bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 12162: Acute Myocardial Infarction Caused by Spontaneous Coronary Artery Dissection of the First Septal Perforator
Authors: Rezkalla Josh , Araoz Philip A , Singh Gurpreet , Tweet Marysia
Published: June 2023

A 68 year old female with hyperlipidemia and tobacco use presented with acute, substernal, chest pressure that occurred during yard work. She had no prior history of coronary artery disease or stable angina. Electrocardiograms (ECG) did not have ischemic changes but high sensitivity troponin was elevated at 285 ng/L and peaked at 1308 ng/L. Therapy was started for acute coronary syndrome and nitroglycerin drip for continued discomfort. Echocardiogram showed ejection fraction of 61% and akinesis of the infero-septum at the mid-ventricle. Coronary angiogram showed diffuse narrowing of the large first septal branch artery (S1) concerning for coronary intramural hematoma. No other significant coronary artery disease was present. Cardiac magnetic resonance (CMR) confirmed hypokinesis of the septum and subendocardial delayed enhancement in the interventricular septum at the mid ventricle suggestive of an isolated septal perforator infarct. She was conservatively managed and discharged 48 hours later. Four days later she had recurrent chest pressure and was re-admitted. Her ECG showed J-point elevation in the anteroseptal leads. Repeat coronary angiogram showed unchanged type 2 spontaneous coronary artery dissection of S1 and a small coronary cameral fistula between the distal septal branch and the right ventricle. The diagnosis of spontaneous coronary artery dissection of the first septal branch is rare and may be missed on angiogram. CMR in addition to invasive coronary angiography aides in the evaluation of this rare cause of acute myocardial infarction and changes clinical management decisions including observation time and evaluation for fibromuscular dysplasia.
Abstract 12175: A Migrated External Iliac Stent - To Retrieve or Not to Retrieve
Authors: Vellanki Shaitalya , Shenoy Padma , Yamane Daivd
Published: June 2023

Endovascular venous stenting has become a more favorable intervention for occlusive, symptomatic deep vein thromboses (DVTs), especially given its decreased complication rate and shorter recovery time than its predecessor, open venous bypass. Risks, however, still exist and can include stent fragmentation and dislodgement causing cardiopulmonary complications. A 57-year-old man with bilateral lower extremity DVTs status post left external ilio-femoral stent and inferior vena cava (IVC) filter placement presented with one month of atypical chest discomfort. CT chest showed migration of his 40cm iliac stent to the IVC and right atrium. Interventional radiology visualized both a patent stent and IVC, however, attempted endovascular removal from the distal margin failed with initial retrieval of fragments only. Other fragments subsequently embolized to the pulmonary and lower lobe arteries and right ventricles. Extraction of more distal fragments was deferred due to risks of structural damage, arrhythmias, and pulmonary vasculature perforation. Fragment analysis by pathology demonstrated evidence of clot, yet cardiothoracic surgical intervention was deferred.The patient continued to experience chest pain and underwent a repeat CT chest three months later that demonstrated the stent extending from the right atrial junction to the infrahepatic IVC. Fragmented portions of the filter in the right ventricle and multiple stent fragments retained in the right upper and bilateral lower pulmonary lobes remained as prior with no evidence of pulmonary embolism (PE), pericardial effusion, or tamponade. Although rare, stent removal complications can occur with increased risk of long-term sequelae. Stent fracturing and dislodgement can result in foreign bodies showering the pulmonary vasculature and cardiac chambers, ultimately placing patients at risk for arterial perforation or dissection, pulmonary hemorrhage, intracardiac damage, tamponade, PE, and chronic thromboembolic pulmonary hypertension (CTEPH). The consideration of such risks, in addition to early involvement of interdisciplinary teams and thorough risk-benefit discussions between patients and providers are essential when undergoing stent removal and related interventions.
Abstract 12219: Social Vulnerability and Cardiometabolic Risk Factors in Pregnant Women in the United States
Authors: Harris Kristen , Reed Joseph , Dong Tony , Al-Kindi Sadeer
Published: June 2023

Background:
In recent years, pregnancy-related mortality rates in the US have increased, with cardiovascular disease accounting for a third of all pregnancy-related mortality. The association between cardiometabolic (CM) health and social determinants of health have not been well understood.

Objectives:
We sought to investigate the relationship between social vulnerability and prevalence of CM risk factors in pregnant women in the US.

Methods:
In this cross-sectional analysis, we linked natality files including all pregnancies resulting in live births in the US (aggregated 2016-2020) with county-level social vulnerability index (SVI), a composite metric of social risk factors with four major domains: socioeconomic, household composition/disability, minority status/language, and housing type/transportation. We investigated the association between SVI and its subdomains with county-level prevalence of maternal pre-pregnancy diabetes, pre-pregnancy hypertension, tobacco use, and obesity.

Results:
A total of 18,953,511 pregnancies were analyzed across 577 counties. All CM risk factors were associated with SVI and/or its 4 subcomponents to varying degrees. Obesity was strongly associated with overall SVI (R=0.52, P<0.001) with an even stronger relationship with socioeconomic vulnerability (R=0.6, P<0.001) and household composition/disability (R=0.66, P<0.001). The rate of pre-pregnancy diabetes was associated with overall SVI (R=0.27, p<0.001), with similar association with socioeconomic vulnerability (R=0.26, P<0.001) and household composition/disability (R=0.28, P<0.001). Chronic hypertension was weakly associated with overall SVI (R=0.15, P<0.001) with similar association with socioeconomic vulnerability (R=0.19, P<0.001) and household composition/disability (R=0.22, P<0.001). Tobacco use was not associated with overall SVI (R=0.034, p=0.41), but was strongly associated with minority status/language (R=-0.71, P<0.001).

