bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 11190: Subgroup Comparison of Electrocardiogram Deep-Learning Model Performance for Estimating Coronary Artery Calcium Score
Authors: Yoo Hakje , Hwang Sung Ho , Yum Yunjin , Kim Jong-ho , Joo Hyung Joon J
Published: June 2023

Introduction:
Despite the clinical usefulness of Coronary artery calcium score (CACS), it is difficult to use it as a routine practice due to its high cost and radiation hazard. Recently, several deep learning (DL) models to estimate CACS using 12-lead electrocardiography (ECG) have been introduced. However, their performance has not been compared among different patient groups. This study compared the performance of DL models to estimate CACS in different patient groups.

Methods:
The data of 5,427 patients who underwent both CT scan and 12-lead ECG at Korea University Anam Hospital from November 2012 to December 2021 was split into 80% training set and 20% test set. CNN-based DL model for predicting CACS ≥ 1 and CACS ≥ 100 using the raw ECG waveforms and several clinical factors as input was developed.

Results:
The DL model showed comparable performance for CACS estimation in the test dataset (area under the receiver operating characteristics curves [AUROCs] 0.77 for CACS ≥ 1 and 0.82 for CACS ≥ 100). The DL model showed better performance in patients with cardiovascular risks less than 3 compared to patients with cardiovascular risks more than 3 (AUROC 0.75 vs 0.71 for CACS ≥ 1, 0.77 vs 0.71 for CACS ≥ 100, Table 1). Among subgroups, the elderly (age > 65 year-old) showed the lowest performance (AUROC 0.72 for both CACS ≥ 1 and ≥ 100). Interestingly, the model performance predicting CACS ≥ 1 is better in patients with normal sinus rhythm, whereas the model performance predicting CACS ≥ 100 is better in patients with non-normal sinus rhythm. This suggests that normal ECG can better predict healthy condition and abnormal ECG can better predict pathological condition.

Conclusions:
The performance of CACS estimation DL model could depend on the patient's cardiovascular risk factors. When applying the DL model to actual clinical practice, it is necessary to consider the performance of the DL model for the patient group to be applied and to selectively apply the appropriate DL model.
Abstract 11196: Germline Mutation in Plakophilin 2 and Associated Hypertrophic Cardiomyopathy: Clinical Debate of Nascent Pleomorphism and Pleotropism
Authors: Vallabhajosyula Saarwaani , baibhav bipul
Published: June 2023

Introduction:
Arrhythmogenic cardiomyopathy(ACM) is often not seen until adolescence or early childhood. Electric abnormalities usually precede the structural remodeling visible on cardiac imaging.

Clinical case:
31-year-old male with asthma and hypertension presented to the ED with palpitations and was in atrial fibrillation with rapid ventricular response. He was treated with diltiazem and converted to sinus rhythm. TTE performed showed basal septal hypertrophy with hypercontractile LV. He was discharged on beta-blocker and anticoagulation. Few days after, he reported lightheadedness and syncopal spells after starting on beta-blocker therapy, and orthostatic by nature. ECG revealed sinus rhythm, left ventricular hypertrophy and inferolateral deep T wave inversions. Family history was revealing for HCM in father and grandmother, but no genetic conditions or sudden cardiac deaths. Stress TTE with diltiazem use showed no LVOT obstruction at rest or after exercise. Cardiac MRI revealed asymmetric basal septal hypertrophy with max thickness of 1.5 cm. Dynamic LVOT obstruction was seen with anomalous insertion of papillary muscle into mid-anterior portion of anterior mitral leaflet. LV was hypercontractile with EF 85%, and no evidence of fibrosis. RV was normal in size/function without abnormal wall motion. Holter monitoring was unremarkable. Cardiomyopathy/arrhythmia multigene panel testing surprisingly showed a heterozygous plakophilin-2(PKP2) pathogenic germline mutation c.1689-1G>C, pathogenic for ARVC.

Conclusion:
Based on current guidelines, he would not have ACM and begs the question of management in patients with positive ACM genetics, but no ACM-related disease expression. The underlining question would be the clinical significance and evolution of such detected mutations, and given the current paucity in evidence, we share your enthusiasm in learning more about this patient’s future clinical trajectory.
Abstract 11222: Differential Perivascular Adipose Response to Metabolic Challenge Leads to Sexually Dimorphic Cardiovascular Impairment in Early Prediabetes: Possible Role of Estrogen
Authors: Dwaib Haneen , Mougharbil Nahed , Obeid Omar , El-Yazbi Ahmed
Published: June 2023

Cardiovascular (CV) risk associated with metabolic dysfunction commences in early stages preceding the emergence of diagnostic markers. In this regard, a protective role of female sex hormones has been observed where males and postmenopausal females are at a higher risk of these complications. Our previous work on non-obese insulin resistant male rats revealed a crucial role for perivascular adipose tissue (PVAT) inflammation in developing CV dysfunction in early prediabetes. This resulted from PVAT hypoxia evoked by increased uncoupling protein 1 (UCP1) expression and adipocyte hypertrophy in response to a dietary metabolic challenge of mild hypercaloric (MHC) feeding .
Here, we examined whether estrogen modulated MHC-induced PVAT dysfunction and its CV consequences.
Male and female Sprague-Dawley rats (4-5weeks) were randomly allocated into 2 dietary groups: control or MHC diet for 24 weeks. To control for estrogen effect, bilateral ovariectomy was performed on female rat sub-groups after 12 weeks of feeding with or without daily treatment with an oral dose of 17 β -estradiol (E2) of 2.8 μg/ 100 gm of body weight for an additional 12 weeks. Daily food intake, body weight, body composition, blood glucose and insulin levels, echocardiographic parameters, and blood pressure were measured. At week 24; rats were catheterized for invasive hemodynamic examination. Cardiac autonomic neuropathy was assessed by measuring baroreceptor sensitivity using the vasoactive method. After sacrifice, aortic contractility and endothelial function were examined and molecular investigation were performed. Indeed, the absence of endogenous E2 seemed to precipitate an obese phenotype in MHC-fed female rats and instigate CV impairment together with hallmarks of early PVAT dysfunction reminiscent of those observed in male rats. Intriguingly, E2 replacement restored the protective phenotype observed in intact females. E2 treatment mitigated PVAT inflammation without affecting UCP1 expression levels possibly suggesting a direct anti-inflammatory role. Our results present a novel framework for the protective role of E2 interrupting the inflammatory machinery in PVAT, as well as the subsequent CV dysfunction in presence of a dietary metabolic challenge.
Abstract 11254: Impact of Transfer Status on Non-St Segment Elevation Myocardial Infarction Outcomes
Authors: Gill Ahmad , Al-Taweel Omar , Al-Tarawneh Saba , Jaradat Mohammad , HAWWASS DALIA , Ahsan Chowdhury
Published: June 2023

