bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 13614: Nationwide Trends in Transcranial Doppler Utilization During Acute Ischemic Stroke Hospitalizations
Authors: Shah Dhaivat , Sreeni Nishitha Sai , Patil Karishma , Thomas Anchu , Jain Aagam , Pandya Rajkamal , adam Abdiwahid , Sekar Pooja , Singla Ramit , Patel Urvish K
Published: December 2023

Background:
Trans-cranial Doppler (TCD), diagnostic ultrasound of the head and neck is a non-invasive, safe, and portable tool to assess dynamic cerebral blood flow. TCD allows us to explore the patient's neurocritical pathological features without invasive testing. Although TCD is portable and inexpensive compared to CT/MR angiograms, its utilization during AIS hospitalization is nonfrequent and unknown.

Aim:
The aim of the study was to evaluate the patterns of TCD use during AIS hospitalizations.

Design/Methods:
Data from the Nationwide Inpatient Sample (NIS-2003-2014) for adults (≥18 yr) were analyzed. Primary discharge diagnoses of AIS and TCD were identified using ICD-9-CM codes 433-436, 437.1, and 88.71, respectively. Cochran-Armitage trend test and multivariable survey logistic regression were utilized to evaluate TCD use and predictors.

Results:
Of 4,224,924 patients identified with AIS 93,673 (2.22%) had TCD examination. There was a significant decline in utilization of TCD (3.84% in 2003 to 1.34% in 2014, p<0.0001). The patients with TCD utilization had a higher mean length of stay (6 vs 5 days; p<0.0001) and cost of hospitalization ($39,270 vs $38,100; p=0.0007) than non-TCD utilization. In multivariate regression analysis, age group 50-64 (aOR:1.55; 95%CI:1.28-1.88), 65-79 (1.66; 1.32-2.08), ≥80 (1.68; 1.29-2.18), African American (1.51; 1.45-1.58), Hispanic (1.63; 1.55-1.72), Asian/Pacific Islander (1.36; 1.26-1.47), zip income 76-100th percentile (1.24; 1.19-1.30), large bed size hospitals (1.44; 1.36-1.52), hypertension (1.05; 1.01-1.09), hypercholesterolemia (1.23; 1.18-1.29; p<0.0001), alcohol abuse (1.09; 1.00-1.18), anticoagulant use (1.47; 1.39-1.56), ischemic heart disease (1.05; 1.01-1.09), and ventricular septal defect (2.69; 1.31-5.52) have higher odds of TCD utilization. We have noticed lower odds of TCD utilization in elective admissions (0.65; 0.59-0.72). (c-statistic: 0.71)

Conclusions:
Over the last decade, there has been a slight but steady decrease in the use of TCD during AIS hospitalizations in the US. Future studies should examine the cost-utility of TCD, especially with the advent of endovascular stroke treatment systems.
Abstract 13644: Management Patterns in Patients With Heart Failure: Insights From iCaReMe Global Registry
Authors: Kosiborod Mikhail N , Lam Carolyn S , Pollock Carol , Khunti Kamlesh , Lambers Heerspink Hiddo , Nicolucci Antonio , Joshi Shashank , Fenici Peter , Goncalves Susana , Vasnawala Hardik , HADAOUI Ahmed
Published: December 2023

Introduction:
Heart failure (HF) is an increasing major case of morbidity and mortality, including in low and middle income countries (LMIC) due to the rising incidence of HTN, T2D and CKD. Little information is available on the management of HF in LMIC. iCaReMe is a unique ongoing registry collecting data from contemporary routine clinical practice in patients with HF, T2D, HTN and/or CKD.

Aims:
Describe clinical characteristics, comorbidities and management of HF patients based on data from iCaReMe Registry.

Methods:
iCaReMe Global Registry (NCT03549754) is a multinational, prospective, observational study to assess the management and quality of care in patients with HF, T2D, HTN and/or CKD. We present baseline descriptive analysis of the HF cohort enrolled from February 2018 to December 2022.

Results:
A total of 3069 adults (mean age±SD 58.7±12.6 years, 59.2% males, 40.3% obese) with HF from 21 countries were evaluated in this initial report. Of the 2307 (75.2%) patients with available LVEF data; 63.4% had HFrEF, 14.3% HFmrEF, and 22.3% HFpEF. The median (IQR) LVEF was 36(30-47) % and 83% had NYHA class II-IV symptoms. Overall, 27.1% of patients reported history of hospitalization for HF. The comorbidities were common including T2D (60.4%), HTN (57.1%), CAD (45.4%), dyslipidemia (36.0%), and CKD (30.5%). In patients with available data, the mean UACR was 282.5 mg/g [reported in 666 (21.7%) patients] and mean eGFR was 70.3 ml/min/1.73m
2
[reported in 2325 (75.8%) patients]. The medications included ACEi or ARB in 66.6%, ARNI in 15.9%, b-blockers in 65%, MRA in 38.7%, and SGLT2i in 40.3%.

Conclusions:
iCaReMe Registry provides a unique perspective on the characteristics and management of patients with HF in low and middle income countries and demonstrates substantial burden of multimorbidity. The data highlight gaps between guidelines and routine care and the need to identify and address barriers to the implementation of optimal management and evidence-based therapies.
Abstract 13651: Pembrolizumab Associated Myocarditis, Myasthenia Gravis, and Myositis
Authors: Alexander Grace , Sternhagen Erin , Rahim Bilal , Jergenson Matthew , Mansour Shareef
Published: December 2023

Case:
A 71 year old man presented with acute generalized muscle weakness, double vision, sagging eye lids, weakness with swallowing, shortness of breath, and dark urine. History was notable for stage IV non-small cell lung cancer with second dose of pembrolizumab therapy completed 12 days earlier. Exam showed bilateral ptosis and muffled speech. He had increased work of breathing, tachypnea, 3/5 strength in the bilateral lower extremities, and 5/5 strength in the upper extremities. His initial NIF was -25. Labs were notable for troponin of 1532, CK 16229, ESR 100, CRP 8.8, ALT 225, and AST 648. EKG revealed a new right bundle branch block and left posterior fascicular block. TTE showed EF of 65% without regional wall motion abnormalities. Cardiac MRI showed mildly elevated T1 and T2 relaxation times, suggestive of diffuse myocardial edema and inflammation without delayed gadolinium enhancement. He was treated with high dose steroids, fluid resuscitation, IVIG, and briefly pyridostigmine. On hospital day 8, he was found to have complete AV block with junctional escape rhythm. He had urgent placement of a temporary pacemaker. He was started on abatacept, ruxolitinib, and oral prednisone. Over the next 14 days he made gradual improvement.

