bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 9111: The Impact of Covid-19 Pandemic on the Treatment of Myocardial Infarction- A Single Center Experience
Authors: Al-abdouh Ahmad , Bizanti Anas , Fashanu Oluwaseun , Mohan Akhila , Edwards Raveena , Sill Anne , Wang David
Published: April 2024

Introduction:
The corona virus disease-2019 (COVID-19) pandemic has been associated with decrease in the rate of myocardial infarction (MI), and this is likely related to patients delaying seeking care due to COVID-19 concerns.

Methods:
In this retrospective observational study, we compared all patient encounters who presented with MI to Ascension Saint Agnes Hospital, Baltimore, MD from March to December 2020 with a cohort of patient encounters who presented with MI during an equivalent period in 2019. We analyzed the data using Statistical Package for Social Sciences (SPSS) and used two sample t-test and Chi-square x
2
to compare the outcomes between the two cohorts as appropriate.

Results:
We had 275 MI admissions that met our inclusion criteria. When comparing MI encounters in 2020 with encounters in 2019, there were no significant differences in mortality (2.1% vs. 4.5%, p=0.274), acute renal failure(14.9% vs. 18.7%, p=0.403), or intensive care unit admission (7.1% vs. 7.5%, p=0.892). There were no significant differences in modalities of treatment including cardiac catheterization (94.3% vs. 95.5%, p=0.652), or medical treatment alone (13.5% vs. 18.7%, p=0.241) in 2020 vs. 2019. Referrals for coronary artery bypass graft surgery (CABG) were significantly higher in 2020 than in 2019 (8.5% vs. 3.0%, p=0.050). When comparing patients who presented during the first 5 months of the pandemic (March-July) with patients who presented in the last 5 months of the pandemic in 2020 (August - December); there were significant decrease in rate of cardiac catheterization (90.5% vs. 98.5%, p = 0.041), and significant increase in rate of medical treatment alone (18.9% vs. 7.5%, p = 0.047) in the first 5 months.

Conclusions:
The first five months of the pandemic were associated with a significant decrease in rates of pursuing cardiac catheterization along with an increase rates of medical treatment alone compared with the following five months.
Abstract 9140: Validity of Coronary Angiography-Based Physiology in Clinical Practice
Authors: de Moura Santos Luciano , carvalho junior wenderval B , Ribeiro Marcelo H , Lopes Maria Antonieta A , Fukushima Julia T , Abizaid Alexandre A , Campos Carlos M
Published: April 2024

Introduction:
The invasive physiological assessment of the severity of coronary obstruction is performed by hyperemic (FFR) and non-hyperemic (iFR) indices. However, the need to insert an intracoronary pressure guidewire are factors that limit its use. Quantitative flow ratio (QFR) is a method that infers the value of FFR, eliminating the use of a pressure wire and coronary hyperemia.

Objectives:
Evaluate the diagnostic accuracy of the QFR, diameter stenosis percentual (DS%) and area stenosis percentual (AS%) in comparison with the FFR, for identification of significant obstructive coronary lesions (FFR ≤ 0.80) and the feasibility to assess QFR in cohort of patients without dedicated angiographic acquisition.

Methods:
Consecutive patients with moderate obstructive lesions in coronary angiography that had previous FFR measurement were evaluated. Validation of QFR was assessed by accuracy, area under the curve (AUC), sensitivity, specificity, correlation coefficient and Bland-Altman plot, using FFR as reference method.

Results:
Out of 102 patients and 143 arteries assessed by the FFR, only 69 (67%) patients and 75 (52%) arteries were possible to be calculated by QFR. The accuracy of the QFR to detect an FFR ≤ 0.80 was 84.0% (95% CI: 75.6% to 92.4%), with a sensitivity of 67.9% (95% CI: 47.6% to 84.1%) and specificity of 93.6% (95% CI: 82.5% to 98.7%). The correlation and agreement between FFR and QFR were r = 0.54, p < 0.01 and mean difference = -0.02 ± 0.09; p = 0.0874, respectively. The AUC to QFR, DS% and AS% comparison are represented in the attached figure.

Conclusions:
QFR demonstrated good accuracy and agreement, compared to the FFR, with moderate correlation in an unselected population of clinical practice. QFR and DS% demonstrated AUC greater than AS%. However, the high rate of exclusion in offline evaluations of angiograms recorded without dedicated acquisition protocol considerably limits the use of this tool in clinical practice.
Abstract 9151: Impact of Adult Congenital Cardiologists on the Care of Adults With Congenital Heart Disease
Authors: Salciccioli Katherine B , Hou Hechuan , Norris Mark D , Cotts Timothy B , Sassalos Peter , Si Ming-sing , Thompson Michael P
Published: April 2024

Introduction:
The adult congenital heart disease (ACHD) population has unique medical needs requiring specialized care. We evaluated the association between ACHD physician visits and guideline-adherent care in a cohort of insured ACHD patients.

Methods:
The Michigan Value Collaborative claims registry was queried for patients aged 18+ with ICD-10 codes for congenital heart disease (CHD) who had continuous insurance coverage from 1/2016 to 12/2020. Anatomic disease severity was stratified as simple or moderate/complex based on 2018 ACC/AHA ACHD guidelines. Patients were counted as seeing an ACHD physician if they had a single claim with a board-certified ACHD physician in Michigan during the 5-year period. Patient distance to nearest ACHD physician clinic was assessed based on home zip code. ACHD guideline adherence was defined as receiving one echocardiogram (all patients), two echocardiograms (moderate/complex disease), cross-sectional imaging (coarctation of the aorta), and/or liver imaging (single ventricle) during the 5-year period.

Results:
A total of 3,636 ACHD patients were identified with 17.9% (N=650) having moderate/complex CHD. ACHD physicians saw 3.4% (N=103/2986) of patients with simple disease and 23.4% (N=152/650) with moderate/complex disease. Most patients lived <50 miles from an ACHD physician - 87.5% of those who saw ACHD and 84.2% of those who did not - with similar distance distributions between groups (p=0.13). Patients who saw an ACHD physician were significantly more likely to have guideline-recommended imaging (
Figure 1
).

