bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 13436: Sex-Specific Predictors of Postoperative Atrial Fibrillation and the Role of Cardiometabolic Diseases
Authors: Paquin Amelie , Roberge Jeanne , Voisine Pierre , Clavel Marie-Annick A , Poirier Paul , Piche Marie E
Published: June 2023

Introduction:
Cardiometabolic diseases increase the risk of postoperative atrial fibrillation (POAF), which in turn is associated with higher long-term risk of major cardiovascular events (MACE). Little is known regarding the sex-specific impact of cardiometabolic diseases on POAF risk. We evaluated the sex-specific predictors of POAF after coronary artery bypass grafting (CABG), with a focus on preoperative cardiometabolic profile.

Methods:
In a prospective registry of patients undergoing isolated CABG (2006-2019), we compared predictors of POAF between sexes. We excluded patients with previous AF history, redo/urgent/off-pump CABG, perioperative mortality, and permanent pacemakers/defibrillators. Abdominal obesity was defined as a waist circumference (WC) >102 cm (men [M]) or >88 cm (women [W]).

Results:
We included 7,851 patients (19% women). Baseline characteristics are presented in Table 1. POAF occurred in 27% of women and 31% of men (p<0.01). Women were older and had a higher prevalence of comorbidities, abdominal obesity and a worse lipid profile. In a logistic regression model adjusting for the variables in Table 1, men had a higher risk of POAF (OR
M
= 1.4 [1.2-1.6], p<0.01). When stratifying by sex, significant predictors (p<0.05) of POAF for both sexes were age, WC (OR
M
= 1.04 [1.00-1.08]; OR
W
= 1.01 [1.00-1.03]), and triglycerides (TG) (OR
M
= 0.98 [0.97-0.99]; OR
W
= 0.97 [0.95-0.99]). Sex-specific predictors were creatinine for women and beta-blockers, extracorporeal circulation time, intensive care stay and hemoglobin for men.

Conclusions:
Women had less POAF but worse preoperative cardiometabolic profile compared to men. WC was a strong predictor of POAF for both sexes, while higher TG levels were protective. Since POAF is linked to future risk of MACE, the preoperative clinical assessment of WC should be encouraged and targeted for preventive strategies, especially in women. More studies are needed to investigate the role of TG in POAF.
Abstract 13451: Cardiovascular Complications During Delivery Admissions Associated With Assisted Reproductive Technology: A National Inpatient Sample Analysis (2008-2019)
Authors: Zahid Salman , Hashem Anas , Minhas Anum A , Harrington Colleen , Quesada Odayme , Aggarwal Niti R , Shufelt Chrisandra , Baker Valerie , Michos Erin D
Published: June 2023

Introduction:
Persons who conceived through Assisted Reproductive Technology (ART) have an increased risk of obstetric-associated complications.

Hypothesis:
ART is associated with increased acute cardiovascular (CV) complications during delivery admissions.

Methods:
We used data from the National Inpatient Sample (2008-2019) while utilizing ICD-9 or ICD-10 codes to identify delivery hospitalizations and ART procedure.

Results:
A total of 45,867,086 weighted delivery cases were identified, of which 0.24% were among individuals who conceived through ART (n=108,542). Persons with an ART history were older at the time of delivery (median 35 vs. 28 years, p<0.01) and had higher prevalence of hypertension, gestational diabetes, and dyslipidemia (all, p<0.01). After adjustment for age, race/ethnicity, comorbidities, multiple gestation, insurance, and income, ART remained an independent predictor of peripartum CV complications including preeclampsia (aOR 1.48 [1.45-1.51], p<0.01), heart failure (aOR 1.94 [1.10-3.40], p<0.01), and cardiac arrhythmias (aOR 1.39 [1.30-1.48], p<0.01) compared to natural conception. Likewise, the risk of acute kidney injury (aOR 2.57 [2.25-2.92], p<0.01), stroke (aOR 1.57 [1.23-2.01], p<0.01), pulmonary edema (aOR 2.29 [2.02-2.61], p<0.01), and venous thromboembolism (aOR 1.92 [1.63-2.25], p<0.01) were higher with ART. However, higher odds of developing peripartum cardiomyopathy or acute coronary syndrome were not associated with ART. Length of stay (3 vs. 2 days, p<0.01) and cost of hospitalization ($5,903 vs. $3,922, p<0.01) were higher for deliveries among persons with history of ART.

Conclusions:
Persons who conceived with ART had higher risk of preeclampsia, heart failure, cardiac arrhythmias, pulmonary edema, AKI, stroke, and VTE during their delivery hospitalizations. This may in part contribute to increased resource utilization seen in patients conceiving with ART
Abstract 13519: 4D Cardiac Magnetic Resonance Strain Associates With Mortality in Duchenne Muscular Dystrophy Associated Cardiomyopathy
Authors: Earl Conner C , Soslow Jonathan H , Markham Larry W , Goergen Craig J
Published: June 2023

Introduction:
Cardiomyopathy (CM) is the leading cause of death in Duchenne muscular dystrophy (DMD) but the pace of CM progression is variable. Identification of biomarkers that associate with mortality could allow clinicians to intensify cardiac therapy. Our
objective
was to determine whether novel 4D (3D+time) cardiac magnetic resonance (CMR) strain analysis predicts mortality.

We hypothesized that the magnitude of regional surface strain (E
a
) would be significantly decreased in DMD patients that progressed to mortality within 5 years of analysis.

Methods:
Short axis cine CMR images for DMD survival (n=40) and non-survival (n=9) groups were compiled into 4D sequences. For all 4D sequences, epi- and endocardial borders were segmented across one cardiac cycle for kinematic analysis using a custom-built MATLAB graphical user interface (MathWorks, Natick, MA). Regional E
a
was measured by determining the relative change in the localized 4D endocardial surface mesh compared to end diastole. Unpaired t-test was used to determine statistical significance.

