bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 17485: Risk of Heart Failure Hospitalizations With Exposure to Colder Temperature and Regional Variations Among Older Adults in the United States
Authors: Bisno Daniel I , Kuhrt Nathaniel , Gandhi Poonam , Parthasarathi Ashwaghosha , Robinson David , Setoguchi Soko
Published: December 2023

Introduction:
Extreme cold was associated with excess heart failure (HF) deaths in ecological studies. The relationship between colder temperatures and HF hospitalizations is not well understood.

Hypothesis:
Lower minimum temperatures (T
min
) increase the risk of HF hospitalization among older adults and the impact varies by climate regions.

Methods:
A time-stratified case-crossover study among adults aged ≥66 hospitalized for HF was conducted using a 20% sample of Medicare data (2008-2019, Nov-Feb). Daily T
min
from the Parameter-elevation Relationships on Independent Slopes model were linked to Medicare data by zip code of residence. We used bidirectional sampling to select up to 5 controls. We used conditional logistic regression with a restricted cubic spline to model non-linear effects between T
min
and HF hospitalization in all patients and regional subgroups.

Results:
Among 529,879 cases (mean age 79, 61% female, 86% white), the risk of HF hospitalization peaked at 4 °F (OR 1.29 [CI 1.28-1.30]) and plateaued over colder T
min
relative to the median T
min
(31.5°F). Above 31.5 °F, the risk was reduced by 18% for every 10 °F (Figure 1). This inverse relationship between T
min
and HF hospitalizations during the winter were most prominent in colder regions (Figure 2).

Conclusions:
T
min
≤4 °F increased the risk of HF hospitalizations by upwards of 29% compared to the national median T
min
. The plateau at more extreme T
min
may be due to avoidance of outdoor exposure. A similar behavioral response may occur in warmer regions, whereas some degree of cold exposure is inevitable in colder regions. HF patients should be aware of the risks from exposure to colder temperatures during winter months.
Abstract 17498: Association Between 5-Year Change in Cardiovascular Risk and Atherosclerotic Cardiovascular Disease Incidence: A Multicohort Study
Authors: Yi Jiayi , Wang Lili
Published: December 2023

Introduction:
Early measurement of atherosclerotic cardiovascular disease (ASCVD) risk factors contains valuable information about an individual's risk history.

Hypothesis:
Individuals with different historical cardiovascular risk statuses have varied risks of future ASCVD incidence.

Methods:
We analyzed pooled data from 7 community-based prospective cohort studies with up to 20-year follow-ups (
panel A
). White or Black participants aged 40-75 years without prevalent ASCVD were included. Cardiovascular risk was assessed using the pooled cohort equation and was categorized into non-high (<20%) or high risk (≥20%). Changes in CVD risk over a 5-year interval were considered. The main outcome is incident ASCVD.

Results:
Among 11026 participants (mean [SD] age,60.0 [8.1] years). 4272 (38.7%) were female and 3127 (28.4%) were Black. During a median follow-up of 9.9 years, 2560 (23.2%) ASCVD events occurred. Compared to individuals with consistently high risk, participants with non-high to high risk (HR 0.67; 95%CI 0.59-0.77), high to non-high risk (HR 0.57; 95%CI 0.41-0.80), and consistently non-high risk (HR 0.33; 95%CI 0.29-0.37) had a lower risk of incident ASCVD. Compared to individuals with consistently non-high risk, participants with high to non-high risk (HR 1.74; 95%CI 1.26-2.41), non-high to high risk (HR 2.04; 95%CI 1.84-2.27), and consistently high risk (HR 3.03; 95%CI 2.69-3.42) had an increased risk of incident ASCVD (
panel B
).

Conclusions:
Changes in the CVD risk status over time inform dissimilar ASCVD risk than a single risk assessment. Dynamic risk evaluation might enable more accurate cardiovascular risk stratification and decision on preventive interventions should take historical risk status into account.
Abstract 175: Adiponectin Alleviates Cortical Neuronal Apoptosis Following Cardiopulmonary Resuscitation by Attenuating MiR-31-5p Carried by Brain Microvascular Endothelial Cell-Derived Extracellular Vesicles
Authors: Cao Yu , Zhou Fating , Gan Lu , Yao Peng
Published: December 2023

Background:
Adiponectin (APN) is a cardiovascular-protective adipokine. Our previous research has shown that APN administration reduced cortical neuron apoptosis in mice after resuscitation. Brain microvascular endothelial cell-derived extracellular vesicles (BMEC-sEVs) have neuroprotective properties, and APN regulates BMEC-sEVs' function to alleviate neuronal apoptosis after resuscitation. However, the specific molecular mechanisms are unclear. MicroRNAs carried by sEVs play essential roles.

Hypothesis:
APN may alleviate cortical neuron apoptosis by regulating miRNAs carried by BMEC-sEVs.

Aims:
To investigate if APN attenuates cortical neuron apoptosis in mice after resuscitation by regulating BMEC-sEVs-miRNAs and to elucidate the underlying molecular mechanisms.

Methods:
BMEC-sEVs
APN
were extracted and identified. BMEC-sEVs were injected into the brain to establish a cardiopulmonary resuscitation mouse model, and cortical neuron apoptosis was assessed. Co-culture experiments were performed between BMEC-sEVs and primary cortical neurons, and apoptosis was evaluated after oxygen-glucose deprivation/reperfusion (OGD/R). Bioinformatics identified miRNAs with pro-apoptotic effects. APN-regulated specific BMEC-sEV miRNAs were screened. Overexpression and inhibition experiments confirmed the neuroprotective effects of the identified miRNA. Target genes were screened, and downstream signaling pathways were explored.

Results:
APN enhanced the protective effect of BMEC-sEVs against cortical neuron apoptosis. APN preconditioning reduced miR-155-5p and miR-31-5p levels in BMEC-sEVs
APN
. MiR-31-5p was highly expressed in primary BMECs and increased after OGD/R. Overexpression of miR-31-5p in cortical neurons aggravated neuronal apoptosis. Inhibition of miR-31-5p reduced apoptotic neurons in Adipoq
-/-
mice after ROSC. Map3k1 was the most affected target gene of miR-31-5p, and its regulatory role in cortical neuron apoptosis was confirmed.

