bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 13956: Multidisciplinary Approaches to Treat Ventricular Arrhythmias With Radioablation and Cardiac Sympathectomy (MAVERICS)
Authors: Scarfone Steven R , Daoud Emile G , Okabe Toshimasa , Houmsse Mahmoud , Weiss Raul , Kalbfleisch Steven J , Hummel John , Matto Faisal , Savona Salvatore , Wallace Grant , Lee John , Thomas Evan , Miller Eric , Ayan Ahmet , Weldon Michael , Harfi Thura , Tong Matthew , Luke Whitney , D'Souza Desmond , Brownstein Jeremy , Rizwan Afzal Muhammad
Published: June 2023

Background:
Ventricular arrhythmias (VAs) are the most lethal arrhythmias. Established therapies to prevent VAs include anti-arrhythmic drugs (AADs) and catheter ablation (CA). For patients with recurrent VAs despite AADs and CA, novel therapies such as cardiac sympathetic denervation (CSD) and stereotactic body radiation therapy (SBRT) exist. This study reports outcomes of CSD and SBRT at a tertiary care academic center.

Methods:
Study comprises all patients undergoing CSD or SBRT at one center from 10/2018 - 10/2021. Patients with less than 2 months of follow-up were excluded. Retrospective chart review was performed to collate data for demographics, clinical characteristics, arrhythmia burden before and after novel therapies (maximum 12 months), and treatment complications. VA burden in the form of anti-tachycardia pacing (ATP) episodes and defibrillator shocks was assessed as primary efficacy outcome. Treatment complications were assessed as primary safety outcome.

Results:
Overall, 25 patients underwent novel therapies for VAs, and 13 were excluded for insufficient follow up. Five, 4, and 3 patients underwent CSD, SBRT, and both, respectively. Median age was 66 years (55-72), and 10 (83%) were male. Median left ventricular ejection fraction was 30% (25%-34%). Four patients (33%) had ischemic cardiomyopathy. Median number of AADs and CA prior to novel therapies was 3 (2-5) and 1 (0-2), respectively. Follow up was available for a median of 12 (12-12) months before and 12 (9-12) months after treatment. Overall, VA burden was reduced in 11 of 12 patients (Figure 1). Mean number of ATP and shock episodes was significantly lower after novel therapies (39±43 vs 3±6; p= 0.008). No procedure-related complications were observed.

Conclusion:
Novel VA treatment modalities are associated with a significantly reduced arrhythmia burden in this single center study. There is a promising role of these therapies as an adjunct to the existing treatment modalities of CA and AADs.
Abstract 13969: Iterative Changes in Alcohol Septal Ablation at the Medical University of South Carolina: A Single-Center Experience
Authors: Moore Ryan , Silkowski Molly , Mostertz William C , Evans Matthew , Nielsen Chris , Fernandes VALERIAN
Published: June 2023

Introduction:
Alcohol septal ablation (ASA) is an effective procedure to treat medically refractory hypertrophic obstructive cardiomyopathy (HOCM). Several modifications have been made to the procedure since its inception. We seek to assess the changes in the procedure and outcomes over the past 20 years

Methods:
We retrospectively analyzed 845 ASA procedures performed from January 2000 to February 2022 using an internally maintained database. These procedures were then split into three groups, with procedures occurring from 2000-2004 (Cohort 1), 2005-2011 (Cohort 2), and 2006-2022 (Cohort 3). Patient demographics, echocardiographic measurements, and procedural data were recorded.

Results:
Average patient age was 53.06 (143:161 M:F, 52.96% female), 59.71 (125:140, 52.83% female), and 63.86 years (99:177, 64.13% female) in Cohorts 1, 2, 3 respectively. The peak resting left ventricular outflow tract (LVOT) gradient was significantly higher in Cohort 2 and 3 (69.893 mmHg, 72.218 mmHg) versus Cohort 1 (57.32 mmHg, p<0.0001). The number of septal arteries injected increased slightly, but the total amount of alcohol injected decreased, thereby implying a reduced amount of alcohol injection per septal artery. The overall infarct size did not show a significant difference between the three Cohorts (peak total creatine kinase, p=0.0871). The average length of hospital stay decreased and pacemaker incidence continued to be <10%. There were no procedural deaths since 2008. See Figure 1.

Conclusions:
ASA has become increasingly safer over the past twenty years at MUSC with maintained efficacy and zero procedural mortality since 2008. Improved patient selection, transition to a bi-radial approach, contrast echocardiographic imaging, slower alcohol injection rate, reduced alcohol volume per septal artery and increased operator experience are responsible for the improvement.
Abstract 13976: Trends in Cardiovascular Health Status During Early vs Late Adolescence, 2007-2018
Authors: Baker-Smith Carissa M , Powell-Wiley Tiffany M , Tabb Loni P , Falkner Bonita E , Akins Robert E
Published: June 2023

Introduction:
Identification of factors associated with preservation of cardiovascular health (CVH) during adolescence may inform strategies to reduce CV disease burden in adulthood.

Hypothesis:
CVH status is worse in later (16-18 years) vs early (13-15 years) adolescence and is influenced by socioeconomic factors.

Methods:
National Health and Nutrition Examination Survey (NHANES) 2007 to 2018 data (6 most recent complete survey cycles) analyzed. CVH status was characterized by AHA Life Simple 7 score (AHAS7). A representative sample (N=5874) of the US adolescent population was analyzed and weights used to estimate trends for the entire US adolescent population. The proportion of US adolescents with ideal (AHAS7 score 12-14), intermediate (8-11), and poor (0-7) CVH status calculated. Consecutive 2-year NHANES cycles were rescaled to consecutive integers to assess change in CVH score over time. Regression models were used to assess trend in CVH score over time and separately by age. Nonlinearity of secular trend was tested by assessing the significance of adding a quadratic term to the regression model (significance, p<0.01). CVH status by early vs late adolescence was assessed via categorical analysis as was the association between CVH status in early vs late adolescence and social determinants such as insurance status, poverty status (above and below 5x’s the national poverty level) and household reference (e.g., parent) education level.

