bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 13731: Right-Sided Precordial U Waves as a Screening Tool for Aortic Stenosis
Authors: Pulaski Matthew , Newadkar Aditi , Richie Iman , Ho Ivan , Joseph Jubin , Matthews Ray , Mehra Anil , Zaman Junaid
Published: December 2023

Introduction:
AS affects 3% of individuals ≥ age 65 and portends an increased risk of morbidity and mortality. Cardiac auscultation to categorize AS severity depends on provider skill. Recent studies have identified an association between AS and right precordial U waves (RPUW) using machine learning. Therefore, the ECG may serve as an adjunctive screening tool for AS.

Hypothesis:
Are RPUW correlated with AS severity?

Methods:
A retrospective cohort analysis was performed of 50 patients ages 65-89 with a diagnosis of HTN, echocardiogram on file, and RPUW (V1-V3) in consecutive leads with U wave amplitude ≥ 0.5 mm in at least one lead. Patients with prior aortic valve replacement, ventricularly paced rhythms, AF or AFL, LBBB, potassium (K) < 3, and HR < 50 were excluded. A control cohort of 50 age- and gender- matched patients with RPUW < 0.5 mm was included. Echocardiograms were unblinded only once patients were selected by ECG criteria.

Results:
In total, 976 charts and 294 charts were reviewed to identify 50 eligible patients for the experimental and control arms respectively. Median time between ECG and lab collection (to ensure a K ≥ 3) was 0 days for both arms. Median time between ECG and echocardiogram was 1 day and 1.5 days respectively for experimental and control arms. U waves were significantly correlated with AS severity using a chi-square test (X2 = 16.77, df = 3, p < .001). A multinomial logistic regression analysis showed no significant association between gender (p = .69) or systolic blood pressure (SBP) as a categorical variable (SBP < 125, 126-145, > 145) (p = .35) and AS severity, but increasing age group (ages 65-73, 74-81, or 82-89) was associated with greater odds of moderate or severe AS (p = .002), OR 3.43 (95% CI: 1.59, 7.40).

Conclusions:
RPUW ≥ 0.5 mm demonstrate a significant correlation with AS severity. A prospective study which collects first-time echocardiograms for patients with RPUW serves as a next step in determining the utility of ECGs for screening of AS.
Abstract 13746: Mental Health and Implantable Cardioverter Defibrillator Implantation in Black Patients at Risk for Sudden Cardiac Death
Authors: Boursiquot Brian C , Sullivan Lonnie T , Maul Andrew , Khedagi Apurva , Young Rebecca , Alhanti Brooke , Sears Samuel F , Jackson Larry R , Thomas Kevin L
Published: December 2023

Introduction:
Black patients with guideline indications for implantable cardioverter defibrillators (ICD) have lower rates of implantation compared to White patients. The Educational Videos to Address Racial Disparities in ICD Therapy Via Innovative Designs (VIVID) trial enrolled self-identified Black individuals with chronic systolic heart failure and studied the impact of a video-based decision-support tool on decisional quality and ICD implantation.

Hypothesis:
We hypothesized that depressive symptoms are associated with greater decisional conflict and lower rates of ICD implantation among study participants.

Methods:
Participants were administered the Patient Health Questionnaire-2 (PHQ-2) depression screen; and the 12-Item Short-Form Health Survey, from which we derived the Mental Component Summary-12 (MCS-12). A decisional conflict scale (DCS) adapted from the Ottawa framework for shared decision-making was used to assess decisional conflict associated with the decision for ICD implantation. An analysis of covariance was used to assess differences in DCS scores. Multivariable logistic regression was used to examine the association between mental health scores and ICD implantation at 90 days.

Results:
Among 306 included participants, 60 (19.6%) reported depressed mood and 142 (46.4%) reported anhedonia. Participants with the lowest MCS-12 scores (poorer mental health) had greater decisional conflict regarding ICD assent compared to those with the highest MCS-12 scores (adjusted mean difference in DCS score = 3.05 [95% CI: 0.32, 5.78]). By 90-day follow-up, 204 participants (66.6%) underwent ICD implantation. There was no significant association between either PHQ-2 score or MCS-12 score and ICD implantation.

Conclusions:
Depressed mood and anhedonia were prevalent among Black patients considering primary prevention ICD. Poorer mental health did not impact the likelihood of ICD implantation in this population.
Abstract 13753: Cumulative Circulating Monocyte Load is Associated With All-Cause Mortality: A Longitudinal Cohort Study
Authors: Wu Dan , Lan Yulong , ding xiong , Feng Baoyu , Wu Chutao , Wang Wei , Xu Wencan , Wu Shouling
Published: December 2023

Introduction:
Monocytic inflammation has been increasingly linked to diverse cardiometabolic risk factors and many age-related pathologies.

Hypothesis:
Cumulative monocyte counts (CumMON) are associated with and predictive of all-cause mortality.

Methods:
Retrospective analyses of data among 43,681 Han Chinese participants from a real-world, prospective cohort (Kailuan Study). Multivariable-adjusted Cox regression analyses were conducted to examine CumMON-associated risks for all-cause mortality.

Results:
Over a median 7.76 (IQR: 7.47-8.03) years of follow-up, 2,810 all-cause deaths were documented. Elevated monocyte load was significantly associated with higher mortality rates (
Figure 1
). Each 1-SD increase in CumMON was associated with a 15% increase in all-cause death (1.15, 95% CI: 1.11-1.20) after adjusting for other risk factors. Higher death incidences and CumMON-associated mortality risks (per-SD increment) were observed in elderly individuals, participants with diabetes (1.18, 95% CI: 1.10-1.27), hypertension (1.16, 95% CI: 1.11-1.21), impaired renal function (1.18, 95% CI: 1.13-1.24), increased LDL-C (1.21, 95% CI: 1.15-1.28 for LDL≥2.6 mmol/L) or decreased HDL-C levels (1.21, 95% CI: 1.12-1.31), but not with CVD or cancer. There were significant supra-additive interactions between elevated CumMON and diabetes (RERI: 0.26, 95% CI: 0.04–0.48), hypertension (RERI: 0.35, 95% CI: 0.12–0.57), and old age (≥60 years) (RERI: 0.46, 95% CI: 0.07–0.85). The addition of cumulative monocyte load into the multivariable model significantly improved the prediction performance of all-cause death (net reclassification improvement: 12.05%;
P
<0.0001).