Conclusion:
Social vulnerability and its domains are associated with prevalence of CM risk factors in pregnant women in the US. Further studies are needed to investigate the impact of targeting social determinants of health to improve CM risk and mortality in pregnant women.
Abstract 12220: Right Bundle Branch and Bifascicular Blocks: Insensitive Prognostic Indicators for Acute Myocardial Infarction
Authors: Rector Graham , Triska Jeffrey , Wang Ann , Haddadin Faris , Ajene George , alam mahboob , Birnbaum Yochai
Published: June 2023

Introduction:
The clinical significance of right bundle branch block (RBBB) or bifascicular block (BFB) in the setting of ST-elevation myocardial infarction (STEMI) is uncertain. Informed by studies demonstrating higher rates of complete occlusion of the infarct-related artery in patients presenting with RBBB, the latest guidelines on STEMI management suggest patients with persistent ischemic symptoms and RBBB be considered for emergent coronary angiography. However, there has been little study of the prognostic implication of either RBBB or BFB in the setting of undifferentiated acute chest pain, and even less of the degree of ST-elevation in concomitant RBBB.

Methods and Results:
A total of 7626 patient encounters presenting to the Baylor St. Luke’s Medical Center between July 2018 and July 2020 with a chief complaint of “chest pain” were identified via electronic health record query. Of these encounters, 211 (2.8%) patients were found to have RBBB. Of that cohort, 18 (8.5%) presented with acute coronary syndrome, with STEMI accounting for 6 (2.8%), non-STEMI 9 (4.3%), and unstable angina 3 (1.4%). New or presumed new RBBBs were found in 59 (28%) of total RBBB patients, of which only 5 (8.5%) were found to have acute coronary syndrome and only 2 (3.4%) STEMI specifically. Similarly, 90 (42.7%) patients with chest pain and RBBB were found to have a BFB. New or presumed new BFBs were found in 40 (19%) patients, of which only 4 (10%) were also found to have acute coronary syndrome. No patients with new-onset BFB had STEMI. Furthermore, real-time diagnosis of anterior STEMI was complicated in two patients presenting with acute coronary syndrome by the masking of ST elevation in leads V1-3 by concomitant RBBB.

Conclusions:
In a large cohort of undifferentiated patients who presented with chest pain and RBBB or BFB (regardless if new or presumed new), only a small fraction had acute coronary syndrome, and even fewer STEMI. These data suggest patients with undifferentiated chest pain and RBBB on ECG with clinical suspicion for acute myocardial infarction and any degree of ST-elevation in leads V1-3 be considered for emergent coronary angiography rather than RBBB or BFB without ST-segment elevation.
Abstract 12221: Work Improvement With Novel Remote Monitoring System (Impella Connect) in Clinical Engineer Involving Acute Mechanical Circulatory Support
Authors: Hamatsu Hirota , Domae Keitaro , Kato Daizo , Hamada Naoya , SHINYA TACHIBANA , Masai Takafumi , Sawa Yoshiki
Published: June 2023

Introduction:
Recent innovations in mechanical circulatory support (MCS) enable physicians to deal with challenging cases with cardiogenic shock. As the number of MCS has increased, the excessive workload of clinical engineers (CEs) who manage MCS has become a serious problem. To overcome such situation, we introduced innovative remote monitoring system of circulatory assist pump catheters (Impella) called Impella Connect (IC) from 2020, which allows medical staff to monitor driving status and alarms of Impella in their mobile devices. Here we reported our experience of IC and the safety and efficacy of our protocol using IC for management of Impella.

Methods:
We identified 63 Impella cases for cardiogenic shock from 2018 to 2021 in our institution. We utilized Impella 2.5/CP in 53 cases and Impella 5.0 in 10 cases depending on their hemodynamic condition. Before introducing IC (nIC period: n=17), CEs were responsible for Impella management in all time periods and needed to work overtime to manage devices in night time. However, after introducing IC (IC periods: n=46), CEs were responsible only in daytime and non-MCS expert medical stuff were responsible in night time supporting by CEs’ remote monitoring with IC. We retrospectively evaluated the safety and efficacy of our management using IC.

Results:
Impella insertion was performed emergently in all cases and the 34 cases (53.9 %) were inserted in night time. Average support time was 6.5±0.6 days (nIC 7.7 vs. 6.0 days). We encountered 13 device trouble in nIC periods (purge system in 8, pressure sensor in 4 and pump malfunction in 1) and 14 in IC periods (purge system in 9, pressure sensor in 3 and pump malfunction in 2). Device trouble requiring intervention was not significantly different in both periods (nIC/IC 10 vs. 11 cases, p=0.85) and adverse event related to delayed or inappropriate response was not observed in both periods. The average of overtime working hours of CEs per month was significantly decreasing in IC periods (53.1±16.8 vs. 8.6±2.6 hours per month, p<0.05).

Conclusions:
Our Impella management using novel remote monitoring system with Impella Connect was safe with no adverse events and effective to reduce overtime work of CEs, which resulted in work improvement of medical stuff involving MCS.
Abstract 12229: Adipokines Are Linked to Heart Failure Through Metabolic Risk-Dependent and Independent Pathways: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Ozkan Bige , Zhang Sui , Echouffo Tcheugui Justin B , Florido Roberta , NAMBI VIJAY , Michos Erin D , Abushamat Layla , Post Wendy S , Gerstenblith Gary , Blumenthal Roger , Hoogeveen Ron C , Ballantyne Christie M , Coresh Josef , Selvin Elizabeth , Ndumele Chiadi E
Published: June 2023

Introduction:
Adipokines have metabolic effects and laboratory studies also suggest direct effects of adipokines on the myocardium. However, there are no population-based studies examining heart failure (HF) risk with multiple adipokines in concert.

