bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 16792: Gender Differences in African Americans and Caucasians With Severe Aortic Stenosis or Bicuspid Aortic Valve
Authors: White Solaru Khendi T , Popovic Zoran , Kalahasti Vidyasagar , Roselli Eric , Barzilai Benico
Published: April 2024

Introduction:
Severe aortic stenosis (AS) is a multifactorial, progressive condition that is associated with high short-term mortality. Risk factors for mortality have been described and include male sex, hypertension, hyperlipidemia, and congenital bicuspid valve (BAV). Senile, calcific AS is thought to affect both genders equally in contrast to BAV which has a 3:1 male preponderance. It is unknown if there are gender differences in the prevalence of severe, senile AS or congenital bicuspid aortic valve in Whites compared to Blacks.

Methods:
10,299 Black or White patients with severe aortic stenosis or bicuspid aortic valve treated at Cleveland Clinic with primary AVR from 1/1/2000 to 1/1/2017 were included in this study. There were 257 Black patients (2.5% of the study population). Categorical data on gender was compared using the Chi-squared test.

Results:
Blacks with severe aortic stenosis were significantly more likely to be female compared to Caucasians (55% vs 36%, p<0.001). There were no differences in gender prevalence among patients with BAV (73% vs 74%, p=0.88).

Conclusions:
Our study found that Blacks with severe AS undergoing AVR are significantly more likely to be female compared to Whites. However, there were no differences in gender prevalence among Blacks and Whites with BAVs. Although Black men are the least likely demographic to access health care, they comprise the majority of the BAV group. Thus, lack of health care access does not fully explain the gender differences in the severe AS group. There may be a strong underlying genetic component accounting for the 3:1 male predominance in all BAV patients.
Abstract 16799: Decellularized Cardiac Extracellular Matrix Increases Cardiomyocyte Elongation and Contractility
Authors: Tang-Quan Karis R , Xi Yutao T , Hochman-Mendez Camila T , Sampaio Luiz C , Taylor Doris A
Published: April 2024

Background:
Cardiomyocyte elongation has been linked to enhanced myofilament organization, which contributes to overall cell contractility and functionality. While tissue scaffolds have been engineered to induce cell elongation using topographical cues, decellularized cardiac extracellular matrix (dECM) bioscaffolds are known to be bioactive and retain native cues for cell organization and regeneration, including the alignment of stem cells. However, the effects of the native extracellular matrix on cardiomyocyte elongation and contractility are still unknown.

Hypothesis:
We hypothesized that dECM increases elongation and contractility of neonatal rat ventricular cardiomyocytes (NRVCMs) versus engineered collagen constructs, resulting in physiologically-relevant, scalable tissues for cardiovascular tissue engineering.

Methods and Results:
Adult rat hearts were harvested and perfusion-decellularized through the coronary vasculature under constant pressure. Hearts were sectioned on a vibratome transversally to create 300 μm-thick rings of the left ventricle. Collagen (type 1) rings of the same size as the dECM rings were made by using rat tail collagen (2.0 mg/ml). Ten million NRVCMs were isolated, purified, and injected into the left ventricle of dECM or collagen rings (n=12 each). Cell survival, distribution, elongation, and alignment were evaluated after 14 days by using immunofluorescence and confocal microscopy. The dECM significantly increased nuclear elongation (major to minor axis ratio of 1.585 for cells in dECM vs. 1.37 in collagen, n=6 each, p<0.01). Microscopic contractions were observed in dECM as early as day 3 (n=3). The number of spontaneous contractions of cells in dECM (n=5) was significantly greater than that in collagen (n=3) (p<0.01), as observed by atomic force microscopy.

Conclusion:
In conclusion, dECM increased cellular elongation and contraction frequency of neonatal rat ventricular cardiomyocytes, suggesting the presence of tissue-specific cues in the extracellular environment of cardiomyocytes is beneficial for tissue function. Studies utilizing human stem-cell derived cardiomyocytes are underway to verify the organizational, functional, and physiologic properties of recellularized dECM.
Abstract 16832: Cardiovascular Health Study of Emerging Adults Entering College: Implications for Prevention Research
Authors: Pfammatter Angela F , Wang Shirlene , Hood Susan H , Mitsos Alexa , Spring Bonnie
Published: April 2024

Introduction:
Cardiovascular disease is a significant societal burden and the college years are a time of risk for loss of cardiovascular health (CVH). Whereas 50% of individuals under age 19 have ideal levels in five of American Heart Association (AHA) Life’s Simple Seven (LS7), that number declines to 16% by young adulthood. NUYou, a randomized clinical trial in AHA’s Strategically Focused Prevention Research Network, tests the feasibility, acceptability, and effectiveness of a mobile health technology supported intervention. To our knowledge, this is the first trial assessing and intervening on multiple behaviors in the college student population for the purpose of preserving CVH.

Methods:
Freshmen were recruited via multiple strategies and cluster randomized by dormitory to receive intervention targeting four CVH related behaviors or four non CVH related behaviors for two years. Baseline CVH was measured using LS7 criteria. During in-person baseline visits, blood pressure, breath carbon monoxide, height, weight, glucose and cholesterol were measured and participants reported diet and physical activity.

Results:
Participants (N=303) were 60% female, and 50% White (12% Hispanic/Latinx), 28% Asian, 10% African American. 92% had ideal BP (Systolic M=100.75, SD 0.48; Diastolic M=63.44, SD=0.42), glucose (M=86.15, SD=0.87), and cholesterol (M=155.52, SD=1.67). In contrast, Figure 1 shows 29% of students met ideal physical activity levels and 2% met ideal diet quality (8% reported eating 5-7 servings of fruits and vegetables daily). Ideal levels of 5 LS7 factors were met by 71%.