Conclusions:
Elevated cumulative monocyte load is significantly associated with all-cause death and improves risk prediction. Chronically elevated monocytes supra-additively enhance the mortality risk among those with old age, diabetes, or hypertension.
Abstract 13769: Prognostic Impact of Sodium-Glucose Co-Transporter-2 Inhibitors Therapy on All-Cause Mortality Among Patients With Diabetes Mellitus and Cancer
Authors: Gvili Perelman Moran , Wolf Ido , Brzezinski Rafael Y , Laufer Perl Michal
Published: December 2023

Introduction:
Diabetes mellitus (DM) and cancer are prevalent diseases associated with the process of aging and exhibit a high likelihood of co-occurrence. Extensive evidence supports the notion that DM serves as a risk factor for various forms of cancer, and it is strongly associated with an unfavorable prognosis. The correlation is believed to be influenced by multiple pathways, including hyperinsulinemia, hyperglycemia, and inflammation. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are effective antidiabetic therapies associated with reduced all-cause mortality and cardiovascular outcomes.

Hypothesis:
The aim of our study was to assess the correlation between SGLT2i therapy and all-cause mortality, among patients diagnosed with DM and cancer

Methods:
We conducted a retrospective, single-center, observational study including all patients diagnosed with DM and cancer between January 2016 to January 2023. Patients were divided into two groups: patients treated with SGLT2i prior to cancer diagnosis (SGLT2i) and patients SGLT2i naive (non-SGLT2i). The primary endpoint was all-cause mortality.

Results:
Overall, 7085 patients were included in our cohort; 985 patients in the SGLT2i group and 6100 patients in the non-SGLT2i group. At a median follow-up of 42 months [IQR 23, 60] we observed a significantly lower all-cause mortality among the SGLT2i group (23% vs. 38%, p<0.001). Using a multivariable Cox regression analysis, SGLT2i therapy emerged as an independent significant predictor for reduced all-cause mortality (Hazard Ratio (HR) 0.637 [95% confidence interval (CI) 0.555-0.731], p<0.001).

Conclusions:
SGLT2i therapy was found to be effective, associated with a significantly reduced all-cause mortality in patients diagnosed with DM and cancer. Randomized clinical trials are needed to establish the role of SGLT2i specifically in cancer patients and better understand its mechanism.
Abstract 13785: QT Prolongation and QT Variability Predict New-Onset Atrial Fibrillation in the General Japanese Population
Authors: Ninomiya Yuichi , Kawasoe Shin , Kubozono Takuro , Tokushige Akihiro , Enokizono Kei , Kamada Hiroyuki , Yoshimoto Issei , Ikeda Yoshiyuki , Miyahara Hironori , Tokushige Koichi , Ohishi Mitsuru
Published: December 2023

Background:
The QT interval, an electrocardiogram (ECG) parameter, can be corrected for heart rate to obtain the QTc, an indicator of ventricular repolarization widely used as a predictor of ventricular arrhythmia. Although prolonged QTc and atrial fibrillation (AF) development are linked, there are few reports of QTc variability and AF development.

Purpose:
To identify a relationship between QTc prolongation and variability and new-onset AF in the general Japanese population.

Methods:
This retrospective study evaluated the annual health check-up data of 103,304 adults (50,438 males; age, 54±15 years) without AF at baseline, between April 2005 and October 2018. Most participants underwent annual health examinations as recommended by the Japanese health welfare policy. The QTc times were calculated with the Bazett formula (QTc=QT/√RR), using the mean QT and RR intervals. QTc variability was evaluated as the difference between the maximum and minimum QTc values at multiple checkups. AF was diagnosed using a 12-lead surface ECG. The strength of the association between QTc prolongation and variability and new-onset AF was determined using logistic regression analyses. Multivariate analyses were adjusted for clinical variables (age, sex, obesity, hypertension, dyslipidemia, diabetes, estimated glomerular filtration rate, and habitual drinking).

Results:
The median follow-up time was 6 years. During follow-up, 341 (0.3%) new AF cases were recorded. Univariate analysis revealed a significant increase in new-onset AF in the QTc prolongation (odds ratio [OR] per 10 ms, 1.08; 95% confidence interval [CI], 1.03-1.13; p<0.001) and the QTc variability (OR per 10 ms, 1.15; 95% CI, 1.07-1.23; p<0.001). After adjusting for clinical variables, multivariate analysis revealed that QTc prolongation and variability were significantly associated with new-onset AF (OR per 10 ms, 1.09; 95% CI, 1.04-1.14; p<0.001) (OR per 10 ms, 1.16; 95% CI, 1.09-1.24; p<0.001).

Conclusions:
QTc prolongation and variability are associated with an increased risk of new-onset AF in the general Japanese population. Although they have been reported to be involved with the autonomic nervous system, the mechanism of this causal relationship requires further investigation.
Abstract 13798: Change Patterns of Nightly Sleep Duration as Well as Sleep Quality and Risk of Cardiovascular Disease: A Chinese Nationwide Cohort Study
Authors: Hu Xiangming , Dong Haojian , Ou Yanqiu , Zhou Yingling , Liu Jieliang , Jin Junguo , Jiang Lujing , Liu Mingqin
Published: December 2023

Introduction:
Sleep has been included by the American Heart Association as a new component of Life's Essential 8, as the adverse effects of too much or low nighttime sleep and bad sleep quality on cardiovascular disease (CVD) are well established.

