bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 13142: Combined Treatment With Dapagliflozin and Exenatide is More Cardioprotective Than Either Agent Alone in a Non-Diabetic Mouse Model of Ischemia-Reperfusion Injury
Authors: Zarrin Khat Dorrin , Siraj Muhammad A , Momen Abdul , Kuzmanov Uros , McFadden Meghan , Lee Frank Shin-Haw , Hadipour-Lakmehsari Sina , Gramolini Anthony , Husain Mansoor
Published: April 2024

Introduction:
Sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) have individually shown cardiovascular benefits in patients with type 2 diabetes (T2D). SGLT2i also reduced events in patients with reduced ejection fraction heart failure, with or without T2D. However, it is not known whether the cardiovascular effects of SGLT2i and GLP-1RA are through shared or distinct mechanisms, and whether combining these agents would confer additive cardioprotection against ischemia-reperfusion injury (IRI) in the absence of diabetes.

Methods & Results:
Non-diabetic male C56BL/6-J mice randomized to 7-d treatment with SGLT2i dapagliflozin (Dapa) and/or GLP-1RA exenatide (Ex-4) or vehicle-controls underwent IRI via 30-min left anterior descending (LAD) artery ligation. Analysis of late cardiac remodeling at d-28 post-IRI revealed preserved ejection fraction (EF) in mice treated with Dapa+Ex4 (50±2%; n=12, P<0.05)
vs.
vehicle-treated controls (36±3; n=11, P<0.05), whereas treatment with Dapa- and Ex-4-alone showed no such benefit. These improvements in LV function were associated with reduced infarct size (%LV) in mice treated with Dapa+Ex4 (17±3; n=8, P<0.001) and Ex-4-alone (29±3; n=10, P<0.05)
vs.
vehicle-control (44±5; n=10). Metabolome and merged proteome+phosphoproteome analyses revealed systemic and myocardial metabolic modulation following 7-d Dapa+Ex-4 treatment, with distinct enrichment of mitochondrial electron transport chain pathways. Cardiomyocytes isolated from mice treated
in vivo
for 7-d also showed enhanced aerobic respiration as measured by oxygen consumption rate (OCR;17.6±1.7 pmol/min/μg protein; n=4 mice) compared Dapa- (8.9±0.8; n=3, P<0.001), Ex-4-alone (11.4±0.9; n=3, P<0.01) and vehicle-treated controls (9.5±0.6; n=5, P<0.001).

Conclusions:
Combined therapy with SGLT2i+GLP-1RA in non-diabetic mice better prevented late cardiac remodeling after IRI compared to either agent alone or vehicle controls. These findings provide rationale for the combined use of these agents in a condition (IRI) for which there remains no approved therapy, and implicate metabolic modulation as a cardioprotective strategy in the absence of diabetes.
Abstract 13156: Acute Myocardial Infarction With Biventricular Thrombi Due to Blunt Thoracic Trauma
Authors: Mok Jacob , Sikanderkhel Saad , Moody Hannah , Patel Dharmendra , Stevens Patrick , Manyam Harish
Published: April 2024

To our knowledge, this is the first ever reported case of biventricular thrombi with acutemyocardial infarction following blunt thoracic wall trauma. We present a case of a man who presented with non-ST segment elevation myocardial infarction with left anterior descending artery (LAD) occlusion and biventricular thrombi after a blunt thoracic wall trauma.

Clinical Vignette:
A 56-year-old man with past medical history of diabetes mellitus and hypothyroidism presented to our ED with dizziness after motor vehicle collision. Initial workup revealed biventricular thrombi, pulmonary embolus, and dural sinus thrombosis. 2D echocardiogram showed decreased systolic function with ejection fraction of 15% and enlargement of both ventricles with biventricular thrombi. Serial troponin I levels consistently elevated from 0.3 to 0.6. After initiating cangrelor and heparin infusion, patient underwent coronary angiography which revealed LAD occlusion with a thrombus. Patient then successfully underwent mechanical thrombectomy with restoration of TIMI grade III blood flow.

Discussion:
Hence, we presented the first ever reported case of biventricular thrombi with LAD occlusion resulting from blunt thoracic wall trauma. While trauma induced musculoskeletal pain may mask symptoms of myocardial infarction, a high index of suspicion for acute coronary syndrome can lead to desirable outcomes in such patients.
Abstract 13158: Improving Clinical Outcomes by Implementing a Multi-Disciplinary Pulmonary Vein Stenosis Team
Authors: Vanderlaan Rachel D , Dragulescu Andreea , Tran Crystal , Fan Steve , Wan Andrea , Yoo Shi Joon D , Seed Mike , Grosse-Wortmann Lars , Grasemann Harmut , Honjo Osami , Barron David , Russell Jennifer L , Caldarone Christopher
Published: April 2024

Introduction:
Pulmonary vein stenosis (PVS) is a rare disease that is associated with high mortality. In 2015, we instituted a multidisciplinary PVS team and surveillance protocol to aid disease detection and treatment.

Hypothesis:
Implementation of a PVS team will improve clinical outcomes in children with PVS

Methods:
In this retrospective study (2009-2019), we compared patient characteristics, disease surveillance and treatment practices for primary PVS patients prior to the introduction of the PVS team (NoPVT, first intervention between 2009-2014) and after the introduction of the PVS team (PVT, first intervention between 2015-2019).

Results:
In our cohort, there were 29 patients in the NoPVT group and 33 patients in the PVT group. We found no significant difference between the median age of first intervention (0.48 (0.22-0.92) years, NoPVT vs 0.66 (0.5-1.1) years, PVT), presence of bilateral disease (34%,NoPVT vs 65%, PVT) and number of veins diseased at diagnosis (2.1 ± 0.15 veins, NoPVT vs 2.3± 0.18 veins PVT). Following pulmonary vein interventions, more patients had surveillance axial imaging after introduction of the PVS team (28% NoPVT vs 72% PVT; p<0.05), with an average number of surveillance scans increased per patient (1.2± 0.46 NoPVT vs 2.4±0.33 PVT, p=0.05). There was an increased number of reinterventions for disease recurrence (17% NoPVT vs 42% PVT; p=0.05). Freedom from death at 1 and 2 years was 56% and 52% in the NoPVT cohort and 83% and 70% in the PVT cohort (p=0.068).

