bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 16140: Utility of Cardiovascular Magnetic Resonance Imaging in Clinical Decision Making for Children and Adolescents With Hypertrophic Cardiomyopathy
Authors: Calhoun Gordon , Cavanaugh Jean , Miyamoto Shelley D , Romanowicz Jennifer
Published: December 2023

Introduction:
Cardiovascular magnetic resonance (CMR) imaging is recommended for surveillance and risk stratification in patients with hypertrophic cardiomyopathy (HCM), but the role of CMR findings in clinical decision making has not been described in a pediatric population.

Methods:
In this single center retrospective study we identified all patients with HCM who underwent CMR. We then determined if there was a clinical management change based on CMR findings.

Results:
We identified 136 patients with an HCM diagnosis from 2005-2022. Of these, 55 patients (40%) underwent 76 CMR studies. The HCM etiology was genetic or familial in 31 (56%), idiopathic in 21 (38%), and syndromic in 3 (5%); 34% of patients were female; and the median age (and IQR) of included patients at first CMR was 12 (9-15) years old. Ten patients underwent more than one CMR. Both awake and sedated CMRs were included and there were no complications. Management changes included confirmation of HCM diagnosis in 9 patients (16%), change in medical therapy for 3 (5%), myectomy recommendation in 1 (2%), and implantable cardioverter defibrillator (ICD) placement recommendation in 11 (20%). Of those recommended for ICD placement, 8 were a result of new late gadolinium enhancement and 3 had massive septal hypertrophy (median Z-score 30) discovered or confirmed by CMR. To date, no ICDs have discharged any shocks. Altogether, changes in clinical management were made based on CMR findings for 22 patients (40%), representing a change in management as a result of 29% of the total CMRs performed.

Conclusion:
CMR is an important contributor to clinical decision making in the management of children and adolescents with HCM. Specifically, CMR in this population was especially useful in defining the diagnosis of HCM in the presence of an equivocal echocardiogram and deciding to place an ICD. Fewer CMRs contributed to decision making regarding medical therapy and septal myectomy.
Abstract 16145: Statin Prescription and Cholesterol Control Among Persons With HIV Without Existing Atherosclerotic Cardiovascular Disease
Authors: McLaughlin Megan M , Durstenfeld Matthew S , Gandhi Monica , Greene Meredith , Ma Yifei , Beatty Alexis , Hsue Priscilla
Published: December 2023

Introduction:
Persons with HIV (PWH) have significantly increased risk for atherosclerotic cardiovascular disease (ASCVD) including acute MI. The REPRIEVE trial recently demonstrated that statins reduce cardiac events in PWH at low-intermediate ASCVD risk. However, statins are underutilized even among PWH who are at high ASCVD risk. Accordingly, we sought to characterize current gaps in cholesterol management in a population of PWH and identify factors associated with statin prescription.

Methods:
We conducted a retrospective study of PWH 40 years and older without existing ASCVD at three HIV clinics in San Francisco, U.S. from 2019-2022. We used ICD-10 codes and electronic health record data to assess cholesterol screening and treatment. Multivariable logistic regression models evaluated clinical factors associated with statin prescription among those eligible.

Results:
The clinical cohort included 2,567 PWH, of which 14% were female, 54% White, 24% Hispanic, and 18% Black, with a median age of 55 years. Among those with complete data on the components of the ASCVD Risk Estimator, the median 10-year ASCVD risk was 7.6%. The majority of PWH (87%) had undergone cholesterol screening, and 43% were eligible for statin therapy based on current guidelines (Figure 1). Of the 1,097 PWH eligible for statins, only 478 (44%) were prescribed statins. Among statin-eligible PWH, statin prescription was positively associated with older age, antiretroviral therapy, undetectable viral load, and chronic kidney disease and negatively associated with hepatitis C. Cholesterol control (non-HDL cholesterol <130 mg/dL) was achieved in 47% of the study population.

Conclusions:
PWH in this study demonstrate suboptimal rates of statin prescription and cholesterol control. Identification of PWH eligible for statin therapy, prescribing statins, and ensuring lipid control are opportunities for improving primary prevention of ASCVD among PWH at heightened risk.
Abstract 16155: Achieving Coronary Artery Disease Regression: A Triumph of Lifestyle Modification and Optimal Medical Therapy
Authors: Ahmed asmaa , Takla Andrew , Hussein Ahmed , Mohamed Mohamed , Elkheshen Ahmed , Patel Tejan , Sharma Gaurav
Published: December 2023

Background:
Coronary artery disease (CAD) is the leading cause of death worldwide. Early recognition of risk factors and targeting them using lifestyle modifications and pharmacological measures is vital for secondary prevention. This case demonstrates the effectiveness of comprehensive management in achieving marked regression of CAD.

Case presentation:
A 45-year-old female with a history of type II diabetes mellitus, hypertension, and hyperlipidemia with markedly elevated lipoprotein (A) of 233 nmol/L presented with chronic coronary syndrome (CCS). She had a strong family history of CAD and denied smoking, alcohol use, and recreational drug use. Transthoracic echocardiography revealed preserved left ventricular systolic function with an ejection fraction of 50%, regional wall motion abnormalities in the form of inferior wall hypokinesia, and mild mitral regurgitation. She underwent coronary angiography (CA) which revealed significant three-vessel CAD. Figure 1

Decision making:
She underwent successful percutaneous coronary intervention (PCI) to the RCA and PDA with two overlapping drug-eluted stents and plain balloon angioplasty to the PL branch. The patient adhered to strict lifestyle modification and was prescribed optimal anti-ischemic and anti-diabetic medications. She lost 22 lbs over two years, her LDL went down from 178 to 14 mg/dl and A1c from 12.2 to 6.8. During follow up, she started to complain of dyspnea on exertion for two weeks. Despite the marked laboratory improvement and despite she was found to be anemic at that time which can explain her symptoms, decision was to proceed to CA given her high pretest probability. A repeat CA showed marked regression in her CAD. Figure 2

