bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 17828: Sex Differences in Mortality Trends of Rheumatic Heart Disease in High-Income Countries
Authors: Hibino Makoto , Shimamura Junichi , Verma Raj , Dhingra Nitish , Yanagawa bobby , Bhatt Deepak , Verma Subodh
Published: December 2023

Introduction:
Rheumatic heart disease has traditionally been considered to be more prevalent among females; however, current trends in mortality in each sex are unclear in high-income countries.

Hypothesis:
We hypothesized that mortality from rheumatic heart disease is higher among females but has improved in both sexes in high-income countries.

Methods:
We analyzed the WHO mortality database to determine trends in mortality from rheumatic heart disease in the UK, Germany, France, Italy, Japan, Australia, the USA, and Canada from 2000 to 2020. Sex-specific age-standardized mortality rates per 100,000 persons were calculated and compared by using female-to-male ratio. Annual percentage change was analyzed using joinpoint regression.

Results:
In the most recent year, female sex-specific age-standardized mortality rates were significantly higher in the UK (0.60 vs 0.44), Italy (1.24 vs 0.98), the USA (0.63 vs 0.47) and Canada (0.79 vs 0.57). Over the observation period, there was a trend to deceasing sex-specific age-standardized mortality rates in both sexes in the UK, France, Japan, and USA (p<0.01, respectively) and only in female sex in Italy and Australia (p<0.01, respectively), while the mortality rates in both sexes were constant in Canada and demonstrated increasing trends in Germany. Average female-to-male mortality rates ranged from 1.07 (95% CI, 1.02, 1.11) in France to 1.59 (95% CI, 1.51, 1.67) in the UK and were decreasing toward 1 with statistical significance in all countries (average annual change ranged from -1.6% to -0.6%) except for France.

Conclusions:
Mortality from rheumatic heart disease in females exhibited a decreasing trend in the 6 studied high-income countries while increasing in Germany and constant in Canada. Female-dominated mortality was becoming less pronounced in the studied high-income countries, with the exception of France, which already had the lowest average female-dominant mortality rates.
Abstract 17831: Magnetic Particle Imaging Using Microparticles of Iron Oxide Targeted to Endothelial Adhesion Molecules Reveals Leucocyte - Endothelium Interaction During Sepsis and Neuroinflammation
Authors: Martinez de Lizarrondo Sara , Pedron Swannie , Vivien Denis , Bonnard Thomas , Gauberti Maxime
Published: December 2023

Introduction:
The ability to track leucocyte - endothelium interactions using non-invasive imaging could allow early diagnosis and monitoring of disease activity in vascular disorders. To this aim, we can use magnetic particle imaging (MPI), a new imaging modality that can detect superparamagnetic material in the human body with high sensitivity.

Hypothesis:
Superparamagnetic microparticles of iron oxide (MPIO) targeted to endothelial adhesion molecules could be used as leucocyte-mimicking particle and reveal the sites of leucocyte - endothelium interactions by MPI.

Methods:
We synthesized MPIO targeted to vascular cell adhesion molecule 1 (VCAM-1). These MPIO@VCAM-1 were characterized in vitro by transmission electronic microscopy, flow cytometry and flow chamber experiments. Then, we performed in vivo imaging in models of vascular inflammation in mice, including sepsis and neurovascular inflammation. MPI was performed using a MPI/CT system (Momentum CT, Magnetic Insight).

Results:
MPIO@VCAM-1 bind specifically to activated endothelial cells in vitro. In control mice, intravenously injected MPIO@VCAM-1 are rapidly eliminated from the circulation by the reticulo-endothelial system and accumulate in the liver and spleen. In LPS-induced sepsis, MPIO@VCAM-1 bind in the lungs and kidneys in a dose dependent manner, revealing inflammation (Figure 1a-b). In conditions of neurovascular inflammation, MPIO@VCAM-1 accumulate on activated endothelial cells of inflamed brain regions (Figure 1c-f). In all these models, control MPIO@IgG do not give any signal beyond passive accumulation in the liver. Moreover, pre-treatment with blocking anti-VCAM-1 antibodies completely abrogates MPIO@VCAM-1 binding, demonstrating imaging specificity.

Conclusions:
MPI using MPIO@VCAM-1 reveals sites of leucocyte trafficking, allowing quantitative assessment of leucocyte - endothelium interactions in clinically relevant contexts.
Abstract 17836: ATP Citrate Lyase Coordinates Lipid Synthesis and Expression Cell Cycle Regulating Genes to Promote Vascular Remodeling in Pulmonary Arterial Hypertension
Authors: Romanet Charlotte , Grobs Yann , Lemay Sarah-Eve , Bourgeois Alice , Shimauchi Tsukasa , SALEM MABROUKA , Martineau Sandra , Breuils Bonnet Sandra , Sauvaget Melanie , Theberge Charlie , Potus Francois , Provencher Steeve , Boucherat Olivier , Bonnet Sebastien
Published: December 2023

INTRODUCTION:
Pulmonary arterial hypertension (PAH) is characterized by progressive obliteration of distal pulmonary arteries (PAs) due to enhanced proliferation, suppressed apoptosis and increased migration of PA smooth muscle cells (PASMCs). Like cancer cells, this abnormal phenotype of PASMCs is driven by epigenetic reprogramming and fueled by a metabolic shift towards glycolysis. ATP-Citrate Lyase (ACLY) is a nuclear-cytosolic enzyme that converts citrate to acetyl-CoA, which serves as substrate for histone acetyltransferases regulating gene expression and as a building block for lipid synthesis (required for proliferating cells to generate membrane). ACLY has recently emerged as a key player and therapeutic target in cancer. However, its role in PAH is unknown.

