bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 15247: Usefulness of Circulating Human Epididymis Protein 4 to Predict Outcomes After Transcatheter Aortic Valve Implantation
Authors: Giuliani Carlos , Sebastien Hecht , Nuche Jorge , Farjat Pasos Julio Ivan , Bernard Jeremy , Tastet Lionel , Abu-Alhayja'a Rami , Beaudoin Jonathan , Cote Nancy , De Larochelliere Robert , Paradis Jean-Michel , Clavel Marie-Annick A , Arsenault Benoit , Rodes-Cabau Josep , Pibarot Philippe
Published: December 2023

Introduction:
Plasma level of Human Epididymis protein 4 (HE4) has been shown to be associated with an increased risk of cardiac events in dilated and ischemic cardiomyopathies.

Hypothesis:
was to examine the prognostic value of HE4 in patients undergoing transcatheter aortic valve implantation (TAVI).

Methods:
Three hundred sixty-two patients (mean age: 79.6 ± 8.2 years; 57.3% men) undergoing TAVI for severe aortic stenosis were prospectively enrolled in this study. The cohort was divided into two groups according to the median value of pre-intervention HE4 plasma levels (115 pmol/l). The primary endpoints were: 1) all-cause mortality and rehospitalization for heart failure (HF), and 2) composite endpoints of rehospitalization for HF and all-cause mortality.

Results:
Patients with higher HE4 plasma levels were older (81.2 ± 7.8 years vs 78 ± 8.3 years, p<0.001) and presented with more global comorbidities (i.e.: diabetes mellitus, chronic heart failure, renal failure, Euroscore II, STS score and left ventricular ejection fraction; all p<0.05). During a median follow-up of 2.5 (1.9-3.2) years, 34 (9.4%) patients were rehospitalized for HF, 98 (27.3%) patients died and composite endpoint 113 (31%). The 4-year survival rate was significantly lower in patients with higher HE4 plasma levels (44% vs. 71%; p<0.001). In the multivariable Cox proportional hazard regression model adjusted for diabetes mellitus, chronic heart failure, coronary artery disease, chronic obstructive pulmonary disease, atrial fibrillation, Society of Thoracic Surgeons score, and left ventricular ejection fraction, patients with HE4 >115 pmol/l was associated with a markedly higher risk of all-cause mortality (HR [95%CI]: 3.32 [1.96-5.60], p<0.001). They also had higher 4-year rates of HF rehospitalization (13 vs 6%; log-rank p-value=0.015) and of the composite of HF rehospitalization and all-cause mortality (45 vs 18%; adjusted HR [95%CI]: 2.38 [1.50 - 3.78], p<0.001).

Conclusion:
Elevated HE4 plasma levels are independently associated with a higher risk of all-cause mortality and HF rehospitalization following TAVI. This novel biomarker may be useful to enhance risk stratification and therapeutic decision-making.
Abstract 15660: Mitral Regurgitation in Patients With Chronic Kidney Disease: Results From the Chronic Renal Insufficiency Cohort Study
Authors: JIN XUANYI , Chen Jing , He Hua , Zhao Cong , Van Dyke Lucy , Suayp Oygen , Alvarado Flor , Alper Arnold B , SWEENEY AARON , Bazzano Lydia A , Mills Katherine T , He Jiang
Published: December 2023

Background:
Mitral regurgitation (MR) is more common in patients with chronic kidney disease (CKD) compared to the general population, However, longitudinal associations of MR and adverse outcomes in CKD, such as mortality and heart failure (HF), have not been well studied yet.

Hypothesis/Aim:
We aim to investigate the prevalence of MR and its association with mortality, incidence of HF, and atrial fibrillation (AF) in patients with CKD.

Methods:
We studied patients with CKD who had an echocardiography exam (2008-2013) in the Chronic Renal Insufficiency Cohort (CRIC) study. Independent t-tests and Chi-square tests were used to compare clinical and echocardiographic characteristics in patients with vs. without MR. The degree of MR was quantified using effective regurgitant orifice area (EROA) from apical-four chamber view and further categorized as trace, mild and moderate/severe. Kaplan-Meier (KM) Curves and Cox hazard models were used to estimate the association of MR degree and EROA with mortality, incidence of HF and AF.

Results:
Among a total of 2951 patients with CKD, 2167 (73.4%) patients had MR (EROA, 0.14±0.19 cm
2
) with degrees of trace, mild, and moderate /severe MR comprising 54.3%, 12.5%, and 6.6%, respectively. Patients with MR were more likely to be female (47.39 vs. 42.73%), non-White race (51.8 vs. 46.8%), and have worse B-type Natriuretic Peptide (NTproBNP; 524.86 vs. 271.66 pg/ml) and left ventricular ejection fraction (53.7 vs. 55.8%) compared to those without MR. When stratified by estimated glomerular filtration rate (eGFR; 60-45, 45-30, <30

ml/min/1.73 m
2
), the group in the lowest eGFR category (n=703) had the highest prevalence of moderate/severe MR (9.2%,
p
<0.05). KM Curves showed patients with CKD and moderate/sever MR had higher incidence of HF and AF than those with CKD and absent, trace, or mild MR (
p
<0.01). EROA was associated with the incidence of AF (hazard ratio [HR] = 1.08,
p
<0.01) and HF (HR=1.06,
p
<0.01), independent of age, sex, race, traditional cardiovascular risk factors, urine albumin-to-creatinine ratio, eGFR and NTproBNP, but not mortality.

