bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 16296: Exploring Data Collection on Sexual Orientation, Gender Identity, and Pronouns in Heart Failure Patients: A Call for Improved Documentation and Barrier Identification
Authors: Schinderle Colleen , Thurber John , Yehya Amin
Published: December 2023

Introduction:
Up to 25% of bisexual, transexual, queer or questioning (LGBTQ) patients avoid medical care for the fear of mistreatment and being stigmatized for their sexual orientation and/or gender identity. In patients with heart failure (HF) the number of individuals who identify as LGBTQ is unknown. The latest upgrade in the electronic medical records (EMR), however, allows to capture patients’ demographics including and gender, sex, sexual orientation, and pronouns, and would allow to fill this knowledge gap.

Hypothesis:
In this analysis we aimed to identify the percentage of individuals who identify as LGBTQ among patients recently discharged for acute HF decompensation.

Methods:
In an advanced HF and heart transplant program, patients age >18 discharged with heart failure as their primary diagnosis August 2022 and February 2023 were identified. The EMR were queried for patients’ demographics including sex, gender identity, sexual orientation, and preferred pronouns.

Results:
We identified 449 patients. Of those, 234 patients identified their sex as female (52.1%) of whom 194 identified their gender identity as females; 215 patients identified themselves as male (47.9%) of whom 172 identified as males. Gender identity of the remaining 83 patients were not listed in the EMR. Only 13.2% of patients had their sexual orientation listed with 0.7% identifying as gay or lesbian, 0.2% unsure, and 12.7% as straight. The majority of patients 87.8% didn’t have their pronouns listed, 5.8% as she/her/hers, 6.0% as he/him/his, and 0.2% unknown (Figure).

Conclusions:
In this sample of HF patients, data related to sexual orientation and pronouns were rarely collected. Future work should focus on identifying the barriers that might have caused the limited data collection in this population.
Abstract 16307: Does the Method of Calculating the 30-day Readmission Rate After Hospitalization for Heart Failure Matter? Data From the VancOuver CoastAL Acute Heart Failure Registry
Authors: Salimian Samaneh , Virani Sean , Roston Thomas , Yao Ren Jie Robert J , Turgeon Ricky , Ezekowitz Justin A , Hawkins Nathaniel
Published: December 2023

Introduction:
The 30-day readmission rate after a heart failure (HF) hospitalization is widely used for assessing healthcare quality and system performance. However, there are different methodological approaches which may influence estimated rates, and no single accepted approach. The combined impact of these methods is unknown.
Goals:
We calculated 30-day HF readmission rates (RRs) of hospitalized patients using different published approaches to sampling and measurement.

Methods:
We included 1,849 patients discharged following unplanned hospitalization with a primary diagnosis of HF between 2016 to 2018 from the VancOuver CoastAL Acute Heart Failure (VOCAL-AHF) registry. We combined five distinct methodological factors (Table 1) to create 64 unique definitions and associated HF RRs. The readmission rates were averaged over 3-years. Multiple linear regression was used to determine the impact of different factors on estimated readmission rates.

Results:
The calculated 30-day RR for HF varied more than twofold depending solely on the methodological approach (6.4% to 15.0%, 8.6% absolute difference, 134% relative difference). The rates were highest when including all consecutive index admissions (11.1% to 15.0%), and lowest including only one index admission per patient per year (6.4% to 11.4%). The regression model ranked variables affecting RR as: index selection method, reference period, ICD-10 codes, 30-day survival, and index day (Table 2, p<0.001 in all).

Conclusions:
Our findings have important implications for policy and reporting. Transparent and consistent methods are needed to calculate 30-day RRs to ensure reproducible and comparable reporting.
Abstract 16323: Functional Autoantibody Analysis in Post-Acute Sequela of COVID-19 Patients With and Without Pots: A Case Control Study
Authors: Jamal Sameer M , Gunning William T , Spatafore John W , Turi Zoltan , Landers David , Hollenberg Steven , Glotzer Taya , Tancredi Jana , Grubb Blair P , Parrillo Joseph E
Published: December 2023

Introduction:
Post-Acute Sequela of COVID-19 (PASC) occurs after recovery from the initial illness. Autonomic dysfunction (AD) may explain these findings. We have previously shown orthostatic intolerance (OI) on standard Italian protocol head-up tilt table in 23 of 24 prospectively studied subjects with PASC and no prior OI. Postural orthostatic tachycardia syndrome (POTS) was noted in 4 of the 23. POTS is associated with elevated levels of autoantibodies. There is a paucity of data evaluating autoantibody presence in subjects with PASC related POTS.

Hypothesis:
We hypothesized that individuals with PASC related POTS would demonstrate higher levels of certain autoantibodies than controls.

Methods:
We recruited healthy, COVID-19 PCR negative controls, all previously vaccinated for COVID, who were age and gender matched with the 4 previously identified PASC related POTS patients. Serum was tested for autoantibodies in both groups.

Results:
Mean ages for the PASC related POTS and control groups were 29 and 31 years, respectively. The PASC related POTS patients had higher levels of functional autoantibodies to several G-protein coupled receptors than controls. The median values for adrenergic A1, adrenergic B2, muscarinic M4, angiotensin 2 and endothelin receptors, comparing controls to PASC related POTS patients, were 10.4 vs 27.5, 14.9 vs 38.5, 7.8 vs 29.0, 12.2 vs 29.5 and 12.6 vs 31.7 Units/ml, respectively. The small size of the 2 groups precludes meaningful statistical testing, but the box plots in Figure 1 show consistent differences in the concentration of antibody receptors seen between the 2 groups.

