bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 12650: Genetic Risk Score and Cardiovascular Mortality in a Portuguese Population
Authors: Mendonca Isabel M , Pereira Andreia , Neto Micaela , Monteiro Joel , Sousa Ana C , Henriques Eva , Freitas Ana , Ornelas Ilidio , Palma dos Reis Roberto
Published: April 2024

Several genetic risk scores (GRS) have been associated with cardiovascular disease; however, their role in survival from proven coronary artery disease (CAD) have yield conflicting results. Objective: To evaluate long-term cardiovascular mortality according to the genetic risk score.

Methods:
A study was performed with a cohort of 1464 CAD patients with angiographic proven CAD who were followed-up prospectively for up to 58.3 (interquartile range 25.8 - 88.1) months. Genotyping of 33 SNP associated with CAD was performed using oligonucleotides probes marked with fluorescence for each allele. GRS was constructed according to the additive model assuming co-dominance and was categorized using the median. Cox Regression analysis was performed to determine independent multivariate predictors of cardiovascular mortality. Kaplan Meier Survival curves compared higher than median GRS vs lower than median GRS and log rank test was calculated.

Results:
During a mean follow-up of 58.3 months (interquartile range 25.8 - 88.1), 156 patients (10.7%) died, 107 (7.3%) of CV causes. Higher than median GRS (≥26) was associated with reduced cardiovascular survival. Survival analysis with COX regression model adjusted for 5 variables showed that high GRS and diabetes were independent risk factors for cardiovascular mortality (HR=1.58, CI: 1.06 - 2.35, p=0.025; HR=1.80, CI: 1.23-2.63, p=0.003, respectively). At the end of follow-up, the estimated survival probability was 70.8% for high GRS, 80.8% for low GRS (Log rank test 5.6; p=0.018).

Conclusions:
Besides the classical risk factors control, this work highlights the relevance of the genetic profile in survival from CAD. It is expected that new therapies will be directed to gene targets with proven value in cardiovascular survival.
Abstract 12709: Addition of Depression Severity Indices to the Intermountain Risk Score for Predicting 3-Year Risk of Chronic Disease: The Mental Health Integration Risk Score
Authors: May Heidi T , Reiss-Brennan Brenda , Brunisholz Kimberly D , Horne Benjamin D
Published: April 2024

Introduction:
Depression (DPN) is a common illness that imposes a disproportionately large health burden. DPN is generally associated with higher prevalence of chronic disease (ChrD) risk factors and may contribute higher ChrD risk. Previously, the Intermountain Mortality Risk Score (IMRS) was shown to predict DPN incidence and post-diagnosis outcomes.

Hypothesis:
Sex-specific Mental Health Integration risk scores (MHIRS) can be developed based on the principles underlying IMRS and adding DPN severity indices to predict 3 year ChrD diagnosis.

Methods:
MHIRS was created to predict the first diagnosis of any of 10 ChrD (diabetes, renal failure, CAD, MI, HF, PVD, AF, stroke, dementia, or COPD) in patients completing a PHQ-9 DPN survey and were free at baseline from those 10 ChrD diagnoses. MHIRS used sex-specific weightings of PHQ-9 results, age, and components of the comprehensive metabolic panel and complete blood count in randomly-chosen derivation (70%) and validation (30%) groups.

Results:
Females (N=10,162; age: 48±16) and males (N=4615, age: 48±15) were studied. Among females, c-statistics for the composite ChrD endpoint were 0.746 (0.725, 0.767) for the derivation group and 0.717 (0.682, 0.753) for the validation group, while males had 0.755 (0.727, 0.783) and 0.742 (0.702, 0.782). See Table for MHIRS prediction of each ChrD. In the validation group, MHIRS strata of low, moderate, and high risk had hazard ratios (HR) for any 3-year ChrD diagnosis among females of HR=3.42 for moderate vs. low and HR=9.75 for high vs low, while males had HR=4.80 and HR=10.68, respectively (all p<0.0001).

Conclusion:
A clinical decision tool composed of DPN severity and common lab tests, MHIRS provided very good discrimination of a 3 year ChrD diagnosis. Designed to be calculated electronically by an electronic health record, MHIRS can be efficiently obtained by clinicians to identify patients at higher ChrD risk who require further evaluation and more precise clinical management.
Abstract 12717: Changing Frequencies, Outcomes and Costs for Ischemic Strokes (ISs), Subarachnoid Hemorrhages (SAHs) and Other Hemorrhagic Strokes (OHSs), 2006-2013
Authors: Gray Darryl T , McLeod Anne M
Published: April 2024

Background:
While ISs, SAHs and OHSs differ in many key aspects, their results are combined in some reported statistics.