Conclusion:
APN alleviates cortical neuron apoptosis after resuscitation by downregulating miR-31-5p expression in BMEC-sEVs; BMEC-sEVs
APN
alleviate cortical neuron apoptosis through the miR-31-5p/MAP3K1 signaling pathway.
Abstract 17511: Aortic Stiffness Among Mexican-American Adults With Diabetes and Prediabetes: Evidence of Accelerated Vascular Aging and Increased Cardiac Biomarkers
Authors: Pickard Benjamin , Hanis Craig , Ballantyne Christie M , NAMBI VIJAY , Brown Eric , Jun Goo , Aguilar David
Published: December 2023

Introduction:
Type 2 diabetes mellitus is associated with increased aortic stiffness, a finding that predicts adverse cardiovascular events. Whether individuals with dysglycemia below the diagnostic threshold for diabetes have increased aortic stiffness has been less studied, particularly in Hispanic adults, a population sharing a disproportionate burden of dysglycemia.

Hypothesis:
We hypothesized that individuals with prediabetes would: (1) have increased aortic stiffness compared to normal glycemia, and (2) increased aortic stiffness would be associated with biomarkers of myocardial injury.

Aims:
We aimed to: (1) identify the relationship between aortic stiffness and glycemic status in a Hispanic cohort, and (2) determine the relationship between cardiac biomarkers and aortic stiffness.

Methods:
We prospectively measured carotid-femoral pulse wave velocity (PWV) and glycemic measures in 728 Mexican American adults in Starr County, Texas. Cardiovascular biomarkers [high-sensitivity troponin T (hs-TnT), galectin-3, and NT-proBNP] were measured in a subset (n=404). Multivariable models (using natural log PWV) were used to adjust for confounders.

Results:
45% of participants had diabetes, and 28% had prediabetes. PWV increased across glycemic categories; median PWV (25
th
, 75
th
) in diabetes was 11.7 m/sec (9.9, 13.7), prediabetes 9.9 m/sec (8.6, 11.1), and normal glycemia 8.7 m/sec (7.9, 9.9) (adjusted p-value <0.001 and 0.008, respectively). The figure demonstrates PWV stratified by age decade; PWV in prediabetes was similar to PWV in those without diabetes who were a decade younger. Median levels of hs-TnT, galectin-3, and NT-proBNP increased across quartiles of PWV (p trend <0.001 for all).

Conclusion:
In a cohort of Hispanic adults, increased aortic stiffness develops before the onset of diabetes and seen in those with pre-diabetes. Importantly, increased aortic stiffness is associated with biomarkers of cardiac injury.
Abstract 17513: Decreased Sensory Neurotransmission Due to Neuronal Mitochondrial Dysfunction Mediates Sex Differences in Vagal Remodeling After Myocardial Infarction
Authors: Devarajan Asokan , Wang Kerry , Lokhandwala Zulfiqar , Emamimeybodi Maryam , Shannon Kassandra , Tompkins John , Vaseghi Marmar
Published: December 2023

Background:
Vagal dysfunction after chronic myocardial infarction (MI) exacerbates heart failure and predisposes to ventricular tachyarrhythmias (VT/VF). VT/VF after MI is more common in males than females. The mechanisms behind these sex differences are unknown.

Hypothesis:
We hypothesized that differences in autonomic remodeling in the vagal ganglia, which in a healthy state, provide beat-to-beat sensory neurotransmission and modulate efferent cardiac vagal tone, may serve as the mechanisms behind the sex differences in the incidence of VT/VF.

Methods:
MI was created (left anterior descending artery ligation) in male and female mice expressing channel rhodopsin in glutamatergic vagal neurons (VGlut2-ChR2-EYFP mice). Sham animals underwent thoracotomy only. Two weeks post-MI, heart rate (HR) responses were assessed following
in vivo
vagal afferent nerve activation via optogenetic stimulation (5 sec duration, 20 Hz, 10 ms and 20 ms stimulations). Ventricular fibrosis was quantified. Mitochondrial oxygen consumption rates (OCR), glutamate levels, and the levels of oxidative stress marker, 4-hydroxy nonenal (4HNE), were measured in the vagal ganglia.

Results:
Male MI animals demonstrated significantly reduced HR responses to optogenetic stimulation than female MI animals. No sex differences in the degree of ventricular fibrosis was observed. A decrease in glutamate content accompanied by decreased mitochondrial OCR and increased 4HNE levels was observed in the vagal ganglia of male infarcted vs. female infarcted mice, figure. There were no differences in the HR responses, glutamate content, mitochondrial OCR, and 4HNE levels between sham males vs. sham females.

Conclusion:
This study demonstrates significant sex differences in vagal remodeling post-MI, with decreased efferent vagal tone in males mediated at least in part by reduced vagal afferent glutamatergic signaling associated with impaired neuronal mitochondrial function.
Abstract 17529: Controlling Nutritional Status (CONUT) Score Predicts Adverse Events in Patients With Chronic Heart Failure Following Cardiac Resynchronization Therapy
Authors: Ono Yuma , Harada Taisuke , Kondo Hidekazu , Yufu Kunio , Shinohara Tetsuji , Teshima Yasushi , Takahashi Naohiko
Published: December 2023

Introduction:
Malnutrition and cachexia have been reported to be associated with poor outcomes in patients with chronic heart failure (CHF).

Hypothesis:
This study aimed to investigate the association between malnutrition determined by the Controlling Nutritional Status (CONUT) score and adverse events in patients with CHF after cardiac resynchronization therapy (CRT).

