bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 12082: Dermatomyositis Associated Pulmonary Fibrosis Masquerading as Severe Aortic Insufficiency
Authors: Farooq Umar , Patel Humail , Dussie Tashina , mrejen karen , Kalimi Robert , Supariwala Azhar
Published: December 2023

Description of Case:
A 56-year-old female with asthma and hypertension presented for two weeks of dyspnea, cough, and fevers. Initial workup revealed bilateral ground glass opacities. TTE revealed severe aortic insufficiency, early mitral valve closure, and a LVEF of 65%. The patient underwent SAVR and was started on diuresis but continued to have significant respiratory distress over the next few months, leading to recurrent hospitalizations and requiring home oxygen therapy. Serial imaging revealed worsening of her pulmonary opacities. Due to persistent musculoskeletal and cutaneous symptoms with an elevated CPK, an alternative diagnosis was considered: dermatomyositis associated pulmonary fibrosis. The patient was started on steroids and immunomodulatory therapy with improvement in her symptoms.

Discussion:
Dermatomyositis (DM) is an inflammatory myopathy characterized by proximal muscle weakness, rash, and other manifestations including ILD and esophageal dysmotility. Mortality in patients with DM is associated with rapid progression of ILD. Patients may also have myocardial involvement and heart failure. Patients with presumed cardiogenic respiratory failure that does not improve with HF optimization should undergo further workup and consideration of a broader differential diagnosis. Unexplained elevated CPK disproportionate to troponins, and persistent hypoxia in patients with multisystem involvement should trigger an autoimmune work up. If such a process is identified, patients may have a rapid improvement in their symptomatology and excellent prognosis following immunomodulatory therapy. If left undiagnosed, it can cause multi-system failure, including significant myocarditis and heart failure.
Abstract 12083: Symptoms of Depression and All-Cause and Cardiovascular Disease Mortality Among US Adults, NHANES 2005-2018
Authors: Zhang Zefeng , Jackson Sandra , Gillespie Cathleen , Merritt Robert K , Yang Quanhe
Published: December 2023

Introduction:
Depression is a common mental health disorder among the US population. Depressive symptoms are associated with increased cardiovascular disease (CVD) incidence and mortality rates. Few recent studies have examined the association between depressive symptoms and mortality among US adults.

Hypothesis:
Depressive symptoms increase all-cause and CVD mortality among US adults.

Methods:
The present study used the National Health and Nutrition Examination Survey (NHANES) 2005-2018 data with the NHANES 2019 Linked Mortality Files among adults aged ≥20 years. Depressive symptoms were defined by the Patient Health Questionnaire-9 (PHQ-9) scores and categorized into 3 groups: (1) none or minimal (0-4); (2) mild (5-9); and (3) moderate to severe (10-27). Cox proportional hazard models were used to evaluate the association between depressive symptoms and all-cause, CVD, and ischemic heart disease mortality, adjusting for sociodemographic factors, lifestyle factors, and clinical characteristics.

Results:
Prevalences of none or minimal, mild, and moderate to severe depression were 77.9%, 14.9%, and 7.2%, respectively. For all-cause mortality, hazard ratios were 1.35 (95% confidence interval, 1.06, 1.72) for mild depressive symptoms vs none, and 1.61 (1.24, 2.10) for moderate to severe depressive symptoms vs none. The corresponding hazard ratios were 1.49 (1.11, 2.00) and 1.79 (1.22, 2.62) for CVD mortality, and 0.96 (0.58, 1.60) and 2.21 (1.24, 3.91) for ischemic heart disease mortality. The associations were largely consistent across subgroups. Approximately 11.0%-16.1% of the associations between depression and mortality could be explained by lifestyle factors.

Conclusions:
Overall, there was a graded and positive association between depressive symptoms and mortality among US adults. Public health and healthcare efforts to improve awareness and treatment of depression and its related risk factors can support a comprehensive strategy to reduce the overall burden of depression nationwide.
Abstract 12107: Cardiovascular Outcomes Associated With Gonadotropin-Releasing Hormone Antagonists vs Gonadotropin-Releasing Hormone Agonists for Prostate Cancer Treatment: A Meta-Analysis of Randomized Controlled Trials
Authors: Jaiswal Vikash , Jaiswal Akash , Saleeb Marina , Jha Mayank , Hanif Muhammad , Kalra Kriti , Evbayekha Endurance O , Agrawal Vibhor , Ang Song Peng , Zacks Jerome S
Published: December 2023

Background:
Androgen deprivation therapy (ADT), comprising the administration of Gonadotropin-releasing hormone (GnRH) agonists and antagonists, is a widely utilized treatment for prostate cancer patients and has been universally accepted as the first-line treatment for symptomatic metastatic prostatic cancer. While ADT has proven effective, concerns about its impact on cardiovascular health have emerged. Conflicting results regarding the association between ADT and cardiovascular events have been reported in the most recent PRONOUNCE trial hence a meta-analysis to systematically evaluate the evidence is desired.

Aim:
The primary objective of this meta-analysis was to investigate and compare the effects of GnRH agonists and antagonists on cardiovascular events in patients with prostate cancer.

Methods:
A comprehensive search was conducted in major electronic databases to identify relevant RCTs. Studies published from inception to April 2023 were scrutinized.

Results:
9 studies met the eligibility criteria and were included in the final analysis. A total of 3648 patients were randomized to receive either an agonist (n=1375) or an antagonist (n=2273). The pooled results revealed a significant reduction in the risk of adverse cardiovascular events by 48% with the use of GnRH agonists compared to GnRH antagonists (RR=0.52; 95% CI=0.39-0.71; p<0.01). Furthermore, GnRH agonists also decreased the risk of all-cause mortality by 46% (RR=0.54; 95% CI= 0.33-0.88; p=0.01) and cardiovascular mortality by 78% (RR= 0.22; 95% CI= 0.07-0.76; p=0.02) compared to GnRH antagonists.