Conclusions:
CVH among elite college freshmen was better than previous findings in this age group, largely due to a majority of students with ideal levels of BP, cholesterol, and glucose. Behavioral metrics were poorer, as a minority had ideal levels of diet and physical activity. The NUYou trial will track the trajectory of CVH and whether CVH is preserved by a mobile health intervention.
Abstract 16848: Over 25 Years of Experience With the Ross Procedure in Children: A Single-Centre Experience
Authors: Martin Elisabeth , Laurin Charles , Jacques Frédéric , Houde Christine , Côté Jean-Marc , Chetaille Philippe , Drolet Christian , Vaujois Laurence , Kalavrouziotis Dimitri , Mohammadi Siamak , Perron Jean
Published: April 2024

Introduction:
Aortic valve replacement in children and infants poses an important clinical challenge. The Ross procedure offers advantages such as growth potential and low thrombogenicity. Concerns regarding pulmonary autograft and homograft longevity as well as subsequent reoperations are well recognized. We reviewed our experience with the Ross procedure with the aim of defining survival rate and freedom from reintervention.

Methods:
This is a single-center retrospective cohort including 63 consecutive children who underwent the Ross procedure. The first Ross procedure was performed in 1990. Complete postoperative clinical and echocardiographic evaluation was obtained. Long-term survival was assessed using Kaplan-Meier estimator.

Results:
There were 51 males (81%) and mean age at surgery was 10.1 (+/- 5.8) years. Isolated aortic stenosis was the most common diagnosis and found in 28 (44.4%) patients. Median follow-up duration was 20.5 years and ranged up to 26.9 years. There was one (1.6%) hospital death. Survival at 5, 15 and 25 years was 96.6%, 94.4% and 94.4%, respectively. Freedom from autograft-related reintervention was 98.1%, 88.9% and 66.8% at 5, 15 and 25 years, respectively. Twelve patients underwent reoperations on the autograft and there was no post-operative death. Among these patients, 7 (58.3%) patients underwent valve-sparing autograft reoperation. Reintervention on the pulmonary homograft was performed on 29 (46.0%) patients. Freedom from homograft-related reintervention was 93.2%, 58.2% and 29.8% at 5, 15 and 25 years, respectively.

Conclusions:
The Ross procedure in children is associated with excellent long-term outcomes. Ross-related reinterventions are more than twice as common on the pulmonary homograft than autograft.
Abstract 16849: Mortality Associated With Mitral Regurgitation and Impact of Intervention Among 76,402 Subjects Referred for Echocardiography Over 17 Years
Authors: Breyley Jared , Rangavajla Gautam , Stewart Thomas G , Farber-Eger Eric , Blair Marcia A , Brittain Evan L , Wells Quinn S
Published: April 2024

Introduction:
Mitral regurgitation (MR) guidelines are largely informed by registries that may not represent patients in current care. We hypothesized that assessing outcomes in a contemporary MR cohort curated from electronic health records (EHRs) would improve understanding of MR-related risk and the impact of interventions.

Methods:
Clinical and echocardiographic data were extracted at the time of first transthoracic echocardiogram (TTE) for all patients in Vanderbilt University Medical Center’s EHR between 1998-2015. Associations between all-cause mortality and MR severity were assessed by Kaplan-Meier (KM) curves and Cox proportional hazards regression model with time-varying covariates.

Results:
There were 76,402 subjects with trace MR. Subjects were median age 59 yrs (45, 70), 52% female, and 86% white. Moderate or greater MR was present in 5,260 (6.9%) subjects, of which 1,085 (1.4%) were severe. KM estimates of 10 year survival for severe vs trace MR were 0.45 (0.42, 0.49) vs 0.72 (0.71, 0.73) - relative 10 year risk 1.95 (1.82, 2.09); p<0.001; Figure 1a. In an adjusted Cox model, features associated with mortality included MR severity, age, male sex, LV ejection fraction, LV systolic dimension, pulmonary artery pressure, heart failure, and atrial fibrillation (p<0.001). In subjects with moderate MR and 1 year follow-up, mitral valve repair/replacement within 1 year of TTE significantly reduced 5 year mortality (0.38 (no intervention) vs 0.17 (repair/replace)) - relative 5 year risk 0.44 (0.01, 0.78); p<0.001; Figure 1b. In KM analysis, the impact of intervention was attenuated at later time points.

Conclusions:
In a large cohort referred for TTE, MR is common and associated with significant mortality. Comorbidities and markers of cardiac remodeling are associated with increased mortality, while risk is attenuated by mitral valve intervention. Future analyses will evaluate predictors of treatment response and etiology-specific associations.
Abstract 16851: Sinus Node Dysfunction Underlies Chronotropic Incompetence in Rats With Heart Failure and Preserved Ejection Fraction
Authors: Cho Jae Hyung , Zhang Rui , Goldhaber Joshua I , Marbán Eduardo , Cingolani Eugenio
Published: April 2024

Introduction:
Chronotropic incompetence is a major limiting factor of exercise capacity in patients with heart failure and preserved ejection fraction (HFpEF) but little is known about the mechanisms.

Hypothesis:
We tested the hypothesis that sinus node dysfunction underlies chronotropic incompetence in rats with HFpEF.

Methods:
Dahl salt-sensitive rats were fed high-salt diet (8% NaCl) to induce HFpEF. Rats fed normal-salt diet (0.3% NaCl) served as controls. Echocardiography was used to confirm the development of diastolic dysfunction in high-salt-fed rats. Telemetry devices were implanted to echo-verified HFpEF rats and treadmill exercise test was performed to assess heart rate response to exercise and exercise capacity. Sinus node recovery time (SNRT) was measured
in vivo
and
ex vivo
optical mapping was performed in isolated sinus node tissues to measure heart rate response to isoproterenol. Reverse transcriptase PCR was performed in RNA samples isolated from sinus node tissues.