Methods:
This retrospective study evaluated 134 patients (90 male, mean age 70.6 ± 9.7 years; 31 (23%) old myocardial infarction, 57 (43%) dilated cardiomyopathy, 46 (34%) others) who underwent CRT implantation between 2004 and 2020 and were followed for at least one year after the operation (mean, 1070 ± 649 days). CONUT score was calculated in those patients before the CRT implantation. Patients with CONUT score of 0 - 4 (n = 106) were allocated to the preserved nutrition group, and those with CONUT score 5 - 12 (n = 28) were allocated to the malnutrition group. The primary endpoint was hospitalization for heart failure. The secondary endpoint was ventricular arrhythmias including both ventricular tachycardia and ventricular fibrillation, requiring anti-tachycardia pacing, cardioversion.

Results:
During the follow-up period, hospitalization for heart failure occurred in 55 patients (41%). Ventricular arrhythmias occurred in 31 patients (23%), and 15(48.6%) patients required cardioversion. Kaplan-Meier survival analysis showed a higher incidence of hospitalization for heart failure (log-rank 6.55;
P
= 0.011) and ventricular arrhythmias (log-rank 6.55;
P
= 0.011) in the malnutrition group. Cox proportional hazards regression analysis revealed that malnutrition group had a higher incidence of hospitalization for heart failure (hazard ratio 2.11; 95% CI:1.14 - 3.70,
P
= 0.018) and ventricular arrhythmias (hazard ratio 2.53; 95% CI:1.17 - 5.19,
P
= 0.020).

Conclusions:
Malnutrition determined by the CONUT score predicts adverse events in patients undergoing CRT implantation.
Abstract 17537: Myocardial Dysfunction is Associated With Impaired Angiogenesis in Patients With Heart Failure With Preserved Ejection Fraction
Authors: Frljak Sabina , Poglajen Gregor , Zemljic Gregor , Cerar Andraz , Vrtovec Bojan
Published: December 2023

Background:
Recent evidence suggests that myocardial microvascular damage may represent a key parameter in the pathogenesis of heart failure with preserved ejection fraction (HFpEF).

Aim:
We sought to investigate a potential correlation between parameters of angiogenesis and myocardial dysfunction in HFpEF patients.

Methods:
We enrolled 30 consecutive HFpEF patients with NYHA class III, left ventricular ejection fraction (LVEF) >50%, E/e' >15, and NT-proBNP >300 pg/ml. In all patients endothelial progenitor cells (EPCs) were mobilized by granulocyte-colony stimulating factor (G-CSF; 10 mcg/kg, 5 days) and collected via apheresis. Before EPC mobilisation we performed echocardiography and measured plasma levels of biomarkers of angiogenesis. All patients underwent electroanatomical mapping for the measurement of myocardial viability; preserved viability was defined as mean unipolar voltage> 8.3 mV.

Results:
Myocardial viability was preserved in 11 patients (37%; Group A) and decreased in 19 patients (63%; Group B). The groups did not differ in age (63±10 years in Group A vs. 61±8 years in Group B, P=0.78), gender (male: 73% vs. 79%, P=0.70), serum creatinine (1.07±0.34 mg/dL vs. 1.04±0.40 mg/dL, P=0.43), or LVEF (60±7% vs. 57±4%, P=0.32). In Group B we found higher levels of NT-proBNP (2370±1020 pg/mL vs. 920±455 pg/mL in Group A, P=0.04) and E/e’ (23.2±3.1 vs. 17.4±1.8 pg/ in Group A, P=0.02). After G-CSF stimulation, we found significantly lower numbers of EPCs in Group B (53±42 x10
6
cells/L) than in Group A (102±52 x10
6
cells/L, P=0.001). Similarly, apheresis yielded lower numbers of EPCs in Group B (85±82 x10
6
cells vs. 200±93 x10
6
cells in Group A, P=0.003). When compared to Group A, patients in Group B displayed lower levels of pro-angiogenic biomarkers (agiopoietin-1: 7.4±2.8 ng/mL vs. 12.4±5.1 ng/mL, P=0.02; vascular endothelial growth factor: 27.5±20.1 pg/mL vs. 51.6±24.2 pg/mL, P=0.01), and higher levels of anti-angiogenic biomarkers (endostatin: 56.5±19.1 ng/mL vs. 33.2±14.3 ng/mL, P=0.01; thrombospondin-2: 16.4±4.3 ng/mL vs. 9.2±5.0 ng/mL, P=0.03).

Conclusion:
In patients with HFpEF, myocardial dysfunction appears to correlate with reduced mobilisation of endothelial progenitor cells and impaired angiogenesis.
Abstract 17556: Predictors of Mortality and Burden of Arrhythmias in the Hospitalized Population With End-Stage Heart Failure; a Five-Year Retrospective Population-Based Study
Authors: Evbayekha Endurance O , Gaibor Carlos , Jelwan Yara , Bastidas Leonela , Kuttab Rani , Abbas Amer , Dixon Brittany , LaRue Shane
Published: December 2023

Introduction:
Heart failure (HF) is a significant cause of morbidity and mortality in the United States, contributing to approximately 1 in 8 deaths. Individuals with end-stage HF (eHF) experience debilitating symptoms leading to poor quality of life (QoL). We aimed to identify arrhythmias contributing to poor QoL and mortality in the inpatient setting.

Hypothesis:
The burden of arrhythmias in eHF may be overwhelming and a significant predictor of mortality. Understanding this may help proffer clinical management and improve outcomes.

Methods:
We used the ICD-10 code for eHF (I5084) from the National Inpatient Sample (NIS) (2016-2020) to identify all patients with eHF. We used a multivariate logistic regression model to adjust for confounders and estimate the mortality probability in each arrhythmia cohort. Our primary outcome was in-hospital mortality risk in each group. A p-value of 0.05 was deemed significant.