Discussion:
While ICI-associated myocarditis is rare, it is worth investigating due to the high mortality. The clinical presentation can range from asymptomatic troponin elevations to cardiogenic shock and ventricular arrhythmias/AV block. Diagnosis requires a high index of suspicion and multiple diagnostic modalities, including ECG, echocardiography, serum biomarkers, and often cardiac MRI and endomyocardial biopsy. There is a large overlap between myocarditis and myositis. The mainstay treatments of ICI-induced myocarditis include holding the offending immune-checkpoint inhibitor, high-dose corticosteroids, and guideline-directed medical therapy for associated heart failure or arrhythmias. Abatacept, a cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) immunoglobulin fusion protein, and ruxolitinib, a JAK 1/2 inhibitor, have recently been suggested as a novel combination to reduce mortality from ICI-associated myocarditis with concomitant myositis.
Abstract 13652: Machine Learning Prediction of RV End-Diastolic Volume in Patients With Pulmonary Regurgitation
Authors: Arivazhagan Naveen , Cohen Jennifer , Kong Grace , Barris David , Castaldo Rosalie , Gayanillo Marjorie , Hopkins Kali , Kailas Maya , Ma Xiye , Marshall Molly , Paul Erin , Tan Melanie , Bebiya Surkhay , Yau Jen Lie , Ezon David , Nadkarni Girish N , Duong Son Q
Published: December 2023

Introduction:
RV end-diastolic volume (RVEDV) by cardiac MRI (cMRI) guides intervention in congenital heart disease. Guideline directed linear and area measurements from two-dimensional echocardiography (2DE) have poor univariable linear correlation with RVEDV. We hypothesized that non-linear modeling of 2DE RV measurements may predict cMRI volume.

Aims:
We sought to develop a prediction algorithm for RVEDV from guideline-directed RV 2DE measurements.

Methods:
Patients from 2009 to 2022 with
>
mild pulmonary regurgitation and cMRI +/- 3 months were included. 2DE measurements were: RV end-diastolic (RVED) apical 4-chamber area, basal RVED diameter (d), mid RVED d, tricuspid annulus d, RVED length; PSLAX proximal RVOT d; PSSAX proximal RVOT d, distal RVOT d. A gradient-boosting decision trees algorithm (XGBoost) regressed cMRI RVEDV (mL) using 2DE inputs (including missing data) with leave-one-out crossvalidation. Predicted RVEDV was BSA-indexed to examine performance at clinical threshold 150 mL/m
2
. Intraclass correlation coefficient (ICC) in 30 samples was measured.

Results:
Of 243 subjects (median age 21 [IQR 16-31] y, 58% tetralogy of Fallot, 22% congenital pulmonary stenosis s/p intervention), 19% had cMRI RVEDV
>
150 mL/m
2
. Missing ranged from 5% (basal RVED d) to 17% (PSSA proximal RVOT), and ICC ranged from 0.46 (basal RVED d) to 0.78 (tricuspid annulus). Mean absolute error was 40 mL (27 mL/m
2
). At the predicted threshold 150 mL/m
2
had 39% sensitivity, 87% specificity, 40% positive predictive value, and 86% negative predictive value for true RV dilation.

Conclusion:
Prediction of RVEDV from guideline recommended 2DE RV measurements is possible. Detection of clinically significant RV dilation has low sensitivity but may be helpful in ruling out cases. Sources of error include interrater variability and missing data due to poor visualization of the RV on 2DE. Future work to develop a consistent and informative feature set for modeling is required.
Abstract 13670: Prevalence and Long-Term Outcomes of Intravenous Iron Sucrose Therapy in Heart Failure With Reduced Ejection Fraction: A Single Institution Retrospective Cohort Study
Authors: Anuforo Anderson C , Paulraj Shweta , Ashok Kumar Prashanth , Soipe Ayorinde , Awoyemi Toluwalase , Sandhu Michael , Ashwath Ashwini , Olojakpoke Eloho , Singh Ravi , Somerville Alexander , Menezes Sherna , Harrison Joshua W , Weinberg Andrew
Published: December 2023

Background:
Iron deficiency (ID) is prevalent in heart failure with reduced ejection fraction (HFrEF) defined as left ventricular ejection fraction (LVEF) ≤ 40%. Most trials used in the 2022 AHA/ACC guidelines studied iron carboxymaltose; most had a short follow-up and evaluated heart failure readmissions. We explored the prevalence of iron use, long-term therapeutic benefits, and impact on all-cause readmission for patients with HFrEF.

Methods:
In this retrospective cohort study, we analyzed electronic medical record data from a university hospital from 2016 to 2021 with an ICD-10 code of systolic heart failure (LVEF < 50%) and ID, or iron deficiency anemia (IDA) (n=619). Intravenous (IV) iron sucrose group was matched to a control group (n = 43) by propensity score matching for age and sex. Conditional logistic regression was utilized to estimate unadjusted odds ratios (uOR) with 95% confidence interval (CI), while Mann-Whitney test was utilized to compare median values of nonparametric estimates. Statistical analysis was done in SAS version 9.4.