Conclusions:
Functional autoantibodies to several G-protein coupled receptors were seen in higher amount in subjects with PASC related POTS compared to healthy controls. While this is a small, case-control study, it suggests a potential autoantibody mediated mechanism that may explain some of the AD seen in PASC patients with POTS.
Abstract 16357: Reducing Repeat Transthoracic Echocardiograms in the Inpatient Setting
Authors: Anderson Shannon , Engels Rebecca , Lee Ken , Richardson Stacie , Gagel Andrew , Hays Allison , Gilotra Nisha A , Pahwa Amit
Published: December 2023

Background:
Transthoracic echocardiogram (TTE) is a common cardiovascular imaging test for hospitalized patients. Repeat TTE testing, defined as a TTE done within one year of a prior TTE, contribute to high resource utilization without clear impact on changes in management.

Hypothesis:
An interruptive electronic medical record (EMR) alert deployed for repeat TTEs will decrease TTE overordering and will help elucidate reasons behind TTE ordering practices.

Methods:
We created an interruptive EMR alert for five hospitals within the Johns Hopkins Health System (JHHS). The alert was triggered when an inpatient TTE was ordered for non-ICU/non-cardiology service patients with a completed TTE within the prior 90 days. The alert displayed most recent TTE results and prompted the clinician to continue with the order or not. If order continuation was selected a free text clinician reason was required. Outcomes were length of stay (LOS) and reduction in repeat TTE orders. Focus groups were held with internal medicine residents to understand practice behaviors, given this was a leading cohort that continued with orders.

Results:
From July 2021- July 2022 the alert triggered 4,976 times, of these 32% of orders were discontinued while 68% were continued. There was no significant reduction in repeat TTE order attempts per month. More orders were continued at academic hospitals compared to the community setting (71% vs 63%, p=<0.01). Medicine and non-medicine departments continued the order at similar rates (69% and 67%, p=0.12). Patients who had a repeat TTE had a longer average LOS compared to those who did not (14 vs 11 days, p=0.08). Twenty internal medicine residents were interviewed for focus groups. Top reasons for order continuation were a change in clinical status (n=8), worsening of chronic conditions (n=5), and post procedure monitoring (n=3). Majority (70%) requested more education within the alert to guide indications for repeat TTE ordering.

Conclusion:
EMR alerts can reduce repeat TTEs without increasing LOS, however knowledge gaps persist for ordering providers. Iterative changes to our health system EMR alert with a focus on best practice guideline incorporation and education may better mitigate overordering, and thus acute care utilization, in the future.
Abstract 16380: Does Non-Alcoholic Fatty Liver Disease Increase the Risk of Ventricular Arrhythmias in Patients With Heart Failure?
Authors: Dondapati Manasa , Gier Chad , almasry ibrahim , Singh Abhijeet , Fan Roger , Rashba Eric J
Published: December 2023

Background:
Non-alcoholic fatty liver disease (NAFLD), including non-alcoholic fatty liver and non-alcoholic fatty steatohepatitis, is associated with increased incidence of heart failure (HF). Previous studies have shown an association of NAFLD with increased incidence of ventricular arrhythmias (VAs). however, it is unknown if the increased rate of VA is related to increased HF or if from an independent NAFLD-related mechanism. Therefore, this study aimed to investigate the effect of NAFLD on VA in patients with HF.

Methods:
A retrospective cohort study of electronic heath records using the TriNetX Research Network was performed. Patients at least 18 years old with diagnosis of cardiomyopathy (CM) or HF were identified by ICD-10-CM codes from January 1, 2014 to December, 31, 2019. Patients were separated based on the diagnosis of NAFLD. Patients who had HF and NAFLD were propensity-score matched (PSM) using age, sex, race, hypertension, hyperlipidemia, ischemic heart disease, cerebrovascular disease, atherosclerosis, diabetes mellitus, acute or chronic kidney disease, acute or chronic respiratory failure, anemia, atrial fibrillation/atrial flutter, body mass index, corrected QT interval, presence of implantable cardioverter-defibrillator, and medications with patients with HF alone. The primary outcomes were 3-year all-cause mortality, hospital admission, and incident VAs.

Results:
After PSM, 50,969 pairs were analyzed. NAFLD diagnosis was associated with significantly higher odds of VA (odds ratio [OR] 2.75, 95% confidence interval [CI] 2.54-2.98,
p
<0.0001) and hospital admission (OR 1.05, CI 1.03-1.08,
p
<0.0001) at 3-years. No significant difference was observed in mortality (OR 0.98, 95% CI 0.95-1.01,
p
=0.10).

Conclusion:
Patients with HF diagnosed with NAFLD had significantly higher odds of VA and hospital admission but not mortality at 3-years. Future studies are needed to evaluate mechanisms of VA in NAFLD patients.
Abstract 16479: The Effects of Pulmonary Artery Catheter Usage and Treatment Intensity on Mortality in Patients With Cardiogenic Shock by Etiology
Authors: Khalife Wissam , Albaeni Aiham , Abraham Jacob , Ton Van-Khue , Guglin Maya , Kataria Rachna , Zhang Yijing , LI BORUI , John Kevin , Hickey Gavin W , Hernandez-Montfort Jaime , Sinha Shashank , Sangal Paavni , Harwani Neil , Kanwar Manreet , Bhimaraj Arvind , Burkhoff Daniel , Kapur Navin K
Published: December 2023

Background:
The routine usage of pulmonary artery catheter (PAC) in the management of cardiogenic shock (CS) by etiology remains controversial.

Objectives:
We sought to study the prognostic effects of PAC usage and the escalation of care in a large CS cohort.

Methods:
Multicenter, retrospective, observational study from the Cardiogenic Shock Working Group registry (CSWG) registry. The baseline characteristics, hospital course, and outcome of patients (pts) with acute decompensated heart failure-CS (ADHF) and acute myocardial infarction-CS (AMI) who had PAC during hospitalization were obtained. Different types of interventions were analyzed and compared between survival and non-survival by etiology.

