mortality (2.0% vs 4.0%, p<0.05). In addition, patients who underwent TVO had more pulmonary complication (49.0% vs 29.5%, p<0.05), acute kidney injury (44.3% vs 34.0%, p<0.05), permanent pacemaker placement (15.0% vs 0.2%, p<0.05), and tracheostomy (3.7% vs 1.8%, p<0.05). After multivariable adjustment, TVO was associated with an increased risk for MACE (aOR=1.55, 95% CI 1.25 - 1.86).

Conclusion:
The utility of surgical intervention remains controversial given the lower rate of mortality, but higher rate of adverse outcomes in this young patient population. Alternative management strategies including percutaneous intervention should be considered given the morbidity associated with this disease presentation.
Abstract 13006: Right Ventricular Dilation and Mortality in Acute COVID-19
Authors: Sun Kaiwen , Win Sithu , Parikh Nisha I , Hsue Priscilla , Durstenfeld Matthew
Published: April 2024

Introduction:
Myocardial injury is associated with COVID-19 mortality, but the prognostic value of adverse right ventricular (RV) remodeling on transthoracic echocardiogram (TTE) is uncertain. Therefore we studied the association between RV dilation and in-hospital mortality in acute COVID-19.

Methods:
We included all adults hospitalized with COVID-19 between March 2020 and February 2021 who had a clinical TTE performed during hospitalization at UCSF Health (Parnassus, Mission Bay, or Mount Zion) or Zuckerberg San Francisco General. Clinical and echo data were extracted from the electronic medical record. Biomarkers (BNP & troponin) were log transformed. The primary exposure was qualitative assessment of RV dilation on TTE and the primary outcome was in-hospital mortality. We conducted analysis with STATA MP 16.1 using logistic regression models with adjustment for age and sex (Model 1) and age, sex, log(BNP), log(troponin), and mechanical ventilation (Model 2) and compared models with and without RV size with the likelihood ratio test.

Results:
There were 225 people hospitalized with COVID-19 who had a clinical TTE performed. The mean age was 62.9 years old, 77 (34%) were female, and 48 (21%) died. The majority of patients identified as Latinx (40%), and most patients received Medicaid (58%). Of 212 TTEs adequate to assess RV size, 47 (22%) had RV dilation of whom 16 (34%) died compared to 31 (19%) with normal RV size (RR 1.81, 95%CI 1.09-3.01, p=0.03). Of 185 TTEs adequate to assess RV function, 18 (10%) had RV dysfunction of whom 6 (33%) died compared to 12 (18%) with normal RV function (RR 1.86, 95%CI 0.89-3.84, p=0.12). There were no differences in tricuspid annulus plane systolic excursion or RV systolic excursion velocity. Adjusted for age and sex, RV dilation was associated with mortality (OR 2.16, 95%CI 1.02-4.58; p=0.045), with a larger effect among those with RV dilation and dysfunction (OR 3.40, 95% CI 0.93-12.4, p=0.063). This effect was attenuated after adjusting for BNP, troponin and mechanical ventilation at the time of TTE (OR 1.61, 95%CI 0.52-4.98, p=0.41).

Conclusions:
RV dilation on TTE is associated with mortality in acute COVID-19, although the effect is attenuated after accounting for mechanical ventilation and biomarkers.
Abstract 13023: Contemporary Echocardiography-Guided Pericardiocentesis Outcomes in a High-Volume Tertiary Teaching Hospital
Authors: Sturzoiu Tudor , Khan Waleed , Kochar Kirpal , DeCaro Mark , DeCaro Matthew , Marhefka Gregary D
Published: April 2024

Introduction:
First performed in the 1970s, echo-guided pericardiocentesis has become the preferred approach for draining pericardial effusions. After identifying the largest pocket, a cardiology attending and fellow use a micropuncture needle kit, confirm placement with agitated saline, and leave a side and end hole 8 French drain stocked with sterile saline. This is drained every 8 hours by nursing and never left to gravity or else it tends to clot. The drain is removed when output is <25 cc in 24 hours, or by 7 days.

Methods:
We prospectively maintained an IRB approved database of pericardiocenteses performed by three experienced cardiology attendings directly supervising a multitude of fellows between 2009-2021 at Thomas Jefferson University Hospital.