Results:
HFpEF rats showed decreased E/A ratio (1.30±0.07 vs. 1.58±0.13, p<0.05) and increased E/E’ ratio (19.17±2.63 vs. 13.78±2.58, p<0.05) compared to controls, indicative of diastolic dysfunction. Ejection fractions were normal (71±7% vs. 73±3%, p=ns) in both groups. Resting blood pressure were elevated in HFpEF rats compared to controls (209±30/120±38 vs. 151±12/88±17 mmHg, p<0.05) and serum catecholamine levels were elevated in HFpEF rats (38.4±5.6 vs. 25.6±1.5 ng/ml, p<0.05). Heart rate at peak exercise was decreased in HFpEF rats compared to controls (496±21 vs. 538±20 bpm, p<0.05) and exercise capacity was reduced in HFpEF rats (170±99 vs. 289±120 meters, p<0.05). Corrected SNRT was prolonged in HFpEF rats (86±34 vs. 58±10 ms, p<0.05), indicative of sinus node dysfunction.
Ex vivo
sinus node preparations showed decreased heart rate response to isoproterenol (119±12 vs. 163±27 bpm, p<0.05). Beta-1 receptors gene expression (
Adrb1
) were not decreased in HFpEF sinus node (93% in HFpEF vs. 100% in control, p=ns) nor were L-type Ca channels gene expression (
Cacna1c
) (95% in HFpEF vs. 100% in control, p=ns). However, pacemaker channels gene expression (
Hcn4
) showed a trend toward reduction in HFpEF sinus nodes (60% in HFpEF vs. 100% in control, p=0.1).

Conclusions:
Sinus node dysfunction underlies chronotropic incompetence in rats with HFpEF. Further investigation is warranted to elucidate the mechanism and design potential therapeutic strategies for this condition.
Abstract 16882: Temporal Changes in the Peripheral Blood Mononuclear Cell Populations After Acute Myocardial Infarction and Prediction of Improvement in Left Ventricular Function in the Cardiovascular Cell Therapy Research Network (CCTRN) TIME and Late-TIME Trials
Authors: Resende Micheline T , Gahremanpour Amir , Perin Emerson C , Chacon Lourdes I , Sampaio Luiz C , Moye Lem , Willerson James T , Taylor Doris A
Published: April 2024

Background:
Despite many cell-mediated attempts to promote myocardial repair after myocardial infarction (MI), no cell treatments are currently available. Instead, cell therapy clinical results remain mixed. We hypothesized that by evaluating changes in circulating cells in improvers and non-improvers in an MI cell therapy study, we could identify cells associated with repair that might be candidates for future cell therapy studies.

Methods:
In this study, peripheral blood (PB) was evaluated by flow cytometry at baseline and days 1, 30, 90 and 180 after bone marrow mononuclear cell (BMMNC) or placebo therapy from 207 consented patients in the CCTRN TIME (n=120) and Late-TIME (n=87) studies. A linear mixed model was used to determine changes over time in cell frequency. Multiple regression and discriminatory analyses were used to identify if changes in circulating cells predict changes in left ventricular ejection fraction (LVEF).

Results:
Changes in circulating cells were observed independent of treatment group. In TIME, a progressive decrease of CD11b+ cells started at day 30 (91.69±4.57 vs. 93.23±3.97%, p<0.05) and CD14+ cells began at day 90 (73.53±10.82 vs. 79.17±10.97%, p<0.05) compared to baseline. In Late-TIME, there was an increase in CD11b+ (94.01±3.82 vs. 92.81±3.98%, p<0.05) and CD14+ (81.70±6.64 vs. 77.94±9.29%, p<0.05) cells at day 1 when compared to baseline followed by a progressive decrease in the follow-up visits. A progressive decline in CXCR4+ cells started at day 30 in TIME (35.39 ±14.81 vs. 42.86±13.83%, p<0.05) and at day 1 in Late-TIME (42.81±14.33 vs. 47.74±15.13%, p<0.05). In TIME, a decrease of CXCR4+ cells at day 90 was a negative predictor of changes in LVEF from baseline to six months.

Conclusion:
Although multiple cell frequencies changed after treatment, only one cell frequency predicted changes in LVEF from baseline to six months. A significant reduction in CXCR4+ circulatory cells at day 90 after treatment is associated with improvement in LVEF. Further studies will be necessary to confirm the changes in circulatory cells and its impact on the regenerative capacity of patients with AMI.
Abstract 16927: Validation of CathPCI Bleeding Model in Transradial vs. Transfemoral PCI Patients
Authors: Flood Shane P , Kennedy Kevin F , Louis David W , Aronow Herbert D
Published: April 2024

Background:
Estimation of bleeding risk in patients undergoing PCI informs the use of bleeding avoidance strategies, allows for personalized consent, and supports quality improvement efforts. The CathPCI Bleeding Model (CPBM) was developed in patients undergoing PCI between 2008 and 2011, when PCI was performed predominantly via transfemoral (TF) access. Whether this model functions equally well in transradial (TR) PCI is unclear.

Objectives:
This study sought to determine if the CPBM behaves differently for PCI performed via TF vs TR access.

Methods:
Patients who underwent PCI between Q4 2010 and Q4 2016 were identified from an institutional CathPCI Registry. The primary outcome was post-PCI bleeding within 72 hours or before hospital discharge. A logistic regression model was created predicting CPBM on the 10-variable reduced model. Interactions between each variable and access site were tested. Using the CPBM integer scoring system, the interaction between low, moderate, and high risk groups with the access site was tested.

Results:
TR access increased from 14% in 2010 to 60% in 2016. Major bleeding was lower for TR than TF PCI (2.5% vs 7.3%, p < 0.001). Prior PCI was protective of bleeding in the TF, but predictive of bleeding in the TR group. There was no significant interaction between access site and all remaining variables (Fig. 1). There was no difference in the discriminative capacity of the CPBM between TR and TF access (Fig. 1). The CPBM integer score behaved similarly between groups, without significant interaction, p = 0.53 (Fig. 2).