Results:
DMD survival patients were younger (13 years [8-24]; median [range]) than non-survival patients (16[12-19]) and a smaller portion had LVEF<55% (11 (28% of total) vs. 6 (67% of total). 63% (n=26) of the survival group had late gadolinium enhancement vs. 100% (n=9) in the non-survival group. Median time to mortality for the non-survival group was 27 months [8-58]. Peak E
a
was significantly worse in the non-survival group globally and in the basal, mid, and apical regions (
p
<0.001 for all; Fig1C). Qualitative E
a
maps show dramatic differences between groups (Fig1A,B).

Conclusion:
Regional E
a
from 4D CMR in DMD was reduced in patients that progressed to mortality within 5 years compared to those that survived.

Figure 1:
Example colorized surface strain (E
a
) from A) survival and B) non-survival patients in both polar map (left) and 3D representations (right). C) Regional E
a
differences between groups. *
p
<0.001.
Abstract 13576: Stereotactic Cardiac Radiotherapy Reduces Structural Heart Disease Associated Refractory Ventricular Tachycardia - A Metaanalysis
Authors: Chaaban Nourhan , Ranka Sagar , Carlson Cameron , Sami Farhad , Akhavan David , Sheldon Seth H , Reddy Madhu , Noheria Amit
Published: June 2023

Introduction:
Cardiac stereotactic body radiotherapy (SBRT) is a paradigm changing treatment for refractory ventricular tachycardia (VT) in patients with structural heart disease. We sought to review the effectiveness of SBRT reported in published studies.

Hypothesis:
There is a reduction in VT events after cardiac SBRT.

Methods:
We performed a comprehensive literature search in PubMed, Embase and Google Scholar including all studies on cardiac SBRT for VT till May 2022. Efficacy was evaluated as random-effects pooled rate ratios (RR) of VT episodes, antitachycardia pacing (ATP) therapies and implantable cardioverter-defibrillator (ICD) shocks post-SBRT (after 6-week blanking) vs. during 3-12 months pre-SBRT, with patients serving as their own controls.

Results:
We included 12 single-arm studies on cardiac SBRT (90 patients) published 2017-2022 with median follow-up ranging 6-28 months. The pooled RR of VT episodes, ATP therapies and ICD shocks post- vs. pre-SBRT were 0.11 (95% CI 0.06-0.21, p<0.001), 0.09 (95% CI 0.04-0.20, p<0.001), and 0.10 (95% CI 0.05-0.19, p<0.001) as shown in Figure 1. There was significant heterogeneity in results (p<0.00001 for all 3 endpoints). The combined 1- and 2-year overall patient survival was 69% and 56% respectively (Figure 2).

Conclusions:
Cardiac SBRT reduces recurrent VT episodes and ICD shocks in patients with VT refractory to medical therapy and catheter ablation. There is heterogeneity in results from different studies, likely related to differences in patient selection and treatment techniques. The overall patient survival in this high-risk population compares favorably to data from catheter ablation trials.
Abstract 13585: In Patients With Right Bundle Branch Block, ECG Z-Axis QRS-T Voltage-Time-Integral Predicts Right Ventricular Structure and Function
Authors: Fairbank Tyan , DeBauge Ashley , Harvey Christopher J , Ranka Sagar , Jiwani Sania , Sheldon Seth H , Reddy Madhu , Beaver Timothy A , Noheria Amit
Published: June 2023

Introduction:
Right bundle branch block (RBBB) is the most common His-Purkinje conduction abnormality seen on ECG. It is currently unclear if there are any quantitative ECG differences in RBBB without and with structural right ventricular (RV) disease. Our aim was to evaluate quantitative ECG predictors of echocardiographic RV measurements [tricuspid annular plane systolic excursion (TAPSE), tissue Doppler imaging RV S’, RV basal and mid diameters, RV systolic pressure (RVSP)].

Hypothesis:
QRS-T VTI in patients with RBBB is a marker for adverse RV remodeling and dysfunction.

Methods:
We included adults with ECG demonstrating typical RBBB and echocardiogram performed within 3 months of each other in 2010-2020. Orthogonal X, Y, Z ECG leads were reconstructed using Kors matrix. In addition to overall QRS duration, QRS voltages and QRS/QRS-T VTIs from 12 standard leads, X, Y, Z leads, and 3D (root-mean-square) ECG were evaluated. Age, sex and BSA-adjusted linear regressions were used to assess associations between ECG variables and RV measurements. We separately generated ROC curves for predicting abnormal RV measurements from ECG variables.

Results:
We included 782 patients (33% women, 71±14 years). Amongst the ECG variables, BSA-indexed Z-axis QRS-T VTI (VTI
QRST-Z
*√BSA) was the strongest independent predictor of all 5 RV measurements (Table 1a shows a comparison of QRS duration, Z-axis amplitude and VTI). VTI
QRST-Z
*√BSA cutoff 62 μVsm had a sensitivity 62.7% and specificity 65.7% to distinguish presence of ≥3 abnormal out of the 5 RV measurements (Table 1b).

Conclusions:
Adverse RV remodeling causes augmentation of the anterior-posteriorly directed QRS-T potential which is seen as a change in Z-axis VTI. VTI
QRST-Z
*√BSA could be used as a marker for right heart failure in patients with RBBB.
Abstract 13641: Feasibility of Same-Day Discharge After Uncomplicated Transvenous Lead Extraction
Authors: Elchouemi Mohanad , Helmy Rami , Gianni Carola , Spinetta Lauryn , Neely Robert C , Asfour Issa , Mohanty Sanghamitra , Della Rocca Domenico G , Patel Akash P , Bassiouny Mohamed A , Coffeen Paul C , Hranitzky Patrick M , Natale Andrea , Canby Robert C , Al-Ahmad Amin
Published: June 2023

Introduction:
Transvenous lead extraction (TLE), while mostly a safe procedure, has risk of serious periprocedural complications. As such, overnight hospitalization remains a routine practice. Same-day discharge (SDD) may be considered in uncomplicated TLE. Herein, we sought evaluate the safety of SDD.

Methods:
This is a retrospective analysis of 89 consecutive pts who underwent TLE in our center from January through December 2020. SDD patients were compared those with longer hospital stay (non-SDD) with respect to clinical and procedural characteristics. The safety endpoint was incidence of re-hospitalization/death at 30-days.