Conclusion:
The findings of this meta-analysis reveal the favorable cardiovascular risk profile associated with GnRH agonists, supporting their role as a preferred treatment option over GnRH antagonists.
Abstract 12155: Trends in the Clinical Outcomes and Resource Utilization of Catheter-Based Thrombolytic Therapy vs. Systemic Thrombolytic Therapy in Patients With Acute Pulmonary Embolism
Authors: Pasha Arham , Ashraf Muddasir
Published: December 2023

Introduction:
Contemporary trends in clinical outcomes and resource utilization in patients with acute pulmonary embolism (PE) undergoing thrombolytic therapy are not well-known.

Research Question:
We wanted to analyze the trends in outcomes of catheter-based thrombolytic therapy (CDT) vs. systemic thrombolytic therapy (ST) in patients with PE.

Aim:
We aimed to compare the trends in in-hospital mortality, length of stay (LOS), and hospital costs in patients with PE who underwent CDT vs. ST.

Methods:
Using the National Inpatient Sample, all adult patients hospitalized with PE from 2012 to 2018 were identified using the International Classification of Disease diagnostic codes. Multivariate linear and logistic regression were used to obtain trends and effect sizes.

Results:
We identified 1.27 million patients with PE, of which 45,950 underwent thrombolytic therapy (CDT=30.1% and ST=69.9%). The mean age of patients receiving CDT vs. ST wasn't different (59.7 vs. 59.3, P=0.14). The proportion of CDT among all patients with PE increased from 0.4% in 2012 to 1.9% in 2018. Baseline characteristics of patients who underwent CDT vs. ST are shown in panel A. Risk-adjusted mortality was significantly lower in patients receiving CDT vs. ST (AOR=0.38, P=<.01). Risk-adjusted LOS was 0.19 days non-significantly higher in patients with CDT vs. ST (P-value=0.12). The hospital cost was significantly higher in patients who underwent CDT vs. ST (β=2917 USD, P<.01). Temporal trends of these outcomes are shown in panels B-D.

Conclusions:
It is encouraging to see an increasing trend in the utilization of CDT. In-hospital mortality decreased in patients with CDT and ST, but CDT continues to be superior. The LOS was not significantly different among these groups but significantly decreased in both groups over time. Finally, hospital cost was higher in patients with CDT vs ST, but these cost differences between CDT and ST narrowed due to decreasing cost of CDT and increasing cost of ST over time.
Abstract 12181: Association of Left Atrial Function With Vascular Brain Injury: The Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS)
Authors: Wang Wendy , Inciardi Riccardo M , Reyes Jorge L , Mosley Thomas , Johansen Michelle C , Gottesman Rebecca F , Alonso Alvaro , Lutsey Pamela L , Jack Clifford R , Solomon Scott , Shah Amil M , Wasserman Bruce A , Chen Lin Y
Published: December 2023

Background:
Lower (worse) left atrial (LA) function is associated with higher dementia risk. It is unclear whether lower LA function is associated with vascular brain injury on brain MRI, an established correlate for higher dementia risk. Using data from the Atherosclerosis Risk in Communities (ARIC) study, we assessed the cross-sectional association between LA function measures and brain MRI markers of vascular brain injury (cerebral microbleeds, brain infarcts).

Hypothesis:
Participants with lower LA function will be more likely to have presence of
>
1 cerebral microbleed or brain infarct.

Methods:
ARIC participants who had both an echocardiogram and brain MRI at visit 5 (2011-13) were included. We excluded those with prevalent dementia, stroke, or atrial fibrillation. LA function measures were obtained from 2D-echocardiograms and assessed in quartiles (highest quartile was the reference). Brain MRI measures were assessed as the presence or absence of
>
1 cerebral microbleed or brain infarct. Logistic regression was used.

Results:
Of the 1502 participants (mean [SD] age 76 [5], 60% female, 27% Black) in this analysis, 345 (23%) and 351 (23%) had
>
1 cerebral microbleed or brain infarct present. Compared to the highest quartile, lower LA reservoir and conduit strain quartiles were associated with higher odds of cerebral microbleeds. LA contractile strain was not associated with cerebral microbleeds. Compared to the highest quartile, the lowest LA conduit strain quartile, but not reservoir strain, was associated with higher odds of brain infarcts. LA contractile strain was inversely associated with brain infarcts.

Conclusion:
In this community-based cohort, lower LA function was cross-sectionally associated with cerebral microbleeds and brain infarcts. The inverse relationship with LA contractile strain may be due to contractile function compensating for a decrease in early diastolic filling. Prospective studies are needed to confirm these findings.
Abstract 12182: Importance of Comorbidities in 24-month AF-Free Survival After Catheter Ablation
Authors: Leavitt Jonas , Varrias Dimitrios , Coleman Kristie , Wolf Elliot , Zafeiropoulos Stefanos , Gasparis Christopher , Zimmer Ari , Goyal Rajat , Epstein Laurence , Mountantonakis Stavros
Published: December 2023

Background:
Presence of cardiac and non-cardiac comorbidities is reported to affect success of catheter ablation (CA) of atrial fibrillation (AF), however their predictive value in 1 and 2 year AF free survival is not reported.

Research Questions:
Which cardiac and non-cardiac comorbidities are most useful in predicting AF free survival after a single CA for paroxysmal and persistent AF.

Goals:
Create a model to identify potential risk factors that may reduce the long term success of catheter ablation for patients with AF to allow for risk modification

Methods:
We included 1435 patients with symptomatic AF undergoing first time CA in 1 of 8 Hospitals of Northwell Health and follow ups for at least 24 months ablation. Baseline echocardiographic and laboratory data were extracted from our common EMR, and clinical outcomes were determined after manual review of the 6, 12 and 24 month visit. Baseline patient characteristics included age, gender, BMI, diagnoses, laboratory and echocardiographic measures used in a stepwise estimation logistic regression model using STATA /IC 16.1.