Methods:
We conducted a prospective analysis of ARIC Visit 2 (1990-92) participants without HF. Adipokines were categorized into quartiles. “Abnormal” adipokine levels were defined as the top quartile for leptin, resistin, and visfatin, and the bottom quartile for adiponectin and apelin. We compared the prevalence of adipokine abnormalities across body mass index (BMI) categories: normal weight (BMI 18.5-<25 kg/m
2
), overweight (BMI 25-<30 kg/m
2
), obesity (BMI 30-<35 kg/m
2
) and severe obesity (BMI ≥35 kg/m
2
). We used Cox regression to examine associations for each adipokine and the number of abnormal adipokines with incident HF.

Results:
Among 10,725 participants (mean age 58, 55% female, 22% Black), higher prevalences of multiple (≥2) adipokine abnormalities were seen with higher BMI (56% of those with severe obesity vs 15% of normal weight). After adjusting for confounders (Table), higher adiponectin and apelin were associated with lower HF risk (Q4 vs. Q1 HR: 0.70, 95%CI: 0.62-0.79; HR: 0.87, 95%CI: 0.78-0.97), and higher leptin and resistin with higher HF risk (Q4 vs. Q1 HR: 2.06, 95%CI: 1.78-2.38; HR: 1.31, 95%CI: 1.17-1.46). Visfatin was not associated with HF. Results were similar when stratified by obesity (BMI ≥30 kg/m
2
). For leptin and adiponectin, HF associations were attenuated by adjusting for metabolic risk factors, but not for apelin and resistin (Table). Having more adipokine abnormalities was linked to progressively higher HF risk (For 4 vs 0 abnormalities HR: 2.92, 95% CI: 1.95-4.30).

Conclusions:
Adipokines are linked to HF risk, with some associations mediated by metabolic risk factors and others independent of metabolic risk. Adipokines may be a key mechanistic link between adipose tissue and HF.
Abstract 12234: A Three-Dimensional Culture System Composed of Hipsc Derived Cms, Ecs, Smcs, and Cardiac Fibroblasts Promotes Hipsc-cm Maturation
Authors: Kahn-Krell Asher , Pretorius Danielle , Guragain Bijay , Lou Xi , Wei Yuhua , Zhang Jianhua , Qiao Aijun , Nakada Yuji , Kamp Timothy J , Ye Lei , Zhang Jianyi J
Published: June 2023

Introduction:
Cardiomyocytes (CMs), endothelial cells (ECs), smooth muscle cells (SMCs), and cardiac fibroblasts (CFs) differentiated from human induced-pluripotent stem cells (hiPSCs) are the fundamental components of cell-based regenerative myocardial therapy and can be used as in-vitro models for mechanistic studies and drug testing. However, newly differentiated hiPSC-CMs tend to more closely resemble fetal CMs than the mature CMs of adult hearts, and current techniques for improving CM maturation can be both complex and labor-intensive.

Hypothesis:
CMs tend to develop a more mature phenotype when cultured as spheroids in a three-dimensional (3D) environment, rather than as two-dimensional monolayers, and the activity of ECs, SMCs, and CFs promote both CM maturation and electrical activity.

Methods:
hiPSCs were differentiated into CMs (hiPSC-CMs) using a belly dancer shaker in 3D condition and seeded into 96-Well of Nunclon Sphera-Treated, U-Shaped-Bottom Microplate (Thermo Fisher Scientific). hiPSC differentiated endothelial cells (hiPSC-ECs), smooth muscle cells (hiPSC-SMCs), and cardiac fibroblasts (hiPSC-CFs) were added to each well to produce cardiac spheroids. Quantitative polymerase chain reaction (qPCR), western blot, immunostaining, bioenergetics, transmission electron microscopy, field potential, and contractility of cardiac spheroids were characterized.

Results:
The inclusion of hiPSC-ECs, -SMCs, and CFs in CM spheroids increased spheroid size and improved cell viability. hiPSC-ECs, -SMCs, and -CFs promoted hiPSC-CMs maturation in cardiac spheroids: a. gene expression levels of TNNI3, N-cadherin, and peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PPARGC1a) significantly increased; b. Contractile fibers were better organized and mitochondria were better aligned; c. ATP level, the ratio of NAD:NADH, and cAMP level were greater in cardiac spheroids; d. Field-potential duration and conduction velocity were greater in CMs in cardiac spheroids.

Conclusion:
we developed a simple and reproducible 3D-culture-based process for generating cardiac spheroids containing more mature hiPSC-CMs in the presence of ECs, SMCs, and CFs.
Abstract 12244: Loneliness, Social Isolation, and Incident Heart Failure in the Southern Community Cohort Study
Authors: Wainwright Kaleel , Xu Meng , Dixon Debra , Lipworth Loren , Gupta Deepak K
Published: June 2023

Introduction:
Loneliness and social isolation are associated with worse outcomes among individuals with prevalent heart failure (HF). Less is known regarding loneliness and incident HF, particularly among individuals of low socioeconomic position.

Methods:
We studied 26,666 Southern Community Cohort Study participants without prevalent HF enrolled between 2002-2009. At enrollment, loneliness was assessed via a 4-level question on the Center for Epidemiologic Studies Depression Scale. Incident HF was ascertained through CMS linkage using ICD-9 (428.x) and ICD-10 (I50.x) claims through 2016. Associations between loneliness and social isolation, e.g., marital status, household size, close friends or relatives, and help in emergency, with incident HF were examined with multivariable Cox regression.

Results:
The study population was predominantly middle-aged (median 54 years), female (63%), Black (69%), with low annual income (70% < $15,000) and education (92% < college graduate). Individuals reporting greater loneliness tended to be younger, female, with lower income and educational attainment. Over a median 9.8 years follow-up, 7,396 (27.7%) individuals developed HF. In Cox models adjusted for demographics and traditional CV risk factors, greater loneliness significantly associated with increased risk for HF (HR: 1.04, 95% CI: 1.01-1.06), which attenuated following adjustment for education and income (HR 1.02, 95% CI: 0.99-1.04) (Table) without evidence for effect modification by either education or income (p-interaction >0.19 for both). Education and income significantly and inversely associated with incident HF risk while social isolation measures did not.