Conclusions:
The CPBM may be used to estimate patients’ bleeding risk regardless of PCI access site.
Abstract 16933: A Decision Aid for the Use of PCSK9 Inhibitors in Patients With Familial Hypercholesterolemia
Authors: Farwati Medhat , Shaw Kevin , Hargraves Ian G , Montori Victor M , Kullo Iftikhar J
Published: April 2024

Introduction:
Familial Hypercholesterolemia (FH) is a common inherited disorder of lipid metabolism. FH patients are at an increased risk of atherosclerotic cardiovascular disease (ASCVD) due to elevated low-density lipoprotein cholesterol (LDL-C) levels. Patients with FH may not reach target LDL-C levels despite maximally tolerated statin (±ezetimibe) therapy (MTT). The AHA scientific statement on FH highlighted the need for developing decision aids (DAs) to facilitate shared decision making (SDM) regarding additional therapy including PCSK9 inhibitors.

Methods:
A user-centered design process was initiated to understand FH treatment decisions and to develop prototype interventions. Patients with FH had their diagnosis confirmed by genetic testing. Encounters between FH patients and health care providers were video recorded and analyzed to assess how decisions are made regarding lipid lowering therapy. Nine encounters were recorded: 3 with a genetic counselor and 6 with an FH specialist. Informed by clinical encounters and literature review, we developed content for a DA related to available therapeutic options for FH patients on MTT.

Results:
A prototype online DA was created to support in-encounter discussion of a patient’s risk of adverse cardiovascular events and which therapies may be best suited to the patient (Figure). 5 and 10-year ASCVD risk is estimated using the SAFEHEART Risk Score (SRS). Risk is communicated in numbers using a 100-person icon array and the language “Out of 100 persons like you...”. Therapeutic options include watchful waiting, bile acid sequestrants, and PCSK9 inhibitors. For each option, the degree of risk reduction, costs, and side effects are presented. The tool is currently being refined by analyzing additional encounters with FH patients.

Conclusion:
We developed an interactive prototype DA to facilitate SDM for FH patients on MTT. After further iterative testing the tool will be deployed in the electronic health record.
Abstract 16934: Targeted Cardiac Delivery of miR-29b Mimic via Ultrasound-Mediated Microbubble Cavitation Attenuates Myocardial Fibrosis
Authors: Feroze Rafey A , Kopechek Jonathan , Lavery Linda , Cyriac Jissy , Zhu Jianhui , Chen Xucai , Villanueva Flordeliza
Published: April 2024

Introduction:
Cardiac fibrosis contributes to adverse ventricular remodeling in ischemic or hypertensive heart disease, increases heart failure risk, and is associated with loss of microRNA-29b (miR-29b). Plasmid or i.v. injection of miR-29b mimic has proven the concept that restoring miR-29b blunts cardiac fibrosis, but these are inefficient, non-targeted delivery strategies with low clinical translational potential. We hypothesized that ultrasound (US) mediated cavitation of microbubbles (MBs) loaded with miR-29b mimic would inhibit cardiac fibrosis. We first tested effects of US-targeted cavitation of miR29b-MBs (UTMC) on cardiac fibroblasts
in vitro
, then performed
in vivo
studies in a mouse model of angiotensin II (ANGII)-induced hypertension/fibrosis.

Methods:
Cationic lipid MBs were loaded with miR-29b mimic or negative control (NC) miRNA, placed with cultured neonatal cardiac fibroblasts, then treated with 10 sec pulsed US (
f
=1.3 MHz, MI 1.6, 4 frames/burst, 4 bursts/second). Cells were harvested at 24 hrs to measure downstream fibrotic mediators. Mice received continuous ANGII infusion via osmotic pump and UTMC with miRNA-loaded MBs at days 0, 3, 7. Serial echo was performed; the heart was harvested on day 10.

Results:
In cardiac fibroblasts, UTMC treatment with MBs loaded with miR-29b mimic vs NC miRNA caused a 543±51% increase in miR-29b (
p
<0.01) and knockdown in transcripts for collagen 1A1 (26±6%,
p
<0.01), collagen 1A2 (53±8%,
p
<0.01), collagen III (31±5%,
p
<0.01), and fibrillin (43±10%,
p
<0.05) (
n
=4/group). ANGII mice treated with UTMC + miR-29b mimic vs. NC miRNA (
n
=8-9/group) had downregulated cardiac fibrillin (37±8%,
p
<0.05); trends of lower collagen IA1, 1A2, and III by RT-PCR; decreased cardiac α-SMA protein by immunoblot (
p
<0.05); and preservation of ejection fraction and fractional shortening (
p
<0.01).

Conclusion:
UTMC-mediated delivery of miR-29b mimic blunts pathologic expression of fibrosis markers and is associated with preservation of left ventricular function in ANGII-induced murine cardiac fibrosis. This is the first demonstration of UTMC-delivery of a miRNA mimic for attenuating cardiac fibrosis, and has promising implications for targeted RNA-based approaches for treating cardiac disease.
Abstract 16948: TXLNB is Necessary for Physiological Hypertrophy During Cardiac Aging
Authors: McLendon Jared M , Zhang Xiaoming , Witmer Nathan H , Abouassaly Gabrielle M , Stein Colleen S , Boudreau Ryan L
Published: April 2024