Conclusion:
In patients with CKD, MR is independently associated with HF and AF, highlighting the importance of MR-specific interventions to improve cardiovascular outcomes.
Abstract 15702: Leveraging Advanced AI Algorithms for Predicting Outcomes in Non-Acute Coronary Syndrome Chest Pain Patients
Authors: Valeri de Freitas Renata , Sousa Thiago , Fuziy Nogueira De Marchi Mariana , Ruiz Uemoto Vinicius , Hortegal Renato , Nakayama Ohe Louis N , Ribeiro Ramadan Hugo , Leite Rogerio , Damiani Lucas , Botelho Roberto , Feres Fausto , Franchini Kleber G
Published: December 2023

Introduction:
Chest pain is often encountered in emergency rooms and the detection of acute coronary syndrome (ACS) is a major focus. However, a notable percentage of patients present with a diverse range of nonACS conditions. Accurately identifying the causes and outcomes of these cases can prevent unnecessary interventions, reduce healthcare costs, and optimize resource allocation. This study aims to explore how advanced AI algorithms can enhance risk assessment, refine classification, and predict outcomes in nonACS chest pain patients using conventional ECG analysis.

Methods:
We studied 3458 nonACS patients referred to the Emergency Room at Instituto Dante Pazzanese de Cardiologia with chest pain. A total of 185 features, including sex, height, ECG diagnostic statements, and measures, were used. The predicted outcome was defined as hospitalization within 14 days and/or death (1 or 0). We employed the AutoGluon framework for feature engineering and early model selection. XGBoost, a tree-based model, was chosen as the architecture. Training and k-fold stratified cross-validation were performed using an oversampled balanced dataset, and evaluation metrics such as AUROC, specificity, and sensitivity were measured using the original data.

Results:
In this study, 18.2% (630 patients) had a positive outcome. The sex distribution was comparable between outcome groups, with men accounting for 57-58% and women for 42-43%. Significant differences (p<0.01) were observed in ECG intervals (QRS, corrected QT, RR interval, PSP) between the groups. The AI model identified important diagnostic statements, including normal ECG (19.4), atrial fibrillation (7.4), left ventricular hypertrophy (7.1), Ischemic T-wave inversion in inferior leads (6.7), T-wave changes in inferior leads (5.9), and first-degree atrioventricular block (5.8). The AI model performed exceptionally well, with a sensitivity of 97.93%, specificity of 96.08%, and an AUROC of 0.97.

Conclusions:
The AI model demonstrated its ability to predict outcomes in patients with acute chest pain without ACS, making it an appealing tool for effective risk stratification. The early identification provided by the AI model presents an opportunity for timely intervention to mitigate adverse outcomes.
Abstract 15738: Synthetic Data Generation for the Get With the Guidelines® Registry
Authors: Wang Lanjing , Picotte Holly , Beon Chandler D , Hall Jennifer L , Zhao Juan , Feng Xue
Published: December 2023

Introduction:
The American Heart Association (AHA) Get With The Guidelines® (GWTG) registry is a vital resource for cardiovascular/stroke research. Encompassing over 13 million records, the GWTG registry offers valuable insights into cardiovascular/stroke care and outcomes across more than 2,600 participating hospitals. However, the governance policies of the GWTG registry data limit use to academic researchers with approved manuscripts and funded awards.

Goal:
The goal of this project was to generate a synthetic dataset for the AHA GWTG registry data, aiming to increase accessibility while preserving data privacy. It provides researchers with the ability to explore the data format, variables and learn how to analyze the data on the AHA’s Precision Medicine Platform, which is a cloud-computing environment designed for researchers.

Methods:
Data was utilized from the GWTG Stroke registry from 2005 to 2021. We randomly sampled 1000 records from the registry and implemented a privacy-preserving data transformation process, which involved shifting datetime variables and replacing identifiable sensitive field values with randomly generated eight digit-numbers. We evaluated the synthetic data generation process by comparing distributions of patient demographics (age, race, gender) and time metric measures.

Results:
The original data from the GWTG Stroke registry includes 7.8 million individuals and 1233 columns with mean (SD) age of 69.56 (14.78) years (White 73.64%, Black 16.47%, Male 48.84%, and Female 51.1%). The synthetic data exhibits similar distributions compared to the original data (synthetic data: mean [SD] age, 69.61 [14.66] years, White 75.3% and Black 14.9%, Male 48.4%, and Female 51.6%). Moreover, all time differences are maintained, such as door-to-needle time, time to Intravenous Thrombolytic Therapy.

Conclusion:
This project demonstrates successful development and evaluation of synthetic data generation methods for the AHA GWTG registry. The synthetic data is accessible to researchers on the AHA’s Precision Medicine Platform, enabling broader access and analysis while preserving privacy to advance cardiovascular and stroke care research.
Abstract 15758: Platelet Aggregation is Elevated in Psoriasis and Associated With Cardiovascular Risk
Authors: Drenkova Kamelia , Mata Vivas Maria Teresa , Garelik Jessica , Lo Sicco Kristen , Neimann Andrea , Berger Jeffrey , Garshick Michael
Published: December 2023

Introduction:
Psoriasis is associated with increased CV risk the mechanisms and prevention of which are not fully known. We evaluated the platelet phenotype (implicated in atherothrombosis) and in vitro response to aspirin in patients with psoriasis and its association with vascular stiffness and coronary atherosclerosis.

Methods:
Patients with psoriasis (n = 64, age 47.9 ± 15 years, 65% male), percent body surface area (BSA) of psoriasis 3%, were compared to controls (n = 40, age 40.8 ± 16 years, 45% male). Percent platelet aggregation in response to agonists adenosine diphosphate (ADP), collagen (Col), and arachidonic acid (AA - with and without aspirin) was measured in freshly isolated platelet-rich plasma via light transmission aggregometry (LTA). Vascular stiffness (via pulse wave velocity [PWV]) and CT coronary angiography were each performed as readouts of CV risk.