Results:
From our patient cohort (age 67.1±10.4, 565 female, 645 persistent), 28% of patients had AF recurrence within the 1st year, and 32.5% within 2 years. Multivariate analysis identified persistent AF as the only independent risk factor for AF recurrence within 12 months (P=.001). For 24-month recurrence the independent predictors were LVEF (p=.014), Diabetes Mellitus (p=.045), cardioversions prior to ablation (DCCV) (p=.001), and pulmonary disease (p=.001). Energy modality was not a significant predictor of AF recurrence. Hypertension (p=.008) was found to be negatively associated with AF recurrence. Our prediction model (Figure 1) for AF recurrence 24 months post-CA produced an ROC curve of 0.8048 and was 77% accurate.

Conclusion:
The presence of baseline comorbidities implies that such comorbidities, rather than procedural failure, are mostly related with AF recurrence after 1 year.
Abstract 12187: Association Between Ultra-Processed Food Intake and Cardiovascular Health Among US Women of Reproductive Age: NHANES 2007-2018
Authors: Zhang Zefeng , Jackson Sandra , Martinez Steele Euridice , Hayes Donald K , Yang Quanhe
Published: December 2023

Introduction:
Studies have showed that higher intake of ultra-processed foods (UPF) is associated with increased risk of lower cardiovascular health (CVH) among adolescents and adults. As UPF intake is a modifiable risk factor of cardiovascular disease, examining the association of UPF and CVH among women of reproductive age (WRA) may help improve CVH among this population.

Hypothesis:
A higher percentage of calories (%kcal) from UPF is associated with lower CVH among WRA aged 22-44 years.

Methods:
We analyzed data on 5,780 WRA from NHANES 2007-2018. UPF was assigned from the Nova classification, which categorizes foods according to the extent and purpose of food processing. CVH was defined by using the Life’s Essential 8 (LE8) on a scale of 0 to 100. Scores of the seven LE8 metrics (excluding diet) were averaged, and the levels of CVH (low, moderate, and high) were defined using tertiles. We estimated the usual %kcal from UPF intake by using up to two 24-hour dietary recalls and the National Cancer Institute’s usual intake method to account for measurement error. We used multivariable linear and multinomial logistic regression to assess the association between UPF and CVH, adjusting for covariates.

Results:
The mean usual %kcal from UPF was 57.2%, and midpoint of quartiles of intake were 43.8%, 53.5%, 60.9%, and 70.6% for Q1, Q2, Q3, and Q4, respectively. Every 10% increase in calories from UPF was associated with 3.6 points lower CVH score (
P <
.001). The adjusted odds ratios and 95% confidence intervals for low CVH were 1.76 (1.52-2.03), 2.70 (2.10-3.47), and 4.72 (3.19-7.04), respectively, comparing Q2, Q3, and Q4 to Q1 of UPF intake. The corresponding adjusted odds ratio and 95% confidence intervals for moderate CVH were 1.17 (1.02-1.34), 1.32 (1.04-1.68), and 1.55 (1.06-2.26). The pattern of association was largely consistent across subgroups, except for non-Hispanic Black women, and was consistent across sensitivity analyses.

Conclusions:
Among US WRA, UPF represented more than half of total calorie intake and showed a graded inverse association with CVH. Our analyses highlight the importance of limiting the consumption of UPF among WRA to maintain CVH.
Abstract 12194: Clinical Application of Virtual Antiarrhythmic Drug Test Using Digital Twins in Patients Who Recurred Atrial Fibrillation After Catheter Ablation
Authors: Hwang Taehyun , Kwon Oh-Seok , LIM BYOUNGHYUN , Yang Sohyun , Kim Daehoon , Park Je W , Yu Hee Tae , Kim Tae-Hoon , Uhm Jae-sun , JOUNG BOYOUNG , LEE Moon Hyoung , Pak Hui-Nam
Published: December 2023

Introduction:
We previously reported that a computational modeling-guided antiarrhythmic drug (AAD) test was feasible for assessing diverse AADs in patients with atrial fibrillation (AF). In this study, we took the virtual AAD test (V-AAD) in patients who took AADs after AF catheter ablation (AFCA).

Hypothesis:
Patients using an effective drug in the VAAD test will have fewer AF recurrences than patients using an ineffective drug.

Methods:
This single-center retrospective study included 246 patients (72.8% male, 60.7±10.2 years of age, 38.6% paroxysmal AF) prescribed AADs within 3 months after AFCA. Using realistic computational modeling, we evaluated the effects of five AADs (amiodarone, sotalol, dronedarone, flecainide, and propafenone; 2 doses for each drug). Clinical AADs (C-AAD) were chosen at the discretion of the physicians blinded to the V-AAD test. We defined the effective V-AAD as the V-AAD that terminated AF or converted AF to atrial tachycardia (AT) and the best V-AAD as the V-AAD that ended virtual AF the fastest. We compared AF recurrence rates after the AAD prescription depending on the results of the V-AAD test.

Results:
The ineffective and best V-AAD were administered in 64 (26.0 %) and 70 patients (28.5%). The recurrence rate within a year after using the ineffective, effective, and best V-AAD were 46.9%, 35.7%, and 25.7%, respectively (log-rank p=0.013). The recurrence rate within a year in patients with at least one V-AAD terminating AF and those without was 33.9% and 50.0%, respectively (log-rank p=0.034). The use of best V-AAD (OR 0.43, 95% CI [0.18-0.96]; p=0.042, vs. ineffective V-AAD) is an independent predictor of AF recurrence within a year of using AAD after AFCA.

