bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 15706: Non-Invasive 3D Electromechanical Cycle Length Mapping for Macroreentrant Atrial Flutter Characterization
Authors: Tourni Melina , Konofagou Elisa
Published: June 2023

Introduction:
Arrhythmia localization prior to catheter ablation is critical for clinical decision making. The current standard of 12-lead EKG interpretation lacks spatial specificity and is anatomically limited. Electromechanical Cycle Length mapping (ECLM) is a high frame rate, echocardiography-based frequency analysis mapping technique, that can noninvasively map, localize and characterize cardiac activation frequencies in 3D.

Hypothesis:
Accurate localization prior to ablation may facilitate pre-op planning, reduce procedural times and fluoroscopic exposure. In this study we access ECLM feasibility for 3D mapping and quantifying macroreentrant atrial flutter (AFL) activation rates.

Methods:
Four patients (N = 4; 65 ± 9yo; 3 M) presented with AFL and were referred to RF ablation. Patients underwent pre-op transthoracic ECLM with simultaneous 3-lead EKG. 3D atrial ECLM cycle length (CL) maps were rendered and areas with arrhythmic CL were identified (100-330 ms). ECLM AFL and Ventricular CLs were defined as the dominant CL of the arrhythmic region and the region that remains synchronized with the ventricular activation respectively. ECLM findings were compared against identified origins and CLs on intracardiac electroanatomic mapping (EAM).

Results:
ECLM successfully identified and localized the presence of atrial typical CTI flutter in all four subjects when compared against successful RF ablation. An ECLM map in a CTI AFL case is shown on Fig. 1a with the CTI circuit in the right atrium. ECLM CLs exhibited excellent agreement with both the CL of the 3-lead EKG (Atrial CL: r
2
= 0.91, Ventricular CL r
2
= 0.99) and the EAM AFL CL (r
2
= 0.92).

Conclusions:
ECLM can localize, map and quantify the electromechanical CLs in AFL in excellent agreement with the clinical electrical CL rates and propagation patterns obtained by clinical albeit invasive procedures, providing thus a clinical noininvasive, non-ionizing mapping tool for RF ablation planning.
Abstract 15712: Imaging Conundrum: The Diagnosis of Unusual Partial Anomalous Pulmonary Venous Return With Dual Connections
Authors: Baig Mariam , OU JIAFU , NASIR AMMAR
Published: June 2023

Case:
A 68 year old male with a past medical history of hypertension, hyperlipidemia and chronic kidney disease presented for progressive dyspnea on exertion and bilateral lower extremity edema over three weeks. He was found to be in decompensated heart failure and new onset Atrial Flutter with rapid ventricular rate. Transthoracic echocardiography revealed severely impaired left ventricular systolic function with ejection fraction <20%, enlarged right ventricle, moderate right ventricular systolic dysfunction, biatrial enlargement, mild pulmonary hypertension. He was started on guideline directed medical therapy and referred for transesophageal echocardiogram (TEE) with cardioversion for new onset Atrial Flutter and possible tachycardia induced cardiomyopathy.

Imaging findings:
During TEE, routine doppler of right upper pulmonary vein showed markedly dilated superior vena cava (SVC) (3.6 cm) and unusual predominant outflow with brief mid late systolic inflow (Fig A and B), suggestive of partial anomalous pulmonary venous return (PAPVR). All three other pulmonary veins appeared normal. Also noted to have positive bubble study likely related to PAPVR. Subsequent right heart catheterization left to right shunt with Qp/Qs 1.6, step up noted between SVC and right atrium. CTA revealed partial anomalous right upper lobe pulmonary vein (RUPV) had dual connection to both SVC via window like communication and left atrium (Fig C), no sinus venosus defect seen.

Conclusion:
This case illustrates an unusual example of PAPVR with bidirectional flow, as well as the importance of thorough evaluation even on routine transesophageal echocardiograms especially for patients with right heart enlargement.
Abstract 15723: Risk Factors for Beta-Blockers Failure in Catecholaminergic Polymorphic Ventricular Tachycardia
Authors: Trancuccio Alessandro , Mazzanti Andrea , Kukavica Deni , Giannini Gala , Marino Maira , Casiraghi Luca , Sugamiele Andrea , Gambelli Patrick , Bloise Raffaella , Morini Massimo , Napolitano Carlo , Memmi Mirella , Priori Silvia G
Published: June 2023

Introduction:
Patients with Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT) may experience life-threatening arrhythmic events (LAE) despite standard-of-care treatment with beta-blockers (BB), but risk stratification is not well defined.

Hypothesis:
Both clinical and genetic risk factors predispose to BB failure, including the class of BBs (β1-selective vs. non-selective).

Methods:
LAE was defined as the composite of sudden cardiac death, aborted cardiac arrest, or hemodynamically non-tolerated ventricular tachycardia. We fitted a Cox proportional hazards regression model with multiple events during BB treatment only with the following explanatory covariates: 1) LAE before diagnosis, 2) unexplained syncope before diagnosis, 3) genotype, and 4) type of BB (as time-dependent variable).

Results:
We included n=238 CPVT patients: n=135 (57%) probands, n=134 (56%) females, n=216 (91%) RYR2, n=10 (4%) CASQ2, n=5 (2%) RYR2-Loss-of-Function, n=4 (2%) TRDN and n=3 (1%) TECRL. Before the diagnosis, 48/238 (20%) patients experienced an LAE, while 110/238 (46%) patients experienced an unexplained syncope. During a mean follow-up of 9.7±7.6 years of treatment with BB only, 35/238 (15%) patients experienced one or more LAEs (annual rate 4.0%, 95% CI: 3.1%-5.0%), with a mean of 2.1±2.4 LAEs per patient. Multivariable analysis with multiple events at follow-up showed that LAE before diagnosis (HR 3.9; 95%CI: 2.3-6.8; p<0.001), syncope before diagnosis (HR 2.7; 95%CI: 1.5-5.0; p=0.001), TRDN mutations (HR 10.9; 95%CI: 4.2-28.0; p<0.001) and use of β1-selective BBs (HR 3.0; 95%CI: 1.7-5.3; p<0.001) were significantly associated with the occurrence of LAE (Figure).