Results:
51 patients had SDD after TLE and 38 had non-SDD (median length of stay, 2 days IQR 1-5). 38% were female, with a mean age of 67±14 years and BMI of 27.9±7.4 Kg/m
2
. The main indication for TLE was malfunction for SDD vs infection for non-SDD (figure). Clinical characteristics were comparable, with a trend for a higher rate of co-morbidities predisposing to infection for non-SDD (figure). As expected, SDD patients had fewer leads to extract (1.5±0.6 vs 2.1±1.1; p=0.003), albeit with a similar dwelling time (105±65 months vs 114±70 months), and shorter procedural times (90±47 min vs 125±87 min; p=0.01). Of note, laser was used as an adjunct extraction tool at a comparable rate (75% vs 76%).

There was no significant difference in the safety endpoint (8% SDD vs 3% non-SDD; p=ns), with 1 post-procedural death (pulmonary embolism) in the non-SDD group, and 4 re-hospitalizations in the SDD group: 1 for evacuation of a pocket hematoma, 1 for drainage of a late symptomatic pericardial effusion secondary to pericarditis, 1 for lead revision.

Conclusions:
SDD discharge following uncomplicated TLE in selected patients is feasible, with an acceptable safety profile with respect to 30-days clinical outcomes.
Abstract 13683: Eicosapentaenoic Acid (EPA) Decreases Endothelin Converting Enzyme-1 Expression and Improves Nitric Oxide Release in Pulmonary Endothelium Following Challenge With Air Pollutants
Authors: Sherratt Samuel C , Libby Peter , Bhatt Deepak L , Dawoud Hazem , Malinski Tadeusz , Mason Preston
Published: June 2023

Background:
Air pollution particulate matter (PM) contributes to global mortality and chronic conditions, especially cardiovascular (CV) disease. Exposure to PM and cytokines like IL-6 cause endothelial cell (EC) dysfunction, leading to nitric oxide synthase (eNOS) uncoupling. The omega-3 fatty acid EPA improves eNOS coupling and reduces vascular inflammation. REDUCE-IT showed that treatment with icosapent ethyl (IPE), a purified EPA ethyl ester, reduced composite CV events. We compared the effects of EPA on pulmonary EC (PEC) function and protein expression following challenge with PMs versus IL-6.

Methods:
PECs were treated with EPA (40 μM) or equivolume vehicle for 2 h and then challenged with IL-6 (12 ng/mL) or PM (50 μg/mL) collected from urban environments (“urban PM”) for up to 8 h. Proteomic analysis was performed using LC/MS to measure relative protein expression. Significant (
p
<0.05) changes between treatment groups (>1-fold) were analyzed by bioinformatic packages. Biological pathways were analyzed by gene set enrichment analysis (GSEA). In parallel, cells were stimulated with calcium ionophore to elicit nitric oxide (NO) and peroxynitrite (ONOO
–
) release as assayed by tandem porphyrinic nanosensors; the NO/ONOO
–
ratio indicates eNOS coupling efficiency.

Results:
Challenge with IL-6 and urban PM caused eNOS uncoupling as evidenced by a decreased NO/ONOO
–
ratio of 35% (1.43 ± 0.04 vs. 2.19 ± 0.02,
p
<0.001) and 50% (1.22 ± 0.07 vs. 2.42 ± 0.15
, p
<0.001), respectively, compared to control. EPA increased the NO/ONOO
–
ratio relative to both IL-6 (39%; 1.99 ± 0.11,
p
<0.001) and urban PM (39%; 1.69 ± 0.14
, p
<0.05). Proteomics revealed that EPA decreased expression of endothelin converting enzyme-1 (ECE1) relative to both IL-6 (1.2-fold, p = 0.017) and urban PM (1.1-fold, p = 0.045). GSEA showed significant modulations to 18 and 35 proteins within the neutrophil degranulation pathway (GO:0043312) with EPA treatment relative to IL-6 and urban PM (
p
<0.0001 in both comparisons).

Conclusion:
EPA favorably reversed EC dysfunction and expression of inflammatory proteins and pathways following challenge with air pollution PMs similar to IL-6. These broad anti-inflammatory actions may contribute to reduced CV risk with EPA as observed in outcome trials.
Abstract 13777: Metabolic Phenotyping in Aortic Stenosis: Insights From a Multi-Parametric Cardiac Magnetic Resonance Study
Authors: Monga Shveta , Valkovic Ladislav , Mahmod Masliza , Myerson Saul G , Neubauer Stefan , Rider Oliver J
Published: June 2023

Introduction:
Left ventricular hypertrophy in Aortic stenosis (AS) results from pressure overload and relates to perturbations in cardiac fatty acid metabolism with evidence of steatosis and deranged myocardial energetics in severe AS. There is, however, wide individual heterogeneity in the degree of hypertrophy and progression to myocardial fibrosis and heart failure. Underlying interplay of metabolism and hypertrophy may explain this variability.

Purpose
We sought to determine if a gradient of myocardial metabolic remodelling exists in AS and its relationship with AS severity, degree of hypertrophy and fibrosis.

Methods:
74 asymptomatic AS participants including mild (n=18), moderate (n=38), severe (n=18), and 13 healthy volunteers underwent CMR imaging for cardiac function, myocardial PCr/ATP and triglyceride content (MTG) assessment. Participants were divided into quartile groups based on LV wall thickness (LVWT) and peak aortic valve gradient (AVG) to study relationship between cardiac metabolism and hemodynamic markers of LV structure and function.

Results:
There was a stepwise deterioration in LV structure and function in both the LVWT and AVG quartile groups (p values significant) with increasing AS severity, as expected. Notably, PCr/ATP was reduced early in mild-moderate AS (Q2 1.43±0.13 vs 1.80±0.14 in Q1 controls, p=0.05) with a progressive decline across groups (Q4 PCr/ATP 1.39±0.14, p=0.02 vs Q1). MTG was elevated in mild-moderate AS (Q2 1.52±0.84 vs 1.25±0.70% in Q1, p = 0.032). Global longitudinal strain was impaired across all AS groups, and was related to the degree of energetic impairment (R 0.219, p 0.03). In addition, PCr/ATP was strongly associated with the presence of myocardial fibrosis (p 0.01).

