bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 13475: Implementation of a Digital Disease Management Platform for Heart Failure: AMAZE
Authors: Paruchuri Kaavya , Bernardo Rachel , Haidermota Sara , Lannery Kim , Finneran Phoebe , Wong Megan , Sanborn Tinamarie , Joice Melvin G , Boyle-Kelly Janet , Silacci Sara , HORNSBY WHITNEY , Linganathan Karthik , Olufade Tope , Januzzi James L , Natarajan Pradeep
Published: December 2023

Background:
Optimal heart failure (HF) management after hospitalization requires ongoing care coordination. Digital approaches with a unified disease management platform (DMP) experience may improve patient care.

Objective:
A single-arm single-institution pilot study to assess feasibility of implementation and engagement with a DMP among HF patients for 60 days post-hospitalization.

Methods:
The DMP included a clinician electronic medical record-integrated dashboard and patient-facing smartphone app that provided patient-reported data entry, educational materials, and secure messaging. Eligible patients admitted to a cardiology service were onboarded with a smartphone DMP app at discharge. Clinical outcomes were compared between the intervention group and propensity-matched historical controls at the same institution and matched contemporary and historical controls at a nearby institution.

Results:
70 of 167 eligible patients (41.9%) enrolled over the 6-month recruitment period and 51 (71.4%) completed the study. Mean age of completed participants was 65.8 (SD 12.9) years; 36 (70.6%) were male and 22 (43.1%) had HF with reduced ejection fraction. Daily DMP engagement (patient-reported data entry or in-app messaging) ranged from 35%-78% and participants engaged a median 44 (IQR 14-53) days during the 60-day study period. There was no correlation between age, sex, or clinical comorbidities and daily engagement. Compared to matched historical controls at the same institution, the study cohort had significantly fewer all-cause readmissions (HR 0.39, 95% CI 0.19 - 0.80, p=0.009). Matched contemporary and historical controls over the same time period on a cardiology service at a nearby institution had no reduction in readmission rates.

Conclusions:
Implementation of a post-hospitalization HF-specific DMP is feasible and may yield improvements in readmission rates, supporting the role for future randomized controlled trials (NCT04782973).
Abstract 13492: Optimal Fluoroscopy Views and Catheter Selection for Coronary Angiography in Porcine Models
Authors: Singh Swaiman , Rizzo Skylar , Witt Tyra A , Nagel Mary , Stalboerger Paul , Behfar Atta
Published: December 2023

Coronary angiography is the gold standard for the diagnosis and treatment of epicardial coronary artery disease. Further, it is an essential tool for conduction of translational cardiac research on large animal models, in the development of novel cardiac therapies. While in humans coronary angiography has an exceedingly low mortality rate; in pigs, procedural mortality has been reported as high as 15%, likely due to unsuitable variations in angiographic techniques. Porcine models are used due to the resemblance of cardiac function and anatomy to humans. However, procedural guidelines delineating proper equipment to be used for angiography in this model has yet to be systematically assessed.

Aims:
To evaluate clinically common catheters for their utility in the safe engagement of the coronary vessels in pigs. Establish optimal workflow and fluoroscopy views for safe coronary artery engagement and angiography.

Method/Results:
Percutaneous superficial femoral artery access was acquired via ultrasound guidance and subsequent cardiac catheterization was performed in sus domesticus weighing 35-50 kg. Catheters that were tested included the JL 2.5, JL3.0, JR 3.0, AR1, AL1, MPA1, Champ1, 3DRC, hockey stick and RCB (5-7 french) operated over a standard .035 J tip wire. AP views were optimum to engage both the left and right coronary vessels. Only AR1, 3DRC, and hockey stick catheters successfully engaged the RCA, while all catheters tested could successfully engage the LCA. AR1 was noted to be the best for RCA engagement and AL1 for Left system engagement. AR1 was also the most succesful in engagement of both LM and RCA in same pig. AL1 provided the most stable engagement for Left coronary system. AR1/JL were better for LAD intervensions. AL1 is best for LCX intervensions

Conclusion:
We present a systematic description of percutaneous coronary angiographic procedures highlighting that AL for the LCA and AR for the RCA are the best choice of catheters for fastest and safest engagement of the coronary arteries limiting both radiation time and contrast use. While variations in anatomy can mandate changes in angiographic angles and catheter techniques, AP visualization and use of AL and AR catheters provided the most consistent and effective approach for porcine angiography.
Abstract 13494: Histopathological Analysis Indicates a Significant Role of Myocardial Perfusion Disturbance in Tissue Lesion in Chronic Chagas’ Cardiomyopathy Experimental Model
Authors: Fabricio Camila G , Tanaka Denise M , Marin-Neto Jose A , Oliveira Luciano , Ribeiro Fernando F , Todorovic Fabro Alexandre T , Batah Sabrina S , Cabeza Jorge M , Romano Minna M , Simoes Marcus V
Published: December 2023

Introduction:
Coronary microvascular perfusion disturbance (MPD) is frequently found in Chronic Chagas' cardiomyopathy (CCC), but its role in tissue lesion and left ventricular dysfunction progression is still unclear.

Hypothesis:
As MPD is associated with more severe subendocardial myocardial injury, we tested the hypothesis that histopathological changes in subendocardial layer could be quantitatively correlated to MPD in experimental model of CCC in hamsters.

Methods:
Female Syrian hamsters (n=23) infected with 3.5x10
4
blood trypomastigote forms of
T. cruzi
(
Y strain
) and their respective controls (n=6) were studied. At 8 months after infection, the animals underwent in vivo high-resolution myocardial rest perfusion scintigraphy with
99m
Tc-Sestamibi and transthoracic echocardiography. After euthanasia, the myocardial tissue was processed for quantitative histopathological analysis of mononuclear infiltrate index (MII) using hematoxylin-eosin staining and myocardial fibrosis using picrosirius staining in LV wall layers: subendocardium, mesocardium and subepicardium.

