bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 12639: Perceived Social Support in Heart Failure Caregiving: A Convergent Mixed-Method Study
Authors: Cuoco Angela , Di Nitto Marco , Younas Ahtisham , Boyne Josiane , Juarez-Vela Raul , Vellone Ercole , Durante Angela
Published: June 2023

Introduction:
Caregivers play an instrumental role in ensuring adequate self-care for their relatives with heart failure (HF). Nevertheless, caregivers can be subject to negative outcomes and sacrifice of personal needs due to their challenging caregiving role, which increases the demand for social support. Previous studies did not provide a comprehensive understanding of perceived social support and its associated factors among caregivers of individuals with HF.

Methods:
A convergent mixed-methods approach was used. In total, 158 patients with heart failure and their informal caregivers completed validated scales to measure their perceived social support, mutuality, anxiety, depression, and quality of life (physical and mental dimensions). Semi-structured interviews were conducted with 50 caregivers. Multiple linear regression analysis was conducted to identify the predictors of perceived social support, and content analysis was performed on qualitative data. The results were merged using joint displays.

Results:
Caregivers had a mean age of 57 (14.4 SD) and gave their care to the patients for an average hours per week of 30.38 (28.28 SD). Patients with HF had a mean age of 73.74 (13.46 SD) mostly (48.7 %) in NYHA class II. Quantitative results showed that caregivers perceived better social support when they had a better mental quality of life and higher levels of mutuality. Likewise, when patients’ levels of mutuality were lower, caregivers felt less socially supported. Qualitative findings support that perceived social support was influenced by the caregiver’s mutuality, the patient’s involvement in self-care and the caregiver’ emotional state. Integration of quantitative and qualitative data confirmed that caregivers’ mutuality and emotional state influenced caregivers’ social support.

Conclusions:
Mental health status can affect caregivers’ ability to perceive social support. There is a need to develop and evaluate individual and community-based strategies to promote caregivers’ mental health for increasing their perceived sense of social support and community belonging. More dyadic strategies should be developed to improve caregiver-caregiver mutuality to increase the sense of support in the heart failure caregiving process.
Abstract 12645: Role of Viral Rna-Triggered Innate Immune Activation on Cardiac Arrhythmias Associated With Covid-19
Authors: Ashok Deepthi , Liu Ting , Mair Devin , Stoddart Laila , Papanicolaou Kyriakos , Foster D B , Villano Jason , Kim Deok-Ho , Orourke Brian
Published: June 2023

Background:
The COVID-19 pandemic has highlighted how little is known about how double stranded RNA (dsRNA) viruses like the SARS-CoV-2 impact cardiac physiology acutely and long-term. While it is unclear if the cardiac effects are direct or indirect, adverse effects in patients are common, including cardiac inflammation, electrophysiological changes in QT interval, atrial fibrillation, bradyarrhythmia, and ventricular tachycardia. Mechanisms underlying these COVID-19-associated arrhythmias are unknown.

Methods:
We assess the effects of SARS-CoV-2 infection on cardiac electrophysiology and inflammatory pathway activation in a hamster model over a 4-week timespan. We further test if activation of antiviral innate immune responses with a dsRNA mimetic, Poly I:C (PI:C) induces similar effects in uninfected hearts and in human iPSC-derived cardiomyocytes (hiPSC-CMs), examining the determinants of RNAseL activation, interferon (IFN) signaling, and cytokine release in vivo and in vitro.

Results:
Intranasal SARS-CoV-2 USA-WA1 infection of hamsters caused ECG abnormalities including bradycardia and cardiac conduction defects including sinus pauses, 2
nd
and 3
rd
degree Atrio-Ventricular block. Bradycardia peaked at 4-5 days after infection. Mean RR interval increased from 182±4ms pre- to 233±6ms post-infection, without significant increases in mock-infected hamsters. In the absence of viral infection, ventricular injection of PI:C induced similar arrhythmias and induction of IFN-stimulated genes. PI:C treatment of hiPSC-CMs induced robust increases in type-I IFN pathway proteins STAT1/pSTAT1, OAS2 (48% increase) and OAS3 (32% increase) and a robust cytokine response. Negative effects on excitation-contraction coupling after 72hr of PI:C treatment, manifested as a 25% reduction in hiPSC-CM Ca
2+
transient peaks. In vitro studies showed increased RNA degradation after PI:C, consistent with activation of the OAS/RNAseL dsRNA sensor pathway.

Conclusions:
COVID-19 in the hamster model recapitulates a subset of arrhythmias observed in COVID-19 patients. Activation of the viral dsRNA innate immune sensor pathway, even in the absence of active cardiac viral replication, may contribute to SARS-CoV-2-associated cardiac dysfunction.
Abstract 12699: Ferroptosis Inhibition Combats Pulmonary Vascular Remodeling and Improves RV-PA Coupling in Monocrotaline Rats
Authors: Vogel Neal , Prisco Sasha Z , Prins Kurt W
Published: June 2023

Introduction:
Ferroptosis is an iron-dependent, non-apoptotic, highly inflammatory form of cell death. Ferroptosis is initiated by lipid peroxidation, and therefore ferroptotic cell death is sensitive to metabolic derangements, altered iron homeostasis, and oxidative stress. In the systemic circulation, ferroptosis inhibition improves endothelial cell function, but the role of ferroptosis in pulmonary arterial hypertension, a disease characterized by pulmonary arterial endothelial cell metabolic derangements and abnormal redox balance, is not well understood.

Methods:
Male Sprague Dawley rats were randomized into 3 groups: control, monocrotaline-vehicle (MCT-V), and MCT rats treated with a small molecule ferroptosis inhibitor (MCT-FI). Treatment started 14 days after MCT to improve translational potential. Pulmonary vascular disease severity, cardiomyocyte hypertrophy, and right ventricular (RV) function were assessed with histology, echocardiography, and closed-chest pressure-volume loop analysis.