Conclusions:
In patients with CPVT, history of LAE and/or unexplained syncope before diagnosis, TRDN mutations and the use of selective BBs are independent risk factors for the occurrence of multiple LAEs at follow-up during BB treatment.
Abstract 15745: Effusive Constrictive Pericarditis After Covid-19 Vaccination
Authors: Penmetsa Mouna , Shaik Ayesha , Nadig Vidya
Published: June 2023

Case Report:
A 42-year-old male with no significant past medical history presented to the emergency department (ED) after a three-week history of myalgias, non-productive cough, and progressively worsening dyspnea accompanied by a two-week history of right-sided chest pain that all started four days after receiving his Pfizer COVID-19 booster vaccine. Chest pain was described as constant, non-radiating, and aggravated by positional changes. On ED arrival, the patient was febrile to 102.9°F and tachycardic with initial labs significant for leukocytosis of 13.6 Thou/uL, C-reactive protein at 17.18 mg/dL, troponins negative x2, and a negative COVID-19 NAAT testing. EKG revealed diffuse T wave inversions and chest x-ray was noncontributory. Transthoracic echocardiogram (TTE) obtained showed a small fibrinous circumferential pericardial effusion with no evidence of cardiac tamponade; however, there was an interventricular septal bounce suggestive of effusive-constrictive pericarditis. This diastolic septal bounce was also seen on cardiac magnetic resonance imaging, along with a pericardial enhancement measuring up to 0.2 cm in thickness. With a negative infectious and autoimmune workup, along with low clinical suspicion for tuberculosis or malignancy, the leading differential was the temporal relationship between receiving the Pfizer COVID-19 mRNA booster vaccine and the development of effusive-constrictive pericarditis (ECP). The patient was started on Colchicine 0.6 mg twice daily, Ibuprofen 400 mg three times daily, and subsequently discharged after symptomatic improvement and being afebrile for 72 hours with plans for close cardiology follow-up.

Discussion:
ECP is a rare syndrome characterized by a concurrent decrease in pericardial compliance with pericardial effusion and is seen in 4.5% to 6.9% of patients who present with pericardial effusions. To date, less than five other case reports internationally have delineated a relationship between COVID-19 mRNA vaccines and the development of ECP, making recognition of this etiology challenging. In patients who have a mixed hemodynamic picture with subacute features of both cardiac tamponade and constrictive pericarditis, clinicians should have a high index of suspicion for ECP.
Abstract 15752: Differential IgG Repertoire in Individuals With Chagas Cardiomyopathy
Authors: Venturini Gabriela , Bes Taniela , Kula Tomasz , Li Mamie , Shrock Ellen , Elledge Stephen , Sabino Ester Cerdeira , Krieger Jose , Pereira Alexandre , Seidman Jonathan G , Seidman Christine E
Published: June 2023

Chagas cardiomyopathy (CC) is caused by the infection of
Trypanosoma cruzi
(
T. cruzi
) and represents a major etiology for heart failure in Latin America. Trying fill gaps related to humoral response in CC, we used a PhIP-Seq technology to describe differential IgG profile between individuals with CC and individuals infected by
T. cruzi
, but without symptoms (Indeterminate - IND). We built a library comprising all
T. cruzi
proteome (12766 proteins) and incubated against 1293 serum samples: 396
T. cruzi
seronegative
samples (98 controls and 298 individuals with cardiomyopathy caused by other causes than Chagas disease) and 897
T. cruzi
seropositive
samples (684 CC and 213 IND). 1870 peptides were increased in
T. cruzi
seropositive IgG compared to
T. cruzi
seronegative samples. Peptides from Nucleoporin NUP149, a flagellar attachment zone protein, basal body protein, surface protein TolT and cytoskeleton associated protein were the peptides with highest IgG response. Using as little as 5 peptides, I derived a classifier model for
T. cruzi
infection with 97% accuracy. Then, I compared CC and IND samples using logistic regression models after splitting our sample into 2 cohort groups. From these, 316 peptides were significantly different between CC and IND: 289 peptides were increased in CC (27% of them belong to the trans-sialidase class) and 27 peptides were increased in IND (FDR>0.01). Aiming to develop a classifier to separate CCC from IND, I analyzed our data using machine learning approaches. LASSO returned the best model using 48 peptides, with 70% of accuracy, 74% of sensitivity and 69% of specificity. The peptides selected for the model belong to 38 proteins, 21% being unknow function proteins, 18% trans-sialidases, 8% flagellar associated proteins, and 60S ribosomal protein, Nucleoporins and R27-2 proteins classes representing 5% each. Ninety (90%) of selected peptides in LASSO were identified in the previous results using the logistic regression model. I showed for the first time that Chagas Cardiomyopathy individuals have a differential IgG profile against
T. cruzi
proteins compared to IND individuals. I described a differential IgG response against 84 sequences (62 increased in CCC and 22 increased in IND) that can be related to disease development.
Abstract 15766: A Perfect [vt] Storm - How All the Wrong Factors Converged During a Dofetilide Load
Authors: McConkey Nathaniel , Shah Ravi , Kuzma Marcin , Rackley Justin , Gonzalez Mario
Published: June 2023

Background:
Dofetilide is a class III antiarrhythmic often used for the treatment of atrial fibrillation. Given its QTc prolonging properties, it is invariably initiated in an inpatient setting. While admissions for this drug are often unexciting, pharmacologic cardioversion in general and dofetilide in particular carry unique hazards.

Objective:
To review a case where several risk factors converged during a dofetilide load to produce a life threatening event.