Hypothesis:
Different change patterns of nightly sleep duration and sleep quality have different CVD risks.

Methods:
A total of 7,905 adults without CVD history were enrolled in 2011, and the incidence of CVD was tracked until 2018. Nightly sleep duration was categorized as good (6-8 hours) and bad (less than 6 or more than 8 hours), and sleep quality was also categorized as good (1-2 scores) and bad (more than 3 scores). Participants were divided into four groups according to categories of the nightly sleep duration change patterns as well as the sleep quality change patterns in 2011 and in 2015. Logistic regressions and restricted cubic splines were performed to assess the association between change patterns of nightly sleep duration as well as sleep quality and CVD risk.

Results:
Over a median of 7 years of follow-up, 873 participants (11.0 %) developed CVD. The nightly sleep duration change patterns of good-bad, bad-good and bad-bad were associated with an increased risk of incident CVD, compared to the good-good group. The sleep quality change patterns of good-bad and bad-bad were associated with an increased risk of incident CVD, compared to the good-good group, while the effect in bad-good sleep quality group was not significant. Changes in nighttime sleep duration had a U-shaped relationship with new-onset CVD in subjects with sleep deprivation, and an increase of less than 4 hours was associated with reduced CVD risk in this population. Sleep quality change linearly related with the incidence of CVD.

Conclusions:
Suboptimal change patterns of nightly sleep duration and sleep quality were both associated with increased CVD risk. For sleep deprived people, supplementing with a certain amount of sleep could reduce the risk of CVD.
Abstract 13908: Racial Disparities in Surgical Approach for Patients With Atherosclerotic Chronic Limb Threatening Ischemia
Authors: Allen William E , Greendyk Joshua D , Haider Syed F , Hossain Afif , Sharma Abhishek
Published: December 2023

Background:
Over 8 million individuals in the US have been diagnosed with peripheral artery disease (PAD) with a cumulative annual cost exceeding $21 billion dollars. Chronic limb-threatening ischemia (CLTI) is the most severe form of this group, with a 2-year mortality as high as 40%. This study aims to identify racial disparities in the different approaches to treatment of CLTI.

Methods:
This IRB-approved retrospective study utilized data from the ACS-NSQIP. All recorded cases of surgical bypass, endovascular revascularization, or amputation below the knee for the treatment of CLTI between 2012 and 2021 were isolated. Propensity score matching and univariate analysis was performed to assess the independent effect of black self-identified race on access and outcomes.

Results:
50,184 cases of CLTI were identified. Using propensity and logistic regression, we identified that black self-reported race is an independent predictor of both endovascular revascularization and amputation rather than open bypass (OR = 1.542, 95% CI=1.451-1.639, p<.001; OR = 1.977, 95% CI=1.797-2.174, p<0.001). Additionally, black patients were significantly less likely to experience any postoperative complications (OR=0.928, CI=0.865-0.996, p=0.037).

Conclusion:
Our analysis revealed a significant racial disparity in access to open bypass surgery. Our results also showed lower incidence of post-operative complications amongst CLTI black patients receiving endovascular revascularization or amputation. Our findings herein warrant further investigation to address racial disparities and barriers in the treatment of CLTI.
Abstract 13913: Value of Ischemia and Coronary Anatomy for Prognosis and Guiding Revascularization Among Patients With Stable Ischemic Heart Disease
Authors: Patel Krishna K , peri-Okonny poghni A , Shaw Leslee J , gimelli alessia
Published: December 2023

Aims:
To assess the value of ischemia versus coronary anatomy for prognosis and to guide revascularization.

Methods:
A total of 1764 patients who had rest-stress SPECT MPI and angiography (invasive or CT) were prospectively enrolled and followed for cardiac death/non-fatal MI. CAD prognostic index (CADPI) was used to quantify extent and severity of angiographic disease. Prognostic value was assessed using Cox models, adjusted for pre-test risk, known CAD, stressor, LVEF, %ischemia and infarct, CADPI, early (90 day) revascularization. Incremental prognostic value was evaluated using net reclassification indices (NRI).

Results:
Mean age was 69.7±9.5 years, 24.4% were women and 29.3% had known CAD. Ischemia was present in 90.9%; >10% in 28.4%. Non-obstructive, single, and multi-vessel disease was present in 256 (14.5%), 772 (43.8%) and 736 (41.7%) respectively. Early revascularization occurred in 579 (32.8%). Cardiac death/MI occurred in 148 (8.4%) over 4.6 year median follow-up. Both % ischemia and CADPI provided incremental prognostic value over pre-test clinical risk (p<0.001,
Table
). In a model containing both ischemia and anatomy, ischemia was prognostic (HR per 1% ↑=1.06, 95% CI:1.02, 1.10,p=0.02), but CADPI was not (HR=1.01 (1.00, 1.02),p=0.07). Early revascularization modified the risk associated with %ischemia (interaction p=0.003,
Figure
), but not with CADPI (interaction p=0.6). % Ischemia and SPECT variables added incremental prognostic value over clinical risk and CADPI (NRI=20.3%, 95%CI: 9%, 32%, p=0.01); however CADPI was not incrementally prognostic over pre-test risk, %ischemia and SPECT variables (NRI=3.1%, 95% CI: -5%, 15%, p=0.21;
Table
).

Conclusion:
Ischemic burden provides independent and incremental prognostic value beyond CAD anatomy and identifies patients who benefit from early revascularization. Anatomic extent of disease has limited incremental benefit for prognosis and guiding revascularization beyond ischemia.
Abstract 13916: Patient Outcomes 6 Months Following Pulmonary Vein Isolation for Atrial Fibrillation With a Novel RF Catheter: Initial Data From NEwTON AF
Authors: Michaud Gregory F , Daccarett Marcos , Haines David , Latcu Decebal G , Kapa Suraj , Nair Devi , Cheung Jim W , Lo Li-Wei , Weiner Stanislav , Cireddu Manuela , Li Cheng-Hung , Dello Russo Antonio , Raybuck Jonathan D , Wehrenberg Scott , Gupta Dhiraj
Published: December 2023

Introduction:
The combination of local impedance (LI), a direct measure of electrical resistance at the catheter tip, and contact force (CF) may facilitate treatment of atrial fibrillation (AF). This trial is designed to examine the safety and effectiveness of a novel RF catheter that allows measurement of both LI and CF.