Results:
Fourteen animals (61%) presented rest MPD. The area of MPD was negatively correlated with LVEF (R=-0.5; p=0.02), and positively correlated with LV diastolic diameter (R=0.83; p<0.01). Animals with MPD exhibited increased extent of myocardial fibrosis in the subendocardial layer (0.67
+
0.18%) as compared to control animals (0.47
+
0.15%), p=0.03. However, the extent of total transmural fibrosis or fibrosis in other myocardial layers were similar among groups. The group with MPD presented higher values of MII in every myocardial layer as compared to controls and animals without MPD. However, only the MII in the subendocardial layer presented positive correlation with the extent of rest MPD (R=0.55, p=0.001).

Conclusions:
Our results indicate that MPD is significantly correlated with histopathological changes located in the subendocardial layer of LV walls. These results suggest that MPD may act as an amplifying and localizing factor for inflammation and fibrosis, suggesting a relevant role for myocardial hypoperfusion in the mechanisms of myocardial injury in CCC.
Abstract 13500: An Improved Reporter Identifies Ruxolitinib as a Potent and Cardioprotective CaMKII Inhibitor
Authors: Reyes Gaido Oscar E , Pavlaki Nikoleta , Granger Jonathan , Mesubi Olurotimi O , Liu Bian , Lin Brian L , Long Alan , Walker David , Mayourian Joshua , Schole Kate L , Terrillion Chantelle E , Nkashama Lubika J , Hulsurkar Mohit M , Dorn Lauren E , Ferrero Kimberly M , Huganir Richard L , Muller Frank U , Wehrens Xander H , Liu Jun O , Luczak Elizabeth , Bezzerides Vassilios J , Anderson Mark E
Published: December 2023

Background:
Ca
2+
/Calmodulin-dependent protein kinase II (CaMKII) hyperactivity is an established driver of cardiac arrhythmias. Despite proven benefits of CaMKII inhibition in numerous preclinical arrhythmia models, translation of CaMKII antagonists into humans has remained unsuccessful, and today, there are no clinically approved CaMKII inhibitors. Our ability to identify potent CaMKII inhibitors has been hamstrung by a lack of a CaMKII biosensor with sufficient sensitivity for high throughput drug discovery.

Research question:
We hypothesized that development of a CaMKII biosensor with high throughput capabilities would enable identification of CaMKII inhibitors capable of preventing arrhythmias.

Methods:
To address this problem, we engineered and validated a new genetically encoded CaMKII biosensor: CaMKAR (CaMKII Activity Reporter). CaMKAR enjoys a dynamic range of 227 ± 11.1 %, seconds-scale kinetics, robust specificity, and dual
in cellulo
and
in vitro
functionality. This makes CaMKAR the fastest and most sensitive CaMKII biosensor to date and the first that is amenable for
in cellulo
drug screening.

Results:
Using CaMKAR, we carried out a drug repurposing screen (4,475 compounds in clinical use) in human cells. This yielded five previously unrecognized CaMKII inhibitors: ruxolitinib, baricitinib, silmitasertib, crenolanib, and abemaciclib (false discovery-adjusted p<3 x 10
-5
). Stand out among these, ruxolitinib, an FDA-approved Janus kinase inhibitor, blocked CaMKII kinase activity with an inhibitory constant of 23.5 ± 2.2 nM. In patient-derived cardiomyocytes, ruxolitinib ameliorated arrhythmogenic Ca
2+
release events (p<0.0001), and in mice, ruxolitinib prevented catecholaminergic polymorphic ventricular tachycardia (p<0.01) and rescued pre-existing atrial fibrillation (p<0.0001).

Conclusion:
Our work presents three impactful
Conclusions:
1)
Our biosensor, CaMKAR, provides the highest CaMKII activity reporting performance to date.
2)
Long sought-after CaMKII inhibitors already exist within the human pharmacopeia.
3)
Our results demonstrate that ruxolitinib—a drug already in human use—is a cardioprotective CaMKII inhibitor and a suitable candidate for cardiovascular repurposing.
Abstract 13508: Baseline Lipid Profile and Risk of Atrial Fibrillation Recurrence After Atrial Fibrillation Ablation
Authors: Tiahnybik Jack , Makimoto Hisaki , Kamioka Masashi , Tanawuttiwat Tanyanan , Watanabe Tomonori , Das Mithilesh , Imai Yasushi , Miller John , Kamioka Masashi , Kario Kazuomi , Suzuki Takeki
Published: December 2023

Introduction:
Dyslipidemia is a modifiable cardiovascular risk factor. However, it is unclear if baseline lipid levels prior to atrial fibrillation (AF) ablation are associated with AF recurrence.

Hypothesis:
This study aimed to examine if there was an association between baseline lipid profiles and AF recurrence after AF ablation.

Methods:
We retrospectively studied patients who underwent AF ablation from January 2016 to September 2021 at two high-volume international centers. Patients with a lipid profile in the previous 24 months prior to AF ablation and a one-year post-ablation follow-up with electrocardiogram were included. AF recurrence was defined as having a 12-lead electrocardiographic evidence of AF or atrial tachycardia within one year after a 3-month blanking period. Logistic regression analysis was performed to examine association of lipid profiles (low-density lipoprotein (LDL), high-density lipoprotein (HDL), total cholesterol (TC), and triglycerides) with AF recurrence. Lipid profiles were evaluated both as continuous and categorical variables. Well-established cut-points were used for LDL, and tertiles were used for HDL, TC, and triglycerides.