Conclusions:
The digital twins-guided V-AAD test was feasible for evaluating the efficacy of multiple AADs in patients with AF who had a high chance of recurrence after AFCA. We need a prospective randomization study to assess the prediction power of the V-AAD test.
Abstract 12224: Long Term Mortality in Patients With Low-Risk Myocardial Perfusion Imaging
Authors: Dasari Mahati , Arun Kumar Pramukh , Bhattad Pradnya Brijmohan , Mishra Ajay K , Sharma Arushi , Bhat Ashwini , Leblanc Michael , Ramsaran Eddison , shah neeta
Published: December 2023

Introduction:
Stress testing is utilized for diagnosis and risk stratification for coronary artery disease, with low-risk myocardial perfusion imaging (MPI) indicating less than 1% cardiac mortality per year. We aimed to determine the long-term cardiac mortality in these patients.

Methods:
We performed a retrospective observational study of 1,300 patients with low-risk MPI in 2015, including pharmacological and exercise studies in a tertiary care center in Central Massachusetts, USA. Each patient was followed from the time of the MPI study for a total duration of 7 years. All-cause mortality and cardiac death were identified. We calculated the pharmacologic and exercise MPI percentage in patients with cardiac death. A cardiac mortality graph was plotted to observe trends over seven years.

Results:
Out of the 1,300 patients, 3.2% [n=42; mean age 74.6+/-20 years, 78% male (n=32)] of patients had a cardiac death in the follow-up period of 7 years. The pharmacological MPI group had 5% (n=41) cardiac deaths as compared to 0.2% (n=1) in the exercise MPI with the low Duke Treadmill Score group (p-value 0.04) [Figure 1a]. The cardiac death trend over the seven years revealed the highest mortality in year 6 (19%, n= 8) and the lowest in year 4 (7.1%, n=3) [Figure 1b].

Conclusions:
The incidence of long-term cardiac deaths is less than 0.5% each year in patients with low-risk MPI, in both groups. Cardiac mortality was higher in patients who underwent pharmacological stress tests indicating appropriate assessment of underlying cardiac pathology. Exercise MPI depends on multiple variables to be optimal, while all patients undergoing pharmacological MPI are maximally stressed. Extensive, multi-center, controlled studies are necessary to evaluate the differences in risk stratification of low-risk MPI between exercise and pharmacological stress tests.
Abstract 12254: The QRS Frontal Plane Axis Changes During Left Bundle Branch Block After Transcatheter Aortic Valve Replacement
Authors: yagel oren , Belhassen Bernard , Planer David , Amir Offer , Elbaz Greener Gabby
Published: December 2023

Background:
Left bundle branch block (LBBB) is common after transcatheter aortic valve replacement (TAVR) and associated with either a left or normal frontal QRS axis.

Research Questions:
To assess the QRS frontal plane axis shift changes during LBBB after TAVR and determine if the risk of procedure-related high degree atrioventricular block (AVB) is affected by these QRS axis shift changes.

Methods:
In a retrospective single-center study of 720 consecutive patients who underwent TAVR, 141 (19.6%) with normal baseline QRS duration developed a new LBBB after TAVR and constituted the study group. Most patients (59.6%) were females, and the mean age of the cohort was 81.2±6 years. About two-thirds of the patients were implanted with a self-expandable valve. The length of hospital stay was 6.6±4.4 days.

Results:
This study show 3 main findings: 1) As compared with the baseline QRS axis before TAVR, the occurrence of LBBB after TAVR was associated with a leftward QRS axis shift (by 40+28.3°) in 73% of the study patients and a rightward (by 18.6+19.4°) or no change in QRS axis in 25.6% and 1.4% of the study patients, respectively. These results were not affected by the type and size of prosthetic valve used. 2) Although the proportion of patients having a left QRS axis (<-30°) markedly increased after TAVR in the study group (from 14.9% to 38.3%) and in the group displaying a leftward QRS axis shift (from 5.8% to 45.6%), converse results were observed in the group displaying a rightward QRS axis shift (decrease from 38.9% to 16.7%). 3) The group of patients exhibiting a rightward or no QRS axis shift tended to show a greater incidence of high degree AVB than the group of patients exhibiting a leftward QRS axis shift (18.4% vs. 6.8%, P=0.056).

Conclusion:
Although post TAVR-LBBB was associated with a leftward QRS axis shift in most patients (73%), a non-negligible proportion of patients (27%) exhibited a rightward or no QRS axis shift. The latter group tended to have a higher risk of developing high degree AVB.
Abstract 12258: Ceramides Predict the Development of Type 2 Diabetes
Authors: Leiherer Andreas , Muendlein Axel , Plattner Thomas , Vonbank Alexander , Laaksonen Reijo , Mader Arthur , Sprenger Lukas , Maechler Maximilian , Larcher Barbara , Fraunberger Peter , Drexel Heinz , Saely Christoph H
Published: December 2023

Introduction:
Ceramides recently have attracted interest as a marker of cardiovascular event risk.

Hypothesis:
We hypothesize that they play a role in the development of type 2 diabetes (T2DM).

Methods:
We analyzed the ceramide ratio Cer d18:18/Cer d 18:24:0 (CerRatio) in 894 consecutive Caucasian patients who were referred to angiography for the evaluation of established or suspected stable coronary artery disease (CAD). T2DM was diagnosed according to ADA criteria. The incidence of T2DM was recorded over a follow-up time of up to 16 years (median: 13 [8-14] years).

Results:
At baseline, the CerRatio was significantly higher in T2DM (n=239) than in non-diabetic patients (4.6e-2 vs. 3.9e-2, p<0.001). During follow-up, diabetes was newly diagnosed in 71 patients, i.e. in 11% of the initially non-diabetic subjects. The CerRatio strongly predicted the incidence of T2DM both univariately (standardized OR 1.47 [1.11-1.96]; p=0.008) and in a multivariately adjusted model (figure) comprising age, sex, BMI, the presence of significant CAD at angiography, and hemoglobin A1c (HbA1c; OR=1.45 [1.07-1.98]; p=0.018). Though the CerRatio was significantly correlated with BMI (r=0.138, p<0.001) and HbA1c (r=0.137, p<0.001), applying a mediation analysis revealed that BMI and HbA1c had only marginal indirect effects (5,7% and 3.6%, respectively) on the association of the CerRatio with T2DM incidence.