Results:
Ferroptosis inhibition blunted pulmonary vascular disease severity as right ventricular systolic pressure and effective arterial elastance were significantly reduced and pulmonary arterial acceleration time was increased. Histological analysis demonstrated RV cardiomyocyte cross sectional area was lowered by ferroptosis antagonism. When evaluating RV function, echocardiography revealed an improvement in both tricuspid annular plane systolic excursion and RV free wall thickening while pressure-volume loop analysis showed RV-pulmonary artery (PA) coupling was restored by ferroptosis inhibition.

Conclusions:
Small molecule-mediated disruption of ferroptosis combated pulmonary hypertension and restored RV-PA coupling in MCT rats.
Abstract 12710: Adipocyte-Derived Exosomal Lncrna Sbf2-as1 Promotes Diabetic Myocardial Fibrosis Through Regulating Hnrnpa1/nrf2 Pathway via Sumoylation
Authors: Guo Yue , Chen Zhuohui , Wu Lingling , Zhuang Xiaodong , Liao Xinxue
Published: June 2023

Introduction:
The inhibition of Nrf2 pathway is regarded as the dominant process that correlates with the pathogenesis of diabetic cardiomyopathy (DCM). Recently, accumulating evidence reveals that lncRNAs play key roles in regulating Nrf2 pathway. However, the underlying mechanisms remain unclear. Here, we found that adipocyte lncRNA SBF2-AS1 (SBF2-AS1) enhanced the SUMOylation of hnRNPA1, which subsequently facilitated the package of SBF2-AS1 into exosomes under high glucose conditions.

Hypothesis:
We hypothesized that AdEXO-SBF2-AS1 promotes diabetic myocardial fibrosis through regulating the hnRNPA1/Nrf2 pathway via SUMOylation.

Methods:
We examined the effect of exosomes from diabetic (db/db) mice-derived adipocytes on ANG-II-induced cardiac fibrosis and function in non-diabetic mice. In the
invitro
study, HG (33mmol/L)-induced AdEXO were cultured with adult human cardiac fibroblasts (aHCFs). Differentially expressed lncRNAs in AdEXO were screened using lncRNA sequencing.

Results:
Intramyocardial injection of diabetic AdEXO in the non-diabetic heart exacerbated myocardial fibrosis. Whereas administration of an exosomes biogenesis inhibitor attenuated cardiac fibrosis in diabetic mice. We identified SBF2-AS1 is a common molecule significantly increased in diabetic AdEXO and HG-stimulated non-diabetic AdEXO. After four weeks of ANG II infusion, EXO-db/dbWT-injected mice displayed significant fibrosis in the heart. However, interestingly, mice receiving SBF2-AS1-deficient db/db-EXO showed a decrease in cardiac fibrosis. Similarly, AdEXO-SBF2-AS1 promoted aHCFs proliferation and transformation capabilities in vitro. Mechanistically, SBF2-AS1 induced UBC9 overexpression to catalyze the SUMOylation of hnRNPA1, which facilitated its packaging into exosomes. Subsequently, exosomal SBF2-AS1 was specifically transmitted into aHCFs and epigenetically downregulated Nrf2 expression by decreasing H3K9 acetylation level in the Nrf2 promoter.

Conclusions:
Our findings highlight a novel mechanism whereby the AdEXO-mediated SBF2-AS1/hnRNPA1/Nrf2 regulatory axis promotes diabetic myocardial fibrosis in a SUMOylation-dependent manner and implicate SBF2-AS1 as an attractive therapeutic target for DCM.
Abstract 12713: Increased Calcium Sensitivity in Hypoplastic Left Heart Syndrome Hearts With Systolic Failure
Authors: Shirley Andrew , Stone Matthew , Miyamoto Shelley D , Nakano Stephanie J
Published: June 2023

Introduction:
Systolic failure of the systemic right ventricle (RV) in children with hypoplastic left heart syndrome (HLHS) is a significant cause of death and a growing indication for heart transplantation. However, the underlying etiology of RV systolic failure in this population remains ill-defined.

Hypothesis:
We hypothesize that cardiomyocyte autonomous defects in contractility, characterized by increased calcium sensitivity, may contribute to systolic failure in HLHS.

Methods:
Explanted RV tissue was collected and flash frozen at the time of heart transplant in pediatric subjects with HLHS. HLHS subjects were classified by their primary indication for transplant: HLHS subjects with normal systolic function (HLHS-NF, N=2) were transplanted secondary to refractory protein losing enteropathy, and HLHS-F subjects (N=9) had end-stage heart failure due to decreased systolic function. Cardiomyocytes were isolated from frozen RV tissue, permeabilized, and glued to a force transducer and length controller. Force generated by the cardiomyocyte at different calcium concentrations was measured and force-calcium dose response curves were generated (modified Hill equation). pCa50 denotes the negative log of calcium concentration required to generate 50% maximal tension.

Results:
Less calcium is required to generate 50% maximal tension in HLHS-F cardiomyocytes (n=33 cardiomyocytes) when compared to HLHS-NF (n=5 cardiomyocytes), demonstrated by a higher pCa50 (5.62 vs. 5.46, p=0.027). Maximal force generation is similar between HLHS-NF and HLHS-F cardiomyocytes (55.5 mN/mm2 vs. 54.8 mN/mm2, p=0.96).