Results:
There were 22703 hospitalizations with eHF (mean age 67 years ±16), 66.5% (15091) were men, 59% (13018) were Caucasians, 27.2% (6017) were Blacks, 8.7% (1924) were Hispanics and 2.9% (505) Asians. Of these, 50.4% (11434) had atrial fibrillation (AFIB), 5.3% (1201) supraventricular tachycardia (SVT), 2.6% (586) ventricular fibrillation (VFIB), 1.6% (372) complete heart block (AVB3), and 0.4% (85) type 2 degree block (AVB2). All subgroups had independent associations with mortality, and VFIB was the highest predictor; adjusted odds ratio (aOR) 5.8 (4.6-7.1, p<0.0001), AFIB 4.3 (3.9-4.5, p<0.0001), SVT 1.9 (1.6-2.4, p<0.0001), AVB3 1.8 (1.3-2.4, p<0.0001), and AVB2 1.3 (0.6-3.0, p=0.5).

Conclusion:
Our analysis revealed that a high percentage of the in-hospital population with end-stage heart failure is burdened with atrial fibrillation. Ventricular fibrillation, atrial fibrillation, supraventricular tachycardia, and complete heart block all carried independent mortality risk, with ventricular fibrillation having the highest risk. Proactive management of arrhythmias in this population is warranted.
Abstract 17557: Single Limb-Lead Electrocardiogram Accuracy in Screening for Ventricular Pre-Excitation
Authors: Sayood Sinan S , Hodgson-zingman Denice , Kwaku Kevin F
Published: December 2023

Introduction:
Consumer devices capable of recording bipolar ECGs have been investigated and validated for atrial fibrillation detection and QT interval monitoring. Application of the technology to other electrical abnormalities like Wolff-Parkinson-White (WPW) is limited but could enhance the ability to screen for risk of cardiac arrhythmias before they occur.

Aims:
1. Determine how frontal lead ECGs perform in identification of ventricular pre-excitation (VPE).2. Determine which of the standard 3 bipolar leads perform best for this detection.3. Quantify the impact of training of the interpreter on identification of VPE with single lead tracings.

Methods:
Standard 12-lead ECGs were obtained from 20 patients before and after successful radiofrequency ablation of a single manifest accessory pathway. 3-second tracings were abstracted from leads I, II, and III from each ECG and were presented in random order to interpreters of varying experience and specialization who were asked to evaluate whether the tracing showed VPE. Results were tabulated to determine the accuracy of VPE identification. Descriptive statistics of the performance of each lead (alone and in combinations) and interpreter type were calculated.

Results:
A total of 52 respondents interpreted 5108 ECG tracings. Some respondents did not read all tracings and there were unequal numbers of respondents in the different interpreter categories. The Table below depicts the performance of each lead and respondent subgroups.

Conclusions:
VPE can be identified with reasonable accuracy using a single limb-lead ECG tracing, with lead I performing better than leads II and III. Addition of lead II or III improved accuracy by 5% only. Most consumer devices record lead I, suggesting that they could be used to screen for WPW. Interpreter specialization correlated more with accuracy than training status.
Abstract 17570: Combining Genomic Profiling and Clinical Data Through Machine Learning Modeling for the Prediction of Coronary Artery Disease Severity: Insights From the Genetic SYNTAX Score (GESS) Trial
Authors: Chatzopoulou Fani , Mittas Nikolaos , KARAGIANNIDIS EFSTRATIOS , Papazoglou Andreas S , STALIKAS NIKOLAOS , Moysidis Dimitrios V , Giannopoulos-Dimitriou Alexandros , Saiti Aikaterini , Ganopoulou Maria , Papa Anna , Chatzidimitriou Dimitrios , Giannakoulas George , Sianos Georgios , Angelis Lefteris , Vizirianakis Ioannis S
Published: December 2023

Background:
Genomic profiling emerges as a powerful partner in the prediction of CAD development.

Hypothesis:
Machine learning (ML) algorithms integrating genomic profiling and clinical data could improve patient outcomes by contributing to earlier non-invasive diagnosis of obstructive CAD.

Aims:
The Genetic Syntax Score (GESS) prospective cohort study aimed to create a ML-algorithm able to predict the severity of CAD based on the analysis of 228 single nucleotide polymorphisms (SNPs) and relevant clinical and demographic data. Ultimate goal of this analysis was to compare the predictive capacity of a SNP-including model with that of a clinical model without SNPs.

Methods:
Patients with suspected CAD (n=919, mean age: 64±12 years) underwent invasive coronary angiography (from 2019 to 2021), and, thereby, their SYNTAX score was determined. Peripheral blood samples were drawn for genomic profiling (next generation sequencing analysis of a custom-made panel consisting of 228 SNPs) under standardized methods. After the ML-based selection of the most important subset of features (clinical/SNPs), two competing meta-learners were fitted, called Model A (including clinical/demographic predictors) and Model B (Model A plus SNPs predictors). The difference in their predictive capacities for the precise assessment of CAD risk (whether a patient presents with SYNTAX score >0 or =0) and CAD severity (whether a patient presents with higher SYNTAX score) was investigated via Delong’s test and Wilcoxon signed-rank test, respectively.

Results:
Our ML-algorithm identified a total of 8 SNPs (rs11984041, rs41291556, rs2023938, rs2107595, rs216172, rs1800562, rs3732379, and rs964184) as significant predictors of CAD risk, and 7 SNPs (rs4845625, rs6689306, rs2046934, rs1332844, rs6801273, rs663129, and rs870142) as significant predictors of CAD severity. Model B demonstrated superior performance compared to Model A (Z=2.451, p=0.014 for CAD risk assessment, and V=16731, p=0.002 for CAD severity assessment).
Conclusion(s):
The combined use of clinical/demographic parameters and genomic profiling might be deployed to improve the prediction of CAD risk and severity under the guidance of ML-techniques.
Registration:
NCT03150680
Abstract 17607: Clonal Hematopoiesis of Indeterminate Potential (CHIP) is an Independent Risk Factor for Cardiomyopathy in Patients With Solid Malignancy
Authors: Matute Martinez Carlos F , Jayakrishnan Ritujith , Ferrigno Guajardo Ana , Leveille Etienne , Lin Derrick , Im Yunju , Christofides Anthos , Chen Nathan , Baldassarre Lauren A , VanOudenhove Jennifer , Halene Stephanie , Hwa John , Kwan Jennifer M
Published: December 2023

Background:
Somatic mutations linked to clonal hematopoiesis of indeterminate potential (CHIP) are associated with increased risk of cardiomyopathy (CM) and all-cause mortality in the general population. However, this relationship is less clear in patients with solid malignancy, and it is unclear if knowing CHIP status can identify patients at risk for adverse cardiac outcomes.
Objectives:
To determine the association between CHIP and the development of CM in patients with solid malignancy, as well as overall survival (OS).