Results:
The registry had 3524 pts (58% ADHF, 28% AMI). The overall mortality rate was significantly higher in the AMI group (41 vs 29%, p <0.0001). There was no difference in PAC usage (68 vs 62%). In ADHF, the mortality was significantly lower when PAC was used (22 vs 35%, P<0.0001). However, in AMI, there was no significant mortality difference with PAC usage (40 vs 46%, P=0.052).Pts who had PAC (n=2260, 71% male, 2/3 ADHF) were then analyzed. ADHF had longer duration of PAC (6.3 vs 4.7 days). ADHF pts had more comorbidities (CKD, DM, AF) and better admission and max SCAI stage. However, AMI pts were older (60±14 vs 66±12 year p<0001), more HTN and higher transfer rate. During hospitalization, the effect of treatment intensity with mechanical circulatory support (MCS) and drugs usage on mortality is summarized in fig.1 (a,b).

Conclusions:
In a large CS registry, we identified that ADHF is more common with much better prognosis than AMI despite similar PAC and drugs usage, and less MCS usage. This can be explained by the difference in baseline characteristic and the shock severity. PAC usage did correlate with better survival only in ADHF group. Multiple MCS and multiple drugs usage were associated with higher mortality in both groups. IABP, when used alone, had better survival.
Abstract 16481: Comparative Measures of Physical Performance in Healthy Subjects and Patients With Subclinical Heart Failure or Coronary Artery Calcium in the Project Baseline Health Study
Authors: Ghazizadeh Zaniar , Ling Albee Y , Cauwenberghs Nicholas , Santana Everton , Dudum Ramzi , Short Sarah , Sullivan Shannon , Maron David J , Douglas Pamela S , Haddad Francois , Mahaffey Kenneth W
Published: December 2023

Introduction:
While exercise stress test is the traditional method for assessing cardiorespiratory fitness, 6-minute walk test (6MWT) and 10-meter walk test (10MWT) can be inexpensive alternatives for physical activity and fitness evaluation. We aim to identify conditions where 6MWT and 10MWT show comparable diagnostic yield to metabolic equivalents of task (MET).

Methods:
All participants in the Project Baseline Health Study (PBHS) with no missing data were included. Participants were assigned a heart failure (HF) stage according to the 2022 AHA/ACC HF guidelines. Mean and standard deviation (SD) were described for each measurement by HF stages: 0 (healthy), A (presence of risk factors (RF)), and B (presence of RF and LVEF<50%, diastolic dysfunction or LVH); and by coronary artery calcium (CAC) score subgroups: 0, 1-99, ≥100 Agatson units (AU). Multinomial regression was applied to estimate the association of each measurement with HF stage and CAC subgroups adjusted for relevant covariates.

Results:
2,181 (87%) of 2,502 PBHS participants had complete data on METs, 6MWT, and 10MWT. The mean (SD) age was 50.1 (17.1) years, with 1224 (56.1%) females. The cohort consisted of participants with Stage 0, A, B (n=711, 742, 372) and CAC = 0, 1-99, ≥ 100 (n=1275, 471, 348). The overall mean (SD) for 6MWT, 10MWT, and METs were 479.8 (79.1) m, 2.0 (0.5) m/s, and 11.6 (4.3), respectively. Each SD decrease of METs was significantly associated with increased odds for more advanced HF stages and CAC subgroups (
Figure A1-B2
). The 10MWT and 6MWT were also able to differentiate significantly between subclinical stages of HF and compare CAC subgroups 1-99 and ≥100 to CAC=0, although with smaller odds ratios
(Figure A1, A2, B1).

Conclusions:
METs, as measured in a graded exercise test, demonstrated the strongest association with HF stage or CAC subgroup. Based on our findings, there is potential for utilizing the simpler assessments of 10MWT and 6MWT to differentiate between subclinical HF stages.
Abstract 16494: Cardiac Structure and Function Predict Incident Atrial Fibrillation and Flutter in Patients With HFpEF - Lessons From PARAGON-HF
Authors: Chang Sheng Nan , Lu Henri , Cikes Maja , Claggett Brian , Inciardi Riccardo M , Shah Amil M , Lam Carolyn S , Desai Akshay S , Solomon Scott , Hegde Sheila , Skali Hicham
Published: December 2023

Introduction:
Incident atrial fibrillation and flutter (AFF) are common among patients with heart failure with preserved ejection fraction (HFpEF) portending a worse prognosis. Cardiac echocardiographic predictors of incident AFF in patients with HFpEF are not well known.

Methods:
Patients without history of AFF enrolled in the echocardiographic sub-study of the PARAGON-HF trial with adequate image quality were included in this analysis. Cardiac structure and function parameters were measured per the American Society of Echocardiography guidelines. Incident AFF was ascertained during serial trial visits. Multivariable Cox proportional hazards models were used to identify parameters of echocardiography associated with incident AFF and were adjusted for variables previously known to associate with incident AFF (age, heart rate, body mass index and NT-pro-BNP).

Results:
Among patients without prior AFF (N=425, 54% women, mean age 71 ± 8 years), 63 developed incident AFF over a median follow-up of 2.8 years (5.4 per 100 person-years). After multivariable adjustment, higher left atrial (LA) volume index (HR: 1.35 per 11.3 ml/m
2
, 95% CI: 1.10-1.66, p=0.004), left ventricular mass index (HR: 1.40 per 25.7 g/m
2
, 95% CI: 1.09-1.80, p=0.008), septal E/e’ ratio (HR: 1.72 per 6.4 units, 95% CI: 1.29-2.28, p<0.001), and lower septal a’ (HR: 0.48 per 2.0 cm/s, 95% CI: 0.33-0.70, p<0.001) were associated with a significantly higher risk of incident AFF. Furthermore, higher (better) LA reservoir strain (LAsr) (HR: 0.66 per 10.8%, 95% CI: 0.48-0.92, p=0.014) and LA contractile strain (absolute LAsct) (HR: 0.71 per 6.7%, 95% CI: 0.51-0.98, p=0.040) predicted lower risk of incident AFF.