Conclusions:
Cardiomyocytes isolated from HLHS-F demonstrate increased calcium sensitivity when compared to those from HLHS-NF. Although future studies are needed, the presence of intrinsic alterations in sarcomeric properties in HLHS-F supports the hypothesis that cardiomyocyte autonomous defects may contribute to systolic failure in HLHS.
Abstract 12721: Acute, High Dose Metformin at Reperfusion Decreases Infarct Size in the High-Risk Aging Heart
Authors: Li Zehui , Bates Lauryn , Wang Hao , Fatmi Mohammad , Chen Qun , Ren Di , Krause-Hauch Meredith , Li Ji , Lesnefsky Edward J
Published: June 2023

Introduction:
Elderly patients (age > 75) sustain larger infarcts with greater mortality from STEMI despite successful TIMI III reperfusion. Elderly age is an independent risk despite correction for clinical and angiographic variables. Mitochondria (MITO) are key mediators of injury during ischemia (ISC) and reperfusion (R) in lab studies. The acute, transient blockade of the MITO electron transport chain (ETC) at complex I during R decreases infarct size in adult heart models. Metformin (MET) inhibits ETC complex I.

Hypothesis:
Acute, high dose MET given at R in high-risk aged STEMI model hearts will reduce infarct size.

Methods:
Young (3-6 mo) and aged (22-24 mo) C57BL/6J mice, male and female (NIA), underwent in vivo ISC-R surgery
via
45 min LAD ligation. At 5 min pre-R, 2 mM MET (or vehicle) was injected via jugular vein. At 24-hr R infarction size and area at risk (AAR) were measured. Echo was performed pre-ISC and end-R.

Results:
MET treatment at R improved contractile function [ejection fraction (EF) and fractional shortening (FS)] following 24 hr R in both male and female aged groups as well as in the young heart (Figure A)(mean ± SD). MET at R substantially decreased infarct size in both sexes in the aged heart (Figure B) to a similar extent as in the young hearts. AAR was similar in all groups.

Conclusions:
Acute, high dose MET treatment directly before R decreased infarction and improved contractile function at 24 hr R in aged murine hearts. This is the initial step to move acute MET toward consideration as a cath lab treatment via intracoronary infusion immediately following R via PCI for elders suffering STEMI to reduce injury and preserve function.
Abstract 12744: Outcomes of Patients With Myeloproliferative Neoplasms Admitted for Myocardial Infarction: Insights From National Inpatient Sample
Authors: Leiva Orly , Siddiqui Emaad A , Mai Andi , Li Jiachen , Caba-Urena Ambar , Hobbs Gabriela , Bangalore Sripal
Published: June 2023

Introduction:
Myeloproliferative neoplasms (MPNs) are chronic clonal stem cell neoplasms with high risk of thrombosis and cardiovascular events. However, outcomes after acute myocardial infarction (AMI) and risk factors for cardiovascular events after AMI in patients with MPN have not been well characterized.

Methods:
Adult patients with a primary admission of AMI from September 2015 to December 2018 (N = 699,786) with (N = 3,156) and without (N = 696,586) a diagnosis of MPN were identified using the National Inpatient Sample. Primary outcome was composite inpatient major adverse cardiac events (MACE) of arterial and venous thrombosis, non-fatal cardiac arrest, and mortality. Patients with and without MPN were compared using propensity score estimation using Generalized Boosted Models(GBM). Outcomes between groups were compared using multivariable logistic regression.

Results:
Patient characteristics are described in Table 1. Patients with MPN were more likely to have a history of heart failure and less likely to have a history of coronary artery disease compared with patients without MPN. Patients with MPN were less likely to undergo revascularization despite similar rates of STEMI. After propensity score weighting with GBM and multivariable logistic regression, MPN patients had increased risk of MACE, arterial thrombosis, VTE and bleeding (Figure).

Conclusions:
Among patients hospitalized with AMI, those with MPN are at increased risk of MACE compared with patients without MPN. Revascularization is less utilized in patients with MPN. More investigation is needed in order to improve post-AMI outcomes in patients with MPN.
Abstract 12752: Ultrasound-Responsive Liposome Enhanced Gene Delivery for Heart Disease
Authors: Yin Xing , Frierson Brion , Wu Jean G , Moody Melanie R , Taegtmeyer Heinrich , Martin James F , McPherson David D , Huang Shaoling
Published: June 2023

Introduction:
Genome editor-CRISPR/Cas9 holds much promise for treatment of heart disease. A critical step is the development of gene transfer platform that can deliver genes into heart muscle efficiently. We have developed ultrasound (US)-responsive echogenic liposomes (ELIP) for controlled payload release, and enhanced payload penetration upon ultrasound application.

Hypothesis:
We hypothesize that ELIP in combination with ultrasound application can enhance gene delivery in cardiomyocytes.

Methods:
FITC (green fluorescence) labeled NF-kB oligonucleotides were used as a prototype for gene delivery. ELIP containing NF-kB-FITC (ELIP-NF-kB-FITC) were prepared by a conventional procedure of hydrating the lipid film, sonication, freezing and drying. Rats were divided into control, ELIP-NF-kB-FITC without US, and ELIP-NF-kB-FITC with US. ELIP-NF-kB-FITC were administered into the left ventricle by injection with the aorta clamped. Ultrasound (1 MHz at 0.5 W/cm2, 100% duty cycle) was applied to the heart for 5 min. Thereafter, heart was excise, fixed and imaged by fluorescent microscopy. The fluorescent intensity of the left ventricular wall was quantified by NIH ImageJ software.

Results:
ELIP-NF-kB-FITC delivered without ultrasound application showed limited green fluorescence in the heart. Ultrasound (US) in combination with ELIP enhanced NF-kB-FITC penetration into the ventricular walls (Fig. 1A). Quantitatively, ultrasound provided 2-fold increase (2.0 ± 0.27, P < 0.01 vs control) in the mean green fluorescence (Fig. 1 B).