Case:
A 75 year old male in persistent atrial fibrillation was admitted for dofetilide and started on 500 mcg PO Q12 (based on QTc and GFR). He did not experience any QTc prolongation after his first two doses, and converted to sinus rhythm on his second day of hospitalization. With this, he had an abrupt decrease in heart rate from 110 to 60 bpm. Within minutes, he suddenly developed flash pulmonary edema and required treatment for acute heart failure with IV diuresis. Fortunately, he improved with therapy in time to receive his third dose, after which QTc remained at 450. However, he had non sustained polymorphic ventricular ectopy overnight. His full AM dose was given before the monitor was reviewed (given his normal QTc), and within 2 hrs of this fourth dose, QTc prolonged markedly. He developed ventricular bigeminy with long-coupled PVCs. Subsequently, he developed sustained torsades requiring chest compressions and defibrillation. The patient recovered well, and dofetilide was discontinued.

Conclusion:
Acute heart failure after restoration of sinus rhythm is an uncommon but known complication of cardioversion, both electrical and pharmacologic. Furthermore, hemodynamic derangement is known to decrease arrhythmia threshold, which, along with his abrupt drop in heart rate and recent diuresis, likely contributed to the development of torsades. Furthermore, while his QTc appeared numerically acceptable before the fourth dose was given, later review revealed an abnormal T wave morphology with prolonged T peak to end time, which might have prompted a dose change if recognized. In short, monitoring dofetilide patients involves more than just GFR and QTc - other observable factors can portend poor outcome.
Abstract 15767: Association of Invasive Hemodynamic Evaluation With 3- and 6-Months Survival in Patients Treated for Cardiogenic Shock
Authors: Khalid Muhammad , Abdelhamid Ahmed , Kshetri Rupesh , Ruiz Ernesto A
Published: June 2023

Introduction:
Cardiogenic shock (CS) is a complex spectrum of low output states which can occur in the setting of Acute Coronary Syndrome (ACS) or Acute Decompensated Heart Failure (ADHF). Its management is guided by frequent hemodynamic assessment and prompt treatment without which the mortality rate ranges from 27% to 51%. Contemporary data suggests that the use of right heart catheterization (RHC) improves in-hospital mortality and survival of patients. Our study aims to compare the difference in survival at 3 and 6 months based on RHC.

Methods:
A single center retrospective analysis was performed on patients admitted with CS secondary to ACS or ADHF from 7/01/2018 till 6/30/2020 at the University of Iowa. Patients were identified by the International Classification of Diseases 10th Revision Clinical Modification (ICD-10 CM) codes and were risk-stratified using the Society of Cardiovascular Angiography & Interventions (SCAI) Shock Classification. 3 and 6 months survival analysis was done with the help of Log Rank test and Kaplan Meier survival curves. RHC was also evaluated as a predictor by Cox Regression analysis among all SCAI groups.

Results:
647 patients admitted with CS, 249 patients underwent RHC during their admission. 51 had ACS and 198 had isolated ADHF as the precipitating cause of CS in patients who underwent invasive assessment. Evaluation by RHC showed improved 3 months survival in patients with SCAI 2 (p<0.01), SCAI3 (p=0.01) and SCAI 5 CS (<0.01). The association was significant at 6 months in SCAI 2 (p<0.01), and SCAI 5 CS (<0.01). RHC was a significant predictor of improved survival in SCAI 2 (HR 0.23; p=0.03; 95% CI 0.06 - 0.9), SCAI 3 (HR 0.26; p=0.01; 95% CI 0.08 - 0.8) and SCAI 5 CS (HR 0.20; p=0.04; 95% CI 0.04 - 0.97) at 3 months and SCAI 5 CS at 6 months(HR 0.20; p=0.04; 95% CI 0.46 - 0.9).

Conclusion:
Our study indicates that invasive hemodynamic evaluation during the treatment of CS favors survival in specially in the SCAI 2, SCAI 3 and SCAI 5 classification groups. In addition, RHC predicts better survival in these patients over 3 and 6 months. We assume that patients in SCAI 4 group may also gain same benefit however, due to limited number of patients our analysis couldn’t reach statistical significance in the SCAI 4 category.
Abstract 15787: Depending on Chain Length Plasma Ceramides Are Associated With Higher or Lower Cardiorespiratory Fitness in the General Population
Authors: Zatloukal Jule , Zylla Stephanie , Markus Marcello Ricardo Paulista , Ewert Ralf , Gläser Sven , Volzke Henry , Albrecht Diana , Friedrich Nele , Nauck Matthias , Peterson Linda R , Jiang Xuntian , Schaffer Jean E , Felix Stephan B , Dorr Marcus , Bahls Martin , Gross Stefan
Published: June 2023

Introduction:
Ceramides are promising new predictive biomarkers for cardiovascular diseases (CVD), but their main mode of action is still unknown. As low cardiorespiratory fitness (CRF) is also linked with CVD, we investigated the association of three of the most abundant blood plasma ceramides and their respective ratios with CRF in a large population-based study.

Hypothesis:
Plasma long-chain ceramide levels are positively associated with higher CRF in the general population, while higher short-chain ceramide levels are associated with lower CRF.

Methods:
Levels of C16:0, C22:0, and C24:0 ceramide were quantified by a liquid chromatography-mass spectrometry and CRF was measured by a cardiopulmonary exercise test in the first follow-up of the Study of Health in Pomerania (SHIP-START-1; n = 1,105; mean age 50.3 years). Multivariable linear regression models were used to assess the association between ceramides and CRF.

Results:
Higher C24:0 levels as well as C24:0/C16:0 ratio were significantly associated with higher CRF, while higher levels of C22:0 or C22:0/C16:0 ratio were associated with lower CRF. Furthermore, we found that body mass index (BMI) interacts with these associations, whereas neither, sex, beta blockers nor lipid-lowering medication had any effect modifying influence.

