bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 12715: Can 18F-Fluorodeoxyglucose Uptake Stratify the Risk of the Patients With Cardiac Sarcoidosis After Initiation of Immunosuppressive Therapy?
Authors: Kawai Hideki , Sarai Masayoshi , Naruse Hiroyuki , Kato Yasuchika , Morimoto Shinichiro , Izawa Hideo
Published: December 2023

Introduction:
While 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) is well-established for diagnosing cardiac sarcoidosis (CS) initially, its potential as a risk stratification tool for patients receiving immunosuppressive therapy remains controversial.

Hypothesis:
We aim to assess the prognostic value of FDG-PET in CS patients after 12 months of corticosteroid treatment.

Methods:
Our study consists of a retrospective review of clinical data and patient outcomes of stable CS cases that underwent FDG-PET following 12 months of corticosteroid treatment initiation. We excluded patients in the previous six months who had a heart failure hospitalization, sustained ventricular tachycardia (SVT) or ventricular fibrillation (VF), recent pacemaker implantation or upgrade, changes in corticosteroid dosage, or newly introduced additional immunosuppressive therapy. Major adverse cardiac events (MACE) include a composite of cardiac death, onset of SVT/VF, appropriate implantable cardioverter-defibrillator intervention, heart failure hospitalization, and cardiac functional deterioration.

Results:
Among the 72 analyzed patients, 35 exhibited cardiac accumulation in FDG-PET scans. Over an average of 49 (22-76) months, 19 patients experienced MACE. The occurrence of MACE was higher in the reduced left ventricle ejection fraction (LVEF) group (<50%) than in the preserved LVEF group (≥50%) (51.5% vs. 5.1%, Log rank p <0.001). Similarly, MACE was more common in the SVT/VF (+) group as compared to the SVT/VF (-) group (50.0% vs. 23.4%, Log rank p =0.041). However, the presence of cardiac accumulation in FDG-PET showed no significant correlation (Log rank p =0.718).

Conclusions:
The presence of residual cardiac accumulation after initiation of immunosuppressive therapy was not associated with the prognosis of the patients with CS. Established predictors, such as reduced LVEF and the occurrence of SVT/VF, remain integral in predicting MACE.
Abstract 12720: A Nationwide Multi Center Study From China, Comparing Long-Term and Standard Cardiopulmonary Resuscitation: Epidemiology, Risk Factors, and Outcomes
Authors: jin kui , Xu Jun , Wang Yue G , Wang Wen w , Yuan Yuan
Published: December 2023

Introduction:
The association between the duration of cardiopulmonary resuscitation (CPR) and patient outcomes remains largely unknown.

Hypothesis:
long-term CPR (LCPR) may benefit certain group of patients.

Methods:
In this retrospective cohort study, data from the Chinese Emergency Triage Assessment and Treatment database 1.0 (CETAT 1.0) were utilized. The study included CA patients admitted to 14 teaching hospitals in 7 provinces between July 2015 and July 2020. Patients were categorized into SCPR and LCPR groups based on the duration of resuscitation, where SCPR referred to CPR duration less than 60 mins, and LCPR referred to CPR duration equal to or more than 60 mins. The primary outcome measured was ROSC rates between the two groups, while the secondary and tertiary outcomes was 24-hour and 7-day survival rates. A multivariate logistic regression model was employed to analyze the factors influencing ROSC between groups.

Results:
A total of 529 patients were enrolled in the study, with 372 in the SCPR group and 157 in the LCPR group. Among them, 126 (33.9%) patients in the SCPR group and 56 (35.7%) in the LCPR group achieved ROSC without statistically difference between groups. Furthermore, 31 patients (8.3%) in the SCPR group and 7 patients (4.5%) in the LCPR group survived at 24 hours, while 13 patients (3.5%) in SCPR and 4 patients (2.5%) in LCPR group survived at 7 days, both without statistical difference. Factors associated with SCPR operation included Lower BMI, previous hypertension, daytime admission, hands-only compression, and ventilation. SpO2 and P
ET
CO2 were independent factors associated with ROSC, Moreover, in both groups higher SpO2 and P
ET
CO2 levels were associated with a higher rate of ROSC, suggesting that for this specific patient cohort, longer duration of CPR should be considered.

Conclusions:
Longer duration of CPR may need to be emphasize for certain group of patients, particularly those with high SpO2 and PET CO2 during CPR.
Abstract 12723: Smooth Muscle-Derived CD34
+
Cells After Vascular Injury Contribute to Vascular Remodeling
Authors: Xie Yao , Lu Yunrui , Ni Hui , Xiang Meixiang
Published: December 2023

Introduction:
Vascular remodeling after injury participates in several atherosclerotic cardiovascular diseases. Vascular progenitors are thought to play vital roles in vascular remodeling, while the specific contribution of newly-generated progenitors from non-progenitors after injury is neglected.

Methods:
We generated a
Cd34
lineage tracing system and marked newly-generated CD34
+
cells in vascular injury models. Single-cell transcriptomes revealed cellular changes of CD34
+
cells during vascular remodeling. To explore the cell origin of these CD34
+
cells, we applied bone marrow (BM) transplantation, pseudo-time analysis of femoral artery cells, and further generated a smooth muscle (SM) lineage tracing system. To examine the role of Doublecortin Like Kinase 1 (DCLK1) in SM-derived CD34
+
cell generation, overexpression of DCLK1 in primary VSMCs and genetic knockout of DCLK1 in SM lineage tracing system was performed.

Results:
A cluster of CD34
+
cells was identified in femoral artery wire injury, which were CD34 negative before injury but CD34 positive after injury. These newly-generated CD34
+
cells co-expressed VSMC or immune cell markers in neointima. BM transplantation clarified that vascular resident newly-generated CD34
+
cells expressed VSMC makers or CD68, while BM CD34
+
cells turned to immune cells but not VSMCs in neointima. These non-BM newly-generated CD34
+
cells partly derived from VSMCs after injury. DCLK1 expression increased along the VSMCs-to-CD34
+
cells transition. DCLK1 overexpression in VSMCs increased progenitor cell marker expression and decreased contractile VSMC marker expression. Genetic depletion of DCLK1 in VSMCs impaired SM-derived CD34
+
cell generation during vascular remodeling.