Conclusions:
Ultrasound application in combination with ELIP enhanced gene delivery into the ventricular walls. This platform offers a promising delivery system of CRISPR components for the correction of cardiomyopathies caused by gene mutation/change.
Abstract 128: Yield Of Computed Tomography After Non-Traumatic Out-of-Hospital Cardiac Arrest
Authors: Tam Jonathan , Soufleris Christopher , Ratay Cecelia R , Frisch Adam N , Elmer Jonathan , Flickinger Kate , Callaway Clifton W , Coppler Patrick J
Published: June 2023

Background
Computed tomography (CT) can identify the etiology of cardiac arrest and injuries related cardiopulmonary resuscitation (CPR). Diagnostic yield of CT has only been characterized in a few small cohort studies with varied imaging practices.

Purpose
To determine diagnostic yield of CT imaging after out-of-hospital cardiac arrest (OHCA).

Methods
We included non-traumatic OHCA patients treated at a single center February 2019 to February 2021. Our practice during the study period was to obtain unenhanced head CT in all comatose patients and CT of the cervical spine, chest, abdomen, and pelvis in most cases. We abstracted patient age and sex, CPR duration, and initial neurological examination from our prospective registry. We reviewed clinical records and identified CT imaging obtained within 24 hours of arrival. We reviewed radiology reports, and summarized findings for each body region.

Results
We included 505 subjects. Mean age was 60 [SD 16] years and 144 (29%) had an initial shockable rhythm. Median CPR duration was 21 [IQR 12-35] minutes and 448 (89%) subjects were comatose on presentation. Almost all subjects had brain imaging (n=481, 95%), of which 33 (7% [95% CI 5-9%]) had intracranial hemorrhage and 157 (33% [95% CI 28-37%]) had cerebral edema. Fewer subjects had a cervical spine CT (n=202, 40%) though 4 (2% [95% CI 0-4%]) had vertebral fractures. Most subjects had a CT of the chest (n=396, 76%), and abdomen and pelvis (n= 347, 69%). Identified chest pathologies included rib or sternal fractures (222, 56% [95% CI 51-61%]), pneumothorax (27, 7% [95% CI 5-10%]), aspiration or pneumonia (300, 76% [95% CI 71-80%]), mediastinal hematoma (18, 5% [95% CI 3-7%]), and pulmonary embolism (13, 3% [95% CI 2-6%]). Significant abdomen and pelvis findings were bowel ischemia (23, 7% [95% CI 4-10%]), and splenic or liver laceration (7, 2% [95% CI 1-4%]).

Conclusions
Cross sectional imaging identifies clinically important pathology that informs early management.
Abstract 12802: Variation by Age in the Use of Telehealth and Remote Monitoring for Patients With Heart Failure in Urban vs. Rural Areas
Authors: Leggett Christopher , O'Malley James , Carlos Heather , Wong Sandra , kraft sally , Mackwood Matthew , Gilstrap Lauren
Published: June 2023

Introduction:
Limited access is a key challenge in the management of chronic diseases, like heart failure (HF), in rural areas. Telehealth (TH), which is the delivery of care via remote technologies, and remote monitoring (RM), which allows a patient’s implanted device to be interrogated at a distance, are potential ways to improve access. However, many older adults live in rural areas and age is negatively associated with the adoption of novel technologies. The aim of this study is to understand the association between age and use of TH and RM in urban vs. rural areas.

Methods:
We created annual, cross-sectional cohorts of patients with HF in each year from 2013 to 2018 with approximately 5 million patients/year by requiring ≥1 inpatient or ≥2 outpatient ICD9/10 codes for HF in the 2 years prior. TH and RM use were determined using validated ICD-9/10 and CPT codes. Rurality was determined using the Rural/Urban Commuting Areas (RUCA) classification. Multivariable, logistic regression models were used to determine the association between age and use of TH and RM in urban vs. rural areas.

Results:
Increasing age was associated with a decreased odds of TH use in both urban and rural areas. However, the decline in use with age was greater in urban (OR=0.41 for 85+ vs 65-69) than rural areas (OR=0.65). In contrast, increasing age was associated with an increased odds of RM in both urban and rural areas, with a larger increase with increase age in rural (OR=1.47 for 85+ vs 65-69) compared to urban areas (OR=1.35).

Conclusion:
TH and RM are viable ways to improve access for rural patients with HFrEF across the age spectrum. With increasing age, TH use decreases but RM increases, suggesting that patients’ ability to navigate technology plays a significant role - TH technology requires more active engagement by the patient compared to RM technology. Efforts to simplify TH technology would likely mitigate the drop in TH use seen with increasing age and improve access to care for older adults with HFrEF.
Abstract 12825: Merging Machine Learning and Patient Preference: A Contemporary, Comprehensive, Patient-Centered Tool for Risk Prediction Prior to Percutaneous Coronary Intervention
Authors: Hamilton David E , Albright Jeremy , Seth Milan , Sukul Devraj , Gurm Hitinder S
Published: June 2023

Introduction
Predicting personalized risk for adverse events following percutaneous coronary intervention (PCI) remains critical in weighing treatment options, employing risk-mitigation strategies, and enhancing shared decision-making.

Hypothesis
We hypothesized that by employing machine learning models, we would be able to use pre-procedural factors to predict common post-PCI complications.

Methods
A patient panel ranked the importance of common PCI complications. A separate group of 66 adults underwent a semiquantitative survey assessing for a preferred list of outcomes and model display. Our cohort included 71,963 PCI procedures performed at 48 hospitals in Michigan between 4/1/2018 and 9/30/2020 in the BMC2 registry divided into two groups for training (75%) and validation (25%). XGBoost and random forest models were created to predict the risk of in-hospital outcomes.