Introduction:
Patients who are transferred between acute care medical facilities are an overlooked population. In this study, we explore the in-hospital outcomes of patients with a non-ST segment elevation myocardial infarction (NSTEMI) who were transferred to an acute care hospital from another acute care center.

Methods:
We queried the National Inpatient Sample database (2016-2019) to identify patients admitted with a principal diagnosis of NSTEMI. We conducted propensity score matching using a greedy nearest neighbor 1:1 model. Multivariable logistic regression was used to compare mortality.

Results:
131,948 patients met our inclusion criteria. Patients with a NSTEMI who were transferred from an acute care center had 1.20 times higher odds of suffering in-hospital mortality compared to regular hospital admissions (aOR 1.20, 95% CI: 1.13-1.28; p < 0.001). When separated by race, acute care transfers had a higher mortality rate amongst White patients (3.5% vs 3.1%, p < 0.001), but a decreased mortality rate in Black patients (3.5% vs 3.6%, p = 0.008, Figure 1). Acute care transfers were more likely to undergo percutaneous coronary intervention (35.9% vs 34.0%, p < 0.001) and have intraoperative cardiac arrest (0.04% vs 0.01%, p < 0.001, Table 1).

Conclusions:
Patients who were transferred to acute care hospitals from other acute care centers with a NSTEMI had higher odds of suffering in-hospital mortality compared to regular hospital admissions. Acute care transfers with a NSTEMI require additional medical support in the inpatient setting. Further studies should explore potential interventions to address these differences in outcomes.
Abstract 11264: The Impact of the COVID-19 Pandemic on Cardiac Implantable Device Monitoring in Urban and Suburban Settings
Authors: Patel Rahul , Khasnavis Tanya , Gustafson Sallie , Lloyd Michael S
Published: June 2023

Introduction:
Remote and in-person monitoring of cardiac implantable devices is an important component to the overall healthcare of cardiology patients. The impact of the pandemic on follow-up and missed appointment rates at cardiology device clinics after the onset of shutdowns is unclear. We analyzed the impact of the COVID-19 pandemic on in-person and remote appointment no-show rates across a large network of cardiology device clinics, including three urban hub clinics and thirteen suburban and rural spoke sites.

Methods:
60,750 encounters at Emory Healthcare’s Cardiology Device Clinic between 1/1/2019-12/31/2019 (“pre-COVID”) and 8/1/2020-7/31/2021 (“post-COVID”) were included. Visits were stratified by “in-person” and “remote” appointment types and analyzed according to no-show or completed status. Subgroup analysis was performed of geographic location (urban vs suburban) clinic sites. A chi-square test was used to analyze statistical significance (p < 0.05).

Results:
The cohort consisted of 26,356 “pre-COVID” and 34,394 “post-COVID” scheduled device visits. The overall no-show rates were higher in the post-COVID time frame (16.5% in 2019 and 19% in 2021-2021, p < 0.001). The higher no-show rates were similar for in-person and remote visits (19.5% vs 21.3% p <0.01 in-person; 15.6% vs 18.5% p <0.001 remote). There were differences in types of no-show rates among urban versus sub-urban clinic sites. For urban sites, there was no impact on in-person no-show rates (20.8% vs 20.3%, p = 0.64) for in-person appointments, but a significant difference (13.6% vs 17.3%, p < 0.01) for remote appointments. In contrast, for suburban sites, pre and post-COVID missed appointment rates showed effects on in-person visits (15.7% vs 23.4%, p < 0.01), but not for remote appointments (48.2% vs 46.9%, p = .56).

Conclusions:
The COVID-19 pandemic impacted long-term in-person and remote device monitoring rates significantly. The effects were different depending on urban versus suburban site location. This analysis of over 60,000 device monitoring visits revealed a substantial impact on no-show rates for all visits and site-specific trends for the type of no-show affected, which may help in the design of higher-adherence follow up schedules in the post-COVID era.
Abstract 11269: Comparing Measures of Adherence and Persistence to Ticagrelor Therapy in Patients With Acute Coronary Syndromes
Authors: Moon Jungyeon , Ozaki Aya , Ko Dennis T , Chong Alice , Fang Jiming , Austin Peter , Sud Maneesh , Jackevicius Cynthia
Published: June 2023

Introduction:
There have been efforts to accurately measure adherence to ticagrelor to identify suboptimal medication therapy in the first year post-ACS as nonadherence during this crucial period is a major obstacle to optimizing clinical outcomes. Our study aims to examine ticagrelor adherence and persistence using different methods to better understand adherence patterns.

Methods:
We conducted a retrospective cohort study of patients aged ≥65 years who had filled a ticagrelor prescription within 7 days post-ACS discharge in Ontario, Canada between 4/2014-3/2018. We estimated mean proportion of days covered [PDC], the proportion of patients with “good” adherence of PDC≥80%, both at 1 year and the proportion of patients who were persistently taking ticagrelor at 1-year, using permissible gaps between prescriptions of 3, 7, 14 and 30 days.