Conclusion:
Among individuals of low-socioeconomic position, an association between loneliness or social isolation and incident HF did not persist after adjustment for education and income emphasizing the importance of socioeconomic status as a risk factor for incident HF.
Abstract 12257: Prognostic Value of Liver T1 Mapping and Extracellular Volume in Dilated Cardiomyopathy
Authors: Wang Jiaqi , Xu Yuanwei , Guo Jiajun , Li Yangjie , Chen Yucheng
Published: June 2023

Introduction:
Cardiac dysfunction closely correlates with liver congestion and effect on liver relaxation time. Liver relaxometry could provide potential prognostic improvement for dilated cardiomyopathy (DCM) patients.

Hypothesis:
Liver relaxometry might have prognostic significance for DCM patients.

Methods:
We prospectively enrolled 433 patients diagnosed with DCM. Cardiac and hepatic T1, T2, and extracellular volume (ECV) were measured on the mid-ventricular mappings. The primary endpoint was defined as heart failure death, sudden cardiac death, and heart transplantation.

Results:
DCM patients who reached primary endpoint showed significantly increased liver native T1 (770.5±103.2ms versus 813.8±137.0ms, p=0.014) and ECV values (30.9±6.8% versus 34.3±10.7%, p=0.009) and decreased liver T2 value (35.8±5.5 versus 34.1±6.2ms, p=0.038). Right ventricular ejection fraction correlated moderately but significantly with liver native T1 (r =-0.293) and ECV (r=-0.245) (both p<0.001). During the follow-up period (median duration 3.9 years) 97 patients reached the primary endpoint. In the Kaplan-Meier survival analysis, DCM patients with elevated liver native T1 or ECV had higher risk of reaching the primary endpoint (cutoff value: 854.9ms, p=0.001 and cutoff value: 34.5%, p<0.001, respectively). Cox analysis indicated that liver ECV was an independent prognostic factor (hazard ratio:1.042, p<0.001) and showed incremental prognostic value to age, sex, NYHA class III-IV, and LVEF.

Conclusions:
Liver native T1 and ECV correlates with cardiac magnetic resonance parameters. Furthermore, Liver ECV provides incremental prognostic value in DCM patients.
Abstract 12264: A Rare Case of Penetrating Aortic Ulcer Causing Hemopericardium and Its Management
Authors: Fichadiya Hardik , Abboud Rachel , Noori Muhammad Atif Masood , Masood Abdullah , Elkattawy Sherif , Khan Arshan , Khandait Harshwardhan , Shruti Jesani , Joshi Meherwan B
Published: June 2023

Introduction:
Penetrating Aortic Ulcer (PUA) is an atherosclerotic lesion with ulceration that penetrates the internal elastic lamina and allows hematoma formation within the medial layer of the aortic wall. As per our literature review, only one case of PUA causing hemopericardium has been reported.

Case Presentation
66-year-old male with an unknown past medical history was bought in by the emergency medical services following a cardiac arrest. Initial rhythm was pulseless electrical activity and return of spontaneous circulation was achieved after ten mins of cardio-pulmonary resuscitation on the field. Initial echocardiogram was significant for a 4.6 cm ascending aorta with large hemopericardium causing tamponade physiology. CT chest with contrast revealed an ectatic ascending aorta with mild irregularity along the posteromedial wall, concerning for aortic leak secondary to a penetrating aortic ulcer (as indicated by the yellow arrow in the image below). Controlled pericardiocentesis was planned as a bridging therapy while awaiting transfer to a specialized cardiothoracic unit. But, the systolic blood pressure (SBP) rose to 170 mmHg when the chest tube was first inserted, worsening the hemopericardium. The patient's condition rapidly deteriorated, causing another cardiac arrest and death.

Discussion
The recommended treatment for Type A and B PUA-associated Intra Mural Hematoma is urgent surgical aortic graft placement. For hemodynamically unstable patients who cannot be taken for urgent surgery, The 2015 European Society of Cardiology guidelines recommend controlled pericardiocentesis to maintain a target SBP of 90 mmHg as a temporary measure.

Conclusion
In addition to aortic dissection, PAU should be considered in the differentials of patients with dilated ascending aorta and hemopericardium. An acute rise in blood pressure above 90 mmHg during pericardiocentesis is associated with worsening tamponade.
Abstract 12315: Prognostic Value of Proteinuria on Cardiac Events in Japanese Patients With Atrial Fibrillation: The Fushimi AF Registry
Authors: Ikeda Syuhei , Iguchi Moritake , Ogawa Hisashi , Nakanishi Yumiko , Minami Kimihito , Ishigami Kenjiro , DOI KOSUKE , Hamatani Yasuhiro , Yoshizawa Takashi , Ide Yuya , Fujino Akiko , Ishii Mitsuru , Masunaga Nobutoyo , Esato Masahiro , Wada Hiromichi , Hasegawa Koji , Abe Mitsuru , Akao Masaharu
Published: June 2023

Background:
Previous studies have suggested that proteinuria is independently associated with incidence of atrial fibrillation (AF). However, data regarding the impact of proteinuria on clinical outcomes in patients with AF are limited.

Methods:
The Fushimi AF Registry is a community-based prospective survey of AF patients in Fushimi-ku, Kyoto, Japan. Follow-up data were available in 4,489 patients, and 2,164 patients with available data of proteinuria as the results of the urine test by dipstick were examined. We divided these patients into three groups according to the level of proteinuria; positive group (n=339), trace group (n=267) and negative group (n=1,558).