Conclusions:
A novel cluster ‘SM-derived CD34
+
cells’ was defined after vascular injury. These findings enriched our knowledge in pathological process of vascular remodeling and provided an avenue for future clinical interventions.
Abstract 12735: Investigating Cardiac Function After Anthracycline Exposure in Childhood Cancer Survivors With Modifiable Cardiovascular Risk Factors
Authors: Souder BriAnna M , George Ian , Meernik Clare , Oeffinger Kevin , Foote Henry , Campbell Michael J , Hildebrandt Michelle , Roth Michael , McCrary Andrew , Landstrom Andrew P
Published: December 2023

Introduction:
Anthracycline exposure can lead to cardiac dysfunction, which may possibly be worsened by secondary cardiovascular risk factors (CVRFs), such as hypertension, hyperlipidemia, obesity and diabetes. The prognostic impact of CVRFs in childhood cancer survivors is largely unknown. Now with advanced cardiac imaging, it is now possible to identify how CVRFs might influence subclinical cardiac function.

Hypothesis:
Anthracycline-exposed childhood cancer survivors with CVRFs will demonstrate echocardiogram-based subclinical cardiac dysfunction more frequently than those without.

Methods:
This is a single-center, retrospective study. Inclusion criteria are:
<
18 years old, history of anthracycline-containing chemotherapy and 2 echocardiograms performed. Exclusion criteria are: congenital cardiac disease, subsequent cancer relapse and inadequate imaging quality. Echocardiographic images were analyzed for longitudinal left ventricular strain, left ventricular ejection fraction (LVEF) and myocardial performance index (MPI). Wilcoxon rank-sum test was used to compare measures of cardiac function between patients with at least one CVRF (at time of cancer diagnosis) and patients without.

Results:
There were 111 patients identified with 49.5% having dysfunction at some point in time. CVRFs were identified in 19 patients with the majority of those being obese (52.6%). At baseline, there was a statistically significant difference in mean strain between those with CVRFs vs those without (-19.4% vs -21.3%). At 1-6 months after chemotherapy completion, LVEF was significantly reduced in those with CVRFs vs those without (48.7% vs 59.7%) as well as mean strain (-15.8% vs -20.0%). At >5 years after chemotherapy, there was a decrease in strain magnitude in those with CVRFs vs those without (-17.7% vs -20.5%) along with abnormal mean MPI (0.57 vs 0.44).

Conclusions:
Anthracycline-exposed pediatric cancer survivors with CVRFs demonstrate reduced cardiac function at baseline and both at near-and long-term follow-up. Further investigation is warranted to investigate the significance of these reduced echocardiographic measures and CVRFs among childhood cancer survivors to mitigate cardiac morbidity as they age into adulthood.
Abstract 12755: Increased Physical Activity and Higher Perceived Social Support Are Associated With Improved Quality of Life in Patients With Heart Disease Reporting Hopelessness
Authors: Alotaibi Maha , Cajita Mia I , Tintle Nathan , Luong Anna , Goodyke Madison , Rivera Stephanie Eleanor , Hrynyk Heather , Dunn Susan L
Published: December 2023

Introduction:
Hopelessness has been identified in up to 52% of patients with ischemic heart disease (IHD). Hopelessness is associated with both decreased self-reported physical activity (PA) and lower perceived social support. Quality of life (QOL) is positively associated with PA and perceived social support in patients with IHD. However, the relationships among PA, perceived social support, and QOL in patients with IHD reporting hopelessness has not been explored.

Purpose:
To examine the associations among PA, perceived social support, and QOL in patients with IHD reporting hopelessness.

Hypotheses:
1) Higher PA and increased perceived social support are each separately associated with higher QOL. 2) PA mediates the relationship between perceived social support and QOL.

Methods:
Data were collected two weeks after hospital discharge from patients with moderate to severe hopelessness using the State-Trait Hopelessness Scale. Perceived social support, PA, and QOL were measured using the ENRICHED Social Support Inventory, Cardiac Rehabilitation Exercise Participation Tool, and EQ-5D-5L, respectively. Linear regression was performed to assess the associations among study variables, controlling for age, gender, marital status, and employment.

Results:
The majority of participants (n = 154) were male (68.2%) and non-Hispanic white (90.9%) with a mean age of 62 years (SD = 9.68). Approximately half of participants were married (53.9%) and not working (55.2%). Higher perceived social support and higher PA were each separately associated with higher QOL after adjusting for demographic variables (perceived social support: r
partial
= 0.23, p = 0.011; PA: r
partial
= 0.23, p = 0.007). PA partially (21.30%) (r
partial
= 0.181, p = 0.040) mediated the relationship between perceived social support and QOL (r
partial
= 0.172, p = 0.066), suggesting that increasing perceived social support may improve PA, thus improving patients’ QOL.

Conclusions:
Our hypotheses of positive association among PA, perceived social support, and QOL were confirmed. Further research in larger, more heterogeneous samples is needed to examine potential causal relationships among PA, perceived social support and QOL in patients with IHD who report hopelessness.
Abstract 12772: In Hospital Outcomes With Extracorporeal Membrane Oxygenation Alone vs Combined With Percutaneous Left Ventricular Assist Device
Authors: Lakhani Fatima , Ebner Bertrand , Kaur Sukhpreet , Colombo Rosario , Munagala Mrudula
Published: December 2023

Background:
Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is often used to support patients with cardiogenic shock. However, it is associated with an increase in systemic afterload which can lead to worsening cardiac function. The use of a percutaneous left ventricular assist device (pLVAD) plus ECMO has emerged as a strategy to offload the left ventricle, with some studies showing improved outcomes.