Hypothesis:
Demonstrate the safety and effectiveness of a novel radiofrequency catheter with LI and CF for treatment of drug refractory, recurrent, symptomatic Paroxysmal AF (PAF).

Methods:
NEwTON AF is a multi-center, global, prospective, single arm study. Patients received index treatment for PAF with the study catheter. The present 6-month endpoint analysis was prospectively planned.

Results:
The study treated 299 patients at 45 sites in North America, Europe, and Asia. Patients were 39.5% female with a mean age of 62yrs (±12), and had a mean LVEF of 59% and an LA diameter of 3.9cm. Procedure time, LA dwell, and fluoroscopy times were 166, 136, and 15 minutes, respectively. High-power short-duration (HSPD, 45-50W) was exclusively used in 210 cases, which had notably shorter procedure times than the 82 cases that used conventional power, 148 vs 208 min, respectively. Acute procedural success was observed in 98.3% of cases. As of 6 months, freedom from documented recurrence of any atrial arrhythmia was 79.9% (Figure). Recurrence in relation to LI shows that pts with a 20Ω LI drop (in at least 60% of lesions) had better 6m outcomes (84.2% vs 73.3, p=0.04). The freedom from safety event rate at 30d was 96.0%; events included pericarditis (6), access complications (2), pulmonary edema (2), embolism (2), cerebrovascular accident (1), tamponade (1). Pericarditis was higher in pts with a history of COVID at enrollment, 16.3% vs 5.9%, p=0.025.

Conclusions:
This data suggests that patient outcomes and safety for this novel catheter are promising. Further data from this study, including 12m outcomes, and detailed analysis of local impedance data are forthcoming.
Abstract 13922: Reducing Health Care Disparities by Improving ICD Knowledge in a Diverse Population, a Quality Improvement Initiative to Align ICD Settings With Goals of Care
Authors: Godfrey Sarah , Viamontes Christopher G , Garrett Brenden , Patel Nakul , Shah Nainesh , Newcomer kelley , Sulistio Melanie
Published: December 2023

Background:
Patients with implantable cardioverter defibrillators (ICDs) often lack understanding of ICD functioning, most dramatically in at-risk populations. Patient knowledge gaps preclude adequate communication regarding goals of care and informed decision-making with the potential for unwanted shocks at end of life (EOL). Both ICD studies and ICD patient education tools historically lack both diversity and accessibility. Ways to improve patient ICD comprehension in populations with barriers to care have not been well established.

Research Questions:
Does a patient-centered educational video improve ICD knowledge and/or affect patients’ ICD preferences in hypothetical EOL scenarios?

Methods:
We surveyed 30 admitted heart failure patients with ICDs using 10 validated true-false ICD knowledge questions, 4 preference questions in hypothetical EOL scenarios, and multiple qualitative questions at a diverse urban, safety-net hospital. A novel 7-minute ICD educational video narrated by real patients with ICDs, using 3
rd
grade or below language was then shown either in English or Spanish. Post viewing, the same questions were repeated to assess knowledge and preferences. (Link to video:
https://youtu.be/8n_M--33Ia
w
)

Results:
The mean age was 58 years, and 38% identified as female. Of the 30 patients, 63% were Black, 37% were White, and 17% were Hispanic. Patients had a mean ejection fraction of 31%, and 50% of participants had prior ICD shocks (1 to 14 times). The mean pre-test knowledge score was 50% (SD 22.8) and mean post-test score significantly improved to 82% (SD 15.1) correct (W=346, p<0.00001). Scores did not significantly vary by age, sex, race, or prior shock status. After watching the video, 66% of patients changed their EOL ICD preferences in at least 1 scenario. All participants rated the video as either very helpful or helpful.

Conclusion:
In a diverse group of admitted heart failure patients with ICDs, intervention with an educational video on ICDs and shocks at EOL significantly improved patient knowledge. Educational materials designed for diverse patient populations can reduce healthcare disparities, by expanding patient knowledge and therefore empowering patients to make informed decisions on ICDs at EOL.
Abstract 13924: Combined Gene Therapy Approach Targets Parasympathetic Signaling and Oxidative Stress to Reverse Pre-Existing Persistent Atrial Fibrillation in a Canine Model
Authors: Mikhailov Aleksei , Pfenniger Anna , Yoo Shin , Johnson David , Zhang Wenwei , Marszalec William , Ghosh Asish K , Ober Rebecca A , Passman Rod S , Knight Bradley P , Arora Rishi
Published: December 2023

Introduction:
Atrial fibrillation (AF) is a multifactorial disease, with oxidative stress (NADPH oxidase 2, NOX2) and autonomic remodeling (hyperinnervation and parasympathetic signaling) playing an important role. Disrupting both mechanisms simultaneously with gene-based therapy may allow for reversal of established remodeling in AF.

Hypothesis:
Gene therapy aimed at attenuation of parasympathetic signaling (Gαi/o inhibitory peptides, GiGo_ct) and prevention of nerve sprouting (nerve growth factor short hairpin RNA, NGF shRNA) combined with reduction of oxidative stress (NOX2 shRNA) can reverse AF in a large animal chronic AF model.

Methods:
Chronic AF model was created by rapid atrial pacing (RAP) at 600bpm in 5 dogs, followed by gene therapy treatment (Panel A). A combination of NOX2 shRNA and GiGo_ct plasmids with (n=2) or without (n=3) NGF shRNA was injected in both atria followed by electroporation to facilitate gene delivery. Control RAP dogs did not receive gene (n=5) or underwent scrambled gene injection (n=6). AF burden was assessed over time and residual AF was recorded at terminal EP study. NOX2 and NGF knockdown and GiGo_ct expression were evaluated by PCR.