Results:
66.7% of the studied population were male and 61.1% were ≥ 65 years. The common comorbid conditions were ischemic cardiomyopathy (39.6%), chronic kidney disease (CKD) (26.2%), and gastrointestinal (GI) bleeding (12.3%). ID was present in 115 (18.6%); IDA in 95 (15.4%) and 43 (6.9%) received IV iron sucrose. IV iron administration was significantly associated with LVEF 41-49% (uOR = 2.65, 95% CI: 1.10 - 6.43), GI bleeding (uOR = 16.00, 95% CI: 2.12 - 120.65), chronic kidney disease (uOR = 3.67, 95% CI: 1.49 - 9.04), iron deficiency (uOR = 26.00, 95% CI: 3.53 - 191.60]) and iron deficiency anemia (uOR = 24.00, 95% CI: 3.23 - 177.41). LVEF ≤40% was non-significantly associated with all-cause mortality (uOR = 1.50, 95% CI: 0.61 - 3.67). The IV iron group had a higher median rate of 6-year readmissions (8 [IQR:8] vs.1 [2]; p<0.001), and blood transfusions (11 [24] vs. 3.5 [2]; p=0.05).

Conclusions:
Patients with HFrEF were less likely to receive IV iron sucrose and more likely to die. Those with frequent blood transfusions, GI hemorrhage, and CKD were more likely to receive IV iron. The study indicates the impact of disease severity and comorbidities on management. Larger studies are needed to investigate this postulation.
Abstract 13671: A Case of Diffuse Alveolar Hemorrhage While on Systemic Anticoagulation for Impella
Authors: Ghosalkar Radhika , Miyashita Satoshi , Kawabori Masashi , Vest Amanda R
Published: December 2023

A 57 year old male with PMH of non-ischemic cardiomyopathy (EF 30%), atrial fibrillation, and VT s/p ICD was admitted to the cardiac intensive care unit for cardiogenic shock. His condition deteriorated necessitating Impella 5.5 implantation as bridge to cardiac transplant. Systemic heparin was started per Impella protocol with a lower anti-Xa goal of 0.2 - 0.3 given post-op bleeding at the R axillary Impella site. Five days post Impella placement he developed bloody secretions from the endotracheal tube requiring multiple blood transfusions and discontinuation of systemic heparin, while maintaining heparin purge. Labs were notable for anti-Xa 0.22, hemoglobin 9.7, and platelets 221. CT Chest demonstrated parenchymal opacities concerning for diffuse alveolar hemorrhage (DAH) which was confirmed via bronchoalveolar lavage; he had no known history of lung disease. High-dose corticosteroids were administered as a high ANA titer (1:128) and low C3 suggested capillaritis. However, decreasing ANA (1: 320) and a negative autoimmune workup decreased the likelihood of a rheumatologic cause for DAH and steroids were discontinued. DAH secondary to acquired von Willebrand syndrome (aVWS) was considered, but factor VIII and vWF activity levels were normal. The bloody secretions improved with inhaled thromboxane and systemic heparin was restarted. Orthotopic heart and kidney transplant was performed with subsequent Impella removal 104 days after Impella placement.

Discussion:
We present the first documented case of DAH with isolated Impella 5.5 support. Previously reported cases of DAH post-Impella were observed in patients with concurrent ECMO or RVAD. As autoimmune and coagulopathic causes of DAH were excluded, bland DAH secondary to systemic anticoagulation is most likely in this case. This raises a question about how to balance the risk of bleeding with the risk of device thrombosis, stroke and embolic events and when to switch from heparin to sodium bicarbonate purge.
Abstract 13673: Effects of Bariatric Surgery on Blood Pressure Management in Type 2 Diabetes: Analysis From a Thirteen-Year Cohort Study
Authors: Mannan Fahmida , Wiltshire Ryan , Heald Adrian
Published: December 2023

Introduction:
Bariatric surgery (BS) is an effective intervention for both weight loss and improved metabolic health in those with Type 2 diabetes (T2D), yet there is limited data on its long-term effect on blood pressure (BP) control.

Aim:
This prospective cohort study aims to evaluate the long-term effect of BS on BP and metabolic health in T2D patients in a tertiary centre in North-West England.

Methods:
Patients who underwent BS (gastric bypass/sleeve gastrectomy) between 2009 - 2012 at a single tertiary surgical centre in North-West England were followed for up to 13 years. Preoperative and follow-up data including BP readings, HbA1c, BMI and antihypertensive medication use was obtained from electronic patient records at regular intervals to ascertain longitudinal outcomes in BP, BMI and HbA1c.

Results:
119 patients were included in the study. Optimal metabolic health state was achieved at 12 months post-surgery for BMI (-14.78kg/m
2
(95%CI: 13.37-16.20, p<0.001)), systolic BP (sBP) (-15.02mmHg 95%CI: 8.23-21.81mmHg, p<0.001)), diastolic BP (dBP) (-8.1mmHg, 95%CI: 4.26-11.91, p<0.001)) and HbA1c (-24.41mmol/mol, 95%CI: 18.25-30.58, p<0.001). A sustained reduction in both sBP and dBP was maintained for up to 5 years, mirroring a reduction in concurrent use of antihypertensive medications (164 prescriptions v 66 at 5 years). However, at latest follow-up, there was an observed increase in antihypertensive prescription (95 v 66) yet there was no statistically significant change in mean BP. Furthermore, the number of patients with clinically diagnosed hypertension (BP 140/90 or more was lowest at 5 years (n=53 v 86 pre-op) before rising at the latest follow-up (n=57).

Conclusions:
Our study demonstrates that BS has a sustained benefit on BP as reflected by both absolute measurements and reduction in antihypertensive medication use. It remains an effective strategy not only for weight loss but also for the comprehensive management of metabolic comorbidities in T2D patients as evidenced by reductions in antihypertensive use, HbA1c, BMI and BP. However, more research is needed to explore the longer-term effects of these benefits at ≥ 10 years given the increases in antihypertensive use, BMI and HbA1c after this period.
Abstract 13677: Incidence and Survival to Hospital Discharge After Maternal Cardiac Arrest: A Systematic Review and Meta-Analysis
Authors: Nagraj Sanjana , SAFIRIYU ISRAEL , Kokkinidis Damianos , Kharawala Amrin , Seo Jiyoung , Varrias Dimitrios , Pargaonkar Sumant , Sridhar Shruthi , Hassanain Sahar , Naser Ahmad , Tzoumas Andreas , Thachil Rosy
Published: December 2023

Introduction:
Maternal cardiac arrest (MCA) is considered a rare but devastating complication of pregnancy. However, the overall incidence, etiologies, and maternal and neonatal survival outcomes remain unknown.