METHODS/RESULTS:
ACLY, p-ACLY (active form) expression and its nuclear localization were increased in distal PAs and PASMCs from PAH patients (WB and IF, p<0.01). Similar results were observed in the Sugen/Hypoxia (Su/Hx) animal models.
In vitro
, ACLY inhibition (BMS, siRNA) decreases PAH-PASMCs proliferation (PLK1; Ki67; p<0,01) and survival (Survivin; Annexin-V; p<0.01). These effects were accompanied with a decreased glycolysis (PFKBP3, p-PDH) and increased OCR/ECAR (Seahorse). Moreover, ACLY inhibition decreases the PAH-PASMCs migratory potential. Using RNA-Seq, we demonstrated that inhibition of ACLY downregulates genes associated with cell division and lipid synthesis. Further experiments revealed that ACLY promotes nuclear acetyl-CoA production favoring acetylation of H3K27, H3K9, H4, and GCN5-mediated transcriptional activation of genes responsible for cell cycle progression. Accordingly, we demonstrated that GCN5 inhibition decreases proliferation and survival of PAH-PASMCs (Ki67, AnnexinV).
In vivo
,
Acly
loss-of-function targeted to SMCs conferred protection against Su/HX-induced PAH in mice (echo and RHC). Accordingly, pharmacological inhibition of ACLY using BMS-303141 or Bempedoic Acid improved hemodynamics (RVSP, mPAP, SV, TPR, p<0.05) and vascular remodeling (EVG, p<0.05) in Su/Hx rats with established PAH.

CONCLUSION:
We demonstrated that ACLY inhibition may represent a novel therapeutic avenue to improve vascular remodeling in PAH.
Abstract 17852: A Right Atrial Mass(querader) Causing Complete Heart Block in an Otherwise Healthy Female
Authors: Aleuy Lana , Sharma Apoorva , Jain Harshita , Brown Matthew T , Attia Tamer , Williams B Robinson
Published: December 2023

Introduction:
Right atrial masses are ominous and have a broad differential including thrombus, primary cardiac tumors such as myxoma vs sarcoma, metastatic processes like lymphoma, and, rarely, autoimmune etiologies. In this case, an apple watch notification of bradycardia was a simple start to a complicated course of rapidly progressive conduction disease arising from an unusual presentation of cardiac sarcoidosis.

Case Presentation:
A 45-year-old previously healthy female originally presented to clinic with a one-month history of exertional dyspnea and palpitations with bradycardia noted on her Apple Watch and an ongoing event monitor revealing transient type II second-degree atrioventricular block. In the office, she was normotensive but bradycardic at 33 beats per minute with electrocardiogram revealing complete heart block with junctional escape. She was admitted for additional work-up with transesophageal echocardiogram (TEE) which was unrevealing. Cardiac magnetic resonance imaging (cMRI) identified two 2 x 2 cm right atrial masses that appeared hypermetabolic on cardiac fluorodeoxyglucose positron emission tomography (FDG cPET) in addition to bilateral hilar lymph nodes. A temporary-permanent pacemaker equipped with a lead capable of floating atrial bipolar sensing was placed while biopsy plans were arranged. Transbronchial ultrasound guided biopsy of the hilar lymph node returned benign. She then underwent two different attempts at transcatheter biopsy of the right atrial masses - one TEE guided, another intracardiac echo (ICE) guided - with most samples unrevealing except one with an inconclusive amount of spindle cells raising concerns for sarcoma. The decision was made to pursue cardiothoracic surgical resection of the right atrial masses with pathology returning with granulomatous lesions consistent with sarcoidosis.

Discussion:
Cardiac involvement is present in 25% of cases of sarcoidosis and most commonly manifests as conduction abnormalities, ventricular arrhythmia, and/or heart failure. Only a few cases of atrial masses are reported in the literature and its presence in this woman with heart block confounded the picture before a diagnostic biopsy of this treatable condition could be obtained.
Abstract 17861: Separating Patients With Long-Term Success versus Acute Response From Atrial Fibrillation Ablation Using Explainable Machine Learning
Authors: Ganesan Prasanth , Pedron Maxime , Feng Ruibin , Ruiperez-Campillo Samuel , Rogers Albert J , Deb Brototo , Chang Hui Ju , Brennan Kelly A , Srivastava Viren , Clopton Paul L , Narayan Sanjiv M
Published: December 2023

Introduction:
It is difficult to predict outcomes from atrial fibrillation (AF) ablation. In particular, it is unclear what physiology explains patients with long-term AF elimination yet no acute response, or vice versa.

Hypothesis:
We hypothesize that different combinations of electrophysiological and clinical features predict long-term outcome or acute response to AF ablation. We tested this hypothesis using machine learning of a large Registry.

Methods:
We studied N=561 patients at pulmonary vein isolation (65±10 years, 28% female) with rich clinical data (44 elements, ECGs), and 64 pole global electrograms (EGMs). We propensity matched the dataset 70/30 for training/testing (fig A). We extracted (i) 4 EGM features: dominant frequency (DF), similarity over time, rate (CL), and voltage; (ii) 6 ECG features; (iii) 44 clinical features. We compared 6 ML models including logistic regression to predict 1 year and acute outcomes in the test set, then used explainability (e.g. Shapley scores) to explain the top models and contributing features for each outcome.