Results:
After 3.3±1.3 weeks of RAP, all 11 animals reached >80% AF burden. Combined (NOX2+GiGo±NGF) gene therapy significantly reduced AF burden by 66% (p<0.05) compared to scramble controls and by 38% (p<0.05) compared to pre-treatment AF burden (Panel B). Residual AF after the treatment was slower and more organized than in controls (panel C). PCR analysis showed NOX2 and NGF downregulation and evidence of GiGo_ct expression.

Conclusions:
Gene-based attenuation of autonomic remodeling through inhibition of parasympathetic signaling and nerve sprouting, and reduction of oxidative stress by NOX2 downregulation may be effective at reversing AF. Development of optimized gene therapy to target multiple AF mechanisms simultaneously may lead to more effective treatments for persistent AF.
Abstract 13940: Remnant Lipoprotein Particles and Cholesterol Contribute to Proatherogenic Phenotype and Subclinical Inflammation in Youth-Onset Type 2 Diabetes
Authors: Chowdhury Aruba , Davis Faith , Krenek Andrea , Dixon Sydney , Mabundo Lilian , Chung Stephanie T
Published: December 2023

Introduction:
Youth-onset type 2 diabetes (YT2D) is a rapidly progressive disease characterized by severe insulin resistance (IR), elevated triglyceride concentrations, and low HDL-cholesterol (-C). However, the contribution of triglyceride-rich remnant lipoproteins (TRLp) and remnant-C to overall atherogenic risk in YT2D is unknown, especially in the absence of clinically relevant elevations in LDL-C.

Hypothesis:
We hypothesized that YT2D would have higher remnant TRLp, remnant-C, and greater subclinical inflammation and IR compared to healthy peers with obesity.

Methods:
We measured fasting lipoprotein particle size and number, GlycA (a composite marker of inflammation), and lipoprotein IR index (LPIR) using NMR LipoProfile® in 61 YT2D (age 17.2 ±2.9 y, mean±SD, BMI 39.1 ±8.4 kg/m2) and 25 healthy peers (age 17.9 ± 5.1 y, BMI 35.8 ±5.7 kg/m2). Remnant Lp (small TRLp plus very small TRLp) and remnant-C (total-C minus HDL-C minus LDL-C) were calculated and the relationship with GlycA and LPIR determined by spearman correlations.

Results:
YT2D had higher HemoglobinA1c (7.6 ± 2.0 vs 5.8 ± 0.8%), GlycA (427 [388, 474] vs 376 [332, 406] nmol/L, median[25th,75th]), LPIR (53.7 ± 23.6 vs 29.6 ± 16.5). YT2D had higher remnant TRLp and remnant-C (Figure 1) and a more proatherogenic lipid and lipoprotein profile: LDL-C: 89 ± 23 vs 74 ± 20 mg/dL; total LDLp: 1392 ±368 vs 1075 ±289 nmol/L; small LDLp: 890 ±450 vs 519 ±232 nmol/L, all P<0.01. LPIR was associated with remnant-C (r=0.6, P<0.001) but not with LDL-C (r=0.1, P=0.6). GlycA was associated with remnant-C, remnant TRLp, and small LDLp (all r≥0.3, P<0.01).

Conclusion:
The proatherogenic profile in YT2D is characterized by higher small LDLp, remnant TRLp, and remnant-C and is related to IR and subclinical inflammation compared to healthy peers with obesity. Future research is needed to determine whether reducing all proatherogenic lipoproteins and inflammation will reduce ASCVD risk.
Abstract 13950: Real-World Effectiveness and Safety of Evinacumab in Pediatric and Adult Patients With Homozygous Familial Hypercholesterolemia: A Multi-Site US Perspective
Authors: Wilkinson Michael J , Bijlani Priyesha , Davidson Michael H , Duell P B , Horan Mary , Malloy Mary J , Newfield Ron , Pradeep Pallavi , Sam Colleen , Shah Prediman K , Stock Eveline O , Warden Bruce , Ito Matthew K
Published: December 2023

Introduction:
Homozygous familial hypercholesterolemia (HoFH) is an autosomal co-dominant disorder characterized by extreme elevations in LDL-C and early onset ASCVD. Unfortunately, patients with HoFH generally experience poor LDL-C lowering with standard lipid-lowering therapy and rarely achieve LDL-C goals. Evinacumab is a monoclonal antibody administered by monthly IV infusion that binds angiopoietin-like 3 and when added to standard lipid-lowering therapies lowers LDL-C by ~50% in clinical trials involving patients with HoFH. Real-world effectiveness and safety of evinacumab is unknown.

Methods:
We performed retrospective chart review to assess effectiveness and safety of evinacumab in patients with HoFH in clinical practice at six US academic medical centers. The primary efficacy endpoint was the percent change in LDL-C from baseline to first follow-up and to most recent follow-up after evinacumab initiation. Secondary efficacy endpoints were percent change in non-HDL-C, triglycerides, total cholesterol, HDL-C, and achievement of an LDL-C <70 mg/dL. Adverse events were recorded.

Results:
Twenty-four patients (mean age 38 yrs; range 5-75) with HoFH were followed for a median of 63 weeks. Fifty percent were female, 66.7% had ASCVD, 87.5% were on a statin, 83.3% on ezetimibe, 66.7% on a PCSK9i, 24% on lomitapide, and 33.3% were undergoing lipoprotein apheresis. Significant reductions in LDL-C, non-HDL-C, total cholesterol, triglycerides, and HDL-C were observed both at first follow-up (4 weeks) and most recent follow-up (63 weeks) (p < 0.001 for all) (Table). Significantly more patients achieved LDL-C <70 mg/dL after evinacumab was added. No serious adverse events occurred and evinacumab was generally well-tolerated.