Conclusions:
We conclude that ceramides strongly and independently predict the development of diabetes.
Abstract 12267: Timing and Mode of Death Following Treatment of Neonatal Symptomatic Tetralogy of Fallot
Authors: Trucco Sara M , Zhang Yun , McCracken Courtney , Glatz Andrew C , Petit Christopher J , Qureshi Athar Mahmood , Zampi Jeffrey , Shahanavaz Shabana , Nicholson George , Abejero Nathalie , Ligon Allen , Patel Jay , Mascio Christopher , Maskatia Shiraz A , Romano Jennifer , Obyrne Michael L , Stack Kathryn , Wong-Siegel Jeannette , Beshish Asaad , Law Mark , Hock Kristal , Batlivala Sarosh P , Speed Sarah , Meadows Jeffery J , Goel Disha , Khan Hala , Goldstein Bryan H
Published: December 2023

Introduction:
Neonates with tetralogy of Fallot and symptomatic cyanosis (sTOF) require early intervention, using a staged (SR) or primary repair (PR) strategy. Independent of management, the risk of post-procedural mortality is considerable. Although risk factors for late mortality after TOF repair have been established, the modes of death and associated factors have not been defined in early childhood following treatment of sTOF.

Methods:
Neonates with sTOF who had an initial intervention from 2005-2017 at 9 centers of the Congenital Cardiac Research Collaborative were reviewed. Among the patients who died, additional details related to timing and cause of death, and last clinical follow-up, were obtained and described. Comparisons of patient characteristics between survivors and non-survivors were performed.

Results:
Of 572 sTOF patients (230 PR, 342 SR), there were 52 (9%) deaths at a median age of 82 (25
th
- 75
th
%ile: 28, 246) days
.
Timing of mortality included: inpatient post-palliation (n=9), interstage in SR pathway (n=11), inpatient post complete repair (CR) (SR, n=5; PR, n=11) and post-CR following hospital discharge (n=16). Death occurred within 30 days of palliation or repair in 52% of cases. Most deaths were due to cardiac etiologies, with only 6 including ≥1 non-cardiac cause of death (NEC (n=2), sepsis (n=1), CNS bleed (n=2), trauma (n=1)). Risk factors for mortality included presence of genetic syndrome, non-cardiac anomaly, prematurity, low birth weight, and need for ventilation prior to initial intervention (p<0.05 for all). Modes and timing of death in the 16 patients who died after CR discharge are shown (Figure). In these, RV dysfunction at last echo was present in 50%.

Conclusions:
When death occurs after interventions for sTOF, it frequently occurs early, and relates to traditional risk factors. Amongst patients with childhood mortality following discharge from CR, sudden death and reintervention-related events predominate known causes.
Abstract 12295: The Timing of Appearance of Untimely Dissociated Potentials After Pulmonary Vein Isolation for Atrial Fibrillation is Related to the Respiratory Phase
Authors: Mine Takanao , Sugitani Miho , Kogame Takehiro , Fukuhara Eiji , Ishihara Masaharu
Published: December 2023

Introduction:
Ectopic beats originating from the pulmonary vein (PV) trigger atrial fibrillation (AF). However, the mechanism and timing of Ectopic beat occurrence remain unclear.

Hypothesis:
The dissociated potentials (DPs) after pulmonary vein isolation (PVI) for AF are related to the respiratory phase and left atrial pressure (LAP).

Methods:
93 patients underwent AF ablation under deep sedation and BiPAP ventilation. [Study1] Respiratory waveforms of 20 patients were recorded simultaneously with LAP. [Study2] In 73 patients, DPs after PVI or left atrial posterior wall (LAPW) isolation were recorded simultaneously with respiratory waveforms for 3 min, and the preceding coupling intervals (CI) of all DPs were measured. Sites with DPs frequencies <10/min were defined as rare DPs sites. In sites with DPs frequencies ≧10/min, sites where the number of DPs with CI shorter than the mean - SD of CI was greater than the number of DPs with CI longer than the mean + SD of CI were defined as short-coupling DPs sites, and long-coupling DPs sites were defined in the opposite cases.

Results:
[Study1] Respiratory waveforms showed fluctuations similar to LAP, and LAP increased within the respiratory interval in all patients (Fig.1). [Study2] The incidence of DPs on the left PV was lower than that on the right PV and LAPW (28 of 61 left PV 46%, 41 of 66 62%, 3 of 3 100%, P=0.0306). Additionally, the CI of DPs on the left PV was longer (3.1±5.4sec, 2.0±2.8, and 1.6±0.5, P<0.0001). The timing of appearance of DPs was not related to the respiratory phase in all DPs assessments (2126 beats during the respiratory interval and 2155 beats during the rest interval). However, inopportune DPs appeared during the specific respiratory phases: the respiratory interval for short-coupling DPs, and the rest interval for long-coupling DPs and rare DPs sites (P=0.016, Fig.2).

Conclusions:
The timing of appearance of untimely DPs is related to the respiratory phase and may be associated with an increase in LAP.
Abstract 12297: A Rare Case of May-Thurner Syndrome Due to External Compression of the Right and Left Common Iliac Veins
Authors: Schwarzman Logan S , Aguilar Jack , Siddiqui Mohammed , Megowan Nichelle
Published: December 2023

Description of Case:
A 54yr male with HTN and CKD stage IIIa presented with asymmetric right greater than left lower extremity (LE) edema. Vital signs were normal. His exam showed asymmetric right greater than left LE edema to the mid-thighs. ECG revealed sinus rhythm. Medical therapy with increasing titration of diuretics was unsuccessful in resolving his asymmetric LE edema. A TTE showed EF of 55-60% with normal bi-ventricular size and function and no significant valve abnormalities. Bilateral duplex US showed no DVT. CT abdomen pelvis showed no hydronephrosis or compressive masses. Right heart catheterization revealed normal bi-ventricular filling pressures. Bilateral peripheral venogram showed bilateral common iliac vein stenosis (Figure 1A). IVUS showed external compression of the right common iliac vein (RCIV) between the right external and internal iliac arteries with external compression of the left common iliac vein (LCIV) by the right common iliac artery (RCIA) against the lumbar spine (Figure 1A). A diagram of the compression observed in this case is included (Figure 1B). The RCIV had an 18mmHg gradient with no significant gradient on the LCIV. The RCIV was stented using an 18x60mm self-expanding stent and balloon dilation. Final IVUS and venogram showed no residual stenosis, edge dissection or perforation (Figure 1D). The patient was discharged on dual-antiplatelet therapy for three months and aspirin thereafter with continued diuretics. He had significant reduction in asymmetric LE edema with marked improvement in ambulation capacity and no further LE asymmetry at the 30-day follow-up visit.