Results:
Of 561 patients, N=390 (69.5%) had 1 year success and N=278 (49.6%) had AF termination by ablation. The best ML model predicted acute response (Random Forest), provided AUROC = 0.83 (fig B) with highest predictors of AF type, RR interval, CL, DF, and voltage. Conversely, the best model for long-term success provided AUC of 0.65 (accuracy of LT vs acute: p<0.001 McNemar test), but top features were PR interval, QRS axis, AF duration, and age (shapley Rsq = 0.11, fig C). Predictors for long term outcome poorly predicted acute outcome and vice versa (fig C).

Conclusions:
Clinical features for long-term and acute response to AF ablation were quite different, applying several classification methods to a well-characterized registry. Confirmation in other registries may reveal novel phenotypes to guide clinical decision making or procedural planning, and shed mechanistic insights.
Abstract 17875: Quality Improvement Initiative to Improve Screening and Diagnosis Rates of Iron Deficiency in Patients Hospitalized for Acute Heart Failure With Reduced Ejection Fraction
Authors: Jakulla Roopesh Sai , Fatima Ifrah , Gunta Preetham , Gill Keerat , Mohammed Mohammed S , Elsayed Marwa , Tselovalnikova Tatiana , Goyal Amandeep , Bhyan Poonam , Yarrarapu Siva Naga S , Priya Lakshmi , Banderas Julie , Wooldridge David , Lopez-candales Angel
Published: December 2023

Introduction:
Despite being associated with reduced exercise capacity and poor quality of life in HFrEF, iron deficiency (ID) is underdiagnosed and undertreated. The 2022 ACC/AHA guidelines define ID in HFrEF as either a serum ferritin level < 100 ng/ml or 100-299 ng/ml with transferrin saturation (TSAT) <20 %. Treatment with IV iron is associated with a reduced risk of hospitalizations for HFrEF. A review of 20 inpatient acute HFrEF records revealed 10 had iron studies ordered, and 9 of them met criteria for ID, but only 1 patient received IV iron.

Aim statement:
To improve the testing rates for ID in hospitalized acute HFrEF patients at our hospital by 10% from January through March 2023.

Methods:
QI project included the implementation of an electronic health record (EHR) alert (Fig. 1) and resident education. The EHR alert was designed to be activated at the time of admission for patients with specific ICD codes for acute HFrEF to aid in ordering iron studies. A 20-minute educational session was delivered to residents, and handouts were provided to residents with reference material.

Results:
Pre-intervention data from January-December 2022 revealed a testing rate of 68% (154/194). ID was present in 58% (113/194). Post-intervention data from January 2023-March 2023 showed an improvement in the testing rate to 91% (67/73) and a concurrent increase in the diagnosis rate to 72% (53/73) (Fig. 2). Before discharge, 43.4% of patients (23/53) with ID received IV iron sucrose.

Conclusion:
Education and implementation of EHR alert were successful in increasing the testing rates for ID in acute HFrEF irrespective of anemia status. EHR tools should enhance sustainability compared to education alone.
Abstract 17880: The Association of Social Determinants of Health at Birth With Cardiovascular Health in Young Adulthood: The Future of Families and Child Wellbeing Study
Authors: Allen Norrina B , Ning Hongyan , Marma Amanda M , Hou Lifang , Zheng Yinan , Van Linda , Stein James H , Notterman Daniel , Lloyd-Jones Donald M , Goldman Noreen
Published: December 2023

Background:
Social determinants of health (SDoH) are known to influence an individual’s risk for CVD. Childhood is a vulnerable period during which the influences of SDoH may have a stronger impact on future health outcomes. Little is known about early life SDoH and associations with cardiovascular health (CVH) in early adulthood.

Methods:
In 1998-2000, the Future of Families and Child Wellbeing Study (FFCWS) enrolled 4898 mother-baby dyads from large cities across the US. Births to unmarried mothers were oversampled. When the offspring were 22 yrs, they completed an in-person exam for CVH metrics. SDoH at birth included maternal and paternal education, mother living in a public housing project, having income within the past year from public assistance/welfare/food stamps. Life’s Essential 8 (LE8) Score (without sleep) was assessed at age 22. Linear regression models examined the association of individual SDoH measures with LE8 score adjusting for age, gender and race/ethnicity.

Results:
This study included 1211 participants, mean age 22 yrs (55% female; 51% Black, 25% Hispanic, 20% White, 4% Other). Adverse SDoH were common with 10% living in a public housing project at birth and 36.7% of mothers having received public assistance within the past year. Adjusted CVH scores were 3.0 (95% CI 1.2-4.8) pts lower for individuals whose mother reported having received public assistance in the past year. Compared to mothers with a college or graduate degree, those with less than high school, high school, and some college had 8.0 (5.0-10.9), 7.1 (4.2-10.0) and 3.2 (0.3-6.1) lower scores CVH scores. Findings were similar for paternal education. No significant associations were observed with living in a public housing project.

Conclusion:
SDoH at the time of birth have long lasting influence on the CVH of offspring. Interventions to promote CVH within children and families experiencing adverse SDoH are critical to promote health equity and break the inter-generational cycle of CVD.
Abstract 17881: A Predictive Algorithm to Identify Late Gadolinium Enhancement Using Echocardiography
Authors: Rainer Katharine W , Nezafat Reza , Tsao Connie W , Strom Jordan B
Published: December 2023

Background:
Late gadolinium enhancement (LGE) on cardiac MRI (CMR) correlates with fibrosis and arrhythmic risk, but cannot be used in several clinical settings compared the availability of echocardiography (TTE).

Aim:
To develop and evaluate a machine learning (ML) model that uses standard clinical and echocardiography (TTE) variables to identify LGE on paired CMR.