Conclusions:
Adoption of a surveillance protocol and dedicated PVS team has the potential to improve outcomes in children with primary PVS.
Abstract 13168: Total Lipoprotein Lipase Deficiency Does Not Impact Atherosclerosis Development in Low Density Lipoprotein Receptor Deficient Mice
Authors: Basu Debapriya , Kanter Jenny E , Izquierdo Maria Concepcion , Gonzalez Ainara , Huggins Lesley-Ann , Hu Yunying , Mullick Adam E , A Fisher Edward A , Bornfeldt Karin E , Goldberg Ira J
Published: April 2024

Introduction:
Elevated LDL cholesterol (LDL-C) is a major causal factor for CVD. However, the importance of elevated triglyceride rich lipoproteins (TRLs) on CVD is still being investigated. Lipoprotein lipase (LpL) is the rate limiting enzyme hydrolyzing circulating very low density lipoprotein (VLDL) and chylomicrons. The effect of increased TRLs as an independent factor on atherosclerosis is not known, in part, because hypertriglyceridemia associates with low levels of LDL-C.

Objective:
We tested whether whole body LpL deficiency in mice combined with LDL receptor (LDLR) deficiency and an atherogenic diet affects lesion formation.

Hypothesis:
LpL deficient mice will not show increased atherosclerosis progression as compared to control mice, despite severe dyslipidemia, due to reduced infiltration of atherogenic lipids into the aortic endothelium.

Methods:
Induced global LpL deficiency (i
Lpl
-/-
) was created by tamoxifen injection to activate beta actin-driven cre. To knock down hepatic LDLR we utilized anti sense oligonucleotides (ASOs) as well as a PCSK9 expressing AAV.

Results:
i
Lpl
-/-
mice on chow diet have elevated plasma triglycerides, increased VLDL cholesterol, lower LDL-C and lower high density lipoprotein cholesterol (HDL-C) compared to control
Lpl
fl/fl
mice. However, when hepatic LDLR was knocked down with using LDLR ASO or AAV PCSK9,
iLpl
-/-
mice displayed elevated LDL-C of about 150 mg/dl, similar to the levels seen in control mice with LDLR knockdown. When i
Lpl
-/-
mice were fed an atherogenic Western diet for 16 weeks, i
Lpl
-/-
mice developed severe hypertriglyceridemia (1500-8000 mg/dl) and increased total cholesterol to ~1500 mg/dl. LDL-C levels were similar to those of control mice with LDLR knockdown; ~200 mg/dl. HDL-C was lower in i
Lpl
-/-
mice compared to the controls (~10 mg/dl vs ~30 mg/dl). i
Lpl
-/-
mice had slightly smaller lesions in brachiocephalic arteries but macrophage content was similar to the controls. Aortic root lesion size was similar in both groups of mice.

Conclusion:
Despite severe hypertriglyceridemia, hypercholesterolemia and low HDL-C,
iLpL
-/-
mice did not exhibit altered atherosclerosis progression, likely because of the absence of LpL-derived atherogenic lipids or remnant lipoproteins.
Abstract 13170: Mechanical Thrombectomy or Bridging Therapy for Anterior Circulation Large Vessel Occlusion Strokes?
Authors: Trifan Gabriela , Biller Jose , Testai Fernando
Published: April 2024

Introduction:
The superiority of intravenous thrombolysis plus mechanical thrombectomy in combination, also known as bridging therapy (BT), relative to mechanical thrombectomy (MT) alone in large vessel occlusion (LVO) stroke has not been established.

Hypothesis:
BT may have similar efficacy an safety profiles as MT for anterior circulation LVO.

Methods:
A systematic search of biomedical literature databases was performed up to March 2021, to identify prospective and retrospective studies that reported the rates for functional independence (defined as modified Rankin Scale 0-2) and mortality at 90 days, in-hospital symptomatic hemorrhage (sICH), and successful recanalization rates for MT and BT. Effect size was represented by odds ratio (OR) and analysis was done using random effects meta-analyses. Heterogeneity was assessed by I
2
and Cochrane’s Q statistics.

Results:
Overall, 35 studies with 11,332 patients were included in the analysis. Mean age ± standard deviation for BT and MT was 69±12 and 70±12 years, respectively. BT group had 28% higher odds for functional independence (OR=1.28, 95% CI 1.13-1.46, I
2
=53%), 33% higher odds of successful reperfusion (OR=1.33, 95% CI=1.13-1.56, I
2
=43%) and a 31% decrease in odds for mortality (OR=0.69, 95% CI 0.59-0.81, I
2
=49%) compared with MT. The sICH prevalence was similar between groups (OR=1.03, 95% CI=0.87-1.22, I
2
=0%). When only RCTs with intention-to-treat analysis comparing BT to MT were included in the analysis (n=1,633), there were no differences in functional independence (OR=0.99, 95% CI=0.81-1.20, I
2
=0%), successful reperfusion (OR=1.33, 95% CI=0.95-1.87, I
2
=0%), sICH (OR=1.23, 95% CI=0.82-1.83, I
2
=0%) or mortality (OR=0.94, 95% CI=0.72-1.21, I
2
=0%) between the groups.

Conclusions:
The odds for functional independence, successful reperfusion and mortality favored the use of BT over MT. The study had medium heterogeneity and low quality of the evidence. However, when the analysis was restricted to RCTs intention to treat analyses, BT and MT had similar efficacy and safety outcomes, with no heterogeneity.
Abstract 13173: Early Determination of Residual Inflammatory Risk and Its Association With Adverse Clinical Events in East Asian Patients Treated With Percutaneous Coronary Intervention
Authors: Ahn Jong-Hwa , Udaya Tantry , Kang Min Gyu , Park Hyun Woong , Koh Jin-sin , Bae Jae Seok , Cho Sang Young , Kim Kye-Hwan , Jang Jeong Yoon , Park Jeong Rang , Park Yongwhi , Schlaich Markus , Kwak Choong Hwan , Hwang Jin-Yong , Gurbel Paul A. , Jeong Young-hoon
Published: April 2024

Background:
East Asian population has substantially low level of inflammation compared with Western population. It remains uncertain that early determination of residual inflammatory risk (RIR) and its clinical impact in East Asian patients with coronary artery disease (CAD).