Results:
A total of 287 patients were included in the study (mean age (SD), 63.6 (10.5), 36% female). Patients with LDL<70 mg/dL or TC < 141 mg/dL had a decreased risk of AF recurrence in unadjusted analysis. These associations remained significant after adjustment by traditional AF risk factors and statin use (odds ratios (ORs) (95% confidence interval): 0.27 (0.09 - 0.79) and 0.28 (0.09 - 0.84), respectively. TC analyzed as a continuous variable was associated with increased risk of AF recurrence (1.012 (1.002 - 1.022) per 1 mg/dL increase). (Table).

Conclusions:
In our international registry, patients with LDL <70 mg/dL or TC <141 mg/dL were associated with a reduced risk of AF recurrence, suggesting a beneficial effect of low LDL and TC in patients with AF undergoing catheter ablation.
Abstract 13519: US Population Eligibility and Estimated Impact of Tirzepatide on Obesity Prevalence and Preventable Cardiovascular Disease Events in US Adults
Authors: Wong Nathan D , Karthikeyan Hridhay , FAN WENJUN
Published: December 2023

Background:
Tirzepatide, a novel GIP-GLP-1 receptor agonist therapy, has been shown to be beneficial for weight loss and reduction of cardiovascular disease (CVD) risk factors in adults with obesity in the SURMOUNT-1 trial. We estimated US population eligibility for tirzepatide and the impact on reduction of CVD events in US adults with obesity.

Methods:
We applied SURMOUNT-1 eligibility criteria (body mass index [BMI]
>
30 kg/m
2
or BMI
>
27 kg/m
2
with at least one risk factor or CVD, excluding diabetes) to US adults aged
>
18 years in the US National Health and Nutrition Examination Survey (NHANES) 2015-2018 to estimate the US eligible population using NHANES sample weighting. Tirzepatide 15 mg group weight changes in the SURMOUNT-1 trial were applied to estimate the population impact on weight and obesity, and in those aged 30 to 74 years without prior CVD, the estimated 10-year CVD risks utilizing the BMI-based Framingham CVD risk scores. The difference in the estimated risks with and without tirzepatide “treatment” multiplied by the eligible weighted population represented the estimated “preventable” CVD events.

Results:
We identified 4015 US adults weighted to an estimated population size of 93.4 million [M] (38% of the US adult population) who fit SURMOUNT-1 trial eligibility criteria, of which 51% were female and 89% were without prior CVD. Applying tirzepatide 15 mg SURMOUNT-1 treatment effects on weight loss resulted in an estimated 70.6% (65.9 M) and 56.7% (53.0 M) showing
>
15% and
>
20% weight reductions, respectively, translating to a 58.8% (55.0 M) reduction in obesity (BMI
>
30 kg/m
2
) prevalence and 36.4% (34.0 M) increase in normal weight (BMI <25 kg/m
2
) prevalence among the eligible population. Among those without CVD, estimated 10-year CVD risks were 10.1% “before” and 7.8% “after” tirzepatide “treatment” reflecting a 2.3% absolute (and 23% relative) risk reduction (number needed to treat [NNT]=43) translating to an estimated 1.95 million preventable CVD events over 10 years.

Conclusions:
Tirzepatide treatment in eligible US adults may reduce obesity prevalence nearly 60% representing 55M adults and prevent up to 2M CVD events over 10 years, suggesting a dramatic impact on societal burden and healthcare costs in those with these conditions.
Abstract 13523: Association of Central Arterial Stiffness With Atrial Myopathy: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Mascarenhas Lorraine , Ji Yuekai , Wang Wendy , Inciardi Riccardo M , Parikh Romil , EATON ANNE , Cheng Susan , Alonso Alvaro , Matsushita Kuni , Shah Amil M , Solomon Scott D , Meyer Michelle , Chen Lin Y , Zhang Michael J
Published: December 2023

Introduction:
Atrial myopathy—defined as abnormal left atrial (LA) size and function— is associated with an increased risk of atrial fibrillation, heart failure, and dementia. Defining risk factors for atrial myopathy is important for identifying preventative therapies.

Objective:
Examine the cross-sectional association of central arterial stiffness with LA function.

Methods:
We included 2,825 Atherosclerosis Risk in Communities (ARIC) study participants from Visit 5 (2011-2013) without coronary heart disease, heart failure, sustained arrhythmias, peripheral arterial disease, or morbid obesity (mean age=75 years, 65% female, 20% Black). Central arterial stiffness was measured by carotid-femoral pulse wave velocity (cfPWV). cfPWV was analyzed continuously per standard deviation (SD) increment and categorically by quartiles. LA strain (function) was measured by speckle-tracking echocardiography. Multivariable linear regression was performed.

Results:
When analyzed per SD increment, cfPWV was significantly associated with LA reservoir and conduit strain, after adjusting for demographics, clinical characteristics, systolic blood pressure, and left ventricular (LV) function and mass (β=-0.33, 95% CI [-0.60, -0.06] and β=-0.31, 95% CI [-0.52, -0.10], respectively) (Table). When cfPWV was assessed as quartiles, compared to the referent 1
st
quartile (lowest), participants in the 4
th
quartile (highest) of cfPWV had significantly lower LA reservoir and conduit strain (β=-0.83, 95% [-1.58, -0.08] and β=-0.96, 95% CI [-1.54, -0.38], respectively). There was no significant association between cfPWV and LA contractile strain.

Conclusion:
Higher central arterial stiffness is cross-sectionally associated with lower LA reservoir and conduit (but not contractile) strain, independent of LV function and mass. Future research examining the prospective association of central arterial stiffness with change in LA function is warranted.
Abstract 13529: Outcomes After Emergency Department Visits for Dyspnea: Population-Based Interrupted Time-Series Analysis of Implementation of B-Type Natriuretic Peptide Assays
Authors: Bobrowski David , Abdel-Qadir Husam M , McNaughton Candace D , Chu Anna , Wang Xuesong , Austin Peter , Wijeysundera Harindra C , Ross Heather , Lee Douglas S
Published: December 2023

Introduction:
The population-level impact of hospital-based natriuretic peptide (NP) implementation in a universal health care system is unclear. We examined temporal associations between introduction of NP testing in-hospital with outcomes after emergency department (ED) visits for dyspnea.