Methods:
Amongst 725 patients (mean age 56.9 ± 16.5 years, 40.3% female) with TTE and CMR within 3 months at our institution, 2018-2023, we derived and tested several ML models (recursive partitioning, random forest, boosted tree, neural networks, LASSO/Elastic Net) to identify LGE on CMR using age and 24 TTE features. Ten-fold cross validation was used for internal validation.

Results:
A total of 165 (23%) had the presence of LGE (40% ischemic, 60% nonischemic pattern). Of tested models, a boosted neural network performed best (validation area under the curve [AUC] = 0.98;
Figure
). In the validation cohort, the algorithm had a sensitivity and specificity of 93.8% and 94.6% for identifying presence of LGE. Accuracy remained high regardless of gender (M vs. F, AUC, 0.987 vs. 0.988) or race (blacks vs. whites, AUC, 0.987 vs. 0.984) and was not related to time between studies (r = -0.06, p = 0.09). Accuracy was better for ischemic LGE (AUC = 0.94) than nonischemic LGE (AUC = 0.90). Left ventricular size, age, fractional shortening, and wall thickness, were amongst the top predictors of LGE presence in the model.

Conclusions:
In this single center study, a boosted neural network using TTE features identified LGE on paired CMR with high sensitivity and specificity. If confirmed in external data, this suggests possible utility of ML for improving the diagnostic value of TTE for LGE assessment.
Abstract 17883: Subacute Native Aortic and Mitral Valve Endocarditis Manifesting as Embolic ST-Elevation Myocardial Infarction
Authors: sreedhara karthik , Nasser Jason , McGervey Megan
Published: December 2023

Case description:
A 54-year-old male presented with one day of substernal chest pain. He also reported two months of malaise, myalgias, chills, and intermittent fevers. Medical history was notable for well-controlled hypertension and negative for dyslipidemia, diabetes, or drug and tobacco use. Family history was negative for premature coronary artery disease.

Vitals were notable for fever of 103F, blood pressure of 108/56 mmHg, and heart rate of 88 beats per minute. Physical exam showed bounding pulses and a soft diastolic murmur at the left lower sternal border.

Electrocardiogram showed inferior lead ST-elevations. He was taken for cardiac catheterization and found to have a totally occlusive thrombus in the distal right coronary artery with minimal disease in the remaining vessels. He underwent aspiration thrombectomy and placement of drug eluting stent with normal flow. He was transferred to the coronary intensive care unit.

Labs showed mild leukocytosis, normal serum creatinine, and unremarkable urinalysis. Echocardiogram showed a 1.7 x 0.5 cm mobile echodensity on the aortic valve with severe aortic regurgitation and a small echodensity on the anterior mitral leaflet. Blood cultures grew Enterococcus faecalis. A CT scan of the head, chest, abdomen, and pelvis revealed no embolic disease.

He underwent urgent surgery due to concern for infective endocarditis with coronary embolism. Purulence was found at the stent site and the posterior descending artery was obliterated by necrotic tissue. A bypass graft was placed distal to the stent site and infected territory was unroofed and irrigated. Mitral and aortic valve replacement was performed. He tolerated surgery and was discharged with 6 weeks of intravenous antibiotics.

Discussion:
This case was unique in the subacute chronicity of endocarditis and lack of other systemic emboli. Clinically relevant coronary embolism was reported in only 1.5% of cases of infective endocarditis but microemboli were found in 60% postmortem. Embolization is more common with mitral valve involvement, >10 mm vegetation, and fungal or staphylococcal disease. Angiographic evidence of heavy thrombus burden or lack of significant atherosclerosis after myocardial infarction may prompt evaluation for coronary embolism.
Abstract 179: Reversal of Clinical Death by Intra-Arterial Infusion of Phospholipid Nanoparticles (VBI-1)
Authors: Mishriky Stephen , Shallie Philemon , Anamthathmakula Prashanth , Simpkins Cuthbert
Published: December 2023

Introduction:
Ninety percent of deaths from potentially survivable injuries on the battlefield are attributed to hemorrhagic shock, leading to clinical death (CD) with the loss of pulse and respiratory drive before reaching a surgeon. However, currently available fluids are inadequate for rescuing warfighters who have experienced exsanguination. Furthermore, these fluids have the potential to cause reperfusion injury in vital organs. We developed a rat model of CD to evaluate the effectiveness of two phospholipid nanoparticle formulations (VBI-1, VBI-S) and compared intra-arterial (IA) versus intravenous (IV) infusion on resuscitation.

Hypothesis:
We hypothesized that the nanoparticles would restore breathing and blood pressure (BP) in rats after CD induced by hemorrhagic shock.

Goals:
To establish a model that reliably restores breathing and maintains a survivable BP for 240 minutes after CD.

Methods:
Male and female Sprague Dawley rats were divided into four groups (n=6-7). The rats were anesthetized with isoflurane, followed by cannulation of femoral arteries. Blood was withdrawn over two minutes until respiration ceased. Equal volumes of either Ringer’s Lactate (LR), shed blood, VBI-1, or VBI-S were infused over one minute, with continuous monitoring of BP.

Results:
Loss of respiration occurred with blood withdrawal ranging from 39.8% to 43.2% of the predicted total blood volume. Post-IA infusion, the survival rates of the four groups for 240 minutes were as follows: 100% with VBI-1 (n=6), 83.3% with blood (n=7), 66.7% with VBI-S (n=6), and 0% with LR (n=6). Two-way ANOVA analysis revealed a significant difference in mean arterial pressure (MAP) among the four fluids (p=0.0004). Post-hoc analysis indicated the fluid responsiveness in elevating MAP as follows: VBI-1 > VBI-S = shed blood > LR. Regarding the VBI-1 infusion routes, the IA infusion demonstrated 100% survival (n=6) compared to the IV infusion with 40% (n=6) survival.