Conclusions:
In the PARAGON-HF echocardiographic sub-study, worse diastolic and LA function, larger LA size and higher LV mass were associated with a higher risk of incident AFF.
Abstract 16513: Decreased Pulmonary Blood Flow and Airway Volumes in Patients With Long COVID Syndrome Assessed by Functional Respiratory Imaging
Authors: Gyongyosi Mariann , Han Emilie , Lukovic Dominika , Samaha Eslam , Bergler-Klein Jutta K , Hasimbegovic Ena
Published: December 2023

Introduction:
In contrast to normal chest X-ray, lung computed tomography (CT), and physiological lung and cardiac functions, many patients with long COVID syndrome suffer from shortness of breath.

Hypothesis:
The aim of this study was to quantify the pulmonary blood and airway volumes of long COVID patients compared with that of healthy controls.

Methods:
Patients with long COVID syndromes were included if they had PCR-verified previous (≥3 months) SARS-CoV-2 infection, had normal laboratory (e.g. inflammation, coagulation, cardiac or other organ) parameter, normal pulmonary morphology (chest X-ray and CT) and function (spirometry and body plethysmography). The lung CT images were postprocessed by Functional Respiratory imaging analysis by using 3D reconstruction with automated lung vessel segmentation algorithm. Data of the quantitative images were compared with age, gender, and BMI-matched healthy controls.

Results:
Thirty patients (45±13 years, 37% male, 25.9±4.3 kg/m^2) at a median time of 256 (118-574) days after a confirmed COVID infection and 30 healthy controls (55±7y, 37% male, 26.3±2.7 kg/m^2) were included. All long COVID patients complained of dyspnoea and 14 (48.3%) patients reported thoracic pain. The total pulmonary blood volume was significantly lower in the long COVID patients compared to controls (190±24.3 mL/m^2 vs230.6±26.2 ml/m^2, p<0.001). Similarly, the capillary-small vessel blood flow (vessel cross sectional area <5 mm^2) was reduced in the long COVID population (118±19 mL vs 132±23 mL, p=0.011). (Figure). The specific image-based airway volume of the distal lung regions was lower than that of the healthy population (11.1±6.74 mL vs 17.33±7.7 mL, p<0.05).

Conclusions:
Both the reduced global and capillary pulmonary blood flow, and distal airway volumes indicate impaired gas exchange and might explain the pulmonary complaints of patient with long COVID syndromes even severe months after Coronavirus infection.
Abstract 16552: Coronary Vasomotor Response to Intracoronary Ergonovine Provocation Test According to the Severity of an Insignificant Coronary Artery Fixed Stenosis
Authors: Rha Seung-Woon W , Choi Byoung Geol , Ahn Woo Jin , Choi Se Yeon , Byun Jae Kyeong , Cha Jinah , Hyun Sujin , Park Soohyung , Kang Dong Oh , Park Eun Jin , Choi Cheol Ung
Published: December 2023

BACKGROUND:
Coronary artery spasm (CAS) is a major cause of variant angina in patients with chest pain without significant coronary stenosis. However, whether there are differences in the incidence of CAS according to the severity of underlying coronary artery fixed stenosis is limited.

Methods:
A total of 608 patients without significant coronary artery disease (CAD) who underwent the ergonovine (ERG) provocation test between January 2018 and December 2021 were enrolled. Significant CAS was defined as having≥70% of temporary narrowing by ERG test. Patients were divided into three groups, based on the presence of coronary artery stenosis: None group (n=456), mild group (30-49%,n=114) and moderate group (50-69%,n=38).

Results:
In patients with chest pain without significant coronary artery stenosis, mild stenosis was 18.8%, and moderate stenosis was 6.3% in the population. The baseline characteristics of the patients were worse in the mild and moderate group than in the None group, including age, hypertension, diabetes, and smoking habit. In the ERG test, CAS occurred in 44.4% (270/608) of the overall population. The incidence of CAS of the mild (55.3%) and moderate (52.6%) groups were higher than the None group (41.0%). Also, in the case of CAS occurrence, focal CAS (Length<20mm) was more frequent in the mild (14.3%) and moderate (30%) groups than in the no group (8.6%).
CONCLUSIONS:
In patients with resting chest pain without severe coronary artery stenosis, CAS was observed in a high proportion of nearly half by ergonovine provocation test. Moreover, the mild to moderate coronary artery fixed stenosis showed higher incidence of CAS and focal CAS than patients without fixed stenosis.
Abstract 16561: Noninvasive Left Ventricle Pressure-Volume Loop Determination Method With Cardiac Magnetic Resonance Imaging and Carotid Tonometry Using a Physics-Informed Approach
Authors: Liu Jing , Bregasi Alda , Mitchell Gary F , Pahlevan Niema M
Published: December 2023

Introduction:
The left ventricle (LV) pressure-volume loop (PV-loop) is a powerful tool for evaluating LV function. Current non-invasive cardiac MRI-based methods for estimating LV PV-loops provide limited diastolic LVP information (Circ Cardiovasc Imaging. 2019; PMID: 30630347).

Aim:
In this study, we introduced a new noninvasive method for PV-loop determination from cardiac MRI and noninvasive carotid pressure waveform using a physics-informed optimization method.