Cardiac aging in mice and humans is associated with cardiac hypertrophy, fibrosis, diastolic dysfunction, and a reduced ability to adapt to stress. Recent evidence suggests that cardiac proteostasis - the coordinated regulation of protein synthesis, repair, and degradation mechanisms - is dysregulated during cardiac aging and contributes to cardiac structural and functional deficits, but the underlying molecular mechanisms are unknown. In recent work, we identified beta-taxilin (
TXLNB
) as a cardiac-enriched protein that regulates cardiomyocyte proteostasis. Overexpression of
TXLNB
in neonatal rat cardiomyocytes increased protein synthesis, decreased ubiquitination, increased proteasome activity, and increased autophagy. In addition,
TXLNB
-knockout (
TXLNB
-KO) mice generated by CRISPR/Cas9 exhibited altered cardiac proteasome activities (Fig. 1A: decreased 26Sβ5 activity (p=0.025, n=8), increased 26Sβ1 activity (p=0.13, n=8), and accumulate ubiquitinated proteins (Fig. 1B). Despite this profound proteasomal insufficiency,
TXLNB
-KO mice develop normal cardiac structure and function (at 12 weeks of age) and show appropriate hypertrophic responses to pressure overload via transverse aortic constriction. This suggests that
TXLNB
is not required for cardiac development or cardiac hypertrophy in young mice. We therefore initiated follow-up studies in 3, 6, 10, and 24 week-old mice to evaluate the role of
TXLNB
in aging-related cardiac hypertrophy. In these mice, there was no significant difference in body weight or tibia length based on genotype; however, between 10-24 months of age,
TXLNB
-KO mice did not show the typical increase in heart size observed in WT mice (Fig.1C, 10 months, p=0.023, n=7; 24 months, p=0.026, n=3-4). This suggests that
TXLNB
is necessary for adaptive cardiac remodeling that occurs during aging. Ongoing work will establish if aged
TXLNB
-KO mice have decreased cardiac function or an impaired adaptation to cardiac stress.
Abstract 16954: Should We Perform Transcatheter or Surgical Aortic Valve Replacement in Patients With Severe Aortic Stenosis and Obstructive Sleep Apnea? A Nationwide Inpatient Sample Matched Analysis
Authors: Kolkailah Ahmed A , Fugar Setri , Ranka Sagar , Sleiman Jose , Hirji Sameer A , Al-Ogaili Ahmed , Ayoub Ali , Paz Rios Luis H , Campagnoli Tania , Doukky Rami
Published: April 2024

Background:
Transcatheter aortic valve replacement (TAVR) is an established alternative treatment strategy to surgical aortic valve replacement (SAVR) in select patients with severe aortic stenosis (AS). Obstructive sleep apnea (OSA) is associated with increased perioperative morbidity and mortality. We sought to compare the in-hospital outcomes after SAVR and TAVR in patients with severe AS and OSA.

Methods:
We identified patients who underwent either SAVR or TAVR in the Nationwide Inpatient Sample (NIS) between 2012 and 2015 using ICD-9-CM procedure codes 35.21, 35.22 and 35.05, 35.06, respectively. We identified OSA with code 327.23. A 1:1 propensity-matched cohort was created to examine the primary endpoint of in-hospital mortality. Secondary endpoints included hospital length of stay (LOS), cost, and post-procedural complications.

Results:
We identified 1113 matched-pairs of TAVR and SAVR patients. The need for non-invasive ventilation was similar between TAVR and SAVR, respectively (9.3% vs. 10.4%, OR 0.88, p=0.36). However, TAVR patients had fewer respiratory complications, including pneumonia (0.5% vs. 1.3%, OR 0.43, p=0.08), acute respiratory failure (12.8% vs. 23.4%, OR 0.48), re-intubation (3.3% vs. 8.0%, OR 0.40), and tracheostomy (0.5% vs. 3.0%, OR 0.18), all p<0.001. TAVR was also associated with significantly lower rates of acute myocardial infarction (1.9% vs. 4.7%, OR 0.39, p<0.001), bleeding requiring blood transfusion (14.0% vs. 38.0%, OR 0.27, p<0.001), and acute kidney injury (5.1% vs. 7.4%, OR 0.68, p<0.03). However, TAVR did portend a greater risk of permanent pacemaker (PPM) implantation (24.7% vs. 6.8%, OR 4.55, p <0.001). Although in-hospital mortality was similar between TAVR and SAVR (2.8% vs. 2.3%, OR 1.19, p=0.51), TAVR was associated with lower total median cost and shorter LOS ($206,585 vs. $222,805.50, p<0.012 and 5 vs. 8 days, p<0.001, respectively).

Conclusions:
In patients with severe AS and OSA, in-hospital mortality was comparable between TAVR and SAVR. Aside from higher risk of PPM implantation, TAVR was associated with significantly less post-operative complications, decreased total cost, and shorter LOS. These findings suggest that TAVR may be the preferred option in patients with severe AS and OSA.
Abstract 16998: Overuse of Cardiac Stress Testing in Asymptomatic Patients Results From a National Database
Authors: Ruzieh Mohammed , Mandrola John , Naccarelli Gerald V , Foy Andrew J
Published: April 2024

Background:
Cardiac stress testing is indicated in patients with symptoms suggestive of ischemic heart disease. Nonetheless, asymptomatic patients frequently undergo stress testing for screening purpose.

Objective:
To assess the frequency of stress testing use among asymptomatic patients.

Methodology:
We used the Truven MarketScan database to identify our cohort. We screened patients who had an outpatient stress testing between 2006 - 2014. Patients who had an emergency department visit or a hospital admission within a month before the stress test, or those who had surgery within a month after the stress test, were excluded from the study. Patients were considered asymptomatic if they didn’t have a diagnosis code of chest pain, angina, shortness of breath or palpitations in the three months before the stress test. Data from the baseline period, which started a year before the index date and ended on the index date, were used to obtain baseline characteristics and comorbidities. Data identified using [ICD-9-CM] diagnoses codes.

Results:
A total of 5,430,008 stress tests included in the final data analyses. The number of stress tests in asymptomatic patients was 1,822,817 (34%). Since 2006, there has been a decrease in the number of stress tests performed in asymptomatic patients. However, this remained high at 31% in 2014, figure1. Mean age was similar between patients who had symptoms-related and asymptomatic stress tests (53 ± 8 vs. 55 ± 7). However, compared to symptoms-related stress tests, patients with asymptomatic stress testing were more likely to be men (50% vs. 67%), and were more likely to have DM (21% vs. 26%), hypertension (50% vs. 56%), and history of CAD (53% vs. 61%), respectively.