Hypothesis:
The use of ECMO plus pLVAD is associated with improved outcomes compared to the use of EMCO alone.

Methods:
The National Inpatient Sample was queried from 2011-2018 for relevant ICD-9 and ICD-10 codes to identify patients with cardiogenic shock supported with ECMO or ECMO plus a pLVAD (Ecpella) during the same admission. Baseline characteristics and in-hospital outcomes between groups were compared. Logistic regression was performed to adjust for pre-specified co-variates for outcomes. p-value was considered significant if <0.001.

Results:
Of 20,171 patients with cardiogenic shock supported with ECMO, 16,064 (79.6%) were treated with only ECMO and 4,107 (20.4%) were treated with ECMO plus pLVAD. Patients in the Ecpella group were more likely to be male (72% vs 66%), have a history of hypertension (50% vs 47%), diabetes (21% vs 15%), chronic kidney disease (27% vs 22%), coronary artery disease (54% vs 44%), myocardial infarction (6% vs 4%, p<0.001 for all). Age (55.6 vs 55.2 years (p = 0.09) and rate of atrial fibrillation and flutter were not significantly different. After adjusting for significant variables, patients in the Ecpella group, had higher rates of mortality (OR 1.2; CI [1.1-1.3]), stroke (OR 1.3; CI [1.2-1.5]), and major bleeding (OR 1.5; CI [1.4-1.7], p < 0.001 for all). The rate of inpatient dialysis was lower in the Ecpella group (OR 0.7; CI 0.7-0.8; p < 0.001).

Conclusions:
Cardiogenic shock patients treated with ECMO plus pLVAD had worse outcomes compared to patients treated with ECMO alone. Although it is possible that patients treated with ECMO plus pLVAD had a more critical presentation, further studies are needed to evaluate these findings.
Abstract 12786: Predictors of Intermediate to Long-Term Ventricular Pacing Requirement Following Transcatheter Aortic Valve Replacement
Authors: Feng Emerald , Gehi Anil , Mazzella Anthony , Vavalle John
Published: December 2023

Objectives:
To identify factors associated with persistent atrioventricular (AV) block in patients with permanent pacemaker (PPM) in the peri-transcatheter aortic valve replacement (TAVR) setting.

Background:
Patients undergoing TAVR may develop AV block requiring pacing. However, whether there are patients who recover AV conduction over time is unknown.

Methods:
Patients who underwent TAVR and either had pre-existing PPM implanted for sinus node dysfunction or required PPM implantation during the peri-procedural TAVR period were identified from two hospitals in the University of North Carolina Health system. Demographic, electrocardiographic, echocardiographic, and procedural characteristics were abstracted. PPM data was abstracted from remote and in-person PPM interrogations at intermediate (1-12 mo) and long-term (>12 mo) checks. Patients were separated into cohorts with negligible (<1%) or significant (>1%) ventricular pacing burdens. Bivariable and multivariable analyses were performed to identify factors associated with a significant ventricular pacing requirement.

Results:
The cohort consisted of 159 patients with PPM implanted prior to (n=38) or in the peri-procedural (n=121) TAVR period. Bivariate analyses identified pre-procedural RBBB (17.1% vs 42.9%, p=0.007) and post-procedural RBBB (15.2% and 39.3%, p=0.015) with significant ventricular pacing requirement in the intermediate or long-term period after TAVR. In multivariate analyses, atrial fibrillation (AF) (OR 5, 95% CI 1.78-16.6, p=0.003) and RBBB (OR 11, 95% CI 2.2-100.0, p=.008) in the post-TAVR period were associated with significant ventricular pacing requirements. Patients without AF or RBBB less often required significant ventricular pacing in the intermediate (19.3% vs 80.7%) or long-term periods (19.8% vs 80.2%) after TAVR.

Conclusions:
Post-procedure RBBB or a history of AF predict long-term persistence of AV block post-TAVR. However, patients without RBBB or AF less often require long-term ventricular pacing and may be candidates for temporary or more basic pacing options (e.g. leadless ventricular devices) as necessary in the peri-op period.
Abstract 12793: Atrial Arrhythmias in the Young and Syncope: Insights From the Nationwide Readmissions Database
Authors: Singh Supreet , Agrawal Saloni , Whang William
Published: December 2023

Introduction:
Atrial fibrillation and atrial flutter are two of the most common cardiac arrhythmias in the general population, and have been recognized in patients who present with syncope. Atrial arrhythmias could be a marker for autonomic dysfunction, especially in the younger population. Large database studies investigating the impact of atrial fibrillation and atrial flutter on patients with syncope are lacking. This study aims to utilize the Nationwide Readmissions Database (NRD) to analyze patients admitted with syncope and to compare readmission rates among those with versus without atrial arrhythmias.

Methods:
We queried the 2018 NRD for admissions with a primary diagnosis of syncope in patients aged 18 or older. Admissions were grouped into two cohorts: the atrial fibrillation/atrial flutter (AFF) cohort and the non-AFF cohort. Propensity score matching was used to balance the two groups. The cohorts were analyzed over a 6-month follow-up period using readmission for syncope as the primary outcome. A multivariate cox-regression model was utilized to examine the association between atrial arrhythmias and readmission for syncope.

Results:
7,986 non-AFF index admissions were matched to 8,046 AFF index admissions. Overall, readmission rates between non-AFF and AFF cohorts were similar (2.2% vs 2.1%, p = 0.75), however, young patients (60 or younger) in the AFF cohort had a higher readmission rate than young patients in the non-AFF cohort (6.4% vs 3.2%, p = 0.04). There was a statistically significant interaction between age and atrial arrhythmias; patients aged 60 or younger with atrial arrhythmias were twice as likely to be readmitted for syncope over the 6-month follow-up period (HR: 2.09 (1.07 - 4.09), p = 0.03).