Methods:
This was a cohort analysis with CAD patients (n=5,840) undergoing percutaneous coronary intervention (PCI) with serial assessment of inflammatory status from East Asian registry. Inflammatory status was determined by measuring high-sensitivity C-reactive protein (hs-CRP) at on-admission and 1-month follow-up. Patients were stratified into 4 groups according to hs-CRP criteria (≥2 mg/L): (1) persistent low RIR (51.0%); (2) fortified RIR (low
on-admission
-high
1-month
) (10.3%); (3) attenuated RIR (high
on-admission
-low
1-month
) (12.1%); and (4) persistent high RIR (18.3%). Primary endpoint was defined as a composite of CV death, non-fatal MI, and non-fatal stroke.

Results:
With a median follow-up of 37.0 (IQR: 19.9, 72.9) months, primary endpoint was occurred in 11.4% of the cohort. Levels of hs-CRP were decreased over time (on-admission vs. 1-month: median 1.3 vs. 0.9 mg/L;
P
<0.001), which association with primary outcome appeared incremental. Risk of primary endpoint was significantly different across the groups (log-rank test,
P
<0.001). After adjustment, patients with persistent high RIR showed a higher risk of primary endpoint compared to subjects with persistent low RIR (adjusted HR, 1.41; 95% confidence interval, 1.12 to 1.78;
P
<0.001).

Conclusion:
About one-fifth of East Asian patients with CAD have persistent high RIR, which impact on ischemic events appears robust. Unique RIR profile of these patients may explain their better clinical outcomes compared with Western populations.
Abstract 13182: Dapagliflozin and Changes in Metabolic Syndrome in Patients With Type 2 Diabetes: A DECLARE TIMI 58 Sub-Analysis
Authors: Moura Filipe A , RAZ Itamar , Cahn Avivit , Goodrich Erica , Bhatt Deepak L , Leiter Lawrence A , WILDING JOHN , Gause-nilsson Ingrid A , Mosenzon Ofri , Sabatine Marc S , Wiviott Stephen D
Published: April 2024

Introduction:
SGLT2 inhibitors reduce cardiovascular (CV) risk in a broad range of patients including those with and without type 2 diabetes mellitus (DM). In addition, non-glycemic effects modify parameters that define metabolic syndrome (MetS) such as weight, BP, and lipid profile. In this context, we investigated the effects of dapagliflozin on key components of MetS and the association with outcomes.

Methods:
17,160 patients with DM were randomized to dapagliflozin or placebo in DECLARE-TIMI 58. Since all had DM, MetS was classified using a modification of IDF criteria requiring BMI ≥30 kg/m
2
and ≥1 of the following: triglycerides ≥150 mg/dL, HDL-C <40 in men or <50 mg/dL in women, SBP ≥130 or DBP ≥85 mmHg. Classification of MetS and its subcomponents were tracked at baseline and follow-up visits (6-48 months). An analysis adjusted for baseline characteristics and treatment was performed to assess the association of MetS with key outcomes.

Results:
At baseline, 53% had MetS. On adjusted analysis, MetS was predictive of CV death or hospitalization for heart failure (CVD/HHF) (HR 1.28, 95%CI 1.11-1.47, p<0.001), HHF (HR 1.62, 95%CI 1.33-1.97, p<0.001), and MI (HR 1.22, 95%CI 1.05-1.4, p=0.008). From 6 to 48 months, there was a lower prevalence of MetS in the dapagliflozin arm (47.9% vs. 52.5%, p<0.001, Figure 1), as well as lower prevalence of BMI ≥30 kg/m
2
(54.9% vs. 58.0%), low HDL-C (38.7% vs. 42.6%), and elevated BP (58.2% vs. 65.7%) with p<0.001 for each. In the dapagliflozin arm, there were lower odds of progression to MetS (10.5% vs. 13.5%; OR 0.76, 95%CI 0.64-0.89, p<0.001) and, in those with MetS at baseline, higher odds of regression (24.6% vs. 18.3%; OR 1.45, 95%CI 1.29-1.64, p<0.001) at 48 months.

Conclusions:
The presence of MetS is prognostically important in patients with DM. Dapagliflozin led to significant early and sustained changes in the likelihood of MetS.
Abstract 13183: Persistent Anemia Was Associated With Higher Long-Term Mortality in Patients With Chronic Kidney Disease Following Primary Percutaneous Coronary Intervention
Authors: Koike Takuma , Chikata Yuichi , Iwata Hiroshi , Yasuda Hidetoshi , Funamizu Takehiro , Doi Shinichiro , Shitara Jun , Endo Hirohisa , Wada Hideki , Naito Ryo , Ogita Manabu , Dohi Tomotaka , Kasai Takatoshi , Okazaki Shinya , Miyauchi Katsumi , Daida Hiroyuki , Minamino Tohru
Published: April 2024

Background:
Anemia is one of the most common complications of chronic kidney disease (CKD), renal anemia, which has a significant link with increased risk of the morbidity, as well as the mortality of cardiovascular disease. However, the prognostic implication of the temporal change of anemia status has been rarely addressed, especially in secondary prevention of coronary artery disease (CAD).

Methods and Results:
This long-term (median follow-up range: 5.7 years) single center observational study involved consecutive 416 patients with CKD over stage 3 (defined by eGFR<60 ml/1.72/m
2
) who underwent percutaneous coronary intervention (PCI) for the first time since 2003 to 2018. All-cause death was set as an endpoint. Participants were divided into 4 groups by the median of hemoglobin (Hb) at PCI (baseline, 12.0 mg/dl) and 8.1±2.1 months after PCI (follow-up, 12.7 mg/dl), respectively: Groups of Continuously high-Hb (n=146), Increased-Hb (n=51), Attenuated-Hb (n=61) and Persistently low-Hb (n=158). Categorized Cox proportional hazard analysis with setting Continuously high-Hb group as a reference showed a significantly increased risk of all-cause death in groups of Attenuated- (Hazard ratio (HR) 2.6, 95% confidence interval (CI) 1.3-5.2, p=0.01) and Persistently low-Hb (HR 2.6, 95%CI 1.4-4.8, p=0.002), respectively, while similar in Increased-Hb group (HR 1.1, 95%CI 0.3-3.2, p>0.5)
(Figure)
.