Conclusion:
Significant number of stress tests are performed in asymptomatic patients. Although, this has decrease over time, educational efforts should continue to target overuse of stress tests. 
Abstract 11904: Heart Health for South Asians: Improved Cardiovascular Risk Factors and Outcomes With a Culturally Tailored Health Education Program
Authors: Vafaei Paniz , Pursnani Seema , Vadlakonda Uma , Liu Chi-Mei , chan yu
Published: April 2024

Introduction:
The Kaiser Permanente (KP) Northern California Heart Health for South Asians (HHSA) Program is a two-hour educational class offered at KP Santa Clara, California. The class provides culturally relevant lifestyle and dietary recommendations to South Asian patients, in an effort to reduce the known disproportionate burden of cardiovascular (CV) disease in this population. We aimed to evaluate the impact of the HHSA Program on CV risk factors and major adverse CV events (MACE).

Methods:
A retrospective cohort study identified 1517 participants of South Asian descent, age ≥ 18 years old from 2006-2019. We evaluated the change in individual risk factors with program attendance (median follow up of 6.9 years) for the following variables: systolic blood pressure (SBP), diastolic blood pressure (DBP), triglycerides (TG), LDL, HDL, BMI, and HbA1c. We also performed a propensity matched analysis to evaluate differences in MACE including stroke, myocardial infarction (MI), coronary revascularization, and all-cause mortality.

Results:
Differences in individual risk factors are outlined in figure 1A and show a significant improvement in SBP, DBP, TG, LDL, HDL and HbA1c at follow up. In the propensity matched analysis, there was a statistically significant reduction in revascularization (OR 0.33, 95% CI 0.14-0.78, p= 0.011) and mortality (OR 0.41, 95% CI 0.22-0.79, p= 0.008), a trend towards reduction in stroke (OR 0.22 , 95% CI 0.05-1.03, p= 0.054), and no statistically significant difference in the rate of MI (OR 0.93 , 95% CI 0.43-1.98, p= 0.85) (Figure 1B).

Conclusions:
Our study demonstrates the efficacy of a culturally tailored South Asian health education program in improving CV risk factors and reducing MACE. The program highlights the importance and value of providing culturally tailored, motivational health education in primary CV disease prevention.
Abstract 11905: Implications of Periprocedural Myocardial Injury and Reinfarction After Left Main PCI in Patients With Acute Myocardial Infarction
Authors: Wang Haoyu , Xu Bo , Dou Kefei
Published: April 2024

Objectives:
We aimed to investigate 1) the association between biomarker elevation with CK-MB or cTn following PCI and mortality in patients undergoing LM PCI for acute myocardial infarction (AMI), and 2) the prognostic impact of periprocedural myocardial reinfarction rates according to various PMI definitions on long-term mortality.

Methods:
The study enrolled 313 consecutive AMI patients undergoing LM PCI at a single center from January 2009 to December 2016. CK-MB and cTn were routinely collected at baseline and at frequent intervals between 8 and 48 hours after PCI. Periprocedural myocardial reinfarction was adjudicated occurring within 48 h of PCI according to definitions of the SCAI, ARC-2, and 4th UDMI. The primary and secondary outcomes were the covariate-adjusted 3-year rates of cardiovascular (CV) mortality.

Results:
28.2% and 51.2% of patients had a new absolute increase (≥1хURL) in CK-MB and cTnI values, respectively. Compared with patients with absolute post-procedural <1х URL, the risk of 3-year CV death was higher in those with absolute post-procedural CK-MB levels of ≥1хURL (HR: 2.67, 95% CI: 1.11-6.41), ≥3хURL (HR: 4.95 [2.05-11.95]), ≥5х URL (HR: 4.50 [1.73-11.27]), ≥10х URL (HR: 8.36 [3.21-21.78]), ≥35х URL (HR: 77.12 [14.13-421.07]), respectively. We did not observe an incremental CV mortality rate using a higher isolated cTnI cutoff (≥1хURL, HR: 3.02 [0.61-14.95]; ≥3хURL, HR: 4.03 [0.81-20.00]; ≥5хURL, HR: 2.93 [0.70-12.26]; ≥10хURL, HR: 2.19 [0.55-8.77]; ≥35хURL, HR: 0.73 [0.09-5.93]). Periprocedural myocardial reinfarction rates (SCAI, ARC-2, and 4th UDMI) were 8.0%, 12.5%, and 20.4%, respectively. SCAI-defined periprocedural myocardial reinfarction was associated with a 7-fold increase in adjusted hazards of 3-year CV mortality (adjusted HR: 6.88; 95% CI: 2.66-17.77), which had greater prognostic relevance than ARC-2 and 4th UDMI (ARC-2, adjusted HR: 3.07 [1.15-8.20]; 4th UDMI, adjusted HR: 2.60 [1.04-6.50]).

Conclusions:
In a large cohort of consecutive patients with AMI undergoing LM PCI, periprocedural myocardial reinfarction according to the SCAI, ARC-2, and 4th UDMI definitions were both associated with significant risk for 3- year CV mortality, with the patients with SCAI definition having a higher risk for CV death.
Abstract 11909: Racial and Gender Differences in Lifetime Healthcare Costs Across Cardiovascular Risk Factors
Authors: Khera Rohan , Liu Mengni , Kondamudi Nitin , Spatz Erica S , Ayers Colby , Powell-wiley Tiffany , Halm Ethan A , Pandey Ambarish
Published: April 2024

Background:
Healthcare costs pose a major challenge, but their assessment is limited to major healthcare events. An understanding of the burden of healthcare costs over the lifetime of individuals, particularly among those with cardiovascular risk factors (CRFs) and among disadvantaged groups based on race and sex, has important implications for health of individuals.