Results:
Patients in positive group and trace group were older (positive vs. trace vs. negative; 75.9±9.7 vs. 75.7±10.8 vs. 73.4±10.5; p<0.01), had higher prevalence of heart failure (HF), hypertension, diabetes mellitus and renal dysfunction (estimated glomerular filtration rate <60 ml/min/1.73 m
2
), and had higher CHADS
2
score (2.6±1.4 vs. 2.5±1.3 vs. 2.0±1.3; p<0.01) and HAS-BLED score (2.2±1.2 vs. 1.9±1.0 vs. 1.7±1.0; p<0.01). During the median follow-up of 2,978 days, the incidence rates of cardiac events (composite of cardiac death or HF hospitalization during follow-up) were higher in patients in both of positive group and trace group than patients in negative group (3.8% vs. 4.0% vs. 1.9% per person-year; p<0.01) (Figure). Multivariate Cox proportional hazards regression analysis revealed that proteinuria was an independent determinant of cardiac events (positive vs. negative; adjusted hazard ratio [HR]: 1.44, 95% confidence interval [CI]: 1.12-1.85, trace vs. negative; adjusted HR: 1.60, 95% CI: 1.23-2.09).

Conclusion:
In Japanese patients with AF, the presence of proteinuria, even if it was trace level, was associated with higher incidence of cardiac events.
Abstract 12321: Patient-Reported Outcomes in Clinical Studies of Patients With Hypertrophic Cardiomyopathy
Authors: Reza Nosheen , Day Sharlene , Owens Anjali T
Published: June 2023

Introduction:
Therapy for hypertrophic cardiomyopathy (HCM) is primarily targeted toward alleviation of symptoms and improvement in function and quality of life. Yet, the contemporary landscape of patient-reported outcomes (PROs) in HCM clinical research has not been investigated.

Methods:
ClinicalTrials.gov was queried to identify clinical studies of HCM that reported PROs as outcome measures. All studies of HCM as the disease condition were included, and PROs were identified using specific search terms in the Outcome Measures field. Study characteristics were collected and compared between those that did versus did not report PROs.

Results:
From November 1987 to February 2022, 181 studies including participants with HCM were registered on ClinicalTrials.gov. Of these, 35 (19%) included PROs as primary or secondary outcome measures. Studies reporting PROs were more likely to be interventional (85.7% vs. 46.6%; p<0.001) and to involve randomization (65.7% vs. 24.7%; p=0.003) compared with those that did not report PROs. Prior to 2007, no clinical studies that reported PROs were registered in ClinicalTrials.gov; however, PRO reporting has increased over the last 15 years. Ninety-four percent of studies that reported PROs as outcomes enrolled fewer than 500 participants. In total, 66 PRO tools or domains were listed as outcome measures. Of these, the Kansas City Cardiomyopathy Questionnaire (KCCQ) was the most often used.

Conclusion:
Only approximately one in five registered clinical studies of participants with HCM report PROs. Only one PRO tool, the KCCQ, has been validated in studies of patients with HCM. HCM-specific symptoms such as palpitations, dizziness, angina, syncope, and psychiatric impacts are not adequately assessed by existing PRO tools. Future research is needed to develop and validate PRO tools that adequately capture HCM-specific symptoms and longitudinal health status trajectories in patients with varying HCM subphenotypes.
Abstract 12322: Red Meat Consumption and The Risk of Cardiovascular Diseases and Diabetes: A Systematic Review and Meta-analysis of Observational Studies and Randomized Controlled Trials
Authors: Shi Wenming , Huang Xin , Sching C Mary , Zhao Jie
Published: June 2023

Introduction:
Observational studies show inconsistent associations of red meat consumption with cardiovascular disease (CVD) and diabetes. Moreover, red meat consumption varies by sex, whether the associations vary by sex remains unclear.

Methods:
This systematic review and meta-analysis was performed to summarize the evidence concerning the association of unprocessed and processed red meat consumption with CVD, coronary heart disease (CHD), stroke, type 2 diabetes (T2DM), and gestational diabetes mellitus (GDM). Two researchers independently searched PubMed, Web of Science, Embase, and the Cochrane Library for observational studies and randomized controlled trials (RCTs) published before September 2021.

Results:
A total of 44 observational studies (N=4,857,244) for CVD and 28 observational studies (N=1,897,591) for diabetes were included. Red meat consumption was positively associated with risk of CVD [relative risk (RR) 1.11, 95% confidence interval (CI) 1.05 to 1.17 for unprocessed red meat; RR 1.15, 95% CI 1.09 to 1.22) for processed red meat], CHD and stroke, with no clear sex disparity. Both unprocessed and processed red meat consumption were related to a higher risk of T2DM, and unprocessed red meat consumption was related to risk of GDM. The associations with T2DM were more evident in men than in women, and in western countries.

Conclusions:
Our study suggests that unprocessed and processed red meat consumption are both associated with higher risk of CVD, CHD, stroke, and diabetes, with a more obvious association in women for diabetes. These findings highlight the need for a better understanding of the mechanisms to facilitate improving cardiometabolic health.
Abstract 12325: Burden of Premature Ventricular Complex is Associated With New-Onset Atrial Fibrillation
Authors: Lee Po-Tseng , Hsu Chih-Hui , Lin Sheng-Hsiang , Liu Ping-yen
Published: June 2023

Introduction:
Large burden of premature ventricular complex (PVC)lead to more cardiovascular mortality. A recent nationwide population-based database demonstrated that presence of PVC is associated with increased risk of atrial fibrillation. The relationship between burden of PVC and new onset of atrial fibrillation (AF), however, has never been investigated.
Hypothesis:
The purpose of the study is to clarify whether burden of PVC is associated with more new-onset AF.

Methods:
We designed a single-center, retrospective, and large population-based cohort to clarify the role of PVC burden and new-onset atrial fibrillation in Taiwan. PVC patients without history of atrial fibrillation with were divided into low burden group (<1000/day) and moderate to high burden group (≥1000/day) based on the report of 24-h Holter ECG. New-onset AF was defined as new or first detectable events presenting as either persistent or paroxysmal AF.