Conclusions:
Increased risk of re-admission for syncope in the younger population with AFF could be an indicator of autonomic dysfunction and warrants further exploration for potential treatments that address this common mechanism.
Abstract 12802: Impact of Atrial Fibrillation on Percutaneous Coronary Intervention With Orbital Atherectomy
Authors: Memon Rahat A , Ramphul Kamleshun , Ravalani Abhimanyu , Kumar Nomesh , Dhaliwal Jasninder , Sombans Shaheen , Bawna Fnu , Dhillon Balkiranjit Kaur , Sakthivel Hemamalini
Published: December 2023

Introduction:
Patients with atrial fibrillation risk various complications following cardiovascular procedures. As there is a lack of data on the disparities in outcomes in atrial fibrillation patients undergoing orbital atherectomy (followed by the percutaneous intervention (PCI)), we aim to bridge this knowledge gap via our study.

Methods:
We queried cases of PCI between 2016-2020 via the National Inpatient Sample. Patients with a code for orbital atherectomy (followed by PCI) were retained as per past studies. We compared patient characteristics between patients with and without atrial fibrillation, and the adjusted odds ratios (aOR) of various complications were studied via logistic regression analysis.

Results:
Our analysis found 20710 patients (ages 18 and more) who underwent orbital atherectomy between 2016-2020 in the United States, which included 5250(25.4%) of cases with atrial fibrillation. Compared to cases without atrial fibrillation, patients with atrial fibrillation undergoing orbital atherectomy showed higher odds of various complications such as acute ischemic stroke (AIS) (aOR 1.507, p<0.01), sepsis (aOR 1.389, p<0.01), pericardial effusion (aOR 1.931, p<0.01), major bleeding (aOR 1.423, p<0.01), cardiogenic shock (aOR 1.258, p<0.01), acute kidney injury (AKI) (aOR 1.438, p<0.01), and mortality (aOR 1.298, p<0.01). While fewer cases of coronary artery dissections were noted among patients with atrial fibrillation (2.0% vs. 2.3%), the results were not statistically significant (aOR 0.862, p=0.256).

Conclusions:
Atrial fibrillation predisposed patients undergoing orbital atherectomy to poorer outcomes, including AKI, AIS, sepsis, pericardial effusion, major bleeding, cardiogenic shock, and death. Physicians must therefore address this issue via proper screening for cardiac arrhythmias pre- and post-procedure and maintain a close follow-up in at-risk individuals.
Abstract 12810: Short-Term Hospital Outcomes of Elderly Patients With Mechanical vs. Bioprosthetic Heart Valves Admitted for NSTEMI
Authors: Memon Rahat A , Ramphul Kamleshun , Ravalani Abhimanyu , Dhaliwal Jasninder , Kumar Nomesh , Ramphul Yogeshwaree , Sombans Shaheen , Bawna Fnu , Lohana Petras , Sakthivel Hemamalini
Published: December 2023

Introduction:
Valvular heart disease(VHD) is a significant cause of morbidity and mortality among the elderly. While the use, merits, and demerits of mechanical heart valves (MHV) and bioprosthetic heart valves(BHV) to treat VHD are well-documented in the literature, there needs to be more data on the outcomes following events of NSTEMI.

Methods:
We explored the 2016-2020 National Inpatient Sample for patients ages≥60 years hospitalized for a primary diagnosis of NSTEMI via their ICD-10 codes. We further retained those with a presence of MHV or BHV, and differences in outcomes between the two groups were evaluated.

Results:
Our study found 32775 adults of age 60 and more hospitalized with NSTEMI, which included 23670 (72.2%) cases with MHV, while 9105 (27.8%) patients had a BHV. No differences in mean Charlson Comorbidity Index (CCI) scores were found between the two groups (mean CCI in MHV patients: 4.14 vs. 4.22 in those with BHV, p=0.233). Compared to cases with BHV, those with MHV showed higher odds of acute kidney injury (aOR 1.108, p<0.01), atrial fibrillation (aOR 1.110, p<0.01), supraventricular tachycardia (aOR 1.46, p<0.01), and use of CABG (aOR 1.289, p=0.031). However, patients with MHV were less likely to undergo PCI for NSTEMI than those with BHV (aOR 0.781, p<0.01). No differences between the two cohorts were found for events of ventricular tachycardia (aOR 0.907, p=0.072), ventricular fibrillation (aOR 1.021, p=0.80), cardiogenic shock (aOR 1.012, p=0.876), or death (aOR 0.928, p=0.187). Finally, those with MHV reported a slightly more extended stay (mean length of stay 4.41 days) than those with BHV (mean length of stay 4.02 days, p<0.01).

Conclusions:
Patients with MHV showed higher odds of complications such as AKI, Atrial fibrillation, supraventricular tachycardia, and use of CABG following NSTEMI while reporting lower odds of PCI use than those with BHV.
Abstract 12816: Changes in Self-Care and Quality of Life After Hospitalization for Coronary Heart Disease
Authors: Ingadottir Brynja , Svavarsdottir Margret H , Jurgens Corrine Y , Lee Christopher S
Published: December 2023

Background:
Self-care is an important part of secondary prevention for patients with coronary heart disease (CHD). But, we know little about how CHD self-care influences quality-of-life (QOL) over time.

Hypothesis:
Changes in CHD self-care would be associated with changes in QOL.

Aims:
Identify distinct trajectories of change in self-care following a hospitalization for CHD that were associated with significant differences in QOL over time.

Methods:
Longitudinal study (Iceland). Patients completed surveys at hospital discharge and 6 months later. Self-care was measured with the Self-Care of CHD Inventory (maintenance and management scores = 0-100, higher=better) and QOL was measured with the SF-12 (physical and mental QOL = 0-100, higher=better). Growth mixture modeling was used to identify trajectories of CHD self-care behaviors.