Methods:
We linked the longitudinal multiethnic Dallas Heart Study that recruited participants in 2000-2002 with inpatient and outpatient claims from all hospitals in the Dallas-Fort Worth metroplex through 2018, capturing encounter costs. Hypertension, diabetes, hyperlipidemia, smoking, and overweight/obesity as CRFs were defined at cohort enrollment. For each individual, costs were indexed to age and cumulated over follow up with missing costs imputed using chained random forests with predictive mean matching. Lifetime costs across race, sex, and CRFs were evaluated as interactions in generalized additive models with costs modeled as a 4
th
order function of age landmarked at 40y.

Results:
2091 individuals (mean age, 45 [10] y; 62% women, 53% Blacks) were included. Among those with inpatient or outpatient care, median lifetime cumulative healthcare costs at age 40y were $84809 (IQR, $187958, $2777270). Lifetime healthcare costs were significantly higher in Blacks vs non-Blacks ($97401 vs $73918; P < .01), particularly in advanced age (P, age-race interaction <.001). There were modestly higher costs among men. Lifetime costs were progressively higher with more CRFs. After accounting for CRFs, Blacks and men with CRFs had higher lifetime costs than matched non-Blacks and women, respectively (P interaction <.001) (
Figure
).

Discussion:
Black individuals and men are burdened by higher lifetime healthcare costs, with disproportionately higher costs among Blacks with the same CRFs. Costs differences also emerge in old age, highlighting the need for early prevention of risk factors among Blacks.
Abstract 11920: Early Changes in Echocardiographic Variables of Patients With Pulmonary Hypertension Undergoing Bilateral Pulmonary Thrombo-Endarterectomy: Experience of a Tertiary Care Center in Latin-America at 8660 Feet Above Sea Level
Authors: Garnica Sepulveda Diego Eduardo , Salazar Gabriel , CONDE RAFAEL , Manrique Frida T , Guerrero Albert F , Medina Hector , Umaña Juan P
Published: April 2024

Introduction:
Chronic thromboembolic pulmonary hypertension (CTEPH) is a reversible cause of pulmonary hypertension when patients undergo bilateral pulmonary thrombo-endarterectomy (BPT). We aim to compare TTE findings before and after BPT in a tertiary care center with an unusual altitude above sea level in Bogota, Colombia.

Methods:
Retrospective cohort, including CTEPH patients undergoing BPT between 2016 and 2021. We compared TTE done pre and post-operatively. We evaluated TTE volumetric and functional data including inter-ventricular dependence using the ratio of end-systolic diameter of right and the left ventricle (RV/LV).

Results:
We included CTEPH 17 who underwent BPT in our institution and compared studies done before and within the first 6 months after the procedure. Compared to the pre-op studies, the post-op TTE′s showed lower basal and middle diameters of the RV, lower TAPSE and higher CAF values with no changes in tricuspid S’ wave. The LVEF and right atrium area were similar to pre-operative TTE′s. Of notice, diastolic parameters such as E/A and E/e’ ratios improved to a normal diastolic filling pattern. Higher left atrium volume was also noticed. Finally, we observed lower PASP, a longer pulmonary valve acceleration time and lower RV/LV end-systolic diameter ratio in the early post-operative state (Table 1).

Conclusions:
In a tertiary care center with an altitude of 8660 feet above sea level, early TTE post BPT in CTEPH patients demonstrated decrease in the size of the right-sided chambers, higher volumes in left-sided chambers, normalization of diastolic parameters, decrease in PSAP, increase in the pulmonary valve acceleration time, and decrease of inter-ventricular dependance. Our findings suggest early remodeling phenomena after BPT despite the high altitude of where the surgery was performed.
Abstract 11923: Ventricular Parasystole: An Under-Recognized Risk Factor for Ventricular Fibrillation in Patients With Implantable Cardioverter-Defibrillators
Authors: OMeara Kyle T , Meyer Scott , Do Duc H
Published: April 2024

Introduction:
Ventricular parasystole is an uncommon characteristic of ventricular ectopic beats characterized by cyclical depolarization that is independent of the dominant rhythm. The relationship between ventricular parasystole and ventricular arrhythmias including ventricular tachycardia (VT) and fibrillation (VF) is unknown. We sought to quantify the prevalence of ventricular parasystole in patients with implantable cardioverter defibrillators (ICDs) with VT and VF.

Methods:
We reviewed all inpatient ICD interrogations between June 2019 and August 2020 at a single tertiary care hospital and identified patients with VT/VF. For each patient, we fully evaluate all available electrocardiograms, daily 7-lead rhythm strips during hospitalization, Holter monitors, stress test electrocardiograms, and ICD interrogations to identify evidence of ventricular parasystole.

Results:
Out of 468 ICD interrogations, 129 patients with VT/VF were identified (mean age 55.1 ± 20.3 years; 14 (11%) single chamber, 57 (44%) dual chamber, 12 (9%) subcutaneous, 46 (36%) biventricular). Of these, 88 (68%) patients had VT only, 31 (24%) VF only, and 10 (8%) both VT and VF. Ventricular parasystole was identified in 2/88 (2%) VT only patients, 7/31 (23%) VF only patients, and 3/10 (30%) patients with VT and VF. Patients with VF were significantly more likely than those with VT to have parasystole (p<0.001). Nine of the 10 patients with VF and parasystole (90%) had presumed premature ventricular contraction (PVC) induced VF of unclear etiology (no acute ischemia or channelopathy). Additionally, in 4 patients with VF and parasystole (3 with VF only, 1 VT and VF), all with dual chamber ICDs, we also identified intradevice interactions with ventricular parasystole which led to R-on-T pacing-induced VF episodes (this was the only cause of VF in 1 patient).