Conclusion
A gradient of myocardial energetic deficit and steatosis exists across the spectrum of hypertrophied AS hearts, notably these metabolic changes precede irreversible LV remodelling and subclinical dysfunction.
Abstract 13811: A Percentile Approach to Refining ECG Criteria for Screening Female Athletes for Cardiac Risk
Authors: Harris Chelsea S , Froelicher Vic F , Wheeler Matthew T
Published: June 2023

Introduction:
Despite known differences in electrocardiographic (ECG) findings by sex, only empirical thresholds for both sexes exist in current ECG guidelines for screening athletes for risk of sudden cardiac death (SCD). We hypothesize that our large dataset - with diversity in age, race, and sport participation - can be utilized to improve ECG screening in female athletes.

Methods:
Computerized 12-lead ECGs were recorded and analyzed in female athletes who underwent PPE between 06/2010 and 09/2021. The 2017 international criteria for ECG interpretation were compared to either the 99th percentile in our cohort or the percentile that corresponded to the known disease prevalence for HCM and Long QT syndrome. For ST depression the 99.5th percentile, a marker for HCM, was used; for QTc prolongation, the 99.9th percentile was used. RS wave amplitude was considered a marker for hypertrophy or low voltage.

Results:
Of 3476 athletes, the 2017 international criteria classified 2.2% with at least one ECG abnormality requiring cardiological evaluation. Rates were similar across ages, race/ethnicity, and sporting discipline. Using a percentile approach based on our population, 3.3% would require additional workup. Surprisingly, ST depression up to 0.03 mV was a normal finding in this cohort. If RS voltage extremes were considered abnormal findings, an additional 9.6% of the population would be flagged using current definitions. This number decreases to 3.4% if using the 99th percentile.

Conclusions:
These results highlight a difference in the reported prevalence of ECG abnormalities when comparing empirically derived thresholds to statistically derived ranges that fall outside the 99th percentile. Consideration of new metrics specific to the female athlete population has the potential to further refine athlete ECG screening.
Abstract 13820: Four Revelations on the Table of Truth: A Confounding Case of ST Elevation
Authors: Hussain Kifah , Minga Iva , Patil Rupa , Rosenberg Jonathan
Published: June 2023

Background:
We present a case of a patient with new onset ST elevation on EKG, found to have multiple pathologies on emergent cardiac catheterization.

Case:
A 81 yo woman with no prior cardiac problems; with syncope 3 days ago, came to the emergency department with worsening left-sided chest pain, that started a few hours earlier. Vitals were within normal limits. She was noted to have left facial ecchymosis, from the fall. She had an otherwise normal physical exam. Her EKG on presentation showed ST elevation in anterior leads with deep T wave inversions. She was planned for emergent cardiac catheterization following noncontrast head CT that showed no intracranial bleed. In the lab, she had no evidence of obstructive epicardial coronary artery disease. However, we noted abnormally slow filling of coronaries (suggestive of microvascular dysfunction) and evidence of a myocardial bridge in the mid-segment of the left anterior descending artery. Since neither of these would explain her acute presentation, a left ventriculogram was performed that showed apical ballooning suggestive of Takotsubo cardiomyopathy and filling defect consistent with thrombus. MRI brain showed acute ischemic stroke involving the right occipital lobe which was likely the physical stressor in her case.

Discussion:
Takotsubo cardiomyopathy is frequently associated with ST elevations and T wave inversions on EKG. It is hypothesized that microvascular dysfunction may be more common in Takotsubo cardiomyopathy and may explain its increased incidence among post-menopausal women and the correlation with emotional and physical stressors. Myocardial bridge of the left anterior descending artery has been associated with stress cardiomyopathy in up to 76% of cases.

Conclusion:
This is a rare case of stress cardiomyopathy that presented with both evidence of microvascular dysfunction and prominent myocardial bridge, with all three conditions being diagnosed in the cardiac catheterization lab.
Abstract 14012: Association Between Direct Oral Anticoagulant Concentration Upon Acute Stroke and Stroke Outcomes
Authors: Lin Shin Yi , Tang Sung-Chun , Kuo Ching-Hua , Huang Chih-Fen , Jeng Jiann S
Published: June 2023

Introduction:
Ischemic stroke (IS) or intracranial hemorrhage (ICH) has been reported during direct oral anticoagulant (DOAC) therapy. However, data regarding the DOAC level upon acute stroke is lacking.

Hypothesis:
The DOAC level upon acute IS or ICH may be associated with stroke outcomes.

Methods:
Patients aged ≥ 20 years, under DOAC therapy and developed acute ischemic or hemorrhagic stroke were enrolled. The DOAC level upon hospital arrival was measured with ultra-high-performance liquid chromatography with tandem mass spectrometry. The primary outcome was the composite outcomes included IS, ICH, major bleeding or death at 3 months. The secondary outcome included modified Rankin Scale (mRS) 0 to 3 at 3 months.

Results:
During 2018 to 2022, a total of 105 patients who developed IS and 26 patients who developed ICH during DOAC therapy were enrolled. Among the IS cohort, 45 (42.9%) had DOAC level<50 ng/mL. The initial National Institutes of Health Stroke Scale (NIHSS) was similar between patients with DOAC level <or≥50 ng/mL. The primary outcome occurred in 13 and 9 patients with DOAC level<or≥ 50 ng/mL. After adjustment, factors associated with composite outcomes at 3 months included reduced creatinine clearance (HR=0.96 [0.93, 0.995]), higher initial NIHSS (HR=1.08 [1.01, 1.15]) and DOAC level<50 ng/mL (HR=5.63 [1.47, 21.65]). To predict mRS 0 to 3 at 3 months, initial NIHSS, and DOAC level<50 ng/mL displayed inverse association (OR=0.82 [0.75, 0.90] and 0.19 [0.05, 0.78]). Among the ICH cohort, 19 patients (73.1%) has DOAC level<50 ng/mL. Compared to patients with DOAC level≥50 ng/mL, their initial hematoma size was smaller. The primary outcome occurred in 0 and 5 patients with DOAC level <or≥ 50 ng/mL. The proportion of patients with hematoma expansion and having mRS 0 to 3 points were similar between patients with DOAC level<or≥50 ng/mL (40.0% versus 43.8%, p=1.00 for hematoma expansion; 85.7% versus 52.6%, p=0.19 for mRS 0 to 3 points).

