bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 14350: CVSA Early Career Investigator Award Finalist: Association of Aneurysm Wall Stresses With Diameter Indices and Three-Year Outcomes in Veterans
Authors: Zamirpour Siavash , XUAN Yue , Wang Zhongjie , Gomez Axel , Hope Michael D , LEACH JOSEPH , Saloner David , Guccione Julius , Ge Liang , Tseng Elaine E
Published: June 2023

Introduction:
Current diameter-based guidelines for ascending thoracic aortic aneurysms do not consistently predict risk of dissection/rupture. Aneurysm wall stresses may better predict risk but correlate weakly with diameter. Our objective was to correlate aneurysm wall stresses with indexed diameters in relation to 3-year all-cause mortality.

Methods:
Finite element analyses were performed on 255 patients with aneurysms ≥4.0cm. Three-dimensional geometries were reconstructed from computed tomography and models developed accounting for pre-stress geometries. A fiber-embedded hyperelastic material model was applied to obtain circumferential (circ.) and longitudinal (long.) wall stress distributions under systolic pressure. Peak wall stresses were compared across diameter/[body surface area (BSA)] and diameter/[height (ht)] thresholds from the literature. Hazard ratios for 3-year all-cause mortality and surgical aneurysm repair were estimated using cause-specific Cox proportional hazards models.

Results:
Compared to the 22% cumulative incidence of aneurysm repair at 3 years, indexed diameter indicated repair at baseline in 17/255 (7%) patients, including only 4/230 (1.7%) with diameter <5.5cm. Peak wall stresses did not significantly differ across literature-proposed thresholds for diameter/BSA (circ: p=0.15; long: p=0.18), but did differ for diameter/ht (circ: p=0.003; long: p=0.048). All-cause mortality was associated with peak long. stresses independent of indexed diameter (p=0.009). Peak long. stresses were best predicted by diameter (c-statistic=0.66), followed by diameter/ht (c-statistic=0.59), and diameter/BSA (c-statistic=0.55).

Conclusions:
Diameter/ht better stratified peak wall stresses than diameter/BSA. Peak long. stresses independently predicted all-cause mortality, adjusting for age and indexed diameter. Peak long. stresses may aid risk stratification for adverse events.
Abstract 14365: In-Hospital Outcomes of Septal Myectomy versus Alcohol Septal Ablation for Hypertrophic Cardiomyopathy - An Update and Insights From the National Inpatient Sample
Authors: Inestroza Karla , Ergui Ian , Matute-Martinez Carlos , Albosta michael , Vergara-Sanchez Carlos , Dangl Michael , Hernandez Rafael J , Ebner Bertrand , Vincent Louis T , Grant Jelani , Maning Jennifer , Alfonso Carlos , Colombo Rosario
Published: June 2023

Introduction:
Septal Myectomy (SM) and Alcohol Septal Ablation (ASA) improve symptoms in patients with Hypertrophic Cardiomyopathy (HCM), however, outcomes data in this population is predominantly from specialized centers.

Methods:
The National Inpatient Database was queried from 2011- 2019 for relevant ICD-9 and -10 diagnostic and procedural codes. Baseline characteristics and in-hospital outcomes of patients with HCM who underwent SM vs. ASA were compared. A p-value <0.001 was considered statistically significant.

Results:
We identified 17,245 patients who underwent septal reduction therapies, of whom 62.5% underwent SM and 37.5% underwent ASA. Patients who underwent SM had higher all-cause mortality (OR:2.2 [1.7-2.9]), post procedure ischemic stroke (OR: 2.4 [1.8-3.2]), acute kidney injury (OR: 1.9 [1.7-2.2]), vascular complications (OR: 4 [2.8-5.7]), ventricular septal defect (OR: 4.6 [3.5-6.1]), aortic dissection/aneurysm (OR: 1.6 [1.3-2.1]), cardiogenic shock (OR: 2 [1.5-2.6]), sepsis (OR:5.2 [3.3-8.1]), and left bundle branch block (OR: 3.2 [2.8-3.7]) (p<0.001 for all), compared to ASA. Patients who underwent ASA had higher post procedure complete heart block (OR: 1.2 [1.1-1.4]), 2
nd
-degree AV Block (OR: 2 [1.4-3]), right bundle branch block (OR: 6.4 [5.3-7.8]), ventricular tachycardia (OR:2 [1.8-2.3]), supraventricular tachycardia (OR: 1.4 [1.2-1.7]), and more commonly required pacemaker (OR: 1.4 [1.2-1.6]) or implantable cardioverter-defibrillator (OR: 1.3 [1.1-1.5]) (p<0.001 for all) insertion compared to SM.

Conclusions:
This nationwide analysis evidenced patients undergoing SM had higher in-hospital mortality and periprocedural complications compared to ASA, however, those undergoing ASA had higher post-procedure conduction abnormalities and pacemaker or ICD implantation. The implications of these findings warrant further investigation in regards to patient selection strategies for these therapies.
Abstract 14369: “July Effect”: Impact of Academic Year Transition on In-Hospital Outcomes of Patients With Cardiac Arrest
Authors: Markson Favour , Orji Richard , Kesiena Onoriode , Horoub Ali , Omaliko Chidiebele
Published: June 2023

Introduction:
The transition of training to a new Academic year and the beginning of training for new interns and fellows have been suggested to affect the quality of patient care and health care outcomes in critically ill patients, a phenomenon known as the “July Effect” in the United States. Prior studies have shown mixed reports regarding the “July Effect” existence. This study provides an insight into the “July Effect” in patients who suffered Cardiac arrest using a National Database.