Conclusion:
Being seen by a board-certified ACHD physician was associated with greater adherence to guideline-recommended care in this cohort of insured ACHD patients. However, the vast majority of patients did not see an ACHD physician despite having continuous insurance coverage and geographic accessibility. More work is needed to identify the barriers to obtaining ACHD-specific care.
Abstract 9174: Integration of Nonlinear Analysis and Artificial Intelligence for Human Ipsc-based Drug Cardiotoxicity Classification
Authors: Ma Zhen , Kowalczewski Andrew
Published: April 2024

Introduction:
Recent advances in human induced pluripotent stem cell (
hiPSC
) technology have granted novel tools to evaluate drug-induced cardiotoxicity on human cardiomyocytes. The contractile signals recorded from hiPSC-derived cardiomyocytes (
hiPSC-CMs
) are highly complex and dynamic with great degree of characteristics to various drug treatment. However, traditional linear methods often fail to capture the subtle variations in these signals generated by hiPSC-CMs. In this work, we integrated nonlinear analysis, dimensionality reduction techniques and machine learning algorithms for better classifying the contractile signals from hiPSC-CMs in response to different drug exposure.

Methods:
Beating hiPSC-CMs were treated with different drugs and analyzed based on contractile motions and calcium flux. Nonlinear analysis was used to compute the dimensional properties. All the contractile parameters are incorporated in different machine learning algorithms to detect the variations in contractile behaviors that reflect cardiotoxic effects. The visualization of drug treatment and dosages were accomplished utilizing dimensionality reduction techniques, t-distributed stochastic neighbor embedding (t-SNE).

Results:
Machine learning algorithms combined with nonlinear analysis proved far more sensitive to the changes in contractile functions than when using traditional linear analysis alone. Using Radom Forest algorithm, classification between drug-treatment and baseline control showed an accuracy higher than 96% with the inclusion of nonlinear parameters. Higher dimensional relations between variables and treatment groups were successfully visualized utilizing t-SNE to gain further insights of each drug.

Conclusions:
Integration of nonlinear analysis and artificial intelligence has proven to be a powerful tool for analyzing cardiotoxicity and classifying toxic compounds through their mechanistic action.
Abstract 9208: Prognostic Significance of Acute Reconnection Following Adenosine Administration During Catheter Ablation of Atrial Fibrillation: Insights from the UC San Diego AF Ablation Registry
Authors: Aldaas Omar M , Darden Douglas J , Mylavarapu Praneet , Han Frederick , Hoffmayer Kurt S , Krummen David E , Ho Gordon , Raissi Farshad , Feld Gregory K , Hsu Jonathan C
Published: April 2024

Introduction:
The use of adenosine-guided pulmonary vein isolation is controversial. We sought to evaluate the prognostic significance of unmasking acute pulmonary vein reconnection with adenosine during catheter ablation of atrial fibrillation (AF).

Methods:
We performed a retrospective study of all patients who underwent radiofrequency catheter ablation enrolled in the University of California, San Diego AF Ablation Registry. The primary outcome was freedom from atrial arrhythmias on or off antiarrhythmic drugs (AAD).

Results:
Of 357 patients who were administered adenosine during catheter ablation of AF, 39 (10.9%) had acute reconnection of at least one pulmonary vein and 318 (89.1%) did not. Fluoroscopy [75 (56, 89) vs 63.5 min (50,77); p=0.017] and procedure [309 (256, 362) vs 270 min (237,320); p=0.002] times were significantly longer when reconnection was seen after adenosine, but there were no statistically significant differences in antiarrhythmic drug use (p=0.086) or procedural complications (p=0.852). After multivariable adjustment, the recurrence of atrial arrhythmias on or off AAD (Adjusted Hazard Ratio (AHR) 0.95 (95% CI 0.56-1.62); p =0.848], all-cause hospitalizations [AHR 1.41 (95% CI 0.73-2.74); p=0.303] (
Figure 1
) or all-cause mortality [AHR 5.61 (95% CI 0.09-362.87); p=0.418] were not different during follow-up in those with or without reconnection after adenosine.

Conclusion:
In this registry analysis, reconnections seen after adenosine resulted in longer fluoroscopy and procedure times without a reduction in recurrence of atrial arrhythmias, all-cause hospitalizations, or mortality.
Abstract 9212: Smartwatch-Based 6 Minutes Walking Distance Measurement in Pulmonary Hypertension Patients: A Pilot Study
Authors: Li Weihao , Guo Jiajun , Wang Lili , Chen Yucheng
Published: April 2024

Introduction:
The 6 minutes walking test (6MWT) is a simple and practical measurement of exercise capacity with minimal cost. In pulmonary hypertension (PH), 6MWT results indicates severity of disease and risk of adverse events, thus working as a main end point for clinical trials. Conventionally, 6MWTs are conducted by health care professionals.

Hypothesis:
Smartwatch might help to conduct 6MWT and measure walking distances.

Methods:
Patients with PH on routine follow-up visits and asymptomatic volunteers were enrolled in this study. Every studied subjects was required to wear a smartwatch (HUAWEI Watch GT2) on each wrist before walking on a 50-meter long, flat and straight path. The 6 minutes’ walk was under the supervision of two trained doctors, with dedicated research application and vibration of smartwatches as a reminder of start and stop. No encouragement were used during walk. Walking distances measured by the doctors were recorded. Distances measured by smartwatches were retrieved from HUAWEI Research platform.