Conclusions:
This study showed that ceramides are associated with CRF, one of the most important risk factors of CVD. Ceramide C24:0 as well as C24:0/C16:0 ratio might be beneficial regarding CRF, whereas C22:0 and C22:0/C16:0 ratio might be detrimental. Our study results were independent of many cardiovascular risk factors, which highlights ceramides as potential predictive biomarkers. Future studies with larger numbers of subjects are needed to verify these results, and to evaluate whether the observed interaction with BMI could limit the use to specific BMI subgroups.
Abstract 15799: Autograft External Support is Associated With Fewer Aortic Reinterventions in Patients >13 Years Old After the Ross Procedure
Authors: Diaz-Castrillon Carlos , VIEGAS MELITA , Tarun Shwetabh , Lewis Jordann , Maihle Tamara , Castro Mario , Morell Victor O
Published: June 2023

Objective:
To assess intermediate outcomes among patients older than 13 years old who underwent a Ross procedure at a single center and to describe the relationship of external reinforcement with the need for aortic reinterventions

Methods:
Retrospective analysis of a single center clinical records from 2005 to 2020. Comparative analysis of baseline and perioperative variables was done using non-parametric test between Ross procedure and modified Ross procedure. Kaplan Meier function was used to evaluate the survival free from aortic reintervention.

Results:
A total of 40 patients with a median age of 17.9 years (IQR 15.4 - 20.1), 88% (n= 35) males and median weight of 64.1 Kg (IQR 55.8-83.2) were included, where 15% (n= 6) had a Ross-Konno procedure and 85% (n= 34) a Ross procedure. Overall, 70% (n= 28) of the patients had the pulmonary autograft reinforced with a woven vascular graft, with a median size of 28 mm (IQR 26 - 28). The most common indication for surgery was a mixed stenotic/insufficiency lesion in 75% (n=10) of cases, and the most common anatomic configuration was a bicuspid valve in 73% (n= 29); 65% (n= 26) of the patients had had a pre-Ross aortic intervention. No differences were observed between the reinforced and non-reinforce group in terms of age (16 vs 18 years: p=0.29), and weight (63 vs. 69 kg; p=0.57) nor indication for surgery (Table 1). After a median follow up time of 5.1 years (IQR 2.6 - 7.8), 25% (n=3) of the non-reinforced Ross had required aortic reinterventions compared to 4% (n=1) with the reinforced group. The survival free from aortic reintervention at 5 years was 96% (CI 87 - 99) in the cohort, without differences in the Kaplan Meier curves between the 2 groups (log rank= 0.18)

Conclusion:
Intermediate outcomes after the Ross procedure in patients >13 years old are favorable, with a lower rate of reintervention in patients with a reinforced autograft. Long term outcomes are needed to further elucidate the greater impact of external support of valve competency.
Abstract 15816: Cardiovascular Health Status in Young Adulthood and Incident Diabetes Mellitus by Middle Age: The Coronary Artery Risk Development in Young Adults (Cardia) Study
Authors: Salvi Shachi , Ning Hongyan , Bancks Michael , Carnethon Mercedes R , Lloyd-Jones Donald M
Published: June 2023

Background:
Data are sparse on the association of cardiovascular health (CVH), and change in CVH, during young adulthood with incidence of diabetes mellitus (DM) by middle age.

Methods:
We characterized CVH at baseline (Year [Y]0), 1985-1986) in 4916 CARDIA participants (ppts) based on six of the AHA’s Life’s Simple 7 definitions for diet, physical activity, smoking, BMI, lipids, and blood pressure metrics, excluding fasting blood glucose (FBG) data. We created a CVH score ranging from 0 (all poor CVH metrics) to 12 (all ideal) points. We also examined change in CVH score from Y0 to Y7. Incident DM was defined as meeting at least one of the following criteria: HbA1c level ≥6.5%, oral glucose tolerance test ≥200 mg/dL, FBG ≥126, or taking glucose lowering medications. We used Cox models to quantify the association between baseline CVH status and incident DM over 30 years of follow up.

Results:
At Y0, 46% of ppts were men, 51% Black, and the mean age was 24 years; 22% of ppts had low (0-6 points), 73% had moderate (7-10), and 5% had high (11-12) CVH scores. Of note, FBG levels were similar across CVH strata at baseline. Over 30 years, incident DM occurred in 518 ppts (10.5%). Higher CVH level in young adulthood was associated with lower DM incidence by middle age (Table); ppts with high CVH were at 86% lower and ppts with moderate at 62% lower hazards for DM, compared to ppts with low CVH. Improvement in CVH score from Y0 to Y7 was also associated with lower incidence of DM, even after adjustment for Y0 CVH (Table). There were no significant interactions by race or sex. Results were similar using all 7 CVH metrics (including FBG) in secondary analysis.

Conclusions:
Higher CVH scores in young adulthood, regardless of baseline glucose levels, are associated with substantially lower risk of incident diabetes mellitus by middle age. Improvements in CVH score over time are also associated with lower risk of diabetes mellitus. Focusing on CVH from early life may assist in reducing risk for diabetes in later life.
Abstract 15819: Longing for a Pacemaker, Association of Prolonged Qrs and Permanent Pacemaker in the Tavr Population
Authors: Dohse Carlos A , Sreepathy Pranati , Zayyad Zaid , Polman David , Bhayani Siddharth , Twing Aamir , Ambalavanan Manoj , Brett Rachel , Nasrollahi Farrah , Patel Keshav , Tiu David , Dickens Helena , Kansal Mayank M , Ibrahim Khalil , Shroff Adhir R
Published: June 2023

Background:
The duration of the QRS carries valuable information regarding structural disease, conduction defects, or even ischemia. Studies have shown that a widened QRS (>120) is associated with poor cardiovascular outcomes. In this study we investigated the impact of the presence of a widened QRS (wQRS )previous to Transcatheter Aortic Valve Replacement (TAVR) and clinical outcomes.