Methods:
We performed a retrospective analysis using the National inpatient sample (2016- 2019). The NIS was searched for hospitalized adult patients with cardiac arrest as a principal diagnosis. We subsequently divided our sample into two cohorts based on the quarter of training (1st quarter, July to September, and the Last quarter of Training April to June). The primary outcome was inpatient mortality, and the secondary outcomes were the length of stay (LOS), total hospitalization charges (THC), and transfer frequency to other acute care facilities.

Results:
There were 27,940 Patients who suffered a cardiac arrest in the first and last quarter of our study period. Approximately 49.2% (13,755) vs. 50.8% (14,185) patients were identified in the 1st and Last quarters, respectively. There was a similar distribution of Age (63.5 ± 0.2) and Sex (Females) (43%) in both cohorts. There was similar inpatient mortality for patients who presented in both quarters (AOR 1.05, 95% CI 0.855-1.14, p=0.935). There was also no significant difference in LOS (adjusted coefficient -0.19, 95% CI -0.50-0.46, p=0.937), THC (adjusted coefficient 115.9, 95% CI -6483.46 - 6715, p=0.973) and frequency of transfer to other acute care facilities (AOR 0.95, 95% CI 0.82-1.11, p=0.57).

Conclusions:
This study suggests that the “July Effect” is not apparent in patients who suffered cardiac arrest as there were no significant differences in the rate of in-hospital mortality, length of stay, total hospitalization charges, and frequency of transfer to other acute care facilities.
Abstract 14374: Clinical and Echocardiographic Characteristics of Patients Who Develop Post Liver Transplant Non-Ischemic Cardiomyopathy
Authors: Basharat Sohaib A , Chung Joseph , KARAMAT SAAD , Abramov Dmitry , Fraser Gary E , Parwani Purvi
Published: June 2023

Background:
Non-ischemic cardiomyopathy is a well-known but poorly understood cardiac complication post orthotopic liver transplantation (OLT).

Methods:
We performed a nested case control study in a cohort of 590 patients who underwent OLT at Loma Linda University between 2013 - 2021. 29 (4.9%) patients developed post-OLT non-ischemic cardiomyopathy. 100 patients who did not develop cardiomyopathy were selected randomly from the cohort to serve as control group. Clinical characteristics of cases and controls were compared and echocardiograms of patients who developed cardiomyopathy reviewed.

Results:
Patients who developed cardiomyopathy were more likely to be female, less likely to have history of hypertension, had lower baseline hemoglobin and platelets, and higher MELD scores (
Table 1)
. Mean pre-transplant ejection fraction (EF) was 69% among patients who developed cardiomyopathy. Cardiomyopathy developed on average 10 days after OLT with mean EF dropping to 26%. 24 (83%) patients had reduced EF (<40%) and 5 (17%) had mid-range EF (40-49%). Wall motion analysis revealed global hypokinesis in 11 (38%) patients, mid-ventricular takotsubo in 11 (38%) patients, apical takotsubo in 5 (17%) patients, and basal takotsubo in 2 (7%) patients
(Figure 1)
. 24 (83%) patients recovered EF (≥ 50%) on average of 113 days after initial diagnosis of cardiomyopathy.

Conclusions:
Female sex and higher MELD scores were associated with development of non-ischemic cardiomyopathy post OLT. Global hypokinesis and mid-ventricular takotsubo were the most common patterns of wall motion abnormality. EF recovery was noted in majority of patients indicating operative stress related etiology.
Abstract 14387: Early Atherosclerosis on CCTA: Insights From Artificial Intelligence-Enabled Quantitative CT Analysis of Serial Scans From the Paradigm Trial
Authors: Cardoso Rhanderson , Min James K , Choi Andrew , Earls James , Blankstein Ron
Published: June 2023

Introduction:
Non-obstructing small coronary plaques are not always appreciated during coronary CTA (CCTA) but may be identified by artificial intelligence-enabled quantitative CT (AI-QCT). It is unclear if these are true early atherosclerotic plaques or false positive findings.

Hypothesis:
Serial CCTA exams may provide insights into the natural history of these findings, as a plaque appearing in the same anatomical location and demonstrating interval change is likely real.

Methods:
399 plaques measuring between 0.1 and 50.0 mm
3
were identified using AI-QCT in 83 patients with serial CCTA exams (N=166 exams) from the PARADIGM Trial. The total volume (TPV), calcified (CP), non-calcified (NCP) and low-density plaque (LD-NCP) volume, and % diameter stenosis of each plaque were recorded. Serial studies were processed in a blinded manner and linked after processing. The presence and change in plaque characteristics were assessed.

Results:
Overall 345/399 (86%) of small plaques were present in the same location on follow-up (mean interval 3.8 years), including 313/350 (89%) of plaques >2.0mm
3
(Figure 1). Plaques were nonobstructive (<=50%) in 99.5% of initial and 97.5% of follow-up studies. On follow-up, 82% (250/305) increased in size and 293/304 (96%) increased in calcified plaque content. Plaques in statin taking patients demonstrated higher median increase in CP (8.7 vs 4.0 mm
3
, p<0.05) and transformed from all NCP to mixed NCP + CP at a higher rate (59.3 vs 43.9%, p=0.0027

Conclusions:
Small coronary plaques depicted with serial AI-QCT are often present in the same location upon follow-up, increase in volume, and develop or increase calcification with statin therapy. While further data regarding the natural history and prognosis of these plaque is warranted, these findings provide a rationale for identifying early coronary atherosclerotic plaques.
Abstract 14507: Perceptions and Attitudes About Advance Care Planning Among Healthcare Professionals of Cardiac Care: A Q Methodology Study
Authors: Kim JinShil , Ko Hana , Shin Myoung Hwan , Shin Mi-seung , Hwang Yoon Young , Kim Mi Yeong , Cho KyungAh , Park SeongHu , Yi Hani
Published: June 2023

Background:
Provision of advance care planning (ACP) in patients with cardiovascular diseases is suboptimal in South Korea, which leads to an increase in the burden of care. Healthcare professionals’ perspectives of ACP are particularly important to facilitate its utilization. However, Korean healthcare professionals’ perspectives on ACP remain unknown.