Conclusion:
This study showed a significant association between the reduced Hb overtime and increased mortality risk in patients with CKD and CAD, which might potentially indicate a prognostic merit of the intervention for renal anemia in this population.
Abstract 13192: Local Delivery of Thrombin Inhibiting Nanoparticles Preserves Cardiac Function and Modulates NLRP3 Inflammasome Processes in Acute Myocardial Infarction
Authors: Vargas Ian , Zhou Qingyu , Grabau Ryan , Chen Junjie , Weinheimer Carla J , Kovacs Attila , Dominguez-Viqueira William , Pan Hua , Wickline Samuel
Published: April 2024

Introduction:
The role of thrombin in acute myocardial infarction (AMI) has been well described, with recent attention having turned to its effect on NLRP3 inflammasome activation and the role that plays in the pathogenesis of AMI. Perfluorocarbon nanoparticles conjugated to phenylalanine-proline-arginine-chloromethylketone (PPACK NPs) are extremely potent local inhibitors of thrombin, but their role in therapy for AMI remains unclear. We hypothesize that pre-treatment with sustained locally acting PPACK NPs preserves cardiac function by attenuating thrombin-induced inflammatory processes, including those driven by the NLRP3 inflammasome.

Methods:
Nine mice underwent left anterior descending (LAD) occlusion for 45 minutes. At 30 minutes before LAD occlusion, mice were injected with PPACK (n=5) or control NPs (n=4). 24 hours post-reperfusion, hearts were excised and perfused. LAD was re-occluded and Lectin-488 perfused through the excised heart. Echo was performed pre- and post-reperfusion to assess cardiac function. Hearts were sectioned for follow up histological and protein analysis.

Results:
PPACK NP treated mice exhibited evidence of preserved cardiac function 24 hours post-reperfusion (Figure 1, A-B), reduced nuclear translocation of p65 in infarcted myocardium (Figure 1, C-D), and reduced inflammatory markers with better vessel preservation in the area adjacent to uninjured myocardium (Figure 1, E-F). The PPACK NP group also demonstrated suppression of NLRP3 inflammasome activation (Figure 2).

Conclusion:
Local inhibition of thrombin with anti-inflammatory PPACK NPs preserves cardiac function when administered systemically as pre-treatment.
Abstract 13677: Thirty-Day Readmissions After Transcatheter Aortic Valve Replacement in the United States
Authors: Khan Muhammad U , Khan Muhammmad Zia , Zahid Salman , balla Sudarshan
Published: April 2024

Introduction:
Transcatheter Aortic Valve replacement (TAVR) has revolutionized the treatment of severe aortic stenosis and is now considered the standard of care in prohibitive surgical risk population. Post procedure re-admission is associated with increased morbidity and mortality.

Hypothesis:
To evaluate the 30 day hospital re-admission presentations of patients who underwent recent TAVR.

Methods:
We used National readmission database year 2018 to identify all patients who underwent TAVR using ICD-10 codes (02RF3)

Results:
Of a total of 31,252 patients undergoing TAVR, 9102 (29.1%) patients were re-admitted at least once during the next 30 days. Of these 3475 (38.2%) patients had acute congestive heart failure, 1303 (14.3%) had pulmonary complication, 774 (8.5%) a GI complication, 443 (4.9%) vascular complication, 237 (2.6%) a neurological complication and 119 (1.3%) patients had prosthetic valve dysfunction for re-admission

Conclusions:
Re-admission rates after TAVR remains a significant challenge, with varying presentations, however, acute heart failure remains the leading re-admission diagnosis.
Abstract 13708: Left Ventricular Thrombus in Patients With Takotsubo Cardiomyopathy in the US Veteran Affairs Healthcare System
Authors: Alqam Bilal , Habash Fuad , Gheith Zaid , Vallurupalli Srikanth , Maskoun Waddah
Published: April 2024

Introduction:
Takotsubo cardiomyopathy is characterized by significant transient left ventricular (LV) dysfunction that is not due to obstructive coronary artery disease. LV thrombus is a known complication of Takotsubo cardiomyopathy, but the outcomes of these patients are not well described in the literature. The aim of our study was to investigate the rates and outcomes of patients diagnosed with Takotsubo cardiomyopathy with LV thrombus in the Veteran Affairs (VA) system.

Methods:
We performed a retrospective study using chart review for patients diagnosed with Takotsubo cardiomyopathy between 2005 and 2018 in the VA national database. We included patients who met the Mayo Clinic diagnostic criteria for Takotsubo cardiomyopathy. We collected data for demographics, clinical course, and outcomes.

Results:
320 patients (69% males) were included. Median age was 64 years, 20.3% were known to have coronary artery disease, 34.7% had Diabetes and 61.3% had hypertension. 96.8% of patients had Apical variant of Takotsubo cardiomyopathy. LV thrombus was diagnosed in 8.8% of patients, all of those patients had apical variant of Takotsubo cardiomyopathy. There were no significant differences in the mortality rates in the hospital (14.3% vs 7.4%, p=0.15) and at 30-day follow up (4.2% vs 1.9%, p=0.45) in patients who developed LV thrombus compared to patients who did not. For patients who developed LV thrombus, only 1 patient developed a stroke on 30-day follow up; that patient was on therapeutic doses of warfarin for anticoagulation at the time of the stroke.

Conclusions:
In patients diagnosed with Takotsubo cardiomyopathy with LV thrombus, there was no significant difference in mortality rates in the hospital or at 30 day follow up when compared to patients with no LV thrombus. Only one of those patients developed a stroke during follow up, suggesting that the embolic risk is low with appropriate treatment.
Abstract 13725: Comparison of 30-day Readmission After Hospitalization for Heart Failure With Amyloidosis versus Those Without Amyloidosis: Insight From National Readmission Database
Authors: ASEMOTA IRIAGBONSE , Akuna Emmanuel , SOON-SHIONG RAQUEL , LI LIN , KANG CYRA-YOONSUN , KHANAL SMRITI , ALMANI MUHAMMAD , Elbermawy Mahmoud , Sharma Bharosa , SHRESTHA PRAJWAL , KUMI DENNIS
Published: April 2024

Introduction:
Heart failure is a common presentation in patients with amyloidosis. The aim of this study was to compare the non-elective 30-day readmission rates among patients hospitalized with heart failure (HF) with and without a secondary diagnosis of amyloidosis.