Methods::
Retrospective analysis of electronic medical records from 2018-2020 at the University of Illinois Chicago identified TAVR patients. Patients were placed into two groups: a wQRS and a nQRS group. Those with pacemakers prior to procedure were excluded. Primary outcomes included PPM placement prior to discharge, composite MACE (all-cause mortality, MI, or CVA), and (LOS) at 6 and 12 months.

Results:
We included 149 patients in this analysis. There were 76.1% male, 57.1% non-white, and 74 ± 13 years old on average. A wQRS was found in 46 (30.9%) and 103 (69.1%) were found to have a nQRS. Of this group, 40.2% had a history of congestive heart failure (CHF). The average ejection fraction (EF) was 50% with 80% of patients having a normal (EF). The CoreValve was placed in 65.7% of patient compared to 34.3% of patients having the Sapian valve placed. There were no differences in age, sex, or race between the two groups. Of all patient’s in the study, those with a wQRS were more likely to have a PPM placed prior to discharge compared to those with nQRS (17.4% (8) vs 5.8% (6) , p=0.025). Though not significant, 14% (13)of patients with the CoreValve placed required PPM prior to discharge compared to 2.5%(1) in the Sapian valve group (p=.175). There was no statistically significant difference in composite MACE, LOS, or significant bleeding events in either groups at 6 or 12 months.

Conclusion:
Our results suggest that patients with a wQRS are more likely to receive a PPM placement post TAVR during index hospitalization compared to those with a nQRS. This study suggests further investigation into the predictive nature of EKG parameters on clinical outcomes be done.
Abstract 15820: The Use of Sglt 2 Inhibitors During Hospitalization for Acute Decompensated Heart Failure: A Systematic Review and Meta-Analysis
Authors: Charles Fred Henry Daniel , Mandava Sri , Ayyalu Tanesh
Published: June 2023

Background:
There continues to be emerging data about the benefits of Sodium-glucose co-transporter 2 inhibitor (SGLT2i) in patients with heart failure. This has led to the addition of this medication to guideline-directed medical therapy for heart failure with reduced ejection fraction. There is a discrepancy in whether the use of SGLT2i is beneficial in patients hospitalized for decompensated heart failure.

Methods:
In this study, a search was completed through PubMed, Scopus, Cochrane Library, ProQuest for randomized controlled trials from 2020 to 2022 that evaluated the impact of the use of SGLT-2 inhibitors (Empagliflozin, Sotagliflozin) in patients admitted with acute HF. After screening for our preset inclusion and exclusion criteria, three randomized controlled clinical trials were eligible for inclusion. We carried out a Meta-analysis of the relative odds on the basis of the random effect model using the Mantel-Haenszel method for the major outcome of the incidence of death from any cause, the number of heart failure events, rehospitalization for heart failure, and time to first heart failure event in the acute setting. Comprehensive Meta-analysis version 3 software was used for analysis.

Results:
A total of 2,532 patients from the EMPULSE, SOLOIST-WHF, EMPA-RESPONSE-AHF trials were included. After analysis, it was found that the P-value was 0.000, Z-value was -4.103, and the OR 0.508 (95% CI 0.368; 0.702) for the patients on either Empagliflozin or Sotagliflozin.

Conclusions:
The systematic review and meta-analysis we conducted show that patients who received SGLT-2i (Empagliflozin, Sotagliflozin) during hospitalization within 24 hours or more had a statistically significant decreased odds of all-cause of death, number of heart failure events, and rehospitalization for heart failure.
Abstract 15824: Microvascular Endothelial Kir2.1 Channels Play Important Role in Flow-Induced Dilation During Hypertension in Humans
Authors: Do Couto Natalia , Ahn Sang Joon , Fancher Ibra , Phillips Shane A , Levitan Irena
Published: June 2023

Hypertension is associated with decreased endothelial function through reduced contributions of NO. Our recent study discovered that flow-induced generation of NO in resistance arteries of mice and humans, and flow-induced vasodilation (FIV), a hallmark of the endothelial response to flow, critically depend on endothelial inwardly-rectifying K+ channels (Kir2.1). The goal of this study was to establish whether these channels contribute to the impairment of endothelial function in peripheral resistance arteries of humans with hypertension. We measured microvascular function in vessels extracted from subcutaneous fat biopsies isolated from 28 subjects: normotensive (n=19; 30.6±4.4yo; systolic blood pressure-SBP: 115.2±5.7mmHg; diastolic blood pressure-DBP: 75.3±11.3mmHg) and hypertensive (n=9; 50±5.2yo; SBP: 147.1±6.1 mmHg; DBP: 93.1±16.8mmHg). Consistent with previous studies, we find that FIV is impaired in hypertensive subjects as demonstrated by a significant reduction in dilation when compared to the normotensive group. Furthermore, our data suggest that the impairment of FIV in this cohort can be partially attributed to a Kir-dependent vasodilation. Specifically, we show that blocking Kir channels with a specific inhibitor, ML133, or functionally downregulating with endothelial-specific adenoviral vector containing dominant-negative Kir2.1 (dnKir2.1) result in significant decrease in FIV in normotensive subjects and smaller effect in hypertensive patients. The Kir2.1-dependent vasodilation was negatively correlated to both SBP and DBP indicating that Kir contribution reduces as blood pressure increases. In addition, we show that exposing normotensive vessels to acute high pressure, which is known to impair FIV, results in loss of Kir channel contribution, as high-pressure impairs vasodilation in normotensive vessels but no effect is seen when these vessels were incubated with dnKir2.1. Overexpressing WTKir2.1 in endothelium resulted in some improvement in vasodilation in arteries from all participants, with a greater recovery in hypertensive patients. Our data suggest that hypertension-induced suppression of Kir2.1 is an important mechanism underlying endothelial dysfunction in hypertension.
Abstract 15836: Time Trends in Infectious and Chronic Disease Consultations in Dakar, Senegal: Impact of Covid-19 Preventative Measures
Authors: Diop Massamba , Gaye Bamba , Diop Ibrahima Bara , Cene Crystal N , Jouven Xavier ,   The African Rsch Network
Published: June 2023

Background:
The impact of COVID-19 preventative measures (use of face masks, social distancing, quarantines, and sanitation and hygiene practices) on the time trends in infectious and chronic disease consultations in Sub-Saharan Africa remains unknown.