Results:
There were 9,763 ticagrelor users (mean age 73.6; 65.4% men). The mean 1-year PDC (±SD) was 80.8±29.2, while only 73.0% of the cohort showed good adherence (PDC≥80%). Using a permissible gap definition of 14 days, only 55.7% of patients were persistent with ticagrelor in the year post-ACS. The 1-year persistence rates were as high as 62.6% with an allowable gap of 30 days and as low as 49.7% for a 7-day gap and 39.3% for a 3-day gap.

Conclusions:
Adherence and persistence estimates varied widely based on the definition used. While the PDC estimates implied reasonable 1-year ticagrelor adherence, PDC methods overestimated continuous use of ticagrelor, yet persistence methods with small gaps were likely too stringent. Readers of adherence and persistence studies should pay close attention to the methods and definitions used.
Abstract 11277: Impact of Sex-Specific Echocardiographic Evaluation on Outcome of Patients With Organic Mitral Regurgitation
Authors: Dal Soglio Solenn , Bernard Jeremy , Pageau-Bleau Julien , Salaun Erwan , Pibarot Philippe , Beaudoin Jonathan , Clavel Marie-Annick
Published: June 2023

Background:
In patients with organic mitral regurgitation (OMR), women are less often diagnosed with severe disease and less referred to intervention. One of the potential explanations is the use of non-indexed and non-sex-specific guideline’s-based triggers for surgery.

Aims:
To compare predictors of the composite of cardio-vascular hospitalization and mortality under medical management in men and women with OMR.

Methods:
Between January and December 2014, 295 women and 269 men were diagnosed with at least mild isolated OMR. Event-free survival was compared with the use of adjusted Cox regression and inverse probability treatment weighting. Best thresholds predicting the composite endpoint at 3 years were derives from the Youden index on ROC curves analyses in both sexes separately.

Results:
Mean age was 68.5 ±14.1 years and the majority of patients (46%) had moderate OMR. Severity of OMR was similar between groups and inverse propensity weighting was used to balance clinical characteristics between sexes. Despite unadjusted and adjusted similar even-free survival under medical management, left atrium (LA) and left ventricle (LV) cavities were larger in men than in women (all p<0.001). Interestingly, even after indexation by BSA, thresholds associated with higher mortality were different between men and women (LV mass index: 118 g/m
2
in men, 88g/m
2
in women; LV ejection fraction: ≤ 55% in men, ≤ 65% in women; systolic pulmonary artery pressure: >42mmHg in men, >29mmHg in women), except for LA volume index (>32ml/m
2

in both sexes)
.
The use of sex-specific thresholds improves the prediction of events (p=0.002).

Conclusion:
Management of OMR should integrate sex-specific cut-points to trigger intervention, even for echo parameters indexed to BSA in order to harmonize outcomes between men and women with OMR.
Abstract 11304: Spectrum of Clinical Response in Atrial Tachyarrhythmias Identified by Spatiotemporal Synchronization of Electrograms
Authors: Ganesan Prasanth , Deb Brototo , Feng Ruibin , Rodrigo Miguel , Ruiperez-Campillo Samuel , Rogers Albert J , Clopton Paul L , Wang Paul J , Rappel Wouter-Jan , Narayan Sanjiv M
Published: June 2023

Introduction:
A clinical spectrum exists for atrial tachyarrhythmias, wherein tachycardia (AT) often responds to ablation, some patients with atrial fibrillation (AF) respond well to ablation, and others do not. It is undefined if this clinical spectrum can be predicted pathophysiologically.

Hypothesis:
We hypothesize that the size of regions within which electrograms (EGMs) show repeating shapes also synchronized in time reveals a spectrum from AT, to AF patients who respond acutely to ablation, to AF patients without acute response.

Methods:
We studied N=160 patients (35% women, 65.0±10.4Y) of whom (i) N=150 were AF patients propensity-matched for those whose AF terminated by ablation (N=75; “Term”) and those which did not (N=75; “Non-term”); (ii) N=10 with AT. All patients had mapping by 64 pole baskets to identify areas of repetitive electrical activity in shape and timing (REACT, range 0 to 1), by correlating unipolar electrograms (EGMs) in 2x2 grids iteratively across the atria (Fig A&B).

Results:
Synchronized regions (REACT) fell from AT to AF Term to AF Non-term (0.63±0.15, 0.37±0.22, 0.22±0.18, p<0.001, Fig C&D). On ROC analysis, AUC for predicting AF termination was 0.70 ([0.61, 0.78] 95% CI). Simulations revealed a nomogram in which increasing REACT represented increasing variability in clinical EGM shape and timing. Unsupervised machine learning of REACT plus 50 variables yielded 4 clusters of increasing risk for AF termination (p<0.01, chi-sq) but clinical profiles alone were less predictive (p<0.001).

Conclusions:
The area of synchronized EGM shape and timing within the atrium reveals a spectrum of clinical response in atrial tachyarrhythmias. These fundamental EGM properties, which do not reflect any specific mechanism or mapping technology, predict outcome and offer a platform to compare mapping tools and mechanisms between AF patient groups.
Abstract 11308: Genome-Wide Polygenic Risk Scores Incoronary Artery Disease Risk Prediction: Results From the Asian Indian Diabetic Heart Study/Sikh Diabetes Study
Authors: Rout Madhusmita
Published: June 2023

Introduction:
Polygenic risk score (PRS) has been shown to be highly effective in predicting coronary artery disease (CAD) risk in Western European populations. However, such studies on South Asians are scarce despite the fact that they account for 50% of the global burden of CAD.

Hypothesis:
In this study, we evaluated the predictive efficacy of PRS derived from the Asian Indian (AI) ancestry-specific score (PRS
AI
) and European-derived PRS (PRS
EU
). Also, we compared these with the clinical risk score (CRS).