Results
The overall rate of mortality was 1.76% (n=1,264), AKI 2.64% (n=1,712), new need for dialysis 0.41% (n=295), major bleeding 0.89% (n=631), and transfusion 2.43% (n=1,746). The XGBoost model was selected as the final model and demonstrated excellent discrimination and calibration for all outcomes including mortality (AUC: 0.950 [95%CI 0.939-0.962]), AKI (AUC: 0.889 [95%CI 0.874-0.904]), dialysis (AUC: 0.949 [95%CI 0.928-0.969]), transfusion (AUC: 0.918 [95%CI 0.905-0.931]), and major bleeding (AUC: 0.892 [95%CI 0.861-0.922]). Survey subjects preferred a comprehensive list of individually reported post-procedure outcomes.

Conclusion
Using common pre-procedural risk factors, we designed an XGBoost machine learning model that accurately predicts individualized post-PCI outcomes. Utilizing patient feedback, we created a patient-centered tool to clearly display risks to patients and providers (Figure, shiny.bmc2.org/pci-prediction/). Enhanced risk prediction prior to PCI could help inform treatment selection and shared decision-making discussions.
Abstract 12833: Evaluating Preferences for Data Access and Sharing Among Older Adults With Heart Failure and the Ethical Implications for Research
Authors: Nino de Rivera Stephanie , Mangal Sabrina , Reading Turchioe Meghan , Masterson Creber Ruth M
Published: June 2023

Introduction:
Health information collected during research studies is rarely returned to patients although it can provide benefits for ongoing clinical management. Little is known about preferences for data access and sharing from older adults with heart failure.

Methods:
The research team developed an interview guide based on participants’ perspectives on the ethical implications of data sharing and access in research studies. Interview length ranged from 20-40 minutes each. Qualitative data were analyzed using a directed content analysis approach. Two authors double-coded the first 10% of transcripts and discussed discrepancies to consensus, consulting additional reviewers at weekly meetings when needed.

Results:
Overall, 22 participants were recruited and the mean age was 72 (56-75) years, 27% were female, 14% were Hispanic/Latino, the majority were highly educated (95% completed college or above), and also reported a disability (54%). The three primary themes on the facilitators to data access and sharing were: support for self-management, enhancing clinician communication and motivation to help others (Table). The three primary themes on barriers to data access and sharing were: fear of loss of health insurance benefits, privacy concerns, and a lack of confidence interpreting complex health information.

Conclusions:
Older adults with heart failure strongly endorsed a preference for having access to health research information and being able to share that information with healthcare professionals to optimize management of their care. Psychological barriers to meaningful use of health information can be addressed through transparency with data use and access.
Abstract 12840: The Risk of Hemorrhagic Stroke Among Various Statins Carrying Intensive LDL-Lowering Capability in Asians
Authors: Chen Po-Sheng , Lin Jia-Ling , Lin Hui-Wen , Lin Sheng-Hsiang , Li Yi-Heng
Published: June 2023

Background:
Although high-intensity statin (HIS) is recommended in modern lipid guidelines, hemorrhagic stroke (HS) is one of the concerns in Asia because HIS was reported to increase the risk of intracerebral hemorrhage. Whether the HS risk is different among different high potency statins was unknown.

Methods and Results:
We screened the database of the Taiwan National Health Insurance from January 2013 to December 2018. Adults (≥ 18 years old) who received pitavastatin 2-4 mg/d plus ezetimibe 10 mg/d (combination group) and those who received atorvastatin 40 mg/day or rosuvastatin 20 mg/day (HIS group) for any reason were enrolled for further analysis. The primary endpoint was HS. We also assessed the differences of a composite safety outcome which included hospitalization for drug-related hepatitis or myopathy and new onset diabetes. All censored subjects were follow-up till December 2019. After 1:10 propensity matching, 41437 patients were included (37670 with HIS and 3767 with combination group). After median follow-up for 3.05 ± 1.66 years, HS occurred in 1.29% and multivariable analysis showed subjects in combination group had lower rate of HS than those in HIS group (combination vs. HIS, adjusted HR: 0.650, 95% CI: 0.443-0.953). Moreover, pre-specified subgroup analysis showed similar results in those with previous history of HS or ischemic stroke as whole population. In composite safety endpoint, there was no difference between these two groups (combination vs HIS, adjusted HR: 0.910, 95% CI: 0.809-0.953).

Conclusions:
Our study showed Asian general population with pitavastatin plus ezetimibe had less HS during follow-up comparing to those having HIS. These results suggested that pitavastatin plus ezetimibe was a favorable choice in Asian population who needed strict lipid control but with concern of HS.
Abstract 12847: Atrial Fibrillation and Atrial Flutter: What Are the Substrate Differences Seen in 3D Panoramic Optical Mapping?
Authors: Melki Lea , Saadallah Najla , Ji Ruiping , Wan Elaine Y
Published: June 2023

Background:
Panoramic optical mapping (POM) is an effective tool for 3D visualization and analysis of action potential duration (APD) heterogeneity, a key driver for initiation and persistence of reentry. POM may elucidate cardiac electrophysiological predisposition to develop chaotic arrhythmia such as atrial fibrillation (AF) or organized arrhythmia such as atrial flutter (AFL).

Objective:
To determine the APD differences in AF and AFL in a transgenic (TG) murine model.

Methods:
We performed high resolution POM with 4 simultaneous CMOS cameras on 14 Langendorff perfused TG murine hearts (SCN5A mutation at lidocaine binding site F1759A) with spontaneous AF and AFL. We generated serial 2D activation and APD maps in normal sinus rhythm (NSR), while phase movies were created in AF/AFL. All optical maps were then reconstructed in 3D. We averaged the APD80 and APD dispersion values over each atrial chamber and compared the mean differences: i) within AF and AFL across right atrium (RA) and left atrium (LA); and ii) within RA and LA across AF and AFL.