Results:
Compared to controls, psoriasis patients were older, of Caucasian ethnicity (Figure 1A), and overweight, but otherwise similar. Platelet aggregation after treatment with Col (p=0.01), ADP (p < 0.01), and AA (p = 0.05) were all higher in psoriasis vs. control (Figure 1B-D). Platelet aggregation after activation with high dose AA was similar between groups (Figure 1E) however co-incubation with high dose AA plus aspirin displayed incomplete platelet inhibition of psoriasis platelets vs. controls (Figure 1F). Platelet aggregation to low dose AA and high dose AA plus aspirin co-incubation were each higher in those with enhanced vascular stiffness (figure 1G/1H) and the presence of coronary plaque (Figure 1I/1J).

Conclusion:
Platelet aggregation is consistently elevated in psoriasis across a variety of agonists, incompletely inhibited by aspirin, and associated with biomarkers of CV risk such as vascular stiffness and the presence of coronary plaque. These findings highlight the need to evaluate various anti-platelet strategies to reduce atherothrombotic risk in patients with psoriasis.
Abstract 15871: Clinical Characteristics Associated With Response to Exercise and Serious Adverse Events During Home-Based Walking Exercise in People With Lower Extremity Peripheral Artery Disease
Authors: Thangada Neela D , Zhang Dongxue , Tian Lu , Zhao Lihui , McDermott Mary M
Published: December 2023

Background:
Home-based walking exercise improves walking performance in people with lower extremity peripheral artery disease (PAD). However, whether clinical and sociodemographic factors, such as age, sex, race, comorbidities, and income, are associated with response to exercise or rates of serious adverse events (SAEs) during a home-based walking exercise intervention for PAD is unclear.

Methods:
Data from participants randomized to two clinical trials of home-based walking exercise for PAD were pooled. Both clinical trials used behavioral methods to help participants adhere to walking exercise up to 5 days/week for up to 50 minutes/session for 6-months. Outcomes were change in six-minute walk (6MW) at 6-months and rates of SAEs at 12-months. SAEs were defined as death or hospitalization.

Results:
325 unique participants [mean age 69.8 (9.1), 161 (49.5%) female, 182 (56.0%) Black] had available 6MW and SAE data. Home-based walking exercise improved 6MW distance, compared to control, at 6-month follow-up [mean: +46.4 meters (95% CI: +31.5 meters, 61.2 meters)]. The effect of home-based exercise on 6MW was similar across clinical and sociodemographic characteristics. 51 (27.3%) participants reported SAEs in the home-based exercise group and 32 (23.2%) reported SAEs in the control group (p=0.40). Among those randomized to home-based walking exercise, odds of SAE were significantly higher among Black compared to White participants, those with history of coronary artery disease (CAD) and heart failure (HF) compared to those without (Figure). Statistically significant interactions were identified between Black race (P<0.001), coronary artery disease (P=0.006) and lower income zipcodes (P=0.047) and the effect of exercise on rates of SAEs.

Conclusion:
In people with PAD randomized to home-based exercise, those who were Black, had a history of CAD or HF were significantly more likely to experience SAEs, compared to people without these characteristics.
Abstract 15882: Pulmonary Hypertension in Patients With ESRD and Arteriovenous Access Removal: A Necessary Evil?
Authors: Warner Eric , Corsi Douglas , Jimenez Diana , Brailovsky Yevgeniy , Oliveros Estefania , Alvarez Rene , Bhardwaj Anju , Rajapreyar Indranee
Published: December 2023

Introduction:
Pulmonary Hypertension (PH) is a common sequelae of arteriovenous fistulas (AVF) and grafts (AVG) due to the creation of shunt physiology and increased pulmonary blood flow. PH has been consistently associated with increased mortality but there is a paucity of data in regards to management.

Methods:
Using the United States Renal Data System, we identified all patients over age 18 initiated on dialysis from 2012-2019 who did not receive renal transplant. We identified a) predictors for the development of PH; b) analyzed survival for patients with PH who had their AVF or AVG removed.

Results:
We identified 478,896 patients initiated on dialysis from 2012-2019 of whom 27,787 (5.8%) had PH. The median age was 65 (IQR: 55-74) years and 59.1% were male. Reduced ejection fraction, any congestive heart failure, obstructive sleep apnea, and female sex were the strongest predictors of PH. AVG and AVF were also associated with an increased rate of PH relative to catheter-based dialysis (p<0.001). Among patients with PH, the removal of AVF or AVG was associated with significantly improved survival (p<0.001).

Conclusions:
Patients with AVA should be screened using echocardiography and those with PH should be strongly considered for AVA removal or revision.
Abstract 15922: Integrative Analysis of Extracellular Vesicles in Heart Transplant Rejection: From Biomarker Discovery to Novel Immune Mechanisms
Authors: Bagwell Monique S , Abbas Mohsin , Meenakshi Siddhartha Dhivya V , Mahlberg Ryan , Nagel Mary , Witt Tyra A , Stalboerger Paul , De Vitto Humberto , Behfar Atta
Published: December 2023

Introduction:
At the forefront of post-heart transplant care is early detection of transplant rejection. However, the current gold standard for detecting acute cellular transplant rejection is recurrent invasive endomyocardial biopsies (EMB). We aimed at developing a non-invasive biomarker for acute cellular heart transplant rejection (ACR) using a plasma extracellular vesicle (EV) platform.

Methods:
Peripheral and coronary sinus plasma samples were prospectively collected from 183 (31.7% female) patients from 2020 to 2023 during routine surveillance EMB. A discovery cohort comprised five patients who displayed ISHLT 0-1R biopsy followed by an ISHLT 2R grade rejection event. Plasma EVs were isolated from the baseline (0-1R) and rejection (2R) time points. Subsequently, integrative analysis of plasma EV proteomic, miRNomic, and metabolomics was performed pairwise with the samples.