Research Question:
What is the incidence of MCA? What are the underlying etiologies and survival to hospital discharge rate in women with MCA?

Methods:
Electronic databases PubMed, Embase, and Cochrane were searched from inception up to May 2023 for studies reporting the incidence, etiology, or outcomes of MCA (in-hospital or out-of-hospital cardiac arrest). Primary outcomes of interest were pooled incidence of MCA per 100,000 maternities and maternal survival to hospital discharge rate. Secondary outcomes of interest included frequency of underlying etiologies, perimortem cesarean section (PMCS) rate, and neonatal survival rate. A random-effects model meta-analysis was performed. Heterogeneity was assessed using I-squared test.

Results:
Eight studies surveying 63,859,400 maternities were included. Median (interquartile range) gestational age at the time of MCA was 32.03 (26.33-37.72) months. Pooled incidence of MCA was 5.83 (95% CI: 3.07-8.59) per 100,000 maternities
(Figure 1A)
. Rate of survival to hospital discharge after MCA was 42% (95% CI: 30-54)
(Figure 1B)
. Of the studies that reported etiologies, most common were maternal obstetric hemorrhage (30%; 95% CI: 16-43), cardiac etiology (20%; 95% CI: 11-28), amniotic fluid embolism (13%; 95% CI: 12-14) and venous thromboembolism (13%; 95% CI: 6-19). Incidence of PMCS was 36% (95% CI: 11-62) and neonatal survival rate in women with MCA was 45% (95% CI: 18-73).

Conclusions:
Less than half of the women with maternal cardiac arrest survived to hospital discharge and only 36% underwent perimortem cesarean section. The most common etiologies of MCA were maternal obstetric hemorrhage, cardiac etiology, amniotic fluid embolism and venous thromboembolism.
Abstract 13681: Association of Serum Trimethylamine N-oxide Levels With Cardiovascular Disease and All-Cause Mortality: A Systematic Review and Dose-Response Meta-Analysis of Prospective Cohort Studies
Authors: Siu Teenie , sahye-pudaruth Sandhya , Mannan Fahmida , blanc raphael , Zurbau Andreea , Paquette Melanie , Patel Darshna , Chiavaroli Laura , Blanco Mejia Sonia , Khan Tauseef , Kendall Cyril , Sievenpiper John L , Jenkins David
Published: December 2023

Background:
Trimethylamine N-oxide (TMAO), a gut microbiota-derived metabolite of red meat, has emerged as a potential biomarker for CVD and all-cause mortality. It is also found in preformed amounts in fish. However, the association between serum TMAO levels and CVD outcomes remain unclear.

Aim:
To conduct a systematic review and dose-response meta-analysis evaluating the association between serum TMAO and CVD and all-cause mortality in prospective cohort studies.

Methods:
A comprehensive literature search was conducted in MEDLINE, EMBASE, and Cochrane Library up to and including March 6, 2023. A manual search through references found in reviews and meta-analyses was also conducted. Studies reporting hazard ratios (HRs) or relative risks (RRs) with 95% confidence intervals (CIs) for the association between serum TMAO levels and CVD or all-cause mortality in adults ≥ 18 years with follow-up of ≥ 1 year were included. Random-effects models were utilized for pooled risk estimates and assess the dose-response. GRADE was used to evaluate certainty of evidence.

Results:
2459 papers, 44 prospective cohort studies were included involving 84771 participants included in final analysis (fig.1). Pooled analyses revealed a significant positive association between elevated serum TMAO levels and the risk of total CVD (RR 1.29 [1.16-1.44]), CVD mortality (RR 1.51 [1.23-1.87]) and all-cause mortality (RR 1.30 [1.21,1.39]). Non-significant associations were found for MI, stroke, total CHD, MI mortality and CHD mortality. All outcomes were of low to very low certainty.Dose response analysis revealed a significant linear association with all-cause mortality (RR 1.01 [95% CI 1.01, 1.02] per 2μM/L) up to a threshold of 6μM/L and total CVD (RR 1.04 [1.02-1.06]).

Conclusion:
This study provides evidence supporting the positive association of serum TMAO levels with increased risk of total CVD, CVD mortality and all-cause mortality. A recent review found 13/15 studies demonstrated a strong positive correlation between TMAO and fish intake, complicating the hypotheses relating TMAO in red meat and CVD risk. Thus, further assessments of diet components are needed to explore the clinical implications of the associations found in our study.
Abstract 13696: Sotagliflozin is Associated With Early Clinical Benefit for Heart Failure and Atherosclerotic Events
Authors: Aggarwal Rahul , Bhatt Deepak , Szarek Michael , Davies Michael J , Banks Phillip , Pitt Bertram , Steg Philippe G
Published: December 2023

Background:
SGLT inhibitors reduce cardiovascular (CV) death and heart failure (HF)-related outcomes in HF patients, with benefits observed within 1 month. Less data exist for the time to clinical benefit for reducing HF or major cardiovascular events (MACE; CV death, myocardial infarction, and stroke) with SGLT inhibitors in patients with chronic kidney disease at high CV risk.

Objective:
This analysis evaluates the time to clinical benefit for HF-related events and MACE with sotagliflozin, a dual SGLT1 and SGLT2 inhibitor, in SCORED.

Methods:
SCORED was a randomized, double-blind study of 10,584 patients with type 2 diabetes, chronic kidney disease, and other CV risk factors, where patients were randomized 1:1 to sotagliflozin or placebo. The primary endpoint was total CV death, hospitalization for HF, or urgent visit for HF. A prespecified secondary endpoint was total MACE. The present post hoc analysis calculated the sotagliflozin:placebo hazard ratios (HR) and 95% confidence intervals (CI) for each of these outcomes and determined the day after randomization where the treatment effect reached statistical significance (p<0.05) and remained statistically significant for the duration of follow-up.