Conclusions:
Across six US academic medical centers, evinacumab was generally well-tolerated by patients with HoFH and lowered LDL-C by ~50%, consistent with results from clinical trials.
Abstract 13954: The Canadian Tia Score as a Predictor of Ischemic Lesion on Magnetic Resonance Imaging in Transient Ischemic Attack or Minor Stroke Following a Negative Computed Tomography Scan
Authors: Robitaille Matthieu , Sharma Mukul , Emond Marcel , Mackey Ariane , Blanchard Pierre-Gilles , Nemnom Marie-Joe , Sivilotti Marco , STIELL Ian , Stotts Grant , Lee Jacques , Worster Andrew , Morris Judy , Cheung Ka Wai , Jin Albert , Oczkowski Wieslaw J , Sahlas Demetrios , Murray Heather , Verreault Steve , Camden Marie-Christine , Yip Samuel , Teal Philip A , GLADSTONE David J , Boulos Mark , Chagnon Nicholas , Shouldice Elizabeth , Atzema Clare , Slaoui Tarik , Teitelbaum Jeanne S , Wells George A , Perry Jeffrey J
Published: December 2023

Introduction:
Patients with a diagnosis of transient ischemic attack (TIA) or minor stroke with an acute infarction on brain imaging are at higher risk of subsequent stroke. Our goal was to establish if the Canadian TIA Score (CTS) could predict infarction on magnetic resonance imaging (MRI) when a computed tomography (CT) scan was negative for stroke and aimed to identify clinical factors predictive of a positive MRI.

Methods:
Patients were selected from the prospective cohort used for the validation of the CTS in 13 centers. Patients with negative CT scans who underwent MRI within 7 days were analyzed. The main outcome was cerebral infarction defined as MRI diffusion-weighted imaging (DWI) positivity. Associations between confirmed stroke and demographic characteristics, clinical features, laboratory findings, and medications were determined using a multivariate logistic regression model. Subsequent stroke rate at 7, 30, and 90 days was analyzed.

Results:
From 11,507 patients, 1,048 met inclusion criteria. MRI positivity was 15.4%, 30.4%, and 50.0% for the low, medium, and high-risk CTS groups, respectively. Subsequent stroke/TIA rates were higher with confirmed ischemic lesions on MRI at 90 days: twice (10.0%) in the low-risk group, 51 (22.3%) in the medium-risk group, and 20 (24.7%) in high-risk patients. 1.7% of DWI negative patients had a subsequent stroke. Predictive factors in multivariable models for DWI positivity in the medium-risk group were male (OR=1.53; 95% CI 1.11-2.12), hypertension (OR=1.63; 95% CI 1.17-2.27), clinical history of unilateral weakness (OR=2.09; 95% CI 1.50-2.91), language disturbance (OR=1.43; 95% CI 1.03-1.97), and the presence of pronator drift on examination (OR=2.18; 95% CI 1.37-3.47).

Conclusion:
The CTS helps predict MRI findings and confirmed ischemic lesion is a predictor of the recurrence risk of stroke. The low-risk group showed few positive MRIs and had a lower recurrence rate justifying less urgent MRI. In the medium-risk group, we highlighted findings that should raise the suspicion of an ischemic lesion and these patients should be prioritize for rapid investigation of stroke etiology. In the high-risk group, patients are at risk for stroke despite negative imaging and MRI should not delay management.
Abstract 13958: A Novel Approach to Quantifying Guideline-Directed Medical Therapy Accounting for Treatment Intensity
Authors: Khan Mirza S , Sherrod Charles F , Jones Philip G , Fonarow Gregg C , Butler Javed , Devore Adam D , Chan Paul S , Spertus John A
Published: December 2023

Introduction:
Measuring the intensity of guideline-directed medical therapy (GDMT) is foundational for improving care in heart failure (HF). Existing measures either discount dose intensity or use inconsistent weighting.

Methods:
The primary aims were to create the Kansas City Medical Optimization (KCMO) score, an interpretable GDMT score customizable to individual patients’ treatment eligibility, and to compare KCMO score distributions with the HF Collaboratory (HFC) and modified HFC scores in the CHAMP-HF registry. KCMO is the average of total daily to target dose percentages for eligible GDMT drug classes, reflecting the percent of optimal GDMT prescribed (range 0-100%). The HFC and modified HFC scores transform total daily to target dose percentages into points: 0 if none, 1 if < 50%, 2 if ≥ 50%, or (HFC only) set points for MRA (2) or ARNI (3) if on any dose. In the CHAMP-HF registry, we computed KCMO, HFC (range 0-7), and modified HFC (range 0-100) scores for each patient at baseline and 1-yr change from baseline for the 3 established GDMT therapies at the time (MRA, BB, and ACEI/ARB/ARNI). We compared baseline and change score distributions and the coefficient of variation (CV) across scores.

Results:
At baseline (n = 4,532), the mean KCMO, HFC, and modified HFC scores were 37.0 (SD 25.0), 3.4 (1.6), and 38.7 (18.3), respectively. Of those with data at yr 1 (n = 4,061), mean change from baseline for the KCMO, HFC, and modified HFC scores were -1.67 (17.7), -0.10 (1.31), and -1.98 (15.1), respectively. Baseline CV was highest for KCMO (0.68) indicating greater variability around the mean and more sensitivity than HFC (0.48) and modified HFC (0.47) scores.

Conclusion:
The KCMO score measures GDMT intensity incorporating dosing and treatment eligibility, provides more granularity than existing methods, has clear interpretability, and can be adapted as performance measures evolve. Further study of its association with outcomes and usefulness for quality improvement are needed.
Abstract 13964: Dynamic Assessment of Shock Severity in Cardiac Intensive Care Unit Patients
Authors: Jentzer Jacob C , Van Diepen Sean , Patel Parag C , Henry Timothy D , Morrow David A , Baran David A , Kashani Kianoush B
Published: December 2023

Introduction:
A single assessment of the SCAI shock classification robustly predicts mortality, and a repeat assessment may improve prognostication.