Results:
The study collected 943 sample time points from 183 patients. Of these sample collections, 43 (4.5%) cases were 2R rejections. Our proteomic analysis of the plasma EVs identified 28 proteins found explicitly during a grade 2R rejection and 87 differentially expressed proteins during a 2R rejection event. An Ingenuity Pathway Analysis (IPA) analysis of the upregulated proteins highlighted EVs mediated mTOR signaling and antigen presentation as central to rejection events. Although all patients in the discovery cohort were negative for antibody-mediated rejection (AMR), the proteomic findings also revealed increased B-cell receptor signaling, implying a mechanistic intersection of ACR and AMR.

Conclusions:
A distinct set of proteins were found in plasma EVs during ACR events, providing potentially specific and sensitive biomarkers to reduce the need for EMB that could be exploited for ACR diagnosis. The proteins identified formed an immune signaling network that suggests a novel role for EVs in ACR pathogenesis.
Abstract 15939: Site of Origin Associated With Differences in Day-to-Day Variability of Premature Ventricular Contractions
Authors: Vanchiere Catherine , Narowska Gabriela , Garber Rebecca , Cooper Joshua M , Cronin Edmond
Published: December 2023

Background
Premature ventricular contractions (PVC) from the ventricular outflow tracts are well characterized, but there is limited literature to describe how other sites of origin (SOO) correlate with clinical and electrophysiologic characteristics.

Methods
We analyzed single lead ambulatory loop monitors (Zio, iRhythm, San Francisco, CA) from 1/2017-3/2020 (n=581) at a single institution. All included subjects had a PVC burden >1% and monitoring period of >72 hours. Twelve-lead ECG of the PVC for each subject was reviewed by an electrophysiologist to identify the SOO. Demographic information, clinical presentation, and cardiac testing results were collected from the electronic medical record. Those without a PVC captured on ECG or with atrial fibrillation or flutter were excluded. Analysis was performed via calculation of odds ratios for presence of dichotomous characteristics and two-tailed t-tests for comparison of means, stratified by outflow tract (OT) versus non-OT SOO and perivalvular (PV) versus non-PV SOO.

Results
Of 39 subjects who met criteria for inclusion, stratified by SOO (analysis 1: OT (n=18), non-OT (n=21), analysis 2: PV (n=30), non-PV (n=9)), there were no significant differences in the odds of developing certain symptoms or exhibiting certain PVC characteristics. PVCs from OT vs. non-OT and PV vs. non-PV locations had similar burden and numbers of single PVCs, couplets, and triplets. Odds of reporting symptoms were higher with OT than non-OT PVCs (OR 1.49, 95% CI 0.86 - 2.58) and with PV than non-PV PVCs (OR 1.70, 95% CI 0.85 - 3.41). PVC-Native QRS Duration index was no different between SOO groups. Day-to-day variability of PVC burden was higher in OT vs. non-OT SOO (p=0.08), with no difference in PV vs. non-PV SOO (p=0.90). Odds of RV dysfunction were higher in PV vs. non-PV SOO (OR 8, 95% CI 1.54 - 41.64). Coupling interval was longer in non-PV PVCs vs. PV PVCs (n=29, p=0.02).

Discussion
Electrophysiologic characteristics of PVCs from different sites of origin were similar, suggesting common mechanisms. OT PVCs exhibited more day-to-day variability, emphasizing the need for extended monitoring to characterize true PVC burden. Exploratory analysis by SOO suggests more frequent symptoms with OT PVCs, and RV dysfunction with non-PV SOO.
Abstract 15999: Proportional Pulse Pressure and Shock Index as Predictors of Cardiac Index in Patients With Intermediate-Risk Pulmonary Embolism
Authors: Alviar Carlos L , Postelnicu Radu , Padilla-Lopez Mireia , Zhang Robert , Alam Usman , Elbaum Lindsay , Tarabanis Constantine , Grossman Kelsey , Singh Arushi , Greco Allison , Hena Kerry , Mukherjee Vikramjit , Hall Sylvie , Harari Rafael , Keller Norma , Bangalore Sripal
Published: December 2023

Background:
Risk stratification in intermediate-risk pulmonary embolism (PE) plays an important role in appropriate selection of therapies, however this is often challenging given variable phenotype. Proportional pulse pressure (PPP) and shock index (SI) have demonstrated to accurately predict cardiac index (CI) in patients with cardiogenic shock. Nonetheless, their applicability to patients with acute PE remains uncertain. Our objective is to investigate whether PPP and SI correlate with invasive assessment of CI in intermediate-risk PE.

Methods:
We retrospectively analyzed patients included in the Pulmonary Embolism Response Team (PERT) registry at NYCH+H/Bellevue who underwent invasive hemodynamic assessment. PPP was calculated as systolic blood pressure - diastolic blood pressure/systolic blood pressure. SI was calculated as heart rate/systolic blood pressure. Linear regression and correlation coefficients were used to examine the relationship between PPP, SI and CI as well as other clinical variables.

Results:
A total of 45 intermediate-risk PE patients were included (mean age was 57 ± 13 years and 43% were female). The SI moderately correlated with the composite pulmonary embolism shock score (CPES) (r = 0.5, p=0.0002), sPESI (r = 0.37, p=0.007), cardiac index (-0.42, p=0.004) and poorly correlated with lactate levels (r=0.23, p=0.18). PPP correlated poorly with CPES (r = 0.01, p=0.96), sPESI (r = -0.04, p=0.73), CI (r = 0.1 p=0.51) and lactate (-0.18, p=0.2). There was poor correlation between SI and PPP (r = -0.17, p=0.23). For every 0.1 increase in the shock index, the cardiac index was lower by 0.17L/minute/m
2
(p=0.017).