Results:
Of 391 pericardiocenteses, 61% were for tamponade. 66% were done from an apical approach, 18% subcostal, 11% left parasternal, and 2% right parasternal. Drains were left in for an average of 3.1 days (range 1-10 days). An average of 578 mL were drained with the initial procedure (range 5-2670 mL), and 62% of effusions were bloody. A total of 42% were deemed idiopathic, without an identifiable cause, 27% were associated with malignancy (56% of these had positive cytology with remaining unlikely from any other cause), 9% after open heart surgery (valve replacement, heart transplant, dissection repair), 8% post-procedural (electrophysiology, cardiac catheterization, line placement), 5% were in chronic dialysis patients, and the remainder were due to a combination of hemorrhage not related to a procedure, rheumatic, post-radiation, or medication-induced. The rate of serious complications was 3% and included 4 pneumothoraces, 3 hemothoraces, 3 cases of pericardial decompression syndrome, 1 RV microperforation, and one PEA arrest resulting from cardiac perforation. There were no mortalities. The rate of non-serious complications was 4% and included pleural placement of drain in 8, severe pain remitting with drain removal in 5, prolonged bleeding from puncture site in 2, and SVT during placement in 1.

Conclusion:
Overall, echocardiography-guided pericardiocentesis by experienced providers supervising fellows-in-training is a safe and effective means of draining pericardial effusions.
Abstract 13032: Endothelial Cell Response to Intravenous Immunoglobulin, Infliximab and Atorvastatin Treatment During the Acute Phase of Kawasaki Disease
Authors: Shimizu Chisato , Kim Jihoon , He Ming , Hoffman Hal , Shyy John , Burns Jane , Tremoulet Adriana H
Published: April 2024

Introduction:
Damage to coronary arteries (CA) during the acute phase of Kawasaki disease (KD) is linked to inflammatory cell infiltration, myofibroblast generation (EndMT: endothelial-mesenchymal transition), and endothelial cell (EC) dysfunction. To promote EC health, we performed a Phase I/IIa clinical trial (6-week course) of atorvastatin in patients with acute KD and coronary artery Z score > 2.5. We demonstrated that atorvastatin was safe and well-tolerated. However, its effect on EC in KD has not been systematically studied.

Hypothesis:
Treatment with atorvastatin added to intravenous immunoglobulin (IVIG) and infliximab (IFX) promotes EC health in acute KD patients.

Methods:
We performed RNAseq on human umbilical vein ECs (HUVECs) incubated with pooled sera from KD patients (pre-treatment or subacute illness day 17-25) treated with IVIG and IFX with or without atorvastatin added to their initial treatment.

Results:
Differentially expressed genes (DEGs) from HUVECs incubated with sera pooled from 5 KD patients collected pre- and post-treatment (IVIG + IFX) that were suppressed by treatment included
IL-8
,
CCL2
and
ICAM1
, molecules in the TNFα and IL1β pathways that have key roles in recruitment of inflammatory cells to EC. Subacute sera pooled from 5 patients treated with IVIG + IFX + atorvastatin induced expression of
NOS3
,
KLF2
and
KLF4
, molecules that promote EC homeostasis and angiogenesis, and suppressed expression of
TGFB2
and Dickkopf WNT signaling pathway inhibitor 1 (
DKK1
), molecules in the TGFβ and WNT signaling pathways. These results were validated by RT-PCR on HUVECs incubated with independent individual sera from patients treated with/without atorvastatin.

Conclusions:
HUVECs incubated with pre- or post-treatment sera from KD patients showed upregulation of IL1 and TNFα pathway genes that were dramatically suppressed after treatment with IVIG and IFX. Incubation of HUVECs with post-treatment sera from patients who also received atorvastatin showed reduced expression of
DKK1
and
TGFB2
, suggesting reduced EndMT, and increased
NOS3
and
KLF4
, key mediators of EC homeostasis. These results suggest that atorvastatin improves EC health and may block KD-induced myofibroblast proliferation in the CA wall.
Abstract 13068: Use of Cardiac Implantable Electronic Devices in Carcinoid Heart Disease
Authors: Ward Robert , Luis Sushil A , Shabtaie Samuel , Pellikka Patricia A , Connolly Heidi M , Miranda William , Schaff Hartzell , Shen Win-Kuang , Cha Yong-mei , Asirvatham Samuel , Deshmukh Abhishek , Desimone Christopher V
Published: April 2024

Introduction:
Carcinoid heart disease (CHD) is a rare sequelae of hormonally active neuroendocrine tumors that often requires cardiac surgical intervention. Little is reported on cardiac implantable electronic device (CIED) implantation in the CHD patient population.