Methods:
CHIP mutation status was determined by next-generation sequencing of DNA from peripheral blood samples of 173 participants with solid malignancy. A somatic variant pipeline using MUTECT2 selected for somatic CHIP variants with a variant of allele frequency between 2-40%. CHIP association with the outcomes of OS and CM was assessed using Kaplan-Meier survival and Cox regression analyses.

Results:
Participants’ median age was 63 years, and 76% were female. CHIP mutations were detected in 39% of participants, most commonly in DNMT3A, TET2, and IDH2 genes. Majority were breast cancer patients 54% (n= 94). More patients with CHIP had diastolic dysfunction (21% vs 9%, p=0.037) compared to those without CHIP. After a median follow-up of 36 months, those with CHIP had an earlier time to death and earlier time to CM. Cox regression analysis showed that metastatic disease (HR 2.92, P=0.003) and male gender (HR 2.35, P=0.03) were independent risk factors for death, and CHIP (HR 2.120, P=0.02) was an independent risk factor for CM (Figure).

Conclusions:
Our study showed that solid malignancy patients with CHIP had worse outcomes with shorter time to death and shorter time to CM, with CHIP being an independent risk factor for CM. CHIP assessment can help us identify patients who may be at greater risk for adverse cardiovascular events during and after cancer therapy and who may warrant closer monitoring.
Abstract 17646: Maternal and Neonatal Outcomes in Pregnant Women With Congenital Heart Disease: The Magee Obstetric Maternal and Infant (MOMI) ACHD Substudy
Authors: Saraf Anita , Patel JIl , Hindes Morgan , Berlacher Kathryn , Hoskoppal Arvind , Catov Janet M , Kalogeropoulos Andreas P
Published: December 2023

Introduction:
Adult patients with congenital heart disease (ACHD) have a life-long burden of cardiovascular morbidity that contributes to increased maternal and neonatal risk during pregnancy and the peripartum period.

Hypothesis:
Women with ACHD and their neonates have a higher risk of adverse pregnancy and peripartum outcomes as compared to women without ACHD.

Methods:
We matched 565 deliveries from women with ACHD and 1130 deliveries from women without cardiac disease (1:2 matching), for a delivery year, race and maternal age as a substudy of the Magee Obstetric Maternal and Infant (MOMI) study, of women who received perinatal care at the Magee-Womens Hospital at the University of Pittsburgh Medical Center between 1995-2020. We evaluated for in-hospital maternal and neonatal outcomes.

Results:
Of the 565 women with ACHD, 24.0% had aortic outflow and mitral valve abnormalities, 19.5% had pulmonary outflow and tricuspid valve abnormalities, 28.1% had isolated atrial or ventricular septal defects, 0.3% had single ventricle physiology, and 1.4% had outflow vessel abnormalities. Maternal and neonatal outcomes are summarized in Table 1. Women with ACHD had a higher rate of pregnancy loss (32.4% vs 26.2% p<0.001), induction of labor, and cesarean section. Neonates from ACHD women were delivered at an earlier gestational age, with a lower birth weight, and had a higher incidence of respiratory distress syndrome. ACHD women had a higher incidence of cardiovascular events (predominantly arrhythmias and pulmonary edema) and required intensive care more frequently (10.5% vs 1.2%, p<0.001) and for longer periods (2.1±1.8 vs. 1.1±0.3 days; P=0.027) after delivery.

Conclusion:
Women with ACHD are at higher risk for adverse clinical outcomes during pregnancy and delivery. Neonates of ACHD women are delivered slightly earlier by induction of labor and have consequent sequelae after birth.
Abstract 17647: Potential Candidates for Partial Oral Treatment in Patients With Endocarditis at a US Center
Authors: Pries-Heje Mia , Connolly Erin , Hartman Dylan , Kim Andy , Joyce Mary-Ruth , Itoh Akinobu , Cunningham Mark , Ogara Patrick T , Sun Yee-Ping , Slavin Samuel , Maguire James , Aghayev Ayaz , Weber Brittany N , Di Carli Marcelo , Suzuki Joji , Iversen Kasper , Baden Lindsey , Bundgaard Henning , Woolley Ann
Published: December 2023

Introduction:
In the Danish POET trial, oral step-down antibiotic therapy was non-inferior to intravenous antibiotic therapy (IVAB) in stabilized patients with left-sided infective endocarditis (IE). It is unknown whether oral treatment for IE can be efficacious in the US population.

Aim
Identify patients with IE who may have been candidates for POET treatment in a US cohort and assess the reduction of IVAB days and differences in characteristics and outcomes compared to participants in the POET trial.

Methods:
Retrospective study of patients admitted with IE at a US single center in Jan 2021 - July 2022. Possible candidates for POET treatment were patients with left-sided IE and infection with
S. aureus
,
E. faecalis
,
Streptococcus
, or coagulase-negative staph (CoNS), who had reached stabilization of infection or were discharged. Primary outcome was a composite of all-cause mortality, relapse of bacteremia, embolism or unplanned cardiac surgery within 6 months.

Results:
Of 152 patients with IE, 90 (59%) were possible candidates for POET treatment. Median length of IVAB after stabilization was 33 days (IQR 24-37). Compared to POET-trial patients, POET candidates in the US cohort were younger (64 vs 70 years), more often had diabetes (30% vs 17%), cancer (30% vs 8%), intravenous substance use (8% vs 1%) or pacemakers (18% vs 9%) [Table]. Prevalence of
S. aureus
(35% vs 22%) and CoNS infections (23% and 6%) was higher;
Streptococcus
was less common (30% vs 49%). Primary outcome occurred in 25 patients (28%) compared to 42 patients (10%) in the POET-trial (p<0.001).