Results:
CVH scores improved from 2007 to 2018 (
p<0.0001
), however, the proportion of youth with ideal CVH status declined with age and was highest in early and lowest in later adolescence (early 59% vs later 41%) (
p<0.0001
). The proportion of adolescents with ideal physical activity, smoking status, blood pressure, and cholesterol was lowest among older adolescents. Older adolescents are more likely to have no insurance (early 44% vs later 56%,
p<0.0001
). Other social determinants were not significantly different.

Conclusions:
Efforts to improve CVH status should begin no later than adolescence. Greater focus on preserved physical activity, BP and cholesterol management, reduced smoking and maintenance of health insurance coverage may lead to sustained CVH status throughout adolescence.
Abstract 13995: Relationships Between Neighborhood Disadvantage and Cardiovascular Findings at Autopsy in Subjects With Sudden Death
Authors: Cornelissen Anne , Guo Liang , Neally Sam J , Kleinberg Leah , Forster Ashley , Nair Rajeev , Gadhoke Neel , Ghosh Saikat , Sakamoto Atsushi , Sato Yu , Kawakami Rika , Mori Masayuki , Kawai Kenji , Fernandez Raquel , Dikongue Armelle , Abebe biniyam , Kutys Robert , Romero Maria , Kolodgie Frank D , Baumer Yvonne , Powell-Wiley Tiffany M , Virmani Renu , Finn Aloke
Published: June 2023

Introduction:
Neighborhood disadvantage is associated with a higher risk of sudden cardiac death. However, autopsy findings have never been investigated in this context. Here, we sought to explore associations between neighborhood disadvantage and cardiovascular findings at autopsy in cases of sudden death in the State of Maryland.

Methods:
State of Maryland investigation reports from 2,278 subjects within the CVPath Sudden Death Registry were screened for street addresses and 9-digit zip-codes. Area Deprivation Index (ADI), used as metric for neighborhood disadvantage, was available for 1,464 subjects; 650 of whom self-identified as Black and 814 as White. The primary study outcome measurements were causes of death and gross and histopathologic findings of the heart.

Results:
Subjects from most disadvantaged neighborhoods (
i.e.
, ADI ≥ 8; n = 607) died at younger age compared with subjects from less disadvantaged neighborhoods (
i.e.
, ADI ≤ 7; n = 857; 46.07 ± 14.10 versus 47.78 ± 13.86 years; p = 0.02) and were more likely Black or women. They were, however, less likely to die from cardiac causes of death (61.8% versus 67.7%; p = 0.02) and had less severe atherosclerotic plaque features, including plaque burden, calcification, intraplaque hemorrhage, and thin-cap fibroatheromas. In addition, subjects from most disadvantaged neighborhoods had lower frequencies of plaque rupture (18.8% versus 25.1%, p = 0.004). However, these associations were omitted after adjustment for traditional risk factors and race.

Conclusion:
Neighborhood disadvantage did not associate with cause of death or coronary histopathology after adjustment for cardiovascular risk factors and race, implying that social determinants of health other than neighborhood disadvantage play a more prominent role in cardiovascular pathology.
Abstract 13997: What is the Role of Pulmonary Artery Catheterization in Patients With Acute Myocardial Infarction Complicated With Cardiogenic Shock?
Authors: Pahuja Mohit , Tuli Aakash , Case Brian C , Kallur Akhil , Ben-Dor ITSIK , Johnson Adam , Hashim Hayder , Saxena Abhinav , Zhang Cheng , Shea Corey , rappaport hank , Satler Lowell F , Sheikh Farooq , Bernardo Nelson L , Waksman Ron
Published: June 2023

Background:
Acute myocardial infarction (AMI) remains one of the most common cause for cardiogenic shock (CS). Emergent revascularization with and without mechanical support demonstrated the benefit in patients with AMI-CS, but data on the utility of pulmonary artery catheter (PAC) in patients with AMI-CS is lacking.

Methods:
We performed a retrospective study from a large healthcare system (11 hospitals) from October 1
st
2014 to October 2021. We divided the patients with AMI-CS, into two groups those who received PAC and those who did not. Propensity matched analysis was performed for baseline characteristics, comorbidities, and laboratory values to account for the underlying cofounders. The in-hospital outcome was recorded for both groups

Results
The total cohort included 2585 patients (STEMI: 797; NSTEMI: 1788). Of these 517 patients underwent PAC placement: 19.7 % of the patients in the STEMI group, and 20.4% of patients in the NSTEMI group. Mean age was similar among the PAC and the non-PAC groups (68.87 years vs 67.12 years respectively. Patients who underwent PAC had more diabetes (59.4% vs 53.1%, p=0.011), chronic kidney disease (50.9% vs45.2%, p=0.020), and coronary artery disease (77.8% vs 71.9%, p = 0.007). Overall, in-hospital mortality was lower in patients who underwent PAC and higher in patients who did not receive PAC (25.9% vs 35.9%, p<0.001) and these results remained significant after propensity matching as shown in Figure 1. Similar results were seen across all SCAI stages with improved mortality in PAC group. Overall mechanical circulatory device utilization was higher in the PAC group.