Aim:
We explored perspectives and attitudes regarding ACP among healthcare professionals (physicians and nurses) who provide care to patients with cardiovascular diseases, using a Q methodology.

Methodology:
The Q sample consisted of 40 statements representing perspectives for and attitudes toward ACP derived from a literature review, mass media reports, and an in-depth qualitative interview. P samples consisted of 10 physicians and 14 nurses. The P sample filled each grid with a statement in the Q sorting table. Data were analyzed using the PQ Method program.

Results:
Seventy-one percent of the variance was explained with four factors represented by 18 Q – sorters, with each variance explained by each factor ranging from 16% to 20%: Factor A (n=5), healthcare professional-led decision about ACP; Factor B (n=5), patient value-based persuasive decision about ACP; Factor C (n=5), prognosis-based passive support for ACP; Factor D (n=3), comprehensive consideration -induced decision for ACP. Six Q-sorters fell into either confounded or non-significant. Shared perspectives for ACP among Korean healthcare professionals emerged in areas including conceptual definition, educational support and training, and ethical and legal concerns, while each factor also presented unique and primary perspectives for ACP.

Conclusions:
Our research revealed shared and unique perspectives for ACP in Korean healthcare professionals who treat cardiac patients. The findings of this study provide basic data for the provision of ACP in which, as a major stakeholder, healthcare providers’ perspectives should be considered in educational support and training.

Keywords:
advance care planning; cardiac disease; nurse; physician; perspectives; Q methodology
Abstract 14524: Low Testosterone Levels and Cardiovascular Disease: Insights From the Houston Methodist CVD Registry
Authors: Yahya Tamer , Lu Shannon , Gullapelli Rakesh , Lahan Shubham , Taha Mohamad , Makram Omar M , Jaawan Fady , BOSE BUDHADITYA , Nwana Nwabunie , Jones Stephen , Patel Kershaw , Soliman Ahmed , Cainzos Achirica Miguel , Hubbard Logan C , Starke Nathan , Nasir Khurram
Published: June 2023

Introduction:
Low testosterone (LowT) has been suggested to be associated with increased ASCVD risk and mortality, but results are conflicting across studies. We evaluated the independent relationship between low testosterone levels in adult males and ASCVD using data from an EHR-based database. Methods Cross-sectional study using the Houston Methodist CVD Learning Health System Registry, which includes data from 1.1 million patients aged ≥18 years (June 2016-April 2022). Analyses were restricted to men, and those on testosterone replacement therapy were excluded. We evaluated the associations between total testosterone levels (categorized as quartiles [Q], lowest Q as exposure of interest and highest Q as reference) and ASCVD (CAD, PAD, stroke), using logistic regression. Conditions and risk factors were identified using ICD 10-CM codes.

Results:
We evaluated 30,150 men ≥18 years (mean age 55.3 years, 12% NHB, 15% Hispanics) with testosterone level data. Men in testosterone Q1 (lowest levels: ≤285 ng/dl) had higher prevalence of almost all risk factors and composite ASCVD compared to Q4 (highest levels: ≥515 ng/dl)
(Panel A).
In unadjusted analyses, men in testosterone Q1 vs Q4 had higher odds of ASCVD (OR 1.54, 95% CI 1.41-1.68). In multivariable adjusted logistic regression, the increased odds persisted adjusting for age, sex, and race OR 1.33 (CI 1.21 - 1.46), while it was fully attenuated (OR 1.04 CI 0.94 - 1.14) after adjusting for risk factors (DM, HTN, dyslipidemia, obesity)
(Panel B).
The attenuation in association with prevalent ASCVD was highest adjusting for DM (67%) and HTN (58%)
(Panel C).
Similar results were noted when cutoff of <200 ng/dl was used for LowT.

Conclusions:
ASCVD and CV risk factors are widely prevalent among men with LowT. The association between LowT and ASCVD might be related to CV risk factors, mainly hypertension and DM. Early identification and intensive CV risk factor management among men with LowT levels may help reduce their risk of ASCVD.
Abstract 14567: Safety of Concomitant Percutaneous Left Atrial Appendage Occlusion Among Patients Undergoing Catheter Ablation for Atrial Fibrillation
Authors: Asahina Chisa , Tonegawa-Kuji Reina , Kuno Toshiki , nakai michikazu , Kanaoka Koshiro , Iwanaga Yoshitaka , Kusano Kengo
Published: June 2023

Background:
The safety of concomitant percutaneous left atrial appendage occlusion procedure (LAAO) among patients undergoing catheter ablation (CA) for atrial fibrillation (AF) is unclear. This study aimed to evaluate the association between concomitant LAAO vs non-receipt LAAO with the risk of in-hospital complications and 30-day all-cause readmission among patients undergoing CA for AF.

Methods:
We performed a retrospective study using the Nationwide Readmission Database of the United States. The primary outcome was the in-hospital composite complications, which was defined as a composite of death, tamponade, hematoma, pneumothorax, and blood transfusion. The secondary outcome was the 30-day all-cause readmission. We performed a 1:10 propensity score (PS) matching analysis to compare the safety of performing and not performing LAAO on the same day of CA for AF. Logistic regression analysis was performed to evaluate the association between performing LAAO and the endpoints in the PS-matched cohort.