Conclusions:
More than half of patients admitted with IE were possible POET candidates, for whom 4 weeks of IVAB may have been converted to oral antibiotics. Candidates in the US cohort had more comorbidities and primary outcome was three times higher than in the POET trial. Prospective studies are needed for verification of POET treatment in higher-risk US IE patients.
Abstract 17676: An Electrocardiographic Deep Learning Model is Informative for the Prediction of Atrioventricular Block After Transcatheter Aortic Valve Replacement
Authors: Aggarwal Arjun , Mayl Jonathan , Butler Liam , Thiesfeldt Scott , Patel Nisha , Pattanaik Sanket , Thomas Abigail , Yohannan Ethan , Celik Turgay , Akbilgic Oguz , Bhave Prashant , Zhao David X
Published: December 2023

Introduction:
Atrioventricular block requiring a permanent pacemaker (PPM) is an important complication after transcatheter aortic valve repair (TAVR). While several risk factors have been identified, a clinically useful risk prediction algorithm has been challenging to develop. Furthermore, while artificial intelligence methods utilizing structured clinical data have been used, a deep learning approach using raw electrocardiogram (ECG) data is a novel method in this field.

Research Question: The objective of our study was to develop an electrocardiographic artificial intelligence (ECG-AI) model to assess the risk of PPM placement after TAVR using only the pre-procedure ECG.

Methods:
We analyzed data from 651 patients that underwent TAVR at Atrium Health Wake Forest Baptist in the last 10 years. We obtained raw ECG files in XML format from General Electric (Boston, MA, USA). The ECG data were used as inputs within a convolutional neural network (CNN) model. The CNN was an adjusted residual network with a batch size of 64, had 100 epochs, and used Adam optimization with default parameters. The model was trained using a 5-fold cross-validation strategy on 80% of the data and validated on a 20% hold-out set. The CNN was supervised on need for new PPM within 30 days after TAVR. All model evaluations were performed on the hold-out set.

Results:
Of the 651 patients in our sample, 61 patients required PPM placement within 30 days after TAVR. The average age was 77.2±9 years and there were 260 females (40%). In our sample, 34/268 (12.7%) patients with self-expanding valves and 26/377 (6.9%) patients with balloon-expanding valves received a PPM. Results of our final model on the hold-out set yielded an area under the receiver-operator characteristic curve (AUC) of 0.74 (95% CI 0.56-0.92). The accuracy of our preliminary model was 77% with a sensitivity of 60% and specificity of 79%.

Conclusion:
Our ECG-AI model achieved a moderate AUC for the prediction of PPM after TAVR. This serves as a proof of concept that pre-TAVR ECGs alone are informative for prediction of PPM. Future work includes model optimization and adding demographic and clinical variables to refine and develop a robust predictive model with continual improvement of the accuracy for prediction of TAVR outcomes.
Abstract 17679: Prognostic Implications of Left Ventricular Hypertrophy Regression Based on 4-Tiered Classification of Left Ventricular Hypertrophy
Authors: Park Gyu Tae , Kim Hyue Mee , Hwang In-chang
Published: December 2023

Introduction:
4-tiered classification of left ventricular (LV) hypertrophy (LVH), which accounts for increased LV wall thickness and LV volume, has been suggested to identify subgroups of patients at differential risk. This study was conducted to evaluate prognostic impact of 4-tiered classification of LVH in newly diagnosed hypertension patients with LVH.

Methods:
We retrospectively enrolled patients who had LVH on echocardiography at the time of diagnosis and had serial echocardiography taken within a 6-18-month interval with anti-hypertensive medication. Patients were divided into 5 groups based on 4-tiered LVH classification (eccentric LVH with dilatation or without dilatation, concentric with dilatation or without dilatation), and LVH regression group by the follow up echocardiography. The primary outcome was the composite of adverse cardiovascular (CV) outcomes, including CV death, hospitalization for heart failure, coronary revascularization, stroke, and aortic events.

Results:
Among the 837 patients in the five groups the concentric LVH group and dilated eccentric group demonstrated significantly higher incidence of CV outcomes. Compared with LVH regression group, those with dilated concentric (adjusted hazard ratio [adjHR]: 8.95; 95% confidence interval [CI]: 4.34 to 18.48), dilated eccentric (adjHR: 6.24; 95% CI: 2.96-13.18), non-dilated concentric (adjHR: 2.04; 95% CI: 1.26-3.32) LVH exhibited increased in CV risk according to multivariable cox-regression analysis. However, the non-dilated eccentric LVH group did not demonstrate a significant increase in CV risk (adjHR: 0.75; 95% CI: 0.24-2.35).

Conclusions:
In patients with hypertension, regression of LVH during anti-hypertensive treatment is associated with better CV outcomes. However, non-dilated eccentric group were not increase CV risk compared with regression group. The 4-tiered LVH classification can be helpful to stratifying CV risk in patients with hypertension.
Abstract 17695: Atrial Myopathy as a Predictor of Ischemic Stroke Independent of Atrial Fibrillation in Native Americans: Analysis of Strong Heart Study
Authors: Barber Rylee , Reese Jessica , Tauqeer Ali , Zhang Ying , Leidner Jean , Okin Peter , Devereux Richard B , Umans Jason G , Fretts Amanda M , Stavrakis Stavros
Published: December 2023

Introduction:
American Indian individuals have high rates of ischemic stroke. This increased incidence of stroke within the American Indian patient population compared to other ethnic groups may be due to the increased prevalence of atrial fibrillation or it may be due to atrial myopathy. Recent reports suggest that atrial myopathy, may be an independent risk factor for ischemic stroke prior to the development of atrial fibrillation.

Hypothesis:
Determine if atrial myopathy defined by C-reactive protein (CRP) or increased left atrial diameter (LAD) index independently predicts stroke irrespective of atrial fibrillation diagnosis in American Indians.