Hypothesis:
We sought to establish the safety and efficacy of CIED implantation in patients with CHD.

Methods:
We retrospectively reviewed patients with a diagnosis of CHD who underwent CIED implantation at our institution (Mayo Clinic) and evaluated indications for implant, perioperative complications, and mortality.

Results:
A total of 27 patients with a cumulative follow up of 75 patient-years were identified during the study period. The most common indication for device implant was high grade atrioventricular block (n=18, 66.7%). 14 (51.8%) had baseline conduction disease and 26 (96.2%) underwent cardiac surgery prior to CIED implant. The majority of devices implanted were dual chamber permanent pacemakers (PPM) (n=17, 63.0%), while other devices included single chamber PPM, epicardial PPM, chronic resynchronization devices, and intracardiac defibrillators. Peri-operative complication occurred in 6 patients (22.2%), with 2 patients requiring ICU level care. No patient suffered carcinoid crisis during implantation and there was no peri-implant mortality. Long term, 3 patients required device extraction: 1 for infection, 1 for lead related pain, and 1 for generator migration. The median time to death from implant was 2.5 years, with one-year mortality at 15%.

Conclusions:
In this unique cohort of patients with CHD, CIED can be performed safely. CIED most often occurred in the post cardiac surgical period and carcinoid crisis was uncommon.
Abstract 13103: Increased Mitochondrial Oxidative Stress and Decreased Mitochondrial Respiration in an
in vitro
Model of Ischemia Reperfusion Injury
Authors: Ismaeel Ahmed , Papoutsi Evlampia , Miserlis Dimitrios , Bohannon William , Smith Robert , Haynatzki Gleb , Koutakis Panagiotis
Published: April 2024

Introduction:
Peripheral artery disease (PAD) patients experience ischemia during activity and reperfusion of ischemic skeletal muscle during rest. Cycles of ischemia and reperfusion (I/R) result in a compromised metabolic myopathy that adds to the pathophysiology of PAD. We have recently developed an I/R in vitro model that can mimic the skeletal muscle damage seen in the PAD gastrocnemius. We hypothesized that cycles of I/R will increase mitochondrial oxidative stress and mitochondrial respiration in skeletal muscle myotubes.

Methods:
Primary human skeletal muscle cells derived from PAD patients and non-PAD-control gastrocnemius biopsy samples were differentiated in myotubes and exposed to constant normoxia, cycles of normoxia-hypoxia, or cycles of normoxia-hypoxia-hyperoxia, to mimic I/R, with the OxyCyler C42. A substrate inhibitor protocol was used to measure mitochondrial hydrogen peroxide and respiration using an Oroboros fluorespirometer. Mitochondrial gene and protein expressions and transmitted electron microscopy were used to identify changes in mitochondrial function and morphology.

Results:
The oxygen consumption rate was significantly reduced in the PAD myotubes compared to control myotubes followed by significant increase of H
2
O
2
production. The mRNA and protein expression of several mitochondrial energy metabolism components were significantly reduced in the PAD myotubes. Cycling of normoxia-hypoxia and normoxia-hypoxia-hyperoxia significantly altered the mitochondrial function and morphology in both control and PAD myotubes.

Conclusions:
Our
in vitro
model of I/R injury can alter oxidative stress, mitochondrial function and morphology in control and PAD myotubes. Therefore, the pathophysiology of PAD can be modeled
in vitro
, which allows for a method to test novel therapeutics to treat PAD.
Abstract 13143: Sushi Containing Domain 2 in Cultured Human Cardiac Myofibroblasts Predicts the Assembly of Intact Fibronectin-Rich Sheets
Authors: Zhou Tianhua , Roy Sushmita , Schmuck Eric G , Conklin James , Wattanayuth Nisha , Mosher Deane F , Schwarzbauer Jean E , Raval Amish N
Published: April 2024

Introduction:
Fibronectin (FN) has key roles in cell adhesion, differentiation, migration, alignment and immune modulation in the developing heart, but is of low abundance in the postnatal heart. Replenishing injured myocardium with insoluble FN could be a novel therapeutic approach; however, methods to produce ECM enriched with insoluble FN have remained elusive. Our team recently developed a method to produce decellularized fibronectin-rich (dFN) sheets assembled by dense human cardiac myofibroblast (CMF) cultures. We discovered that the transmembrane protein, Sushi Containing Domain 2 (SUSD2), is broadly expressed on cultured CMFs.