Results:
A total of 16030 AF-naïve patients who underwent 24-h Holter ECG were enrolled in this study with a mean follow-up time of 973 days. A propensity-score matched analysis demonstrated moderate to high burden PVC group had a higher risk to have new-onset AF in comparison with low burden (4.96% vs 2.79%, p<0.001). Multivariate Cox regression analysis showed that moderate to high burden of PVC is an independent risk factor to develop new-onset AF. A Kaplan-Meier analysis also showed that patients with moderate to high burden of PVC is associated with more new-onset AF (log rank p<0.001).

Conclusions:
Burden of PVC is associated with new-onset atrial fibrillation. Patients with moderate to high burden PVC are at a higher risk to have new-onset atrial fibrillation.
Abstract 12331: Prospective Evaluation of Risks Ventricular Arrhythmia Ablation With Half Normal Saline Irrigation
Authors: Hasegawa Kanae , Yoneda Zachary T , Tokutake Kenichi , Richardson Travis D , Jay Montgomery A , Shen Sharon T , Estrada JC , Pablo Saavedra J , Emerson Amy , Walker Marilyn L , Michaud Gregory F , KANAGASUNDRAM Arvindh N , Stevenson William G
Published: June 2023

Background:
Failure of radiofrequency ablation (RFA) of ventricular arrhythmias (VA) is often due to inadequate lesion size. RFA with half-normal saline (HNS) irrigation has the potential to increase lesion size, but can increase steam pops, which could increase risks of perforation and emboli. Optimal energy titration is not defined.

Objective:
To assess peri-procedural complications of ventricular arrhythmia (VA) ablation with HNS RFA guided by impedance monitoring and intracardiac ultrasound (ICE).

Methods:
All patients undergoing endocardial RFA only for VA from October 2018 to September 2021 were prospectively assessed for complications in hospital and at 30 days by clinic visit or phone call. Of 862 procedures 616 patients undergoing 663 endocardial RFA were included. HNS or normal saline (NS) RF irrigation and were selected at the discretion of the physician. RFA power was titrated to a
<
15 Ohm impedance fall with intracardiac ultrasound monitoring for tissue whitening and increasing bubble formation in most cases.

Results:
Of 663 procedures HNS was used in 552 (83%) and NS in 111 (17%). The HNS group was older, with more heart disease, ventricular tachycardia, LV ablation sites, and RFA time. There were 59 complications (8.9%) in 53 procedures, including 11 pericardial effusions (1.6%) (2 requiring surgical repair), and 2 strokes (0.3%). There was no significant difference between HNS and HS in complications or mortality (table).

Conclusion:
HNS irrigation ablation with power guided by impedance fall and ICE is associated with a low incidence of serious complications. A small difference can not be excluded, but would require a very large trial and seems unlikely to be clinically relevant.
Abstract 12333: Therapeutic Window of Low-Dose Prasugrel for Platelet Reactivity in the Chronic Phase of Post-Percutaneous Coronary Intervention: The Chaperon Study
Authors: Fukase Tatsuya , Doi Shinichiro , Tomotaka Dohi , nishio ryota , Takahashi Norihito , Chikata Yuichi , Hirohisa Endo , Nishiyama Hiroki , Okai Iwao , Iwata Hiroshi , Okazaki Shinya , Daida Hiroyuki , Minamino Tohru , MIYAUCHI Katsumi
Published: June 2023

Introduction:
There are many reports on the effects of on-treatment platelet reactivity using P2Y
12
reaction units (PRU) on the ischemic or bleeding risk in patients who underwent percutaneous coronary intervention (PCI). However, there was little report including low-dose prasugrel (2.5mg).

Hypothesis:
We assumed that low-dose prasugrel use may contribute to the effectiveness and safety in the chronic phase of PCI in Japanese patients.

Methods:
This prospective observational study included 398 patients who underwent PCI between 2017 and 2018 (mean age: 68±11 years, male: 83%). Serial PRU measurements were performed; the baseline was at 6 to 12 months after PCI, and the follow-up was after 6 months later. The PRU was measured by the VerifyNow® P2Y
12
assay, and we assessed the distribution of PRU in each P2Y
12
inhibitor, after defined PRU 86 to 238 as therapeutic window.

Results:
Among 398 patients, the follow-up PRU was obtained in 360 patients (90%), and 80 patients (22%) were taking prasugrel 2.5mg. The baseline PRUs of clopidogrel 75mg, prasugrel 3.75mg, and prasugrel 2.5mg were 175±64, 147±55, and 154±66, respectively (
p
<0.001), and the portions of PRU ≤239 (ischemic risk) were 14.6%, 4.4%, and 9.5%, respectively (
p
=0.007). At the time of follow-up, a statistically significant trend of PRU was revealed in 24 patients changed clopidogrel 75mg to prasugrel 2.5mg (baseline vs. follow-up: 183±64 vs. 149±43,
p
=0.037). Regarding distribution of PRU, prasugrel 2.5mg was less frequent in PRU ≤85 (bleeding risk) compared to prasugrel 3.75mg (7.5% vs. 21.0%,
p
=0.019). In addition, a multivariable logistic regression analysis revealed that prasugrel 2.5mg use was an independent predictor of therapeutic window (odds ratio: 2.15; 95% confidence intervals: 1.01-4.59,
p
=0.044).

Conclusions:
We found prasugrel 2.5mg use after PCI significantly associated with therapeutic window. Thus, we believe low dose prasugrel use may contribute to the future risk reduction after PCI.
Abstract 12337: Mortality Trends in Aortic Valve Stenosis in High-Income Countries: The Impact of Recent Advances in Procedures
Authors: Hibino Makoto , Pandey Arjun , Verma Raj , yanagawa bobby , Verma Subodh
Published: June 2023

Introduction
Aortic stenosis is a critical but addressable structural heart disease which has traditionally been treated with open surgery. Recently progress in transcatheter aortic valve replacement provides less invasive treatment option especially in elderly patients. The actual impact on death from aortic stenosis across countries remains unclear.