Conclusion:
Among patients who develop IS during DOAC therapy, low DOAC level, along with higher initial NIHSS and worse renal function, predicts worse clinical outcomes.
Abstract 14170: Ratio of Early Transmitral Inflow Velocity to Early Diastolic Strain Rate Predicts Atrial Fibrillation Following Acute Myocardial Infarction
Authors: Bjerregaard Caroline L , Olsen Flemming J , Lassen Mats , Fritz-Hansen Thomas , galatius soeren , Iversen Allen Z , Pedersen Sune H , Biering-Sørensen Tor
Published: June 2023

Background:
The ratio of early transmitral filling velocity to early diastolic strain rate (E/e’sr) has been proposed as a new measurement of left ventricular filling pressure. We aimed to investigate the ability of E/e’sr to predict atrial fibrillation (AF) after ST-elevation myocardial infarction (STEMI).

Methods:
This was a prospective cohort study of patients with STEMI treated with primary percutaneous coronary intervention (pPCI). Patients underwent an echocardiographic examination a median of two days after pPCI. By echocardiography, transmittal early filling velocity (E) was measured by pulsed-wave Doppler, and early diastolic strain rate (e’sr) was measured by speckle tracking of the left ventricular. The E was indexed to e’sr to obtain the E/e’sr as well as to the early myocardial relaxation velocity to obtain the E/e’. The endpoint was new-onset AF.

Results:
During follow-up (median 5.6 years, IQR:5.0-6.1), 23 of the 369 patients developed AF. In unadjusted analyses, both E/e’sr and E/e’ were significantly associated with AF [E/e’sr: HR=1.06; (1.03-1.10); p<0.001, per 0.1 increase] and [E/e’: HR=1.11 (1.05-1.17); p<0.001, per 1 increase] and had equal Harrell’s C-statistic of 0.71. However, only E/e’sr remained an independent predictor after multivariable adjustments for clinical and echocardiographic parameters [E/e’sr: HR=1.06 (1.00-1.11); p=0.042, per 0.1 increase] and patients with high E/e’s compared to those with a low E/e’sr had and almost four-fold risk of AF during follow up (HR=3.85 (1.43-10.35), p<0.02) (figure). These findings were unchanged in competing risk analyses accounting for death as a competing event. E/e’sr was also significantly associated with AF in patients with normal filling pressure by E/e’ (HR=1.07 (1.01-1.17); p=0.030, per 0.1 increase).

Conclusion
E/e’sr is an independent predictor of AF in STEMI patients, even in subjects with seemingly normal filling pressure.
Abstract 14256: Dual-Targeted NIRF Molecular Imaging Combined With Intravascular OCT for Inflammatory Micro-Calcification in the High-Risk Plaque
Authors: Kang Dong Oh , Lim Yong Geun , Kim Yeon Hoon , Kim Ryeong Hyun , Kim Hyun Jung , Nam Hyeong Soo , Song Joon Woo , Kim Jin Hyuk , Park Ye Hee , Oh Wang-Yuhl , Park Kyeongsoon , Yoo Hongki , Kim Jin W
Published: June 2023

Background/Objectives:
Micro-calcification is a major target for high-risk plaque but the mechanistic linkage with macrophage-driven inflammation remains questionable. To address this issue, we newly innovated dual-targeted multimodal imaging strategy for calcifying inflammatory activity by integration of intravascular OCT with near-infrared fluorescence (NIRF) molecular imaging.

Methods/Results:
We fully integrated dual-targeted NIRF molecular imaging with intravascular OCT. Novel NIRF emitting probe targeting micro-calcification was fabricated by chemically coupling alendronate and Cy5.5 to the ends of azide-PEG-NHS ester (Al-Cy5.5). Based on whole body biodistribution, OCT/dual-NIRF in vivo imaging of rabbit aortoiliac atheroma was acquired 48 hrs and 72 hrs after intravenous injection of Al-Cy5.5 (5.0 mg/kg) and macrophage mannose receptor targeted Cy7-emitting probe (7.5 mg/kg), respectively. NIRF signals of Cy5.5 and Cy7 were highly enhanced at the area of micro-calcification and macrophage accumulation within the plaque (Figure) (p<0.01). Fluorescence microscopy and immunostainings from the corresponding sections well corroborated the in vivo findings and concomitantly elevated dual-NIRF signals indicated the presence of calcifying inflammatory activity in atheroma. Intriguingly, osteogenic activity (TRAP stain) was closely interconnected with macrophages in superficial micro-calcification rather inner dense calcification (p<0.01).

Conclusions:
Our intravascular OCT/dual-NIRF imaging was feasible to simultaneously visualize micro-calcification, osteogenic activity and macrophages in the coronary-sized atheroma. This novel imaging strategy is expected to expand our pathophysiologic insight for the biological behavior of calcifying inflammatory activity existing on the superficial fibrous cap portion of high-risk plaques.
Abstract 14422: Mitochondrial ROS Scavenger JP4-039 Improves Mitochondrial Oxidative Phosphorylation and Induces Angiogenesis in Murine and Human Coronary Artery and Atrial Endothelial Cells
Authors: Brinck Teixeira Rayane , King Michelle , Abedin Taslova , Karbasiafshar Catherine , Raj Sidharth , Tucker Aja , Sabra Mohamed , Stanley Madigan , Zhang Peng , Wipf Peter , Sellke Frank W , Abid Ruhul
Published: June 2023

Introduction:
Reducing mitochondrial ROS (mito-ROS) has been a therapeutic goal to improve cardiovascular disease. Here, we evaluated the effects of mito-ROS scavenger JP4-039 with a focus on mouse heart and human coronary artery endothelial cell (MHEC, HCAEC).