Hypothesis:
We hypothesized that SUSD2 abundance predicts whether CMFs produce intact dFN sheets.

Methods:
Primary CMFs were isolated from healthy left ventricles of human cadaveric donors. CMFs were sorted by median fluorescence intensity (MFI) into SUSD2-Bright and SUSD2-Dim populations using flow cytometry. Our previously reported methods to produce dFN sheets were applied to both populations, and the resulting ECM was graded: 0=no ECM, 1=fragmented, 2=friable, and 3=intact sheet (Figure).

Results:
SUSD2 was detected on 98±1% of CMFs among 7 strains with each evaluated in triplicate. The average MFI across all samples was 167,000 ± 51,000. CMFs that produced Grade 0-2 (n=4) and Grade 3 (n=3) dFN sheets had an average MFI of 62,000 and 270,000, respectively (P=<0.0001). SUSD2-Bright cells sorted from natural SUSD2-Dimmer strains produced intact sheets. Conversely, SUSD2-Dim cells sorted from natural SUSD2-Brighter strains failed to produce intact sheets.

Conclusions:
SUSD2 abundance on CMFs predicts intact dFN sheet production. Ongoing protein analyses of CMFs and their matrices across varying ages, gender and health status will clarify SUSD2’s previously unidentified role in CMFs and ECM assembly, which has important implications for tissue-engineering and cardio-therapeutic applications.
Abstract 13659: Cerebral Small Vessel Disease is a Potent Independent Risk Factor for Alzheimer’s Disease
Authors: Serino Alexa , Coughlin Emily , Mhaskar Rahul , Wickline Samuel , Pan Hua
Published: April 2024

Alzheimer’s Disease (AD) is the leading cause of dementia worldwide. Current treatments may slow the progression of the disease but cannot reverse the pathology, thereby confirming the medical need for measures of prevention and early detection. Recent studies established a connection between cardiovascular disease (CVD) risk factors and AD. Small vessel disease, which shares similar risk factors and pathology as CVD, is receiving attention as a potential risk factor for AD as well. We sought to quantify the risk associated with confirmed diagnosis of cerebral small vessel disease (CSVD) for the development of AD as a first step to defining the condition as a treatment target for preventing AD. We hypothesized patients with image-based evidence of CSVD would have a greater risk of having AD.In this retrospective clinical study, we selected patients from the National Alzheimer’s Coordinating Center database with image-based evidence of CSVD including lacunar infarction, microhemorrhage, and white matter hyperintensity (n=3,895). We quantified the risk of each of these conditions for association with clinical AD, elevated β-amyloid, and tau protein accumulation. In addition, we compared the rates of AD development between men and women within these CSVD populations. Using a linear regression analysis, we controlled for shared comorbidities between CSVD and AD. We observed an increased risk as defined by odds ratio (OR) of AD in patients with microhemorrhage (OR=1.32, p=0.04). Patients with white matter hyperintensity also exhibited increased risk of developing AD, which increased with disease severity (Moderate: OR= 1.63, p<0.01; Extensive: OR=2.72, p<0.01). Lacunar infarction did not demonstrate independent risk for developing AD. CSVD did not confer any additional risk for increased tau protein or amyloid based on imaging. The risk of AD was not higher for women as compared to men with confirmed CSVD. Here we elucidate a clear association between CSVD and risk of AD and observe increased risk with the extent of the disease. With a more comprehensive understanding of these relationships, CSVD imaging could be used as an early biomarker for accelerated AD and provide an opportunity to test methods for controlling CSVD as a novel early intervention.
Abstract 13666: Effectiveness and Durability of Remote Algorithmic Cholesterol Management
Authors: Blood Alexander J , Miller Angela , Vogeli Christine , Chaney Kira , Gordon William , Gaziano Thomas , Cannon Christopher P , Plutzky Jorge , Scirica Benjamin M
Published: April 2024

Introduction:
In collaboration with an insurer, a remote cholesterol management pilot in patients with elevated LDL cholesterol (LDL-C) with, or at increased risk of, ASCVD achieved an average 45% LDL-C reduction in program completers. A key question for this novel strategy is the durability of this benefit, reported here at 1 year vs LDL control in a matched cohort.