Conclusion:
Regression of coronary artery disease is a reality giving hope for not just stopping disease progression but achieving reduction in plaque size with optimal medical therapy, where pharmacological measures and lifestyle modifications work synergistically.
Abstract 16166: Self-Care Self-Efficacy Predicts Long-Term Health-Related Quality of Life in Patients With Heart Failure
Authors: Okada Akiko , Hayashi Kanako , Tsuchihashi-Makaya Miyuki
Published: December 2023

Introduction:
Health-related quality of life (HRQOL) influences prognosis in heart failure (HF). Self-care and self-care self-efficacy are important in improving HRQOL; however, their effect on long-term HRQOL is yet to be elucidated.

Aims:
To determine the effect of self-care and self-care self-efficacy on long-term HRQOL in patients with HF.

Methods:
This longitudinal study enrolled outpatients with HF, who were followed-up at 3, 6, and 12 months. Self-care and self-care self-efficacy were assessed using the Self-Care of Heart Failure Index ver.7.2 and the Self-care Self-Efficacy scale, respectively. HRQOL was assessed using the Patient-Reported Outcomes Measurement Information System. Linear regression analysis was conducted to determine the association between baseline self-care and self-care self-efficacy and physical and mental dimensions of HRQOL at each time period. Adjusted variables were age, sex, body mass index, HF severity, comorbidities, activities of daily living, marital status, education level, and depressive symptoms.

Results:
This study analyzed 315 patients (mean age, 73±13 years, 72% male). The physical dimensions of HRQOL at all time points were associated with baseline self-care self-efficacy (baseline, 3, 6, and 12 months: p < 0.001, p < 0.001, p < 0.001, and p < 0.001, respectively) but not with baseline self-care maintenance (p = 0.057, p = 0.108, p = 0.101, and p = 0.153), symptom perception (p = 0.111, p = 0.101, p = 0.662, and p = 0.944), and self-care management (p = 0.737, p = 0.229, p = 0.387, and p = 0.167). The mental dimension of HRQOL at all time points were associated with self-care self-efficacy (baseline, 3, 6, and 12 months: p < 0.001, p < 0.001, p < 0.001, and p < 0.001, respectively). Multivariate linear regression analysis revealed that high scores on the physical and mental dimensions of HRQOL at all time points were significantly associated with high baseline self-care self-efficacy despite adjustment for all variables (physical and mental dimensions: baseline, p < 0.001 and p < 0.001; 3 months, p < 0.001 and p < 0.001; 6 months, p < 0.001 and p < 0.001; 12 months, p < 0.001 and p < 0.001).

Conclusion:
Improving self-care self-efficacy is important for maintaining long-term HRQOL in patients with HF.
Abstract 16180: The Adherence and LDL-C Lowering Effect of Inclisiran Among Patients Who Received Treatment at Outpatient Clinics
Authors: Desai Nihar R , Van Hise Nicholas , Niu Charlene , Ghera Elizabeth , McElligott Sean
Published: December 2023

Introduction:
Inclisiran is a novel small interfering RNA (siRNA) indicated as an adjunct to diet and maximally tolerated statin to lower LDL-C among adults with clinical atherosclerotic cardiovascular disease (ASCVD) or heterozygous familial hypercholesterolemia (HeFH) in the US. It is administered subcutaneously initially, again at 3 months, and then every six months by an HCP. Subsequent doses may be administered within three months after the scheduled dose without restarting a new dose schedule. Metro Infusion Center (MIC) is one of the largest infusion centers across the US with over 200 centers in 38 states and has clinician oversight over each administration.

Hypothesis:
To describe the real-world adherence to inclisiran and changes in low-density lipoprotein cholesterol (LDL-C) levels associated with inclisiran use at MICs.

Methods:
Patient charts for those who initiated inclisiran from March 1, 2022 to November 31, 2022 were reviewed retrospectively. Demographics and clinical characteristics at initiation were collected and patients were followed until May 2023 for the current analysis. The study outcomes included the proportion of eligible patients who received the 2
nd
or 3
rd
dose and the percent change in LDL-C levels from baseline to the latest available data.

Results:
A total of 562 patients were included in the analysis from 107 different MICs in over 21 states. Mean (SD) age was 70.6 (9.6) years; 51% were female. The majority of patients (80%) were covered by Medicare. 492 (88%) had a history of ASCVD and 60 (11%) had HeFH. Mean (SD) baseline LDL-C was 147.6 (59.9) mg/dl. Of the 562 patients initiated inclisiran, 531 (95%) received their 2
nd
dose, and 91% received the 2
nd
dose within ±7 days of the schedule. There were 233 patients eligible to receive a 3
rd
dose, 196 (84%) of them had received the 3
rd
dose. Among 274 patients who had the LDL-C measured after inclisiran initiation, the average LDL-C reduction from baseline was 46.3%. On average, the first LDL-C measurement was taken at 3 months after receiving at least one dose of Inclisiran.

Conclusions:
These real-world data demonstrate high adherence to inclisiran with LDL-C reductions of 46.3% at 3 months. This finding was consistent with the ORION clinical development program.
Abstract 16188: Fibrosis-4 Index in the Evaluation of Non-Ischemic Myocardial Injury in the Emergency Department
Authors: Golino Michele , morello matteo , Blasi Federico , Oliva Carlo A , Zappa Martina , Angeli Fabio , De Ponti Roberto
Published: December 2023

Introduction:
Fibrosis-4 (FIB-4) is a recognized score of liver fibrosis that is associated with ischemic heart disease and cardiac death. The relationship between FIB-4 index and non-ischemic myocardial injury (ni-MI) has not yet been investigated.