Hypothesis:
We hypothesized that JP4-039 would improve oxidative phosphorylation (OXPHOS) in EC and induce angiogenesis in post-AMI (acute myocardial infarction) hearts.

Methods:
Human atrial explants, NOX2-overexpressing (OE) MHEC, and HCAEC were treated with 1-5μM JP4-039 and examined for sprouting, tube formation, mitochondrial complex expression (Western blot), and OXPHOS measurements (Seahorse). FVB mice (n=8/group) underwent AMI surgery and were assigned to vehicle (sunflower seed oil) or JP4-039 group (1mg/kg, i.p., 3x/week for 4 weeks). Left ventricle (LV) function and capillary density in infarcted LV were assessed by echocardiogram and immunofluorescence, respectively, 28 days after AMI. Data were analyzed by One-way ANOVA and Tukey’s post-hoc, or student’s t test, as appropriate. A p-value <0.05 was considered statistically significant.

Results:
HCAEC treated with JP4-039 showed significantly increased expression of mitochondrial complex I (0.7±0.1 vs. 1.1±0.1) and V (1.0±0.1 vs. 1.2±0.1) with corresponding increase in basal (19.8±0.4 vs. 23.0±1.0) and maximal respiration (31.2±1.6 vs. 56.0±2.6), ATP production (16.6±0.3 vs. 18.5±0.4) and spare respiratory capacity (11.3±1.6 vs. 33.0±2.9) as compared with vehicle-treated cells. JP4-039 increased tube formation in NOX2-OE MHEC (12.6±2.2 vs. 21.3±2.4 tubes), HCAEC (33.6±3.1 vs. 49.0±2.6) as well as EC sprouting in mouse atrium (4496±1857 vs. 19552±4352 pixel
2
). In post-AMI animals, JP4-039 improved LV systolic function (EF 24.4±3.6 vs 41.3±5.2%) and capillary density (451.7 (379.9; 629.7) vs. 698.3 (503.6; 965.8) capillaries/mm
2
)
in vivo
.

Conclusions:
JP4-039 improved OXPHOS in ECs
in vitro,
and induced coronary angiogenesis in post-AMI hearts
in vivo
and in atrial tissues
ex vivo
. These findings were associated with improved cardiac function in post-AMI animals, suggesting that a mito-ROS scavenger may have significant roles in coronary angiogenesis in ischemic myocardium.
Abstract 14455: Impact of Cardiac Rehabilitation on Peak Vo
2
in the Renal Transplant Candidate
Authors: Unzek Freiman Samuel , Edwards Alex , Arrom Andrea , Montchal Jacob J , Leuck Lauren R , Rohman Catherine C , Trombley Marcelle L
Published: June 2023

Introduction:
Cardiopulmonary fitness measured by peak VO
2
is effective in cardiovascular screening prior to renal transplantation and even predicts survival.

Hypothesis:
Will cardiac rehabilitation impact functional status on renal transplant candidates when compared to other factors that affect peak VO
2

Methods:
A peak VO
2
test is performed with the initial transplant evaluation and repeated annually for patients on the waiting list. Peak V0
2
, heart rate max (HRmax), respiratory exchange ratio (RER), pulmonary or cardiac output limitation, deconditioning, obesity were evaluated. If any of the prior parameters were noted to be abnormal, they were acted upon.

Results:
A total of 107 patients (38 females and 69 males) received initial and repeat CPET testing. The average time interval between repeat tests was 342 days (11 months). The data was adjusted for various interventions to determine the magnitude to which they affected increases in peak VO
2
. The patients were able to complete an average of 36 exercise sessions (phase III) and demonstrated an average increase in peak VO
2
of 5.02 mL·min
-1
·kg
-1
which was the largest difference among interventions observed. Patients that improved HRmax or RER between tests demonstrated similar changes in VO
2
(1.98, and 0.42 mL·min
-1
·kg
-1
respectively). Among patients that lost weight, an average decrease of 13.1 lbs was noted with their respective increase of peak VO
2
by 0.68 mL·min
-1
·kg
-1
. The initial test identified 83 patients with cardiac output limitation and 10 patients received cardiac interventions between their testing interval, resulting in an average VO
2
increase of 0.74 mL·min
-1
·kg
-1
. Only 32 patients were identified to have pulmonary abnormalities from their initial test, 3 had pulmonary interventions and the average VO
2
increase was 1.53 mL·min
-1
·kg
-1

Conclusion:
Cardiac rehabilitation program has the highest impact on peak VO
2
that may translate into a better and healthier renal transplant candidate.
Abstract 14482: Clinical Impact of Advances of Short-Term Mechanical Circulatory Support Devices and Therapeutic Strategies in Patients With Cardiogenic Shock
Authors: Watanabe Takuya , Seguchi Osamu , Fukushima Satsuki , Fujita Tomoyuki , Tsukamoto Yasumasa
Published: June 2023

Introduction:
Although revised US adult heart allocation system has provided the opportunity of urgent heart transplantation and improved clinical outcomes in urgent patients, it may not offer select temporary mechanical circulatory support (MCS) patients the opportunity and adequate time to recover to the point of waitlist removal. Severe donor shortages have increased the need for assessment of reversibility of cardiac function. Advances of MCS devices may provide the longer time to assess the appropriate therapeutic strategy.

Hypothesis:
The aim of this study was to evaluate the impact of bridge-to-decision (BTD) strategies which used recently developed short-term MCS devices strategies.

Methods:
We retrospectively reviewed the medical records of 108 patients who received BTD strategies from January 2017 to February 2022.