Hypothesis
We hypothesized that mortality trends from aortic stenosis would be improving in high-income countries.

Methods
We analyzed the WHO mortality database to determine trends in mortality from aortic stenosis in UK, Germany, France, Italy, Japan, Australia, USA, and Canada from 2000 to 2020. Crude mortality rate and age-standardized mortality rate per 100,000 persons were calculated. We calculated age-specific mortality rates in three groups (<64, 65-79, and ≥80 years). Annual percentage change was analyzed using joinpoint regression.

Results
In the most recent year, crude mortality rates and age-standardized mortality rates from aortic stenosis ranged from 3.38 in Australia to 8.93 in Germany, and 0.93 (95%CI, 0.91, 0.96) in Japan and 2.20 (95%CI; 2.15, 2.25) in Germany, respectively and in USA, they were 4.22 and 1.65 (95%CI; 1.62, 1.68), respectively. There were trends towards increased age-standardized mortality rates during the observation period in the UK, Germany, Italy, Japan and Canada, and no significant change in France, Australia, and the USA. Decreasing age-standardized mortality rates were observed in Germany after 2012 (-1.2%, p=0.015), Australia after 2011 (-1.9%, p=0.005), and USA after 2014 (-3.1%, p<0.001). In contrast to other younger age groups, favorable mortality trend change was identified in those with ≥80 years in all 8 countries.

Conclusions
Trends in mortality from aortic stenosis are increasing or constant in the 8 countries over the observation periods, however favorable trend changes were identified especially in age group of ≥80 years.
Abstract 12343: Competing Roles of Angiostatin on SARS-CoV-2 Cellular Infection: Effects of Acidosis
Authors: Franczak Aleksandra , Joyce Michael , Tyrrell Lorne , Jurasz Paul
Published: June 2023

Introduction:
Angiostatin - plasmin(ogen) break-down product - is generated by platelets in an urokinase(uPA)-dependent manner. Angiostatin is anti-inflammatory during normoxia, and pro-apoptotic during hypoxia/acidosis. In SARS-CoV-infected mice, the uPA-plasminogen pathway was transcriptionally enriched regulating sublethal vs. lethal infection. Similarly, uPA was transcriptionally upregulated in SARS-CoV-2; however, role of angiostatin has not been investigated. Angiostatin level progressively increases in the blood of severe COVID-19 patients and this increases risk of lethal infection. We aimed to assess role of angiostatin in COVID-19.

Methods:
VeroE6 cells were infected with wild-type SARS-CoV-2 and treated with angiostatin (140 μg/ml) at pH 7.5 or 6.9. Cell death was quantified by the percentage of detached cells. Immunofluorescent staining against spike protein was used to confirm cellular infection. Additionally, HEK293-ACE2 cells were infected with replication-incompetent SARS-CoV-2 Reporter Virus Particles (RVP; GFP-expressing; Wuhan-Hu-1 D614G) with/without angiostatin and analyzed by flow cytometry. Co-immunoprecipitation of angiostatin and spike protein (Alpha variant) was carried out, followed by SDS-PAGE.

Results:
At pH 7.5 angiostatin significantly decreased the percentage of detached (24±7 vs 58±6%, p=0.002) VeroE6 following infection, and did not have a significant effect on uninfected cells. Conversely, at pH 6.9 angiostatin alone increased the percentage of detached cells (25% detachment, p=0.014), and failed to reduce the death of infected cells (detachment:53.5±4 vs 50±5%). Angiostatin lowered the percentage of spike protein-positive VeroE6 (59±3 vs 89±3%, p<0.001) and GFP-expressing HEK293-ACE2 (7±0.5 vs 29±3, p=0.001) at both pH 7.4 and 6.9. Spike protein and angiostatin were co-immunoprecipitated.

Conclusions:
Angiostatin likely has a complex role in COVID-19 pathophysiology. High angiostatin concentrations such as those observed in COVID-19 promote cell death in acidotic microenvironments. Conversely, at physiological pH, angiostatin may have protective effects. Irrespective of pH, angiostatin reduced SARS-CoV-2 cellular entry, possibly by interacting with spike protein.
Abstract 12348: High-Risk Low-Density Non-Calcified Plaque Morphology
Authors: Malkasian Shant , Crabtree Tami , Molloi Sabee , Marques Hugo , Min James K , Chang Hyuk-Jae , Choi Andrew , Earls James
Published: June 2023

Hypothesis
The morphology of low-density non-calcified coronary plaque is associated with acute coronary syndrome (ACS) and culprit lesion precursors

Methods:
This was a post-hoc analysis of the multicenter ICONIC study. A subset of 94 patients suspected of coronary artery disease (CAD) underwent coronary CT angiography imaging (CCTA) with subsequent follow-up for the occurrence of the first ACS event were selected. At the time of ACS, the culprit lesion was adjudicated by invasive coronary angiography cardiologists blinded to the CCTA.

Quantitative CT was performed by a validated software as a service (Cleerly Labs, Cleerly, Inc., Denver, CO). A level-III reader used multiplanar reformation (MPR) images from this analysis to qualitatively assess individual collections of low-density non-calcified (LDNC) plaques (-189 to 30 HU).

The degree of embedded LDNC plaque (DELP) was the amount a LDNC plaque was surrounded by non-calcified plaque. DELP was categorized as 90, 180, 270, and 360. LDNC plaque shape was categorized as crescent, round, lobular, or bean-shaped. DELP and shape were qualitatively assessed using the cross-sectional MPR image with the greatest LDNC plaque area. LDNC plaques with >270 DELP and round or bean-shaped were considered high-risk plaque (HRP) morphology.