Hypothesis:
There is an association between FIB-4 index and ni-MI in patients admitted to an emergency department (ED).

Methods:
This retrospective study included consecutive patients presenting at the ED within a six months’ timeframe, with at least one high-sensitivity cardiac troponin T (hs-cTnT) value and without acute coronary syndromes diagnosis. The cohort with ni-MI was compared with the group with normal hs-cTnT values (control group, CG). FIB-4 index was calculated by: {age [years]хAST [U/L]/ [platelet count (10
9
/L)хALT (U/L)
1/2
]}.

Results:
A total of 3,853 patients were enrolled, 1,950 (51%) males, 64 [48-78] years, 1,372 (35.6%) with ni-MI. FIB-4 index was higher in the cohort with ni-MI compared to the CG (1.90 [1.28-2.78] vs. 1.01 [0.64-1.49]; p<0.001), with no sex differences (see
Figure 1)
. After adjustment for other covariates, FIB-4 index was independently associated with ni-MI in overall population (OR 1.468, 95% CI:1.195-1.803; p<0.001), and separately in both males and females (OR 1.385, 95% CI:1.054-1.822; p=0.02 and OR 1.407, 95% CI:1.017-1.946; p=0.039, respectively). FIB-4 index was positively correlated with hs-cTnT (Rho= +0.536, p<0.001), NT-proB-type Natriuretic Peptide (Rho= +0.280, p<0.001) and negatively with estimated glomerular filtration rate (Rho= -0.510, p<0.001). AUC of FIB-4 index for predicting ni-MI in the overall population was 0.790 (optimal cutoff: ≥1.46, sensitivity: 71.9%, specificity: 73.2%).

Conclusions:
FIB-4 index is independently associated with ni-MI in ED, without sex differences, and positively correlated with the grade of cardiac injury, volume overload and renal dysfunction.
Abstract 16193: Differences in Mortality Between Patients With Left Ventricular Assist Devices and End-Stage Renal Disease on Peritoneal Dialysis versus Hemodialysis
Authors: Saleh Ahmed K , Josey Gina , Parcha Vibhu , Neyra Javier
Published: December 2023

Introduction:
End-stage renal disease (ESRD) patients with concomitant heart failure often require left ventricular assist devices (LVADs), but the impact on mortality in peritoneal dialysis (PD) versus hemodialysis (HD) is unclear. This study aims to compare mortality rates in prevalent and incident ESRD patients with LVADs on PD versus HD. Hypothesis: We hypothesize differences in mortality rates and heart transplantation rates between LVAD patients on PD versus HD.

Methods:
A retrospective cohort analysis used data from the TriNetX Research Network database. Propensity score matching compared two cohorts: LVAD with HD (Cohort 1) and LVAD with PD (Cohort 2). Demographic data, comorbidities, and baseline laboratory values were collected. Mortality rates were assessed using risk analyses over a 3-year period following LVAD placement.

Results:
The study cohorts included 252 patients each after propensity score matching, with mean ages of 63.8 ± 14.3 years (Cohort 1) and 62.87 ± 15.4 years (Cohort 2). No significant differences were observed in demographic data including gender, race, or ethnicity between the two cohorts. The mortality rate did not significantly differ between Cohort 1 (HD) and Cohort 2 (PD) (0.563 vs. 0.603), with a risk difference of -0.04 (95% CI: -0.126, 0.046, p = 0.366). The risk ratio and odds ratio for mortality also showed no significant differences.

Conclusion:
ESRD patients with LVADs receiving PD demonstrated similar mortality rates compared to those receiving HD. These findings suggest that dialysis modality does not seem to influence mortality outcomes in patients with LVAD. Further research is needed to better understand the differences between these complex patient populations.
Abstract 16194: Relationship Between Change in Global Longitudinal Strain and Sustained Handgrip Induced Afterload as Assessed Using Invasive Left Ventricular Pressure Measurements and Machine Learning Analytics
Authors: Chen Meiling , Kim Mi-Ok , Soni Krishan , Liu Victoria , Cheng Richard , Yeghiazarians Yerem , Agrawal Harsh , Grober Aaron , Martin Adriana , Vera Sarmiento Hernan , Ports Thomas , Abraham Theodore
Published: December 2023

Introduction:
Global longitudinal strain (GLS) is a sensitive, quantitative measure of left ventricular (LV) systolic function and affected by afterload. We sought to compute the impact of LV systolic pressure (LVP) increase on GLS using handgrip stress during invasive LVP measurements.

Methods:
Patients undergoing left heart catheterization (n=51; mean age 64+/-11 years; 31% women; Table) for standard of care indications underwent echocardiography during handgrip stress with a catheter in the LV cavity. GLS and LVP were measured simultaneously over 15 seconds of continuous handgrip. GLS and LVP relationships were analyzed using linear regression and machine learning methods.

Results:
Sustained handgrip (HG) stress significantly increased LVP and reduced GLS. There was no significant correlation between resting and peak HG stress LVP and GLS (p= 0.32 & 0.36, respectively). However, change in GLS was significantly correlated with change in LVP (p<0.0001; Figure) with every 10 unit increase in LVP associated with a 0.6 reduction in GLS. The penalized maximum likelihood machine learning method was used to select key factors associated with the within subject slope of % change in GLS over % change in LVP (median slope -0.53; IQR-0.91 to -0.29). LV ejection fraction was identified as an important predictor of the GLS-LVP slope. LV ejection fraction was significantly associated with the slope (p=0.0005; Figure) with a 10 unit increase in LV ejection fraction corresponding to 0.22 increase in the slope.