Results:
A total of 373 patients (mean age 64.3±8.9, 79% male) completed the study. Two trajectories of CHD self-care were identified. The first one (57.2% of the sample - solid line - “Inadequate and Worsening”) had comparatively worse self-care at both timepoints; maintenance improved but management got significantly worse over time (-6.3±24.4 points, p=0.005). The second trajectory (42.8% of the sample - dashed line - “Adequate and Maintaining”) had comparatively better self-care at both timepoints; maintenance improved significantly (+5.0±16.2 points, p<0.001), and management was unchanged over time (+0.8±21.9 points, p=0.713). Participants in both trajectories had significant improvements in their physical and mental QOL (both p<0.001) over time (
Fig. 1
). Participants in the first trajectory had comparatively worse physical and mental QOL at both timepoints (all p<0.05).

Conclusion:
Two distinct trajectories of self-care were identified and linked to significant differences in QOL following a hospitalization for CHD. Care models that focus on improving self-care skills might also improve QOL of patients with CHD.
Abstract 12817: The Mediator Role of Physical Function in the Relationship Between Caregiver Contribution to Self-Care and Caregiver Quality of Life in Heart Failure
Authors: Heo Seongkum , An Minjeong , KIM SUN HWA , Kang JungHee , Cho KyungAh , Yang jisun , Kim JinShil
Published: December 2023

Introduction:
Caregivers of patients with heart failure (HF) commonly show reduced physical function and quality of life (QOL). Caregiver contribution to self-care maintenance (CC-SC maintenance) may result in reduced physical function, and, in turn, poor QOL. However, these relationships have not been tested in caregivers of patients with HF.

Aim:
To test the mediating role of physical function in the relationship of CC-SC maintenance to caregiver QOL in HF.

Hypothesis:
Physical function mediates the relationship between CC-SC maintenance and caregiver QOL in caregivers of patients with HF, controlling for covariates (i.e., age, marital status, relationship to patient, comorbidity, depressive symptoms, and caregiver confidence to self-efficacy).

Methods:
In this cross-sectional, correlational study, data on physical function (Korean Activity Status Index), CC-SC maintenance (Caregiver Contribution to Self-care Maintenance), caregiver confidence to self-care (Caregiver Confidence in Contributing to Self-care Scale), caregiver QOL (EuroQol Quality of Life Scale), depressive symptoms (Patient Health Questionnaire-9), and sociodemographic characteristics (Sociodemographic Questionnaire) were collected from 92 caregivers of patients with HF (mean age = 53.8) from 4 hospitals in South Korea. PROCESS macro for SPSS was used to test the hypothesis.

Results:
CC-SC maintenance was associated with caregiver QOL indirectly through the effect on physical function. Higher levels of CC-SC maintenance (p = .021) were significantly associated with poorer physical function, and poorer physical function (p < .001), but not CC-SC maintenance (p = .362), was significantly associated with poorer caregiver QOL (F = 7.021, R
2
= .435, p < .001), controlling for the covariates (standardized indirect effect = -.105, bootstrap 95% CI = -.217, -.017).

Conclusions:
The findings of this study supported the hypothesis. Physical function was a mediator in the relationship between CC-SC maintenance and caregiver QOL, implying that CC-SC maintenance was associated with QOL only indirectly through the effects on physical function. Healthcare providers should consider CC-SC maintenance and physical function of caregivers at the same time to improve their QOL.
Abstract 12837: Studies of Suboptimal Low Density Lipoprotein Reduction Following Lipid Lowering Therapy on Cardiovascular Outcomes in Patients With Acute Coronary Syndrome
Authors: FUJIOKA SHIMPEI , Shishikura Daisuke , Morita Hideaki , Shiba Mariko , Hoshiga Masaaki
Published: December 2023

Introduction:
Current guidelines advocate achieving a fixed LDL-C target and attaining a more than half reduction of LDL-C levels. As the heterogeneity of response to lipid lowering therapy, effective LDL-C reduction is not achieved even in patients achieved a fixed LDL-C target.

Aims:
This study ought to investigate the clinical impact of suboptimal LDL-C reduction following lipid lowering therapy on cardiovascular outcomes in patients with acute coronary syndrome.

Methods:
A total of 561 consecutive ACS patients undergone PCI with measurement of LDL-C levels at the index of admission and 12 months after PCI were enrolled in the study. Based on the current guidelines, <50% LDL-C reduction within 12 months were defined as suboptimal LDL-C reduction. The relationship between the suboptimal LDL-C reduction and cardiovascular events including the composite of cardiac death, myocardial infarction, target vessel reperfusion, and stent thrombosis was evaluated.

Results:
In the current study, under the use of lipid-lowering therapies (statin: 84.1 %; high intensity statin: 18.9 %, ezetimibe: 24.8 % and PCSK9 inhibitor: 1.2 %), 24.6 % of study population exhibited LDL-C <1.4 mmol/L at 12 month after the index of PCI and 24.2 % achieved more than half reduction of LDL-C within 12 months. There were no significant differences in cardiovascular events between 2 groups according to LDL-C < 1.4 mmol/L (23.2 % - 17.4 %, P = 0.15), whereas the MACEs were higher in the suboptimal reduction group than the optimal reduction group (24.9 % - 11.8 %, P= 0.007). Of note, even in patients with LDL-C <1.4 mmol/L, the MACEs were highly observed in the suboptimal reduction group than the optimal reduction group (25.0 % - 12.4 %, P= 0.04). Multivariate analysis adjusting baseline LDL-C, HbA1c, sex and age revealed that suboptimal LDL-C reduction was an independent predictor of cardiovascular outcomes (HR: 0.7, 95% CI: 0.49-0.90).