Results:
A total of 45 patients with pulmonary hypertension (aged 40.0±11.8) and 21 asymptomatic volunteers (aged 24.2±1.25) participated this study. 6MWTs were successful for all participants, with 2 PH patients prematurely stopped walking due to mild dizziness. Smartwatches gave valid measurements of distances for all tests. Walking distances measured by doctors and by smartwatches showed good consistency. (No statistically significant differences, p=0.794; Intraclass correlation coefficient 0.9782(0.9630 to 0.9870) for left wrist, 0.9568(0.9276 to 0.9742) for right wrist). And the difference between left and right wrist measurements were minimal (paired t tests: 8.73±6.07 m, CI: -3.42-20.88, p=0.156).

Conclusions:
Smartwatch-based 6MWT measurements were feasible in PH patients and volunteers. Although further calibration may be needed, it’s promising for future management of PH and other cardiopulmonary diseases.
Abstract 9219: More Extensive Ablation in Addition to Pulmonary Vein Isolation Can Improve Quality of Life in Elderly Patients With Persistent Atrial Fibrillation: Insights from the Earnest-pvi Trial
Authors: Kanda Takashi , Masuda Masaharu , Inoue Koichi , Egami Yasuyuki , Watanabe Tetsuya , Minamiguchi Hitoshi , Miyoshi Miwa , Sunaga Akihiro , Sotomi Yohei , Dohi Tomoharu , Hikoso Shugo , Sakata Yasushi
Published: April 2024

Introduction:
Improving the quality of life (QoL) is one of the main purposes of catheter ablation of persistent atrial fibrillation (AF). QoL improvement in persistent AF patients has not been fully clarified. The EARNEST-PVI trial was a multi-center randomized trial comparing clinical outcomes of pulmonary vein isolation (PVI) alone and more intensive ablation in addition to PVI including complex fractionated atrial electrogram (CFAE) and linear ablation (PVI plus).

Objective:
To investigate the QoL changes after persistent AF ablation and the differences between the PVI-alone strategy and the PVI plus strategy in elderly and non-elderly patients.

Methods:
In the EARNEST-PVI trial, patients with persistent AF who underwent an initial catheter ablation (n = 512) were randomly assigned in a 1:1 ratio to either PVI alone or PVI plus. Quality of life was assessed at baseline and at 12 months after ablation for AF using the 36-Item Short Form Health Survey. Scores were also converted to a physical health component summary (PCS), a mental health component summary (MCS) and a role/social component summary (RCS).

Results:
After excluding 68 patients for whom preoperative or postoperative QoL assessment was not available, 444 patients were divided into two groups: those 65 years old and over and those under 65 years old, and assessed whether there was a difference in QoL improvement between the ablation strategies. In non-elderly patients, although there was improvement in all aspects of QoL after ablation, there was no difference between strategies. In contrast, the improvement in PCS was significantly greater in elderly patients who underwent PVI-plus. (PVI group 0.8 ± 10.3 vs. PVI-Plus group 3.8 ± 11.2, P=0.021)

Conclusions:
While ablation for persistent AF improved QoL regardless of strategy, more extensive ablation in addition to PVI could improve QoL in the elderly patients.
Abstract 9290: Relationship Between Body Weight and Pharmacokinetics of Apixaban in Patients With Atrial Fibrillation: Insights from the ARISTOTLE Trial
Authors: Harrington Josephine , Giczewska Anna , Wojdyla Daniel , WASHAM Jeffrey B , Fudim Marat , Hijazi Ziad , Lopes Renato D , Hylek Elaine , Hohnloser Stefan H , Goto Shinya , Bahit Maria , Wallentin Lars C , Granger Christopher B , Alexander John H
Published: April 2024

Introduction:
Apixaban dosing in atrial fibrillation (AF) is 5 mg BID or 2.5 mg BID in patients with ≥2 dose-reduction criteria: age >80 years, weight <60 kg, or creatinine >1.5 mg/dl. There is a question of whether drug monitoring might be useful to guide dosing, particularly in patients with extremely high or low body weight (BW). Previous work has demonstrated that the effects of apixaban versus warfarin are similar across BWs. We aimed to investigate the relationship between BW and exposure to apixaban in patients with AF.

Methods:
Exposure to apixaban was assessed as area under the curve steady state (AUC
SS
) using population pharmacokinetics (PK) data from the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial. The relationship between BW and AUC
SS
was assessed continuously and by BW categories of ≤60kg, >60-120kg, or >120kg overall and by apixaban dose.

Results:
Of patients with PK data (n=2924), 8.9% were ≤60kg, and 5.8% >120kg. Compared to the overall group, patients ≤60kg were more likely to be older (74 vs 70 years), female (67 vs 33%), had lower creatinine (0.92 vs 1.02 mg/dL) and higher CHA
2
DS
2
-VASc scores (3.9 vs 3.4). There was a weak but significant correlation between BW and AUC
SS
assessed continuously (correlation -0.38, p<0.001) and by BW group: ≤60kg [median AUCSS 4089 (25
th
3073, 75
th
5148 ng•hr/ml)], >60-120kg [3566 (2926, 4286 ng•hr/ml)], and >120kg [2699 (2284, 3226 ng•hr/ml)] (p<0.001) (Figure). This relationship persisted with stratification by apixaban dose (data not shown).

Conclusions:
There is a significant relationship between body weight and predicted exposure to apixaban, including at the extremes of BW, but with wide variation in exposure at every weight. This variation, and the absence of an association between body weight and apixaban’s observed safety and efficacy compared with warfarin, make it unlikely that routine therapeutic monitoring of apixaban will be clinically useful.
Abstract 9298: Associations of Demographic, Socioeconomic, and Cognitive Characteristics With Mobile Health Access Indicate a Digital Divide: Results from the Multi-Ethnic Study of Atherosclerosis (MESA)
Authors: Patel Reshmi J , Ding Jie , Marvel Francoise A , Shan Rongzi , Plante Tim B , Blaha Michael J , Post Wendy , Martin Seth S
Published: April 2024

Background:
Mobile health (mHealth) has an emerging role in prevention of cardiovascular disease (CVD), but there is rising concern about inequities in access. This study aimed to evaluate possible divides in mHealth access by demographic, socioeconomic, and cognitive characteristics.