Methods:
Using the 2018 nationwide readmissions database, we identified patients with a principal discharge diagnosis of heart failure and stratified all cause 30-day readmissions to two groups, those with coexisting amyloidosis and those without amyloidosis. We utilized Chi-square tests to compare baseline characteristics between readmissions for both groups. The mean length of hospital stay (LOS) and total hospital charge (THC) were also compared for both groups using regression analysis.

Results:
HF failure patients with co-existing amyloidosis had a significantly higher 30-day all-cause readmission rate (22% vs 16.5%, P=0.03), with 4.25 days increase in the unadjusted mean LOS (5.68 vs 9.94 days, P=0.026) compared to their cohorts without amyloidosis. The amyloidosis group were older (68.4 vs 64.7 years, p=0.149), had a higher odd of inpatient mortality (AOR: 2.69, P = 0.144), and accrued a higher THC of $30,525 ($84,549 vs $54,024, P=0.11) in comparison to their non-amyloidosis counterparts however, these were statistically non-significant.

Conclusions:
Patients admitted with heart failure with amyloidosis had a higher 30-day all cause readmission rate and stayed longer in the hospital in comparison to HF patients without amyloidosis. Early risk stratification and intensive treatment may help reduce unplanned readmission rates among heart failure patients with amyloidosis.
Abstract 13753: Clinical Characteristics and Outcomes of Patients Presenting With Acute Myocardial Infarction and Cardiogenic Shock During Coronavirus Disease 2019: An Analysis From the National Cardiogenic Shock Initiative
Authors: Srivastava Pratyaksh K , Ahlers Michael , Basir Mir B , Hacala Michael , O'Neill William W , Nsair Ali
Published: April 2024

Introduction:
The coronavirus disease 2019 (COVID-19) pandemic has created challenges in the delivery of acute cardiovascular care. Here, we evaluate the clinical characteristics and outcomes of patients presenting with acute myocardial infarction and cardiogenic shock (AMICS) during the COVID-19 pandemic.

Hypothesis:
COVID-19 time period will associate with longer door to intervention times, and increased all-cause mortality among patients presenting with AMICS.

Methods:
Using the National Cardiogenic Shock Initiative database, we identified 406 patients who presented with AMICS. This group was divided into those who presented prior to COVID-19 (N=346, 5/9/2016-2/29/20) and those who presented during the pandemic (N=60, 3/1/20-11/10/20). Clinical characteristics, treatment patterns, and outcomes were compared between the two groups.

Results:
The median age (25
th
-75
th
percentile) of the cohort was 64 (55-72) years, and 23.7% of the group was female. There were no significant differences in age, sex, and medical comorbidities between the two groups. Patients presenting during the pandemic were less likely to be of Black race, and more likely to be of Hispanic and White race than patients presenting prior to COVID-19. Median door to balloon (89.5 vs. 88 mins, p=0.38), door to support (88 vs. 78 mins, p=0.13), and onset of shock to support (73.5 vs. 62 mins, p=0.15) times were not significantly different when comparing those who presented prior to with those who presented during the pandemic. Rates of transfer from another hospital, and cardiac arrest prior to arrival in the cardiac catheterization lab were similar between the two groups. ST-Elevation Myocardial Infarction presentations were increased during the COVID-19 period (95% vs 80%, p=0.01). In adjusted logistic regression models, time period (during vs pre-COVID-19) did not significantly associate with survival to discharge (OR 1.17, 95% CI 0.59-2.35, p=0.65) or with one month survival (OR 0.82, 95% CI 0.42-1.61, p=0.56).

Conclusions:
Care of patients presenting with AMICS has remained robust among hospitals participating in the National Cardiogenic Shock Initiative during the COVID-19 pandemic.
Abstract 13764: Prognostic Value of a Novel Echocardiographic Risk Score for Long-Term Clinical Outcomes in Patients With Ischemic Heart Failure
Authors: Nordbeck Peter , Liu Dan , hu kai
Published: April 2024

Introduction:
Two-dimensional-echocardiography (2DE) derived global longitudinal strain (GLS) could predict outcome in patients with heart failure. Mitral annular plane systolic excursion (MAPSE) derived from M-mode echocardiography is a classical indicator of clinical outcome in heart failure patients.

Hypothesis:
This study aimed to compare the prognostic performance of GLS and MAPSE as well as a new echocardiographic risk score for the prediction of mortality and cardiovascular (CV) rehospitalization risk in ischemic heart failure (IHF) patients with reduced left ventricular ejection fraction (LVEF).

Methods:
This retrospective observational study comprised 1277 IHF patients with reduced LVEF (<50%) receiving echocardiography including GLS. All patients completed at least one-year clinical follow-up by telephone interview or clinical visit. The primary endpoints included all-cause death, heart transplantation, CV death, or rehospitalization. Measures were used to develop a novel risk score for clinical outcome.

Results:
After adjusted for age, sex, and other clinical risk factors, lower LVEF (≤30% vs. >30%, HR=1.39 and 1.53, P=0.005 and 0.002), lower MAPSE (≤7 vs. >7mm, HR=1.35 and 1.35, P=0.007 and P=0.021), or lower GLS (≤8.4% vs. >8.4%, HR=1.31 and 1.51, P=0.012 and 0.001) remained as independent predictors for overall and CV mortality, but not for CV rehospitalization. Prediction efficacy of a new echocardiographic risk score including multiple echocardiographic parameters, including systolic dysfunction (LVEF, MAPSE, or GLS), diastolic dysfunction, LV remodeling, and right-side cardiac dysfunction (right ventricular diameter and systolic pulmonary artery pressure) was tested stratifying low, intermediate, and high risk. Patients with high-risk score faced both significantly higher risk of overall mortality (HR=1.99 or 1.42) CV mortality (HR=2.15 or 1.60), and CV rehospitalization risk (HR=2.01 or 1.43) as compared patients with low or intermediate risk score (all P<0.05).