Conclusions:
In addition to a fixed LDL-C target, more than half reduction of LDL-C following lipid lowering therapy is another relevant potential to reduce cardiovascular outcomes in patients with ACS.
Abstract 12839: Anti-Thrombotic Therapy, Bleeding, and Mortality in Patients With Acute Myocardial Infarction and a History of Cancer: A Report From JAMIR, the Multi-Center, Nationwide Prospective Registry
Authors: Adachi Ayumi , Oyama Kazuma , Takahashi Jun , Honda Satoshi , Kensaku Nishihira , Kojima Sunao , Takegami Misa , Asaumi Yasuhide , Yamashita Jun , Saji Mike , Hibi Kiyoshi , Sakata Yasuhiko , Takayama Morimasa , Sumiyoshi Tetsuya , Ogawa Hisao , Kimura Kazuo , Yasuda Satoshi
Published: December 2023

Background:
The relationship between a history of cancer and clinical outcomes including bleeding in acute myocardial infarction (AMI) patients remains unclear in a contemporary cohort.

Aims:
This study aimed to analyze clinical outcomes of patients following AMI according to the history of cancer.

Methods:
Consecutive patients with spontaneous onset of AMI were enrolled between December 2015 and May 2017 at 50 institutions in the Japan AMI Registry (JAMIR), a multi-center, nationwide prospective registry. The outcomes of interest were all-cause death, major bleeding defined as BARC type 3 or 5, and composite ischemic events defined as cardiovascular (CV) death, MI, and ischemic stroke.

Results:
A total of 3,411 AMI patients were enrolled, and followed for a median of 358 days. Among those, 292 patients (8.6%) had a history of cancer. They were older, had more comorbidities, and were more likely to use clopidogrel but not prasugrel than those without. They had a similar risk of composite ischemic events, and major bleeding compared with those without, whereas were at higher risk for all-cause mortality (adjHR 1.64 [95% CI 1.16-2.32], P=0.005;
Figure 1
). While no between-group difference in CV death was observed, non-CV death and death due to cancer were higher in the cancer group than in the no-cancer group (adjHR 2.05 [95% CI 1.24-3.39], P=0.005; adjHR 18.16 [95% CI 6.74-48.97], P<0.001, respectively;
Figure 2
). When further stratified by age, the difference in all-cause mortality became pronounced in the group aged<75 years but not in the group aged>75 years (adjHR 3.32 [1.88-5.85] and 1.26 [0.81-1.96], respectively; P for interaction=0.008;
Figures 1
and
3
).

Conclusion:
The nationwide multi-center registry, JAMIR demonstrated that a history of cancer was associated with increased mortality in AMI patients aged<75 years. These results might suggest the need for a multidisciplinary approach to improving the prognosis of younger AMI patients with a history of cancer.
Abstract 12840: Left Atrial Enlargement is a Useful Predictor for Incident Heart Failure in Atrial Fibrillation Patients Without Pre-Existing Heart Failure
Authors: Hamatani Yasuhiro , Iguchi Moritake , Ishigami Kenjiro , Ikeda Syuhei , DOI KOSUKE , Yoshizawa Takashi , Ide Yuya , Fujino Akiko , Ishii Mitsuru , Masunaga Nobutoyo , Abe Mitsuru , Akao Masaharu
Published: December 2023

Background:
Atrial fibrillation (AF) increases the risk of heart failure (HF). However, little focus has been placed on the risk stratification for HF in AF patients.

Hypothesis:
Left atrial diameter (LAD) is a simple prognostic parameter in patients with HF. We hypothesized that LAD is a useful predictor for incident HF in AF patients even without pre-existing HF.

Methods:
The Fushimi AF Registry is a community-based prospective survey of AF patients in Fushimi-ku, Japan. After excluding patients with pre-existing HF (defined as having one of the following; prior HF hospitalization, New York Heart Association class ≥2, or left ventricular ejection fraction <40%), we investigated 2,464 patients with the data of LAD at enrollment. We divided the patients into 4 groups stratified by LAD (<40 mm, 40-44 mm, 45-49 mm, and ≥50 mm), and compared the backgrounds and incidence of HF hospitalization between the groups.

Results:
Of 2,464 patients (mean age: 72±11 years, female: 919 [37%], paroxysmal AF: 1,405 [57%], and mean CHA2DS2-VASc score: 3.0±1.6), the mean LAD was 42±8 mm (<40 mm: 1007 [41%], 40-44 mm: 650 [26%], 45-49 mm: 467 [19%] and ≥50 mm: 340 [14%], respectively). Patients with larger LAD had a higher prevalence of elderly and non-paroxysmal AF, and had a higher CHA2DS2-VASc score (all P<0.001). During the median follow-up of 6.0 years, 260 patients (11%) were hospitalized for HF (annual incidence: 1.8% per person-year). Kaplan-Meier curves revealed that LAD was able to stratify the incidence of HF hospitalization in AF patients without HF (Figure). Multivariable Cox regression analysis demonstrated that larger LAD were independently associated with the risk of HF after adjustment by age, sex, AF type, and CHA2DS2-VASc score (Figure).

Conclusion:
Larger LAD was significantly associated with the higher incidence of HF hospitalization in AF without pre-existing HF, suggesting the utility of LAD regarding the risk stratification for HF in these patients.
Abstract 12848: Edaravone Dexborneol Protects Against Cerebral Ischemia/Reperfusion -Induced Blood-Brain Barrier Dysfunction by Inhibiting Ferroptosis via Activation of Nrf-2/HO-1/GPX4 Signaling
Authors: Xiao Peng , Zhao Hanshu , Liu Ruijia , Sun Zhiyu , Liu Yushuang , Chen Nan , Zhang Zhongling
Published: December 2023

Background and aims:
The blood-brain barrier (BBB) is a pivotal factor in the pathogenesis of cerebral ischemia-reperfusion (I/R) injury. Edaravone dexborneol (Eda.B) is a novel cytoprotective drug widely employed in ischemic stroke (IS). Recent research implicated ferroptosis in BBB disruption during cerebral ischemia. This study aimed to investigate the protective effects of Eda.B on the BBB in I/R from the standpoint of ferroptosis, exploring potential mechanisms and targets.