Methods:
LV volumes (LVV) were computed using short axis MRI images from a standard clinical protocol, while noninvasive carotid pressure waveforms were obtained using arterial tonometry in a clinical cohort consisting of 51 healthy and 25 heart failure (HF) participants. We formulated constraints and objective functions to optimize a time-varying LV elastance model (double-Hill) based on LVV and carotid pressure waveforms, considering LV-arterial coupling during aortic valve opening and decoupling during closure. This model allowed for individualized characterization of systolic and diastolic LV pressure and LV PV-loop.

Results:
In HF, our PV-loop analysis produced significantly smaller stroke work (p<0.0001), mean external power (p<0.05), ESPVR (p<0.0001), ventricular efficiency (p<0.0001), Ees/Ea (p<0.0001), LV systolic pressure (p<0.05), and +dP/dt (p<0.05. Additionally, there was an increase in potential energy (p<0.0001) and LV end-diastolic pressure (LVEDP) (p<0.05) for the HF group (Fig. 1). These observations were all consistent with general PV-loop characteristics of HF patients. Previous methods failed to capture certain functional characteristics of HF, including reduced stroke work, decreased mean external power, and elevated LVEDP.

Conclusions:
Our physics-informed optimization method effectively captures HF-related functional changes in LV PV-loops. This method may facilitate noninvasive HF diagnostics and lead to improved therapeutic management.
Abstract 16586: Differences in Medical Care Across the Left Ventricular Ejection Fraction Spectrum Following New Heart Failure Diagnosis in a US Healthcare System
Authors: Nichols Gregory A , Kraus Bettina J , Qiao Qing
Published: December 2023

Introduction:
Heart failure (HF) is a major public health concern with increasing prevalence and burden on healthcare systems. HF is aggravated by type 2 diabetes (T2D) and chronic kidney disease (CKD).

Research Question:
Understanding how HF is treated after new diagnosis could improve care.

Aim:
Describe treatment of patients with newly diagnosed HF.

Methods:
Observational, longitudinal study using electronic medical record data from 24,340 adults (≥18 years) in the US between 2005-2019 with new diagnosis of HF, defined as no HF identified at least 12 months prior to index diagnosis. Outcomes were stratified by HF type (reduced ejection fraction [HFrEF; LVEF ≤40%], preserved ejection fraction [HFpEF; LVEF ≥50%]) and presence of CKD and T2D.

Results:
For the 24,340 incident HF cases, mean age was 72.1±13.4 years. 51.1% had HFpEF and 10.0% HFrEF; 38.6% also had CKD, 39.7% had T2D and 40.3% had neither. Most patients were diagnosed in hospital (41.7%), Emergency Department (23.3%) or Primary Care (16.9%). First visit after HF diagnosis was most commonly with Primary Care (34.0%) or other specialties (39.6%), with only 10.7% with a cardiologist, regardless of comorbid CKD or T2D. Within the first year, those with HFpEF vs HFrEF were less likely to be seen by a cardiologist (51.7% vs 79.6%). Hospitalization rates within the first year were higher in patients with HF and both comorbidities (49.6%). All-cause mortality was slightly higher in HFpEF (15.3%) compared to HFrEF (13.9%), particularly in those with HFpEF and CKD (19.2%). At time of diagnosis, patients were likely to use any HF medication. Patients with HFpEF were more likely than those with HFrEF to be treated with angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARB; 46.1% vs 40.7%), β-blockers (BB; 53.2% vs 41.3%) and diuretics (41.0% vs 26.5%). Within 90 days of diagnosis, fewer patients with HFpEF vs HFrEF initiated ACEi/ARB (42.8% vs 70.4%), BB (35.4% vs 56.2%) and diuretics (47.8% vs 65.2%).

Conclusion:
Primary care plays a major role in early HF care. Comorbid CKD and T2D increased hospitalization and mortality rates but not cardiology care. However, patients with HFpEF were less likely to be seen by a cardiologist or initiate medication following diagnosis vs those with HFrEF.
Abstract 16588: Electrophysiology Procedural Access and Growth in Remote Geographies Using Novel Remote Mapping and Clinical Support Software
Authors: Mahtani Arun , Lee Bridget , Doty Brandon , Brider Jamarcus , Gopi Arun , Nair Devi
Published: December 2023

Introduction:
COVID-19 redefined workflows in the field of electrophysiology (EP). The geographic paucity of experienced clinical mapping support was a crucial issue that limited the worldwide adoption of complex ablation procedures.

Hypothesis:
To ascertain the feasibility of utilizing a novel software for remote mapping and clinical support for all spectrums of cardiac ablation procedures in a remote geography.

Methods:
Ablation procedures performed at Metromed International Cardiac Centre (MICC); India were included in this early feasibility analysis (EFA). All procedures were performed by a single EP operator. Remote clinical support was provided by an EP physician (primary operator's sibling) in the US. Mapping was performed by an experienced mapper from a remote location 400 miles away from MICC. The mapping system utilized was Ensite Precision with SJM Connect software.

Results:
360 contiguous ablation procedures from 2020 to 2023 were included in this EFA and compared to procedures performed between 2017 to 2019. The SJM Connect software allows remote access to the Ensite console via a secured connection. It requires the operator to be granted access to the console via a permission request. The software then allows the remote operator to access the system as view-only or complete control of the console providing full remote support. Communication occurs between the remote user and the console via a chat and voice call. There was an overall increase by three times in the total number of ablations performed after using the remote system. There was also an increase in different types of complex ablation procedures performed.