Results:
The overall risk of the primary endpoint was reduced by 26% (HR (95% CI) = 0.74 (0.63, 0.88); p<0.001) with sotagliflozin, with a sustained significant reduction 95 days after randomization (HR (95% CI) = 0.70 (0.50, 0.98) at 95 days; Figure A). For MACE, the overall risk reduction with sotagliflozin was 23% (HR (95% CI) = 0.77 (0.65, 0.91); p<0.001), with a sustained significant reduction 94 days after randomization (HR (95% CI) = 0.69 (0.47, 0.99) at 94 days; Figure B).

Conclusion:
In this stable, outpatient population at high risk for CV events, the time to clinical benefit with sotagliflozin was very early at approximately three months for both HF- and MACE-related outcomes.
Abstract 137: Importance of Ventilation Rate When Assessing EtCO
2
Levels and Applying TOR Guidelines
Authors: Leturiondo Mikel , Urigüen Jose Antonio , Redondo Koldo , Azcarate Izaskun , Gutiérrez Jose Julio , Russell James K , Daya Mohamud R
Published: December 2023

Introduction:
Ventilation is essential for the elimination of carbon dioxide (CO
2
) from the body during CPR. However, variation in ventilation rate (VR) is an acknowledged confounder for the interpretation of EtCO
2
. VRs that are not according to guidelines alter measured EtCO
2
levels and make the decision of termination of resuscitation (TOR) based on EtCO
2
unreliable.

Aim:
To retrospectively analyze the effect of ventilation rate on levels of EtCO
2
for patients that do not achieve ROSC during prehospital resuscitation.

Methods:
Capnograms obtained from monitor-defibrillator recordings of non-ROSC adult OHCA cases, attended by TVF&R (OR, USA), were manually inspected to identify individual ventilations. Episodes were partitioned into consecutive 1-min segments, each characterized by its mean EtCO
2
and VR. We corrected the mean EtCO
2
values by adjusting the VRs to the recommended standard for patients with advanced airways (10 vpm), and obtained new EtCO
2,s
values multiplying by the standardization factor 1.64 (1 - 0.91
VR
) published previously.

Results:
One-minute segments (
n
= 3,791) from 244 cases were studied, for a total number of 27,312 ventilations. Of these, 206 cases had a duration equal or greater than 20-min, and 9.7% met the TOR criterium of EtCO
2
< 10 mmHg at 20-min. Median (IQR) VR, measured EtCO
2
and corrected EtCO
2,s
were 8.1 (6.2-10.6) vpm, 27.7 (17.9-39.8) and 24.1 (16.0-33.7) mmHg, respectively, all at the 20-min mark. Median EtCO
2,s
was at all times lower than measured EtCO
2
, with differences from 10 to 20 min ranging from 3.3 to 5.1 mmHg.

Conclusion:
TOR guidelines lack consensus, but the threshold of EtCO
2
< 10 mmHg at the 20-minute mark of resuscitation, as predictive of non-survivability, needs re-examination. Modern CPR introduces several confounders that produce higher measured EtCO
2
, including low VRs that are common but can be corrected. Based on a ventilation rate of 10 vpm, a new threshold should be considered as part of a multimodal approach in TOR guidelines.
Abstract 13723: Waitlist Outcomes for Pediatric Heart Transplantation in the Current Era: An Analysis of the PHTS Database
Authors: Butts Ryan J , Toombs Leah , Kirklin James K , Schumacher Kurt , Conway Jennifer , West Shawn C , Auerbach Scott R , Bansal Neha , Zhao Hong , Cantor Ryan S , Nandi Deipanjan , Peng David M
Published: December 2023

Introduction:
Waitlist mortality (WM) remains high in pediatric heart transplantation (HT). Allocation policy is a potential tool to help improve WM. This study aims to identify patients listed status 1A at highest risk for WM to potentially inform future allocation policy changes.

Hypothesis:
Significant variation in WM will exist even within highest urgency waiting status (1A).

Methods:
The pediatric heart transplant society database was queried for all patients <18 years of age listed for HT between January 1, 2010 to December 31, 2021. WM was defined by death while awaiting transplant or being removed from the waitlist due to clinical deterioration. Kaplan-Meier analysis, log-rank testing, and Cox-proportional hazard models were created to determine association with WM. Subgroup analysis was performed in 1A patients based upon body surface area (BSA) at time of listing, cardiac diagnosis, and presence of mechanical circulatory support.

Results:
Among 5,974 children listed, 3928 (65.8%) were status 1A. Patients listed 1A had a higher burden of WM (p<0.01) compared to patients listed status 1B or status 2. Among 1A patients, BSA<0.3m
2
, congenital heart disease (CHD), and lower eGFR was associated with higher WM. VAD support at listing was associated with lower WM (figure, all p-values<0.01) except in the single ventricle cohort (CHD-SV) (HR 2.13, p<0.01). For BSA<0.3m
2
listings, diagnosis other than dilated cardiomyopathy was associated with increased risk of WM . Prior cardiac surgery was associated with WM in the BSA 0.3-0.7m
2
and >0.7m
2
groups. ECMO was associated with increased risk of WM in all cohorts (HR 2.26, p<0.01).

Conclusions:
Significant variability exists in WM in patients listed 1A. Future changes to the pediatric allocation system should factor in the increased risk of WM in patients supported by ECMO, CHD-SV on VAD support, and small children with CHD, RCM or HCM.
Abstract 13734: Gender Differences in Authorship of Top Congenital Heart Disease Publications
Authors: Chua Janice T , Pillutla Priya
Published: December 2023

Introduction:
Despite progress in the representation of women in medical training, men continue to dominate fields such as academic medicine and cardiology. The proportion of female cardiology trainees and physicians has increased over time; however, women continue to be underrepresented in published cardiology literature.