Hypothesis:
Implementation of NP testing is associated with improved outcomes for ED patients seeking care for dyspnea.

Methods:
Administrative databases were linked to identify adults ≥40 years of age with a first ED visit for dyspnea between 2014 and 2019 at hospitals introducing onsite NP testing between 2016 and 2018 in Ontario, Canada. We calculated quarterly rates of 1-year age- and sex-standardized mortality and readmission (all-cause, cardiovascular, heart failure [HF]), restricted to 2 years before and after NP introduction to minimize temporal advances in treatment. We conducted an interrupted time series analysis using linear regression and Newey-West autocorrelation adjusted standard errors to quantify rate of change in outcomes before and after NP introduction. Time zero at each hospital was set at 2 years prior to the introduction of NP tests for each hospital (point of interruption).

Results:
We studied 20,294 patients (median age 69 years, 52% female) before and 21,857 patients (median age 68 years, 53% female) after NP introduction across 16 hospitals. The cohort before NP introduction had a higher prevalence of prior HF and chronic obstructive pulmonary disease (P<0.01). Rates of all outcomes were stable prior to NP introduction. Following NP introduction, there were significant declines in rates of all-cause mortality (-1.5/100 persons per year), all-cause readmission (-3.6/100 persons per year), cardiovascular readmission (-1.4/100 persons per year) and HF readmission (-0.8/100 persons per year; Figure).

Conclusions:
Introduction of hospital-based NP tests was associated with decreasing rates of adverse outcomes after ED visits for dyspnea.
Abstract 13530: Life Quality, Work and Functional Recovery of Cardiac Arrest Survivors After Hospital Discharge
Authors: Lu Kuan-Ting , Wu Yi-Wen , Chen Tai-Yuan , LEE HSIN YU , Chiang Wen-chu , Ma Matthew , Tsai Min-Shan
Published: December 2023

Background:
Along with the improvement in resuscitation science and post-cardiac arrest care, an increasing number of cardiac arrest (CA) victims survived to hospital discharge.

Research Questions:
Do cardiac arrest survivors return to their life and work after hospital discharge?

Aims:
To investigate whether the life quality, work ability, and neurological recovery of cardiac arrest survivors improves continuously within 1 year after hospital discharge.

Methods:
The retrospective single center study enrolled 169 non-traumatic adult CA patients who survived to hospital discharge between 2017 and 2020. The following were excluded: patients who expired within 1 year following hospital discharge, patients who unable to be contact after hospital discharge, and patients who refused to join the study. A total of 71 patients were included in this study. The use of medical service including outpatient and ER visit, and hospital admission were collected from medical record. The work status, life quality and neurological function were evaluated by questionnaires including the World Health Organisation Quality of Life Brief Form and EuroQol 5-Dimension, 5-Level Health Scale (EQ-5D-5L).

Results:
There were 67 patients (94.4%) discharged with cerebral performance category (CPC) of 1, and the 2 patients (2.8%) with CPC of 2. Most patients (64, 90.1%) returned home. Sixty-seven patients (94.4%) returned to outpatient visit at a median time of 6 days, 22 patients (31%) visited ER at a median time of 70 days, and 21 patients (29.6%) were hospitalised again at a median time of 44 days. The neurological function evaluated by CPC at 3 months and 1 year post-discharge did not show significant improvement. Patients demonstrated improved ability to work as well as improved scores for overall life quality, general health, physical, psychological, social relations, and environmental status. With regard to mobility, self-care, usual activities, pain/discomfort, and health state assessed by EQ-5D-5L, the patients with more than moderate impaired also decreased significantly.

Conclusions:
Life quality and work ability of CA survivors improved continuously within 1 year after hospital discharge.
Abstract 13531: Uptake of SGLT2i and Outcomes in Patients With Diabetes and Chronic Heart Failure: A Community-Based Cohort and a Specialized Clinic Cohort
Authors: Gagnon Luke R , Hazra Deepan , Perera Kevin , Wang Kaiming , Kashyap Niharika , Sadasivan Chandu , Chu Luan Manh , Dover Doug , Kaul Padma , Simpson Scot , Bello Aminu , Finlay McAlister , Oudit Gavin Y
Published: December 2023

Introduction:
Sodium/glucose cotransporter 2 inhibitors (SGLT2i) have an established benefit in people with diabetes mellitus (DM) and chronic heart failure (HF). We aimed to evaluate the uptake and impact of these agents in two cohorts: a community-based cohort of all adults with DM and HF in Alberta who had an echocardiogram and a cohort of people with DM and HF being cared for in a specialized heart failure clinic (HFC).

Methods:
We identified the community-based cohort using validated ICD code-based case definitions for DM and HF (physician claims, outpatient, hospitalization databases) with an echocardiogram study (available from two major centres) from 2015 (when SGLT2i were available provincially) to March 2022. In addition, we identified the HFC cohort by chart review of patients seen in the Mazankowski Alberta Heart Institute HFCconsented between February 2018 and August 2021 with HF and DM and followed them until August 2022. We examined the association between SGLT2i use and all-cause mortality and/or cardiovascular (CV)-related hospitalizations using Cox proportional hazard models adjusted for clinical covariates and time-varying SGLT2i use.

Results:
In 12,150 people with DM and HF in the community-based cohort, 2,321 (19.1%) were dispensed an SGLT2i compared to 208 (39.2%) of the 530 patients with DM and HF followed in the HFC. SGLT2i was associated with less CV-related hospitalization and all-cause mortality (the composite outcome) (aHR 0.65 [95%CI 0.58 - 0.73]) in the community but no difference (aHR 0.88 [95% CI 0.64 - 1.21] in the HFC. SGLT2i use was associated with less all-cause mortality (aHR 0.50 [95% CI 0.44 - 0.57]) in the community but no difference (aHR 0.81 [95% CI 0.54 - 1.20]) in the HFC.