Conclusions:
This EFA demonstrates the safety and efficacy of using remote clinical support and mapping for ablation procedures. It opens a world of possibilities including the expansion of ablation technology to all corners of the world with experienced clinical mapping support connecting the EP community on a worldwide platform.
Abstract 16612: Cardiomyocyte PGC-1α Prevents Cardiac Atrophy and Failure in Response to Endurance Exercise Training
Authors: Khetarpal Sumeet , LI Haobo , Castro Claire , Houstis Nicholas A , Rhee James , Sprenger Hans-Georg , Mittenbuhler Melanie , Kuznetsov Alexandra , Freeman Rebecca , Asnani Aarti , Dumesic Phillip , Roh Jason D , Rosenzweig Anthony , Spiegelman Bruce
Published: December 2023

Introduction:
Aerobic exercise promotes physiologic hypertrophy of the heart in healthy individuals. In skeletal muscle and heart, a key orchestrator of the adaptation to exercise is the transcriptional regulator PGC-1α. PGC-1α may mediate cardiac adaptation to physiological stress through myriad mechanisms. The role of cardiac PGC-1α to the systemic training response is poorly understood.

Methods:
We generated PGC-1α cardiomyocyte-specific knockout (KO) mice to study its role in endurance exercise. We also silenced Ppargc1a expression in a cell model of physiologic cardiomyocyte hypertrophy.

Results:
Sedentary KO mice demonstrated normal cardiac function and minimal differences in acute exercise tolerance. However, KO mice demonstrated a lack of ability to augment exercise capacity after 6 weeks of wheel running (work achieved 32.9 J in WT [39% increase] vs 23.1 J in KOs [no change vs baseline], p<0.001, unpaired t-test). This was despite comparable voluntary wheel distance run during training (2.93-3.67 km/day for both over 5 weeks, p=0.58). Unexpectedly, after 6 weeks of training, KO mice developed a dilated cardiomyopathy and exercise-related dysfunction (contractile reserve [ΔFS
stress-rest
] +6.0 in WT vs -6.4% in KO, p<0.05, unpaired t-test). They also demonstrated features of cardiac cachexia as measured by 27% and 19% reductions in inguinal adipose and gastrocnemius mass, respectively (P<0.05, unpaired t-test). RNA sequencing of the hearts from these mice demonstrated activation of pathological (
Nppa
,
Nppb
,
Myh7/Myh6
), fibrotic and atrophic secreted factors (
Gdf15
,
Fstl3
). Silencing Ppargc1a in rat cardiomyocytes after IGF1 treatment failed to induce physiologic hypertrophy and activated fibrotic programs and conferred atrophy.

Conclusions:
Our studies posit cardiomyocyte PGC-1α as a key mediator of the adaptive response to exercise training and unveil its central role in protecting from exercise-related cardiac atrophy and fibrosis.
Abstract 16613: Study of Modified HEART Score and HEART Pathway as Predictor of Major Adverse Cardiac Events (MACE) in Patients Presenting With Non ST Elevation- Acute Coronary Syndrome (NST-ACS)
Authors: Dahiya Roopali
Published: December 2023

Introduction:
Among the various scores studied in literature, the modified HEART score and HEART pathway were found to have high discriminatory power of predicting major adverse cardiac events (MACE) in Non ST elevation acute coronary syndrome (NSTEACS) patients in various international studies. This warrants need for evaluation of these scores for better management of patients in hectic emergency departments of Indian healthcare system.

Methods:
This prospective observational study was conducted between January 2021 and May 2022 in a tertiary care hospital of New Delhi, India. Modified HEART score was calculated based on history, ECG, age, risk factors and highly sensitive troponin I (hsTrop I) values for 60 patients. Collected serum samples of hsTrop I at 0 and 3 hours were measured using ELISA kits. As per the score, patients in low risk group were discharged safely and intermediate and high risk groups were assessed with the help of stress testing and coronary angiography and managed accordingly. The occurrence of MACE was assessed at 30 days from presentation to healthcare facility.

Results:
The study showed that proportion of patients with MACE was significantly higher in high risk group (82.14%) as compared to low (0%) and intermediate risk group (20.83%) (p value <0.001). Modified HEART score was the best predictor of MACE at cut off point of >6 with 88.1% chances of correctly predicting MACE. Negative predictive value of HEART pathway was found to be 100% which enabled safe disposition of low risk group patients.

Conclusions:
Hence, when modified HEART score and HEART pathway were used together, it allowed efficient use of resources and prediction of MACE in NSTEACS. This was the first study done on Indian population where modified HEART score and HEART pathway were used simultaneously to predict the occurence of MACE.
Abstract 16663: Psychometric Summary of the Heart Failure Symptom Survey
Authors: Higgins Melinda , Alonso Windy , Butts Brittany , Graven Lucinda J , Reilly Carolyn M , Schmaderer Myra S , Struwe Leeza , Dunbar Sandra B , Pozehl Bunny J
Published: December 2023

Introduction:
The Heart Failure Symptom Survey (HFSS) was adapted from the Cardiac Symptom Survey to measure common symptoms experienced by heart failure (HF) patients. The HFSS assesses four components (frequency, severity, interference with physical activity and enjoyment of life) for 14 symptoms including shortness of breath at rest, with activity or when lying down or during the night; extremities swelling; bloating; fatigue; chest pressure; irregular heartbeat; worsening cough; dizziness; difficulty sleeping; forgetfulness; and feeling down. To date the formal psychometric analysis and validation of the HFSS has not been published.

Hypothesis:
Determine reliability and validity of the HFSS using baseline data from multiple HF studies.

Methods:
Data were merged from several HF studies from four research universities. The HFSS items were summed to compute scores for symptom frequency, severity, interference with physical activity, interference with enjoyment of life, and a total score of all 4 components. Internal consistency was evaluated using Cronbach’s alpha for reliability as well as computing the number of factors from exploratory factor analysis Scree test. Initial external validity was explored by comparing New York Heart Association (NYHA) class to the four component and overall total scores.