Methods:
An I/R model in Sprague-Dawley rats was established, and we assessed the effects of Eda.B by evaluating infarct volume, cellular apoptosis, and neurofunctional recovery through TTCstaining, TUNEL staining, and modified Garcia scoring system, respectively. The protective effects of Eda.B on BBB integrity was evaluated via Evans blue leakage measurement and protein expression of both ZO-1 and occludin. Additionally, we explored the correlation between ferroptosis and BBB integrity. Western blot analysis and immunohistochemical detection were used to detect changes in the expression levels of related proteins.Meanwhile the information of microscopic structural changes observation, GSH and MDA level measurements, and Fe
2+
tissue content determination were recorded. Bioinformatics analysis was also performed to probe the mechanisms of ferroptosis in BBB injury induced by cerebral ischemia, and we detected the expression of related proteins in the Nrf-2/HO-1 signaling pathway through western blot analysis.

Results:
Our findings revealed that Eda.B treatment enhanced neuro scores, diminished infarct volumes and cellular apoptosis, while ameliorated BBB integrity. Furthermore, expression of ZO-1, occludin, GPX4, and xCT protein expression was up-regulated, while 4-HNE expression was reduced in the Eda.B group. Eda.B also led to decreased MDA and Fe
2+
levels in the ipsilateral brain tissues, while GSH content was increased. Ultimately, an elevated expression of proteins associated with the Nrf-2/HO-1 signaling pathway has been discovered.

Conclusions:
Our study indicated that Eda.B safeguarded the blood-brain barrier (BBB) from cerebral I/R injury by inhibiting ferroptosis through the activation of the Nrf-2/HO-1/Gpx4 signaling pathway.
Abstract 12855: Early vs. Late Transcatheter Aortic Valve Replacement in Acute Heart Failure Hospitalizations: National Inpatient Sample (2015-2020)
Authors: Hashem Anas , Khalouf Amani , Mohamed Mohamed Salah , Ismayl Mahmoud , Kashou Anthony H , Rai Devesh , Depta Jeremiah , balla sudarshan , Sulaiman Samian , Bhatt Deepak
Published: December 2023

Introduction:
Data on clinical outcomes of early transcatheter aortic valve replacement (TAVR) (<48 hours) compared to late (≥48 hours) TAVR in patients hospitalized with acute heart failure (AHF) and aortic stenosis (AS) remains limited. We aim to evaluate the differences between early vs. late TAVR regarding major clinical outcomes using a real-world US database.

Hypothesis:
There is no differences in the clinical outcomes based on the timing of TAVR procedural intervention in patients with acute heart failure.

Methods:
We used the National Inpatient Sample database by utilizing ICD-10 codes to identify all hospitalizations with a diagnosis of AHF and TAVR (2015-2020). The associations between the time of TAVR and outcomes were examined using multivariable logistic regression. Propensity-score matched (PSM) analysis was utilized to determine the adjusted odds ratio (aOR) of major clinical outcomes.

Results:
A total of 25,285 weighted hospitalizations of AHF were identified, of which 6,855 patients (27.1%) underwent early TAVR and 18,430 (72.9%) had late TAVR. Compared with early TAVR, Late TAVR was associated with less need for mechanical circulatory support (MCS) (aOR 0.97 [0.96-0.98], p<0.01) and acute hypoxic respiratory failure (aOR 0.99 [0.98-0.99], p<0.01), but higher odds of developing septic shock (aOR 2.06 [1.52-2.80], p <0.01). However, there was no significant difference between both procedures regarding in-hospital mortality (aOR 1.01 [1.00-1.02], p=0.14), cardiac arrest (aOR 0.99 [0.98-1.00], p=0.21), and stroke (aOR 1.01 [1.00-1.02], p=0.18).

Conclusions:
Most patients with AHF and AS undergo TAVR after 48 hours of their presentation. After PSM, there was no difference in inpatient mortality, cardiac arrest, and stroke between both procedures. Late TAVR was associated with lower odds for MCS and acute hypoxic respiratory failure. The optimal timing of TAVR in patients with AHF and AS needs further study.
Abstract 12881: Lnc(RNA)-ing COX-2 and Cardioprotection: A PACERR Story
Authors: Hennessy Elizabeth J , Fitzgerald Garret A
Published: December 2023

NSAIDs are amongst the most commonly used drugs by adults, but their use is complicated by an increased risk of adverse cardiovascular events that are consequent to suppression of cyclooxygenase-2 (COX-2) dependent prostaglandin (PG) formation, particularly prostacyclin (PGI
2
). Amongst the mechanisms HDL may help to mediate cardiovascular risk is via its regulated expression of COX-2 and production of PGI
2
by vascular cells. This affords restraint on thrombogenesis, atherogenesis and hypertension. Another might be to accelerate cholesterol efflux by macrophages in the atherosclerotic plaque. Depletion of COX-2 has been reported to reduce efflux coincident with an altered HDL phenotype that fosters atherogenesis. Long non-coding RNAs (lncRNAs) contribute to the regulation of essential cellular processes, such as the progression of cardiovascular disease. Through the investigation of lncRNAs involved in the cellular response to HDL we have uncovered a regulatory role for a lncRNA encoded on the opposite strand of COX-2, called PACERR. Examining the human GTEx database, we found PACERR is most highly expressed in vascular tissues including aorta with several
cis
-eQTLs modulating aortic PACERR expression. Patients in the Penn Medicine Biobank with these SNPs exhibit an increase in odds ratio towards vascular inflammatory traits including polyarteritis nodosa (PAN). HDL induces the expression of PACERR in vascular cells, signifying its potential role in mitigating risk towards cardiovascular disease phenotypes. Using gain-and-loss of function approaches we have found that PACERR modulates HDL induced COX-2 and prostaglandin formation by smooth muscle and endothelial cells under flow as well as HDL mediated cholesterol efflux by macrophages via the regulation of the cholesterol transporter ABCG1. By modulating the expression of PACERR in vitro and in vivo, we have elucidated a mechanism by which both HDL and COX-2 have a linked cardio-protective effect contributing to our understanding of the heterogeneous effects of current drugs used to raise HDL cholesterol levels and the cardiotoxicity of NSAIDs observed in clinical trials.
Abstract 12885: Pathological Perk/Atf4 Activation in Abdominal Aortic Aneurysm Formation
Authors: Zhang Hongyu , Mangum Kevin D , Joshi Amrita , Callow Brennan , Xing Xianying , Tsoi Lam C , O'Riordan Mary , Gudjonsson Johann , Gallagher Katherine A , Davis Frank M
Published: December 2023