Methods:
The Multi-Ethnic Study of Atherosclerosis (MESA) is a population-based observational cohort study of adults free of CVD at baseline in 2000-02. Multivariable logistic regression modeling assessed associations of age, sex, race/ethnicity, education level, annual family income, health insurance status, and Cognitive Abilities Screening Instrument (CASI) with three mHealth outcomes in 2019-20.

Results:
Among 2796 participants (mean [SD] age 75 [9], 55% women, 40% White, 25% Black, 21% Hispanic, 14% Chinese), 63% (n=1756) had internet access (IA), 65% (n=1828) owned a computing device (CD), and 9% (n=248) owned a fitness tracker (FT). There were lower odds of all mHealth outcomes for older age (per 10 years odds ratios (OR) from 0.35 to 0.55), Hispanic ethnicity (vs. White 0.49-0.59), and lower income (<$35,000 vs. ≥$75,000 0.32-0.47) (Figure). For IA and CD, lower odds were seen with Black race (vs. White OR [95% CI] 0.54 [0.41-0.73], 0.66 [0.41-0.73]) and higher odds with higher education (≥Bachelor’s degree vs. <high school 4.75 [3.19-7.12], 3.08 [2.09-4.56]), HMO/private health insurance (vs. other 1.66 [1.31-2.11], 3.08 [2.09-4.56]), and higher CASI score (per 10 points 1.14 [1.02-1.27], 1.15 [1.04-1.28]). There was an inconsistent pattern for Chinese race and sex. Chinese race (vs. White) had lower odds of IA and FT but higher odds of CD, and men (vs. women) had higher odds of CD but lower odds of FT. All results were from a multivariable model.

Discussion:
All mHealth outcomes varied by major demographic, socioeconomic, and cognitive characteristics, indicating the presence of a digital divide. mHealth interventions should consider individual barriers to access.
Abstract 9318: Cardiac Computed Tomography versus Transesophageal Echography for the Detection of Left Atrial Appendage Thrombus: A Systemic Review and Meta-Analysis
Authors: Yu Shandong , Li Hongwei
Published: April 2024

Introduction:
Transesophageal echocardiogram (TEE) has been considered the gold standard for left atrial appendage (LAA) thrombus detection. Nevertheless, TEE is a semi-invasive and time-consuming procedure that may sometimes induce discomfort and cause complications. Cardiac computed tomography (CCT) has been studied extensively for LAA thrombus detection.

Hypothesis:
We performed this systemic review and meta-analysis to assess the diagnostic accuracy of CCT for LAA thrombus detection compared with TEE.

Methods:
A systemic search was conducted in the PubMed, Embase and Cochrane Library databases. Sensitivity, specificity and posterior probability were calculated to assess the diagnostic accuracy of CCT.

Results:
A total of 27 studies involving 6852 were included in our study. The summary sensitivity was 0.98 (95% CI, 0.91-1.00), and the specificity was 0.96 (95% CI, 0.92-0.98). Based on the overall LAA thrombus incidence, the positive posterior probability was 53.21%, and the negative posterior probability was 0.08%. In the subgroup analysis of the early and delayed imaging groups, the delayed imaging method significantly improved the specificity and positive posterior probability. The summary sensitivity of early imaging studies was 0.95 (95% CI, 0.79-0.99), and the specificity was 0.89 (0.85-0.92). The positive posterior probability was 19.11%, and the negative posterior probability was 0.16%. The summary sensitivity of delayed imaging studies was 0.98 (95% CI, 0.92-1.00), and the specificity was 1.00 (0.98-1.00). The positive posterior probability was 95.76%, and the negative posterior probability was 0.12%.

Conclusions:
Compared with TEE, CCT with a delayed imaging method has good diagnostic accuracy for LAA thrombus detection.
Abstract 9332: A Case of Fulminant Vasculitis Complicated by ST-Elevation Myocardial Infarction and Stroke
Authors: Pham Vy A , Kovach Christopher P , Gordon Patti Karl , Manning Evan S , Slade Stephen J , Pollard Rebecca , Weinstein Elena , Simpson Jennifer , carter James E
Published: April 2024

Introduction:
Acute coronary syndrome is a rare complication of vasculitis. We present a case of fulminant medium-vessel vasculitis complicated by ST-elevation myocardial infarction (STEMI) and stroke.

Case report:
A 30-year-old woman with a history of painful skin lesions presented with acute headache, neck pain, and right arm weakness with paresthesia. CT angiography revealed high-grade stenosis of the internal carotids. Subsequently, she reported acute chest pain and dyspnea. ECG revealed anterior STEMI (Figure 1). She underwent emergent coronary angiography that revealed an acute occlusive thrombus of the proximal LAD that was successfully treated with aspiration thrombectomy and drug-eluting stent deployment (Figure 1). The patient was transferred to our institution with concern for fulminant vasculitis complicated by STEMI and stroke. Upon arrival to our hospital, CT and MRI revealed severe occlusions of the bilateral internal carotid arteries and a left middle cerebral artery infarct (Figure 1). Echocardiogram demonstrated severe left ventricular systolic dysfunction with regional wall motion abnormalities. Additional imaging demonstrated inflammation of the thoracic aorta, common iliac, and renal arteries, as well as occlusions of the inferior mesenteric and infratibial arteries. An extensive serologic evaluation for rheumatologic disease was negative. The patient was treated with IV corticosteroids and cyclophosphamide for fulminant medium-vessel vasculitis.