Results:
For the 623 patients in the merged dataset, ages ranged from 22 to 99 with a mean of 65.0 +/- 13.8; 61.0% were male; 69.0% were White, 28.9% were African American; 88.4% had reduced ejection fraction <=40%; 41.0% were NYHA class II and 33.3% were class III. Internal reliability estimates for each component were: frequency (Cronbach’s alpha=0.892), severity (alpha=0.913), interference with physical activity (alpha=0.915), and interference with enjoyment of life (alpha=0.921) and overall total (alpha=0.976). For each component and the total scale, a single factor was indicated by the Scree test. The four component and total scores were all correlated moderately with NYHA class (Spearman’s rho, 0.337 to 0.352).

Conclusions:
The HFSS showed high reliability across multiple HF samples and positive association with NYHA class reflecting validity in relation to heart failure clinical severity useful for tailoring symptom management.
Abstract 16668: Characterisation of the Structural Phenotype in Atrial Fibrillation by Combined Cardiac Computed Tomography and Atrial Magnetic Resonance Imaging: Towards a Differentiated Approach to Patients With Atrial Fibrillation
Authors: Tonko Johanna , Lee Angela , Whitaker John
Published: December 2023

Rational:
Atrial remodelling (AR) is the persistent change in atrial structure and/or function and contributes to the initiation, maintenance and progression of AF. Left atrial (LA) size, geometry, fibrosis, wall thickness (LAWT) and ejection fraction (LAEF) have all been shown to vary with pathological AR. The association of these global remodelling markers with each other for differentiating structural phenotypes in AF is not well investigated.

Method:
Patients referred for first-time AF ablation and controls without AF were prospectively recruited to undergo cardiac CT and MRI with 3D atrial LGE sequences. LAWT based on the eikonal equation, atrial myocardial mass, LA volume and sphericity were calculated from CT. Biplane LA EF and LA fibrosis burden (IIR method) were derived from atrial MRI. Results were compared between patients with AF and controls. Statistical significance was set at α 0.05.

Results:
42 AF patients (64.3% male, age 64.6+/- 10.2 , CHA2DS2-VASc 2.48+/- 1.5, 69.0% paroxysmal AF, 31% persistent AF, LVEF 57.9+/-10.5%) and 37 controls (64.9% male, age 56.6+/-7.2, CHA2DS2-VASc 1.54 +/-1, LVEF 60.4 +/- 4.9%) were recruited. Patients with AF had a significantly higher LAWT, mass, fibrosis burden, left atrial size and lower LAEF compared to controls. There was no significant correlation between % fibrosis with LAWT (p 0.573), mass (p 0.775), volume (p 0.407) or sphericity (p 0.855). LAWT had a weak positive correlation with LA volume (p=0.041), but not with sphericity (p 0.86). LAEF had a weak negative correlation with fibrosis (p 0.025) and LAWT (p 0.017)

Conclusion:
AF is associated with significant quantifiable structural changes yet individual remodelling markers do not or only weakly correlate with each other suggesting different remodelling subtypes exist (e.g. fibrotic, hypertrophic, dilated). Structural phenotyping may provide insight in the individual AF mechanism and inform a more differentiated approach to the heterogenous AF population.
Abstract 16670: Significance of Cardio-Ankle Vascular Index as an Indicator of Renal Function Decline: A Systematic Review and Meta-Analysis
Authors: Tavolinejad Hamed , Chirinos Julio A
Published: December 2023

Introduction:
Large artery stiffness leads to increased pulsatile energy transmission to the microvasculature, resulting in microvascular damage in high-flow low-resistance organs, including the kidneys. Cardio-ankle vascular index (CAVI) is an index of arterial stiffness that is less blood pressure dependent. However, its association with renal function remains understudied.

Hypothesis:
To determine if baseline CAVI is associated with renal function decline.

Methods:
The databases PubMed, Scopus, and Web of Science were systematically searched until June 2023 for original longitudinal studies. The study outcome was defined as renal function decline or incidence/progression of chronic kidney disease. The “Methodological Index for Non-Randomized Studies” (MINORS) was used for quality assessment. Pooled effect measures were calculated with random-effects models that were stratified based on CAVI cutoffs and the reported effect measure.

Results:
Among 7 studies (66,595 subjects; 45% male) the ranges of average age, eGFR, and follow-up duration were 46-69 years, 51-87 mL/min/1.73m2, and 1-7 years, respectively. All but one study (Kusunose et al.) reported adjusted models. The meta-analyses showed significant associations between high baseline CAVI and worsening renal function outcomes among studies reporting hazard ratios for a categorical exposure (HR=1.30; 95% CI [1.18-1.43]; P<0.001; I
2
=38%), continuous exposure (HR [per SD] =1.14 [1.04-1.25]; P=004; I
2
=23%), and for odds ratios (OR [categorical exposure] =1.67 [1.01-2.76]; P=0.046; I
2
=71%).

Conclusions:
We observed a significant association between higher baseline CAVI and renal function decline over time. These results suggest that CAVI is a marker of kidney disease risk. Further research is warranted to investigate the role of CAVI as an indicator of risk of end-organ damage, and to investigate interventions targeting arterial stiffness to mitigate the burden of chronic kidney disease.
Abstract 16679: Growth Differentiation Factor 15 in the Initial Evaluation of Suspected Coronary Artery Disease
Authors: Karaji Iman , Steiro Ole-Thomas , Myrmel Gard , Omland Torbjorn , Langoergen Joerund , Bjoerneklett Rune , Skadberg Oyvind , Bonarjee Vernon V , Mjelva Oeistein , Collinson Paul O , Vikenes Kjell , Pedersen Eva , Aakre Kristin Moberg M
Published: December 2023

Introduction:
The cytokine growth differentiation factor 15 (GDF-15) is expressed in several tissues including cardiomyocytes, and is up-regulated in conditions of tissue injury and stress.