Discussion:
Here we present a rare case of May-Thurner Syndrome via compression of the LCIV by the RCIA and RCIV by the right internal and external iliac arteries with successful management. We also illustrate the importance of a broad differential diagnosis in patients with persistent asymmetric LE edema refractory to diuretic management
Abstract 12299: Sex Differences in the Outcomes of Patients With Heart Failure Undergoing Catheter Ablation for Atrial Fibrillation
Authors: Agarwal Siddharth , Munir Bilal , Desimone Christopher V , Deshmukh Abhishek , Asad Zain Ul Abideen U , Stavrakis Stavros
Published: December 2023

Introduction:
There is a lack of data on the impact of sex on the outcomes of patients with heart failure (HF) undergoing atrial fibrillation (AF) ablation.

Hypothesis:
We hypothesized that outcomes of patients with HF undergoing AF ablation differ between males and females and tested this hypothesis using data from a nationally representative sample of the US population.

Methods:
The National Readmissions Database (NRD) was analyzed from 2016-2019 to identify patients ≥ 18 years old undergoing AF ablation. Patients were then divided into two cohorts based on their sex. A multivariable logistic regression model was used to adjust for confounders.

Results:
A total of 21,439 patients with HF underwent AF ablation between 2016-2019, of which 8,103 had heart failure with preserved ejection fraction (HFpEF) [64.8% were females], and 13,336 had heart failure with reduced ejection fraction (HFrEF) [38.4% were females]. Crude outcomes are shown in Figure 1. After multivariate adjustment, among patients with HFrEF, females had a longer length of stay (adjusted mean difference (aMD): 0.55 (0.16-0.93) days longer, p<0.01) along with lower odds of routine home discharge (adjusted odds ratio (aOR):0.62; 95% confidence interval (CI):0.55-0.70; p<0.01). Females had similar odds of in-hospital mortality, procedural complications, and 30-day/ 180-day all-cause, heart failure, and arrhythmia-related readmissions as compared to males. Among patients with HFpEF, females had higher odds of 30-day (aOR: 1.91; 95% CI: 1.24-2.93; p<0.01) and 180-day heart failure readmissions (aOR: 1.53; 95% CI: 1.04-2.28; p=0.03) along with lower odds of routine home discharge (aOR:0.67; 95% CI: 0.57-0.78; p<0.01), as compared to males.

Conclusion:
In conclusion, our results show that females with HFrEF undergoing AF ablation have similar odds of in-hospital/30-day/180-day outcomes whereas females with HFpEF have higher odds of 30-day/180-day HF readmissions, as compared to males.
Abstract 12317: UBC9 Alleviates Diabetic Cardiomyopathy via the Modulation of Mitophagy
Authors: Wu Hanlin , Zhou Ting , Wang Jing , Bu Yuxin , Yang Zheming , Yan Chenghui , Liu Dan , Han Yaling
Published: December 2023

Introduction:
Type 2 diabetes is prevalent worldwide. Cardiovascular complications in patients with diabetes include diabetic cardiomyopathy (DCM). Ubiquitin-conjugating enzyme E2 I (UBC9) is the only SUMO-E2 enzyme that plays a key role in cardiomyocytes.

Hypothesis:
The present study aimed to elucidate the role and mechanism of action of UBC9 in the development of DCM.

Methods:
We established myocardial-specific UBC9 knockout (UBC9-CKO) and adeno-associated virus-overexpressing mouse models. Additionally, a mouse model of DCM was established using high-fat diet feeding and low-dose streptozotocin injection. This mechanism was explained by the stimulation of cultured cardiomyocytes with palmitic acid.

Results:
The transcript and protein levels of UBC9 were significantly decreased in the myocardium of patients with DCM. Myocardial-specific UBC9 knockout aggravated cardiac dysfunction, alleviated myocardial fibrosis and hypertrophy, and promoted mitophagy and mitochondrial damage. Meanwhile, UBC9 overexpression exhibited the opposite effects. UBC9 exerted mitochondrial protective effects independent of SUMOylation. UBC9 regulated RUNX2 degradation by directly binding to NEDD4, thus regulating PSEN2 to exert protective effects against mitophagy. Moreover, the effect of UBC9 on mitochondrial function was reversed upon PSEN2 knockdown.

Conclusions:
UBC9 regulates mitophagy through the NEDD4/RUNX2/PSEN2 pathway and alleviates DCM development by improving myocardial mitochondrial dysfunction. These findings offer novel perspectives on the application of UBC9 as a therapeutic target for DCM.
Abstract 12331: Cardiovascular Hospitalizations and Mortality Among Young Adults Aged 25 to 64 Years in the United States
Authors: Henry Chantal M , Oseran Andrew S , Zheng ZhaoNian , Dong Huaying , Wadhera Rishi K
Published: December 2023

Introduction:
Declines in cardiovascular mortality have stagnated in the United States since 2011. There is growing concern that these patterns may reflect worsening cardiovascular health in younger populations. However, little is known about how the burden of acute cardiovascular hospitalizations and mortality have changed in young adults.