Discussion:
This report provides a rare opportunity to consider the management of fulminant vasculitis, most likely polyarteritis nodosa, presenting as STEMI and acute stroke. The patient’s presentation, imaging, and laboratory findings were inconsistent with alternative diagnoses such as Tayakasu’s arteritis, Behçet’s disease, or a systemic rheumatologic condition. The patient improved with immunosuppression and follows with cardiology for chronic heart failure.
Abstract 9346: Results of a Randomized Study to Understand the Patient Experience of Pain and Satisfaction During Cardiac Catheterization Using an Interval of Time
Authors: Mall Anna E , Girton Thomas A , Yardley Kevin , Simpson Elinore , Ronn Meghan , Rossman Paige , McEwen Tiffany , Ohman E Magnus M , Jones Schuyler , Granger Bradi B
Published: April 2024

Background:
Research on the patient experience during cardiac catheterization is lacking. Opportunity exists to improve the delivery of procedural sedation to positively impact patient’s report of pain, comfort and satisfaction. We aim to evaluate if the time interval between procedural sedation and subcutaneous lidocaine influences patient experience.

Methods:
We conducted a prospective, randomized controlled study to determine the effect of 2 time intervals (
<
6 minutes vs
>
7 minutes) on 1) total medication dosage, 2) patient-reported and observed pain and 3) patient satisfaction in 175 adults undergoing elective, outpatient cardiac cath from December 2020 to April 2021. Patient reported pain and satisfaction were assessed using the Procedural Sedation Assessment Survey. Observed pain was assessed using the Behavioral Pain Assessment Tool. Generalized linear mixed models were used to analyze the effect of time interval on total medication dose, pain and satisfaction.

Results:
Of 175 patients randomized, 9 were excluded and 5 withdrew. In the final sample (n=161), the mean age was 62 (SD 13.4), a majority were male (106, 66%), white (117, 74%), with a mean BMI of 28.5 (SD 5.6). Total procedural sedation did not differ between groups. Likewise, patient-reported pain and satisfaction and observed measures of pain did not differ, even after adjustment for age, sex, race, BMI, fellow involvement, vascular access and procedure type.

A 3-way interaction was found between procedure type, group assignment, and reported pain during the procedure (p=0.03). Patients undergoing PCI, with intervals
<
6 minutes self-reported more intra-procedural pain, despite post hoc analysis showing patients undergoing PCI had higher total medication dosages of both fentanyl and midazolam (p<0.001 & p<0.001) in both groups.

Conclusions:
No differences were found between groups related to total medication dose, pain or satisfaction regardless of timing between sedation and lidocaine. However, the findings suggest that longer intervals may reduce reported pain among patients undergoing PCI. Further investigation of sedation timing during PCI is needed to potentially improve the patient experience.
Abstract 9363: Ascending Aorta Dilation is Less Frequent in Bicuspid Aortic Valve With Coarctation of Aorta Compared to Isolated Bicuspid Aortic Valve
Authors: Shikhare Anuja , Hassan Moeez , Coffey Mary , Gonzalez Rangel Ismael
Published: April 2024

Introduction:
Bicuspid aortic valve (BAV) is known to be associated with aortopathy and aortic valve dysfunction. There is paucity of data in the pediatric population comparing ascending aorta (AA) dilation related to BAV in patients with and without coarctation of aorta (CoA).

Hypothesis:
We assess the hypothesis that BAV is associated with decrease in incidence of AA dilation in patients with CoA when compared to patients with isolated BAV.

Methods:
A retrospective cross-sectional study was done for all BAV patients 0-26 years of age seen from 2012 through 2021 in the outpatient pediatric cardiology clinic. The patients were subdivided into two groups: associated CoA (cBAV) and isolated BAV (iBAV)
.
Exclusion criteria were pregnancy, connective tissue disorders and/or aortic valve interventions. Patients with late repair of CoA (
≥
9 years) were excluded from the analysis of AA diameters because persistent hypertension, associated with late repair, could be a risk factor for AA dilation. Aortic insufficiency and aortic stenosis were defined by color Doppler and Doppler velocity by echocardiogram. Aortic dilation was defined by Z-score above 2.0. 95% score confidence intervals were used to compare the proportion of patients with an outcome in the two groups.

Results:
345 patients with bicuspid aortic valve were included (67.5% male, median age 13). CoA history was present in 32 patients (9.3%). Of the 27 patients with CoA included to assess AA dilation, two patients did not need intervention for CoA. Incidence of AA dilation was 11.1% in cBAV and 28.7% in iBAV (CI: [-26.5%, 0%]; p= 0.05). AS was noted in 63 (18.3%) and AI in 184 (53.3%) of the 345 patients. AI was less common in cBAV at 34.4% than in iBAV at 55.3% (CI: [-35.9%, -2.7%]; p= 0.024). Incidence of AS was 9.4% in cBAV and 19.2% in iBAV (CI: [-17.5%, 5.6%]; p= 0.17).

Conclusions:
In conclusion, our study suggests that the ascending aorta in pediatric patients with BAV and CoA (who underwent early repair or did not meet criteria for intervention) may have less frequent dilation than in those with isolated BAV. Patients with BAV and CoA also have lower risk for aortic insufficiency and may have lower risk for aortic stenosis. The results are limited by the small sample size of patients with CoA and further study is recommended.
Abstract 9368: Concordance of LDL-Cholesterol Levels Between the Friedewald, Martin/Hopkins, and Sampson Equations in Patients With Atherosclerotic Cardiovascular Disease
Authors: Sajja Aparna , Li Hsin-Fang , Spinelli Kateri , Virani Salim S , Martin Seth S , Gluckman Ty
Published: April 2024

Introduction:
Accurate estimation of low-density lipoprotein cholesterol (LDL-C) is important for cardiovascular risk assessment and guiding cholesterol-lowering therapy. Different methods currently exist to estimate LDL-C. There is limited data in patients with atherosclerotic cardiovascular disease (ASCVD) in prior studies.

Objectives:
To assess concordance of estimated LDL-C using the Friedewald, Martin/Hopkins, and Sampson equations.