Results:
AF (n=7) and AFL (n=7) were present at baseline (8/14) or induced by 10Hz burst pacing (6/14). Mean APD80 in RA/LA was: 57.03 ± 4.66 / 50.93± 3.38ms (p<0.05) in AF vs 77.18 ± 4.30 / 58.25 ± 3.88ms (p< 0.01) in AFL, and mean dispersion: 6.23 ± 1.04/ 7.25± 1.71ms in AF vs 5.49 ± 0.80/ 8.42 ± 1.15ms (p<0.01) in AFL. High mean APD80 in the RA with low intra-atrial dispersion in the RA lead to AFL rotational reentry cores, while lower overall APD80 values with high intra-atrial dispersion in the LA resulted in the presence of AF phase singularity points.

Conclusion:
Development of AF was associated with high intra-atrial APD dispersion in NSR, whereas AFL was associated with high inter-atrial APD dispersion in NSR (1.4-fold higher mean APD80 in the RA). Certain atrial APD dispersion patterns observed in NSR are associated with development of chaotic vs. organized atrial arrhythmias.
Abstract 12849: Impact of Age on Exercise Capacity After Home-Based Cardiac Rehabilitation During the Covid-19 Pandemic
Authors: Hama Tomoaki , Chacin Suarez Audry , Bissen Thomas G , Olson Thomas P
Published: June 2023

Introduction:
The COVID-19 pandemic resulted in the closure of many center-based cardiac rehabilitation programs leading many institutions to rely on home-based cardiac rehabilitation (HBCR) to provide critical secondary cardiovascular disease prevention and rehabilitation. The impact of age on the change of exercise frequency and exercise capacity as a result of HBCR during the COVID-19 pandemic remains unknown.

Methods:
Retrospective cohort study of 567 HBCR patients between March 2020 and May 2021. Patients who completed the Duke Activity Status Index questionnaire at enrollment and completion of HBCR were included. We calculated the number of reported exercise days/week , exercise min/day, and VO
2
peak estimated. Patients were divided into two groups according to age (Younger<65 y.o; Older≥65 y.o). Continuous data are described as mean ±SD and baseline data compared with a two-sample t-test. The delta change from pre-post between groups also are compared with a two-sample t-test.

Results:
Of 567 HBCR patients, 118 patients completed both pre and post HBCR questionnaires (Younger, n=54, 56±8 years old vs Older, n=64, 74±7 y.o, p<0.05). Both groups improved exercise days/week (4.4±2.8 to 5.8±1.3 vs 3.8±2.9 to 5.6±1.6 days, p<0.05 for both), exercise min/day (21±20 to 41±17 vs 20±20 to 37±17 min, p<0.05 for both), and VO
2
peak (20.5±7.1 to 27.6±8.0 vs 21.9±8.1 to 25.1±7.7 ml/min/kg, p<0.05 for both). The delta change for exercise days/week and exercise min/day were not significantly different between groups (1.4±2.7 vs 1.9±2.7 days and 19±19 vs 17±18 min, p>0.05); however, the Younger patients significantly increased their VO
2
peak more than the older patients (7.1±6.1 vs 3.2±5.3 ml/min/kg, p<0.05).

Conclusions:
During the COVID-19 pandemic, exercise frequency (days/week and min/day) and exercise capacity (estimated VO2peak) increased in all patients participating in HBCR. With this, the increase in estimated exercise capacity was greater in younger patients compared with older patients. These findings suggest that additional work is needed to explore factors potentially limiting improvement and strategies to maximize improvement in exercise capacity in older patients participating in HBCR.
Abstract 12852: Transcatheter Aortic Valve Replacement for Aortic Stenosis in Small Aortic Annulus: Medium-Term Follow-Up
Authors: Garcia Escobar Artemio , Vera Silvio , Tébar Daniel , Jurado Alfonso , Jiménez Santiago , Guillermo Galeote , Moreno Raúl
Published: June 2023

Introduction:
Small aortic annulus (SAA) is a clinical challenge in managing aortic stenosis (AS). The SAA has been associated with poorer outcomes after surgical AVR with an increased risk of perioperative and overall mortality, suboptimal valvular hemodynamics, and adverse cardiovascular events.

Hypothesis:
TAVI could be a therapeutic alternative in these patients.

Methods:
We performed a retrospective analysis of all patients with AS treated with TAVI from 2015 to 2021 in our center, with SAA defined as the aortic annulus of ≤22mm perimeter-derived diameter (PDD), measured by CT.

Results:
Sixty-eight patients were included (85.3% women, 83.2± 6.5 years) with a mean PDD of 20.7 ± 1.1 mm. The 14.7% had LVEF <50% and 1.4% had bicuspid aortic valve. The Access route was transfemoral in 64 patients (94.2%) and 4 transapical (5.8%). Self-expanding prostheses were used in 78% of the cases, balloon-expandable prostheses in 17.6%, and mechanically-expandable prostheses in 4.4%. The size of the aortic prostheses was 23mm in 82.3% and >23mm in 17.7%. The perioperative implant success rate was 100% defined as single prosthesis implantation with a mean gradient <20mmhg and angiographic paravalvular leak <2. The rate of new permanent pacemaker implantation was 13.2%. The in-hospital complications rate was 5.8% (4 patients): major vascular complication in 1 patient (1.4%), acute kidney injury stage ≥2 in 1 (1.4%), disabling stroke in 2 (2.9%). There were no deaths in the first 30 days of the procedure. At discharge, the TTE máximum gradient was 19.8 ± 9.2mmhg, the mean gradient 9 ± 4.8mmhg, and 4 patients had paravalvular leak grade ≥2 (5.9%). During a mean follow-up of 27.8 ±7.6 months, 45 patients were in NYHA functional class I (66.2%), 19 in NYHA 11 (27.9%), and 3 in NYHA III (4.4%). Eight patients (11.7%) were readmitted due to heart failure, 10 died (14.7%) due to all-cause mortality, and only 3 of them died due to cardiovascular causes (4.4%).