Methods:
469 Blue Cross Blue Shield (BCBS) patients completed the Brigham-Lipid Optimization (B-LO) program between 2/2016-12/2017. Retrospectively, we identified a control cohort of non-BCBS commercial patients (n=3955) matched for demographic and clinical characteristics. A difference-in-differences analytic approach compared LDL-C changes as adjusted for sex, age, race, prior statin intolerance, diabetes, ASCVD, and prior LDL>190.

Results:
B-LO patients who completed the program achieved 45.3% greater reduction in LDL-C from baseline to program exit than observed among matched-control patients receiving standard of care. This greater LDL-C reduction occurred despite higher baseline LDL-C among B-LO participants vs controls, even after extensive matching. 99% of program participants reached LDL goal, vs 16% of control patients (p<0.01.). (Figure) At 1-year post intervention, adjusted estimates of being at LDL goal were 83% of intervention patients vs. 52% of control patients.

Conclusions:
A remote cholesterol algorithmic management program that reduced LDL-C effectively also achieved more durable LDL control 12 months post-intervention, and to a greater extent than in matched controls. The efficacy of remote LDL management may also offer longer term effectiveness than usual care, arguing for further study into scalability and economic feasibility of remote population-level health interventions.
Abstract 13700: Combined Landscape of Single-Nucleotide Variants and Copy-Number Alterations in Clonal Hematopoiesis and Their Impact on Hematological and Cardiovascular Outcomes
Authors: Saiki Ryunosuke , Momozawa Yukihide , Nannya Yasuhito , Nakagawa Masahiro M , Ochi Yotaro , Yoshizato Tetsuichi , Terao Chikashi , Kuroda Yutaka , Shiraishi Yuichi , Chiba Kenichi , Tanaka Hiroko , Niida Atsushi , Imoto Seiya , Matsuda Koichi , Morisaki Takayuki , Murakami Yoshinori , Kamatani Yoichiro , Matsuda Shuichi , Kubo Michiaki , Miyano Satoru , Makishima Hideki , Ogawa Seishi
Published: April 2024

Background:
Clonal hematopoiesis (CH) in apparently healthy individuals has recently been highlighted and implicated in the development of hematological malignancies (HM) and cardiovascular diseases. In previous studies, CH has been investigated through detecting either single-nucleotide variants and indels (SNVs/indels) or copy number alterations (CNAs), but not both.

Methods:
Here, we performed a combined analysis of CH-related SNVs/indels and CNAs in 11,234 individuals with a median age of 70, including 672 with subsequent HM events, to delineate their relationships and impacts on clinical outcomes.

Results:
Overall, CH-related SNV/indels or CNAs were detected in 40% of the subjects, and they significantly cooccurred in 16% of the CH-positive subjects. In addition to the largest effect of age on the prevalence of CH, male gender and cigarette smoking were also significantly associated with variable CH-related SNV/indels and CNAs while alcohol drinking was associated only with del(20q). As for clinical impacts, CH-related SNVs/indels and CNAs coordinately affected blood cell counts and the mortality from HM, depending on the maximum clone size and total number of both lesions (Figure 1). In particular, as is the case with those in myeloid neoplasms, SNVs/indels and CNAs affecting
DNMT3A
,
TET2
,
JAK2
, and
TP53
significantly co-occurred, predicting a high HM mortality. CH-related SNV/indels were also associated with the risk of cardiovascular mortality and independently predicted the presence of hypertension in multivariate modeling (Figure 2). The association with cardiovascular mortality was more prominent when SNVs/indels were combined with CNAs (Figure 3), even though the effect of CNAs alone was not evident.

Conclusion:
These findings provided novel insight into the interplay between SNVs/indels and CNAs in CH, highlighting the importance of detecting both types of lesions in estimating the impact of CH on hematological and cardiovascular outcomes.
Abstract 13714: Stress-Related Neural Pathways Mediate the Link Between Depression/Anxiety Disorders and Cardiovascular Disease
Authors: Mezue Kenechukwu N , Zureigat Hadil , Abohashem Shady , Abbasi Taimur , Gharios Charbel , Cardeiro Alexander , rosovsky rachel , Osborne Michael , Tawakol Ahmed A
Published: April 2024

Background:
Depression and anxiety disorders are linked with a greater risk of major adverse cardiac events (MACE) via unclear mechanisms. Since heightened stress-related neural activity (SNA) associates with a greater risk of MACE, we hypothesized that the link between depression/anxiety disorders and MACE is in part mediated by increased SNA.