Conclusion:
Despite robust randomized trial evidence of clinical benefit, the uptake of SGLT2i even in people with DM and HF remains low. Although uptake is higher in a specialized HFC overall the rate is below optimal. Multifaceted Strategies (targeted to healthcare professionals, patients, and policymakers) to guide risk identification and raise awareness on the clinical benefits of these agents are warranted.
Abstract 13561: Hospital Outcomes of Chronic Kidney Disease Patients After Transvenous Lead Removal of Infected Cardiac Implantable Electronic Devices
Authors: Ang Qi Xuan , Tan Min Choon , Talaei Fahimeh , Lee Justin
Published: December 2023

Background:
Chronic kidney disease (CKD) is a common comorbidity among patients who require transvenous lead removal (TLR) of infected cardiac implantable electronic devices (CIED). However, its impact on the outcomes of this procedure remains unclear.

Objective:
This study aimed to investigate the impact of CKD and end-stage renal disease (ESRD) on the outcomes following TLR of infected CIED.

Method:
Using the Nationwide Readmissions Database, we identified and analyzed the hospital outcomes of patients aged ≥18 years, who underwent TLR of infected CIED from 2017 to 2020. The patient cohort was further stratified by the presence of CKD diagnoses. Survey-based weighted univariable and multivariable analyses were performed to investigate whether CKD of different stages independently predicts worse outcomes among these patients.

Results:
A total of 10,928 patients who underwent TLR of infected CIED were included in our study. Amongst, 3,794 (34.7%) patients had CKD not requiring dialysis, and 605 (5.5%) patients had ESRD on dialysis. The patients with ESRD on dialysis had the highest rates of early mortality (10.6% vs 7.7% vs 4.1%, p<0.01), non-home discharge (46.1% vs 43.3% vs 30.5%, p<0.01), prolonged hospitals stay (90.6% vs 84.9% vs 72.6%, p<0.01), and 30-day readmission (25.5% vs 24.6% vs 17.1%, p<0.01) compared to CKD not requiring dialysis patients and non-CKD patients. Via multivariable analyses, the risk of poorer in-hospital outcomes increased with the severity of CKD. Apart from cardiac arrest, CKD was not significantly associated with increased procedural complications following the TLR procedure.

Conclusion:
Chronic kidney disease, particularly ESRD was associated with poorer hospital outcomes following TLR of infected CIED. The procedural complications were not significantly increased in CKD patients, except for cardiac arrest. These highlight the importance of meticulous peri-procedural management in CKD patients.
Abstract 13568: Proteomic Analysis Reveals Protein Alterations in Drp1 Cardiac Knockout Mice With Circadian Rhythm Disruption
Authors: Qian Juying , Yin Ming , chen zhangwei
Published: December 2023

Introduction:
Mitochondria dynamics are altered in circadian rhythm disruption, and dynamin-related protein 1 (Drp1) may be an important target.

Methods:
Wild-type and Drp1 cardiac-specific knockout mice were divided into normal circadian group and circadian disorder group, respectively. Normal circadian group mice were housed in a standard environment (12 hours of light/12 hours of darkness), while dark group mice were housed in a 24-hour dark environment. After 4 weeks, the cardiac tissues were analysed using Tandem Mass Tag proteomics. Differentially expressed proteins (DEPs) was identified. Subsequently, Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were performed. Gene set enrichment analysis (GSEA) was performed to find enriched biological processes.

Results:
Compared with the WT/N group, the Drp1-/N group possessed a total of 176 DEPs. These proteins are widely involved in mitochondrial membrane and metabolism process. We identified several differentially expressed mitochondrial dynamics-related genes, including Drp1, using Western blotting. Compared with the WT/D group, the Drp1-/D group exhibited a total of 126 DEPs. GO and KEGG showed that the DEPs were mainly involved in response to stress, metabolic pathways. For Drp1 cKO mice, the protein changes caused by the circadian rhythm disorder were mainly concentrated in vitamin transport, complement coagulation cascades.

Conclusions:
This study may provide an insight into the myocardial protein changes caused by Drp1 cKO with circadian rhythm disruption, which may involve in terms such as metabolic pathways, complement coagulation, and vitamin transport.
Abstract 13590: Comparative Efficacy and Safety of Bare-Metal versus Drug-Eluting Stents in Managing Saphenous Venous Graft Disease: A Meta-Analysis and Systematic Review
Authors: Rahman Mansoor , Hanif Muhammad , Mumtaz Mahrukh , Nair Abhinav , Ali Junaid , Khan Babar , Ullah Waqas , Savage Michael P
Published: December 2023

Introduction:
Current understanding of the relative safety and efficacy of bare metal stents (BMS) vs. drug eluting stents (DES) in patients with saphenous venous graft disease (SVGD) relies on analysis of small datasets.

Methods:
Literature search was performed using PubMed, Embase and Web of Science to identify relevant articles on outcomes of BMS vs. DES in patients with SVGD. A random effects model was used to calculate odds ratios (ORs) for several safety and efficacy outcomes including major adverse cardiovascular events (MACE), target lesion revascularization (TLR), total vessel revascularization (TVR), in-stent restenosis, and stent thrombosis.