Conclusions:
Although the optimal approach for treating patients with AS and SAA remains controversial. TAVI is a very attractive option in these patients, allowing the implantation of prostheses with excellent immediate hemodynamic results, a low rate of complications, and significant clinical improvement in the follow-up.
Abstract 12866: Risk Factors For Major Adverse Cardiovascular Events Post-Acute Coronary Syndrome Hospitalization in Patients With Myeloproliferative Neoplasms
Authors: Leiva Orly , Jenkins Andrew , Rosovsky Rachel , Karp-Leaf Rebecca , Goodarzi Katayoon , Hobbs Gabriela
Published: June 2023

Introduction:
Myeloproliferative neoplasms (MPNs) are clonal stem cell neoplasms associated with increased thrombotic risk. However, long-term outcomes after acute coronary syndrome (ACS) and identification of MPN-specific risk factors have not been characterized.

Methods:
Single-center, retrospective cohort of patients with MPN admitted for ACS from 2000 to 2020 (n = 41). Primary outcomes were major adverse cardiac events (MACE) and bleeding. MACE was composite of cardiovascular (CV) death, myocardial infarction, ischemic stroke, and heart failure (HF) hospitalization. Patients with and without MACE and bleeding were compared to identify risk factors; univariable and multivariable Cox proportional hazards and competing-risk regression models were used.

Results:
Patient characteristics described in Table 1. After a median follow-up of 80 months, 28 patients had MACE and 14 experienced bleeding. Patients with MACE had shorter median time to index ACS event (35 mos vs 76) and higher rates of JAK2 mutation (82% vs 54%), history of HF (46% vs 15%), and median white blood cell count (WBC, 13 vs 8) at index event compared with patients without MACE. Patients with bleeding had higher rates of JAK2 mutation (93% vs 63%) and WBC (17 vs 10), and lower hydroxyurea use (50% vs 85%) compared with patients without bleeding. Cox and competing-risk regression results in Table 2.

Conclusions:
Patients with MPN and ACS are at high risk of MACE and bleeding. JAK2 mutation and elevated WBC count (≥ 20 K/μL) at time of index ACS were associated with MACE and bleeding. ACS event occurring within 12 months of MPN diagnosis was associated with MACE. Larger studies are needed to confirm our results.
Abstract 12894: Murine Arterial Wall Strain Estimation With Ultrasound-Based Lagrangian Carotid Strain Imaging and Validation Against Histological Findings
Authors: Mukaddim Rashid Al , liu Yuming , Graham Melissa , Eickhoff Jens , Weichmann Ashley M , Tattersall Matthew C , Stein James H , Varghese Tomy , Eliceiri Kevin , Mitchell Carol
Published: June 2023

Introduction:
Early identification of arterial injury by non-invasive imaging can facilitate research into mechanisms of arterial injury and has the potential to improve patient management. We tested the hypothesis that Lagrangian carotid strain imaging (LCSI) combined with adaptive Bayesian regularization could detect early arterial injury and monitor atherogenesis in a murine model by associating findings with histological examinations.

Methods:
Radio-frequency (RF) data were collected from the right and left common carotid arteries (CCA) of 10 (5 male and 5 female) ApoE
tm1Unc/J
mice at 6, 16 and 24 weeks using a high frequency ultrasound system. Cumulative axial, lateral and shear strain images were estimated using LCSI and 3 strain indices: maximum accumulated strain index (MASI), peak mean strain of full ROI index (PMSRI) and strain at peak axial displacement index (SPADI). Mice were euthanized (n=2 at 6 and 16 weeks, n=6 at 24 weeks) for histological examination.

Results:
We observed sex-specific differences in the temporal variation of strain indices. For male mice, axial PMSRI and SPADI changed significantly from 6 to 24 weeks (mean axial SPADI at 6 = 14.10±6.30 % and 24 weeks = 0.24±6.22%; p=0.0004). For female mice, lateral MASI was significantly higher at 24 than 6 weeks (mean lateral MASI at 6 = 10.26±3.13 % and 24 weeks = 16.42±7.15% p=0.048). Both sexes had strong associations with histological findings. For males, axial PMSRI and SPADI showed significant correlation with the number of elastin fibers (axial PMSRI:

r
s

=0.83, p=0.01; axial SPADI:

r
s

=0.76, p=0.02). For females, lateral and shear MASI had significant correlations with plaque scores (lateral MASI:

r
s

=0.66, p=0.04; shear MASI:

r
s

0.77, p =0.009).

Conclusions:
LCSI can quantify carotid arterial wall strain in a murine model non-invasively. Changes in strain were associated with changes in arterial wall microstructure after plaque formation.
Abstract 12895: Blood Pressure Outcomes After 9 Months With Remote Patient Monitoring For Hypertension in Primary Care: A Prospective Cohort Study in Electronic Health Records Using Propensity Score Matching
Authors: Persell Stephen D , Petito Lucia , Lee Ji Young , Peprah Yaw , Anthony Lauren , Li Jim , Sato Hironori
Published: June 2023

Introduction:
Remote patient monitoring (RPM) for blood pressure (BP) in primary care may support hypertension control.

Hypothesis:
Among Medicare patients enrolled from six pilot primary care clinics, those prescribed RPM would have better BP control (BP <140/90 mm Hg), and lower office SBP at 3, 6 and 9 months compared with matched controls.