Aim:
To evaluate cardiovascular hospitalizations (AMI, heart failure, ischemic stroke) and in-hospital mortality among adults 25-64 years, overall and by income-level, as well as population-level cardiovascular mortality.

Methods:
We determined age-standardized cardiovascular hospitalization rates from 2012 to 2019, and fit quasi-Poisson and quasi-binominal regression models to compare hospitalizations and mortality between low- and higher-income young adults.

Results:
Between 2012 and 2019, age-standardized AMI hospitalization rates increased modestly among young adults from 162.0 (161.4, 162.6) to 163.7 (163.3, 164.2) per 100,000 (p<0.001). In contrast, there were significant increases in heart failure (163.9 [163.3, 164.5] to 231.5 [231.0, 232.0], p<0.001) and ischemic stroke hospitalizations (92.3 [91.8, 92.8] to 110.2 [109.9, 110.6], p<0.001). Across all 3 conditions, low-income adults experienced a more pronounced rise in hospitalizations, and the gap between the low- and higher-income groups widened (p-interaction<0.001), while in-hospital mortality decreased for heart failure and stroke. Population-level cardiovascular mortality rates increased in the subgroup of young adults aged 45-64 years (162.5 to 168.3 per 100,000, p<0.001), particularly in the low-income population.

Conclusions:
There has been an alarming increase in cardiovascular hospitalizations and population-level cardiovascular mortality among young adults over the past decade in the US, with evidence of widening disparities between low- and higher-income populations.
Abstract 12362: High Rates of Mortality in Uganda Following Acute Rheumatic Fever: Findings From a Community-Based Prospective Cohort Study
Authors: Wirth Scott H , Pulle Jafesi , Seo Jang Dong , Nakagaayi Doreen , Sable Craig , Bowen Asha C , Parks Tom , Carapetis Jonathan , Okello Emmy , Beaton Andrea Z , Ndagire Emma
Published: December 2023

Introduction:
Rheumatic heart disease (RHD) is the largest contributor to cardiac mortality in children worldwide. Little contemporary data exist on its antecedent illness, acute rheumatic fever (ARF). There is an urgent need to understand outcomes following ARF in RHD-endemic settings. We aimed to describe medium-term mortality, disease recurrence, and change in carditis among Ugandan children following ARF diagnosis, and to identify correlates of mortality.

Methods:
We conducted a prospective cohort study of children diagnosed with definite ARF in 2017-2020 during a community-based incidence study. Patients were enrolled in a national registry and followed with annual review, most recently in August 2022. Kaplan-Meier (KM) survival analysis was used to describe all-cause mortality and individual Cox proportional hazards regression models were used to identify correlates of death. Descriptive statistics were used to characterize changes in carditis.

Results:
Among 135 children with definite ARF, 22/135 (16.3%) experienced death, 19/135 (14.1%) cardiac death, 5/135 (3.7%) ARF recurrence, and 5/135 (3.7%) surgery over a median (interquartile range) of 4.25 (3.4, 5.1) years. KM analysis saw 14/22 (63.6%) of deaths occur by one year, 16/22 (72.7%) by two years, and 20/22 (90.9%) by three years. The presence of moderate/severe carditis (HR 14.1, 95% CI 4.2, 47.7) and PR prolongation (HR 3.9, 95% CI 1.5, 9.9) at diagnosis was associated with increased cardiac mortality. Among 107 survivors included in echocardiographic sub-analysis, 27/107 (25.2%) had improvement in carditis, 70/107 (65.4%) no change, and 10/107 (9.4%) progression.

Conclusions:
These are the first contemporary data from sub-Saharan Africa reviewing medium-term outcomes following ARF. Adverse outcome rates exceeded those reported elsewhere. Most decedents already had advanced cardiac involvement upon first ARF diagnosis, as evidenced by PR prolongation and high-grade carditis, suggesting a history of prior undiagnosed ARF recurrences that had already compounded into RHD. These data indicate that a high burden of ARF exists in the community that is undetected by current methods, emphasizing the need for better point-of-care diagnostics to improve early ARF detection.
Abstract 12370: Atrial Fibrillation and Atrial Remodeling Deteriorates Right Heart Function With Preserved LV Function in LKB1
f/f
/ANF
Cre+
Mice
Authors: Fukuma Nobuaki , Tzimas Christos , Russo Ilaria , Dun Wen , Tsai Emily J
Published: December 2023

Introduction:
Atrial fibrillation (AF) and right ventricular dysfunction(RVD) are each highly prevalent in heart failure (HF) patients; their co-existence represents a severe HF phenotype. AF and RVD in HF are respectively attributed to left atrial remodeling and pulmonary hypertension due to left heart disease. Yet clinical studies have found that AF, not pulmonary pressure, is independently associated with RVD in HF. These findings suggest the possibility that AF can cause RV dysfunction.

Hypothesis:
Atrial fibrillation can cause progressive RV dysfunction even in the absence of pulmonary hypertension.

Methods:
We created an atrial-specific LKB1 knockdown (atrial-LKB1 KD) by injecting AAV9-ANF-Cre retro-orbitally into adult male LKB1
fl/fl
mice (age 8 wks). Echocardiography and telemetry were performed at 4- and 12- weeks post AAV9-ANF-Cre. At 12-weeks post-AAV injection, both right ventricular and left ventricular pressure- volume loop recordings were performed. Histological and molecular analyses were also performed at study endpoint. LKB1
fl/fl
mice (Cre-) were used as controls (CTL).

Results:
At 12 wks post-injection, the incidence of AF with atrial remodeling was 100% in atrial-LKB1 KD. Echocardiography revealed RV systolic dysfunction by RV FAC (50.72% vs. 60.45%, p<0.05) and TAPSE (0.89mm vs. 1.15mm, p<0.05) in atrial-LKB1 KD vs. CTL. In contrast, LV FS were comparable between atrial-LKB1 KD and CTL. (40.4% vs. 42%, p=0.38). Atrial-LKB1 KD demonstrated abnormal RV-pulmonary arterial coupling, increased RV systolic pressure, and preserved LV function following atrial remodeling. Expression of genes related to remodeling and inflammation were upregulated in the RV of atrial-LKB1 KD. Compared to that of CTL, RV expression level of Nppb was 3.4-fold higher (p<0.05) and IL1β was 7.1 fold higher (p<0.05) in atrial-LKB1 KD.