Conclusions:
LV afterload is associated with significant decrements in GLS. LV ejection fraction is an important predictor of the GLS-LVP slope. These data provide the foundation to build models that would account for change in LVP during serial measurements of GLS thus allowing reliable comparison of repeated GLS measurements.
Abstract 16207: Deep Learning-Based Natural Language Processing of Discharge Summaries for Automated Identification of Heart Failure With Reduced Ejection Fraction
Authors: Aghajani Nargesi Arash , Adejumo Philip , Rosand Benjamin , Dhingra Lovedeep S , Hengartner Astrid , Sen Sounok , Ahmad Tariq , Ahmad Faraz S , Krumholz Harlan M , Khera Rohan
Published: December 2023

Background:
Implementation of a national program to improve guideline-directed care in heart failure with reduced ejection fraction (HFrEF) has been limited by the lack of automated tools to measure care quality. A key challenge for this approach is to identify patients with HFrEF at hospital discharge, an opportunity to evaluate and improve care.

Methods:
We developed a novel deep-learning language model to detect patients with HFrEF from discharge summaries using a semi-supervised learning framework. Hospitalizations with heart failure (HF) at Yale New Haven Hospital between 2015-2019 were labeled as HFrEF if left ventricular ejection fraction was under 40% on antecedent echocardiography. The model was internally validated with model-based net reclassification improvement (NRI) assessed against chart-based diagnosis codes. We externally validated the model on discharge summaries from hospitalizations with HF at Northwestern Medicine, community hospitals of Yale Health, and MIMIC-III database, confirmed with chart abstraction.

Results:
A total of 13,251 notes from 5,392 individuals (age 73 ± 14 years, 48% female), including 2,487 (46.1%) patients with HFrEF were used for model development (train/validation/test: 70/15/15%). The model achieved an AUROC 0.97 and AUPRC 0.97 in detecting HFrEF on the test set. In external validation, the model had high performance in identifying HFrEF with AUROC 0.91-0.95 and AUPRC 0.91-0.96 among 19,242 discharge summaries at Northwestern Medicine, 139 notes from Yale community hospitals, and 146 notes from MIMIC-III. Model predictions corresponded to an NRI of 28 ± 7% compared to chart diagnosis (p< 0.001) and identified significant gaps in the use of guideline-directed therapies (Figure).

Conclusions:
We developed and validated an NLP model that automates the identification of HFrEF from clinical notes with high precision and accuracy, representing a key element to automate quality-of-care measurements in HFrEF.
Abstract 16208: Population Pharmacokinetics of Intravenously and Orally Administered Sotalol in Patients With Cardiac Arrhythmias
Authors: Yellepeddi Venkata K , Watt Kevin , Ghaffari Kimia , Deering Thomas F , Holubkov Richard , Kennedy Robert , Mittal Suneet , Pokharel Parash , Perez Marco V , Piccini Jonathan P , Savona Salvatore , Bunch T J , Steinberg Benjamin A
Published: December 2023

Introduction:
Recently, an intravenous (IV) formulation of sotalol was approved to provide a loading dose before initiating oral sotalol therapy to reduce hospitalization days. However, the population pharmacokinetics (PK) of sotalol after administration of an IV loading dose regimen in patients with atrial fibrillation were not characterized. Understanding the PK of IV sotalol loading dose in patients with atrial fibrillation is required to ensure safety and optimal therapeutic outcomes.

Hypothesis:
The population PK model of IV and orally administered sotalol can be developed using data from two clinical PK studies with reasonable empirical Bayes estimates (EBEs) of PK parameters absorption rate constant (Ka), clearance (CL), and volume of distribution (Vd).

Methods:
The PK dataset of sotalol was from: 1) Relative bioavailability study with IV and oral sotalol PK data by sponsor AltaThera Inc., 2) Prospective Evaluation Analysis and Kinetics of IV Sotalol (PEAKS) registry study. Population PK was evaluated using NONMEM® 7.5, Perl-speaks-NONMEM (PsN®) version 5.3.0.

Results:
545 sotalol concentrations in 25 patients were analyzed. A one-compartment model with a first-order elimination rate best described the data (Figure 1). The data correlated QTc interval levels within the observed sotalol concentration range (1.2 to 1900 ng/mL) were below 500 ms. In the final model, the EBE’s of sotalol PK parameters were, Ka - 1.44 hr
-1
, CL 0.46 - L/h/kg, and the Vd -5.6 L/kg. Further PK/PD studies are needed to establish the correlation between sotalol PK and safety in this population.

Conclusions:
The PK of sotalol after IV and oral doses were adequately described using a population PK modeling approach. The QTc levels correlated to the plasma concentrations in this study were within the safety limit of 500 ms. This population PK model could be used to correlate the PK with safety (QTc interval prolongation) further to optimize the sotalol IV and oral dosing regimen.
Abstract 16226: Stressed Out - When Sinus Bradycardia is Not Benign
Authors: Narowska Gabriela , Makkapati Shreya , Tragesser Lauren , Zaidi Syed M , Cooper Joshua M
Published: December 2023

Background
Sinus bradycardia is often a benign and asymptomatic finding in athletes due to an increased vagal tone. However, when patients develop symptoms of decreased exercise tolerance, this warrants further investigation. We present a case of sinus bradycardia caused by adrenal insufficiency in a high-end athlete with exceptional physical reserve which resolved with treatment of the underlying cause and prevented unnecessary pacemaker implantation.