Hypothesis:
We hypothesized that frequent serial assignment of the SCAI shock stage could further improve risk stratification.

Methods:
Unique AHA Level 1 cardiac intensive care unit (CICU) admissions at a single center from 2015 to 2018 were reviewed retrospectively. Time-stamped electronic health record data were used to assign the SCAI shock stage in each 4-hour block during the first 24 hours of CICU admission. Shock was defined as SCAI shock stage C, D, or E. In-hospital mortality was evaluated using logistic regression.

Results:
Among 2,918 CICU patients, 1,537 (52.7%) met criteria for shock during >=1 block and 266 (9.1%) died in hospital. The SCAI shock stage on admission was: A, 37.6%; B, 31.5%; C, 25.9%; D, 1.8%; E, 3.3%. Patients with worsening SCAI shock stage after admission (first 4 hours) were at higher risk of mortality (
Figure A
), as were patients who met SCAI criteria for shock (particularly those with shock on admission,
Figure B
). The pattern was consistent in patients with acute coronary syndromes, heart failure, or cardiac arrest (who had very high mortality). Each higher admission (aOR 1.36, 95% CI 1.18-1.56, AUC 0.70), maximum (aOR 1.59, 95% CI 1.37-1.85, AUC 0.73) and 24 hour mean (aOR 2.42, 95% CI 1.99-2.95, AUC 0.78) SCAI shock stage were incrementally associated with increasing in-hospital mortality. Discrimination was highest for the mean SCAI shock stage (p <0.05). Each additional 4 hour block meeting SCAI criteria for shock was associated with higher mortality (aOR 1.15, 95% CI 1.07-1.24).

Conclusions:
Dynamic assessment of shock using serial SCAI shock classification assignment can improve mortality risk stratification in CICU patients. Cumulative time in shock was a strong mortality risk indicator, highlighting the area under the curve of shock severity as an important determinant of outcomes.
Abstract 13966: Change in Troponin I Levels With Intensive Blood Pressure Control: A Post-Hoc Analysis of SPRINT
Authors: Yerabolu Krishin , Shetty Naman S , Gaonkar Mokshad , Patel Nirav , Patel Kershaw , Arora Garima , Arora Pankaj
Published: December 2023

Introduction:
Cardiac troponin T (cTnT) levels have been shown to increase by intensive blood pressure (BP) control and longitudinal changes in cTnT predict cardiovascular disease (CVD) and mortality. However, similar data on cTnI, a specific marker of myocardial injury, are lacking.

Methods:
This post-hoc analysis of the SPRINT (Systolic Blood Pressure Intervention Trial) included participants who had cTnI values at randomization and 1-year. The cohort was stratified by change in cTnI at 1 year into ≥50% decrease, ≥50% increase, or unchanged (<50% change). The difference in log(cTnI
randomization
) and log(cTnI
1
year
) was calculated. The primary outcome was CVD events. Secondary outcomes included a composite of all-cause mortality or CVD events, all-cause mortality, and a composite of heart failure or all-cause mortality. Geometric mean ratios for change in log cTnI levels with intensive BP lowering compared with standard treatment were estimated using adjusted linear regression models. Adjusted Cox models were used to assess the risk of the outcomes of interest after 1 year with the change in cTnI levels. Events within 1 year were censored.

Results:
Among the 8,011 participants with cTnI levels at randomization and 1 year, cTnI decreased, did not change, and increased in 393 (4.9%), 6,442 (80.4%), and 1,176 (14.7%) participants at 1 year, respectively. Compared with the standard treatment, ≥50% reduction in cTnI at 1 year was more common with intensive treatment. The intensive treatment group had a 7% decrease [geometric mean ratio: 0.93 (0.91-0.95)] in cTnI compared with the standard treatment group after adjusting for covariates. An increase in the change in log cTnI at 1 year was associated with a higher risk of incident CVD events [HR
adj
: 1.67 (1.36-2.05)] and the composite of all-cause mortality or CVD events[HR
adj
: 1.36 (1.13-1.64)].

Conclusions:
cTnI levels decreased with intensive BP control and the change in cTnI at 1 year predicted incident CVD events.
Abstract 13997: Identification of Novel Spectral Densities in Arterial Pressure Time Series for Cardiovascular Risk Stratification in Early Prediabetes: Machine Learning Beyond Conventional Frequency Domain Analysis
Authors: Mostafa Abdalrhman , Bakkar Nour-Mounira , Abdelhack Mohamed , El-Yazbi Ahmed F
Published: December 2023

Introduction:
Despite the extensive use of average BP for diagnosis of cardiovascular disease (CVD), research has shown that changes in BP variability can better reflect CV deterioration. As patients with type 2 diabetes present to the clinic with pre-established CVD, there is a pressing need for early identification of aberrant BP fluctuations useful for risk appraisal.

Hypothesis:
We hypothesized that deep learning models with superior capacity in feature extraction would enable comprehensive characterization of arterial pressure (AP) time-series allowing CV risk stratification in early prediabetes.

Methods:
We trained a convolutional neural network (CNN, Figure 1A) to classify spectrograms generated using short-term Fourier transforms of beat-to-beat AP signals collected from control vs. prediabetic rats of both sexes fed a high-calorie diet for 12 or 24 weeks, representing young and old rats. Model performance was assessed on different sampling rates for binary and multi-level classifications of sex, age, and diet. Saliency maps were generated by back-propagation of model scores to extract frequency values crucial for classification. Conventional frequency domain analysis was performed on the original AP time-series and the power spectral densities (PSD) were determined for the frequencies identified for each classification task. PSD were compared among sex, age, and diet groups using 3-way ANOVA and principal component analysis.