Conclusions:
The new echocardiographic risk score derived from multiple echocardiographic indicators is associated with satisfactory prognostic performance on both mortality and CV rehospitalization.
Abstract 13854: Association Between Pulmonary Function, Cardiac Structure and Function, and Cardiovascular Outcomes in the General Population
Authors: Andersen Ditte M , Johansen Niklas , Modin Daniel , Marott Jacob , Jensen Gorm B , Schnohr Peter , Sivapalan Pradeesh , Jensen Jens-Ulrik S , Mogelvang Rasmus , Biering-Sørensen Tor
Published: April 2024

Introduction:
We investigated the association between the lung function and cardiac structure and function, and how the lung function affects the prognostic value of cardiac structure and function in the general population.

Methods:
All participants from the 4
th
Copenhagen City Heart Study examination round who had an echocardiography and spirometry performed were included in the present analysis. Participants were classified as having either normal lung function with a forced expiratory volume in one second (FEV1) >=80% of expected or decreased lung function with FEV1<80%.The endpoint consisted of cardiovascular death, acute myocardial infarction, or incident heart failure.

Results:
Participants (n=2,149) were followed for a median 14.4 years (IQR 10.8-14.9), and there was a total of 371 (17%) events. The mean age was 57 ± 16 years, 57% were women, 44% had hypertension, and 64% were current or previous smokers. Decreased lung function at baseline was associated with a lower left ventricular ejection fraction (LVEF), a higher left ventricular mass index (LVMI), and a higher E/e’. In univariable analysis, LVEF, LVMI, E/e’, and left atrial volume (LAV) were predictors of the composite outcome in both groups. After multivariable adjustment for clinical and echocardiographic parameters, only LVMI remained an independent predictor of the composite outcome in both groups (normal lung function: HR 1.04, 95% CI (1.01-1.07), p=0.010; decreased lung function: HR 1.06, 95% CI (1.01-1.10), p=0.009). LVEF and LAV remained predictors of the composite outcome only in participants with normal lung function.

Conclusions:
In participants from the general population, a FEV1 below 80% was associated with a lower LVEF, a higher LVMI and a higher E/e’. For participants with normal lung function, LVEF, LVMI, and LAV were independent predictors of adverse cardiovascular events. For participants with a FEV1 below 80%, only LVMI was an independent predictor of adverse cardiovascular events.
Abstract 13900: Ex vivo Evaluation of Vascular Toxicity of Tobacco Products
Authors: Jin Lexiao , Conklin Daniel J
Published: April 2024

Introduction:
Tobacco smoke is the single most significant modifiable risk factor of cardiovascular disease (CVD), yet the contribution of electronic cigarettes (e-cig) to CVD risk is uncertain.

Objective:
The purpose of this study was to test an ex vivo approach for evaluation of vascular toxicity of tobacco products including e-cig aerosols.

Methods:
The assay relies on 2 facts of aortic function: 1) it is a biomarker of endothelial dysfunction; and, 2) it is nearly 100% dependent on endothelial-derived nitric oxide synthase (eNOS). To assess real-time eNOS function, phenylephrine-precontracted (PE) murine aortas were incubated with L-nitroargininemethylester (L-NAME) that subsequently increased tension and blocked (>99%) acetylcholine-induced relaxation (ACh %). The ‘L-NAME PE Contraction Ratio’ (PECR) was calculated as: ‘PE Tension post-L-NAME’ divided by ‘PE Tension pre-L-NAME’, and regressed vs ACh % relaxation.

Results:
Validation 1: PECR and ACh % values of naïve aortas were strongly and positively correlated (PECR vs ACh %, r
2
=0.91, n=7). Validation 2: Retrospective analyses of published PECR and ACh % data of aortic function of female mice exposed to air, propylene glycol:vegetable glycerin (PG:VG), formaldehyde (FA), or acetaldehyde (AA) for 4d, 6h/d showed that the PECR in air-exposed mice (PECR=1.42±0.04, n=16) correlated positively with the ACh % (r
2
=0.40) as in naïve aortas. Similarly, PECR values were significantly decreased in aortas with endothelial dysfunction yet retained positive regression coefficients (PG:VG r
2
=0.54; FA r
2
=0.55). Unlike other toxicants, AA exposure significantly increased both PECR and ACh % values yet diminished regression (r
2
=0.09). Validation 3: Naïve aortas were incubated (1h) with particles of either mainstream cigarette smoke (MCS) or PG:VG, and the PECR was significantly increased by MCS (1.97±0.17; p<0.05) yet not by PG:VG (1.34±0.05) compared with controls (1.48±0.05) indicating MCS induced vascular toxicity.

Conclusions:
Because the PECR reflects eNOS function directly, it is a robust tool for evaluating tobacco toxicity and predicting endothelial dysfunction. Thus, it strongly complements and extends insights gained using ex vivo measures of vascular toxicity.
Abstract 13919: Ticagrelor versus Clopidogrel in Patients With Acute Coronary Syndrome: A Meta-Analysis
Authors: Prasad Rohan M , Mujer Mark , Al-abcha Abdullah , Pandrangi Pranay , Rayamajhi Supratik , Abela george
Published: April 2024

Introduction:
P2Y
12
receptor antagonists are potent antiplatelet medications used in acute coronary syndrome (ACS). As compared to clopidogrel, ticagrelor has been shown to decrease the risk of myocardial infarction, stroke, and mortality. However, ticagrelor’s effect on the microcirculation of the coronary arteries is not well defined.

Methods/Results:
This meta-analysis compares the index of microcirculatory resistance (IMR), coronary flow reserve (CFR), and fractional flow reserve (FFR) of ticagrelor versus clopidogrel in ACS patients immediately post-PCI. Four randomized controlled trials were included with 375 patients. IMR was significantly lower in the ticagrelor arm (mean difference (MD) -6.34, 95% confidence interval (CI) -8.60 to -4.09, p<0.00001, I
2
=66%) (Figure 1). CFR was significantly higher in the ticagrelor arm (MD 0.26, 95% CI 0.04-0.47, p=0.02, I
2
=0%). Finally, FFR was determined to be similar between ticagrelor and clopidogrel.