Results:
Of 3644 total citations on the initial search, 40 studies comprising 83,151 (33,306 BMS, 49,845 DES) patients qualified for quantitative analysis. The mean age was 72 years, and the mean ejection fraction was 47%. The inter group proportion of hypertension was 78% vs. 83%, diabetes mellitus was 37% vs. 14%, and hyperlipidemia was 69% vs. 78% in patients with BMS vs. DES, respectively (Table). Patients receiving DES had significantly lower odds of MACE (OR 0.63, 95% CI 0.52-0.77), and its components; TLR (OR 0.67, 95% CI 0.49-0.92), TVR (OR 0.61, 95% CI 0.46-0.81); and stent restenosis (OR 0.61, 95% CI 0.45-0.84) compared with BMS (Figure). The risk of stent thrombosis (OR 0.84, 95% CI 0.61-1.15) was similar between the two groups.

Conclusions:
Compared with BMS, patients receiving DES for SVGD demonstrated a lower risk of adverse events, stent stenosis, and need for revascularization.
Abstract 13601: Distinct Proteomic Profiles in Human Thoracic Aortic Aneurysm by Segment May Drive Prognostic Differences: Conventional & Machine Learning Analysis
Authors: Elbatarny Malak , Kuzmanov Uros , Eliathamby Daniella , Chu Vivian , Nedadur Rashmi , Reitz Cristine , Hamed Omar , Simmons Craig A , Chung Jennifer , WANG BO , Ouzounian Maral , Gramolini Anthony
Published: December 2023

Background:
Acute Type A Aortic Dissection (ATAD) is a surgical emergency with 18% mortality. Anatomic segment (root, ascending, arch, descending) impacts aneurysm natural history but mechanisms remain unclear.

Aim:
To compare proteomic profiles of human thoracic aortic segments that could account for distinct phenotypes and clinical outcomes; to analyze the largest cohort to date with enhanced depth of coverage.

Methods:
Aortic tissues were collected (N=148) from 82 unique individuals and analyzed using our customized proteomics protocol (
Figure 1A
). Conventional statistics, machine learning (t-distributed Stochastic Neighbour Embedding, t-SNE), and functional enrichment analyses were used to characterize significant phenotypic differences by segment. Differential protein expression was validated using immunofluorescence.

Results:
From all samples, 7251 proteins were identified (5660 quantified), exceeding literature (by 100s-1000s). Significant differences were greatest in comparisons of root, ascending, and descending aorta (
Figure 1B-C
). Root vs descending and ascending vs descending comparisons had clear separation in t-SNE analysis; root and ascending samples also clustered modestly (
Figure 1D
). MFAP4, a cellular-binding protein previously associated with descending thoracic dissection in Marfan patients, was significantly elevated in ascending aortic segments compared to root and descending. This was validated by immunofluorescence (
Figure 1E
).

Conclusions:
We extensively profiled thoracic aneurysm tissue using enhanced coverage, customized proteomics from the largest known cohort of human samples. Thoracic aneurysm phenotype differs by aortic segment as a function of intrinsic biochemical (proteomic) processes. Potential thoracic aneurysm biomarkers likely must account for aortic segment. Multiomic integrative analysis (DNA, RNA, post-translational data) are underway.
Abstract 13603: Inhibition of Exercise-Regulated Long Noncoding RNA SALTe1 Reverses Vascular Aging and Age-Related Cardiac Dysfunction
Authors: Li Haobo , Kang Jiayi , Zhou Yirong , GUERRA JUSTIN , Lerchenmueller Carolin , Tai Wai Lydia , Rosenzweig Anthony
Published: December 2023

Rationale:
Age is a major risk factor for cardiovascular disease. Recent work suggests vascular aging is an important determinant of longevity and end-organ function, although its role in age-related cardiac dysfunction and how exercise mitigates these phenotypes remain unclear.

Objective:
To identify exercise-regulated, cardiac long noncoding RNAs (lncRNAs) that modulate vascular aging.

Methods and Results:
Twenty-month-old mice underwent voluntary wheel running for eight weeks. RNAseq identified a novel set of lncRNAs altered in exercised aged hearts, termed
S
enescence
A
ssociated
L
ncRNA
T
ranscripts in
E
xercise (SALTes). SALTe1 was conserved and primarily expressed in endothelial cells (ECs). SALTe1 increased in aged hearts but decreased with exercise. Myocardial perfusion and CD31 positive cells were reduced in 20-month-old vs 10-week-old mice while EC senescence (CD31 and p16 or γH2AX double-positive cells) and cardiac diastolic dysfunction increased (p<0.05 for all). In 20-month-old mice, SALTe1 inhibition using antisense GapmeR or EC-specific knockdown in CAS9-mice reversed multiple hallmarks of vascular aging. Recovery from hindlimb ischemia improved (post-surgery day 28 perfusion ratio, Control: 0.58±0.03 vs GapmeR: 0.73±0.03, p=0.04, n=12/group) and aortic stiffness was reduced to levels seen in young animals. Myocardial perfusion (time-to-peak, Control: 2.585±0.08 vs GapmeR: 2.048±0.11 seconds, p=0.03, n=12/group) improved. Cardiac EC number increased, and EC senescence decreased (p<0.05 for all). Inhibition of SALTe1 reduced E/E’ (-20.16±1.60 vs -15.4±1.10, p=0.04, n=12/group) and increased global longitudinal strain (-15.88±0.84 vs 20.66±1.02, p=0.02, n=12/group). Mechanistic studies in vitro and in vivo revealed that SALTe1 works through regulation of Poly (ADP-Ribose) Polymerase Family Member 9 (PARP9) and RNA-binding protein with multiple splicing (RBPMS).