Conclusion
Our study shows that the use of PAC patients with AMI-CS was associated with improved mortality. If proven in randomized clinical trials PAC should be routinely used for all patients presenting with AMI-CS.
Abstract 14008: Socioeconomic Status and Prediction of Incident Heart Failure in the Atherosclerosis Risk in Communities (ARIC) Study
Authors: Mathews Lena M , Zhang Sui , Turkson-Ocran Ruth-Alma , Collison Amira , Crews Deidra , HEISS Gerardo M , Windham B Gwen , Chang Patricia , Coresh Josef , Matsushita Kuni , Ndumele Chiadi E
Published: June 2023

Introduction:
Socioeconomic status (SES) is a potent risk factor for heart failure (HF), but current HF prediction models do not incorporate data on SES. It is not known if the performance of HF risk prediction algorithms differs by SES, and how including SES in risk models impacts risk prediction.

Methods:
We performed an analysis of participants without HF at Visit 1 (1987-89) of the ARIC study. SES was assessed by household income, educational attainment, Area Deprivation Index, and as a combined cumulative SES score that included all three measures. Incident hospitalizations and deaths related to HF were assessed through 12/31/2019. We compared risk discrimination (c-statistic) of the established ARIC HF risk score across SES categories, and assessed calibration within SES strata by comparing observed versus predicted risk. We examined changes in risk discrimination, net reclassification and calibration (calculating the Hosmer-Lemeshow statistic for the latter) with adding SES to the ARIC HF risk score.

Results:
We studied 14,468 individuals; 54% were women, 26% were Black adults and 22% had low cumulative SES. There were 3,568 HF events over 33 years of follow-up. The c-statistic of the ARIC HF risk score was lower in those with low versus high cumulative SES (0.726 vs 0.765). There were differences in the ARIC HF risk score’s calibration by SES, with lower predicted than observed HF risk in those with low SES in all quintiles of predicted risk (Figure). Calibration improved with adding SES to the risk model (change in Hosmer-Lemeshow 127.6 to 98.3), especially in those with low SES (Figure). Adding SES to the model modestly improved risk discrimination (change in c-statistic 0.767 to 0.771; p<0.001) and changed net reclassification (0.05 [95% CI 0.02-0.08]).

Conclusions:
HF prediction algorithms underestimate HF risk in those with low SES. Systematic assessment and incorporation of SES data may enhance HF risk prediction in socioeconomically diverse populations.
Abstract 14022: Involvement of Rho-Associated Coiled-Coil Containing Kinase (ROCK) in BCR-ABL1 Tyrosine Kinase Inhibitor Cardiovascular Toxicity
Authors: Yu Brian , Osman Afaf E , Sladojevic Nikola , Prabhu Nicole , Tai Haw-Chih , Chen Daiqing , Perla Gerardo , Park Linus , Larson Richard A , Liao James K
Published: June 2023

Introduction:
Second and third generation BCR-ABL1 tyrosine kinase inhibitors (TKIs) are associated with cardiovascular adverse events (CVAE) in patients with Philadelphia-chromosome positive (Ph+) leukemia.

Hypothesis:
We hypothesized that second and third generation BCR-ABL1 TKIs may cause CVAE through activation of Rho-associated protein kinase (ROCK).

Methods:
Peripheral blood mononuclear cells from 53 Ph+ patients on TKIs and 15 control patients without Ph+ leukemia were assessed for ROCK activity through capillary electrophoresis (median follow-up = 26 months [Q1-Q3, 5-37]). We also investigated the effects of TKIs and ROCK on endothelial dysfunction
in vitro
, which could contribute to CVAE.

Results:
Patients receiving second and third generation TKIs had 1.6-fold greater ROCK activity compared to both patients receiving imatinib and control patients. Elevated ROCK activity was associated with increased incidence of CVAE in Ph+ leukemia patients (Figure). In endothelial cells
in vitro
, we found that dasatinib and ponatinib treatment lead to changes in actin intensity and endothelial permeability, which can be reversed by pharmacologic inhibition of ROCK. Ponatinib leads to decreased cell proliferation, but this was not accompanied by senescence. Dasatinib and ponatinib treatment lead to phospho-inhibition of endothelial nitric oxide synthase (eNOS) and decreased nitric oxide production. ROCK inhibition reversed endothelial permeability and eNOS-related endothelial dysfunction. Imatinib and nilotinib induce phosphorylation of p190RhoGAP.

Conclusions:
Our findings suggest ROCK activity may be a prognostic indicator of CVAE in patients receiving BCR-ABL1 TKIs. ROCK inhibition may be a promising approach in reducing the incidence of CVAE associated with second and third generation BCR-ABL1 TKIs.
Abstract 14051: QRS Duration After Pulmonary Valve Replacement in Adults With Repaired Tetralogy of Fallot: Prediction of Ventricular Arrhythmias and Correlation With Right Ventricular Size
Authors: Bou Chaaya Rody , Barron Emily , Herrmann Jeremy , Brown John , Ephrem Georges
Published: June 2023

Background:
Tetralogy of Fallot (ToF) patients face complications such as heart failure and ventricular arrhythmias (VA) after early repair which may be mitigated by pulmonary valve replacement (PVR). Prior studies have shown significant decreases in QRS duration and right ventricular (RV) size following PVR. We aimed to determine whether QRS duration reduction independently identifies patients at lower risk of VA and/or correlates with a decrease of RV size on cardiac magnetic resonance imaging (CMR) with long-term follow-up.

Methods:
We retrospectively identified patients ≥18 years old with repaired ToF who underwent surgical or transcatheter PVR, respectively, at our tertiary care center. Demographics, imaging, and ECGs (pre-PVR, 30 days to 1-year post-PVR, and closest to follow up CMR) were collected. Patients with ventricularly paced rhythm were excluded. The composite primary outcome was defined as sustained VT, ICD shock for sustained VT or inducible VT on EP study.

Results:
During the study period, 85 patients were included (median follow-up 3.6 years; median age 34 years; 51% females, 68% surgical PVR and median LVEF 56%). The primary outcome was observed in 8 (9.6%) patients. QRS duration decreased by 5 ms (pre-PVR mean 154±28 ms to 149±28ms post-PVR; p=0.0001). Increased age at PVR (OR 1.1 per year), QRS≥180ms post-PVR, no reduction in QRS after PVR (ΔQRS ≤ 0ms), and a history of VT were significantly associated with the composite outcome. (Table) The change in QRS was linearly correlated with the change in RVEDVi (R = 0.66; p=0.002).