Conclusion:
This meta-analysis shows that ticagrelor significantly decreases IMR and subsequently the risk of myocardial damage and microvascular injury. Ticagrelor is also associated with significantly higher values of CRF and thus a decreased plaque burden and microvascular burden. In correlation with the decreased adverse effects, ticagrelor may be more efficacious in improving microcirculation than clopidogrel immediately post-PCI in patients who present with ACS.
Abstract 13926: Air Pollution and Pulse Wave Velocity in Patients With Hypertension
Authors: Al-Kindi Sadeer , Brook Robert D , Dobre Mirela A , Rahman Mahboob , Wright Jackson T , Rajagopalan Sanjay
Published: April 2024

Introduction:
Ambient air pollution has been linked with increased cardiovascular risk, yet the mechanisms of this are incompletely understood. We sought to investigate the linkage between ambient particulate matter (PM
2.5
) and pulse wave velocity (PWV), a marker of arterial stiffness, in the systolic blood pressure intervention trial (SPRINT).

Methods:
A subset of SPRINT participants underwent PWV measurements at baseline, and annually through 3 years using the Sphygmocor CPV® system and were linked with ambient PM
2.5
using participant address at study entry. Spearman’s correlations and linear regression analyses were performed to investigate the relationship between PM
2.5
, baseline PWV, and change in PWV through year 3.

Results:
A total of 517 participants were included (259 to standard BP, and 258 to intensive BP). Mean PM
2.5
was 9.5±1.8 μg/m
3
and mean baseline PWV was 10.7±2.7 m/s. Over 3 years, PWV increased by a mean of 0.27 m/sec from baseline (P<0.001). There was no correlation between PM
2.5
and PWV at baseline (rho=0.01, P=0.84) or year 1 (rho=0.04, P=0.38). PM
2.5
, however, significantly correlated change in PWV between baseline and year 2 (rho=0.23, P<0.001), and between baseline and year 3 [ΔPWV
0-3
] (rho=0.26, P<0.001). The association between PM
2.5
and ΔPWV
0-3
was similar in the intensive (rho=0.29, P<0.001) and standard BP arms (rho=0.25, P<0.001). After adjusting for age, sex, race, study randomization, Framingham risk score, smoking, prevalent cardiovascular disease, and eGFR, PM
2.5
remained associated with ΔPWV
0-3
(β 0.37 per 1 μg/m
3
of PM
2.5
, standard error 0.06, P<0.001). Among participants living under the national air quality of 12 μg/m
3
, there was no change in PWV over 3 years (ΔPWV
0-3
0.13 m/s, P=0.26) while participants living above the NAAQS threshold experience significantly increased PWV over 3 years (ΔPWV
0-3
1.3 m/s, P<0.001), P=0.001 between PM
2.5
<12 vs ≥12 μg/m
3
.

Conclusions:
SPRINT participants who live in areas with higher ambient air pollution (PM
2.5
) levels experienced larger increase in PWV over 3 years, without a significant impact of intensive BP lowering strategy. Arterial stiffness should be investigated as a mediator of air pollution-related cardiovascular risk.
Abstract 13929: Do Tipsy Young People Develop More Atrial Fibrillation Than Sober Ones? - The Impact of Alcohol Burden on the Risk of Atrial Fibrillation: A Nationwide Population-Based Study
Authors: Han Minju , Lee So-Ryoung , Choi Eue-keun , Chung Jaewook , Lee HuiJin , Choi JungMin , Park Sang-Hyeon , Lee Seung-woo , Han Kyung-Do , Kim Sunhwa , Oh Seil , Lip Gregory
Published: April 2024

Introduction:
Alcohol is an adjustable risk factor for atrial fibrillation (AF), but its impact on the young population is unclear. We examined the effect of alcohol intake on the risk of AF in young Korean adults.

Hypothesis:
The alcohol intake will show positive relationship with the risk of AF.

Methods:
From the National Health Insurance Service database, we identified 1 537 836 people aged 20-39 without AF who underwent 4 serial annual health checkups during 2009-2012. At the first checkup, we sorted subjects into “No” and “Yes” groups, according to whether their weekly drinking exceeded 105g. They were also scored according to their usual weekly alcohol intake: “0” (n=507 463), “1” (<105g/wk, n=639 651), “2” (105≤g<210/wk, n=242 842), and “3” (210g≤/wk, n=147 880). We defined the alcohol burden as the number of times the subject answered he/she drank more than 105g of alcohol weekly, in the four checkups. Score of cumulative amounts of alcohol was computed by adding up one’s alcohol intake scores over the 4 years. The AF risk was estimated using Cox proportional hazards model.

Results:
During a median of 5.6±1.2 years, new AF was diagnosed in 3 066 (0.2%). “Yes” group showed a higher risk of AF compared to “No” group (adjusted hazard ratios (aHR) 1.15, 95% confidence interval (CI) 1.06-1.25,
p
≤0.001, Panel A). The risk was also in a positive association with the first drinking scores: aHRs with 95% CIs of the “1”, “2”, and “3” groups compared to “0” group were 1.00 (0.91-1.10), 1.11 (0.99-1.24), and 1.21 (1.07-1.37),
p
=0.039 (Panel B). As 57.3% in alcohol burden 0 group, 13.2% in 1, 9.6% in 2, 9.4% in 3, and 10.0% in 4, aHRs of burden 1, 2, 3, and 4 compared to burden 0 were 1.14 (1.02-1.27), 1.03 (0.90-1.17), 1.15 (1.02-1.30), and 1.24 (1.11-1.39);
p
=0.001 (Panel C). The score of cumulative amounts of alcohol was in a positive relationship with the risk of AF (
p
=0.003, Panel D).