Methods:
This was a pragmatic observational study. Patients were included if they belonged to any of six primary care practices that were in pilot studies of the Omron VitalSight
TM
RPM system which enabled transmission of BP and pulse from a BP monitor into the electronic health record without manual entry. We used 1:4 propensity score matching to identify contemporary matches for 288 RPM-prescribed patients from the same clinics, based on age, sex, systolic BP (SBP), marital status, and several other clinical and healthcare use characteristics. Outcomes included controlling high blood pressure (most recent primary care office or RPM BP <140/90 mm Hg), most recent primary care office SBP, and most recent primary care or RPM SBP, and were assessed after 3, 6, and 9 months.

Results:
Baseline characteristics of the 288 RPM patients and 1152 controls were similar. The mean ages (SD) were 73.6 (7.4) and 73.8 (7.9) years, respectively. Corresponding mean (SD) SBPs were 142.7 (19.5) and 141.2 (18.7) mm Hg. Controlling high blood pressure was greater in the RPM-prescribed cohort than in matched controls at 3, 6 and 9 months (Table). Mean of last office SBPs did not differ. Means of most recent SBP that included remote values were lower for the RPM-prescribed cohort at 3, 6 and 9 months.

Conclusions:
BP control and mean of last office or remote SBP diverged quickly and were partially sustained at 9 months. As mean office SBPs did not differ, additional evaluation is needed to assess the degree to which observed differences were due to greater declines in BP overall among RPM patients vs. differences between measured home and office blood pressures.
Abstract 12921: National Trends and Sex Differences in Adults < 35 Years Old With Acute Myocardial Infarction in the United States From 2010 - 2018
Authors: King Sara J , Patel Rajiv C , Arora Sameer , Smith Sidney C , Stouffer George A
Published: June 2023

Introduction:
Few studies have examined acute myocardial infarction (AMI) trends among adults < 35 years old. We analyzed hospitalization and mortality trends, risk factors, and sex differences among patients < 35 years old with AMI.

Methods:
We queried the National Readmissions Database (NRD) for all hospitalizations from 2010 to 2018 aged 20-34 with a principal diagnosis of AMI. We assessed the annual trend in AMI hospitalization rates and in-hospital mortality using linear regression, stratifying by sex. We analyzed procedures and risk factors both overall and by sex, and performed bivariate analyses using chi-square to compare sex differences. All frequencies were weighted to reflect national estimates provided by the NRD.

Results:
A total of 40,209 AMI hospitalizations in individuals < 35 years old were identified from 2010 to 2018. Hospitalization rates were higher in men as compared with women (9.6/100,000 vs. 4.0/100,000, p < 0.05) and remained stable for men while there was a trend towards increasing hospitalization rates for women (Figure, p = 0.06). Women were more likely to be hypertensive, diabetic, and obese, while men were more likely to have hyperlipidemia and a history of tobacco or cocaine use (all p < 0.01). The rate of obesity increased over time for both men and women while rates of hypertension and diabetes increased only for women (all p < 0.05). As compared with men, women were less likely to get PCI (47.8% vs. 54.9%, p < 0.01) but in-hospital mortality rates were similar (2.22% vs. 1.60%, p = 0.29).

Conclusions:
Among those < 35 years old with AMI, women were more likely to be hypertensive, diabetic, and obese, with increasing prevalence, while men were more likely to have hyperlipidemia and a history of tobacco or cocaine use. Hospitalization rates for AMI were higher in men and there was a significantly higher use of PCI in men compared to women although in-hospital mortality rates were similar.
Abstract 12924: The Role of Cardiac Magnetic Resonance Imaging Derived-Right Ventricular Ejection Fraction in Predicting the Risk of Right Heart Failure in Patients Who Underwent Left Ventricular Assist Device Implantation
Authors: Nuqali Abdulelah , Dalia Tarun , McKinley Grant , tayeb taher , Hu Jinxiang , Mei Xiaohang , Rosamond Thomas , Shah Zubair
Published: June 2023

Introduction:
Despite the advancement in the left ventricular assist devices (LVADs), right heart failure (RHF) remains a challenging adverse event after LVAD implantation and is associated with increased morbidity and mortality. Cardiac magnetic resonance (CMR)-derived right ventricular ejection fraction (RVEF) is a promising surrogate of the right ventricular function and is an independent predictor of major cardiovascular events. In this study, we aim to assess the role of CMR-derived RVEF in predicting the risk of post-LVAD RHF.

Methods:
We retrospectively assessed adult patients (>18 years) who underwent CMR prior to LVAD implantation at our center from 2016 to 2021. Overall baseline characteristics and clinical outcomes were compared between the patients who developed post-LVAD RHF and those who did not.

Results:
A total of 42 patients were included in this study. Nine patients (21%) developed RHF; four had early post-implant RHF, and five had late RHF. The mean age was 47±14 years, and 76% were males. Most of the patients were on milrinone infusion at LVAD implantation (69%). The mean cardiac index (using the thermodilution method) was 1.5±0.8 ml/kg/m2, and CMR-derived LVEF was 17±7%. About half of the patients were on destination therapy, and half were on a bridge-to-transplant strategy. The mean CMR-derived RVEF was 25±13%, with no statistically significant difference between the two groups. The mean of the CMR-derived right ventricular volume index trend was higher in those with post-LVAD RHF but did not achieve statistical significance (76±28 ml/m2 vs. 65±25 ml/m2; p=0.31). Patients with post-LVAD RHF had lower mean arterial pressure (MAP) at the time of the right heart catheterization (77±10 vs. 85±12 mmHg; p0.039) and had more HF hospitalizations (2.7±2.2 vs. 0.7±1.5 hospitalizations; p=0.001).

Conclusions:
In patients who underwent CMR prior to LVAD implantation, CMR-derived RVEF was not an independent predictor of post-LVAD RHF. Larger multicenter studies are needed to confirm this finding.