Methods:
We conducted a cohort study on all emergency medical consultations over a five-year period, January 2016 to July 2020, from SOS Medecins in Dakar, Senegal. The consultation records provided basic demographic information such as age, ethnicity (Senegalese v. Caucasian), and sex as well as the principal diagnosis using an ICD-10 classification (‘infectious, ‘chronic’, and ‘other’). Firstly, we investigated how the pattern in emergency consultation differed from March to July 2020 compared to previous years. Secondly, we examined any potential racial/ethnic disparities in COVID-19 consultation.

Findings:
Data on emergency medical consultations were obtained from 53,583 patients of all ethnic origins. The mean age of patients was 37·0 ± 25·2 and 30·3 ± 21·7 in 2016-2019 and 45·5 ± 24·7 and 39·5 ± 23·3 in 2020 for Senegalese and Caucasians. The type of consultations between the months of January and July were similar from 2016 and 2019; however, in 2020, there was a drop among the numbers of infectious disease consultations, particularly from April to May 2020 when sanitary measures for COVID-19 were applied (average of 366·5 and 358·25 in 2016-1019 and 133 and 125 in 2020). The prevalence of chronic conditions remained steady during the same period (average of 381 and 394·75 in 2016-2019 and 373 and 367 in 2020). In a multivariate analysis after adjusting to age and sex, infectious disease consultations were significantly more likely to occur in 2016-2019 compared to 2020 (OR for 2016= 2·39, 2017= 2·74, 2018= 2·39, 2019= 2·01). Furthermore, the trend in the number of infectious and chronic consultations were similar among Senegalese and Caucasian groups, indicating no disparities among those seeking treatment.

Conclusion:
During the implementation of COVID-19 preventative measures, infectious disease rates dropped as chronic disease rates stayed stagnant in Dakar. Furthermore, no racial/ethnic disparities were observed among the infectious and chronic consultations.
Abstract 15845: Microfabricated Anisotropic Tissue Bundles for the Production of 3D Cardiac Tissue at Scale
Authors: Jewett Maggie , Bluem Amanda , Xi Susan , DePalma Samuel , Stis Austin , Baker Brendon
Published: June 2023

Rationale:
Following myocardial infarct, tissue ischemia and cardiomyocyte (CM) death trigger inflammation followed by extracellular matrix (ECM) remodeling mediated by cardiac fibroblasts (CF). The cardiac tissue engineering field aims to replace damaged myocardium and restore normal cardiac function. The ECM’s high degree of structural anisotropy and the organization of resident cell populations are critical features necessary to recapitulate healthy myocardial function. Thus, there is a critical need for biomanufacturing technologies that can organize ECM and multiple, distinct cell types with microscale precision in tissue grafts of translationally relevant scale. Here, we propose a scalable material strategy for fabricating individual myofiber-like tissues with anisotropic organization and relevant cell populations comparable to native myocardium.

Methods and Results:
Microchannels of varying widths were perfused with fibrin (20mg/mL fibrinogen with 1U/mL thrombin supplemented with 0.05mg/mL aprotinin for the first 3 days of culture) or a mixture of fibrin and collagen (10mg/ml fibrinogen with 1U/mL thrombin and 2mg/ml collagen). Hydrogels contained up to 40 million/mL cells (25% CFs and 75% CMs) and 8 vol% RGD-functionalized dextran-vinyl sulfone (DVS) electrospun fibers. Microchannel perfusion of composite hydrogel solutions resulted in flow-induced alignment of DVS fibers across all channel sizes (200, 300, 400, and 500 μm), although fiber alignment decreased with increasing channel size. Tissue size, cell spreading, CM contraction, and myofibril development and alignment varied with channel size, cell density, and hydrogel formulation over two weeks inculture. Overall, hydrogel composites with aligned fibers and a combination of CMs and CFs resulted in anisotropic, myofiber-like tissue structures.

Conclusion:
In this study, we developed a microfabrication approach to produce anisotropic myofiber-like bundles using composites of naturally derived ECM and synthetic polymeric fibers that can be flow-aligned within microfabricated microchannels. This approach allows us to fabricate unit cell tissues of desired size and alignment that can be combined into a larger tissue construct for therapeutic applications.
Abstract 15846: Etiologies for Hospitalizations and in Hospital Mortality in Patients With Heart Failure: Insight From National Inpatient Sample Database
Authors: DeAngelo Sean , Hammo Hasan , ASEMOTA IRIAGBONSE , Yilmaz Mahir , Sana Muhammad Khawar , Sharma Bharosa , Usman Muhammad , Almani Muhammad Usman , Shaka Hafeez
Published: June 2023

Introduction:
Heart failure is a common clinical syndrome that leads to high volumes of hospitalizations and in hospital mortality. Previous studies have attempted to characterize the various reasons for the high rates of morbidity and mortality associated with heart failure. Our study aimed to utilize large database information to identify the most common indicators for and cause of death in patients with heart failure.

Methods:
Using the National Inpatient Sample database, we analyzed heart failure hospitalizations during the years 2016-2019 and categorized reasons for hospitalization and in-patient mortality using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10).

Results:
We identified a total of 5,281,210 hospitalizations with heart failure as the principal or secondary diagnosis ICD-10 code. The leading cause for admission was heart failure (65%), followed by sepsis (8.5%), non ST elevation myocardial infarction (NSTEMI) (6.0%), acute chronic obstructive pulmonary disease (COPD) exacerbation (2.5%) and pneumonia (2.2%). There were a total of 161,417 cases of in-hospital mortality in patients with heart failure during this period. The most common reason for mortality was heart failure itself (49.8%), followed by sepsis (41.2%), NSTEMI (12.8%), acute hypoxic respiratory failure (7.8%) and acute-on-chronic hypoxic respiratory failure (5.9%).