Methods:
The study used 4602 participants (791 CAD cases and 3790 controls) from the Asian Indian Diabetic Heart Study/Sikh Diabetes Study. Weighted PRS was constructed using 100 significant SNPs from our Punjabi/Sikh CAD GWAS and 75 SNPs identified from the European GWAS catalog. The CRS was derived using the clinical risk factors described for the Framingham risk score.

Results:
Ancestry-specific PRS
AI
showed an enhanced efficacy of over 30% in estimating the relative risk for CAD over PRS
EU
. In sensitivity analysis, the area under the curve (AUC) for PRS
AI
and

PRS
EU
were 0.84 and 0.72, respectively, while the AUC remained unchanged on combining the PRS
(AI+EU)
, i.e., 0.84. PRS
AI
also predicted the risk for increased waist to hip ratio (β=0.11, p=4.1x10
-13
) in both gender, while fasting glucose levels (β=0.08, 3.0x10
-3
) were confined to females.

Conclusions:
The results highlight evidence for the utility of PRS for identifying genetically predisposed high-risk individuals and attest to its broader clinical value. Also, sex differences may play a role in determining the risk for CAD, and increased fasting glucose and type 2 diabetes (T2D) are known to increase the risk of heart disease in women more than men, especially after menopause.
Abstract 11349: Longitudinal Analysis of Cardiac Biomarkers and Renal Function in Transthyretin Cardiac Amyloidosis: Association With Mortality and Tafamidis Use
Authors: Zhang Jingwen , Bhattacharya Priyanka T , Teruya Sergio , Helmke Stephen , Maurer Mathew S
Published: June 2023

Introduction:
Biomarkers have prognostic value in transthyretin amyloid cardiomyopathy (ATTR-CM). However, their temporal trends and the impact of tafamidis use on biomarkers have not been well-described.

Hypothesis: There are differences in the trajectory of cardiac biomarkers and estimated glomerular filtration rate (eGFR) in ATTR-CM patients who died compared to those who survived and among those who did or did not receive tafamidis.

Methods:
This was a retrospective study of consecutive ATTR-CM patients referred to Columbia University Medical Center with ≥3 years of biomarker data. We plotted individual data over time in each cohort (alive vs. dead, tafamidis vs. no tafamidis) and fitted exponential regression slopes for each using linear mixed effects modeling.

Results:
Patients who died had a higher average baseline NT-proBNP and troponin and lower eGFR than patients who survived. Baseline median (IQR) NT-proBNP in pg/mL was 2847 (1131, 5011) and increased to 6127 (2874, 13184) prior to death, while for patients who survived, the median was 1151 (641, 3080) at baseline and 1415 (791, 2856) at last follow-up. Median (IQR) troponin T in ng/mL was 0.038 (0.020, 0.053) at baseline and 0.080 (0.050, 0.149) prior to death, while in patients who survived, the median was 0.030 (0.010, 0.043) at baseline and 0.037 (0.024, 0.043) at last follow-up. The rate of increase of troponin T and NT-proBNP was greater in the patients who died than patients who survived (p<0.0001). During this period, eGFR fell 14.3% from baseline in patients who died and 8.6% in patients who survived. There were no apparent differences in the trajectory of these biomarkers between patients with and without tafamidis treatment.

Conclusions:
Serial analysis of cardiac and renal biomarkers shows substantial heterogeneity of these measures. The trajectories of biomarkers differed over 3 years before death. Tafamidis use in the real world was not associated with changes in biomarkers and eGFR over time.
Abstract 11438: The Inflammatory Proteome, Obesity, and Medical Weight Loss in Humans
Authors: Perry Andrew , Tanriverdi Kahraman , Risitano Antonina , Hwang Shih-Jen , Murthy Venkatesh , Nayor Matthew G , Zhao SHilin , Levy Daniel , Shah Ravi V , Freedman Jane E
Published: June 2023

Introduction:
Most individuals regain weight after medical weight loss via “metabolic adaptation,” the mechanism of which remains unclear. Here, we studied the relation of circulating inflammatory proteins with weight loss and regain to identify a role for inflammation in metabolic adaptation.

Methods:
We analyzed 74 proteins related to inflammation and native immune regulation (Olink) in plasma from a maximum of 490 participants serially in a trial of medical weight loss maintenance. Linear and mixed effects regression models and
t
-tests were used to measure cross-sectional and longitudinal association of proteins with weight, with replication in the Framingham Heart Study (FHS).

Results:
Subjects included (60% women, 35% African American) had initial median weight of 94 kg, with a median loss 8 kg over 6 months of supervised medical weight loss, with subsequent median regain 2 kg over 30 months. We observed broad changes in inflammatory proteins with initial weight loss, many of which also tracked with weight regain (e.g. hepatocyte growth factor, interleukin-18, colony stimulating factor 1;
Figure
). While many proteins have been implicated in weight regulation from mouse/human models, several are novel. Proteins associated with weight change involve pathways of angiogenesis, cell cycle regulation and immune response and are secreted from lung, adipose tissue, smooth muscle and others. Several proteins specifying chemotaxis and innate immune responses were associated with different rates of weight regain. Association with prevalent (but not incident) obesity was replicated for several proteins in the FHS.

Conclusions:
Broad changes in the inflammatory state track with weight (and its change during medical therapy) and may identify specific pathways that modify risk of weight regain. Further studies of innate immune activation in metabolic adaptation in humans to limit weight regain are warranted.
Abstract 11454: Sarcopenia Evaluated by Thoracic Computed Tomography is Associated With Higher Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement
Authors: Persits Ian , Mirzai Saeid , Estep Jerry , Chen Po-Hao , Reed Grant W , Tang Wai Hong W
Published: June 2023

Introduction:
Sarcopenia is associated with worse outcomes in various clinical situations. Traditional markers of strength and frailty have been used for pre-operative risk stratification in transcatheter aortic valve replacement (TAVR). However, the availability of computed tomography (CT) scans provides an opportunity to obtain direct skeletal muscle measurements.