Conclusion:
In conclusion, adults with repaired ToF experience a reduction in QRS duration post-PVR. This change correlates with the change in the RV size post-operatively. A QRS ≥180ms post-PVR, no reduction in QRS, increased age at repair, and a history of VT independently predict the occurrence of VT post-PVR. Patients with these risk factors may warrant closer monitoring and/or ICD consideration.
Abstract 14056: The Presence of Very Low QRS Voltage in Multiple Frontal Leads is a Powerful Predictor of Recurrent Neurally Mediated Syncope
Authors: Schiop-Tentea Calina P , Coseriu Giorgia , Mocanu Lorena , Eotvos Csilla Andrea A , Zehan Iulia G , Porca Adriana D , Andrei Mihai G , Chiorescu Roxana M , Pop Sorin , Blendea Dan
Published: June 2023

Introduction:
Isolated very low QRS voltage (VLV; ≤ 0.3mV) on frontal leads on the electrocardiogram (ECG) has been shown to predict recurrence of neurally mediated syncope (NMS). In most patients VLV occurs in only one isolated ECG lead, however a small number of patients have ≥ 2 leads with VLV (Figure A), the significance of this pattern being unknown.

Hypothesis:
The aim of the study was to explore the potential relationship between the number of frontal leads with VLV and NMS recurrence.

Methods:
We included 268 patients with NMS (age 48±20 years, 150 women), with a median of 3 syncopal episodes who were followed for a median of 12 months.

Results:
Very low voltage was present in one frontal lead in 98 patients (37%), in 2 leads in 16 patients (6%), and in 3 leads in 1 patient (0.4%). Patients with VLV in multiple frontal leads had significantly smaller left ventricular end diastolic diameter (LVEDD) and left ventricular systolic diameter (LVESD) than patients with no VLV (42.8±3.9mm vs. 45.6±5.2mm; p = 0.029, and 27.7±3.9mm vs. 30.3±5.0mm; p = 0.049, respectively). During follow-up 69 patients (26%) experienced recurrent syncope. The actuarial total syncope recurrence rate increased progressively with the number of frontal leads displaying VLV (log rank test chi
2
=34.78; p < 0.0001; Figure B). Multiple frontal leads with VLV was associated with a relative risk of syncope recurrence of 5.5 in univariate analysis. Multivariate Cox regression revealed that the number of frontal leads displaying VLV predicted recurrent syncope (HR 1.83, 95%CI 1.28-2.62) in a model that included history of presyncope and syncope (HR 3.43, 95%CI 1.77-6.65) and LVEDD (HR 0.94, 95%CI 0.89-0.99).

Conclusions:
Very low voltage in multiple frontal leads is rare. If this pattern occurs, it is associated with a high risk of recurrent NMS. This phenomenon, which appears to be related at least partially to a smaller LV cavity size, may help generate new diagnostic tools and insights into the pathogenesis of NMS.
Abstract 14067: Outcomes of Transcatheter Aortic Valve Replacement Among Patients With Prior Coronary Artery Bypass Graft: A Nationwide Analysis
Authors: Abumoawad Abdelrhman , Afify Hesham Mohamed Aly , Alzu'bi Hossam , Saleh Mohammed , elmoghrabi adel , Jneid Hani , Khalife Wissam , Elbadawi Ayman
Published: June 2023

Background:
There is a paucity of data regarding the temporal trends and outcomes of transcatheter aortic valve replacement (TAVR) among patients with prior coronary artery bypass graft (CABG) surgery.

Methods:
We queried the Nationwide Readmissions Database (2016-2019) for hospitalized patients who underwent TAVR using ICD-10 codes. We evaluated the trends and outcomes of TAVR among patients with versus without a history of prior CABG. Multivariable regression analysis was used to adjust for patients’ and hospitals' characteristics when comparing the study groups. The primary outcome was in-hospital mortality.

Results:
The final analysis included 173,274 admissions who underwent TAVR of whom 31,271 (18.3%) had a history of prior CABG. During the study years, there was a decrease in the proportion of patients with prior CABG among those undergoing TAVR (22.0% in 2016 vs. 16.2%, Ptrend=0.01), while there was no change in their in-hospital mortality rate (1.08% in 2016 vs. 1.25% in 2019, Ptrend= 0.43). Patients with prior CABG were younger and less likely to be women compared with those without prior CABG. On multivariable adjustment, In-hospital mortality was lower among the group with versus without prior CABG (adjusted odds ratio [aOR] 0.77; 95% confidence interval [CI] 0.65-0.91, p<0.01). Adjusted analysis showed lower rate of 90-day readmission (OR 0.95; 95%CI 0.90-0.98, p=0.01), and similar rate of ischemic stroke (aOR 0.89; 95%CI 0.76-1.03, p=0.89), permanent pacemaker (PPM) implantation (aOR 0.99; 95%CI 0.93-1.05, p=0.99). Among those with prior CABG, female gender, and chronic kidney disease ≥3 were independently associated with higher in-hospital mortality, and obesity was associated with lower in-hospital mortality.

Conclusion:
In this analysis, there was a decrease in the proportion of patients with prior CABG among those undergoing TAVR. TAVR among those with prior CABG was not associated with increased short-term mortality or PPM implantation.
Abstract 14071: Sleep as a Contributor to Socioeconomic Disparities in Hypertension: The Midlife in the United States (MIDUS) II Study
Authors: Aqua Jasmine K , Barnum Olivia , Johnson Dayna A
Published: June 2023

Introduction:
Hypertension is highly prevalent among adults in the United States and is a major risk factor for cardiovascular disease (CVD). Previous research has found that hypertension is distributed inequitably, with a higher burden of hypertension among individuals of lower socioeconomic status (SES). However, limited studies have investigated the role of sleep quality, a risk factor for CVD, in understanding socioeconomic disparities in hypertension.