Results:
Among 25,834 patients (median age 70 years [62-78], 45% female) who underwent CA for AF between 2017 and 2019, 146 patients (0.6%) underwent LAAO on the same day. After the PS matching, a total of 1,515 patients (145 in the LAAO group and 1,370 in the non-LAAO group) were included in the comparative analysis. Concomitant LAAO procedure was not associated with higher risk of in-hospital complications (LAAO vs. non-LAAO; 10% vs. 7.9%; odds ratio [OR]; 1.35, 95% confidence interval [CI]; 0.76-2.38) and 30-day all-cause readmission following discharge (10% vs. 14%; OR; 0.71, 95% CI; 0.41-1.24).

Conclusions:
There was no significant difference in the in-hospital complications and 30-day all-cause readmission rates following LAAO and CA for AF compared to that of those who underwent CA for AF without LAAO.
Abstract 14616: Lineage-Specific Integrin alpha-V Augmentation Promotes Integrin/Akt/mTORC1 Signaling Pathway in Marfan Syndrome Aortic Aneurysm
Authors: Nakamura Ken , Yokoyama Nobu , Dalal Alex R , Pedroza Albert J , Leipzig Matthew , Mitchel Olivia , Kusadokoro Sho , Uchida Tetsuro , Fischbein Michael P
Published: June 2023

Introduction:
Marfan syndrome (MFS) patients classically develop focal aortic root aneurysms. Previously, we demonstrated
in vitro
activation of the integrin/Akt/mTORC1 signaling pathway in MFS second heart field iPSC derived SMCs. Integrin αV (ITGAV) antagonism via selective inhibitor GLPG0187 attenuated the signaling cascade. Therefore, we hypothesize that ITGAV blockade may have a potential therapeutic effect to reduce MFS aneurysmal growth.

Methods:
Fbn1
C1039G/+
mice were treated with (1) ITGAV antagonism (GLPG0187, 100mg/kg/day, IP) or (2) vehicle control (age 6-14 weeks). WB and ELISA were performed at baseline and after treatment. Aneurysm growth and elastin fragmentation were measured with ultrasound and histology respectively. Proliferation marker Ki-67 was used with IHC staining.

Results:
ITGAV and p-Akt protein levels were elevated in Fbn1
C1039G/+
aortic specimens at both 6 and 14 weeks of age compared to wild-type littermate controls. P-Akt and mTORC1 activities were attenuated following GLPG treatment compared to vehicle control (p-Akt
Thr308
: 1.37- vs. 1.11-fold, p<0.05; p-RPS6
Ser235/236
: 5.13- vs. 1.15-fold, p<0.001; p-RPS6
Ser240/244
: 4.36- vs. 1.25-fold, p<0.05, n=6). Compared to vehicle control, GLPG reduced aneurysm growth (2.12±0.14mm vs. 1.82±0.19mm, p<0.001, n=12) and elastin fragmentation (1.09 [0.99-1.18] vs. 0.84 [0.75-1.01] breaks/lamina, p<0.05, n=6) in Fbn1
C1039G/+
mice. Ki-67 expression was suppressed with GLPG treatment.

Conclusions:
As biological proof of concept, GLPG0187 treatment in Fbn1
C1039G/+
mice decreased aneurysm growth via reduced ITGAV signaling. Mechanistically, blockade of ITGAV leads to diminished Akt and mTORC1 activation. Ultimately reducing aortic SMC proliferation, migration and phenotype modulation, which have all been associated with aortic aneurysm development and growth. ITGAV blockade via GLPG0187 may be a promising therapeutic approach to slow MFS aneurysmal growth.
Abstract 14641: Diastolic Dysfunction “In a Dish“- A Novel Organoid Model of Heart Failure With Preserved Ejection Fraction
Authors: Haiim Idan R , Bashai Caroline , Kazma Noam , Nevo Anastasia , Caspi Oren
Published: June 2023

Introduction:
Heart failure with preserved ejection fraction (HFpEF) is a major cause of mortality. No therapies have shown a survival benefit in HFpEF. A potential reason may be the lack of an
in-vitro
model for identifying novel therapeutic targets. Here, we aimed at generating a model of HFpEF using engineered cardiac organoids.

Methods:
Human cardiomyocytes generated from human-induced pluripotent stem cells were used to form 3D cardiac organoids. The organoids were exposed to conditions mimicking the comorbid conditions (Diabetes, hypertension, obesity, inflammation) leading to HFpEF: high glucose media with insulin deprivation; pro-fibrotic and hypertrophic stimuli such as Angiotensin II and Endothelin-1; free fatty acids, and pro-inflammatory factors (
e.g.,
IL-1 ). The passive stiffness, active contractile forces, and tau (relaxation constant) were evaluated using a force-transducer and a length controller. Structural and molecular phenotyping were conducted as well.

Results:
Exposure to HFpEF-inducing media resulted in single cells hypertrophy with an increase of average cell size (6670.87±1363.86 um^2) in comparison to control media (2840.56±520.70 um^2). The generated organoids exposed to HFpEF media developed a significant increase in passive force of 7.35±2.47 N/m vs. 2.04±0.85 N/m for control. Relaxation was prolonged in the HFpEF media and resulted in an increased ratio of 1.87±0.21 of relaxation constant, tau, in comparison to baseline and no modulation of tau in the control (1.08± 0.08 ). Structural and molecular evaluation showed characteristic HFpEF phenotype.

Discussion:
Cardiac organoids can recapitulate HFpEF phenotypes such as the increase in passive force, elongation of diastole, hypertrophy, and no change in the active force. An HFpEF in-vitro model may provide an unprecedented insight into the early pathogenetic mechanisms involved in HFpEF and may serve as a high-throughput platform for drug discovery.
Abstract 14645: Progression of Left Ventricular Ejection Fraction in Hospitalized COVID19 Patients With New Onset Cardiomyopathy
Authors: Kumar Sachin , Nair Raunak , Rikabi Sarah , Ghimire Bindesh , Reed Grant W , Khot Umesh N , Shah Gautam
Published: June 2023

Introduction:
New-onset cardiomyopathy (NOC) has been seen in hospitalized patients with COVID19 infection. Such NOC was associated with increased 30-day mortality. Long-term follow-up to assess the reversibility of such cardiomyopathy is lacking. We studied the follow-up echocardiograms in such patients and assessed the reversibility of their cardiomyopathy.