Hypothesis:
We hypothesized that sarcopenia would lead to worse outcomes in patients following TAVR.

Methods:
Patients undergoing TAVR between January to July 2018 with pre-procedural chest CT were included. Semi-automatic measurements of skeletal muscle area (SMA) were made at the twelfth thoracic vertebra. SMA was normalized by height to obtain skeletal muscle index (SMI, cm
2
/m
2
). Sarcopenia was defined as the lowest sex-stratified SMI tertile. Strength and functional testing data had been collected as part of the routine pre-TAVR evaluation. The primary outcome of interest was all-cause mortality.

Results:
A total of 76 patients were included, 26 sarcopenic based on SMI. Table 1 shows comparisons between the groups. During a median follow-up of 1496 (1401-1562) days, 10 (38.5%) deaths occurred in the sarcopenic group and 9 (18.0%) in the non-sarcopenic group. Figure 1 demonstrates this significant difference by Log-Rank testing (p=0.042). The secondary outcomes of length of stay and 30-day readmission did not differ between the groups on unadjusted comparison.

Conclusions:
Sarcopenia was associated with increased mortality in patients who underwent TAVR. A larger study is underway to assess the potential of muscle measurements serving as an additional pre-operative risk stratification tool.
Abstract 11462: Alcohol Septal Ablation vs Surgical Myectomy for Hypertrophic Cardiomyopathy: A Systematic Review and Meta-Analysis
Authors: El Iskandarani Mahmoud , Shatla Islam , Kassab Mohamad , Paul Timir K
Published: June 2023

Introduction:
Surgical Myectomy (SM) is the gold standard treatment for hypertrophic obstructive cardiomyopathy (HOCM). However, alcohol septal ablation (ASA) has emerged as an alternative option for selected patients. Nonetheless, the long-term efficacy and safety of ASA have been debated in recent years. The aim of this metanalysis is to evaluate the long-term outcomes of ASA vs SM in HOCM patients.

Hypothesis:
ASA is a safe and effective alternative to SM in HOCM.

Methods:
: Unrestricted searches of the PubMed, EMBASE, and Cochrane databases from inception till June 1, 2022, for studies comparing long-term outcomes of ASA with SM in HOCM patients. Relevant data were extracted and analyzed using Revman 5.3 software. Odds Ratio (OR) and 95% Confidence interval (CI) were calculated using the random-effects model.

Results:
: A total of 12 retrospective studies were included examining 7,599 HOCM patients (2,010 ASA vs 5,589 SM). After a mean follow-up of 5.04 years, all-cause mortality was similar between the two groups (OR 1.18; 95% CI 0.60-2.29). However, ASA was associated with high rates of reinterventions (OR 15.68; 95% CI 6.71-36.61), and pacemaker insertion (OR 2.74; 95% CI 1.39-5.41).

Conclusions:
Although there was no difference in mortality between ASA and SM, ASA was associated with higher rates of reinterventions and pacemaker insertion in long-term follow-up. Therefore, the selection of septal reduction therapy in HOCM should be individualized and should be performed in a comprehensive center after detailed risk and benefits discussions with an experienced team.
Abstract 11476: The Clot Thickens: Massive Left Ventricular Thrombus After Sub-Acute Myocardial Infarction
Authors: Ho Tiffany , Noureddine Belal , Haji Mohammed , Parulkar Sanchita S , Wyllie Joseph , LEVINSON ANDREW
Published: June 2023

Introduction:
Left ventricular thrombus (LVT) following myocardial infarction (MI) can affect up to 19.2% of patients with anterior wall MI. The mechanism is thought to be due to stasis from LV regional wall akinesia, endothelial injury from prolonged ischemia, and hypercoagulability from acute coronary syndrome. In patients with LVT after MI, anticoagulation choice and duration is still a matter of debate.

Case Report:
A 51-year-old woman with diabetes and prior anterior wall MI with LVT presented with non-healing diabetic leg wounds. One year ago at the time of the MI, transthoracic echocardiogram (TTE) showed a 4.0 x 1.3 cm mural thrombus. She was discharged on prasugrel and apixaban. Apixaban was discontinued after five months, with follow-up TTE showing resolution of LVT, with 30% LV ejection fraction and evidence of LV remodeling. This hospitalization, while awaiting discharge, the patient developed sudden undifferentiated shock requiring norepinephrine and dobutamine. Repeat TTE revealed a 6.0 x 5.5 cm apical LVT filling more than 50% of the LV cavity, with unchanged LV ejection fraction. Heparin drip was started. Prior to evaluation by cardiothoracic surgery, patient became acutely unresponsive, had a cardiac arrest, and expired. Cause of death suspected to be due to cardioembolic events, worsened with mixed shock and low-output heart failure from LVT.

Discussion:
Management of LVT after MI remains unclear. Current guidelines indicate treatment with vitamin K antagonist (VKA) for at least 3 - 6 months, and consideration of prophylactic anticoagulation with VKA for patients with apical dyskinesis after MI. Retrospectively, this patient may have benefitted from a prolonged course of anticoagulation given the extent of LV remodeling five months after initial event despite resolution of LVT. Anticoagulation must be evaluated on a case-by-case basis weighing propensity of thrombotic events with risk of bleeding.
Abstract 11485: Neighborhood Childhood Opportunity Index is Associated With Impaired Exercise Performance in Pediatric Heart Transplant Patients
Authors: Edelson Jonathan , Lane-Fall Meghan , HUANG JING , Wang Zi , Mercer-Rosa Laura M , Mitchell Jonathan , Paridon Stephen , O'Connor Matthew J , Rossano Joseph , O'Byrne Michael
Published: June 2023

Introduction:
Pediatric heart transplant (HT) patients have impaired exercise performance which cannot be fully explained by cardiac limitations. Environment may influence physical activity and consequently exercise performance, but the degree to which environmental factors are associated with exercise performance is unknown.