Results:
Etiology of cardiogenic shock were myocarditis (35.2 %), idiopathic cardiomyopathy (26.0 %) and ischemic cardiomyopathy (30.5 %). Ninety-three (86.1%) had been used any temporary MCS prior to BTD strategy using short-term MCS devices, including intra-aortic balloon pumping, peripheral veno-arterial extracorporeal membrane oxygenation (ECMO) and low-flow percutaneous VAD. Sixty-five (60.2 %) had been inserted extracorporeal centrifugal-flow pump VAD (CF-VAD group), twenty-eight (25.9 %) had high-flow percutaneous VAD (P-VAD group) including with ECMO (ECPELLA) (50 %), and fifteen (13.9 %) had extracorporeal pulsatile-flow pump VAD (PF-VAD group). Duration of short-term MCS support was 42.5±44.1 days. Twenty-five (23.1 %) needed the conversion to other pumps. Forty-eight (40.7%) were withdrawn for recovery of cardiac function (mean duration to decision; 27.7±23.8 days), other forty-eight (40.7 %) were implanted durable implantable VAD for no-recovery of cardiac function (mean duration to decision; 48.4±40.7 days). Twenty patients (18.5 %) died. Clinical prognosis was comparable in three groups (P=0.943).

Conclusions:
BTD strategies using recently developed short-term MCS devices provided relatively long-term support duration to decision for definitive therapy, and showed favorable clinical outcomes. However, conversion or exchange to other pumps was needed for long-term support.
Abstract 14504: Gender and Racial Disparities in Patients Using Sodium-Glucose Cotransporter-2 (SGLT2) Inhibitors and Glucagon-Like Peptide-1 (GLP-1) Analogues in a Real-World Scenario
Authors: Tuli Aakash , Varghese Jobin , Smith Damien , Garcia-Garcia Hector
Published: June 2023

Introduction:
Sodium-glucose Cotransporter-2 (SGLT2) Inhibitors and Glucagon-like Peptide-1 (GLP-1) analogues are relatively new classes of prescription drugs showing promising benefits for cardiovascular outcomes. There is a paucity of data regarding the cardiovascular risk profile of patients receiving these medications outside of clinical trials. We aim to describe the same in the Medstar Health outpatient population and to explore whether there are any racial/gender disparities.

Methods:
Records were obtained for 12,305 patients who had been reviewed as outpatients in the Medstar Health System and prescribed either an SGLT2-I or a GLP1-A between 2018 and 2021 inclusive. 2379 patients had sufficient data to allow calculation of their athero-sclerotic cardiovascular disease (ASCVD) risk. Variables collected included demographic information, selective vitals, and lab values. Patients’ ASCVD risk was calculated where appropriate using 2013 ACC/AHA guidelines.

Results:
Of 2379 patients, 1695 (71.2%) were prescribed a GLP1-A and 684 (28.8%) an SGLT2-i. Groups did not differ in terms of smoking status, use of anti-hypertensive medications, history of ACS or stroke, systolic blood pressure, or cholesterol levels. The GLP1-A group had more female patients (60.4% vs. 45.8% in the SGLT2-i group, p < 0.001), more African American patients (52.0% vs. 40.0%, p < 0.001), and fewer patients with diabetes mellitus (26.3% vs. 27.9%, p < 0.001). The GLP1-A group was also significantly younger, had a higher average BMI, and higher average HDL and lower average HbA1c (7.68 vs 8.06, p < 0.001). 10-year ASCVD risk was significantly higher in patients prescribed an SGLT-2 inhibitor (18.10 vs 15.66, p < 0.001).

Conclusions:
Among demographic indicators, there were proportionally more women and African-Americans in the GLP1-A group than in the SGLT2-i group, which may indicate disparity in utilization of these drugs for certain populations. There were more diabetics in the SGLT2-i group, likely reflecting the use of GLP1-As for obesity in non-diabetics. The 10-year ASCVD risk was lower in the GLP1-A group compared to the SGLT2-i group. Further research will explore the clinical outcomes of these groups.
Abstract 14528: Impact of Environmental Factors on Cardiovascular Death Comparing Two First World Countries: Great Britain and United States of America: Global Burden of Disease 2019 Study
Authors: Titus Anoop , Arun Kumar Pramukh , Dasari Mahati , Saji Anu , Baburaj Abiram , Patel Nirav , Minhas Sohaib , AlYami Bandar , Mohamed Nida , Syeed M. Sakil , Avinashsingh Eswarsingh FNU
Published: June 2023

Introduction:
Environmental exposure has an important role in the development and progression of cardiovascular death (CVD). We studied the 30-year CVD in countries with similar risk factors comparing the environmental exposures.

Methods:
Populations with environmental risk factors (Table 1), who died between 1990 and 2019 in the GBR and USA were selected from GBD 2019 Study. The 30-year mean CVD death was compared using Welch's t-test. Trends of the CVD deaths with pertaining risk factors over total CVD were estimated.

Results:
A total of 33,041,416 patients were analyzed. Mortality rates among lead and particulate matter pollution exposed populations were found to be significantly different. In lead exposure, the USA has observed more deaths (RR=0.024 vs. 0.014, p=<0.001) compared to the GBR, whereas the death was more in particulate matter exposure in the GBR (RR=0.065 vs. 0.050, p=0.001). No statistically significant difference was found in case of smoking and second-hand smoke exposure. In mortality trend analyses in terms of percentage of CVD death, a steady declining pattern was seen in both countries in all four risk factors (Fig 2).

Conclusions:
CVD proportions was significantly higher in USA in population with higher risk of lead exposure, while particulate matter showed higher proportion of CVD in GBR- for which further research is warranted.*GBD=Global Burden of Disease
Abstract 14544: Association Between Employment Status and Occupational Groups With Prevalent Hypertension in Working-Age Adults in the United States in 2020
Authors: Aijaz Amna , Parekh Tarang , Hagan Kobina , Kesiena Onoriode , Javed Zulqarnain , Allahverdiyeva Aysha , Braunstein Jacob , Nasir Khurram
Published: June 2023

Introduction:
Hypertension remains a strong risk factor for cardiovascular disease Besides established risk factors for hypertension, socioeconomic determinants including employment status and occupation are now emerging. With unemployment rates peaking in the US in 2020, we examined the burden of hypertension by employment status and occupation type.