Conclusions:
SALTe1 regulates EC senescence through PARP9 and RBPMS. SALTe1 inhibition reverses multiple hallmarks of vascular aging and improves age-related cardiac dysfunction. These findings suggest a primary role for EC senescence in age-related cardiac dysfunction and identify SALTe1 as a potential new therapeutic target.
Abstract 13615: Diagnostic Accuracy of Cardiac MRI for Detecting Wall Motion Abnormalities and Coronary Artery Stenosis - A Systematic Review and Umbrella Meta-Analysis
Authors: Panchal Viraj , Saifa-Bonsu Johnnie , Tamdin Tenzin , Honganur Nagaraj Sanchitha , Noei Farahnaz , Konka Srujana , Samala Venkata Vikramaditya R , Sivasubramanian Barath Prashanth , manjani lokesh , Dave Mihir , Savani Priya , Jaiswal Richa , Thirupathy Umabalan , Patel Urvish K , Vekaria Pratikkumar
Published: December 2023

Introduction:
Conventional coronary angiography (CCA) is the gold standard for the diagnosis of coronary artery disease (CAD). It is an invasive test and carries risks. Increased mortality is linked with reduced coronary flow, thus aggressively measuring coronary flow is important. Cardiac MRI (cMRI) is an emerging non-invasive test that can also help in assessing ventricular function, myocardial perfusion, and detecting anomalies.

Aim:
We aimed to analyze the diagnostic accuracy of cMRI compared to CCA through an umbrella meta-analysis.

Methods:
We searched PubMed articles comparing the diagnostic accuracy of cMRI with CCA in patients having CAD published from 2000 to 2022 according to PRISMA guidelines. We used the generic inverse variance method to pool sensitivity (SN), specificity (SP), negative likelihood ratio, positive likelihood ratio, and diagnostic odds ratio (DOR) with 95% confidence interval keeping alpha criteria of 0.05 as significant. RevMan 5.4 was used to calculate random effects models.

Results:
In this umbrella meta-analysis, 9 studies with 14615 patients met inclusion criteria. Overall pooled SN was 0.88 (95% CI: 0.87-0.90), SP was 0.85 (0.81-0.89), PLR was 6.07 (5.02-7.33), NLR was -1.99 (-2.10 to -1.87), and DOR 38.94 (31.96-47.46). (p<0.00001)

Conclusion:
The diagnostic accuracy of a non-invasive, cMRI is comparable, if not superior to an invasive test like CCA.
Abstract 13617: Spironolactone Use is Associated With Better Survival in Heart Failure Patients With Preserved Ejection Fraction With Concomitant Angiotensin Receptor Blocker Treatment
Authors: Liu Xiao , Wang Yue , Pan Hong , Jiang Yuan , Cao Zhengyu , Wu Maoxiong , Chen Zhiteng , Abudukeremu Ayiguli , Yiu Kaihang , ZHANG Yuling , Wang Jingfeng
Published: December 2023

Introduction:
The guidelines recommend using renin-angiotensin-aldosterone system inhibitors, including spironolactone and angiotensin II receptor blocker (ARB), and spironolactone rather than angiotensin-converting enzyme inhibitors (ACEI) for treating heart failure with preserved ejection fraction (HFpEF). However, it is unclear whether there is an additive effect of spironolactone when combined with ACEI/ARB on HFpEF.

Hypothesis:
Spironolactone combined with ACEI or ARB may provide additional benefits in patients with HFpEF.

Methods:
We conducted a
post
hoc
analysis of the TOPCAT (Heart Failure Trial with Aldosterone Antagonist for Preservation of Heart Function) trial using Cox proportional hazards models to evaluate the effect of spironolactone on the clinical prognosis of HFpEF patients, with or without ACEI or ARB. Our primary outcomes were defined as death from cardiovascular causes, aborted cardiac arrest, and hospitalization for heart failure.

Results:
A total of 1767 HFpEF patients from the Americas were included (49.9% women, median age 71.5 years). During a median follow-up of 2.98 years, 522 (29.5%) primary outcomes occurred. Compared with placebo, spironolactone use was associated with a lower incidence of primary outcomes (hazard ratio [HR]: 0.69, P=0.02), cardiovascular mortality (HR: 0.45, P=0.004) and all-cause mortality (HR: 0.58, P=0.01) after adjustments in HFpEF patients who were concomitantly taking ARB at baseline but not in those without ARB use. Significant interactions were found between spironolactone use and baseline ARB use for cardiovascular and all-cause death (P=0.01). In contrast, spironolactone use was associated with lower cardiovascular death (HR: 0.59, P=0.01) in patients without ACEI baseline use but not in those with ACEI use. There was no significant interaction observed between spironolactone use and baseline ACEI for adverse outcomes.

Conclusions:
Among HFpEF patients enrolled in TOPCAT-Americas, the survival benefit of spironolactone was enhanced by ARB use but not ACEI use. Further prospective studies are necessary to validate these findings.
Abstract 13622: Association Between Self-Reported Medication Adherence and Therapeutic Inertia in Hypertension: A Secondary Analysis of the Systolic Blood Pressure Intervention Trial (SPRINT)
Authors: Jacobs Joshua A , Derington Catherine G , Zheutlin Alexander R , King Jordan B , Cohen Jordana B , Bucheit John , Kronish Ian M , Addo Daniel K , Morisky Donald E , Greene Tom H , Bress Adam P
Published: December 2023

Introduction:
Therapeutic inertia (TI), the failure to intensify antihypertensive medication when blood pressure (BP) is above goal, remains highly prevalent in hypertension management. The degree to which self-reported antihypertensive adherence is associated with TI when targeting intensive BP goals remains unclear.

Methods:
Cross-sectional analysis of the 12-month visit of participants randomized to the intensive systolic BP (SBP) arm of the SBP Intervention Trial (SPRINT), which randomized adults at high cardiovascular disease risk to an intensive (<120 mm Hg) vs. standard (<140 mm Hg) SBP treatment group. TI was defined as no change in the antihypertensive medication regimen intensity score, which incorporates the medication number and dose, when the SBP >120 mm Hg. Self-reported medication adherence was assessed using the 8-item Morisky Medication Adherence Scale (MMAS-8) and categorized as low (<6), medium (6 to <8), and high (8). Poisson regression models with robust error variance estimated prevalence ratios (PRs) and 95% confidence intervals (CIs) for TI associated with MMAS-8 category.