Methods:
This cross-sectional study included 8-18y HT recipients, evaluating the association of the childhood opportunity index (COI) with maximum oxygen consumption (max V02) during cardiopulmonary exercise testing. Geospatial techniques were used to map subject addresses onto corresponding measures of the COI which includes neighborhood level indicators of 3 domains: education, health and environment, and social and economic. Higher values indicate more favorable COI scores.

Results:
Of the 32 patients included in the study, 16 were female, 10 self-identified as Black, and nearly 2/3 had congenital heart disease (n=18). The median duration from HT was 6.2y (IQR 2.3-12.4). The majority (n=20) had a normal cardiac index (CI
>
3 L/min/m2) and pulmonary capillary wedge pressure
<
10mmHg (n=20) on cardiac catheterization closest to exercise testingThe median COI was 79.0 (IQR 47-90;
Figure 1a)
and the median max V02 was low at 28 ml/kg/min (IQR 22-33). In a multivariate adjusted model, worse COI was independently associated with reduced max V02
(p=0.04
)
(Table 1, Figure 1b)

Conclusions:
Childhood opportunity index is associated with impaired exercise performance after HT independent of cardiac status, suggesting an impact of environmental factors on the health of HT recipients.
Abstract 11512: Association Between Use of Oral Anticoagulants After Minor Bleeding and Mortality Outcomes in Patients With Atrial Fibrillation: The Fushimi AF Registry
Authors: Ishigami Kenjiro , Ogawa Hisashi , Nakanishi Yumiko , Minami Kimihito , Ikeda Syuhei , DOI KOSUKE , Yoshizawa Takashi , Hamatani Yasuhiro , Ide Yuya , Fujino Akiko , Ishii Mitsuru , Iguchi Moritake , Masunaga Nobutoyo , Esato Masahiro , Wada Hiromichi , Hasegawa Koji , Abe Mitsuru , Akao Masaharu
Published: June 2023

Introduction:
Oral anticoagulants (OAC) reduce the risk of ischemic stroke, but may increase the risk of major or minor bleeding in atrial fibrillation (AF) patients. However, little is known about the management of anticoagulation in patients with AF after a minor bleeding event. This study assessed the association between use of OAC and outcomes in AF patients after minor bleeding.

Methods:
The Fushimi AF Registry is a community-based prospective survey of the AF patients in Fushimi-ku, Kyoto, Japan. A total cohort of 4,489 AF patients were analyzed in the present study. We investigated patients in whom minor bleeding occurred during follow-up period, and compared between patients with OAC and those without OAC after minor bleeding.

Results:
During the median follow-up period of 1,844 days, minor bleeding occurred in 744 patients (5.7% per patient-year). After excluding patients with missing prescription data after minor bleeding, 494 patients were prescribed OAC and 234 were not prescribed after minor bleeding. Patients with OAC were more often non-paroxysmal type of AF (27.4% vs 48.0%, p<0.01), and were more likely to have previous thromboembolism (23.3% vs 11.5%, p<0.01) and heart failure (29.4% vs 19.2%, p<0.01). They had significantly higher CHADS2 score (2.11 vs 1.79, p<0.01). They were less likely to have history of major bleeding (2.6% vs 5.6%, p<0.05). All-cause mortality after minor bleeding occurred in 91 patients with OAC (4.5% per patient-year) and 62 (7.5% per patient-year) patients without OAC with hazard ratio (HR) 0.62 (95% confidence interval [CI], 0.45-0.86; p<0.01). After adjusted by age, sex, type of AF, and comorbidities, patients with OAC after minor bleeding were significantly associated with lower incidence of all-cause mortality (HR 0.52 [95% CI, 0.37-0.73; p<0.01]).

Conclusions:

Conclusion:
Use of OAC after minor bleeding was significantly associated with lower incidence of all-cause mortality in Japanese AF patients.
Abstract 11559: Prognostic Significance of Senescence-Associated Secretory Phenotype (SASP) Biomarkers in Heart Failure (HF)
Authors: Qian Chenao , Zamani Payman , Salman Oday , Jehangir Qasim , Cohen Jordana , Gunawardhana Kushan L , Greenawalt Danielle , Zhao Lei , Chang Ching-Pin , Gordon David A , Ramirez-Valle Francisco , Cappola Thomas P , Chirinos Julio A
Published: June 2023

Background:
Cell senescence is involved in various age-related pathologies, including HF. The SASP is a characteristic secretory phenotype from senescent cells. We aimed to assess the prognostic significance of the SASP assessed by a combination of plasma protein biomarkers in human HF.

Methods:
We measured 25 known SASP associated proteins among 2248 Penn HF Study (PHFS) participants using the SomaScan V4 assay. Factor analysis was used to extract the common variance among these proteins. We assessed the relationship between factor scores and: (1) All-cause death; (2) The composite of death or heart failure hospital admission (DHFA). Hazard ratios (HR) were standardized (per unit increase in z score) to facilitate comparisons.

Results:
Two SASP factors were identified. The levels of both factors did not differ between HF with reduced EF (n=1761) and HF with preserved EF (n=253). Both factors were associated with the risk of death (Factor 1: HR 1.43 [95%CI, 1.32-1.54]; P<0.0001; Factor 2: HR 1.63 [95%CI, 1.54-1.72]; P<0.0001;
Figure 1A
) and DHFA (Factor 1: HR 1.36 [95%CI, 1.29-1.43]; P<0.0001; Factor 2: HR 1.32 [95%CI, 1.26-1.38]; P<0.0001;
Figure 1B
). After adjustment for the MAGGIC score and NTproBNP levels, both factors remained associated with death (Factor 1: HR 1.14 [95%CI, 1.03-1.26]; P=0.008; Factor 2: HR 1.47 [95%CI, 1.34-1.61]; P<0.0001;
Figure 2A
) and DHFA (Factor 1: HR 1.10; [95%CI, 1.03-1,18]; P=0.004; Factor 2: HR 1.09 [95%CI, 1.02-1.17]; P=0.012;
Figure 2B
).