Methods:
We reviewed all cases of hospitalized COVID19 patients from the Cleveland Clinic COVID19 registry from 18
th
March, 2020 to 18
th
May, 2021. Patients who received an in-hospital echocardiogram and had echocardiogram prior to and post COVID19 hospitalization were selected for the study. NOC was defined as a reduction in left ventricular ejection fraction (LVEF) of
>
10% with a new LVEF of
<
53%. Cardiomyopathy was considered reversible if the follow-up echocardiogram showed an improvement in LVEF, with new LVEF >53%. The mean interval between the in-hospital and follow-up echocardiogram was 5.6 months.

Results:
Of the 1537 hospitalized COVID19 patients receiving echocardiogram, 907 had a prior echocardiogram, of which 77 (8.5%) had NOC. Patients with NOC were significantly more likely to be females and have chronic kidney disease. Of the 77 patients with NOC, 35 (45.5%)

had follow-up echocardiograms. Of these, only 13 (37.1%) had reversible cardiomyopathy while 22 (62.9%) had persistently decreased LVEF.

Conclusions:
Our study highlights the lack of follow-up echocardiograms for patients with NOC and a persistence in decreased left ventricular systolic function in those that received one. All patients with NOC and COVID19 infection should receive follow-up echocardiography to guide their management.
Abstract 14669: Type 2 Diabetes and Atrial Fibrillation: Exploring Causal Pathways Using Mendelian Randomization
Authors: Ardissino Maddalena , Reddy Rohin K , Ng Fu Siong
Published: June 2023

Introduction:
The association between type 2 diabetes mellitus (T2DM) and atrial fibrillation (AF) has been established in observational studies. This has not been replicated in genetic studies, suggesting that it might be driven by confounding.

Hypothesis:
Mendelian randomization (MR) uses genetic variants as instrumental variables to study casual relationships between exposures and outcomes. We conducted a two-sample multivariable MR study to investigate whether T2DM is causally related to AF risk.

Methods:
182 uncorrelated (r
2
<0.001) SNPs associated with T2DM (
p
<5х10
–8
) were extracted from a GWAS on 180,834 affected individuals. Inverse-variance weighted (IVW) MR was used for primary analysis, weighted median and MR-Egger as sensitivity analyses. Radial MR was used to identify outlier SNPs. Potentially pleiotropic phenotypes were identified by phenome-wide scanning of outlier SNPs using MR-TRYX. Multivariable MR adjusting for these phenotypes was then performed.

Results:
Genetically-predicted T2DM was associated with AF in univariable analysis (IVW OR: 1.08, 95% CI 1.02 - 1.13,
p
= 0.003). Sensitivity analyses identified pleiotropic effects (MR-Egger intercept
p
= 0.02). Four outlier SNPs were identified, and these were associated with low-density lipoprotein cholesterol (LDL-C), body-mass index (BMI) and systolic blood pressure (SBP). T2DM remained associated with AF after adjustment for LDL (OR:1.09, 95% CI 1.02-1.16,
p
= 0.01) and BMI (OR: 1.09, 95% CI 1.01 - 1.17,
p
= 0.02). However, following adjustment for SBP the relationship between T2DM and AF was fully attenuated (OR: 1.04, 95% CI 0.95 - 1.13,
p
= 0.40).

Conclusions:
We took a stepwise approach towards parsing the independent effects of T2DM on AF risk. T2DM was found to be associated with AF through a parallel, pleiotropic genetic pathway influencing SBP. This implies SBP reduction alongside hypoglycaemic therapies may provide particular benefit in reducing AF risk in patients with T2DM.
Abstract 14683: Cardiovascular Risk Perception in Young Patients With Coronary Artery Disease
Authors: Adhikari Anish , Vaidean Georgeta , Wutawunashe Caleb , Yang Angela , Findling Chloe , Hentz Roland , Gianos Eugenia
Published: June 2023

Introduction:
Risk perception is one of the factors influencing adoption of health protective behaviors, cardiac rehabilitation, and quality of life. While younger CAD patients tend to experience lower quality of life, their risk perception profile is less well-characterized.

Methods:
The Young Heart Study enrolled 60 patients ≤59 years old, with coronary artery disease noted on cardiac catheterization or CT coronary angiogram and at least two uncontrolled risk factors: BMI>25 kg/m2, A1C >7% in patients with diabetes, and >5.6% in those without, systolic blood pressure >130 mmHg, LDL>70 mg/dL or active smoking. Perception of cardiovascular (CV) risk and health was collected via structured questionnaires.

Results:
Among the 60 patients in the study, the median age (Q1-Q3) was 51 (45-55), 70% were male, 46.7% were white. Participants had hypertension (76.7%), hyperlipidemia (91.7%), diabetes (36.7%), prediabetes (28.3%), obstructive CAD (88.3%), myocardial infarction history (38.3%), family history of premature ASCVD (48.3%) and self-reported depression or anxiety (11.7%). Health perception related questions were answered by 46 of these patients. Gender-specific waist circumference goals were not met in 54.6% and metabolic syndrome was noted in 60%. Most (91.7%) had a BMI greater than 25. Participants rated their CV risk as below average (21.7%), average (30.4%), and above average (47.8%) risk of peers of same age and sex. Only 8.3% identified a need for change to their medication regimen, despite most having biomarkers above targets (52.5% for LDL, 53.3% for BP, and 68.1% for A1c). Diet and physical activities were identified as areas for improvement by 83.3%, and weight by 72.9% of patients. Among smokers, all felt their smoking status could be improved. Most (68.1%) reported they were confident they could control their CV risk, while 21.3% answered neutral and 10.7% disagreed.