Results:
ACS occurred in 64 patients. 247 LDNC plaques were analyzed. Patients without and with ACS had, on average 0.40±0.86 and 1.02±1.21 (p-value = 0.014) LDNC plaques with HRP morphology. The proportional hazard ratio associating the presence of one or more HRP morphology plaques with ACS was 2.03 (1.19, 3.48; p-value = 0.009), after controlling for diameter stenosis, age, sex, and family history of CAD. The odds ratio of the association of HRP morphology with culprit lesion precursors was 10.93 (3.77, 31.71; p-value <0.001), after controlling for diameter stenosis, age, sex, and family history of CAD.

Conclusion
HRP morphology may improve the stratification of patients at risk for ACS.
Abstract 12353: Clinical Outcomes of Telehealth in Coronary Artery Disease and Heart Failure Patients During Covid-19 Pandemic
Authors: Woo Pauline , Chung Joanie , shi jiaxiao M , Tovar Stephanie , Adams Annette L , Lee Mingsum
Published: June 2023

Introduction:
The COVID-19 pandemic necessitated a rapid adoption of telehealth (TH). Few studies have assessed the safety of TH in subspecialty clinical practice. This study aimed to assess the clinical outcomes of TH use in patients with coronary artery disease (CAD) and/or heart failure (HF) during the initial phase of the COVID-19 pandemic as care delivery model shifted.

Methods:
This retrospective cohort study assessed continuously enrolled members in an integrated healthcare delivery system in the United States. Adult patients with CAD and/or HF with outpatient cardiology encounters from 3/1/2020 to 8/31/2020 (TH period) were identified via EHR using ICD-10 codes. Accounting for the dynamic shift in the proportion of TH use, patients were divided into two 3-month sub-cohorts (March-May, June-August) and compared with corresponding periods in 2019 (pre-pandemic period). The primary endpoint was outcome events including ED visits and hospitalization for any cardiovascular (CV) cause within 3 months follow-up. The secondary endpoint was cardiovascular events over 6 months of follow-up. Multivariable logistic regression was used to evaluate the association between TH use and CV outcomes.

Results:
The study cohort included 6485 patients with outpatient cardiology encounters during the TH period and 7557 patients during the pre-pandemic period. The mean age was 70 years, with 40% of patients being aged ≥ 75 and 35% being female. TH visits accounted for 0% of visits during the pre-pandemic period, compared to 68% during the TH period. Telephone visits comprised ≥ 92% of all TH encounters. Compared to the pre-pandemic period, patients seen during the TH period had fewer CV events 3 months after the index visits (aOR 0.77, 95%CI 0.66-0.89) and 6 months after the index visits (aOR 0.78, 95%CI 0.69-0.87). Subgroup analysis evaluating patients aged ≥75 showed similar findings.

Conclusions:
TH particularly via telephone visits accounted for a large share of ambulatory cardiology encounters during the initial phase of the COVID-19 pandemic. No increase in CV events was detected with the use of TH, suggesting that TH can be safely incorporated into ambulatory cardiology practice.
Abstract 12354: Novel Coronavirus Disease 2019 Infection in a Cohort of Patients With Phenotypic Hypertrophic Cardiomyopathy: An Extended Report
Authors: Gasimli-Gamache Leyla , Le Marjolein , Cabrera Felicia , Shirani Jamshid
Published: June 2023

Background:
Patients with preexisting heart disease suffer more severe outcomes after COVID-19. Hypertrophic cardiomyopathy (HCM) is a common inherited cardiac conditions. We previously reported incidence and outcomes of COVID-19 in HCM in early days of the pandemic. We report results from an expanded and extended HCM cohort.

Methods:
343 patients with HCM [age 59±17 years, 55% men, 19% NYHA class >1, 63% obstructive, 14% septal reduction therapy, 24% positive family history, 42% selectively genotyped (43% positive for pathogenic mutations), 22% implantable cardioverter-defibrillator (ICD) implants, 27% paroxysmal or permanent atrial fibrillation (AF), 4% AF ablation] were evaluated for COVID-19 from December 2019 to May 2022.

Results.
Overall, 54 (16%) patients were diagnosed with COVID-19 [56% men, age 55±17 years, 60% obstructive HCM, 5.5% dilated phase HCM, 28% positive family history, 15% genotype positive, 28% with ICD, 17% NYHA class >1, 31% AF]. There were 289 patients without COVID-19 [55% men, age 58±17 years, 63% obstructive HCM, 3% dilated phase HCM, 23% positive family history, 17% genotype positive, 21% with ICD, 19% NYHA class >1, 27% AF]. Patients with COVID-19 were slightly younger (55±17 vs 58±17 years, p 0.046) and more often had dilated phase HCM (5.5% vs 3%) and more often had ICD (28% vs 21%). Eleven (20%) patients with COVID-19 were hospitalized and 1 (2%) died of the disease. Compared to those with mild disease, hospitalized patients with COVID-19 were more often men (82% vs 49%, p 0.04), older (age 59±15 vs. 54±18 years), with obstructive phenotype (73% vs 56%) and with NYHA class >1 symptoms (27% vs 12%). In the studied patient cohort 70% had at least one dose of COVID-19 vaccine. Prior to the infection 63% of patients had no vaccination against SARS-CoV2. Among hospitalized patients 9 (82%) had no vaccination and 2 (18%) were vaccinated and had mild disease.

Conclusions.
Although Covid-19 infection rate (16%) in studied cohort was slightly lower than in general US population (~25%), hospitalization rate was higher (20% vs 9%) with similar death rates (1-2%). Older man with symptomatic obstructive HCM phenotype noted to have higher risk for hospitalization. Patients with vaccination against SARS-Cov2 tended to require less hospitalization.