Results:
The model successfully classified AP spectrograms according to age, sex, and diet revealing sex- and age-specific CV deteriorative processes in early prediabetes (Figure 1B-E). Saliency maps identified frequencies of 2, 13, 19, and 43 Hz as crucial for DietxAgexSex classification. Comparison of PSDs for these frequencies was not sufficient for CV risk separation (Figure 1F, G).

Conclusions:
Employing a CNN overcomes the shortcomings associated with CV risk stratification using conventional methods.
Abstract 13999: The Relationship Between Neighborhood Deprivation, Diabetes, and Extracellular Vesicles in African American Women at Risk for CVD: Data From a Pilot Study of the Step It Up Physical Activity Intervention
Authors: Baumer Yvonne , Miller Noel , Bavuso Matthew , Vijayakumar Nithya , Neally Sam , Potharaju Kameswari , Ceasar Joniqua N , Curlin Kaveri , Andrews Marcus , Turner Briana , Gutierrez Huerta Cristhian , Troendle James , Mitchell Valerie , Collins Billy , Sampson Maureen , Remaley Alan , Dobrian Anca , Powell-Wiley Tiffany M
Published: December 2023

Background:
African American women (AA) are at disproportionally high risk for diabetes and cardiovascular disease (CVD) which is accelerated when residing in resource-limited neighborhoods. Extracellular vesicles (EV) are emerging to be of importance in CVD development and progression, but little is known about a potential impact of neighborhood socioeconomic deprivation (NSD). In this study we examined associations between NSD, plasma EV, and markers of diabetes risk in a community-based cohort of AA women at risk for CVD from resource-limited neighborhoods in Washington, DC.

Methods:
Participants were enrolled in pilot testing of Step It Up, a community engaged physical activity intervention. Blood samples were drawn to measure clinical labs during participants’ baseline visit to the NIH Clinical Center. EV were isolated from heparinized plasma using size exclusion chromatography with size and numbers determined by nanoparticle tracking analysis. NSD was calculated using 2018 US Census tract data as a measure of neighborhood deprivation. Associations between NSD, EV, and diabetes-related clinical measures were analyzed using multivariable regressions adjusted for BMI and ASCVD 10-year risk score.

Results:
The study cohort was a convenience sample of AA women at risk for CVD (N=24, Age: 57±12, BMI: 35±6, ASCVD: 9±5). NSD associated with fasting glucose (β=0.54, p=0.007) and Hemoglobin A1c (HA1c) (β=0.51, p=0.007). Additionally, NSD associated with lower EV size (β=-0.42, p=0.03), with no association with EV concentration. Fasting glucose and HA1c associated negatively with EV size (β=-0.48, p=0.03 and β=-0.50, p=0.02, respectively) but no association was found with EV concentration.

Conclusions:
Thus, our data show that higher neighborhood deprivation is associated with lower EV size which, in turn, is associated with higher diabetes risk markers. More research is needed to understand the role of EV in diabetes and CVD development and progression. While larger studies further evaluating these observations are needed, our data highlight the importance of increased diabetes screening and multi-level interventions in patients residing in under-resourced communities to reduce existing health disparities.
Abstract 14012: The Importance of Right Bundle Branch Block in Suspected ST-Elevation Myocardial Infarction is Independent of ST-T Deviations
Authors: Soerensen Nils A , Fakhri Yama , Gossling Alina , Haller Paul M , Toprak Betül , Lehmacher Jonas , Twerenbold Raphael , Westermann Dirk , Andersson Hedvig , Jensen Lisette Okkels , Holmvang Lene , Neumann Johannes T , Clemmensen Peter
Published: December 2023

Background:
In patients with suspected acute coronary syndrome (ACS) and bundle branch block (BBB) an emergent invasive strategy is recommended. While left bundle branch block (LBBB) is a well-known high-risk feature in patients with acute myocardial infarction, data supporting this strategy for right bundle branch block (RBBB) are scarce.

Hypothesis:
RBBB poses a high-risk feature in suspected ST-elevation myocardial infarction (STEMI).

Methods:
2,139 patients with suspected STEMI were triaged to acute coronary angiography based on a prehospital, tele-transmitted digital 12-lead ECG. All discharge diagnoses were independently adjudicated. Sensitivity and specificity for STEMI-ECG-criteria were compared in RBBB and non-BBB patients. Adjusted hazard ratios for 1-year overall mortality were computed.

Results:
STEMI was adjudicated in 1,832/2,139 (85.6%) of all patients and in 102/117 (87.2%) of RBBB patients. ST-segment deviation followed typical patterns in most RBBB patients (n=36 for anterior, n=49 for inferior and n=15 for lateral STEMI) and among these a final diagnosis of STEMI was adjudicated in 88. Out of 17 patients without significant ST-changes, 14 (82%) were adjudicated as STEMI.

Diagnostic accuracy of STEMI-criteria was comparable in RBBB and non-RBBB patients for anterior (sensitivity: 51.1% vs 59.1%, p=0.14; specificity: 66.7% vs 52.1%, p=0.33) and inferior STEMI (sensitivity: 35.2% vs 36.6%, p=0.80; specificity: 58.3% vs 49.5%, p=0.55). There was a statistical difference for lateral STEMI (sensitivity: 14.8% vs 4.4%, p=0.001; specificity: 75.0% vs 98.4%, p=0.001).

Patients with RBBB had significantly higher1-year mortality compared to non-BBB patients. Adjusted hazard ratio for 1-year mortality comparing RBBB to non-BBB patients was 2.3% (95% CI 1.25-4.21, p=0.007).

Conclusion:
ECG-criteria for the detection of STEMI show comparable diagnostic accuracy in RBBB and non-BBB patients. However, STEMI was frequently present in RBBB patients not fulfilling diagnostic ECG-criteria. In addition, RBBB-patients showed poorer outcome after 1 year. Our data therefore reinforce current guidelines in designating ACS patients with RBBB, independent of ST-T deviations, high-risk and candidates for acute invasive evaluation.