Methods:
We used cross-sectional data from the Midlife in the United States (MIDUS) II. Participants underwent seven days of actigraphy and completed biological assessments, including blood pressure measurements. Sleep quality was measured as actigraphy-defined wakefulness after sleep onset (WASO) and sleep efficiency. Our analysis consisted of participants with complete data on educational attainment, our proxy for SES (n=426). Poisson and linear regression models were fit to examine associations between SES, sleep quality, and hypertension or blood pressure (continuous). We controlled for age, gender, race, body mass index, and perceived stress. Sensitivity analyses measuring SES with the Socioeconomic Index Score were also conducted (n=274).

Results:
Participants had a mean age of 53.5 years (SD=12.4), were 59.6% female, and were 42.5% Black American. The prevalence of poor WASO (> 30 minutes), low SE (<85%), and hypertension was 77.7%, 67.1%, and 61.0%, respectively. Low SES was associated with a higher prevalence of hypertension but was attenuated after adjustment for race. SES was not associated with sleep or hypertension after adjustment for covariates. Individuals with high (vs. low) sleep efficiency had 19% lower prevalence of hypertension (PR=0.81, 95% CI: 0.66, 0.98), lower systolic blood pressure (β= -4.69, 95% CI: -8.63, -0.75), and lower diastolic blood pressure (β= -2.59, 95% CI: -5.00, 0.18) after adjustment for covariates. There was no evidence of sleep mediating the SES-hypertension relation.

Conclusions:
Effective interventions to lower the prevalence of hypertension should consider strategies that target sleep efficiency. Future research should explore the intersectionality of SES and race, as race may modify the association between SES and hypertension.
Abstract 14080: LINC02397 in Skeletal Muscle: A Marker of, and Therapeutic Target for, Chronic Limb Threatening Ischemia
Authors: YOSHIDA Shohei , McClung Joseph , Koseoglu Mehmet , Brewer Lauren , Heuslein Joshua , Annex Brian H
Published: June 2023

Background:
Chronic limb threatening ischemia (CLTI) is the most severe complication of peripheral arterial disease (PAD) and the leading cause of amputations for US adults. The response to reduced blood flow within ischemic muscle plays a role in determining disease outcome in PAD, but the response mechanisms have not been fully elucidated. Recently, long non-coding RNAs (lncRNAs) have been shown to regulate gene expression and modify disease. The objective of this study is to identify and characterize lncRNA that is differentially expressed in ischemic muscle in CLTI to serve as a therapeutic target in PAD.

Methods:
RNA sequencing (n=6/group) and whole transcriptome shotgun sequencing (WTSS n=15/group) from human muscle tissue in CLTI and healthy adults (HA) were performed to identify differentially expressed lncRNA candidates. qPCR (n=10/group) was performed on separate muscle samples to validate the findings. In-vitro experiments were conducted to examine which major cell type in muscle tissue likely expressed the candidate lncRNAs which were subsequently knocked down in cell types with the highest expression to determine function by qPCR, metabolic assay, and flow cytometry.

Results:
RNA-seq and WTSS analysis identified LINC02397, and qPCR confirmed LINC02397 was expressed significantly higher in CLTI patients (cT count 27.3±1.7 vs 34.1±1.4 in HA, p <0.0001). Differentiation of monocytes isolated from human PBMCs to macrophages (a process triggered by inflammatory stimuli) increased expression of LINC02397 by 2
4
, the highest expression level among major cell types in muscle. In monocytes (THP-1 cells), PMA treatment induced a macrophage-like phenotype, and LINC02397 expression increased in conditions that trigger inflammatory activation: PMA, LPS, and hypoxia serum starvation. LINC02397 knockdown significantly downregulated inflammatory cytokines IL-1β and IL-6, CD86+ cells, and glycolysis. LPS-activated monocyte media increased the proliferative capacity of endothelial cells after knockdown, suggesting potential promotion of angiogenesis.

Conclusions:
LINC02397 is uniquely expressed in skeletal muscle of CLTI patients and may serve as a promising therapeutic via its ability to limit inflammation and promote angiogenesis.
Abstract 14084: Safety and Outcomes of Percutaneous Coronary Intervention in Patients Presenting With Acute Coronary Syndrome With Prior Liver Transplantation
Authors: Abumoawad Abdelrhman , Ahmed Mohamed , Baweja Paramdeep , gupta Kamal
Published: June 2023

Background:
There is a paucity of data about the outcomes of performing Percutaneous coronary intervention (PCI) for Liver transplant (LT) patients presenting with acute coronary syndrome (ACS).

Methods:
We queried the national readmission database for patients who underwent PCI hospitalized between 2016 and 2019, patient were classified into two groups based on prior LT status. International classification of disease codes (ICD-10) were used for diagnosis and procedures codes. Our outcomes were In-hospital mortality and 90-day readmission rate. A multivariate adjusted regression model was performed to risk adjust for predictors of 90-day readmission (all-cause).

Results:
A total of 1400,861 patients underwent PCI between the years 2016 and 2019 for ACS and underwent PCI. 1,532 patients had a history of LT (0.1%). Hospitalized patients with prior LT were of similar age (65.2 ±0.31 vs 65.3 ±0.04 years, p=0.9), and less likely to be women (20.8.6% vs. 32.5%, p<0.01) compared with those without prior LT history. Hospitalized patients with prior LT had similar In-hospital mortality rate (3.9% vs 2.9%, p=0.3), shock (5.3% vs 4.5%, p=0.34), and Mechanical circulatory support utilization rate (4.9% vs 4.3%, p=0.452) but longer length of stay (5.8±0.3 vs 4.1±0.02, P<0.001) compared to the cohort that had no prior LT. Patients with prior LT had a higher readmission rate within 90 days 29.6% vs 19.4%, p= 0.001), and were less likely to have repeat PCI in the readmission (7.9% vs 12.3%, p<0.001), however more likely and acute kidney injury. Both cohorts had similar rates of acute heart failure exacerbation, bleeding complications, or in-hospital mortality in the readmission.