Conclusions:
In patients with intermediate-risk PE, a higher SI was associated with a lower CI, while PPP was not associated with CI. SI may provide additional valuable information to risk-stratify patients with acute PE and can potentially assist clinicians in triaging monitoring level therapeutic decisions.
Abstract 16132: Cardiometabolic Risk Factors and Non-Culprit Plaque Characteristics in Patients With STEMI in REAL-TIMI 63B
Authors: Abdelrahman Khaled , Bergmark Brian A , Park Jeong-Gun , Vavere Andrea , George Richard , Hoffmann Udo , Sabatine Marc S , Morrow David , Bonaca Marc P
Published: December 2023

Introduction:
Greater non-calcified plaque volume (NCPV) measured by coronary CT angiography (CCTA) is associated with higher risk of future myocardial infarction in stable patients. However, NCPV and associations with clinical characteristics in patients presenting with a first acute STEMI are not well described.

Methods:
The REAL-TIMI 63B trial randomized 593 patients with no prior MI presenting with acute STEMI to intravenous recombinant human lecithin-cholesterol acyltransferase (MEDI6012) or placebo; a subset were to undergo CCTA 48-72h after STEMI. Global NCPV, low-attenuation PV (LAPV), and calcified PV (CPV) were measured by a centralized core laboratory blinded to treatment arm. Revascularized segments were excluded from coronary plaque quantification.

Results:
188 patients had a CCTA performed at baseline. Of these, 80.3% had NCPV and 77.4% had LAPV outside of the revascularized segments. Median NCPV was 28.4mm
3
[IQR 1.4-92.1], LAPV 3.8mm
3
[0.1-14.9], and CPV 92.4mm
3
[22.6-201.8]. Among the characteristics examined, male vs. female sex (51.3 mm
3
[3.47-100.3] vs 5.6 mm
3
[0.0-17.3]; p=0.0003), BMI >25 kg/m
2
(overweight or obese) (41.20 mm
3
[2.01-104.50] vs 10.98 mm
3
(0.0-61.5); p=0.01) and diabetes (82.6 mm
3
[59.0-123.4] vs 24.2 mm
3
[1.21-85.2]; p=0.038) were associated with greater NCPV (Figure).

Conclusions:
Among patients with no prior MI undergoing primary PCI for STEMI, we found that most patients had NCPV and LAPV outside the culprit lesion. Male sex and markers of cardiometabolic disease including higher BMI and diabetes were associated with a greater burden of NCPV. These observations underscore the need for intensive medical therapies that may stabilize vulnerable plaque in patients presenting with acute myocardial infarction.
Abstract 16196: E/e' Predicts Exercise Capacity in Participants Undergoing Exercise Stress Test
Authors: Patil Pooja , Lin Emily , PURVIS ADAM , Harrison Kara , Toy Kevin , Patel Amit , Bilchick Kenneth , Mehta Nishaki M , Breathett Khadijah , Kwon Younghoon , Mazimba Sula
Published: December 2023

Introduction:
The ratio of early transmitral flow velocity (E) to early diastolic mitral annular velocity (e’) is a surrogate for left ventricular (LV) filling pressure. Post-stress E/e’ has been shown to predict exercise capacity, but few studies have investigated this correlation with baseline E/e’. Our aim was to evaluate the relationship between baseline E/e’ and exercise capacity during stress test.

Methods:
All patients undergoing exercise stress testing at University of Virginia from 1/2015 through 9/2015 with the required echo data were included in this study. E/e’ was categorized into quartiles. ANOVA was used to evaluate the relationship between quartiles of E/e’ and exercise duration or METS. Multivariate linear regression was used to adjust for the variables: age, sex, ejection fraction, systolic blood pressure, heart rate, and regional wall motion abnormalities.

Results:
Baseline characteristics of the 312 participants based on E/e’ quartiles are shown in Table 1; those with higher E/e’, on average, had higher baseline SBP, were older, and had a higher percentage of females. There was a significant difference in exercise duration and METS between E/e’ quartiles (Table 2A) [p < 0.001]. There was an inverse correlation between E/e’ and exercise capacity; the significance was more pronounced with increasing E/e’ (Table 2A) and was present even after adjusting for multiple covariates (Table 2B).

Conclusions:
Baseline E/e’ correlates with exercise capacity (both duration of exercise and total METS achieved). This suggests that elevated LV filling pressures at rest can predict exercise capacity and may be targeted in future studies to improve exercise tolerance.
Abstract 16269: Heart Failure With Preserved Ejection Fraction and Sudden Cardiac Death in the General Population
Authors: Cyr Kevin J , Reinier Kyndaron , Uy-Evanado Audrey , Jui Jonathan , Chugh Sumeet S
Published: December 2023

Background:
Published data indicate that 50% of individuals with heart failure and reduced ejection fraction (HFrEF) suffer sudden cardiac death (SCD), however the burden of SCD in heart failure with preserved ejection fraction (HFpEF) remains inconclusive.

Aim: Determine the prevalence of HFpEF in a community-based cohort of SCD.

Methods:
We prospectively identified cases with out-of-hospital SCD in a large metro area of the US Northwest (Pop. 1 million, 2002-2017) and determined HF status prior to SCD based on review of clinical records. Heart failure was subdivided into HFpEF (EF≥50%), HFmrEF (EF 40%-50%), and HFrEF (EF≤40%). In addition, since HFpEF is often underdiagnosed, we evaluated a modified H2FPEF algorithm for the identification of HFpEF among our SCD cohort with unknown HF subtypes. The score was comprised of clinical variables including age, BMI, atrial fibrillation, hypertension, and myocardial infarction. Score accuracy was assessed using receiver operating characteristic (ROC) analysis comparing known HFpEF from clinical records and echocardiography versus non-HF subjects. Next, the score was used to identify missing HFpEF cases within the HF and SCD population.

Results:
Among 4,683 total SCD cases, 1,013 (22%) had a clinical history of HF. Prevalence of HF sub-types was 42% for HFpEF, 19% for HFmEF and 39% for HFrEF cases. An algorithm score of 5 or greater differentiated HFpEF subjects from non-HF subjects with an AUC of 0.68 (p < 0.01). The algorithm was then deployed on cases with an unknown heart failure subtype and an additional 117 HFpEF subjects were identified. The adjusted total prevalence of HFpEF was 542 subjects (53%) in the SCD the cohort with HF.