Conclusion:
Increased SASP components are independently associated with adverse outcomes in HF. Further study is needed to assess whether SASP components are suitable therapeutic targets in heart failure.
Abstract 11599: Risk of Bleeding With Concomitant Use of Oral Anticoagulants and Aspirin: A Systematic Review and Meta-Analysis
Authors: Malone Daniel , Ghule Priyanka , Panic Jennifer
Published: June 2023

Introduction:
Oral anticoagulants (OAC) (e.g., warfarin, rivaroxaban, dabigatran) and salicylates (e.g., aspirin) can trigger the occurrence of bleeding events when used alone or in combination.

Objective:
The objective of this study was to conduct a systematic review and meta-analysis to examine the risk of bleeding in individuals exposed to a combination of OAC and aspirin, compared to those taking OAC monotherapy.

Methods:
PubMed, EMBASE, Scopus, and Web of Science were queried in January 2021. Studies that described combined exposure to OAC and salicylates, had a control arm of monotherapy of OAC and reported the number of bleeding events in each arm were included. After studies were identified for potential inclusion, first, the title and abstract were screened, followed by a review of the full text. The following information was extracted from the included studies: citation, drug and dose of medication, the average age of participants, number of patients and bleeding events in each group, and population of interest. Pooled odds ratios were calculated using a random-effects model. Heterogeneity was evaluated with Cochran’s Q and I2 statistics.

Results:
A total of 509 studies were identified, of which 35 met the inclusion criteria for the meta-analysis. Studies were further categorized into two groups based on the design of the study (randomized control trial or observational studies). Out of 35 studies, 16 randomized control trials compared combined OAC and salicylates vs warfarin monotherapy and combination therapy was associated with an increased odds [OR: 1.37, (95% CI 1.17 to 1.61)] of bleeding compared to warfarin monotherapy. The second group consisted of 19 observational studies comparing combined OAC and salicylates vs warfarin monotherapy. The results suggested that combination therapy was associated with an increased odds [OR: 1.42, (95% CI 1.09 to 1.87)] of bleeding compared to aspirin monotherapy.

Conclusion:
Risk of bleeding is significantly increased among patients taking salicylates and OAC together as compared with those taking warfarin alone.
Abstract 11615: The Prevalence and Association of Exercise Test Abnormalities With Sudden Cardiac Death and Transplant-Free Survival in Childhood Hypertrophic Cardiomyopathy
Authors: Conway Jennifer , Min Sandar , Villa Chet , Weintraub Robert G , Nakano Stephanie J , Godown Justin , Kathyrn Armstrong , Richmond Marc E , Kaufman Beth D , Lal Ashwin K , Balaji Seshadri , Power Alyssa , Gardin Letizia , Kantor Paul F , Parent John J , Aziz Peter F , Jefferies John L , Papaz Tanya , Jeewa Aamir , Benson Lee N , Russell Mark W , Whitehall Robert , Rossano Joseph , Howard Taylor , Mital Seema
Published: June 2023

Introduction:
Hypertrophic cardiomyopathy (HCM) can be associated with an abnormal exercise response. In adults with HCM, an abnormal exercise stress test (EST) is predictive of heart failure outcomes. Our goal was to determine if an abnormal exercise response is associated with adverse outcomes in pediatric HCM patients.

Methods:
: In an international cohort study with 20 centers (PRIMaCY), children <18 years with primary HCM were included. Abnormal EST was defined as an abnormal heart rate or blood pressure response, arrhythmias and/or ischemic ECG changes on exercise. Sudden cardiac death (SCD) events were defined as a composite of SCD and aborted SCD including appropriate implantable cardioverter defibrillator discharges. Using Kaplan-Meier survival analyses, we analyzed the association of abnormal EST with SCD and transplant-free survival.

Results:
Of 724 eligible patients, 604 underwent at least one EST on follow-up. There were no differences in clinical characteristics between those with or without an EST. The median age at EST was 13.8yrs (IQR 11.0-15.7yrs), 76% were male, 55% were on beta-blockers. 299 (49.5%) had an abnormal EST. Patients with an abnormal EST had more severe septal hypertrophy, higher left atrial diameter z-scores, higher resting LV outflow gradient at first evaluation, and a higher proportion were genotype-positive (p<0.05) compared to those with a normal EST. An abnormal EST was associated with lower 5-year transplant-free survival (99% vs. 95%, p=0.0082) and lower 5-year freedom from SCD events (96% vs. 92%, p=0.025) (Figure 1).

Conclusions:
Exercise abnormalities are common in childhood HCM. An abnormal EST in children with HCM was associated with lower transplant-free survival and more SCD events. Further analysis will determine if the inclusion of EST results can increase the predictive accuracy of current pediatric SCD risk prediction models.
Abstract 11648: ECG-Derived Features Enable Prediction of Sudden Death in Ischemic Cardiomyopathy
Authors: Ruiperez-Campillo Samuel , Deb Brototo , Selvalingam Anojan , Feng Ruibin , Ganesan Prasanth , Tjong Fleur V , Chang Hui Ju , Kolk Maarten Z. H. , Kowalewski Christopher , Vasireddi Sunil K , Goyal Jatin , Rogers Albert J , Clopton Paul L , Narayan Sanjiv M
Published: June 2023

Introduction:
Low left ventricular ejection fraction (LVEF) is an imperfect predictor of sudden cardiac death (SCD) in patients with ischemic cardiomyopathy. Novel features identified via automated ECG analysis might improve the prediction of sudden cardiac death risk.