Case Presentation
A 44-year-old female athlete with no medical history who at baseline runs ultramarathons and weight lifts presented with severely symptomatic bradycardia. After initial recommendation of pacemaker placement during recent hospitalization, patient sought a second opinion. During her hospitalization, the patient underwent extensive work up including basic laboratory work, TSH, CT angiogram of the chest and TTE - all of which were found to be normal. She also had an exercise stress test and was only able to increase her HR to 50% of age-predicted rate. On further review, she was found to be hypothermic and reported menstrual irregularities, raising suspicion for endocrine abnormalities. Bradycardia, hypothermia and chronotropic incompetence prompted further workup which revealed a depressed cortisol with a low ACTH leading to a diagnosis of adrenal insufficiency. Further imaging revealed a pituitary microadenoma. The patient was referred to endocrinology and started therapy with steroids with resolution of her symptoms and is undergoing evaluation for surgical intervention.

Conclusion
Sinus bradycardia is a well-recognized occurrence in well trained athletes, caused by an increased vagal tone and is usually a benign finding. In our case, a patient underwent extensive work up for lightheadedness and exercise intolerance in the setting of her bradycardia which was unrevealing with initial recommendation of pacemaker placement. Upon further investigation, increased vagal tone alone was not responsible for severely symptomatic bradycardia and chronotropic incompetence. Notably, a combination of bradycardia, hypothermia, and irregular menses, resulted in work up revealing adrenal insufficiency, ultimately avoiding unnecessary pacemaker implant.
Abstract 16239: Left Atrial Function by Speckle-Tracking Echocardiography in Mitral Valve Prolapse: Evidence of a Primary Atriopathy and Clinical Implications
Authors: Tastet Lionel , Lim Lisa J , Bibby Dwight , Arya Farzin , Delling Francesca N
Published: December 2023

Background:
Prior studies support the prognostic role of left atrial (LA) volume in predicting overall mortality in mitral valve prolapse (MVP). However, the prognostic impact of LA function on cardiac outcome as quantified by speckle tracking echocardiography (STE) is unknown. Moreover, whether the mitral leaflet “atrialization” observed in bileaflet MVP with mitral annular disjunction (MAD) affects LA function irrespective of mitral regurgitation (MR) severity remains unclear. We sought to investigate the prognostic role of LA global longitudinal strain (LAGLS) and MVP subtype in a large registry of MVP patients with various degrees of MR.

Methods:
We identified 411 consecutive patients (59±17 years, 52% women) with MVP and clinical, echocardiographic and outcome data. LAGLS was measured offline using STE. Survival analysis was performed to assess the composite risk of cardiac death, heart failure hospitalization, or new onset of atrial fibrillation.

Results:
Compared to other MVP subtypes, bileaftlet MVP had lower LAGLS regardless of MR severity (
Fig 1A&1B
). Of note, in the subgroup with no or mild MR, LAGLS was significantly lower in bileaflet compared to posterior MVP (p=0.003). There was a trend toward lower LAGLS according to MVP with vs without MAD (p=0.08) (
Fig 1C
). In multivariable linear regression adjusted for several risk factors, including MR grade, bileaflet MVP remained significantly associated with lower LAGLS (p=0.003). A total of 79 cardiovascular events occurred during a mean follow-up of 4.6±2.9 years. There was a significant increase in the risk of events as LAGLS decreased (log-rank: p<0.001) (
Fig 1D
).

Conclusion:
Bileaflet MVP is associated with lower LAGLS regardless of MR severity, suggesting a primary atriopathy in this MVP subtype. Abnormal LAGLS is linked to higher risk of cardiovascular events. Hence, assessment of LA function using STE may help improve risk stratification in MVP and could represent a useful tool in clinical practice.
Abstract 16265: Precipitants of Acute Hemodynamic Instability in Patients With Hypertrophic Cardiomyopathy Admitted to the Cardiac Intensive Care Unit
Authors: Nair Raunak M , Chawla Sanchit , Higgins Andrew , Lee Ran , Jaber Wael A , Rampersad Penelope , Cremer Paul C , Menon Venu
Published: December 2023

Background:
Hypertrophic cardiomyopathy (HCM) is the most common genetic heart disease in the United States which can infrequently present with acute hemodynamic instability. Our study aimed to identify the precipitants of acute cardiovascular decompensation resulting in Cardiac Intensive Care Unit (CICU) admission in patients with HCM.

Methods:
All patients admitted to Cleveland Clinic Cardiac Intensive Care Unit (CICU) between Jan 1
st
, 2010, to Dec 31
st
, 2021, with a diagnosis of CS and co-existing HCM were identified through electronic medical charts. Only those with previously uncorrected HCM in the form of no prior myectomy/alcohol septal ablation and not on mavacamten were included in our study. Chart review was performed by physician investigators to identify the etiology precipitating hemodynamic instability in these patients.

Results:
Overall, 2754 patients were admitted to our CICU with CS during the study period, of which 21 patients (1%) had coexisting uncorrected HCM. The median age of patients with HCM admitted to our CICU was 61 years, 52% (n=11) were females, and 86% (n=18) were White Americans. The in-hospital mortality of patients with HCM-CS was around 24% (n=5). Retrospective chart review to identify the precipitating agent revealed atrial fibrillation with rapid ventricular response (Afib-RVR) to be the most common precipitant (33%, n=7), followed by severe MR in the setting of dynamic outflow obstruction (19%, n=4) and non-obstructive heart failure (19%, n=4).

Conclusion:
Identification of the precipitating mechanisms is critical to manage HCM patients presenting with hemodynamic instability. Rapid atrial fibrillation appears to be the most common precipitant leading to hemodynamic instability in this population.
Abstract 16267: Burden of Cardiovascular Disease in Sub-Saharan Africa
Authors: Alhuneafat Laith , Al Taani Omar , Elhamdani Adee , Altarawneh Tala , Naser Abdallah , Ghanem Fares , Al-Adayleh Rand , Al Ahmad Majd , Al Akeel Mohannad , jabri ahmad
Published: December 2023

Introduction:
This study aims to explore the burden of cardiovascular disease (CVD) and associated risk factors in Sub-Saharan Africa (SSA) using data from the Global Burden of Disease (GBD).