Conclusion:
At least 40% of the SCD cases with HF carry a diagnosis of HFpEF, and our estimates suggest the prevalence may be as high as 53%. Ultimately, these findings highlight the need to develop effective options for primary prevention of SCD in HFpEF patients.
Abstract 16293: Subsequent Pregnancies and Long-Term Cardiac Outcomes Among Patients With Prior Peripartum Cardiomyopathy in Kaiser Permanente Northern California
Authors: Choo Monica S , Fairman Alix P , Xu Richie Houhong , Joshi Nikhil , Stephenson Megan , Gunderson Erica P , Pursnani Seema
Published: December 2023

Introduction:
Current recommendations for subsequent pregnancies after peripartum cardiomyopathy (PPCM) have been based on previously reported ~30% recurrence rates of PPCM, but evidence has evolved along with clinical practice.

Research Questions:
What is the incidence of repeat pregnancy in patients with PPCM, and what are cardiac outcomes during and after subsequent pregnancies?

Methods:
Retrospective study of subsequent pregnancies among 110 pregnant patients identified with a confirmed diagnosis of peripartum cardiomyopathy (PPCM) between 1995-2004 in a Kaiser Permanente Norther California (KPNC) cohort.

Results:
Among 110 women with a diagnosis of PPCM, there were 58 subsequent pregnancies, including 23 live births in 16 women (15%), and 35 therapeutic or spontaneous abortions in 24 women (21%) over a follow-up period of up to 26 years. The live births included one birth for 11 women, two births for 3 women, and three births for 2 women. Among the 32 women with subsequent pregnancies, there was no maternal mortality or need for advanced mechanical circulatory support. There was 1 woman with relapse of PPCM in subsequent pregnancy, with left ventricular ejection fraction (LVEF) improvement at the latest follow up. There was no significant differences in LVEF at the latest available echocardiogram among those women with and without subsequent live birth pregnancies (Table 1, X
2
-value 0.901, p=0.95). Only 2 women, both with no documented subsequent pregnancy, had persistent severe LV systolic dysfunction at the end of follow-up.

Conclusions:
In the KPNC cohort, most patients with PPCM recovered LV function and there were no significant differences in LVEF among those women with and without subsequent live birth pregnancy.
Abstract 16391: Pro-Neoplastic Properties of Small Extracellular Vesicles From Failing Hearts
Authors: Caller Tal , Rotem Itai , Shaihov–Teper Olga , Lendengolts Daria , Schary Yeshai , Shai Ruty , Glick-Saar Efrat , Dominissini Dan , Boomgarden Alex , D'Souza-Schorey Crislyn , Naftali Shani Nili , Leor Jonathan
Published: December 2023

Background:
Heart diseases are associated with an increased incidence of cancer independently of shared risk factors. The mechanism beyond this link is complex, unclear and limits our ability to develop effective therapies. We aimed to test the hypothesis that small cardiac extracellular vesicles (sEVs) contribute to the link between HF and cancer.

Methods & Results:
We used mouse models of heterotopic and orthotopic lung cancer and post-myocardial infarction (MI) heart failure (HF). sEVs were isolated by size exclusion chromatography. To determine the role of cardiac EVs in tumor growth, we focused on sEVs from cardiac mesenchymal stromal cells (cMSCs). cMSCs after MI secreted twice more sEVs, characterized with a unique proteome, compared with cMSCs from sham-MI (
Fig 1A
). cMSC-sEVs from post-MI HF harbored more tumor-promoting cytokines and microRNA (miR), such as periostin, osteopontin, IL-6, TNFα, galectin-3, and miR's 221 and 21. The pro-neoplastic effects of cMSC-sEVs on cancer cells were depended on cancer type, with a marked increase in proliferation and migration of lung and colon cancer cells but only a modest increase with more malignant triple-negative breast and melanoma cancer cells. Next, we inoculated lung cancer cells into mice and found that post-MI HF accelerated tumor growth. Furthermore, adoptive transfer of cMSC-sEVs from failing hearts accelerated tumor growth with and without systemic EV depletion (
Fig 1B
). Finally, we found that spironolactone mitigated the neoplastic effects of HF, attenuated tumor growth (
Fig 1C
), and reduced the number of cMSC-sEVs by 26%.

Conclusions:
We show, for the first time, that cardiac extracellular vesicles from post-MI failing heart harbor pro-neoplastic properties and promote tumor growth independently of other secreted factors. Spironolactone reduces the number of cardiac extracellular vesicles and the pro-neoplastic effects of post-MI heart failure.
Abstract 16493: An Evaluation of Heart Failure Management in the Non-White Population at a Safety Net Hospital Compared to a National Registry
Authors: Martinez Margarita , Barforoshi Shiva , Jaalouk Emily , Miller Sophie , Aguilar Jack , Chand Robin
Published: December 2023

Introduction:
The importance of guideline-directed medical therapy (GDMT) to improve outcomes in patients with heart failure has been proven in multiple studies. However, providers still fall short in prescribing these medications to heart failure patients. This is reflected in the CHAMP-HF registry, one of the largest registries utilized to observe and analyze the use of GDMT for heart failure. The CHAMP-HF registry population includes 3,518 patients from 150 U.S. primary care and cardiology practices. Of this population, approximately 25.1% are non-White. It remains unclear what GDMT treatment patterns are in a majority non-White population.

Objective:
This study aims to compare GDMT treatment patterns for heart failure at Harbor-UCLA Heart Failure (HUCLA HF) clinic, with a majority-minority population, to the CHAMP-HF registry published data.