Methods:
Data from the National Health Interview Survey (NHIS) 2020 was used to study the association of hypertension and employment status and hypertension and occupation groups using logistic regression. Adults aged 18 years and older residing in the US were included in the sample. A subgroup analysis was conducted among those aged 65 years and younger to assess if there was a difference if the model excluded most retired individuals.

Results:
We studied 28,973 US adults and the overall prevalence of hypertension was 24.7%, with significant differences amongst all subgroups except for sex. The adjusted odds of having hypertension was 0.64 (0.59, 0.70) times among employed adults compared to the unemployed. All occupation groups had significantly lower adjusted odds of hypertension than the unemployed, ranging from OR = 0.41 (0.33, 0.52) for Natural Resources, Construction, and Maintenance Occupations to OR = 0.78 (0.64, 0.94) for Healthcare Practitioners and Technical Occupations. A subgroup analysis amongst those aged 65 years and younger was not significantly different from the main model.

Conclusion/Significance:
Employment was associated with reduced odds of hypertension. All occupation groups were associated with reduced odds of hypertension compared to the unemployed. Further studies are needed controlling for more confounders (such as work life balance, shift work), studying these associations prospectively and retrospectively. Studies among higher risk occupations identifying job related factors associated with hypertension could guide relevant policy actions.
Abstract 14633: A Case of Acute Coronary Syndrome With Incidental Acquired Factor VIII Deficiency With Inhibitor Present: How to Navigate Being Between a “Rock” and a Bleeding Disorder
Authors: Nagamine Todd , Zhang James , Ali Mohammed , Gozun Maan Kathryn , Shah Parthav , Techasatian Witina , Benavente Kevin , Yeo Jihun , Kuniyoshi Jason , Banerjee Dipanjan
Published: June 2023

Introduction:
Acute coronary syndrome (ACS) occurring in the presence of a bleeding diathesis can make clinical decision-making difficult. We present a case of a non-ST elevation MI in the presence of an acquired factor VIII deficiency with an inhibitor present.

Case:
A 66-year-old male with a medical history significant for coronary artery disease and COPD presented with a 4-day history of persistent, profuse bleeding after attaining a laceration on his arm. Shortly after admission, he reported pressure-like chest pain relieved by sublingual nitroglycerin. His 5th generation troponin level was 61 ng/L on presentation and peaked at 600 ng/L 36 hours later. The EKG revealed ST depressions in leads V3 and V4 and T-wave flattening in leads V5 and V6. Transthoracic echocardiography revealed preserved ejection fraction but could not exclude wall motion abnormalities due to poor windows. Hematology was consulted due to uncontrolled bleeding, and the patient was diagnosed with acquired factor VIII deficiency with an inhibitor present. Low-dose heparin infusion was initiated. He was taken for a diagnostic left heart catheterization, which revealed left main with moderate obstruction, left anterior descending (LAD) with 70% proximal stenosis, and a small diagonal branch with 90% stenosis. The patient had been previously offered evaluation for coronary artery bypass graft(CABG) surgery but declined. CABG work up was ultimately deferred in favor of percutaneous coronary intervention based on literature review extrapolated from hemophiliac patients. The patient’s hematologic care is ongoing with recombinant antihemophilic factor, porcine sequence, prednisone, cyclophosphamide, and rituximab administration.

Discussion:
Choosing the type of coronary revascularization in coagulopathic patients poses a significant challenge. To avoid complications, a multidisciplinary approach to short- and long-term anticoagulation management is necessary. In this case we decided to use existing data that is based on hemophilia patients in the past with myocardial infarction where dual antiplatelet therapy is limited to 1 month with factor 8 activity maintained above 30%. Then transition to aspirin alone for maintenance with factor 8 levels maintained above 10%.
Abstract 14643: Benefits and Risks of Single- vs. Dual- Chamber Implantable Cardioverter Defibrillators for Primary Prevention of Sudden Cardiac Death
Authors: Choi Jin Hee , Hwang Ki Won , Im Jihoon , Kim Ga Yun , Kim Seok Hyun , Oh Ji Soo , Lee Soo Y , Chon Min Ku , Lee Sang Hyun , Kim Jeong Su , Park Yong Hyun , Kim June-hong , Chun Kook Jin
Published: June 2023

Introduction:
Implantable cardioverter defibrillator (ICD) is the more effective and safer treatment for the primary prevention of sudden cardiac death. It remains unclear whether dual-chamber ICD offers the clinical benefits over single-chamber ICD without increasing complications.

Hypothesis:
The study aimed to evaluate the benefits and risks of dual-chamber ICD compared with single-chamber ICD for primary prevention of sudden cardiac death in clinical practice.

Methods:
Using the Korean National Health Insurance Service database from January 2008 to December 2019, we include patients with primary prevention ICD and no documented indication for pacing. The propensity score matching method was used to balance covariates across single- and dual-chamber ICDs. Primary outcomes were all-cause mortality, hospitalization of heart failure, and hospitalization of cardiovascular cause.

Results:
Among 1,929 patients, 1,098 (56.9%) received a single-chamber ICD and 831 (43.1%) received a dual-chamber ICD. In 752 pairs of patients after propensity matching baseline characteristics were balanced between the 2 groups (median age 62 years; male 72%). Over a mean follow-up of 2.7±2.4 years, 1- and 5-year all-cause mortality (5.5% vs. 5.6%, P=0.910; 19.4% vs. 19.3%, P=0.948), 1- and 5-year hospitalization for cardiovascular cause (14.9% vs. 14.9%, P=1.000; 23.9% vs. 22.6%, P=0.542), and 1- and 5-year hospitalization for heart failure (10.8% vs. 8.6%, P=0.163; 16.8% vs. 14.0%, P=0.133) were similar in both groups. However, cardiac tamponade in the rates of device-related complications was 0.1% in the single-chamber ICD vs. 1.1% in dual-chamber ICD groups (P=0.013).

Conclusions:
In the real-world population receiving a primary prevention ICD, dual-chamber ICD was associated with higher rates of cardiac tamponade than single-chamber ICD. One and five-year rates of all-cause mortality and hospitalization did not differ significantly between the two groups.