Hypothesis:
That the burden of CVD has increased in SSA over time, and there are associated risk factors contributing to this burden.

Methods:
We analyzed CVD prevalence, mortality, and incidence in 46 SSA countries using Bayesian regression, demographic methodologies, and mortality-to-incidence ratios. Disability-adjusted life years (DALYs) were calculated, and risk factors were assessed through the comparative risk assessment framework of the GBD.

Results:
Between 1990 and 2019, CVD prevalence in SSA increased by 131.7%, with a modest rise of 2.1% in age-standardized prevalence rates. Ischemic heart disease, stroke (CVA), and rheumatic heart disease were the most prevalent conditions. CVD deaths increased from 564,140 to 1,003,893, with a 14.4% decrease in death rates. Non-rheumatic valvular disease showed a significant increase. DALYs increased by 68.4%, but some CVDs saw decreases in DALY rates.

Conclusions:
Despite rising CVD prevalence in SSA, age-standardized rates only modestly increased. However, the persistently high burden, increasing non-rheumatic valvular disease, and rising DALYs highlight challenges in prevention and management. These findings highlight the persistent challenge of CVD in SSA and emphasize the need for continued efforts in prevention and management strategies to address the growing burden of CVD in this region.
Abstract 16270: Pulse Pressure Amplification Contributes to the Exaggerated Peripheral Blood Pressure Response to Exercise in Patients With HFpEF
Authors: Wakeham Denis J , Howrey Matthew M , Bagga Joetsaroop , Brazile Tiffany M , Balmain Bryce , Tomlinson Andrew R , Macnamara James P , Babb Tony , Levine Benjamin D , Hearon Christopher , Sarma Satyam
Published: December 2023

Background:
Patients with suspected heart failure and preserved ejection fraction (HFpEF) undergo invasive (right heart catheterization) cardiopulmonary exercise testing (iCPET) to confirm diagnosis. During iCPET peripheral arterial blood pressure (BP) is measured using a brachial cuff or radial arterial catheter. Notably, peripheral BP is typically higher than central BP and this difference is assessed by measuring pulse pressure amplification (PPA; peripheral - central PP; PP = systolic BP [SBP] - diastolic BP). The effect of PPA on the assessment of (exaggerated) exercise BP in HFpEF is unknown.

Methods:
20 patients with HFpEF (75% Female; age: 69±7 years, BMI: 38±7 kg/m
2
) were studied at rest and during submaximal and maximal cycling exercise. We measured radial BP (arterial catheterization) and derived ascending aortic BP using a transfer function applied to radial arterial waveforms (SphygmoCor). Pulse pressure amplification was assessed as radial-aortic pulse pressure. Data were compared with one-way and two-way (Site*Exercise Stage) ANOVA.

Results:
The increase in radial PP with exercise was greater than aortic PP (Site*Stage P<0.001; Figure A); thus, PPA increased with exercise (ANOVA,
P
=0.001; Figure B). The increase in PPA was due to a greater increase in radial compared to aortic SBP (Site*Stage P=0.002; Figure C). The change in diastolic pressure was not different between sites (Figure D). Increases in PPA accounted for ~30% of the increase in radial SBP. The incidence of exaggerated exercise SBP (Male: >210 mmHg; Female: >190 mmHg) was higher in the radial artery compared to aorta (95 vs 40 %, χ2<0.001).

Conclusion:
Peak exercise SBP was ~50 mmHg greater in the radial artery compared to aorta. The marked overestimation of central BP during exercise when measuring peripheral BP leads to misguided interpretation of BP responses to exercise, the magnitude of afterload and has implications for the assessment of ventricular-arterial coupling.
Abstract 16277: Glycoprotein 130 Antagonism Improves Right Ventricle Function in Pulmonary Artery Banded Piglets
Authors: Mendelson Jenna , Sternbach Jacob , Hartweck Lynn , Kazmirczak Felipe , Prins Kurt W
Published: December 2023

Introduction:
Right ventricular dysfunction (RVD) is a risk factor for death in multiple cardiovascular diseases, but RV-specific therapies are lacking. We recently showed inhibition of glycoprotein 130 (GP130) signaling with the small molecule SC144 improved RV function via modulation of microtubules and mitochondria metabolism in rodent RVD. However, SC144’s efficacy in a translational large animal model of RVD is untested.

Methods:
Ten 4-week-old castrated male piglets underwent pulmonary artery banding (PAB). After 3 weeks, PAB pigs were randomized into 2 groups (daily injections of SC144 [2 mg/kg, PAB-SC144,
n
=5] or vehicle control [PAB-Veh,
n
=5] for 3 weeks). Five pigs of a similar age served as controls. Cardiac MRI evaluated RV function, mass, and volume. Immunoblots of RV extracts quantified microtubule and GP130 pathway protein levels. Quantitative proteomics evaluated RV mitochondrial enrichments. KEGG pathway analysis delineated the biochemical pathways associated with RV ejection fraction.

Results:
SC144 significantly improved RV ejection fraction (
A
, Control: 59.5±4.2, PAB-Veh: 22.6±10.8, PAB-SC144: 37.6±6.4) without changing RV afterload (
B-C
). Molecularly, GP130 antagonism normalized abundances of microtubule proteins and increased levels of suppressor of cytokine signaling 3 (SOCS3), an endogenous GP130 antagonist. Mitochondrial proteomics analysis revealed amino acid metabolism and oxidative phosphorylation suppression was mitigated by SC144 (
D
).