Results:
Among 1,009 intensive arm participants with SBP >120 mm Hg at the 12-month visit (mean age 69.6 years, 35.2% female, 28.8% non-Hispanic Black), TI occurred in 50.8% of participants. Participants with low self-reported adherence (vs. high) were younger and more likely to be non-Hispanic Black or current smokers. The prevalence of TI among low, medium, and high adherence was 45.0%, 53.5%, and 50.4%, respectively. After adjustment, neither low nor medium adherence (vs. high) were associated with TI (PR 1.11; 95% CI 0.87,1.42, PR 1.08; 95% CI 0.84,1.38, respectively).

Conclusion:
Although clinician uncertainty about medication adherence is often cited as a reason for why antihypertensive intensification is withheld when the BP is above goal, we observed no evidence of an association between self-reported adherence to antihypertensive medication and TI.
Abstract 13632: Predictors of Death and/or Readmission in Extremely Elderly Patients Hospitalized for Decompensated Heart Failure
Authors: Targino Larissa M , Medeiros Douglas L , Darzé Eduardo S , Oliveira Queila B , Cordeiro Karina C , Ritt Luiz Eduardo F
Published: December 2023

Introduction:
Heart Failure (HF) is the final stage of cardiac illness, and it has become highly prevalent with the aging population. The extremely elderly population is underrepresented in HF clinical studies. This study aims to identify predictors of readmission and mortality in extremely elderly patients hospitalized for decompensated heart failure.

Research Question:
What are the predictors of readmission and mortality in extremely elderly patients hospitalized for decompensated heart failure?

Methods:
Retrospective cohort study in the model of a single-center registry including data from 2019 to 2022. The study was conducted at a private tertiary institution located in Salvador-BA, Brazil and included patients ≥ 80 years old admitted with a diagnosis of HF. Data was collected from electronic medical records and through follow-up performed 30 days after discharge, analyzed using descriptive statistics and compared by parametric or non-parametric tests, as appropriate. Multivariate analysis with logistic regression was performed to evaluate independent predictors of readmission and death from HF.

Results:
A total of 221 extremely elderly patients hospitalized for decompensated HF were included. There was a higher prevalence of females (57.4%), mean age of 87.6 ± 4.9 years, and mean Left Ventricular Ejection Fraction (LVEF) of 49.5 ± 17.1%. After 30 days, it was found that 14.9% of this sample had a death outcome and 16.7% were readmitted, totaling 28.1% of combined outcome (death and/or rehospitalization). The outcome group had older age (88.7 ± 4.6 years vs. 87.2 ± 4.9; p = 0.039), lower diastolic blood pressure (DBP) (74.8 ± 18.4 mmHg vs. 81.5 ± 15.6 mmHg; p = 0.007), higher rate of past ischemic stroke (30.6% vs. 13.2%; p = 0.002), and higher palliative care rate (27.4% vs. 3.2%; p = 0.001). In logistic regression, history of ischemic stroke [OR: 3.43 (CI: 1.30 - 9.05); p = 0.013], DBP [OR: 0.96 (CI: 0.93 - 0.99); p = 0.010], and palliative care [OR: 66.71 (CI: 8.18 - 543.66); p < 0.001] were independent risk factors for the combined outcome at 30 days.

Conclusion:
In extremely elderly patients admitted for heart failure, death or hospitalization at 30 days demonstrated an independent association with a history of ischemic stroke, DBP and palliative care.
Abstract 13641: Cardiovascular Safety of Sleeve Gastrectomy vs. Roux-en-Y Gastric Bypass
Authors: Suissa Karine , Schneeweiss Sebastian , Glynn Robert J , Tavakkoli Ali , Wexler Deborah , Patorno Elisabetta
Published: December 2023

Introduction:
Surgical treatment for obesity, a major risk factor for diabetes and cardiovascular disease, may lead to important improvements in cardiovascular health. Sleeve gastrectomy (SG) procedures have gained popularity over Roux-en-Y gastric bypass (RYGB), though it is unclear which procedure results in better cardiovascular (CV) outcomes. Our objective was to evaluate the comparative cardiovascular effectiveness of SG vs. RYGB for CV outcomes.

Methods:
Using two commercial claims databases, we identified a cohort of patients >18 years with a BMI ≥40 kg/m
2
, who underwent a SG or RYGB procedure between 2010 and 2023. Patients undergoing a SG were propensity-score (PS) matched 1:1 to RYGB patients, adjusting for >75 baseline covariates. Pooled hazard ratios (HR) and 95% confidence intervals (CI) were computed to assess the risk of a primary composite CV outcome, comprising of atherosclerotic CV events (myocardial infarction, stroke, coronary procedure, and unstable angina) and hospitalization for heart failure (HHF). Secondary outcomes were the individual components of the composite outcome and all-cause mortality. Subjects were followed until the first of occurrence of an outcome, end of patient data or enrollment or death.

Results:
A total of 30,375 patients undergoing SG were PS-matched to 30,375 patients undergoing RYGB and followed for a median of 1.5 years (IQR: 0.6, 2.8) (
Table 1
). Mean age was 46 years and 78% were female. Compared to RYGB, patients undergoing SG had a similar risk of the composite atherosclerotic outcome (HR: 1.03; 95% CI: 0.86, 1.23), a lower risk of HHF (HR: 0.78; 95% CI: 0.67, 0.93), and a lower risk of mortality (HR: 0.72; 95% CI: 0.58, 0.89).

Conclusions:
SG was associated with a similar risk of atherosclerotic cardiovascular outcomes and a lower risk of HHF compared to RYBG. In addition, SG was associated with a lower risk of mortality compared to RYGB.