Conclusion:
VBI-1 outperformed all other fluids, including blood, in achieving reanimation and elevating MAP. IA infusion of VBI-1 demonstrated a higher reanimation rate compared to IV infusion. Based on these findings, VBI-1 is a promising new treatment for CD due to severe hemorrhagic shock; potentially saving lives.
Abstract 17909: Pulmonary Hypertension is Associated With Morbidity, Mortality and Prolonged Hospitalization in Premature Infants With Bronchopulmonary Dysplasia
Authors: Becker Kristian C , Bjorkman Kurt R , Ta Hieu T , Schneider Kristin , Bellew Laura , Hysinger Erik , Magness S Melissa , Critser Paul
Published: December 2023

Introduction:
Pulmonary hypertension (PH) is a common comorbidity in premature infants with bronchopulmonary dysplasia (BPD). We sought to assess factors associated with PH and determine its association with morbidity and mortality in a large contemporary BPD cohort.

Hypothesis:
PH is independently associated with increased mortality in premature neonates with BPD.

Methods:
This single center retrospective cohort study identified all infants with BPD born 2010-2021. BPD severity was defined by previously established literature guidelines. PH was defined at ≥ 36 weeks post-menstrual age by echocardiography (RV pressure > 40 mmHg, eccentricity index > 1.1), cardiac catheterization (mean pulmonary artery pressure > 20 mmHg, pulmonary capillary wedge pressure ≤ 15 mmHg and pulmonary vascular resistance ≥ 3 iWU), or treatment with enteral pulmonary vasodilators. Outcomes of death, tracheostomy, hospital duration and comorbidities were compared against a positive PH diagnosis. Univariate and multivariable models were used to assess associations of PH and covariates with clinical outcomes.

Results:
The sample cohort consisted of 726 neonates (median Gestational Age: 26 weeks [IQR 25.0, 28.0], 48.4% female) with PH diagnoses in 190 (26%). 92 PH patients received enteral PH therapy, with 84 (44%) on mono and 8 (5%) on dual therapy, which was discontinued by a median age 9.5 months (IQR 6.6 - 15.3). Lower gestational age (p=0.016), higher BPD severity (p<0.0001), and non-white race (p=0.002) were associated with PH in multivariable models. PH was associated with higher mortality rate (18% vs 5%, p <0.0001), higher tracheostomy rate (50% vs 16%, p<0.0001), and longer hospital duration (median 116 (IQR 61-182) vs 58 (IQR 11-132) days, p = 0.001) in univariate and multivariable models. PH was associated with pulmonary vein stenosis (9% vs 1%, p=0.001), but not NEC, ROP or IVH after adjusting for covariates.

Conclusions:
This study demonstrates that BPD-PH carries an independent risk for mortality and morbidity including BPD severity, tracheostomy, pulmonary vein stenosis, and longer hospitalization. Enteral pulmonary vasodilators were used in almost half of all PH patients, with resolution of PH within 1 year of diagnosis in the majority of infants.
Abstract 17912: Late Potential and the Risk of Major Arrhythmic Events in Brugada Syndrome Patients: A Systematic Review and Meta-Analysis
Authors: Rattanawong Pattara , Vutthikraivit Wasawat , Kewcharoen Jakrin , Kanitsoraphan Chanavuth , Prasitlumkum Narut , Puttapiban Prapaipan
Published: December 2023

Introduction:
Brugada syndrome is an inherited arrhythmic disease associated with fatal ventricular arrhythmias. However, ventricular arrhythmia risk stratification remains challenging and controversial.

Hypothesis:
The late potential may be useful as a predictor of major arrhythmic events in Brugada syndrome patients.

Aims:
We aimed to assess the association between late potential and risk of major arrhythmic events by a systematic review and meta-analysis.

Methods:
We comprehensively searched the databases of MEDLINE and EMBASE from inception to January 2023. The included studies were cohort and case-control studies that reported the relationship between late potential and major arrhythmic events. The included studies were selected to yield a maximum total number of sample sizes without population duplications across the studies. Data from each study were combined using the random-effects model to calculate pooled odds ratio and 95% confidence intervals. The late potential was defined as RMS40 <20 μV and/or LAS40 >38 ms on signal-averaged ECG.

Results:
Five studies were included in this meta-analysis involving 743 Brugada syndrome patients (438 with late potential and 743 without late potential). The mean age was 47.3 ± 14.1 years. The patients were predominately men (61.6%). The late potential was not associated with major arrhythmic events (pooled odds ratio 1.17, 95% confidence intervals: 0.62-2.21, p=0.63, I
2
=21.3%).

Conclusions:
Our study demonstrated that late potential is not associated with a higher risk of major arrhythmic events in Brugada syndrome populations. To our knowledge, our study is the first meta-analysis of late potential in Brugada syndrome patients.
Abstract 17918: Provider Care Team Segregation and Ischemic Heart Disease Outcomes by Race
Authors: Mwansa Hunter , Johnson Adedoyin , Knapp Shannon , Bisono Janina Q , Trabue Dalancee , Yee Ryan , Williamson Francesca , Watty Stephen , Pool Natalie , Thomas Hebdon Megan , Moore Wanda , Yankah Ekoh , Ezema Nneamaka , Kimbrough Nia , Washington Johnnie , Lightbourne Karen , Edmonds Brownsyne , Capers Quinn , Brown David , Johnson Denee , Evans Jalynn , Foree Brandi , Holman Anastasia , Blount Courtland , Nallamothu Brahmajee K , Hollingsworth John , Breathett Khadijah
Published: December 2023

Background:
Black patients have worse ischemic heart disease (IHD) outcomes than White patients. How healthcare provider team segregation, dissimilarity/distinctiveness in the composition of provider teams caring for Black vs White patients within a hospital, contributes to racial inequities in IHD outcomes is unclear.