Conclusion:
In this above-average/high-risk population, we detected a gap between the clinician’s and patient’s CV risk perception. Exploring patient health perception in the clinic may identify areas for education and counseling. Future studies are needed to assess the impact of various interventions on perceived CV risk and on the adoption of cardio-protective behaviors.
Abstract 14708: Cardiovascular Calcium Scoring by Deep Learning is Predictive of Mortality in Emergency Department Patients
Authors: Zhang Ding Yi , Roberge Maude , Gandhi Rushali , Zarour Yaman , El Malt Farida , Shalmiev Albert , Benzur Jordan , Chalati Mhd Diaa , Benizri Nissim , Bharaj Neetika , Afilalo Marc , Afilalo Jonathan
Published: June 2023

Introduction:
Computed tomography (CT) imaging is widely used in the emergency department (ED) setting. Calcifications of the coronary arteries, heart valves, and aorta are common incidental findings that may herald clinical or subclinical cardiovascular disease.

Hypothesis:
We sought to determine whether the quantitative burden of cardiovascular calcifications, as measured by a CT-based deep learning pipeline, would be predictive of short-term mortality in a diverse population of ED patients.

Methods:
We conducted a prospective single-center cohort study nested in the Quebec COVID-19 Biobank from March 2020 to September 2021. For the purposes of this study, we enlisted adult patients presenting to the ED with cardiopulmonary symptoms who were tested for COVID-19 and underwent CT imaging of the chest. We used a deep learning model previously developed by our team to automate the quantitative scoring of coronary artery calcification (CAC), aortic valve calcification (AVC), mitral annular calcification (MAC), and thoracic aorta calcification (TAC) from the CT images. These calcium scores were categorized as sex-stratified tertiles plus a zero-score referent category. The primary outcome was all-cause mortality at 30 and 90 days adjusted for age, sex, and COVID-19 status using multivariable logistic regression.

Results:
The study sample consisted of 731 ED visits among 271 unique patients with a mean age of 66 years and 47% females. COVID-19 illness was the main diagnosis in 29% of ED visits. The prevalence of any quantifiable calcification was 51% for CAC, 33% for AVC, 23% for MAC, and 80% for TAC. The statistically significant adjusted odds ratios for mortality were 2.50 (1.08, 5.81) in the highest AVC tertile at 30 days, 2.73 (1.37 5.47) in the highest CAC tertile at 90 days, and 4.42 (1.01, 19.4) in the highest TAC tertile at 90 days. These odds ratio remained similar after further adjustment for past history of myocardial infarction or heart failure.

Conclusions:
High calcium scores in the coronary arteries, aortic valve, and thoracic aorta are associated with heightened 30-day mortality in ED patients. Deep learning quantification of calcium scores from clinical CT scans is an opportunistic approach for risk stratification.
Abstract 14712: PCI is Safe and Increasing Among Cancer Patients: Nationally Representative Propensity Score Adjusted and Machine Learning Augmented Study of 100 Million Hospitalizations
Authors: Pushparaji Bala , Monlezun Dominique , Palaskas Nicolas L , Koutroumpakis Efstratios , Boudoulas Konstantinos D , Dhoble Abhijeet , Marmagkiolis Konstantinos , Iliescu Cezar
Published: June 2023

Introduction:
The greater use of antithrombotic and antiplatelet agents in the growing population of patients with cardiovascular disease and cancer contrasts with the limited evidence-base on appropriate revascularization management for these patients.

Methods:

This is the first nationally representative multi-year cardio-oncology mortality study of thrombocytopenia (platelets <150,000) and coronary intervention including percutaneous coronary intervention (PCI), and the first such study using machine learning augmentation and propensity score (PS). Utilizing the 2016-2018 National Inpatient Sample (NIS), the PS for receiving PCI was generated, balance confirmed, and regression adjustment completed (also including age, sex, race, income, urban, region, metastasis, NIS-calculated mortality risk by disease-related group), and multivariable regression model performance was optimized using backward propagation neural networks.

Results:

Of the 101,521,656 hospitalized adult patients, 6,456,777 (6.36%) had active cancer of whom 6.14% had thrombocytopenia. Among thrombocytopenia patients, patients with versus without active cancer were significantly (p<0.001) less likely to receive left heart catheterization (1.88 vs. 5.41%) and PCI (0.48 vs. 1.35%). Among cancer patients, patients with versus without thrombocytopenia were more likely to have acute myocardial infarction (4.06 vs. 2.35%) and to receive intravascular ultrasound (62.65 vs. 56.75%) but had comparable rates of fractional flow reserve and optical coherence tomography. PCI nearly doubled from 2016 to 2018 among patients with thrombocytopenia (10.33 vs. 6.16%). In multivariable regression in PCI, neither active cancer (OR 0.89, 95%CI 0.45-1.75; p=0.738) nor any of the 32 tested primary malignancies significantly increased mortality.

Conclusions:

This nationally representative longitudinal study suggests inpatient PCI is safe and is increasing among patients with active cancer regardless of their primary malignancy.
Abstract 14733: Fluid Around a Small Heart- Cardiac Manifestation of Anorexia Nervosa
Authors: Mishra Ajay K , KASIREDDY THRISHALA REDDY , Kumar Deepti
Published: June 2023

Background:
Anorexia Nervosa (AN) is an eating disorder which is characterized by an abnormally low body weight (BMI<18.5), a distorted perception of weight and an intense fear of gaining weight. It is prevalent in about 0.3 to 1% of the US population. Diverse cardiovascular complications are noted in these patients including decreased cardiac output, left ventricular mass and dimensions; pericardial effusion, bradycardia, hypotension and prolonged QT interval. We report a patient presenting with recurrent chest pain, and was diagnosed to have pericardial effusion secondary to AN.