Hypothesis:
We hypothesized that serum GDF-15 can predict obstructive CAD and need of revascularization among acutely admitted chest pain patients. Further, we assessed whether the combination of GDF-15 and coronary artery calcium (CAC) scoring could identify a subgroup with low risk of obstructive CAD, in whom a full coronary CT angiography (CCTA) could be avoided.

Methods:
GDF-15 was measured, using the assay on Cobas e801 (Roche Diagnostics), in 537 patients with chest pain and high-sensitivity cardiac troponin T concentrations ≤99th percentile. All participants underwent CAC scoring and CCTA. Obstructive CAD was defined as >50% lumen diameter narrowing. Associations of GDF-15 with obstructive CAD and 30-days revascularization were calculated by multivariable logistic regression adjusting for age, sex, smoking, hypertension, HbA1c, LDL-cholesterol, GFR and prior AMI. We also evaluated whether GDF-15 could improve sensitivity and negative predictive value (NPV) of CAC=0 for ruling out the presence of obstructive CAD.

Results:
The median (25th-75th percentile) age was 56 (49-65) years, 217 (40.4%) of the patients were women, 83 (15.5%) had obstructive CAD, and 49 (9.1%) had revascularization within 30 days. After multivariable adjustment, elevated GDF-15 (≥1200pg/mL) predicted obstructive CAD at baseline with OR (95%CI) of 2.23 (1.14-4.36), p=0.02. The OR (95%CI) for 30-days revascularization was 2.33 (1.08-5.03), p=0.03. For CAC=0, we observed a sensitivity (95%CI) and NPV (95%CI) of 94.0% (86.5%-98.0%) and 98.0% (95.3%-99.3%) in ruling out obstructive CAD. For patients having both CAC=0 and GDF-15 levels below median (<730pg/mL), sensitivity (95%CI) and NPV (95%CI) for obstructive CAD were 97.6% (91.6%-99.7%) and 98.7 (95.2%-99.8%), respectively.

Conclusions:
Elevated serum GDF-15 predicts obstructive CAD and 30 days revascularization among patients with chest pain, but without AMI. The combination of low GDF-15 levels and CAC=0 appears promising for the identification of low-risk patients, who can possibly be discharged without a full CCTA.
Abstract 16688: Impact on Preoperative Estimation of Atrial Mechanical Amplitudes Before With VDD Leadless Pacemaker
Authors: Komai Yuya , Kondo Yusuke , Nakano Masahiro , Kajiyama Takatsugu , Ryo Ito , Chiba Toshinori , RYUZAKI SATOKO , Yoshino Yutaka , Takanashi Yukiko , Kobayashi Yoshio
Published: December 2023

Introduction:
It would be useful to judge whether the device can sense atrial systole or not before an implantation of a VDD leadless pacemaker (Micra AV
RT
, Medtronic, US).

Hypothesis:
Mechanical atrial amplitude for Micra AV
RT
associated with atrial construction at implantation location.

Methods:
Echocardiographic measurements were performed to quantify the atrial motion of the interventricular septum in patients who received leadless pacemaker implantation. We visually divided the septum into five segments from the base to the apex. The myocardial velocity of each segment measured on tissue doppler imaging (TDI) was defined as EV1, 2, 3, 4, and EV5 (m/s), respectively.

Results:
Fourteen patients (79.5 years, 8 males) receiving Micra AV from November 2021 to February 2023 at our institution were analyzed. The average myocardial velocity of atrial contraction at each site tended to decrease as getting closer to apex (EV1:8.9, EV2:8.0, EV3:7.0, EV4:5.8, EV5:3.5 cm/s) as shown in Figure. The implantation location was estimated from fluoroscopy and postoperative echocardiography, and mechanical atrial amplitude (A4) and the local EV were compared; Patients with lower than 2.0 m/s
2
A4 had also lower the local EV than others. (3.6 vs 5.9 m/s, p=0.037).

Conclusions:
Preprocedural estimation of mechanical atrial amplitude of Micra AV is possible on septal TDI.
Abstract 16693: Trends in the Use of Oral Anticoagulation for Nonvalvular Atrial Fibrillation Vary by Specialty: Real World Results From a Large Integrated Health Care System 2011-2022
Authors: Voyce Stephen J , Grassi Stacey , Chronowski Joseph , Van Enkevort Erin
Published: December 2023

Introduction:
Direct Oral anticoagulants (DOACs) have demonstrated superiority or non inferiority to vitamin K antagonists (VKAs) for stroke/embolic prevention in patients with nonvalvular atrial fibrillation (NVAF). However, clinical inertia may delay widespread adoption of newer therapies in medicine.

Hypothesis:
We evaluated whether uptake of DOACs into clinical medicine varied by physician specialty.

Methods:
We performed a retrospective review of patients with NVAF within the Geisinger Health System from 2011-2022. Longitudinal yearly trends for new/initial prescriptions (Rx) of DOAC vs VKA by cardiology or primary care (PCP) specialties

Results:
We identified patients with NVAF initiated on an oral anticoagulant from the years 2011 through 2023. Figures 1 and 2 demonstrate a statistically significant linear yearly increase in new Rx for DOACs for both cardiology and PCP specialties.By 2022, DOACs currently account for 96% of all new oral anticoagulant Rx by cardiologists and 90% of Rx by PCP. New Rx for DOAC by PCP lagged cardiology at all time points. Cardiology initial Rx >50% DOAC by 2015 while PCP did not achieve this mark until 2018.

Conclusions:
In this real-world setting, we observed a significant increase in DOAC use as the initial prescription for patients with NVAF by both cardiology and primary care specialties.Significant difference in the adoption of DOAC was noted between cardiology and primary care specialties.Primary care use of DOAC as first Rx for NVAF increased over time but lagged cardiology by 2-3 years.