Methods:
For ICD-9-CM principal discharge (D/C) diagnosis codes of 430 (SAH), 431-432 (OHS) and 433-434 (IS), we estimated US nationwide adult stroke frequencies and outcomes using data from the Healthcare Cost and Utilization Project (HCUP). HCUP’s sampling frame captured ~90% of D/Cs from non-Federal acute care hospitals for 2006, and 95+% of such D/Cs by 2013. Data based on HCUP’s Nationwide/al Inpatient Sample (a stratified sample of 20% of HCUP hospital D/Cs) came from the HCUPnet on-line query system.

Results:
There were 653,429 adult stroke D/Cs (290.1/100,000) in 2006. Among ISs (82.0% of all cases), 4.4% died as inpatients, 49.3% were routine D/Cs and the rest (46.3%) went to other care settings. Mean length of stay (MLOS) was 4.8 days. Mean hospital costs (not charges) in 2015 US $ were $11,639/case. Among SAHs (4.1%), inpatient mortality was 23.1% and 35.2% were routine D/Cs. MLOS was 12.3 days. Mean costs were $48,533. Among OHSs (13.9%), 24.3% died as inpatients and 24.3% were routine D/Cs. MLOS was 7.8 days. Mean costs were $20,206. There were 684,620 adult cases (281.9/100,000) in 2013. Among ISs (82.3%), 3.7% died as inpatients; 44.9% were routine D/Cs. MLOS was 4.4 days. Mean costs were $12,101. Among SAHs (3.6 %), mortality was 19.6%; 38.0% were routine D/Cs. MLOS was 11.8 days. Mean costs were $53,202. Among OHSs (14.0%), mortality was 20.3%; 23.7% were routine D/Cs. MLOS was 7.1 days. Mean costs were $19,862. Each year in all stroke types, 85+ year olds had the highest incidence and mortality, especially compared to 18-44 YOs. Rankings by mean LOS and mean costs/case varied by age across stroke types.

Discussion:
Overall and age-specific incidence rates by stroke type changed slightly over time. Adult inpatient mortality and LOS fell for all types. Mean inflation-adjusted costs generally rose, implying increasing mean costs/day. Total aggregate costs (which do not include most rehabilitation costs) rose from $9.4 to 10.0 billion
/
year. ISs accounted for most cases. However, lower incidence rates, worse outcomes and higher resource use seen in OHSs and especially SAHs relative to ISs argue for separate tracking of stroke type results.
Abstract 12719: Heart Failure Self-Care Associated With Brain Injury in Executive Control Regions
Authors: Choi Sarah E , Roy Bhaswati , Kumar Rajesh , Fonarow Gregg C , Woo Mary A
Published: April 2024

Heart failure (HF) patients often have poor self-care (SC) management that is linked to increased morbidity and mortality and decreased quality of life. While inadequate SC is known to be strongly related to cognitive/executive decision-making ability, associations between HF SC and brain injury to regions that control executive function (pre-frontal cortices) has not been reported.

Methods:
To assess the relationships between HF SC and brain injury in the pre-frontal cortices, diffusion tensor imaging (DTI) was performed in 10 HF (age, 56.8±8.1 years; 8 male; body-mass-index, 25.4±4.1 kg/m2; left ventricular ejection fraction, 26.4±11.9%; New York Heart Association functional class II/III 94/6%), using a 3.0-Tesla magnetic resonance imaging scanner, and self-care was measured with the validated Self-Care of Heart Failure Inventory (SCHFI) questionnaire. Mean diffusivity (MD) maps were calculated, normalized to a common space, and smoothed. The region-of-interest (ROI) analyses were performed on the smoothed MD maps by placing left and right prefrontal ROIs. Both left and right prefrontal cortex values were correlated with SCHFI scores (maintenance and confidence subscales) in HF subjects using partial correlation procedures (covariates, age, and gender).

Results:
Continuous data variables were normally distributed (Shapiro-Wilks Test of Normality). Mean SCHFI maintenance score was 74.66±11.24 and SCHFI confidence score was 70.07±16.80. Correlation of MD values with SCHFI Confidence at left prefrontal cortex: r= -0.941, p< 0.001; right prefrontal cortex: r= -0.858, p= 0.006. Correlation of MD values with SCHFI Maintenance at left prefrontal cortex: r= -0.602, p= 0.115/not significant; right prefrontal cortex: r= -0.854, p= 0.007.