Research Question:
Our study aims to investigate whether there are gender disparities in authorship amongst the top congenital heart disease publications.

Methods:
We performed a bibliometric analysis of publications indexed in PubMed from 2018 to 2022 from the top seven Cardiology and congenital heart disease (CHD) journals by impact factor and H5-index. The first authors, last authors, affiliations, and countries of origin were extracted. The genders of the authors were then determined from a database of name-to-gender mappings (
Gender API; gender-api.com
). One sample and independent sample t-tests were performed.

Results:
We identified 1058 CHD articles on PubMed which met the inclusion criteria. Female authors accounted for 38.1% of all first authors and 29.6% of all last authors, which was a statistically significant difference from the proportion of male authors (61.9% and 70.4%, respectively, p<0.001). Europe showed a greater bias towards male first authors than the United States (p=0.010), whereas there was no significant gender difference seen in last authors between the two regions (p=0.170). Publications with a male senior author were more likely to have a male first author (67.1% male, p<0.001), whereas there was no difference in first author gender in publications with a female last author (49.8% male, p=0.954).

Conclusions:
We analyzed the first and last author genders of publications in high-impact cardiology journals over the past 5 years and found that women are underrepresented in both first and last authorship positions. Patterns in underrepresentation emerged, both geographically and based on the gender of the senior author. Additional work is needed to address these gender disparities and identify concrete solutions to increasing female representation in CHD research, as it may elucidate obstacles to female representation in cardiology leadership, recruitment, and academic advancement.
Abstract 13737: Two Episodes of Intermittent Complete Heart Block Following Elective Procedures
Authors: Garcia-Arango Mariana , Vrtikapa Dejan , Gepner Adam
Published: December 2023

Background:
Iatrogenic bradycardia and complete heart block can occur with medications commonly administered during general anesthesia.

Case:
A 79-year-old male with past medical history of coronary artery disease, hypertension, paroxysmal atrial fibrillation and a left bundle branch block, underwent elective lithotripsy procedure, baseline ECG demonstrated in Figure A. Post-operatively, he developed asymptomatic complete heart block approximately 3 minutes after receiving sugammadex, a paralytic reversal agent (see Figure B). He was admitted for monitoring and spontaneously converted to sinus rhythm after 10 hours. The patient was discharged home with a 30-day event monitor; no pauses or high-grade atrioventricular block was noted during the monitoring period. Three months later, he underwent ureteroscopy stent exchange; during the induction with propofol he developed asystole followed by cardiac arrest. CPR was initiated and had return to spontaneous circulation after 3 minutes. The patient was transferred to the ICU, however, once again complete heart block was observed.

Clinical decision-making:
This case highlights recurrent episodes of transient complete heart block in the setting of an underlying left bundle branch and first-degree AV block that were exacerbated by medications during general anesthesia. Because of his underlying conduction disease and recurrent complete heart block and subsequent cardiac arrest, he ultimately underwent insertion of permanent dual chamber pacemaker.

Conclusion:
Iatrogenic transient complete heart block is a rare but potentially fatal complication. Prompt diagnosis and clinical suspicion of reversible causes are warranted. Significant underlying conduction disease should be considered to decide the ideal therapeutic option.
Abstract 13757: Suppression of Ischemia-Hypoxia Reperfusion Injury in Human iPS Cell-Derived Cardiomyocytes Through Downregulation of EGR1 Mediated by miR-124-3p
Authors: Yang Qiaoke , Murata Kozue , Ikeda Tadashi , Minatoya Kenji , Masumoto Hidetoshi
Published: December 2023

Background:
Ischemic heart diseases are one of the leading causes of death globally. Although timely revascularization is performed, some cases may still result in heart failure due to ischemia-hypoxia reperfusion (IH/R) injury. Early growth response 1 (EGR1) was reported to involved in reperfusion injury, but its specific role in IH/R-induced apoptosis in human cardiomyocytes (CMs) remains unexplored.

Hypothesis:
EGR1 is involved in the exacerbation of the IH/R-mediated apoptosis in human CMs, and miR-124-3p acts as an antagonist of EGR1.

Methods:
Human induced pluripotent stem cell (hiPSC)-derived CMs were cultured in serum-free low-glucose medium with a hypoxic chamber. EGR1 expression and the extent of apoptosis were evaluated by qRT-PCR, Western blotting (WB), and immunofluorescent assay (IFA). RNA-seq was conducted to identify specific pathways. SiRNA targeting EGR1 and miR-124-3p mimic were used to downregulate EGR1 under IH/R.

Results:
qRT-PCR (Control vs IH/R: 1.000 ± 0.000 vs 5.749 ± 2.947; P<0.01) and WB (0.037 ±0.038 vs 0.953 ± 0.306; P<0.0001) analyses revealed higher expression of EGR1 in IH/R group. IFA demonstrated a higher ratio of cleaved Caspase-3-positive apoptotic cells in IH/R group (0.202 ±0.206 vs 0.377 ± 0.252; P<0.001). RNA-seq analysis indicated significant downregulation of pathways related to cell survival in IH/R. The siRNA downregulated EGR1 successfully, as confirmed by qRT-PCR, WB, and IFA (IH/R Water vs IH/R siRNA: 0.612 ±0.307 vs 0.257 ±0.122; P<0.01), which led to the suppression of apoptosis (0.288 ±0.143 vs 0.142 ±0.049; P<0.05). miR-124-3p mimic downregulated EGR1 under IH/R conditions, as shown by PCR (IH/R Water vs IH/R miRNA mimic: 3.731 ±1.126 vs 2.568 ±0.959; P<0.0001) and WB (0.947 ±0.438 vs 0.478 ±0.277; P<0.05). IFA proved the suppression of EGR1 by miR-124-3p mimic (0.414 ±0.101 vs 0.062 ±0.064; P<0.0001), which subsequently reduced CM apoptosis (0.234 ±0.127 vs 0.092 ±0.047; P<0.001).