Methods:
We analyzed participants from phase 2 of the Strong Heart Study, 1993-1995 (n=2000) and identified cardioembolic stroke events through 2020 (n=45). Patients were excluded if they had a baseline diagnosis of atrial fibrillation, according to chart review (n=6). To analyze if CRP or LAD index were associated with cardioembolic stroke, we divided these variables into quartiles and then used Cox regression modeling to identify independent predictors of cardioembolic stroke.

Results:
CRP divided into quartiles was significantly associated with cardioembolic stroke (p= 0.03; Figure 1A). Likewise, higher LAD index predicted cardioembolic stroke (p=0.002; Figure 1B). The association between cardioembolic stroke and CRP and LAD index remained significant even after controlling for age, sex, hypertension and body mass index.

Conclusions:
Elevated LAD index and CRP markers of atrial myopathy are associated with subsequent development of cardioembolic stroke in the absence of diagnosed atrial fibrillation in American Indians. Further research is warranted to establish whether these biomarkers could be used for screening for risk of cardioembolic stroke in American Indians.
Abstract 17714: Randomized Clinical Trial Comparing Bare Metal Stents Plus Oral Colchicine versus Drug-Eluting Stents for the Prevention of Hard Clinical Outcomes. Two Years Follow-Up Results
Authors: Rodriguez-Granillo Alfredo M , Correa Sadouet Camila , Mieres Juan , CUROTTO MARIA VALERIA , MILEI JOSE , Swieszkowski Sandra P , Stutzbach Pablo , Fernandez-Pereira Carlos , Pavlovsky Hernan , Ascarrunz Diego , Kastrati Adnan , Rodriguez Alfredo
Published: December 2023

Introduction:
Percutaneous coronary intervention (PCI) for ischemic heart disease is common and stent selection. Bare metal stents (BMS) or drug-eluting stents (DES) impact outcomes. Colchicine has been shown to reduce cardiac events. The long-term efficacy of BMS plus colchicine (BMS+C) vs DES in terms of major adverse cardiovascular events (MACE) is unknown. We presented preliminary results at AHA 2022, we are reporting extended follow-up.

Hypothesis:
PCI with BMS+C have similar MACE compared to DES-treated patients (pts).

Methods:
Multicenter, randomized clinical trial (RCT) enrolled PCI pts from February 2020 to April 2022, randomly assigned to BMS+C or DES and followed at 1, 6, 12 months, and then annually until 5 years. BMS+C received 0.5 mg oral colchicine BID for 3 months. Primary endpoint (EP) compared cost and incidence of MACE, a composite of death, myocardial infarction, stroke, or ischemic-driven target vessel revascularization. Due to the cost difference between devices a non-inferiority 15% threshold level was estimated. Secondary EP included individual components of primary EP and overall costs. Drug tolerance was analyzed. Baseline and 1-month C-Reactive Protein (CRP) levels were assessed and a delta difference was compared. An IRB and local authorities approved the protocol (NCT04382443).

Results:
We included 205 pts in each arm. Baseline characteristics were similar, Acute Coronary Syndromes was 78% vs 74.6% (p=0.24). Syntax Score was 22.2+/-11.4 vs 21.1+/- 9.4, respectively (p=0.49). Follow-up was 25 +/- 5 months. Primary and secondary EP are presented in the table. 5% of BMS+C pts withdraw from the drug due to side effects. Delta CRP between groups showed 5.4 +/- 6.4 vs 1.6 +/- 1.7, BMS vs DES, p<0.001.

Conclusions:
In this RCT of pts with ACS and low Syntax score, a strategy with BMS+C was non-inferior to DES in terms of long-term clinical outcomes. Colchicine diminished inflammation markers. Cumulative costs were lower in the BMS+C group. cost.
Abstract 17732: Vitamin D Deficiency Causes Higher Mortality and Larger Haematoma Post Intracerebral Haemorrhage in Mice
Authors: Lam Tsz Lung
Published: December 2023

Introduction:
From clinical observation study, vitamin D deficiency (VDD) is found to be associated with worse outcome in intracerebral haemorrhage (ICH). However, whether association was causal remained unknown. This study aims to demonstrate the causal association between VDD and worse outcome post ICH, and to investigate its underlying pathophysiology mechanisms if any.

Hypothesis:
VDD caused higher mortality in ICH due to larger haematoma. The larger haematoma was due to dysfunctional platelets.

Methods:
An mice model for ICH was adopted. ICH was induced by injecting collagenase into the cerebrum. VDD was induced via special diet for 3 weeks pre-stroke, while normal group was fed with normal diet
.
Mortality was measured for seven days post-ICH. Haematoma volume was measured with haemoglobin assay, sectioning, and T2*-weighted MRI, and. Blood brain barrier leakage was evaluated with Evans blue extravasation study. Platelet count and platelet activation test was performed.

Results:
VDD caused higher mortality post-ICH. VDD also caused larger haematoma and more severe blood brain barrier leakage. Platelet count was found to be increased, and platelet activation test showed increased platelet activation.

Conclusions:
VDD caused higher mortality and morbidity in mice. The higher mortality and morbidity likely were attributable to the larger haematoma. The larger haematoma was likely attributable to dysfunctional platelets, causing more severe intracerebral bleeding and compromised haemostasis.
Abstract 17733: Self-Care Maintenance Moderated the Associations Among Symptom Burden, Functional Status, and Quality of Life in Patients With Heart Failure: A Moderated Mediation Analysis
Authors: Lin Chin-Yen , Moser Debra , Wu Jia Rong , Lennie Terry , Kang JungHee , Chung Misook L
Published: December 2023

Background:
Patients with heart failure (HF) commonly are symptomatic, which causes a decrease in functional status and results in worse health-related quality of life (HRQoL). Self-care maintenance (SCM) is known to prevent escalation of HF symptoms and improve functional status. However, few studies have tested the mechanisms underlying these relationships.

Purpose:
To determine whether the effect of symptom burden on HRQoL via functional status differs by the high and low SCM groups.