Methods:
Data were obtained from subjects in the Mass General Brigham Biobank (N=118 871). A subset (N=1520) underwent clinical
18
F-fluorodeoxyglucose positron emission tomography imaging. Stress-related neural activity (SNA) was determined as the ratio of amygdalar to regulatory (ventromedial prefrontal cortex) activity. MACE (i.e., myocardial infarction, stroke, and heart failure), depression, and anxiety disorders were defined by the International Classification of Disease codes.

Results:
The median age was 59 years [interquartile range (IQR) 28]; 56.2% were female. MACE occurred in 4149 subjects (4.3%) over a median follow up of 3.3 years (IQR 2.9). Depression and anxiety independently predicted incident MACE (HR [95% CI]: 1.415 [1.323-1.513], p=5.696 x 10
-24
and 1.515 [1.418-1.618], p=4.548 x 10
-35
, respectively, adjusted for cardiovascular risk factors). In the 1520 subjects with brain imaging, depression and anxiety associated with higher SNA (standardized ß [95% CI]: 0.151 [0.048-0.254], p=0.004 and 0.123 [0.022-0.225], p=0.01, respectively, adjusted for age and sex). Further, SNA associated with MACE (OR [95% CI]: 1.295 [1.163-1.443], p=3 x 10
-6
). Using path analysis, increased SNA mediated the effect of both depression and anxiety on MACE (log OR [95% CI]: 0.036 [0.009-0.072], p<0.05 and 0.030 [0.005-0.063], p<0.05, respectively).

Conclusion:
Depression and anxiety disorders associate with greater MACE risk via a mechanism that includes heightened stress-related neural activity. Future studies should evaluate the impact of therapies on this neural pathway and downstream MACE.
Abstract 13722: Co-Existing Cardiac Arrhythmia is Associated With Increased Inpatient Mortality in Hospitalized Patients With Systemic Sclerosis: Analysis of the National Inpatient Sample
Authors: Rivera Pavon Mavi M , Abbasi Ayesha , Shoura Sami , Dutta Abhishek , Ashfaq Dua , Murthi Mukunthan , Viilafranca Alejandro , Kannayiram Sandhya-Shri , Akuna Emmanuel , Sad Aldeen Ziad
Published: April 2024

Introduction:
Arrhythmias are the most frequent cardiac complications in patients with Systemic Sclerosis (SS). Although associated with high mortality and poor prognosis, hospitalization outcomes for SS patients with arrhythmias are yet to be elucidated. This study aims to determine the burden of cardiac arrhythmias in hospitalized patients with SS.

Hypothesis:
Co-existing arrhythmia increases mortality and morbidity in hospitalized SS patients.

Methods:
We searched the National Inpatient Sample (NIS) 2016-2017 databases to identify systemic sclerosis hospitalizations with and without arrhythmia. Using STATA 17 software, we applied multivariate logistic and linear regression to adjust for confounders. The primary outcome was inpatient mortality. Secondary outcomes were mean length of stay (LOS), mean total hospital charge (THC), odds of stroke, heart failure (HF), cardiogenic shock, and cardiac arrest.

Results:
There were over 71 million discharges in the 2016-2017 NIS database. Out of 63,155 SS hospitalizations, 13,994 (22.1%) had a diagnosis of arrhythmia. SS hospitalizations with arrhythmias had higher inpatient mortality (OR 1.63, CI 1.32-2.01, p<0.001), risk of cardiogenic shock (OR 1.81, CI 1.20-2.73 p=0.005), and cardiac arrest (OR 1.81, CI 1.20-2.73), p=0.005) compared to those without arrhythmias. There was no statistically significant difference in the rates for stroke (OR 1.64, CI 0.75-3.59, p=0.2) and HF (OR 1.15, CI 0.98-1.36, p=0.08) between the two groups. SS and arrhythmia patients had increased adjusted mean LOS by 0.85 days (7 days versus 5 days, p<0.001). Patients with SS and arrhythmias incurred higher adjusted THC than those without arrhythmias (85,184 USD versus 64,152 USD, p<0.001).