Methods:
We performed a retrospective analysis of electronic health record data from a large multistate healthcare system. Patients with ASCVD and triglycerides (TG) <400 mg/dL between October 1, 2015 and June 30, 2019 were included. LDL-C was estimated using the Friedewald equation (with a fixed TG to very LDL-C [VLDL-C] ratio of 5:1), Martin/Hopkins equation (with a flexible ratio), and Sampson equation (with estimation of VLDL-C by multiple least squares regression). Pairwise comparisons were performed, with patients categorized as concordant if the LDL-C was <70 mg/dL using both equations and discordant if the LDL-C was <70 mg/dL for the reference equation and ≥70 mg/dL for the comparator.

Results:
The study included 146,106 patients with ASCVD (median age 68 years, 56% male, and 91% White). Discordance rates were 15% for the Friedewald vs Martin/Hopkins comparison, 9% for the Friedewald vs Sampson comparison, and 7% for the Sampson vs Martin/Hopkins comparison. Estimated LDL-C was lower for the Friedewald and Sampson equations compared to the Martin/Hopkins equation. Discordance was more pronounced at lower LDL-C cut points and in those with TG ≥150 mg/dL.

Conclusions:
Important differences in estimated LDL-C exist between the three equations, particularly among those with TG ≥150 mg/dL. These results in ASCVD patients, synthesized with prior evidence, raise concern that reliance upon the Friedewald and Sampson equations may result in underestimation and thus, undertreatment of LDL-C in those at increased risk.
Abstract 9372: Association of Past Discrimination With Medication Adherence and Blood Pressure in the HYpertension and VALUEs (HYVALUE) Trial
Authors: Patel Rajiv , Helmkamp Laura , Hanratty Rebecca , Vupputuri Suma , Blair Irene V , Maertens Julie , Steiner John , Havranek Edward P , Dickinson L. Miriam , Daugherty Stacie
Published: April 2024

Introduction:
Racial discrimination has been associated with worse health outcomes, including blood pressure (BP). Using data from the HYVALUE trial, we examined whether past racial discrimination was associated with systolic blood pressure (SBP), diastolic blood pressure (DBP), or BP medication adherence, for Black and White patients.

Methods:
Black and White patients with hypertension (HTN) were enrolled from 2017-2019. At enrollment, participants were asked how often they had experienced discrimination in any or the healthcare setting based on their race (1=never, 5=all the time). SBP and DBP were measured and anti-HTN medication adherence in the last 6 months was extracted from pharmacy fill data. Generalized linear models tested the associations of discrimination with SBP, DBP, and adherence in separate models adjusting for clinic, age, gender, and number of BP medications; participant race was included as an interaction term in final models.

Results:
Among the 925 participants (55% Black, 47% ≥64 years of age, 60% Female), racial discrimination in any setting was reported as more frequent by Black than White participants (Median (IQR): 3.0 (2.0-4.0) vs. 1.0 (1.0-2.0), p<.001). Discrimination in healthcare was reported as less common overall, but more frequent for Black than White participants (Median (IQR): 1.0 (1.0-2.0) vs. 1.0 (1.0-1.0), p<.001). In adjusted models, discrimination in any setting was not significantly associated with SBP (β= .08, p= .88;), DBP (β= .22, p=0.51) or adherence (β= -.13, p=.08); discrimination in healthcare was not associated with SBP (β= -.35, p=.66), DBP (β= -.29, p=.56), or adherence (β= -.01, p=.88). Participant race did not moderate any of these results (all p > 0.05).

Conclusions:
In this study, 2 single-item measures of past racial discrimination in any or healthcare-settings were not associated with BP or medication adherence, and these results did not differ by race. Because the HYVALUE trial was embedded in health care systems, discrimination may be under-reported or patients being treated for HTN may be less likely to show effects of discrimination on related outcomes. Additional studies are needed to examine prospective associations between discrimination and BP outcomes.
Abstract 9375: Melatonin and Metformin Exert Cardioprotection Against Trastuzumab-induced Cardiotoxicity Through Modulating Cardiac Mitochondrial Dynamics in Rats
Authors: Arinno Apiwan , Maneechote Chayodom , Khuanjing Thawatchai , Chunchai Titikorn , Prathumsap Nanthip , Arunsak Busarin , Kerdphoo Sasiwan , Shinlapawittayatorn Krekwit , Chattipakorn Siriporn , Chattipakorn Nipon
Published: April 2024

Introduction:
The combination of doxorubicin (Dox) and trastuzumab (Trz) in patients with metastatic human epidermal growth factor receptor 2 (HER2) positive tumors is limited by cardiotoxicity, as manifested by cardiac dysfunction. Although several pharmacological interventions including melatonin and metformin have been shown cardioprotection in several cardiovascular diseases, their roles in Trz-induced cardiotoxicity and the underlying mechanisms have never been tested.

Hypothesis:
We hypothesized that either melatonin or metformin exerts cardioprotection against Trz-induced cardiac injury through attenuating cardiac mitochondrial dysfunction.

Methods:
Twenty male Wistar rats were randomly divided into control group (n=5) and Trz group (n=15). Trz-treated rats were intraperitoneally injected with 4 mg/kg/day of Trz for 7 consecutive days, while control rats were injected with normal saline. Then, Trz-treated rats were equally subdivided into 3 co-treatment groups to receive normal saline, melatonin (10 mg/kg/day), or metformin (250 mg/kg/day) via oral gavage. Left ventricular (LV) function was performed using echocardiography, and the hearts were rapidly removed to determine cardiac mitochondrial function and mitochondrial dynamic proteins.

Results:
Trz induced excessive mitochondrial oxidative stress and mitochondrial dynamics imbalance, eventually leading to LV dysfunction (Fig. 1A-D). Treatment with either melatonin or metformin similarly improved contractile function (Fig. 1A), reduced mitochondrial ROS production (Fig. 1B) and mitochondrial dynamic index (Drp1/Mfn2) (Fig. 1C & D), resulting in improved LV function.