Conclusions:
SC144 improves RV function in porcine RV failure, potentially by maintaining oxidative phosphorylation, amino acid metabolism, and microtubule regulation.
Abstract 16279: Does the Number of Antianginals Influence Clinical Outcomes and Quality of Life in Stable Ischemic Heart Disease? Insights From the BARI2D Trial
Authors: Jamil Yasser , Park Dae Yong , More Verde Luis , Sherwood Matthew W , Tehrani Behnam N , Batchelor Wayne B , Epps-Anderson Kelly , Frampton Jennifer , Damluji Abdulla , Nanna Michael
Published: December 2023

Introduction:
Medical therapy is essential for managing stable ischemic heart disease (SIHD), including anti-anginals. remains unclear whether combining anti-anginal agents provides benefits beyond monotherapy in terms of QoL and cardiovascular outcomes.

Hypothesis:
The use of a single anti-anginal (β-Blockers, calcium channel blockers, or nitrates) is non-inferior to ≥2 anti-anginals

Methods:
We utilized data from the BARI-2D trial, which compared cardiovascular and QoL outcomes in patients with SIHD and diabetes mellitus (DM) randomized to revascularization with intensive medical therapy or intensive medical therapy alone. We categorized patients into three groups: ≥2 vs 1 vs 0 anti-anginals. We compared patient characteristics, QoL metrics, and cardiovascular endpoints at baseline and at 5 years, creating a multivariable model to adjust for key clinical confounders.

Results:
Among 2,368 patients, 348 patients (14.7%) were on 0 anti-anginals, 1,020 patients (43.1%) were on 1 anti-anginal, and 1,000 patients (42.2%) were on ≥2 anti-anginals at baseline. The most common anti-anginal class was β-Blockers. At baseline, patients on 0 anti-anginals had better QoL metrics than patients on ≥2 anti-anginals. However, at a 1-year follow-up, patients taking only 1 anti-anginal showed greater QoL improvement than those taking 0 anti-anginal; this superiority in QoL metrics was not seen in patients taking ≥2 anti-anginal agent, even after adjusting for multiple covariates such as age, heart failure, diabetes control and myocardial jeopardy index.
(Figure 1)
Lastly, at 5-year follow-up, after adjustment, there were no differences in all-cause mortality, major adverse cardiovascular events, or myocardial infarction between patients taking different numbers of anti-anginals.

Conclusion:
Treating adults with SIHD and DM with a single anti-anginal was at least as effective in improving QoL compared to two or more anti-anginal agents at one year of follow-up.
Abstract 16285: Persistent or Worsening Depression is Associated With Adverse Cardiovascular Outcomes in Patients With Coronary Artery Disease (CAD)
Authors: Vatsa Nishant , Bennett Josiah , Vatsa Sonika , jain vardhmaan , Gold Daniel , Gold Matthew , Desai Shivang , Ejaz Kiran , Rahbar Alireza , Hartsfield Joy D , Ko Yi-An , Sperling Laurence , Mehta Puja K , Quyyumi Arshed A
Published: December 2023

Introduction:
Depression has been associated with a higher risk of major adverse cardiovascular events (MACE). Whether a longitudinal change in depressive symptoms is associated with MACE in patients remains unknown.

Hypothesis:
We hypothesized that increasing or persistent depression increases the risk of MACE in patients with CAD.

Methods:
5,479 participants with CAD enrolled in the Emory Cardiovascular Biobank (mean age 63.8 years, 39.9% female) were evaluated for baseline depression symptoms with the patient health questionnaire 9 (PHQ9). Depression was defined as PHQ9 >4. At one year, 1,286 participants completed follow-up PHQ9, and the PHQ9 change (1 year minus baseline score) was calculated. Cox models, adjusted for demographics, cardiovascular risk factors, medications, ejection fraction, CAD severity, and high sensitivity C-reactive protein levels, were performed to assess associations between PHQ9 and five-year MACE - a composite of cardiovascular death, nonfatal myocardial infarction, hospitalization for heart failure, and nonfatal stroke.

Results:
During five-year follow-up, there were 1067 (19.5%) MACE, with a 7.2% MACE rate after one year in the subset with follow-up depression data. Of the total, 38.8% were depressed at baseline and 23.6% at one year. Of participants with baseline depression, 34.8% had persistent depression at one year, whereas depression improved in the remaining. Among patients without baseline depression, 15.9% developed new depression at one year. A higher baseline PHQ9 score was associated with higher MACE rates (adjusted hazard ratio (HR): 1.02 [CI 1.00, 1.03], p=0.03). Overall, PHQ9 change independently predicted MACE (adjusted HR: 1.12 [1.05, 1.2], p=0.001); thus, participants with no change or increase in PHQ9 score were 96% (p=0.04) more likely to have MACE compared to those with a decrease in PHQ9 score after one year. Similarly, participants with new or persistent depression (PHQ9>4) at one year had a 59% (p=0.006) higher risk of MACE compared to those with absent or improved depression.

Conclusions:
An increase or persistence of depressive symptoms predicts MACE in CAD. Whether treatment of depression will improve cardiovascular outcomes in this high-risk population needs further investigation.
Abstract 16298: Higher Genetic Risk for Neuroticism Heightens Cardiovascular Risk Related to Chronic Sleep Deprivation
Authors: Abohashem Shady , Grewal Simran S , Aldosoky Wesam , Qamar Iqra , Civieri Giovanni , Alhamam Abdulaziz , Alani Omar , Hanlon Erin R , Gharios Charbel , Seligowski Antonia V , Choi Karmel , Smoller Jordan W , Osborne Michael , Tawakol Ahmed A
Published: December 2023

Introduction:
Chronic sleep deprivation associates with an increased risk of Major Adverse Cardiovascular Events (MACE), in part via heightened stress-related neural mechanisms. Similarly, increased polygenic risk score for neuroticism (nPRS), a measure linked to stress-sensitivity, associates with greater activity in stress-related neural pathways.