Conclusions:
With exception of the left prefrontal cortex and SCHFI Maintenance, there were very strong negative correlations between SCHFI subscales (Confidence and Maintenance) and MD values of the pre-frontal cortices. These findings provide evidence that brain injury in cognitive brain regions have strong associations with HF SC. Further research is needed to determine if interventions which support neurogenesis or neuroprotection of these brain regions can positively impact SC in persons with HF.
Abstract 12728: Impact of Cardiac Function and Hemodynamics on Mortality in Patients After the Fontan Operation
Authors: Ohuchi Hideo , Hayama Yosuke , Negishi Jun , Noritake Kanae , Miyazaki Aya , Shiraishi Isao
Published: April 2024

Background:
High central venous pressure (CVP) with low cardiac output (CO) characterizes Fontan hemodynamics. However, the association of these characteristics with prognosis remains controversial, especially in adult patients.

Purpose:
To elucidate associations of Fontan hemodynamics with the mortality.

Method and Results:
We evaluated cardiac function and hemodynamics in 431 consecutive Fontan survivors (≥ 6 months), including 170 adults, that included CVP (mmHg), cardiac index (CI; L/min/m
2
), systemic ventricular end-diastolic volume index (EDVI; ml/m
2
) and ejection fraction (EF; %), and arterial oxygen saturation (SpO
2
; %). The latest variables were compared with the 5-year all-cause mortality. During follow-up, 22 child and 15 adult patients died. In child and adult patients, higher CVP (hazard ratio [HR]:1.36 and 1.29, respectively, p < 0.01-0.0001), larger EDVI (HR: 1.01 and 1.03, respectively, p < 0.01 for both) and lower SpO
2
(HR: 0.93 and 0.90, p < 0.001 for both) predicted the mortality. Lower EF predicted the mortality only in child patients (HR: 0.42, p < 0.0001). There was an opposite impact of CI on mortality (p < 0.001), i.e., lower CI in child patients (HR: 0.40, 95% confidence interval: 0.20-0.79, p < 0.01), whereas higher CI in adult patients (HR: 2.21, 95% confidence interval: 1.13-4.07, p < 0.05) predicted the mortality and the cutoff value was 2.46 and 2.90, respectively.

Conclusions:
High-CO-associated CVP with preserved EF predicted mortality in adult Fontan patients. The failing pathophysiology in some long-term Fontan survivors may differ from that in child patients although both of them have high CVP in common.
Abstract 12833: Can We Predict the Probability of ROSC by the Change in Cerebral rSO
2
Value?
Authors: Takegawa Ryosuke , Shiozaki Tadahiko , Hirose Tomoya , Mori Nobuto , Sakai Tomohiko , Ohnishi Mitsuo , Shimazu Takeshi
Published: April 2024

Introduction:
There is no consensus on how long we should continue cardiopulmonary resuscitation (CPR). When determining this, it is important to assess the probability of return of spontaneous circulation (ROSC). We have been evaluating the usefulness of regional cerebral oxygen saturation (rSO
2
) during resuscitation since 2007. At the 2014 AHA congress, we reported that the probability of ROSC would be low if the rSO
2
was less than 55%. In the present study, we focused on the relation between the rate of rSO
2
increase and the occurrence of ROSC from the time of hospital arrival.

Methods:
This was a retrospective study of out-of-hospital cardiac arrest (OHCA) patients with successful measurement of rSO
2
from December 2012 to December 2015. During CPR, rSO
2
was recorded continuously from the forehead of the patients by a TOS-OR (TOSTEC, Japan). CPR for patients with OHCA was performed according to the 2010 JRC guidelines.

Results:
Ninety patients with OHCA (59 men, 31 women; mean age 74.8 years) were included in this study, of whom 35 had ROSC. The baseline value of rSO
2
was determined as the mean value of the initial 1 minute of rSO
2
. The rate of change in rSO
2
was calculated as the ratio of the maximum rSO
2
value at 4, 8, 12, 16, and 20 minutes to the baseline value. Receiver operating characteristic curve analysis showed that the area under the curve was 0.72 with the cut-off value set at 14.5%. The specificity and sensitivity of ROSC were 68.6% and 68.6%, respectively. Although this cut-off value is not a criterion for stopping CPR, the probability of ROSC would be low if the rate of change in rSO
2
is less than 14.5%.