Conclusions:
Melatonin and metformin equally exerted cardioprotection against Trz-induced cardiotoxicity. Our findings suggested that either melatonin or metformin can be used as a concomitant intervention for cardioprotection in patients with metastatic HER2 positive tumors being treated with Trz.
Abstract 9828: Active Surveillance of Cardiotoxicity with Cardiac Biomarkers During Chimeric Antigen Receptor T-Cell Therapy
Authors: Lee Dae Hyun , Chandrasekhar Sanjay , Jain Michael , Chavez Julio , Shah Bijal , Lazaryan Aleksandr , Khimani Farhad , Nishihori Taiga , Bachmeier Christina , Fradley Michael , Jeong Daniel , Locke Frederick L , Oliveira Guilherme , Alomar Mohammed
Published: April 2024

Introduction:
Chimeric Antigen receptor T- Cell (CAR-T) immunotherapy has been a breakthrough for various hematological malignancies. Cardiotoxicites such as heart failure, arrhythmia and acute coronary syndrome occur in approximately 1/3 of patients who develop cytokine release syndrome (CRS) following CAR-T. High grade CRS (Grade ≥ 2) and elevated troponin level are associated with increased risk of cardiotoxicity. It is unclear whether active cardiotoxicity surveillance with serial cardiac biomarker measurements during CAR-T would allow early detection of cardiotoxicity.

Methods:
This was retrospective cohort study involving patients diagnosed with non-Hodgkin lymphoma treated with CAR-T therapy (Axicabtagene ciloleucel- Yescarta, tisagenlecleucel- Kymriah, Brexucabtagene autoleucel- Tecartus). Baseline cardiac workup with electrocardiogram (ECG), transthoracic echocardiogram (TTE), troponin (Reference <0.03ng/mL), B-natriuretic peptide (BNP, <100pg/mL) were uniformly performed in all participants. Follow up ECG, Troponin and BNP were obtained at day 5 after CAR-T and at development of CRS Grade ≥2. When clinically indicated, cardiac MRI with gadolinium contrast was performed. Cardiac MRI diagnosis of myocarditis was based on Lake Louise Criteria.

Results:
A total of 47patients undergoing CAR-T therapy were studied. Baseline comorbidities were not predictive of CRS or cardiac events. There were 39 patients with low grade CRS (82.9%) and 8 patients (17.0%) with grade 2 CRS. Five patients had elevated troponin I levels (Grade 1 CRS - 3; Grade 2 CRS - 2). Cardiac MRIs were performed in three patients (two normal studies, one with mild myocarditis). Five patients (10.6%) had an adverse cardiac event (Myocarditis with heart failure - 1; new-onset atrial fibrillation - 3; Type 2 myocardial infarction -1).

Conclusion:
Adverse cardiac events are a relatively common occurrence in patients receiving CART therapy. Active surveillance for cardiotoxicity using cardiac biomarkers in CAR-T patients may play an adjunctive role in the early identification of adverse cardiac events. Larger studies are needed to adjudicate the use of such screening measures in these high-risk patients.
Abstract 9831: Baseline Demographic and Health Characteristics of Scallop Consumers in the United States
Authors: Khawaja Muzamil , Krittanawong Chayakrit , Narasimhan Bharat , Wang Zhen
Published: April 2024

Background:
In animal studies, scallop consumption has been shown to reduce atherosclerotic aortic burden, body weight, visceral adipose tissue, serum lipid, and leptin levels. Data in human models, however, is scarce. We aim to assess baseline demographic and cardiovascular health characteristics of scallop consumers and compare them to non-scallop consumers in the United States.

Methods:
The National Health and Nutrition Examination Survey (NHANES) data between 1999 and 2016 were analyzed. This descriptive analysis compares baseline characteristics and cardiovascular health risk between scallop-consumers and non-consumers using demographics, comorbidities, laboratory values, dietary and lifestyle factors.

Results:
Of the total 4,177 individuals in this cross-sectional analysis, 11.6% of individuals report consuming scallops. The data show older individuals tended to consume scallops (p <0.001). Caucasian ethnicity was associated with scallop consumption (p< 0.0001), while Mexican Americans had a significantly negative association with scallop consumption (p< 0.0001). Scallop consumption was more common among married and divorced individuals (p<0.0001)). Regarding medical comorbidities, more scallop consumers had baseline underlying coronary artery disease, hypertension, diabetes mellitus, and hyperlipidemia as compared to those who did not consume (p= 0.0026, p< 0.0001, p=0.0023, p<0.0001). There was notably no significant association with baseline congestive heart failure, asthma or stroke history, and scallop consumption.

Conclusion:
Scallop consumption is likely associated with the prevalence of coronary artery disease, hypertension, diabetes mellitus, and hyperlipidemia. Prospective studies and clinical trials are needed to determine further the relationship between scallop consumption and cardiovascular health risk.
Abstract 9838: Genetic Architecture and Clinical Outcomes of the Fredrickson-Levy-Lees Dyslipoproteinemias
Authors: Gilliland Thomas C , Trinder Mark , Paruchuri Kaavya , Urbut Sarah M , Haidermota Sara , Bernardo Rachel , Uddin Md Mesbah , Honigberg Michael , Peloso Gina , Natarajan Pradeep
Published: April 2024

Introduction:
In 1967, Fredrickson, Levy, and Lees (FLL) proposed a classification scheme for dyslipidemias based on lipoprotein particle patterns. However, the genetic basis and clinical relevance of the FLL classification has not been evaluated in general population-based cohorts.

Methods:
Among UK Biobank participants free of prevalent coronary artery disease (CAD), we used statin-adjusted triglycerides, total cholesterol, and apolipoprotein-B to infer FLL classes (Types I, IIa, IIb, III, IV, and V). We performed Cox proportional hazards regression to quantify risk of incident CAD comparing each FLL class to unaffected individuals, adjusting for age, sex, statin use, BMI, smoking status, hypertension, diabetes mellitus, principal components 1-5, and genotyping array. Genome-wide association studies (GWAS) were performed for each of the FLL classes.