Conclusion:
This study represents the most recent nationwide data on causes for hospitalization and mortality in patients with heart failure across the United States, with the most common cause of both being heart failure itself followed by sepsis and NSTEMI. A better understanding of why patients are hospitalized may lead to changes in practice to prevent admissions as well as in-hospital management to ultimately prevent death.
Abstract 15871: Associations of Everyday Discrimination and Socioeconomic Status With Insomnia and Short Sleep Duration Among Older Women
Authors: Johnson Dayna A , Ward Laura , Bosque Ortiz Laura , Butler Jonathan , Slopen Natalie B , Redline Susan , Williams David R , Albert Michelle A
Published: June 2023

Introduction:
Discrimination may contribute to sleep disparities, and subsequent adverse cardiovascular health. Despite the higher prevalence of insomnia among women, particularly historically minoritized women compared to men, limited studies examine the association between discrimination and insomnia and sleep duration.

Methods:
Among 26,616 women (Race/Ethnicity: Asian = 323; Black = 457; Hispanic= 258; White=25,287) in the Women’s Health Study stress follow-up cohort (Mean age =72.3
+
6.1 years), we investigated the relationship of discrimination with insomnia and sleep duration and tested education and income as effect modifiers. Insomnia was self-reported as trouble falling asleep OR waking after sleep onset 3+/week and daytime sleepiness 3+/week. Sleep duration was defined according to weekday and weekend bed and wake times, and categorized as short (<7 hours), recommended (
>
7 and <9 hours), and long (
>
9 hours). Everyday discrimination (e.g., treated with less courtesy or respect, received poorer service, etc.) frequency was divided into tertiles then dichotomized as high (upper tertile) and low (lower & middle tertile).

Results:
Insomnia, and short and long sleep duration were reported by 11%, 11%, and 15% of women, respectively, and high levels of discrimination were reported by 40% of women. There was a higher proportion of Asian and Black women who reported high discrimination compared to Hispanic and White women (53.2% and 57.3% vs 39.8% and 38.4%, respectively). Women reporting high vs. low discrimination were more likely to have insomnia and short sleep duration, but less likely to have long sleep [Insomnia Adjusted Prevalence Ratio (aPR): 1.33, 95% CI: 1.28-1.38; Short Sleep (aPR): 1.14, 95% CI:1.09-1.19; Long Sleep (aPR): 0.96, 95% CI: 0.95-0.97)]. Associations of discrimination with insomnia and short sleep duration were pronounced among Hispanic and White, but not Asian and Black women, and those of higher education (
>
bachelors vs <bachelors) and income (
>
$50,000 vs <$50,000).

Conclusions:
Discrimination may be a target for reducing the prevalence of insomnia and short sleep duration among women. Individuals of higher socioeconomic status may have increased vulnerability to the effects of discrimination on sleep.
Abstract 15872: Association Between Cognition and Cardiovascular Function is Modified by Carnosine and Carnosine-Acrolein Conjugates
Authors: Amraotkar Alok R , Hoetker David , Kumar Megh S , Zhao Jingjing , Gomes Daniel , Bhatnagar Aruni , Basner Mathias , O'Toole Timothy
Published: June 2023

Background:
Carnosine, a naturally occurring dipeptide found in highly metabolic tissues like skeletal muscles and brain can reduce oxidative stress caused by acrolein and particulate matter (PM) exposure. The role of carnosine and its acrolein-conjugates (propanol and propanal) maybe crucial in reducing the effects of PM2.5 air pollution on cardiovascular (CV) health.

Methods:
We analyzed data of 103 healthy participants from baseline (Visit # 2, before randomization) of the ongoing Nucleophilic Defense against Particulate Matter Toxicity (NEAT) clinical trial (NCT03314987) which investigates whether dietary supplementation of carnosine can protect against effects of PM2.5 air pollution. All participants underwent computerized cognitive test “Cognition”. The Cognition test includes 10 neurocognitive test batteries (Table 1) and assesses distinct domains of cognition. Tests scores were assessed in blinded fashion by the University of Pennsylvania team for individual batteries and a cumulative score. Two-tailed Spearman’s rho was used for correlation and Generalized Linear Models (GLM) with gamma distribution log-link was used for regression.

Results:
Cumulative cognition score showed a negative association with pulse pressure. Carnosine-propanol levels had a significant modifying effect (Figure 1). Stratified analysis showed that this relationship was significantly modified by low (B= -0.03, P=0.005) and medium (B= -0.016, P=0.046) carnosine-propanol levels. High levels of carnosine-propanol or carnosine-propanal did not show any effect on the cognition-pulse pressure. Indices of metabolic syndrome were also negatively associated with cumulative score (all P<0.05).

Conclusions:
Carnosine readily reacts with acrolein to reduce in-vivo oxidative stress by producing propanol and propanal aldehyde conjugates. Decrease in propanol conjugates is associated with higher CV health and in-turn higher cognitive outcomes.
Abstract 159: Time-course Of Left Ventricular Systolic Dysfunction Recovery After Cardiac Arrest
Authors: Beekman Rachel , Kim Noah , Faridi Kamil , Aneni Ehimen , Chang Tiffany E , Arakaki Andrew , Kitlen Eva , Miller Elliott , Khosla Akhil , Wira Charles R , Greer David M , gilmore emily j
Published: June 2023

Introduction:
Myocardial dysfunction is a well-documented feature of post-cardiac arrest syndrome. The natural history of left ventricular systolic dysfunction (LVSD) remains largely unknown. We sought to characterize the change in left ventricular systolic function after return of spontaneous circulation (ROSC).