Conclusion:
EGR1 participate in exacerbating apoptosis mediated by IH/R in human CMs. The downregulation of EGR1 suppresses IH/R-induced apoptosis. Treatment with miR-124-3p targeting EGR1 may potentially serve as a novel therapeutic approach for cardioprotection in the future.
Abstract 13771: Left Atrial Size and Frailty Indexes Predict Poor Prognosis in Hospitalized Elderly Patients With Heart Failure
Authors: Miura Masakazu , Okuda Shinichi , Murata Kazuhiro , Ikeda Yasuhiro
Published: December 2023

Background:
Left ventricular ejection fraction (LVEF) is a cardiac index used to diagnose and determine heart failure (HF) treatment strategy. However, in elderly patients with HF, LVEF is not a good predictor of prognosis. We have previously found that patient outcomes are associated with left atrial (LA) size and noncardiac factors such as malnutrition, muscle weakness, and cognitive dysfunction. This study examined whether a combination of LA function and noncardiac indicators related to frailty can predict an accurate prognosis in hospitalized elderly patients.

Methods:
Hospitalized HF patients over 65 years of age from January 2019 to December 2022 were consequently enrolled in the Yamaguchi Prefectural Grand Medical (YPGM) Center. We divided three categories: sinus rhythm (SR) with normal LA, SR with LA enlargement (LAE), and persistent or chronic atrial fibrillation (AFib) with LAE. Cox proportional hazard analyses were employed to determine the prognosis factors, i.e., the primary outcome as all-cause death or HF readmission and the secondary outcome as major adverse cardiac and cerebrovascular events (MACCE).

Results:
Overall, 676 HF patients were admitted to YPGM Center. Of those, 462 (median age 84.0, 47% female) met the study criteria. During the follow-up of 204.0 days, 46 patients reached all-cause death (10%), 82 experienced HF readmission (18%), and 116 developed MACCE (25%). LA volume index (LAVI) (Hazard ratio [HR]: 1.012; 95% confidence interval [CI]: 1.003-1.022; p = 0.013) and handgrip strength (HR: 0.917; 95%CI: 0.868-0.970; p = 0.002) were associated with the primary outcome. Nutritional status assessed by geriatric nutritional risk index (GNRI) was associated with the primary and secondary outcome (HR: 0.956; 95%CI: 0.927-0.985; p = 0.003, and HR: 0.937; 95%CI: 0.909-0.966; p < 0.001, respectively), but neither AFib nor LVEF. The adverse events were lower in SR with the normal LA group than in other groups. Furthermore, a multiple logistic regression model, including LAVI, AFib, GNRI, and handgrip strength, most accurately predicted the primary outcome than those with the AFib or LVEF.

Conclusion:
The value of benefits as a prognosis lies more in LAVI and frailty indexes than in the presence of AFib and LVEF in elderly HF patients.
Abstract 13791: Non-Alcoholic Fatty Liver Disease Risk SNP Variants Affect Lipid Metabolism
Authors: Ikezaki Hiroaki , Murata Masayuki , Shimono Nobuyuki , Schaefer Ernst J
Published: December 2023

Introduction:
The impact of non-alcoholic fatty liver disease (NAFLD) risk SNP variants on changes in lipid metabolism in the general population has yet to be determined. We aimed to assess this association using a large prospective cohort study.

Methods:
A total of 1488 Japanese men and women (median age 62 years and median body mass index 24.7 kg/m2) free of cardiovascular disease were studied. Among NAFLD risk SNPs, variants of patatin-like phospholipase domain containing 3 (PNPLA3), transmembrane 6 superfamily member 2 (TM6SF2), glucokinase regulator (GCKR), and neurocan (NCAN) were assessed. Plasma total cholesterol, low-density lipoprotein cholesterol (LDL-C), small dense LDL-C (sdLDL-C), LDL-triglycerides (LDL-TG), high-density lipoprotein cholesterol (HDL-C), HDL3-C, triglycerides (TG), lipoprotein(a), and adiponectin were measured at both baseline and after a five-year follow-up. Univariate and multivariate analyses, Kruskal-Wallis, Wilcoxon’s rank sum, and paired t-tests were performed to examine the associations between NAFLD risk SNPs and lipoproteins.

Results:
All of the measured lipoproteins increased significantly over 5 years. The TM6SF2 variant did not affect lipoproteins at baseline. However, after 5 years, the nonCC group had significantly lower HDL-C and HDL3-C and significantly higher LDL-C, sdLDL-C, and LDL-TG than the CC group. For the GCKR variant, TG, LDL-C, sdLDL-C, and LDL-TG were significantly higher in the CT/TT group at baseline, and LDL-C, sdLDL-C, and LDL-TG were still significantly higher in the same group at 5 years versus the CC group. The PNPLA3 and NCAN variants did not affect lipoproteins in this study.

Conclusions:
NAFLD risk SNP variants associated with gene products regulating both glucose and lipid metabolism can affect atherogenic lipoprotein levels.
Abstract 13946: Predictive Value of FDG-PET/CT Derived Coronary Artery Calcium Scoring in Non-Small Cell Lung Cancer Patients
Authors: Zahergivar Aryan , Auffermann William F , Chamberlin Jordan , Kabakus Ismail , Burt Jeremy R
Published: December 2023

Introduction/Background:
Coronary artery calcium (CAC) scoring on PET-CT has emerged as a potential prognostic tool in patients with cancer.

Research Question/Hypothesis:
CAC determined using non-ECG gated PET-CT data is a useful predictor of major adverse cardiac events (MACE) and overall survival in non-small cell lung cancer (NSCLC) patients.

Goals/Aims:
To investigate the association between CAC scores, MACE, and survival outcomes in NSCLC patients.

Methods/Approach:
We retrospectively analyzed baseline staging PET-CT (n=130) or CT (n=24), clinical history, demographics, and follow-up survival data of NSCLC patients. Patients were divided into four groups based on their CAC scores according to the 2016 SCCT/STR guidelines. Cox regression analysis was performed to assess the association between CAC score and survival, CAC score and MACE, and smoking history and survival.