Conclusion:
There was no significant difference in mortality between both cohorts, however, readmission rate was higher in the LT cohort, Further studies exploring these differences may help to mitigate these readmissions.
Abstract 14099: Prevalence of Left Ventricular Systolic Dysfunction Defined by Standard and Advanced Echocardiographic Measurements in Patients With Systemic Lupus Erythematosus: A Systemic Review and Meta-Analysis
Authors: Gegenava Tea , Gegenava Maka
Published: June 2023

Introduction:
Speckle tracking echocardiography (STE) can be an useful tool for detecting early and subtle myocardial changes in patients with systemic lupus erythematosus (SLE)

Hypothesis:
The present study aimed to perform systemic review and meta-analysis of the studies based on the assessment of the left ventricular (LV) systolic function with LV ejection fraction (LVEF) and LV global longitudinal strain (LV GLS).

Methods:
Data were analysed according to an established protocol of the Cochrane Collaboration steps and meta-analysis

Results:
A total of 850 papers were collected, of those 10 papers including 174 442 SLE patients and 45 608 723 controls with heart failure, also 20 papers including 1121 SLE patients and 1010 controls with measured LVEF and 9 papers including 462 patients and 356 controls with measured LV GLS were selected. Studies have shown, that patients with SLE were characterized with higher prevalence of heart failure as compared to controls (Fig1). Patients with SLE exhibited lower levels of LVEF as compared to controls too (Fig.1), some included studies have shown that the difference in terms of LVEF between groups is not always significant. LV GLS was more deteriorated in SLE patients as compared to controls (Fig.2a, 2b), moreover some studies showed significant association between deteriorated LV GLS and cardiovascular events.

Conclusions:
Patients with SLE are characterized with high prevalence of heart failure. LV systolic function as measured by LVEF and LV GLS is significantly more affected in SLE patients. Data suggest that LV GLS may improve risk-stratification in patients with SLE.
Abstract 14106: Prevalence and Respective Predictive Value of Late Gadolinium Enhancement Phenotypes in Patients Referred for Suspected Infiltrative Cardiomyopathy
Authors: Sarak Bradley , Dyskstra Steven , Flewitt Jacqueline , Satriano Alessandro , Rivest Sandra , Howarth Andrew G , Lydell Carmen P , Miller Robert J , Fine Nowell M , White James A
Published: June 2023

Introduction:
The respective value of different late gadolinium enhancement (LGE) phenotypes in patients with suspected infiltrative cardiomyopathy remains uncertain.

Methods:
In a large cohort of patients referred for suspected infiltrative cardiomyopathy, we evaluated respective associations between the dominant LGE phenotype and the composite endpoint of heart failure hospitalization, survived cardiac arrest or death. Kaplan-Meier survival curves were executed for six pre-defined LGE phenotypes. Multivariable analysis was performed to assess their independent association with the composite outcome, adjusted for relevant confounders. Final diagnosis was adjudicated using standardized disease-specific criteria.

Results:
588 patients (68% male, median age 70 years, mean LVEF 54.7±12.7%) were studied. Of these patients, 139 (24%) were confirmed to have cardiac amyloidosis (CA) (81 [58%] transthyretin, 54 [39%] light chain and 4 [3%] undifferentiated) by objective non-CMR diagnostic criteria. Any LGE was present in 394 patients (67%) with the dominant phenotype being diffuse in 137 (23%), mid-wall patchy in 118 (20%), ischemic in 55 (9.4%), subepicardial in 18 (3.1%), mid-wall striae in 8 (1.4%), and RV insertion site in 58 (9.9%). The sensitivity and specificity of diffuse LGE for CA was 86% and 96%, respectively. Over a median 855 (IQR 372, 1542) days, 239 (41%) experienced the primary outcome. Unadjusted survival curves for each LGE phenotype are shown in the Figure. Following adjustment, diffuse (HR 2.30, p<0.001), mid-wall patchy (HR 1.52, p=0.040) and ischemic LGE (HR 1.78, p=0.023) remained independently associated (Figure).

Conclusions:
In patients referred for suspected infiltrative cardiomyopathy, diffuse, mid-wall patchy and ischemic patterns all showed independent prognostic value. We confirm that diffuse LGE pattern reliably identifies CA patients with high sensitivity and specificity while delivering strong prognostic value.
Abstract 14120: Proteomics of Diabetes-Related Heart Failure: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Echouffo Tcheugui Justin B , Chen Jingsha , Ndumele Chiadi E , Rooney Mary R , Ballantyne Christie M , Boerwinkle Eric , Grams Morgan , Yu Bing , Shah Amil M , Selvin Elizabeth , Coresh Josef
Published: June 2023

Introduction:
Data on the pathophysiology of diabetes-related heart failure (HF) mainly stems for animal studies
.
There is a paucity of large-scale human studies on proteomic alterations that characterize diabetes-related HF.

Hypothesis:
Diabetes-related HF has unique proteomic markers.

Method:
We analyzed 4,955 plasma proteins using SomaLogic v4.0 on 10,189 ARIC Study participants (Visit 2, 1990-92, mean age: 57±7 years, 56% women, 22% Black adults, 14% with diabetes [n=1477]). We used Cox regression to assess proteins associated with diabetes-related HF, in a 2/3 discovery sample and then a 1/3 validation subset, using Bonferroni correction of
P
-values.