Introduction:
Abdominal aortic aneurysms (AAA) are characterized by vascular smooth muscle cell (VSMC) apoptosis leading to pathological aortic remodeling. Activation of the endoplasmic reticulum (ER) stress response has been linked to VSMC dysfunction but the driving factors behind ER stress activation and its role on AAA development remains poorly defined. The epigenetic enzyme, MLL1, plays a critical role in establishing cellular phenotype and regulating gene expression. We examine the MLL-mediated epigenetic regulation of the ER stress response in VSMCs during AAA development and establish the ER stress pathways as a novel target in the treatment AAAs.

Methods:
Single-cell sequencing was conducted on human AAA and control tissue samples. For our murine model, C57BL/6 mice were injected with an AAV encoding a PCSK9 gain-of-function mutation and then fed a saturated fat-enriched diet and infused with AngII (1 μg/kg/min) with or without 4-PBA (20mg/kg/day). The elastase induced AAA model was used as a secondary murine model. AAA maximum diameters were quantified and VSCMs were isolated.
Eif2a, Atf4
, and Chop
gene expression was examined. Apoptosis was quantified by Annexin V staining.

Results:
Using single-cell RNA sequencing of human aortic tissue, we identified
EIF2A, ATF4
, and
CHOP
were profoundly upregulated in aneurysmal VSMCs as well as two murine AAA models. Mechanistically, TNFα signaling in VSMCs leads to activation of MLL1 which trimethylates histone 3 lysine 4 (H3K4me3) at NF-κB binding sites on the
EIF2A
and
ATF4
gene promoters thereby upregulating the ER stress response and driving VSMC apoptosis.
In vivo
pharmacological inhibition of the eIF2A/ATF4 ER stress response via 4-PBA injection inhibited AAA formation in both the AngII-induced and elastase-induced AAA model resulting with in significant reduction in VSMC apoptosis, elastin fragmentation, and inflammatory cytokine infiltration.

Conclusions:
Taken together, our results identify MLL1-mediated activation of the eIF2A/ATF4 ER stress response as a critical regulator of VSMC apoptosis in AAA formation and suggest inhibition of ER stress response as a mechanistic target for the management of AAAs.
Abstract 12887: Cyclin D2 Overexpressing and Hypoimmunogenic Cardiomyocyte Spheroid Transplantation Induced Endogenous Myocardial Regeneration in the Pig Heart After Myocardial Infarction
Authors: Wei Yuhua , Walcott Greg , Nguyen Thanh , Geng Xiaoxiao , Guragain Bijay , Zhang Hanyu , Green Akazha , Rogers Jack , Ye Lei , Zhang Jianyi J
Published: December 2023

Background:
hiPSCs derived cardiomyocytes (hiPSC-CMs) have very low proliferative capacity, while patient hiPSC-CMs may have disease phenotypes which compromise therapeutic efficacy and allogenic hiPSC-CMs are expected to induce an immune response during clinical use. In order to solve these problems, we established a hiPSC line by knocking-out two components of the human leukocyte antigen (HLA) and over-expressing myosin heavy chain driven cyclin D2 (CCND2) systems in hiPSCs (
HLA-KO/CCND2-OE
hiPSCs).

Aim:
To determine the therapeutic efficacy and mechanism of the xeno-transplantation of
HLA-KO/CCND2-OE
hiPSCs derived cardiomyocytes (
HLA-KO/CCND2-OE
hiPSC-CMs) in the pig hearts after myocardial ischemia/reperfusion (IR).

Methods and Results:
HLA-KO/CCND2-OE
hiPSC-CM spheroids were differentiated in shaking flasks. Purified
HLA-KO/CCND2-OE
hiPSC-CM spheroids were intramyocardially injected into pig hearts after IR (the Spheroid Group), while control animals received basal medium injection (the IR Group). Cardiac magnetic resonance imaging (cMRI) showed that pig heart function improved significantly compared to the IR Group at 4 weeks after IR. This finding was associated with a dramatical reduction in the scar size as determined by late gadolinium enhancement measurement. Immunohistology showed that significantly increased porcine CMs expressed cell proliferation markers, such as Ki67, phospho-histone 3 (pH3), and symmetrical Aurora B, and abundant YAP protein expression in porcine CM nuclei in the porcine hearts of the Spheroid Group compared to the IR Group at 1 week after IR. Western Blot analysis of pig heart tissue showed significantly reduced expression of phospho-YAP in the Spheroid Group. snRNAseq showed that number of cycling porcine CMs was > 5 folds in the Spheroid Groups than that in the IR Group. Angiogenic microarray showed that
HLA-KO/CCND2-OE
hiPSC-CM spheroids produced abundant follistatin which induced YAP protein expression and cytokinesis in CMs.

Conclusions:
Transplantation of
HLA-KO/CCND2-OE
hiPSC-CM spheroids effectively recovered porcine heart function, reduced scar size, and induced porcine CM proliferation through modulating YAP protein expression by follistatin secreted by transplanted cells.