Methods:
Using Optum’s de-identified Clinformatics® Data Mart of commercial and Medicare beneficiaries, we identified non-Hispanic Black and White patients with an admission diagnosis of IHD from 2010-2018. We calculated the Segregation Index (SI, 0 - 1; 0 for similarity/complete overlap; 1 for lack of similarity/overlap in the composition of provider teams caring for Black vs White patients). Hospitals were stratified into tertiles with increasing dissimilarity between provider care teams [low (0.16-0.38), medium (≥0.39-0.48), and high (≥0.49-0.97)]. For 30-day readmission, we used generalized linear mixed-effects models including effects of race, SI tertile, race-SI, gender, age-adjusted Charlson Comorbidity Index, and hospital factors including effects of cardiology care, 2-way, and 3-way interactions of race, SI, and cardiology care.

Results:
Among 183,165 patients with IHD, odds of 30-day readmission were similar by race across SI tertiles in the absence of cardiology care. With cardiology care, Black patients in low and medium SI tertiles had higher odds of 30-day readmission than White patients [low: OR 1.08 (95% CI 1.02 - 1.13); medium: OR 1.12 (95% CI 1.04 - 1.21)] but not the high SI tertile [OR 1.03 (95% CI 0.93 - 1.14)] (
Figure
).

Conclusions:
Among patients with IHD seen by a cardiologist, for 30-day readmission there was a significant racial disparity in favor of White patients seen at hospitals with lower levels of provider team segregation. Further research is needed to investigate the causes of this disparity, which may be related to preferential selection of cardiologists among commercial and Medicare insured populations.
Abstract 17934: Performance of an Electrocardiographic Deep Learning Model for Detecting Wall Motion Abnormalities: An Analysis of Impact From Cardiovascular Comorbidities and Race in an External Validation Study
Authors: Ansari Rayan A , bhatia neal , Tooley James , Thakkar Vyom , XU JUSTIN , Torres Jessica , Tung Jagteshwar , Alhusseini Mahmood , Clopton Paul L , Sameni Reza , Clifford Gari , Ashley Euan A , Perez Marco V , Zaharia Matei , Narayan Sanjiv M , Rogers Albert J
Published: December 2023

Introduction:
Cardiac wall motion abnormalities (WMA) are key prognostic indicators for major cardiovascular events and mortality (MACE), yet poorly detected by current ECG screening such as for Q waves. Given that race and gender impact the ECG, it is also unknown if ECG screening for WMA could be applied broadly. We hypothesized that deep learning of the ECG could accurately identify WMA in diverse patients with varying comorbidities at 2 Institutions.

Methods:
We developed a DL Convolutional Neural Network model on N=35,210 ECG records from Stanford University (iECG, Philips), labeled by natural language processing of echocardiography reports within 60 days (
Panel A
). The tested model was then externally validated on an independent set of N=2338 ECGs from Emory University (Muse, GE). Patients with ventricular pacing were excluded. The patient cohort was segmented by cardiovascular comorbidity (<3, >=3) and white vs. non-white race to compare model performance.

Results:
The Stanford cohort (62.9±16.9 years, 47% female, 58% white, 6% black, 16% Asian, 23% >=3 comorbidities) differed from the Emory cohort (61.9±16.0 years, 48% female, 48% white, 41% black, 6% Asian, 52% >=3 comorbidities). Nevertheless, the Stanford model detected WMA in the Emory cohort with AUC 0.723. For patients with low and high comorbidity burdens, the AUC was 0.71 and 0.69, respectively. For White and Non-White patients, the AUC was 0.74/0.70 and 0.65/0.66, respectively (
Panel B
).

Conclusions:
Across racial groups and patients with variable burden of comorbidities, a DL model of electrocardiograms robustly identifies WMAs in an external validation cohort despite differences in the populations. The model’s performance across different comorbidity and racial demographic groups underscores its potential for general clinical application, offering an effective tool for clinical screening and enhanced risk stratification.
Abstract 17953: Predictors of Mortality Among Hospitalized Patients With Chronic Constrictive Pericarditis
Authors: Etuk Aniekeme S , Jackson Inimfon , Olanipekun Olalekan , AJENIFUJA ADENIYI A , Olubowale Olusola , Jacob Mina
Published: December 2023

Introduction:
Studies have been conducted on patients with constrictive pericarditis but there is no literature on the factors associated with mortality among hospitalized patients in this population. We examined the predictors of mortality among patients hospitalized with chronic constrictive pericarditis with or without arrhythmias.

Hypothesis:
Patient and hospital associated factors can predict mortality among hospitalized patients with chronic constrictive pericarditis.

Methods:
Retrospective cohort analyses were conducted using data from the National Inpatient Sample (NIS), 2016-2020. Multivariate logistic regression modelling was used to examine the factors associated with mortality among hospitalized patients with chronic constrictive pericarditis with or without arrhythmias.