Results:
Over a median follow-up of 24 years, there were 2417 HF events overall (605 among individuals with diabetes). After adjustment for demographics, clinical, and metabolic and biological factors (Figure), 18 proteins were associated with HF specifically among individuals with diabetes in the discovery sample (

p<10
-6

), with 13 confirmed in the validation sample (
p<0.05/18
). The validated proteins included cartilage intermediate layer protein 2 and N-terminal pro-BNP, and collagen alpha-1(XV) chain, which are not unique to diabetes-related HF. Of the validated proteins, 11 were uniquely associated with HF among diabetic individuals, and included : myocilin, lymphocyte activation gene 3 protein, and collectin-11. The latter proteins were not associated with HF among individuals without diabetes.

Conclusions:
A large-scale proteomics approach identified unique proteomic markers of diabetes-related HF. Pathway analysis will shed additional light on the exact role of the novel proteins in the pathogenesis of diabetes-related HF.
Abstract 14131: Early Experience With a Novel Extravascular Pacemaker Lead
Authors: Paluri Sarin N , Chin Wesley , Kurup Vijay , Pandravada Abhishek , impens ann , Burke Martin C
Published: June 2023

Introduction:
Transvenous pacemaker leads (TVL) provide electrical support for symptomatic bradycardia patients but requires wiring the vasculature and heart. TVLs create complications such as bleeding, infection and cardiac perforation. We examine here a novel method to deliver an extravascular pacemaker lead (EVL) via the anterior chest without touching the heart.

Hypothesis:
This novel AtaCor extra cardiac pacemaker lead will achieve appropriate pacing in an ambulatory model without significant macro- or micro-dislodgement.

Methods:
4 patients were enrolled to evaluate prototype EVLs for performance and safety. The patients were indicated for permanent pacemaker insertion as an index procedure. The study involved a similar paddle lead that was specifically designed for the anterior mediastinal space. The leads were matched to a delivery tool and delivered via the anterior parasternal left chest. We are developing a sustainable pacing system that provides capture without touching the heart in an ambulatory patient. The imaging was performed by fluoroscopy and x-ray. The position, stability of the lead and the electrical performance will be described in detail and related to the imaging results for up to 7 days in an ambulatory patient as a self-control.

Results:
Stable group (2 patients) showed no micro-dislodgement on fluoroscopic imaging with simultaneous successful pacing. Unstable group (2 patients) showed micro-dislodgement on fluoroscopic imaging which was correlated to poor pacing capture. No patients showed macro-dislodgement on chest x-ray (PA and Lateral).

Conclusions:
AtaCor’s novel extra cardiac pacemaker lead successfully gains temporary pacing. However, due to the size of the cathode electrode, there are limitations in the ambulatory patient population. We recommend the development of further prototype iterations based on this data.
Abstract 14134: Associations of Social Determinants of Health With Pulmonary Hypertension Severity and Reported Quality of Life
Authors: Aronson Benjamin , Humpal Cat , Anguiano Rebekah H , Fraidenburg Dustin R
Published: June 2023

Introduction:
Though the chronic, progressive disease Pulmonary Hypertension (PH) has no known cure, timely and appropriate treatment can improve outcomes. Social determinants of health (SDH) may influence treatment accessibility and outcomes. We hypothesized that Social Vulnerability Index (SVI) and Hardship Index (HDX, i.e., living in a zip code of higher hardship) are associated with measures of PH severity and quality of life (QoL).

Methods:
Patients at UI Health aged ≥18 years, diagnosed with PH from 2017-2021, and with EmPHasis-10 QoL scores and residence zip code data were included. SDH included Social Vulnerability Index (SVI) and Hardship Index (HDX). Income was retrieved from 2019 US Census data and most recent socio-behavioral data from the Chicago Health Atlas. Multivariate and logistic regression analysis were performed using SAS.

Results:
In 58 patients, mean age was 58 (SD 13.5), 47 (81.0%) were women, and 42 (72.4%) were non-Hispanic black. In this cohort, the uninsured rate showed a significant positive correlation with tricuspid regurgitant velocity on echocardiogram (p = 0.048) and, as SVI increased, there was a trend toward higher right atrial pressure (p = 0.07). Unexpectedly, there was a trend toward lower EmPHasis 10 scores (indicating better reported QoL) in subjects with worse SVI or HDX. When examining this further, a modified EmPHasis 10 QoL score focused on rest, exhaustion, and energy showed a significant inverse correlation of QoL with either SVI or HDX (p = .025 and p = .045, respectively).

Conclusions:
SDH appear to be associated with measures of PH severity. These findings suggest that SDH may negatively impact disease, which will need to be tested in a longitudinal study. The inverse correlation of SVI and HDX with QoL, particularly when focusing on personal experience, was unexpected. In theory, perceived norms and cultural context in high hardship, socially vulnerable communities may alter patient perception of disease impact on QoL. Future analysis should focus on further characterization of patient experiences in diverse populations with PH to ensure that we have accurate tools and are addressing the needs of our diverse community.
Abstract 14138: “RAC”ing up the Coronaries: An Underrecognized Echocardiographic Sign
Authors: Medamana John L , Zhang Robert S , Singh Arushi , Vainrib Alan , Saric Muhamed
Published: June 2023

Background:
Both the retro-aortic anomalous coronary (RAC) and bleb signs are underrecognized echocardiographic findings suggestive of an anomalous left circumflex (LCx) coursing posterior to the aortic root. We present a patient in whom these echocardiographic signs were identified and confirmed on additional imaging.