Hypothesis:
We hypothesized that higher nPRS increases the MACE risk associated with chronic sleep deprivation.

Methods:
A total of 9,619 participants (median age 65 years, 46% male) from the Mass General Brigham Biobank were studied. nPRS was assessed. Sleep deprivation was defined as either a short sleep duration (<7 hours/night) or a diagnosis of a sleep disorder (e.g., insomnia, sleep apnea). Sleep duration and disorders, MACE incidence, and cardiovascular risk factors were assessed using health questionnaires and International Classification of Disease codes. Logistic regression models were employed to evaluate the association between sleep deprivation and MACE and the presence of an interaction.

Results:
During a median (Interquartile range) of 4.9 (4.1-5.9) years of follow-up, 807 (8.3%) individuals experienced MACE. Among individuals with higher nPRS (≥median), sleep deprivation associated with a two-fold increase in MACE risk (odds ratio [OR] [95% confidence interval (CI)]: 2.283 [1.929, 2.703], p<0.001*) compared to individuals with lower nPRS (<median) (OR [95%CI]: 1.632 [1.390, 1.917], p<0.001*;
Table 1
) with a significant interaction observed (p=0.010*). A similar trend was observed in a sensitivity analysis that excluded sleep apnea (p-interaction 0.074).

Conclusions:
Our findings suggest that a high nPRS doubles the MACE risk associated with sleep deprivation. Further research is warranted to elucidate the underlying mechanisms driving this relationship.
Abstract 16351: Reference Equations for Pulmonary Artery Size and Pulsatility Using Echocardiography in Pulmonary Arterial Hypertension
Authors: bagherzadeh shadi P , Celestin Bettia , Santana Everton , Salerno Michael , Zamanian Roham , Haddad Francois
Published: December 2023

Background:
A main pulmonary artery (MPA) diameter>25 mm on echocardiography is supportive of the diagnosis of pulmonary hypertension according to the most recent European Society of Cardiology guideline.
[1].
The size of the pulmonary artery may however vary according to body size, age and sex and these considerations may be important for diagnostic purposes.

Objectives:
(1) to derive reference equations for MPA and right pulmonary artery (RPA) size on echocardiography that consider the effect of body size, age and sex; (2) to determine which measure of PA size better classifies pulmonary arterial hypertension (PAH) when compared to controls.
Method:
248 healthy males and females were recruited as part of Stanford aging study and 200 patients with PAH have been retrospectively included from the Stanford Adult PH Program. The diameters of the MPA and RPA were measured from the parasternal short axis. The RPA diameter, area, and pulsatility index were measured from the supra sternal notch view. MedCalc Version 20.2018 statistical software program was used for modeling and assessing the variance function.

Results:
Multivariate regression analysis was used to derive PA size reference equations that consider sex, age, and height. Age retained in all the models and height was the second most influential variable. Using a Z score threshold of 1.96, for the diastolic MPA diameter size yielded an area under the ROC curve (AUC) of 0.91, 87.15% sensitivity and 95.19% specificity to detect PAH. In comparison, the AUC for absolute MPA size >25 mm during diastole and systole yields 0.87 and 0.67, respectively which was significantly different from the z score AUC (Figure-1).

Conclusion:
Our study develops echocardiography reference equations for PA size accounting for the influence of age, height, and sex that can potentially refine PAH diagnostic algorithms if further validated.
Abstract 16373: Pyridoxamine (Vitamin B6) Mitigation of Protein Glycation and Deleterious Platelet-Material Interactions in Bioprosthetic Heart Valve Leaflets
Authors: Toomey Nikia T , Stachelek Stanley J , Nagaswami Chandrasekaran , Alferiev Ivan S , Levy Robert J
Published: December 2023

Introduction:
Though bioprosthetic heart valves (BHV) most often do not require anticoagulation, it has been reported that 12% of BHVs have significant leaflet thrombosis. We identified Vitamin B6 (pyridoxamine, abbr. PYR) as a pretreatment agent to reduce advanced glycation end-product (AGE) accumulation within bovine pericardial (BP) BHVs. AGEs contribute to valvular degeneration through collagen crosslinking and immune signaling. PYR is also known to inhibit platelet aggregation.

Hypothesis:
PYR pretreatment and supplementation mitigate BHV thrombosis.

Methods:
Glutaraldehyde fixed collagen coated (GFC) PVC tubing was used as a leaflet surface model and methylglyoxal (MGO) pretreatment to simulate glycation. PYR pretreated collagen surfaces and perfusate PYR supplementation were compared to untreated controls. These studies were repeated with glycated GFC. Fresh citrated human whole blood from healthy donors was perfused over the surfaces for 4 hours at 37 °C and arterial shear using the Chandler loop apparatus. Post perfusion platelet activation (CD62P expression via flow cytometry) and nitric oxide synthase (NOS) activity were measured. Platelets adhered to the tubing sections were visualized and quantitated via scanning electron microscopy.

Results:
PYR pretreatment of GFC surfaces reduced platelet activation after perfusion compared to the control (Fig1a). Surface glycation with MGO resulted in increased platelet activation, but PYR pretreatment of the glycated surface mitigated the effect of glycation on platelet activation (Fig1b). NOS activity was impaired by surface glycation and PYR treatment appears to rescue function in glycated environments (Fig1c). Platelet adhesion to GFC was increased by glycation (Fig1d-f).

Conclusions:
Glycated surfaces, even in euglycemia, are prothrombotic when compared to non-glycated surfaces. Vitamin B6 reduces platelet activation and adhesion in both glycated and non-glycated environments.