Results/Data:
The mean age of the population was 66.3 ± 10.8 years with 42.9% never smokers. Of the 154 patients evaluated, 49.3% died during a mean follow-up period of 3.5 years. Cox regression analysis revealed a trend toward improved survival rates of patients with lower CAC scores (P= 0.081 for No/Minimal risk and P= 0.039 for Mild group). Current or prior smoking was significantly associated with decreased survival (P = .013, HR = 1.8). Logistic regression analysis showed a significant inverse relationship between CAC scores and MACE (n=32) for no risk/minimal (P = .001) and mild risk (P < .001) groups. Additionally, there was an inverse association between CAC and number of observed acute MI for no /minimal risk group (P= .02) and mild risk group (P= .003).

Conclusion:
Our findings suggest that lower CAC scores, measured at initial staging PET-CT, are associated with decreased MACE and acute MI in NSCLC patients. Further studies are needed to validate these findings and explore the potential of CAC scoring as a routine prognostic tool in NSCLC management.
Abstract 13951: Change in Albuminuria Measured by Urine Albumin-to-Creatinine Ratio (UACR) and Associated Clinical Outcomes in Patients With Chronic Kidney Disease (CKD) Associated With Type 2 Diabetes (T2D)
Authors: Tangri Navdeep , Li Qixin , Chen Yan , Singh Rakesh , Betts Keith A , Farag Youssef M , Beeman Scott , Du Yuxian , Kong Sheldon X , Williamson Todd , Wu Aozhou , Sundar Manasvi , Pantalone Kevin M
Published: December 2023

Introduction:
The impact of change in albuminuria measured by UACR on key clinical outcomes (overall survival [OS], a composite cardiovascular [CV] outcome, and kidney disease progression) in patients (pts) with CKD associated with T2D is understudied.

Hypothesis:
A decreased UACR is associated with a lower risk of clinical outcomes, while an increased UACR is associated with a higher risk of clinical outcomes.

Methods:
Adult pts with an elevated UACR ≥30 mg/g (initial test) after T2D and CKD diagnosis were identified from the Optum EHR database (1/2007-9/2021). UACR change was categorized as increased (>30% change), stable (-30% to 30%), or decreased (<-30%) based on the percentage change between the initial test and the last test (between 6 to 24 months after the initial test). Clinical outcomes, including OS, a composite CV outcome (CV death, myocardial infarction, stroke, or heart failure hospitalization), and kidney disease progression (≥40% eGFR decline or kidney failure) were evaluated after the last UACR test using Kaplan-Meier analysis. Hazard ratios (HR) of clinical outcomes for UACR change were estimated using Cox proportional hazard models adjusting for baseline characteristics.

Results:
Among 160,382 pts (median follow-up: 2.9 years), 89,562 had decreased UACR, 35,117 had stable UACR, and 35,703 had increased UACR. Compared with pts with stable UACR, pts with decreased UACR had significantly lower risks for all clinical outcomes (Figure) with adjusted HR of 0.93 for OS, 0.93 for the composite CV outcome, and 0.84 for kidney disease progression, while pts with increased UACR had significantly higher risks for OS (HR=1.24), the composite CV outcome (HR=1.24), and kidney disease progression (HR=1.41).

Conclusions:
In pts with CKD associated with T2D, >30% UACR decrease was associated with a lower long-term risk of overall mortality, CV events, and kidney disease progression. These findings highlight the importance of albuminuria monitoring in these pts.
Abstract 13972: Metabolic Reprogramming of Diabetic Mesenchymal Stromal Cells by Inhibiting Glypican 3 Enhances Their Cardioprotective Functions via Pyruvate Kinase Activation
Authors: Joladarashi Darukeshwara , Gurrala Charan T , Magadum Ajit , Mallaredy Vandana , TRUONGCAO MAY , Gibb Andrew A , Benedict Cindy , Cheng Zhongjian , Kishore Raj
Published: December 2023

Mesenchymal stromal cells (MSC) represent promising stem cell therapy for the treatment of cardiovascular diseases. Diabetes affects the functional capability of MSC and is an impediment to cell-based therapy. However, the impact of diabetes on MSC myocardial reparative activity, metabolic fingerprint, and the mechanism of dysfunction is still poorly understood. Therefore, our study aimed to understand the molecular basis of diabetes-induced MSC functions and their metabolic mechanism, and potential metabolic reprogramming of diabetic MSC to reverse these dysfunctions may represent a strategy to enhance cell-based therapeutics for myocardial repair in diabetic patients. The seahorse and
13
C glucose tracing studies identified defective energy metabolism in db/db-MSC. Our data also shows the diminished functional activity of db/db-MSCs to improve post-MI cardiac functions. Furthermore, we found that glypican-3 (GPC3), a heparan sulfate proteoglycan, is highly upregulated in db/db-MSC when compared to WT-MSC. GPC3 overexpression in WT-MSC showed abrogated metabolic fingerprints, lowered immunosuppression activity, and reduced angiogenic potential. Interestingly, GPC3 knockdown in WT-MSC showed an improved metabolic state, increased immunosuppression activity, and enhanced angiogenic potential. Furthermore, GPC3 knockdown in diabetic MSC restored their energy metabolism and their functions. Mechanistically, we revealed that GPC3 binds to pyruvate kinase (PK), which subsequently increases the rate of glycolysis and ATP production. In a mouse model of myocardial infarction (MI), intramyocardial transplantation of GPC3-metabolic reprogrammed db/db-MSC promoting neovascularization (at 28 days, post-MI) and lower cardiac fibrosis, leading to improved left ventricular function. These findings indicate that diabetes increased GPC3 expression and altered the metabolic rates in MSC which is detrimental to its function, and transplantation of GPC3-metabolic reprogrammed db/db-MSC into ischemic myocardium promoted their cardiac functions. Thus, inhibiting GPC3 may potentially be used to restore the metabolic state and functions of db/db-MSC for cell therapy applications.