Results:
Among those with arrhythmias, African Americans (AOR: 1.83; CI: 1.36-2.48) and Hispanics (AOR: 2.08; CI: 1.43-3.01) had higher odds of mortality compared to non-Hispanic whites. Those admitted electively were 62% (AOR: 0.38; CI: 0.27-0.53) less likely to die than the non-elective cases. Length of stay of more than 5 days, (AOR: 1.78; CI: 1.41-2.24) was associated with higher odds of mortality relative to 5 days or less. Other predictors of mortality were charlson comorbidity index and median household income national quartiles. Furthermore, among those without arrhythmias, older age (AOR: 1.88; CI: 1.37-2.59), and longer length of hospital stay (AOR: 2.87; CI: 2.27-3.63) were associated with higher odds of mortality.

Conclusions:
Our findings highlight the predictors of mortality among patients hospitalized with chronic constrictive pericarditis. Additional studies are needed to further explore patient and hospital related factors associated with mortality, especially among those with comorbid arrhythmias. This will enable physicians to identify high risk patients who may benefit from closer monitoring.
Abstract 17966: Behavioral Characteristics of High-Risk Postpartum Individuals Predict Response to a Digital Health Intervention to Improve Physical Activity
Authors: Bediako HIlary , Li Tang , Zhang Dazheng , Putt Mary , Levine Lisa , Chen Jinbo , Lewey Jennifer
Published: December 2023

Background:
Hypertensive disorders of pregnancy (HDP) are common among women and increase risk for cardiovascular disease later in life. Postpartum interventions can motivate healthy lifestyle changes but are not universally effective. Patient demographics insufficiently predict intervention response. Our goal is to use cluster analysis to determine how behavioral phenotypes are associated with response to a digital health intervention targeting postpartum women with HDP.

Methods:
We analyzed 122 participants in the STEP-UP Mom study, a randomized clinical trial comparing wearable step tracker and team-based gamification (intervention) to wearable step tracker alone (control) over 12 weeks. Behavioral characteristics were collected at baseline using validated surveys, to which we applied the k-means method to identify two distinct patient clusters. Linear mixed-effects models were used to estimate mean step count difference between arms from baseline across 12-week follow-up in each cluster.

Results:
Among the 122 participants, the median age was 33 years and 54% identified as Black. Participant characteristics in each cluster are shown in the Table. Participants in Cluster 1 had higher baseline steps, lower exercise self-efficacy and greater psychosocial distress. There was no significant difference in change in step count in the intervention arm compared to the control arm (-289 steps, 95% CI -1294, 717; p=0.57). Participants in cluster 2 had lower baseline steps, higher exercise self-efficacy, and less psychosocial distress. In cluster 2, participants in the intervention arm walked 1,309 more steps per day on average compared to the control arm (95% CI 475, 2144; p= 0.003).

Conclusion:
Participants had varied response to a digital health intervention based on behavioral phenotype. This finding may help identify individuals who may benefit from a higher touch or tailored intervention in future studies to increase step count in the postpartum period.
Abstract 17987: The Added Value of Radiomics Texture Features on Late Gadolinium Enhancement Cardiac Magnetic Resonance to Detect Myocardial Inflammation in Patients With Cardiac Sarcoidosis
Authors: Gulhane Avanti V , Muzi Peter , Sadic Murat , Abdelmotleb Mohamed , Chalian Hamid , Shaiefi Mehrzad , Nyflot Matthew J , Vesselle Hubert , Raghu Ganesh , Ordovas Karen G
Published: December 2023

Introduction:
Radiomics analysis provides quantitative pixel-signal-intensity information on cardiac magnetic resonance (CMR).

Hypothesis:
Can radiomics improve performance of CMR for detection of myocardial inflammation in cardiac sarcoidosis (CS)? We aim to assess the added value of CMR radiomics to standard CMR image analysis for the diagnosis of active CS.

Methods:
We retrospectively analyzed CS patients referred for both CMR and F18-FDG-PET/CT(PET) within 90 days of each other. Myocardium was segmented on a dedicated semi-automated workflow by MIM encore software and features extracted by pyradiomics. PET were reviewed for the presence of myocardial FDG uptake, defining segments with inflammation. CMR-segments were reviewed for the presence of late gadolinium enhancement(LGE) and increased T2 signal by 2 experienced radiologists. Analysis was performed to assess for differences in radiomics features in segments with/without inflammation. ROC analysis was conducted to define the added value of radiomics for diagnosis of myocardial inflammation.

Results:
In 80 patients with 1360 AHA-CMR segments (mean age 58 years, 62.5% male) with CS, 276(20.3%) segments had FDG uptake on PET/CT, 252(18.5%) segments showed LGE and 54(3.9%) segments had increased signal on T2W images. Significant quantitative differences for LGE-derived radiomics features were highest for Entropy and Gray Level Cooccurrence Matrix Autocorrelation between segments with and without inflammation on PET (Table1). The presence of LGE was the best independent predictor for inflammation on PET. T2W abnormality alone was not an independent predictor from the presence of LGE. Significant improvement was seen in area under the curve when radiomics features were combined with standard CMR predictors (LGE/T2W) vs standard CMR predictors alone.

Conclusions:
Quantitative radiomics features on LGE-CMR have the potential to improve the ability of CMR for assessment of inflammation in CS.
Abstract 17997: Contemporary Trends in Coronary Artery Anomalies
Authors: Tan Samuel , Siu Wenchy , Kumar Shasawat , Adinugraha Paulus
Published: December 2023

Introduction:
Coronary artery anomalies (CAA) are a group of congenital conditions whose prognostic significance is still widely debated. In part, this is due to the limited data on CAA, given its general incidental nature. Data on age, gender, and ethnic disparities is even more scarce.

Hypothesis:
There is an increase in prevalence of CAA over time with unchanged difference in mortality.