Case Presentation:
A 27-year-old female with history of iron deficiency anemia, benign ethnic neutropenia, anorexia nervosa and borderline personality disorder, presented with insidious onset of atypical chest pain in the substernal region. Her BMI at presentation was 18.4, vital signs and systemic examination were normal. EKG showed a prolonged QT interval. She was noted to have normal blood cell counts, metabolic parameters and cardiac enzymes. A limited bedside echocardiography was normal except for the presence of mild pericardial effusion. She was treated with anti-inflammatory agents and discharged. A week later she presented with similar complaints.

Management:
Repeat cell counts were normal. Electrolytes revealed mild hypokalemia. Her CXR showed evidence of microcardia with a pulmonary artery diameter of 0.40. A repeat echocardiogram showed persistence of mild to moderate pericardial effusion. Etiological evaluation was negative for infections, autoimmune markers, and thyroid abnormalities. There was no evidence of ischemia and no rhythm abnormality. Her symptoms improved with analgesics and reassurance.

Conclusion:
Eating disorders like AN, have protean cardiovascular manifestations. Atypical chest pain in patients with AN is mostly idiopathic (38%) in the absence of risk factors. Silent pericardial effusion is found in about 22% to 71% of patients with AN. In these patients, factors like low BMI, rapid weight loss, low T3 levels, and IGF-1 levels correlate with pericardial effusion. Most patients show resolution of the effusion, normal cardiac dimensions and QT interval, after weight restoration without further intervention necessary.
Abstract 14778: Combined Shear Stress-Molecular Imaging for the Evaluation of Early Arterial Healing Responses Following Implantation of Bioresorbable Scaffold With Different Strut Thickness
Authors: Kim Sunwon , Park Hyun-Sang , Song Joon Woo , Ahn Jae Won , Yoo Hongki , Oh Wang-Yuhl , Park Kyeongsoon , Kim Jin W
Published: June 2023

Introduction and Hypothesis:
Arterial healing following stent implantation involves a series of biological reactions such as thrombosis, inflammation, neointimal regeneration. Clinical evidences have shown favorable arterial healing after thin-strut stents, however, there has been a lack of
in vivo
imaging evidence on how strut thickness affect vascular healing process. We evaluated local endothelial shear stress (ESS) and healing response of a thin-strut bioresorbable scaffold (BRS, 100μm) compared to first-generation 157μm-thickness ABSORB.

Methods and Results:
BRS and ABSORB were simultaneously implanted in left coronary arteries of the same pigs (n=7). Detailed scaffolded-artery 3D model was reconstructed based on OCT and angiography. Scaffold-related inflammation response was serially assessed by dual-modal OCT-near-infrared fluorescence (OCT-NIRF) molecular imaging using macrophage-mannose receptor-Cy7 as an inflammation-targeting agent. On ESS analysis, regions with athero-prone low ESS were significantly greater in thick-ABSORB compared to BRS. Dual-modal OCT-NIRF imaging visualized arterial inflammation activity at peri-strut regions
in vivo
(Figure). Based on coregistered ESS-NIRF data, we found a significant inverse correlation was found between ESS and NIRF activity (p<0.0001), suggesting immune-modulating effect of ESS during early stent healing phase. Arterial inflammation, quantified as target-to-background ratio, was significantly lower in thin-strut BRS than ABSORB at 2 weeks (p<0.01). At week 3, unlike ABSORB with residual peri-strut NIRF signals, inflammation activity dissipated significantly in BRS.
Ex vivo
confocal fluorescence microscopy (Figure) and immunohistochemical analysis well corroborated the findings
in vivo
.

Conclusions:
Thin-strut BRS was associated with less inflammation and rapid resolution of inflammation compared to thicker-strut ABSORB. This study provides
in vivo
imaging insights into how strut thickness affects early arterial healing and the importance of ESS as an inflammatory modulator. Our comprehensive imaging strategy enabling evaluation of complex interplay between scaffold, ESS, and artery is expected to enhance understanding of stent healing.
Abstract 14813: Insulin Resistances in Patients With Fontan Palliations
Authors: Shea Erin V , Yu Sunkyung , Schumacher Kurt R , Lowery Ray , Doman Tammy , Rocchini Albert P
Published: June 2023

Introduction:
Patients (pts) with single ventricles who have undergone Fontan palliation are surviving longer and at increased risk for acquired morbidly. Insulin resistance (IR) and abnormal glucose metabolism are known to be predictors of cardiac morbidity and mortality. Limited studies suggest that IR and metabolic syndrome occur in individuals following Fontan palliation. This study aimed to evaluate IR in Fontan pts.

Methods:
In this prospective, single-center, case-control study, Fontan pts and controls were recruited during clinic or catheterization visits between 6/2021 - 2/2022. Individuals with diabetes mellitus, pregnancy, steroid use, inotropic support, or surgery within the last 6 months were excluded. Control subjects were eligible if they had 2 ventricle circulation and did not have heart failure or systemic illness. Demographic and clinical data were collected via chart review. Fasting serum glucose and insulin were acquired at their visit. Group comparisons were made in IR via natural log-transformed homeostasis model assessment, ln(HOMA-IR), and QUICKI (1/[log(Insulin) + log(Glucose)]), without/with adjusting for age.