Conclusions:
Our findings strongly suggest that atrial fibrillation alone can cause RV dysfunction with concomitant preserved LV function. Remodeling and inflammation of the RV but not LV in the atrial-LKB1 KD also suggests that the right heart is more vulnerable than the left heart to AF-induced dysfunction.
Abstract 12379: AT1-AA (Angiotensin II Type 1 Receptor Autoantibody) Aggravates Abdominal Aortic Aneurysm Through Activating AT1R/Gq Allosterically
Authors: Zhang Xi , Zhang Suli , Wang Meili , Liu Huirong
Published: December 2023

Background:
Angiotensin II type 1 receptor (AT1R) is a key mediator of the rennin-angiotensin-aldosterone system (RAAS). Autoantibodies against AT1R (AT1-AA), as an activator of AT1R, was found in abdominal aortic aneurysm (AAA) related diseases, such as hypertension and atherosclerosis. However, the role of AT1-AA in AAA is still unclear.

Methods:
We used angiotensin II (AngII)-infused male ApoE
-/-
mice model of AAA. Ultrasonography measurement, histological assessment, western blot, qRT-PCR and RNA sequencing were used to assess the severity of AAA. Nanoluciferase-based bioluminescence resonance energy transfer (NanoBRET) assay, radio assay of receptors and homogeneous time resolved fluorescence (HTRF) were used to measure the activation feature of AT1R and the affinity of AT1R with AT1-AA or AngII.

Results:
AT1-AA increased the incidence of AAA (vehicle vs. AT1-AA: 47% vs. 81%; P<0.05), which can be attenuated by AT1R blocker Candesartan. Furthermore, AT1-AA greatly increased severity of AAA, due to augmenting the diameter of abdominal aorta and the degradation of elastin by enhancing the expression of MMP2/9 (matrix metalloproteinase) and the accumulation of inflammatory cells. And AT1-AA could induce phenotypic switch of smooth muscle cells. But AT1-AA does not increase the plasma level of AngII. Mechanically, AT1-AA enhanced AngII-induced recruitment of Gq, but not β-arrestin1/2. AT1-AA potentiated the AngII-mediated Gq-dependent inositol phosphate (EC50 shift=3.829 nM) and the activation of PKC and ERK1/2. The responses were abolished by AT1R blocker and Gq inhibitor. The affinity of AT1-AA for the AT1R in cells was calculated to be 75.49 ± 4.7 nM. AT1-AA cannot compete for the binding of AngII to AT1R. However, AT1-AA significantly potentiated the binding of AngII with AT1R allosterically (mean K
D
± SEM: 34.11 ± 0.9765 nM at 0 nM AT1-AA vs. 25.63 ± 1.826 nM at 100 nM AT1-AA; p<0.05), without altering the maximum binding.

Conclusion:
AT1-AA, as an allosteric activator of AT1R, promotes AAA through increasing the affinity of AngII with AT1R and activating Gq biasedly.
Abstract 12409: Ambient Fine Particulate Matter and Ozone Air Pollution Are Differentially Associated With Hospitalization for Unstable Angina and Acute Myocardial Infarction During Wildfire and Inversion Seasons
Authors: Horne Benjamin D , Haddad Francois , Joy Elizabeth A , Kim Juyong B , Anderson Jeffrey L , Prunicki Mary , Bride Daniel , Bair Tami L , Nadeau Kari C , Knowlton Kirk U
Published: December 2023

Background:
Short-term increases (days to weeks) in fine particulate matter (PM
2.5
) air pollution are associated with hospitalization for acute coronary syndromes (ACS). A changing climate is shifting sources of PM
2.5
toward summer wildfires in the western US. This study evaluated if short-term increases in PM
2.5
and ozone were associated with ACS risks in wildfire (June-October) and winter inversion (Nov.-March) seasons.

Methods:
Case-crossover analyses examined N=21,414 subjects with emergency or inpatient hospitalization at 11 Intermountain hospitals for ACS, including the primary diagnosis of myocardial infarction (AMI, n=20,287) or unstable angina (USA, n=1,127). PM
2.5
data were collected in January 1, 1999 to March 31, 2022 (ozone: 2006-2022) from community monitors on Utah’s Wasatch Front. Odds ratios (OR) and 95% confidence intervals (CI) were computed by Poisson regression with adjustment for weather data.

Results:
Subjects averaged 66±14 years of age and 31.0% were female. Overall PM
2.5
increases were associated with concurrent day (lag 0 days) ACS hospitalizations (OR=1.024 per +10 μg/m
3
, CI: 1.004, 1.043, p=0.019), driven by AMI (OR=1.025 per +10 μg/m
3
, CI: 1.004, 1.045, p=0.017). USA admissions were delayed to the second week [lag moving average (mAvg) days 7-13] after PM
2.5
increases (OR=1.090 per +10 μg/m
3
, CI: 1.024, 1.159, p=0.007) and PM
2.5
associations with USA were strengthened by adjustment for ozone. Analyzed by wildfire and inversion seasons, PM
2.5
associations differed for AMI and USA (Figure). Short-term increases in ozone in wildfire season were associated with lower USA risk at lag 1, lag 2, 3-day mAvg 0-2, and 1-week mAvg 0-6 and lower AMI risk at mAvg 7-13, but not with inversion season risks.

Conclusions:
Short-term increases in PM
2.5
air pollution were associated with ACS hospitalizations for AMI and USA, with patterns of risk differing between wildfire and inversion seasons. Ozone increases were not associated with greater risk.