Methods:
The National Inpatient Sample (NIS) database was queried between 2016-2019 to identify hospitalizations with CAA. The primary outcome was in-hospital mortality. Secondary outcomes included type of hospital, region, age, and complications. Linear regression and Chi-squared were used for analysis.

Results:
Our study identified 7,821 patients diagnosed with CAA. There was a significant increase in the prevalence of CAA from 1,961 in 2016 to 2,127 in 2019 (p<0.001). However, no significant difference in mortality rate (1.89% to 2.05%) in this time period was identified. The average age of the population diagnosed with CAA was 50.4 years, which was not significantly different between the study time periods. Comparing races, 62.35% of those with coronary anomalies were white, 17.54% were African American, 12.1% were Hispanic, and 3.11% were Asians or Pacific Islanders. Of note, 4.14% of those with CAA were diagnosed in a rural hospital, 14.68% in an urban non-teaching hospital, and 81.18% in a teaching hospital. This is a significant difference compared to the percentage composition of each hospital within the database.

Conclusions:
With recent advances in imaging technology, CAA has been detected at earlier stages, allowing for early intervention. However, our study suggests that CAA may still be under diagnosed, given that most were diagnosed at resource heavy teaching hospitals. In addition, the number of minorities diagnosed with CAA increased during the study period, suggesting disparities that exist and will continue to be addressed as access to modern medicine improves. Despite having a low mortality rate, the mortality rate did not improve over the study period. This highlights the need for further studies to identify challenges in diagnosis and management of CAA, especially regarding ethnic and racial disparities.
Abstract 18004: Impact of a Urine Sodium Guided Treatment Protocol on Acute Heart Failure Length of Stay: A Single Center Quality Improvement Study
Authors: Okazaki Ross A , Pareek Karishma , Jones Kyle , Gopal Deepa M
Published: December 2023

Introduction:
Inpatient management of acute decompensated heart failure (ADHF) is associated with high costs and in-hospital complications. Traditional methods of assessing response to loop diuretics for ADHF is prone to inaccuracies that may contribute to costs and complications. More objective evidence-based methods of treating ADHF are needed to improve outcomes for these patients.

Hypothesis:
We hypothesize a treatment algorithm using Una as an objective marker of response to loop diuretics can decrease hospital length of stay (LOS) for patients with ADHF.

Methods:
This quality improvement study took place at a single urban academic center. 3 plan do study act (PDSA) cycles were performed to study the impact of the intervention on key quality metrics. The first two PDSA cycles took place on two medical teams over the course of two weeks each. The third PDSA cycle took place on all medical teams over the course of 5 months. Median hospital LOS, rates of readmission and acute kidney injury (AKI), and protocol use rates were calculated.

Results:
An average of 78 patients per month were admitted with ADHF. Protocol implementation rate was 58%. Patients in the first two PDSA cycles with ADHF who were managed with the UNa protocol on average had lower hospital LOS by 1 day and similar rates of acute kidney injury (AKI). Patients in the third PDSA cycle, however, did not experience any change in hospital LOS or AKI. Readmission rates were stable across all PDSA cycles.

Conclusions:
Protocoling the implementation of spot uNa to diuretic management in a large academic hospital required extensive multi-disciplinary coordination. While there was no observable impact on key quality metrics, maintaining high levels of protocol adherence remains a challenge. The impact of acute and chronic kidney injury on Una-protocol performance should be evaluated. Finally, the efficacy of a Una-based treatment approach across diverse patient demographics must be better understood.
Abstract 18007: Role of Interferon Lambda in Influenza-Induced Exacerbation of Atherosclerosis
Authors: Moras Crystal , Chinnappan Baskaran , Constantinesco Nicholas J , De Vito Louis , Srikanth Sashwath , Alcorn John F , Gopal Radha
Published: December 2023

Introduction and Hypothesis:
Influenza infection is a significant public health and economic threat around the world. Although pneumonia is the most common complication associated with influenza, there are several clinical reports demonstrating increased risk for cardiovascular disease. In influenza infection type I, type II and type III IFNs play an indispensable role in controlling the virus. In atherosclerosis, type I and type II IFNs promote atherosclerosis by inducing chemokines from macrophages and vascular endothelial cells. Studies have shown that the influenza infection exacerbates atherosclerosis. However, there are no studies determining the role of type III IFNs on influenza-induced exacerbation of atherosclerosis. In this study, we hypothesize that the type III IFN (IFNL3) may play a protective role in atherosclerosis.

Methods:
ApoE
-/-
mice were fed with a high-fat diet (HFD) containing 42% Kcal fat (Teklad) for 11 weeks. Mice were then infected with influenza A/PR/8/34 (H1N1) (100 pfu) and treated with recombinant IFNL3 by oropharyngeal (O/P) aspiration or intraperitoneal (I/P) injection, and weight loss, and gene expression of inflammatory cytokines and chemokines were measured. In another study, HFD-fed ApoE
-/-
and ApoE
-/-
IFNLR1
-/-
mice were infected with influenza, and the disease outcomes were measured as described above.

Results and Conclusions:
IFNL3 treatment decreased influenza-induced weight loss in ApoE
-/-
mice during the early phase (4-6 days) of influenza infection. Further, IFNL3 treatment decreased gene expression levels of IL-6 and CCL2 in the aorta in influenza-infected ApoE
-/-
mice. Based on these findings, it seems likely that INFL3 plays a protective role in acute influenza-induced exacerbation of atherosclerosis. However, ApoE
-/-
IFNLR1
-/-
mice recovered body weight faster than wild-type mice suggesting a detrimental role for IFNL after acute infection. These data show that IFNLR plays a protective role during the early phase of influenza infection and potentially a pathological role during the recovery phase of influenza infection.