Conclusions:
Cumulative alcohol burdens and amounts showed positive correlations with the risk of AF in young adults.
Abstract 13936: Cardiac Beta3-Adrenergic Receptors Increase Pentose Phosphate Pathway Flux And Protect Against Hypertrophic Remodeling By Reducing Oxidative Stress
Authors: Michel Lauriane , hrag esfahani , Roelants Veronique , Beauloye Christophe , Bertrand Luc , Jean-Luc Balligand
Published: April 2024

Introduction:
Cardiac beta3-adrenergic receptors (β3AR) mediate effects opposite to those of β1AR and β2AR and are upregulated during the development of hypertrophy or heart failure (HF). We previously showed that upon hemodynamic or neurohormonal stress β3AR confer protection against cardiac fibrosis and hypertrophic remodeling, two key components of the progression towards HF.

Hypothesis:
We tested the hypothesis that modulations of cardiac metabolism are implicated in the myocardial protection by β3AR

Results:
In a transgenic mouse model with cardiac-specific expression of the human β3AR (TG; compared to their wild-type littermates (WT)) myocardial glucose uptake is enhanced both in vivo (
18
Fluoro-deoxy-glucose by PET-CT) and in isolated adult cardiac myocytes exposed to hemodynamic stress by transverse aortic constriction for 9 weeks (TAC). In addition, a decrease in glycaemia during insulin tolerance test as well as an increase in Glut4 transporter in TG post-TAC suggest an insulin-dependency, as well as sensitization underlying the accrued glucose entry. Targeted metabolomics on cardiac tissue from TG (vs. WT) revealed a significant increase of several intermediates of the pentose phosphate pathway (PPP) post-TAC. Transcriptional expression from isolated cardiac myocytes showed an upregulation of several key enzymes of the pathway, that correlate with an elevation of NADPH levels, a major product of the PPP, with no modifications in nucleotides levels, implying a re-entry via the lower glycolysis. Consistent with an upregulated PPP, we found an increase in the ratio of reduced-to-oxidized Glutathione and a decrease in several indicators of oxidative stress (ROS production, MetO) both indicating a reduced oxidative stress.

Conclusion:
β3AR mediate an increased flux through the PPP, sustained by an enhanced glucose uptake, in cardiac myocytes upon prolonged hemodynamic stress. The associated renewal of the NADPH pool and cellular detoxification of ROS may contribute to the protective role of β3AR against hypertrophic remodeling. As β3AR agonists are currently used in clinical practice for urological indications, these original cardiac protective mechanisms may offer immediate perspectives for the prevention or treatment of HF.
Abstract 13979: Meta-Analysis of Efficacy and Safety of Colchicine Therapy in Patients With Acute Coronary Syndrome
Authors: Khan Muhammad U , Lone Ahmad Naeem , Khan Safi U , Khan Muhammmad Zia , Bianco Christopher , balla Sudarshan
Published: April 2024

Introduction:
Colchicine is known to be effective in treatment of inflammatory disorders, however, the effects of colchicine in patients with acute coronary syndrome (ACS) on top of background standard medical therapy remains uncertain.

Hypothesis:
There is paucity of data about colchicine therapy in patients presenting with acute coronary syndrome which may be associated with significant reduction in cardiovascular events.

Methods:
Six randomized controlled trials reporting CV outcomes in patients with acute coronary syndrome were included in MEDELINE, EMBASE and CENTRAL database (Inception to May 2021). The outcome measures were the summary random effects risk ratio (RR) with 95% confidence intervals.

Results:
In 6282 patients presenting with ACS, colchicine therapy did not significantly reduce the risk of all-cause mortality (RR, 1.62 [0.45, 5.88], P=0.87) or CV mortality (RR, 0.98 [0.43, 2.25], P=0.97) or myocardial infarction (MI) (RR, 0.88 [0.69, 1.11], P=0.28). Colchicine therapy had a significant effect on Major adverse cardiovascular events (MACE) (RR, 0.79 [0.64, 0.97], P=0.02), Stroke (RR, 0.33 [0.15, 0.72], P=0.01), and revascularization (RR, 0.46 [0.29, 0.73], P<0.01). In comparison to control, colchicine had significantly higher rate of GI side effects (RR, 1.53 [1.05, 2.23], P=0.03)

Conclusions:
Colchicine therapy in patients presenting with acute coronary syndrome was associated with significant reduction in MACE, stroke and revascularization at the cost of higher rate of GI side effects.
Abstract 13987: Efficacy and Safety of Surgical Repair of Atrial Septal Defect in Asymptomatic Children Less Than 3 Years of Age
Authors: Del Grippo Erica , Banga Gunjan , Bhat Majeed , Pizarro Christian , Tsuda Takeshi
Published: April 2024

Background:
Elective surgical closure of atrial septal defect (ASD) in asymptomatic children is commonly performed at 3 to 6 years of age when catheter-guided closure is not feasible. However, a recommended timing of surgical closure is not based on recent evidence.

Hypothesis:
Surgical ASD closure can be done safely in any age group.

Methods:
Asymptomatic patients with surgically closed isolated ASDs who were not indicated for catheter-guided closure in our cardiac center from 2002 to 2019 were studied. The patients were divided into 4 groups based on the age at surgery (<3 years, ≥3 to <6 years, ≥ 6 to >10 years, and ≥ 10 years). Demographic data, type of ASD, cardiopulmonary bypass time (CPBT), intensive care unit (ICU) stay, total hospitalization days, post-operative adverse events, and readmission rate were studied. Effects of creation of pericardial window (PW) was also examined. Data are shown as mean ± standard deviation.

Results:
Total 163 patients were studied (Table). There was no statistically significant difference in CPBT, ICU stay, or total hospitalization days among the 4 groups. There were no mortalities. Incidence of adverse events during hospitalization was low in < 6 years (1.9 to 4.2%) but higher in older ages (10.8 to 13.5%). Readmission rate was higher in younger groups: 18.6% in < 3 years old, 13.2% in ≥ 3 and < 6 years old, 8.0% in ≥ 6 and < 10 years, and 10.8% in ≥ 10 years, which was mainly due to pericardial effusion (PE). Total 18 patients developed PE postoperatively, 14 of whom were readmitted for treatment. With the creation of PW at the time of initial surgery, the incidence of PE and readmission rate were significantly reduced compared with without PW, especially in younger children. There was no complication due to PW.

Conclusion:
Surgical ASD closure can be performed safely even in younger children with ages <3 years, especially with creation of PW. Routine application of PW markedly reduced postoperative adverse events in surgical ASD closure.