Methods:
This is a retrospective review of cardiac arrest patients at a single tertiary center between 2015 and 2020. We included patients with a transthoracic echocardiogram (TTE) documenting left ventricular ejection fraction (EF) within 1 day of ROSC and at least one follow-up TTE within 6 months after cardiac arrest. LVSD was defined as EF <40% on TTE. Patients with known LVSD preceding cardiac arrest were excluded. Using paired t-test, we compared initial (within 1 day of ROSC) and follow up TTEs, stratified by shockable rhythm status. Recovery of LVSD was defined as improvement in EF to >50%.

Results:
Of 477 cardiac arrest patients, 89 (18.7%) patients met the inclusion criterion. 28 (31.5%) had a baseline TTE on file; 5 patients had LVSD prior to arrest and were excluded, leaving a cohort of 84 patients. Thirty-one (36.9%) patients had LVSD on TTE after ROSC, of which 16 (51.6%) had recovery of EF on follow up TTE. The figure shows the timeline of EF recovery for the whole cohort. In-hospital follow up TTE (n=84) was done at a median (IQR) of 7 (4,16) days and post-discharge follow up (n=26) at 63 (29, 115) days. In patients with shockable rhythm arrest, EF improved from ROSC to inpatient follow up TTE [mean (SD) 36% (2.6) to 50% (2.5), P <0.001]. Patients with non-shockable rhythm arrest had a higher baseline EF with a non-significant change at follow up [50% (2.6) to 56% (2.5), p=0.072].

Conclusion:
Among survivors of cardiac arrest, significant recovery of LVSD was common. Further work is necessary to elucidate predictors of myocardial recovery and to determine optimal timing for repeat echocardiography.
Abstract 15907: Patch Material Does Impact Reintervention After Aortic Arch Reconstruction: Single Center Experience
Authors: Tarun Shwetabh , Diaz-Castrillon Carlos , VIEGAS MELITA , Castro Mario , Da Fonseca Da Silva Luciana , Morell Victor O
Published: June 2023

Objective:
to evaluate reintervention rates after primary aortic arch reconstruction according to patch material.

Methods:
Patients undergoing primary surgical repair from October 2004 to December 2021 were identified. Univentricular physiology anatomies were excluded. Comparative analysis was performed between Homograft (81%), and Bovine pericardium (19%). The primary outcome was surgical or catheter-based reintervention. Kaplan-Meier function and Cox-regression analysis were used.

Results:
we included 160 patients with a median age and weight of 14 days (IQR 7-53) and 3.3 kg (IQR 2.9 - 4.2). The median follow-up time was 6.4 years (IQR 2.8 - 10.4). The clinical breakdown was Hypoplastic Aortic Arch/Aortic Coarctation in 89% (n=142) and Interrupted Aortic Arches in 10% (n= 17) (Table 1). Overall, 25% patients (n= 40) underwent a reintervention; 80% (n= 32) were balloon dilation angioplasties. After 1-, 5-, and 10-years post op, 78%, 74%, 72% of patients survived without reintervention, respectively. No differences were observed in the cumulative hazard between homograft and Bovine pericardium patch repairs (Figure 1). Multivariable cox regression showed an increased hazard for reintervention for bovine pericardium patches (HR 2.9, 95% CI 1.1 - 8.0) after controlling for age, weight, diagnosis, aortic arch, and aortic isthmus Z-Scores.

Conclusion:
Intermediate term outcomes after aortic arch reconstruction are favorable in a single center. Patch material is likely to be an important determinant for the risk of early restenosis requiring reintervention after aortic arch reconstruction.
Abstract 16: Cardiac Mitochondrial Transcription Factor A Overexpression Protects Against Stunning and Improves Mortality in a Mouse Model of Cardiac Arrest
Authors: Rutledge Cody A , Duvall Sam , redding kevin , Dezfulian Cameron , Kaufman Brett A
Published: June 2023

Background:
Cardiac arrest (CA) affects over 600,000 Americans every year and is associated with overwhelming mortality. After CA, myocardial stunning is a common occurrence leading to reduced cardiac output, and nearly 25% of CA die from cardiogenic shock. This cardiac injury is driven by ischemia-reperfusion injury. Mitochondria make up 30% of the heart by volume and are highly prone to ischemia-reperfusion damage. This damage may impair mitochondrial DNA (mtDNA), which is necessary for maintaining mitochondrial function. Mitochondrial transcription factor A (TFAM) can bind and protect mtDNA from damage. In this study, we investigated the role of cardiac-specific TFAM overexpression on cardiac function after CA in a mouse model.

Methods:
Wild-type (WT) and transgenic mice featuring cardiac-specific TFAM overexpression (TFAM OE) were subjected to 8-min of asystole by direct injection of potassium chloride and were revived by cardiopulmonary resuscitation. Surviving mice were assessed by echocardiography and monitored for survival over 4 weeks frame. Hearts were collected and sent for bulk RNA sequencing as well as assessment of mtDNA copy number, mitochondrial morphology, and protein expression.

Results:
TFAM OE mice express 40% more TFAM than WT littermates. TFAM OE mice had protected cardiac EF (51.11±2.95%) one day after CA when compared to WT mice (38.49±3.76%) and improved survival over 4 weeks. Bulk-RNA sequencing implicated dramatic changes to ribosomal expression and protein synthesis in the arrest TFAM OE mice. Western blot analysis of 1-day post-arrest hearts demonstrated increased markers of mRNA translation, including increased phosphorylation of eukaryotic translation initiation factor 4E-binding protein (4E-BP1) and ribosomal protein S6, suggesting that TFAM OE mice support protein translation to aid in cardiac recovery after arrest.

Conclusions:
Cardiac TFAM overexpression protects cardiac function and survival after cardiac arrest. Early evidence suggests that this protection may be mediated by supporting protein translation, which may offer a novel pathway for improving outcomes after arrest.