Conclusion:
Hospitalized patients with SS and arrhythmias have increased odds of inpatient mortality, cardiogenic shock, and cardiac arrest compared to those without arrhythmias. Still, the rates of stroke and HF are similar in both groups.
Abstract 13730: In-Hospital Outcomes for Takotsubo Cardiomyopathy Among Patients With Psychiatric Diagnosis
Authors: Gill Gauravpal S , Burright Isaac , Walters Ryan , Alla Venkata
Published: April 2024

Background:
Takotsubo (or stress) cardiomyopathy (TC) is a transient regional systolic dysfunction, clinically and echocardiographically resembling acute coronary syndrome (ACS) in the absence of obstructive coronary artery disease. The prevalence of psychiatric disorders is high in TC. However, it is unclear whether presence of underlying psychiatric condition impacts outcomes of TC.

Methods:
Hospitalizations for TC from 2012 to 2018 were identified using the National Inpatient Sample (NIS) and stratified by presence or absence of concomitant psychiatric diagnoses (major depression, dysthymia, anxiety, bipolar, substance abuse). Outcomes of interest included mortality, cardiac arrest, cardiogenic shock, intra-aortic balloon pump (IABP), mechanical ventilation, and length of stay. Differences in outcome rates were compared using the Rao-Scott chi-square test; length of stay was compared using a lognormal regression model. All analyses accounted for the NIS sampling design.

Results:
A total of 51,625 hospital discharges with TC were identified, of which 21,690 (42%) carried a psychiatric diagnosis. There were no statistically significant differences in mortality (1.2% vs. 1.6%; p=0.087), cardiac arrest (1.5% vs. 1.5%; p=0.853), cardiogenic shock (4.6% vs. 4.9%; p=0.427), IABP use (1.6% vs. 1.7%; p=0.695), mechanical ventilation (4.9% vs. 4.2%; p=0.113) for patients with and without psychiatric diagnosis, respectively. The length of stay among patients with psychiatric diagnosis, was marginally higher (median 3.7, IQR [3.6-3.8] days vs. 3.5 [3.4-3.6] days; p<0.01).

Conclusion:
Our analysis demonstrates that in-hospital mortality and complications of TC patients with and without psychiatric illness are statistically similar.
Abstract 13750: In-Hospital Outcomes of Mechanical Circulatory Support in Transcatheter Aortic Valve Implantation
Authors: Jehangir Qasim , Lee Yi , Kakouros Nikolaos , Abdel-Hafez Osama , Field Justin , Takruri Yessar , Salih Mohammed , Halabi Abdul R , Patel Kirit , Qureshi Waqas
Published: April 2024

Introduction:
Transcatheter aortic valve implantation (TAVI) is rarely complicated by acute circulatory collapse. Mechanical circulatory support (MCS) acts as a bridge to definitive intervention in these patients, however, the outcomes of MCS devices in TAVI patients are not well studied.

Methods:
Using the Nationwide Inpatient Sample Database from 2016 to 2018, we identified patients who underwent TAVI and required MCS using ICD-10 codes. The MCS devices included intra-aortic balloon pump (IABP) (group 1), Impella (group 2), and extracorporeal membrane oxygenation (ECMO) (group 3). Patients <18 years and those requiring more than one device use were excluded. The primary outcome was in-hospital mortality and secondary outcomes were cardiac arrest, cerebrovascular accident, myocardial infarction, and renal failure.

Results:
Our analysis included 148,210 TAVI patients (based on weighted sample) with 1250 requiring MCS devices (IABP N=655, Impella N=360, ECMO N=235). Patients who required Impella were older than those who required ECMO and IABP (mean age group 1 75.8 ± 11.3, group 78.3 ± 10.1, group 3). The utilization of MCS devices was not different among the gender (females 46.2%; p = 0.2376) and races (Whites 86.8%, African Americans 4.26%, Hispanics 4.96%; p = 0.5038). Incidence of in-hospital mortality was highest in ECMO (group 1 27.5%, group 2 38.9%, group 3 42.6%, p < 0.001) (Figure). The multivariate logistic regression model adjusted for MCS devices, age, race, sex, hypertension, diabetes, cardiopulmonary disease, kidney disease (CKD), liver disease, peripheral arterial disease (PAD), and arrhythmias indicated that use of any MCS device, age, female sex, congestive heart failure, CKD, liver disease, PAD, and arrhythmias were independent predictors of in-hospital mortality.

Conclusions:
In TAVI, the use of ECMO was associated with higher in-hospital mortality, cardiac arrest, major bleeding, and renal failure when compared to Impella and IABP.