Case Presentation:
A 77-year-old male presented with heart failure secondary to severe MR. In the apical 4 chamber (A4C) view, tilting anterior demonstrated the RAC sign, a highly echogenic tubular structure in the retro-aortic region above the mitral valve (panel A). In the parasternal long-axis view, the bleb sign, a round structure next to the aorto-mitral curtain, was identified (panel B). The RAC sign was also seen in the short-axis (SAX) as a tunnel-shaped structure behind the aortic root. This structure also represents an orthogonal view of the “bleb sign” (panel C). An anomalous LCx was suspected and was confirmed on both CTA and coronary angiography (panel D). The patient underwent successful mitral valve replacement.

Discussion:
The most common coronary anomaly is a LCx artery arising from the right sinus of Valsalva. Traditionally, either coronary angiography or CTA, has been required for diagnosis; however, these tests are expensive and invasive. The bleb and RAC signs must be differentiated from other more common echocardiographic findings. In the A4C view, the RAC sign can be mistaken for the coronary sinus, which is typically a more posterior structure, or for calcifications of the aortic valve, which would move with the valve and would not have internal anechoic components. The bleb sign can be differentiated from an abscess of the mitral-aortic fibrosa by identifying the tubular retro-aortic appearance of the structure in the SAX view.

Conclusion:
The RAC and bleb signs offer a noninvasive means identifying an anomalous LCx; however, they must be differentiated from other cardiac structures which can mimic their appearance.
Abstract 14141: A Novel Endothelial Function Test in Predicting Late Coronary In-Stent Restenosis
Authors: Yang Zhuoran , Yin Jiasheng , Zhang Yaqi , Wu Lingling , Jiang Jieyu
Published: June 2023

Introduction:
Endothelial dysfunction is related with in-stent restenosis (ISR) of prior drug-eluting stents (DES) implanted more than 1 year ago (late ISR). EndoPAT is a novel non-invasive test quantifying endothelial function as reactive hyperemia peripheral arterial tonometry index (RHI).

Hypothesis:
EndoPAT is a potential predicting test for late ISR.

Methods:
We conducted a case control study on 186 patients with coronary DES implanted more than 1 year ago in a single medical center. Those who had contraindications to EndoPAT test, acute myocardial infarction, coronary artery bypass graft (CABG), chronic kidney disease (CKD) stage III and above, active infection and rheumatologic disease or acute decompensated heart failure were excluded. Patients were divided into ISR and non-ISR group based on coronary angiography. EndoPAT test was done at 24 to 48 hours prior to catherization. LnRHI is an index after natural log transformation of RHI. A receiver operative characteristic (ROC) curve analysis was used to determine the sensitivity and specificity of LnRHI for predicting late ISR.

Results:
ISR group had significantly more patients with history of ISR or triple-vessel disease, longer stent length and fewer totally occlusive lesions than non-ISR group. LnRHI was significantly lower in ISR group than in non-ISR group (0.66 vs 0.50, p<0.01). Patients with diffuse ISR had lower LnRHI than those with focal ISR (0.40 vs 0.55, p=0.03). Patients without ISR but undergoing revascularization had lower LnRHI than those with patent coronary arteries (0.56 vs 0.70, p=0.02). Endothelial function quantified by LnRHI was an independent risk factor for ISR (LnRHI/0.1, OR=0.79, 95% CI 0.64-0.97, p=0.03). The ROC curve analysis showed LnRHI of 0.44 had a sensitivity of 81.7% and specificity of 53.8% for predicting late ISR.

Conclusions:
Endothelial dysfunction measured by EndoPAT had a clinical potential for predicting the development of late ISR.
Abstract 14145: Relationship of Pharmacokinetic and Biomechanical Parameters With Intraplaque Haemorrhage- An
in vivo
Carotid MR Imaging Study
Authors: Sadat Umar , Usman Ammara
Published: June 2023

Introduction:
Atheromatous neovessels with high permeability have been implicated in the evolution of intraplaque haemorrhage (IPH).
In vivo
quantification of vasa vasorum permeability is possible using dynamic-contrast enhanced-magnetic resonance (DCE-MR) imaging.

Hypothesis:
In vivo
relationship of extent of leakiness of neovessels with critical biomechanical forces i.e. stress and strain in atheroma and with IPH remains unreported.

Methods:
Patients with mild to severe carotid artery stenosis underwent DCE-MR imaging of their bilateral carotid arteries on a 3 Tesla MR system, using TRICKS method. A two-compartment Patlak model was used to generate a parametric map showing partial plasma volume (vp) and K trans. FEA simulations were performed for stress and strain analyses. For histological analysis, carotid plaques were processed and stained.

Results:
Sixteen patients underwent carotid MR imaging. The two groups were comparable for their demographics and co-morbidities. Peak structural stress (PSS) and peak strain (P1) were significantly higher in symptomatic versus asymptomatic patients (p=0.002 and 0.009 respectively). Carotid atheroma with IPH had higher PSS and P
I
compared to those without IPH [p=0.036 and 0.009]. Variations in stress during one cardiac cycle was significantly greater among plaques with IPH (p=0.01); variation in strain was greater in atheroma with IPH [p=0.04]. Adventitial
K
trans
was higher in carotid atheroma of symptomatic patients than asymptomatic cohort (p= 0.016). Plaque
K
trans
, adventitial and plaque
v
p
were however comparable for both patient cohorts (p= 0.81, 0.96, 0.36 respectively). Adventitial
K
trans
and plaque
v
p
were higher in atheroma with IPH (p= 0.04, 0.01) but comparable for plaque
K
trans
and adventitial
v
p
(p=0.46, 0.88 respectively). A strong correlation was observed between variations in strain during the cardiac cycle with adventitial
K
trans
for plaques with IPH [Pearson
r
: 0.84, p=0.03].

Conclusions:
A strong correlation exists between adventitial neovessel permeability and variations in strain in atheroma with IPH. Carotid atheroma with IPH have higher biomechanical stresses and strain and variations in these critical biomechanical conditions compared to non-IPH atheroma.