Hypothesis:
We hypothesized that machine learning of the ECG can be used to predict SCD.

Methods:
We studied 5603 ECG Lead V1 beats in 41 patients (64±10 Y) with coronary disease and LVEF≤40% in steady-state pacing. Patients were randomly allocated to independent training and test cohorts in a 70:30 ratio, repeated K=10-fold. Support vector machines were trained to predict mortality at 3Y from the top 20 features derived from these beats (Fig C). Patient-level predictions were made by computing an ECG score that indicates the proportion of test set beats in that patient computed by the beat-level model to predict SCD.

Results:
Fig A shows the data flow in the study. Beat-level predictions in the validation (n=1678 Lead I beats) cohorts yielded c-statistics of 0.78 for SCD (95% CI, 0.62-0.91). In multivariable models, c-statistic was 0.87 for SCD (95% CI, 0.76-0.98) (Fig B).

Conclusions:
Machine learning of the ECG reveals novel predictors of SCD risk in patients with ischemic cardiomyopathy. This tool may improve risk stratification and allocation for ICD therapy beyond LVEF alone.
Abstract 11653: Prolonged Rilonacept Treatment in Rhapsody Long-Term Extension Provided Persistent Reduction of Pericarditis Recurrence Risk
Authors: Imazio Massimo , Klein Allan L , Abbate Antonio , Arad Michael , brucato antonio , Cremer Paul C , Gaddam Eliyazar , Insalaco Antonella , Lewinter Martin M , Lewis Basil , Lin David , Luis Sushil A , Nicholls Stephen J , Sutej Paul , Wasserstrum Yishay , Samant Manoj , Zou Liangxing , Fang Fang , Paolini John F
Published: June 2023

Introduction:
Rilonacept reduced pericarditis recurrence in the phase 3 trial RHAPSODY. The long-term extension (LTE) enabled further insights into efficacy, safety, and clinical decision making.

Methods:
The RHAPSODY run-in (RI) and randomized-withdrawal periods were followed by an LTE that enabled open-label rilonacept treatment up to 24 additional months. A decision at 18 months after the most recent recurrence was based on clinical status at investigator discretion: 1) continue rilonacept on-study, 2) suspend rilonacept for observation or 3) discontinue from the LTE without observation. Endpoints included recurrence and quality of life.

Results:
In May 2020, 74 of 75 eligible subjects continued to LTE; US subjects (n=45) switched to commercial therapy or discontinued in April 2021 (treatment duration from RI baseline [median; maximum] 18; 27 months). Non-US subjects (n=29) completed the LTE in June 2022 (treatment duration from RI baseline [median; maximum] 27; 33 months). Concomitant oral medications during LTE: 22% NSAIDS, 20% colchicine, 0% corticosteroids, 43% none. Inflammation signs (CRP), RP symptoms (PGIPS), and recurrences were low on-treatment. Before the 18-month decision (n=74), there were 3 investigator-assessed recurrences (0.04 per patient-year). At the 18-month decision (n=52), 64% (n=33) continued rilonacept on-study, 15% (n=8) suspended rilonacept for observation, and 21% (n=11) discontinued the study without observation, of whom 7 switched to commercial rilonacept. There was a 75% recurrence rate (n=6/8) in the off-treatment observation group (median time to event 11.8 [3.7, Not-Estimable (NE)] weeks) but only 1 recurrence in subjects on rilonacept (time to event NE [too few events]) associated with a 4-week interruption; HR 0.018, p<0.0001; Fig 1.

Conclusions:
Continued rilonacept treatment resulted in continued treatment response, whereas treatment suspension at 18 months may be associated with pericarditis recurrence.
Abstract 11667: Physical Activity and Nutrition Self-Efficacy Associates With Self-Reported Cardiovascular Health Behaviors in African Americans: The Washington, DC Cardiovascular Health, and Needs Assessment
Authors: Osei Baah Foster , Ayers Colby , Mitchell Valerie , Collins Billy , Wallen Gwenyth , Powell-Wiley Tiffany M
Published: June 2023

Background:
Increased self-efficacy may improve health behavior, but little is known about the relationship between physical activity (PA) and nutrition self-efficacy and cardiovascular health behaviors associated with weight loss among African Americans (AAs).

Methods:
Examined the associations between PA and nutrition self-efficacy and self-reported PA and nutrition behaviors using AA data from the Washington DC CV Health and Needs Assessment, a community-based participatory research study. All completed the PA and Nutrition Self-Efficacy (PANSE) scale with sub-scores measuring participants’ self-efficacy for engaging in PA and nutrition behaviors (higher scores= greater self-efficacy). PA types (moderate-leisure PA, vigorous-leisure PA, and strength training) and dietary (red meat, fast foods, sodas, and vegetables) behavior scores were calculated using the International Physical Activity Questionnaire (IPAQ) for self-report PA or the National Health and Nutrition Examination Survey (NHANES) dietary screener for consumption of specific food products. Linear regression models were used to assess the associations between PANSE sub-scores and corresponding PA or dietary behavior adjusting for covariates.

Results:
Participants (N=117) were predominantly women (82.1%), mean age=59.4 (SD±12.3) years with mean BMI 32.6 (SD±7.0) kg/m2. While PA self-efficacy remained significantly and positively associated with self-reported moderate leisure PA and strength training, nutrition self-efficacy remained significantly and negatively associated with consumption of fast foods and sodas after adjusting for covariates (Table 1).

Conclusion:
PA and nutrition self-efficacy are associated with self-reported PA and nutrition behaviors among AAs. Interventions that augment self-efficacy may be particularly important in improving cardiovascular health behaviors by enhancing PA and nutrition behaviors aimed at weight loss among AAs.