Methods:
In this cross-sectional study, 114 patients (mean age 63±12 years, 61% male, 70% white, 64% NYHA class III/IV) with HF completed questionnaires on SCM, symptom burden, functional status, and HRQoL measured by the maintenance subscale of the Self-Care of Heart Failure Index, the Memorial Symptoms Assessment Scale-HF, the Duke Activity Status Index, and the Minnesota Living with HF Questionnaire, respectively. Patients were categorized into high and low SCM groups using the standard cut point score of 70. Moderated mediation analysis was conducted using the PROCESS Macro.

Results:
Self-care maintenance significantly moderated the association of symptom burden with functional status, in that the association of symptom burden with functional status was stronger for the high SCM group (effect = -.083, 95% CI [-.115, -.050] than the low SCM group (effect = -.044, 95% CI [-.063, -.025], (moderation effect F = 4.10, p = .045). Symptom burden was significantly associated with HRQoL directly (effect = .176, 95% CI [.139, .213]) and indirectly through functional status for both high and low SCM groups (moderated mediation effect = .022, 95% CI [.002, .048]), and the indirect effect was two times higher for the high SCM group (effect = .046, 95% CI [.016, .080] than the low SCM group (effect = .025, 95% CI [.010, .042]).

Conclusion:
Symptom management aimed at improving symptom burden should focus on promoting SCM, which increases functional status, thereby improving HRQoL in patients with HF.
Abstract 17744: Intracranial Atherosclerosis Disease (ICAD) and Risk of Cognitive Impairment and Dementia: Systematic Review and Meta-Analysis
Authors: Sabayan Behnam , Goudarzi Roham , Borhani-Haghighi Afshin , Ji Yuekai , Olson-Bullis Barbara , Sedaghat Sanaz
Published: December 2023

Introduction:
Intracranial atherosclerosis disease (ICAD) alters cerebrovascular hemodynamics and is linked with brain structural changes and atrophy. Various studies evaluated the relationship between ICAD and risk of cognitive impairment with mixed results. This study aims to systematically review the current evidence and compile data on the association between ICAD and cognitive impairment and dementia.

Methods:
PubMed, EMBASE, PsycInfo and Web of Science were searched from January 1-2000, to March 1-2023, without language restriction. Cross-sectional and prospective cohort studies as well as post-mortem studies were included. Studies containing data on the link between ICAD and cognitive impairment and dementia were screened by two independent reviewers for inclusion in a systematic review and meta-analysis. From each study, data on the association between ICAD (at least 50% stenosis in one intracranial vessel) and cognitive impairment and dementia were extracted.

Results:
A total of 22 (17 observational and 5 post-mortem) unique studies comprising 11,184 individuals (average age range: 59.8 to 87.6 years, 45.7% female, 36.5% Asian) were included in the systematic review. Seven out of 10 cross-sectional studies and 5 out of 7 prospective studies showed a significantly higher risk of cognitive impairment and dementia in association with ICAD.Population-based studies and studies with patients with baseline cognitive impairment or dementia (consist of study participants from Asian, Europe and North America) consistently showed a significant association between ICAD and risk of cognitive decline. In the pooled analysis, ICAD was associated with 1.87-fold (95% confidence interval 1.49-2.35) increased risk of cognitive impairment. Meta-regression analysis did not show a significant impact of age, sex and ethnicity on the findings. All post mortem studies have shown that patients with Alzheimer’s disease and vascular dementia had a higher burden of ICAD as compared to cognitively normal controls.

Conclusions:
ICAD is associated with a higher risk of cognitive impairment and dementia in various age, sex and ethnic groups. Our findings underscore the importance of intracranial vascular health in brain health and prevention of dementia.
Abstract 17772: The Relationship Between Renin-Angiotensin System Inhibition and Coronary Artery Calcification Evaluated by Intravascular Ultrasound
Authors: Kanda Daisuke , Ohmure Kenta , Fukumoto Daichi , Shimono Hirokazu , Tabata Hiroyuki , Ito Nobuhiro , Ikeda Yoshiyuki , Ohishi Mitsuru
Published: December 2023

Introduction:
Coronary artery calcification is significantly associated with major adverse cardiac events in patients with coronary artery disease (CAD), and severely calcified lesions are significantly associated with poor outcomes after percutaneous coronary intervention (PCI).

Hypothesis:
The relationship between renin-angiotensin system inhibition and coronary artery calcification is unknown.

Methods:
Five hundred stable CAD patients undergoing PCI were divided into none/mild and moderate/severe calcification groups according to the grade of calcification in the target lesion evaluated by intravascular ultrasound (IVUS). Calcification with a calcium arch >180° and calcium length >5 mm in the target lesion was defined as moderate/severe calcification. We examined the association between patient’s characteristics and morphology in target lesions assessed by IVUS.

Results:
One hundred ninety of the 500 patients (38%) showed moderate/severe calcification of the culprit lesion. In the moderate/severe calcification group, the survival rate was significantly lower, and cumulative incidence of major cardiovascular and cerebrovascular events (MACCE) was higher than in the none/mild calcification group after PCI (p=0.015 and p=0.003, respectively). Age, body mass index, hypertension, use of angiotensin-converting enzyme inhibitor (ACEI), hemodialysis, high-sensitivity C-reactive protein levels, low-density lipoprotein cholesterol levels, serum albumin levels were associated with moderate/severe calcification lesion in univariate logistic analysis, but the use of angiotensin II receptor blocker was not. Multivariate logistic analysis identified age [odds ratio (OR); 1.05, 95% confidence interval (CI): 1.02-1.08, p<0.001], use of ACEI (OR; 0.46, 95% CI: 0.23-0.91, p=0.025), and hemodialysis (OR; 6.07, 95% CI: 2.39-15.42, p<0.001) as independent factors of moderate/severe calcification lesions. A comparison of P-value for interaction of use of ACEI and hemodialysis was p=0.51.

Conclusions:
Using of ACEI was negatively associated with moderate/severe calcification in target lesions assessed by IVUS. ACEI may have a potential for inhibitory effect on coronary artery calcification.