Methods:
This prospective cohort study followed patients who visited the HUCLA HF clinic over four months. Providers used a checklist to prompt them to review each patient’s GDMT at the end of each visit. Patient demographic data and checklist data were entered into the HUCLA HF clinic registry. The registry was used to analyze the utilization of angiotensin-converting enzyme inhibitor (ACEI)/angiotensin II receptor blocker (ARB), angiotensin receptor neprilysin inhibitor (ARNI), beta-blocker, and mineralocorticoid receptor antagonist (MRA). The percentage of patients using GDMT was compared to those in the CHAMP-HF registry.

Results:
Overall, the HUCLA HF clinic registry revealed a majority-minority patient population with about 91% of patients classified as non-White patients. The HUCLA HF clinic patients had a higher percentage on max ACE/ARB (21% vs 15.7%), max ARNI therapy (42% vs 13.8%), max beta-blocker therapy (47% vs 15.5%), and max MRA therapy (70% vs 14.5%) compared to the non-White population in the CHAMP-HF registry, respectfully.

Conclusions:
This study demonstrates greater utilization of GDMT at the HUCLA HF clinic compared to the patients in the CHAMP-HF registry. This difference was likely due to the checklist that reminded the provider to review the GDMT at each visit. Strategies that prompt clinicians to review GDMT must be implemented to maximize its use.
Abstract 16540: Left Ventricular Longitudinal Strain Analysis Using Four-Dimensional Computed Tomography for the Detection of Apical Sparing in Cardiac Amyloidosis
Authors: Makiko Kinoshita , Takaoka Hiroyuki , Ota Joji , Aoki Shuhei , Suzuki Katsuya , Yashima Satomi , Yoshida Kazuki , Sasaki Haruka , Eguchi Noriko , Kobayashi Yoshio
Published: December 2023

Introduction:
Cardiac computed tomography (CT) not only allows for coronary artery evaluation but also enables myocardial assessment, including left ventricular (LV) ejection fraction (LVEF) and extracellular volume fraction. Advanced software makes it possible to analyze LV longitudinal strain (LS) on CT (Figures A and B).

Hypothesis:
LS analysis using four-dimensional cardiac CT is helpful for the differential diagnosis of LV hypertrophied myocardial diseases and detect cardiac amyloidosis (CA).

Methods:
We analyzed 45 patients with LV hypertrophied myocardial diseases who underwent cardiac CT using 256-detector row or 320-detector row CT in our institutions since 2009. Fifteen patients of them were diagnosed with CA (69 ± 9 years, 12 males), the other 15 patients were diagnosed with hypertrophic cardiomyopathy (HCM) (63 ± 16 years, nine males), and the rest of the 15 patients were diagnosed with aortic valve stenosis (AS) (83 ± 8 years, seven males). We analyzed LV global LS (GLS) and segmental LS using specific software and four-dimensional CT data. We evaluated relative apical LS as the value dividing the average LS of apical segments by the sum of the average LS of basal segments and mid-ventricular segments (Figure C). If the value was ≥ 1, apical sparing was defined as present. We compared the LS data and the percentage of apical sparing among those three myocardial diseases.

Results:
There was no significant difference in LVEF among the three groups (54 ± 12%, 58 ± 13%, and 50 ± 18%, respectively; P = 0.39). There was no significant difference in LV global LS among the three groups (-12.2 ± 3.2%, -11.2 ± 5.0%, and -11.0 ± 5.4%, respectively; P = 0.75). Apical sparing was observed in 6 cases (40%) of CA, which was significantly higher than in one case (7%) of HCM or AS (P = 0.02).

Conclusions:
Advanced image analysis software has made LVLS analysis by cardiac CT possible. It is considered helpful in detecting apical sparing, specifically in CA.
Abstract 16581: Impact of Drug Eluting Stent Deployment and Calcification on Worsening Target Lesion Failure in Femoropopliteal Lesions
Authors: Azumi Yuta , Nakama Tatsuya
Published: December 2023

Introduction:
Endovascular therapy (EVT) with drug coated balloon (DCB) has been proven superior to balloon angioplasty only in the patency rate. EVT with drug eluting stent (DES) also has shown to be superior to balloon angioplasty only or implantation of bare metal stents. Primary patency of EVT in femoropopliteal lesions (FP-EVT) for DES and DCB is around 80%-90% at 12 months respectively. Therefore, the use of drug technology for FP-EVT is reasonable and generally accepted. However, in daily clinical practice, some target lesion failure (TLF) cases show worse clinical and/or angiographic conditions than the original before the intervention, and many of those cases have bad outcomes. There are no reports on predictors of the worse condition.

Methods:
A total of 292 consecutive FP lesions of 194 patients who visited our hospital from April 2017 to March 2021 and underwent FP-EVT with drug technologies (DES: 104, DCB: 188) were retrospectively reviewed. "Worsening target lesion failure (WTLF)" was defined as TLF with acute limb ischemia symptom or occlusion of the lesion which had been stenosis at the initial treatment. We investigated the predictor of WTLF.

Results:
The mean age of all study patients was 72.5±9.3 years and 68% were male. During the follow-up period (median: 568 days), 13 WTLFs were observed. 9 (8.7%) cases were treated with DES and 4 (2.1%) were with DCB at the initial treatment (p=0.01). Cases with WTLF had severer and longer calcification (bilateral calcification: 84.6% vs. 47.7%, p=0.007; calcium length: 162±74mm vs. 85±11mm, p=0.005). Multivariate Cox regression analysis indicated that DES use (Hazard ratio (HR)=4.66, 95% confidence interval [1.28-16.92], p=0.046) and bilateral calcification (HR=7.21, [1.04-50.14], p=0.020) were independently associated with the occurrence of the WTLF. The prevalence of composite outcome, major amputations and all cause deaths, was 54% in the group with WTLF, which was higher than the group without WTLF (p=0.02).