Results:
In total 89 pts (59 Fontan and 30 controls) were included, with median age of 20.2 yrs (interquartile range 15-28.1). Fontan pts showed significant elevation of ln(HOMA-IR) (0.82±0.62 vs 0.24±0.44) and decrease in QUICKI (0.34±0.03 vs 0.37±0.02) compared to controls (both p<.0001); this remained significant even controlling for age (both p≤0.02). Analysis excluding Fontan pts with obesity still showed significant elevation of ln(HOMA-IR) and reduction of QUICKI in Fontan pts compared to controls when adjusting for age (both p<0.05). With older age there was an increase in ln(HOMA-IR) (mean 0.2 in age < 13 yrs vs. 0.53 in age 13-18 yrs vs. 0.78 in ag > 18 yrs, p=0.01). Using a QUICKI < 0.339 defining IR, there was an increase proportion of IR with older age (7% in age < 13 yrs vs. 26% in age 13-18 yrs vs. 48% in age > 18 yrs, p=0.01).

Conclusions:
Fontan pts had significant elevation in IR compared to controls using standard clinical IR serum testing that was independent of age. Additionally, IR continues to increase with age. Further evaluation is needed to understand risk for IR in pts undergoing Fontan palliation.
Abstract 14903: Augmenting Prediction of Intracranial Aneurysm Rupture Status With Computed Velomics
Authors: Jiang Jingfeng , Rezaeitaleshmahalleh Seyedmostafa , Lyu Zonghan , Mu Nan , Strother Charles , Ahmed Azam S , gemmete joseph , pandey aditya
Published: June 2023

Background

Although race is a social construct without biological meaning, race significantly impacts health outcomes. Race is under-reported in clinical trials making it difficult to identify and address health inequities. In this study, we analyze studies pertaining to cerebrovascular accidents (CVA) with the primary purpose to assess the inclusion of racial data in CVA clinical trials. Our secondary purpose is to assess the representation of the various races in CVA clinical trials.

Methods:
This meta-analysis study consisted of CVA clinical trial data from ClinicalTrials.gov. Two researchers extracted data independently. Microsoft Excel was used for data collection and analysis. The search term “stroke” was used to search clinical trials from 1995-2021. The primary outcome is the prevalence of trials with racial data reported. The secondary outcome is the prevalence of each racial subgroup and gender subgroups among trials that report race data.

Results:
7004 trials were identified using “stroke” as a search term. After excluding non-interventional trials, 468 trials remained. A sample of 115 trials were included in preliminary analyses. Out of the 115 trials, 50 studies (43.5%) did not report race. The 65 trials with racial data totaled 7368 participants. 38.7% were female and 61.3% were male. 46.2% of participants were White, 17.3% were Black and 33.8% a “combined other” category (Asian, American Indian, Native Hawaiian, other, and unknown/not reported). Of 12 trials with pharmacologic intervention, 41.7% did not report race. There were a total of 1485 participants from the seven trials with pharmacologic intervention, of which 47.2% were female and 52.7% male. Furthermore, 68.3% of participants were White, 7.5% were Black and 22.9% were the “combined other” category.

Conclusions:

Of the studies reviewed, 43.5% of stroke clinical trials and 41.7% of stroke studies with pharmacologic interventions did not report racial data. Moreover, women and non-White subjects were significantly underrepresented in the stroke clinical trials. The under-representation of women and non-White subjects in these clinical trials raises the concern regarding access to stroke clinical trials and the need to further study the reason behind these disparities.
Abstract 14914: Post-Acute Sequelae of SARS-CoV-2 and Mortality Among Individuals With Breakthrough Infections in Alabama
Authors: Jurado Velez Javier , Kanney Nita , Shrestha Sadeep , Hidalgo Bertha
Published: June 2023

Introduction:
While breakthrough SARS-CoV-2 infections were expected among vaccinated individuals, less is known about the incidence of post-acute SARS-CoV-2 sequelae (PASC) and mortality among vaccinated individuals.

Methods:
A retrospective analysis of Alabama Health System electronic health record (EHR) data was performed for 4,274 individuals with vaccination, clinical, medical, and mortality information between December 2020 and December 2021. The study population consisted of patients who had documented evidence of vaccination (e.g., two doses of Pfizer-BioNTech, two doses of Moderna, or a single dose of Janssen/Johnson & Johnson vaccines).

Results:
Out of 4,274 individuals with EHR data in our cohort, 2,177 were female (51%), with a mean age equal to 56 ± 16.2; 1,245 individuals had received one or more doses of a COVID-19 vaccine. There were 640 COVID-19 related deaths, of which were 265 women (41%), 487 (76%) had obesity/overweight, and 133 patients (21%) that had an organ transplant or had a history of cancer. A greater percentage of unvaccinated individuals had documented COVID-19 deaths compared to individuals who were vaccinated (N=57, 5% and 583, 19%, respectively). The odds of mortality were lower among those who were vaccinated, compared to those who were unvaccinated (OR = 0.2, 95% CI = 0.15, 0.27). Sensitivity analyses showed that mortality among vaccinated individuals comprised of 6% (13) of patients with 1 dose, 5% (42) of patients with 2 doses, and <1% (2) of patients with 3 doses. One hundred and eighteen individuals had a PASC diagnosis, with 57% (67) of patients having received at least 1 dose. PASC occurred in 6% (13) of patients with 1 dose, 10% (84) of patients with 2 doses, and 3% (6) of patients with 3 doses. The odds of having PASC were higher among those vaccinated, compared to those unvaccinated (OR = 3.32, 95% CI = 2.29, 4.81). Among those who were vaccinated and had PASC (N=67), a greater proportion were female than male (69% compared to 31%, respectively).

Conclusions:
At least 1 dose of a COVID-19 vaccine provided a lower odds of mortality in individuals with a breakthrough infection; however, in our population, vaccinated individuals had equal odds of post-acute SARS-CoV-2 sequelae (PASC) as unvaccinated individuals.