Results:
Of 412,502 participants without prevalent CAD, 237,570 (57.6%) had a FLL dyslipoproteinemia: Type I 30 (<0.01%); Type IIa 36,629 (8.9%); Type IIb 86,682 (21%); Type III 12,957 (3.1%); Type IV 101,226 (24.5%); Type V 46 (<0.01%). Over a median of 7.0 years of follow-up, Type IIb individuals were at highest risk of incident CAD (HR 1.97, 95% CI 1.83-2.13) followed by IIa (HR 1.68, 95% CI 1.52-1.86) and IV (HR 1.25, 95% CI 1.16-1.36). Across strata of non-HDL cholesterol, Type IIb pattern was still associated with greater incident CAD risk compared with other dyslipoproteinemias (
Figure
). GWAS revealed 316 total loci contributing to any of the FLL phenotypes, of which 12 were shared; 145 loci were unique to Type IIb. SNP heritability ranged from 23.5% to 53.9% across FLL types.

Conclusions:
Type IIb dyslipoproteinemia pattern is associated with incident CAD independent of non-HDL cholesterol. GWAS revealed the distinct genetic signatures for atherogenic dyslipoproteinemias.
Abstract 9855: Bayesian Multivariate Genetic Analysis of Lipids Improves Translational Insight
Authors: Urbut Sarah M , Selvaraj Margaret Sunitha , Pampana Akhil , Dattilo Lillian , Neale Benjamin , ODonnell Christopher J , Peloso Gina , Natarajan Pradeep
Published: April 2024

Introduction:
Genome-wide association studies (GWAS) of blood lipids have yielded several translational insights for coronary artery disease.

Hypothesis:
We tested the hypothesis that novel Bayesian methods leveraging genetic correlation can improve insights from lipid genetics analyses.

Methods:
We used published lipids GWAS results from 297,626 participants of the Million Veterans Program (MVP), and generated summary statistics for 276,096 participants of the UK Biobank. We employed a multivariate adaptive shrinkage (mashR) model to each dataset. MashR allows the effect of a SNP to be modeled as a mixture of multivariate normal distributions across lipid levels (LDL-C, HDL-C, Total Cholesterol, and triglycerides) and an empirical Bayes approach to appropriately nudge the posterior estimates of the effect in accordance with the overall patterns observed in the data.

Results:
In addition to reproducing all 318 loci significantly associated with lipids in MVP, we identified 4,689 novel loci associated with lipids using mashR. We observed a high degree of agreement between MVP and UK Biobank, with over 95% of UKBB replicated in MVP and an additional 1246 identified. In genetic prioritization analyses, mashR shows improvement in the detection of known Mendelian genes and the consistency of ranks among subgroups compared with univariate results. Our approach improves the estimate of enrichment parameters of known genomic features similar to established GWAS variants. Finally, combining these joint estimates with tools for incorporating the genetic correlation structure, mashR improves the proportion of variation explained by lipid polygenic risk scores by up to 58% (se 0.015) when compared to univariate substrates across lipid traits. This improvement holds across both European and non-European individuals. We show that much of this gain in power arises from improved precision of the posterior estimates where the ratio of original standard error over posterior marginal variance reflects an increased ‘effective sample size’.

Conclusions:
Our framework shows that Bayesian multivariate genetic analysis markedly improves power for genomic discovery, better identifies causal genes, and improves polygenic risk prediction for complex traits.
Abstract 9866: Novel Oral Anticoagulants versus Vitamin K Antagonists in Patients with Atrial Fibrillation and Concomitant Valvular Heart Disease: A Systematic Review and Meta-Analysis
Authors: Memon Muhammad , Siddiqui Asad Ali , Tarique Khadijah Ahmad , Amin Emaan , Khan Mohammad , Doukky Rami , Krasuski Richard
Published: April 2024

Background:
Currently, vitamin-K antagonists (VKAs) are the anticoagulant of choice for treating atrial fibrillation (AF) patients with valvular heart disease (VHD). Novel oral anticoagulants (NOACs) suggest better outcomes and could be a potential replacement for some patients. We aimed to conduct an updated systematic review and meta-analysis to resolve this matter.

Methods:
We queried MEDLINE, Embase and Cochrane central up until May 29, 2021 for studies comparing NOACs to VKAs in AF patients with VHD. Results from studies were presented as risk ratios (RR) with 95% confidence intervals (CI) and pooled using a random-effects model. Subgroup analysis by study design was performed to explore heterogeneity.

Results:
A total of 10 studies (4 RCTs and 6 retrospective observational) containing 196,124 patients (mean age 75.3 years; 54.0% men) were identified and included in the analysis. All 10 studies excluded patients with artificial valves while all 4 RCTS excluded moderate-to-severe mitral stenosis. Pooled analysis revealed significant risk reduction by NOACS of stroke or systemic embolism (RR 0.58 [95% CI 0.46, 0.74]; p<0.001, I
2
=91%), major bleeding (RR 0.60 [95% CI 0.43, 0.83]; p=0.002, I
2
=97%), intracranial hemorrhage (RR 0.40 [95% CI 0.28, 0.57]; p<0.001, I
2
=78%), all-cause mortality (RR 0.67 [95% CI 0.47, 0.96]; p=0.03, I
2
=97%) , myocardial infarction (RR 0.65 [95% CI 0.51, 0.84]; p=0.001, I
2
=0%), and major adverse cardiovascular events (RR 0.89 [95% CI 0.80, 0.99]; p=0.03, I
2
=0%). A significant difference was found upon subgroup analysis between RCTs and observational studies for all-cause mortality (p-value for interaction=0.005)

Conclusions:
NOACs were found to significantly reduce risk of all studied outcomes in patients with AF and VHD. Future RCTs are required to further validate these results.