Conclusions:
Patients with WTLF had bad outcomes. Bilateral calcification and DES deployment were associated with an increased risk for WTLF. For stenotic lesions with bilateral calcification, it may be better to avoid DES deployment.
Abstract 16636: Correlation Between Interatrial Block Detected by High-Resolution Electrocardiography and Echocardiographic Markers of Left Atrial Cardiomyopathy
Authors: Barcos Javier C , Humphreys Juan D , Tello Santacruz Iván A , Fernandez Recalde Maria Luz , Guzman Juan Pablo , Cáceres Monié César R
Published: December 2023

Introduction:
Left atrial cardiomyopathy (LACM) involves electromechanical changes in the left atrium (LA) and is linked to atrial fibrillation (AF) and embolic stroke. Several diagnostic ECG and transthoracic echocardiogram (TTE) parameters have been suggested, but information about their interrelationship is limited.

Hypothesis:
To evaluate if partial or advanced interatrial block (IAB) using high-resolution 12-lead ECG (HR-ECG) is related to TTE indicators of LACM.

Methods:
A retrospective analysis of consecutive patients aged over 18 was performed. The evaluation included HR-ECG (signal-averaging technique, ≥ 200 cycles, QRS-triggered, 0.25-262 Hz bandwidth, 1000 samples/sec) and TTE. Exclusion criteria: AF, pacemaker/ICD carriers, heart surgery history, poor ultrasound window, or significant ECG noise. Inferior leads (DII, DIII, aVF) classified patients into three groups: no IAB, partial IAB (P wave ≥ 120 ms), and advanced IAB (typical/atypical patterns with negative aVF terminal component). TTE parameters of LACM considered were LA volume indexed to body surface area (LAVI), PA-TDI (surface ECG onset P wave to A' peak of LA lateral wall on Tissue-Doppler Imaging), and PALS (peak atrial longitudinal strain) during reservoir phase.

Results:
Of 851 patients, 533 met the inclusion criteria. Both IAB groups had a higher prevalence of TTE indicators of LACM (Table 1), and a statistically significant correlation was found between P wave duration (PWD) and TTE markers of LACM (Figure 1).

Conclusions:
Patients with partial or advanced IAB (assessed by HR-ECG) show a higher prevalence of TTE markers of LACM and a significant correlation between PWD, LAVI, PA-TDI, and PALS.
Unraveling neural complexity: Exploring brain entropy to yield mechanistic insight in neuromodulation therapies for tobacco use disorder
Authors: Jordan Timothy , Apostol Michael R. , Nomi Jason , Petersen Nicole
Published: December 2023

Neuromodulation therapies, such as repetitive transcranial magnetic stimulation (rTMS), have shown promise as treatments for tobacco use disorder (TUD). However, the underlying mechanisms of these therapies remain unclear, which may hamper optimization and personalization efforts. In this study, we investigated alteration of brain entropy as a potential mechanism underlying the neural effects of noninvasive brain stimulation by rTMS in people with TUD. We employed sample entropy (SampEn) to quantify the complexity and predictability of brain activity measured using resting-state fMRI data. Our study design included a randomized single-blind study with 42 participants who underwent 2 data collection sessions. During each session, participants received high-frequency (10 Hz) stimulation to the dorsolateral prefrontal cortex (dlPFC) or a control region (visual cortex), and resting-state fMRI scans were acquired before and after rTMS. Our findings revealed that individuals who smoke exhibited higher baseline SampEn throughout the brain as compared to previously-published SampEn measurements in control participants. Furthermore, high-frequency rTMS to the dlPFC but not the control region reduced SampEn in the insula and dlPFC, regions implicated in TUD, and also reduced self-reported cigarette craving. These results suggest that brain entropy may serve as a potential biomarker for effects of rTMS, and provide insight into the neural mechanisms underlying rTMS effects on smoking cessation. Our study contributes to the growing understanding of brain-based interventions for TUD by highlighting the relevance of brain entropy in characterizing neural activity patterns associated with smoking. The observed reductions in entropy following dlPFC-targeted rTMS suggest a potential mechanism for the therapeutic effects of this intervention. These findings support the use of neuroimaging techniques to investigate the use of neuromodulation therapies for TUD.
Greedy for Effect: The Historiography of US Naval Logistics and the Pacific War
Authors: Klug Jonathan P.
Published: December 2023

Naval and military historians have generally not focused on logistics, and this is true for Second World War naval historians and, more specifically, for United States Navy logistics of the Pacific War (1941–45). Naval logistics deserves more serious study as they circumscribe what surface fleets can accomplish. Recently, historians have started to treat this topic as an integral part of naval strategy, operations, and tactics, which is a step in the right direction. This article explores the current state of historical literature and demonstrates that further historical inquiry is necessary – the topic deserves more attention from historians and, indeed, today’s navies.
Developing Strengths or Remedying Weaknesses? How Perceived Social Mobility Affects Parents’ Purchase Preferences for Children's Educational Products
Authors: Chen Qihui , Wang Yajin , Zhang Ying
Published: December 2023

Does parents’ status motivation affect their educational product choices for their children? Across seven studies, the authors find that when parents believe that society provides enough opportunities for individuals to achieve higher social status through hard work (i.e., high social mobility), they prioritize the status advancement goal and prefer products that help maximize a child's strengths. However, when parents believe that even if one works hard, the opportunity to climb up the social ladder is limited (i.e., low social mobility), they focus on maintaining their current status and prefer products that help remedy a child's weaknesses. Moreover, the research demonstrates that this effect diminishes when the strength and weakness are in the domains that have low relevance to status. Finally, the research shows that when parents believe that children with specialties are more likely to succeed, they prefer products for maximizing strengths, whereas when they believe that well-rounded children are more likely to succeed, they prefer products for remedying weaknesses, regardless of their perception of social mobility.