Conclusions:
Ventricular parasystole was found in 24% of ICD patients with VF, and was significantly more common in ICD patients with VF compared to VT. Ventricular parasystole can lead to pacing-induced VF due to intradevice interactions in dual chamber ICDs. The role of ventricular parasystole and PVC-induced VF requires further study to determine whether parasystole is a causative factor or an epiphenomenon.
Abstract 11938: Mechanisms of Significant Functional Tricuspid Regurgitation in Pulmonary Arterial Hypertension
Authors: Kassis Nicholas , Layoun Habib , Goyal Amit , Dong Tiffany , Saad Anas M , Puri Rishi , Heresi Gustavo A , Tonelli Adriano , Kapadia Samir R , Harb Serge C
Published: April 2024

Introduction:
The relationship between pulmonary arterial hypertension (PAH) and secondary (or functional) tricuspid regurgitation (STR) is well-established, and the simultaneous presence of both conditions portends particularly poor outcomes. Yet not all patients with PAH develop significant STR, and the mechanisms underlying this phenomenon remain unclear.

Methods:
From the Cleveland Clinic Pulmonary Hypertension Registry, patients diagnosed with PAH between 2007-2013 were included. STR, defined by absent primary tricuspid valve disease on transthoracic echocardiogram (TTE), was considered significant if ≥moderate in severity (≥2+ grade) on TTE. Right-sided chambers, annular, and valvular anatomic and functional characteristics by cardiac computed tomography and TTE were compared between patients with significant vs. nonsignificant STR.

Results:
Among 88 included patients, 52 had significant STR. The median age was 57 years, and 78% were female. No differences were observed in all baseline clinical characteristics between groups. Relative to those with nonsignificant STR, patients with significant STR had worse right ventricular (RV) dysfunction as evidenced by lower tricuspid annular planar systolic excursion [1.5 (1.3,1.7) vs 2.1 (1.7,2.4); p=0.02] and fractional area change, and worse RV global longitudinal strain and RV free wall strain. Significant STR was further associated with increased RV sphericity as denoted by a smaller sphericity index [1.8 (1.6,2.1) vs. 2 (1.7,2.5); p=0.004], with similar annular dimensions and shape, mural and septal leaflets’ length and angle, and tenting height.

Conclusion:
Anatomic and functional alterations in the RV rather than in the tricuspid valve are implicated in the development of STR in patients with PAH. The underlying mechanism may be linked to RV dyfunction and remodeling, via increasing RV size and sphericity.
Abstract 11941: Feasibility of a Novel Cardiac Scale in Measuring Blood Pressure
Authors: Centen Corey , Smith Sarah , Patel Sarin , Fudim Marat , Yazdi Daniel
Published: April 2024

Introduction:
There is a need for simple and frictionless methods for measuring blood pressure in the home setting. In this proof-of-concept study we investigated the ability of the Bodyport Cardiac Scale to measure central mean arterial pressure (cMAP). The scale can measure electrocardiography (ECG), impedance plethysmography (IPG), and ballistocardiography (BCG) signals from the user’s feet (Figure 1).

Hypothesis:
Scale-derived biosignals can be used to approximate cMAP.

Methods:
In this single-center, non-randomized, IRB approved study, 87 subjects underwent three paired readings from the reference device, SphygmoCor XCEL, and the Bodyport Cardiac Scale following the ISO 81060-2 standard. A lasso regression model was developed using biosignals derived from the scale including pulse transit time, pulse rate, weight, and other signal features to approximate cMAP obtained from the reference device. The model was trained on 60 subjects (70% of subjects) and independently validated on the remaining unseen 27 subjects.

Results:
The study population had a mean age (standard deviation) of 41.6 years (13.4), mean weight of 178 lbs (50.5), mean cMAP of 91.4 mmHg (18.3), cMAP range of 63-147 mmHg, and 56% were male. The scale estimate for cMAP had a mean error of -1.7 mmHg, standard error of 12.2 mmHg, 95% limits of agreement of -25.63 to 22.23 mmHg, and a Pearson correlation of 0.74, p < 0.0001 (Figure 2).

Conclusions:
This study demonstrates the feasibility of using biosignals from this cardiac scale to predict cMAP without calibration. Future studies would seek to further improve the accuracy of the model and assess longitudinal changes in the blood pressure measurement.
Abstract 11947: Evaluating Critical Values in Predicting Cardiomyopathy With Coronary Artery Disease Using Features Decided by Machine Learning Algorithms
Authors: Vijayaraghavan Sairamvinay , English Carter W , Flack Jeffrey , Mohapatra Prasant , Srivatsa Uma N
Published: April 2024

Introduction:
Cardiomyopathy in coronary artery disease (CAD) is associated with increased mortality. Identification of strong predictors related to cardiomyopathy in coronary artery disease can assist in appropriate ICD candidacy.

Hypothesis:
Identify critical values for predictors of reduced left ventricular ejection fraction (LVEF ≤ 40%) aside from baseline LVEF.

Methods:
We identified 2116 patients hospitalized with CAD and the top 10 predictors to predict follow-up were regressed separately against the follow-up LVEF to identify their critical values, where the fitted regression line meets the predicted follow-up LVEF at 40%. Each predictor is binarized based on the identified critical values and correlation with LVEF. We trained various classifiers to predict the follow-up LVEF ≤ 40%. Hazard ratios were used to compare the efficiency between all variables versus one predictor (baseline LVEF) based on the strong (at least 1 predictor ensures a low follow-up EF) and weak samples.

Results:
Using critical values and correlation trends for each predictor influences follow-up LVEF prediction(Table 1). Using all the variables outperformed the baseline LVEF alone in predicting follow-up EF class(Table 2). Clearly, decision-based algorithms did better because they were able to classify easily based on the binary values of the predictors.

Conclusions:
We identified strong variables and their critical values which aspire to improve the timing and efficiency of appropriate ICD implantation in patients just based on merely looking at any one of the predictor values and the critical value for each predictor. It simplifies the classification of follow-up LVEF for a clinician.