Conclusions:
The rate of change in the rSO
2
value during CPR might be a new index for the prediction of ROSC.
Abstract 12846: Age-specific Difference in the Prognostic Significance of Conversion From Nonshockable to Shockable Rhythm in Out-of-hospital Cardiac Arrest: a Prospective Nationwide Population-based Cohort Study in Japan
Authors: Funada Akira , Goto Yoshikazu , Maeda Tetsuo , Tada Hayato , Teramoto Ryota , Shimojima Masaya , Hayashi Kenshi , Yamagishi Masakazu
Published: April 2024

Introduction:
Early defibrillation in out-of-hospital cardiac arrest (OHCA) patients with conversion from nonshockable to shockable rhythms is associated with favorable neurological outcomes.

Hypothesis:
We hypothesized that the prognostic significance of subsequent shock delivery would differ according to age and the time from initiation of cardiopulmonary resuscitation by emergency medical service providers to the first defibrillation (shock delivery time).

Methods:
We analyzed the records of 219,528 adult OHCA patients with initial nonshockable rhythm. Data were obtained from a prospectively recorded Japanese national Utstein-style database from 2011 to 2012. The primary end point was 1-month survival with favorable neurological outcomes (cerebral performance category scale, category 1 or 2; CPC 1-2).

Results:
The rates of 1 month CPC 1-2 were 1.7% (127 of 7391) in patients with subsequent shock and 0.7% (1530 of 212,137) in those without subsequent shock (p < 0.001). When sorted by age, the rates of subsequent shock delivery were 4.4% (1945 of 44,602), 4.1% (1514 of 36,584), 3.1% (2137 of 69,278), 2.6% (1550 of 58,614), and 2.3% (245 of 10,450), and the rates of 1 month CPC 1-2 in patients with subsequently shocked OHCA were 3.7% (71 of 1945), 2.1% (32 of 1514), 0.8% (18 of 2137), 0.4% (6 of 1550), and 0% (0 of 245), for patients aged 18-64, 65-74, 75-84, 85-94, and ≥95 years, respectively (p for trend <0.001, respectively). Multivariate logistic regression analysis revealed that subsequent shock delivery was positively associated with 1-month CPC 1-2: adjusted odds ratio (aOR) 6.9 (95% confidence interval, CI: 3.5-12.6) for shock delivery times <10 min and 3.4 (2.4-4.7) for 10-19 min in patients aged 18-64 years, and 4.0 (1.4-9.4) for <10 min in patients aged 65-74 years. However, subsequent shock delivery was negatively associated with 1-month CPC 1-2 in patients aged 85-94 years for 20-59 min: aOR 0.2 (95% CI 0.0-0.7). Moreover, subsequent shock delivery was not associated with the 1-month outcomes in OHCA patients aged 75-84 years.

Conclusions:
After rhythm conversion from initial nonshockable to shockable rhythms, early defibrillation was associated with increased odds of 1-month CPC 1-2 in OHCA patients not aged ≥75 years but aged 18-74 years.
Abstract 12857: Echocardiographic Patterns of Post-cardiac Arrest Myocardial Dysfunction
Authors: Cha Kyoung-Chul , Hwang Sung Oh , Kim Hyung Il , Kim Oh Hyun , Cha Yong Sung , Kim Hyun , Lee Kang Hyun
Published: April 2024

Purpose:
Post-cardiac arrest myocardial dysfunction can be developed after successful resuscitation from cardiac arrest. However, echocardiographic patterns of post-cardiac arrest myocardial dysfunction are not yet known. The purpose of this study was to investigate the manifestations of post-cardiac arrest myocardial dysfunction with serial echocardiography during post-cardiac arrest period.

Materials and Methods:
We enrolled non-traumatic out-of-hospital cardiac arrest patients older than 18 years old who were successfully resuscitated after CPR. The patients with myocardial infarction and pre-existing cardiac disease including heart failure or myocardial disease were excluded. Transthoracic echocardiography was performed within 24 hours, between 24 to 48 hours, after 48 hour since restoration of spontaneous circulation (ROSC) was achieved.

Results:
Out of 263 patients, 186 patients (122 males) were enrolled in the analysis. No left ventricular (LV) dysfunction was observed in 120 patients (64.5%). Abnormal LV dysfunction was observed in 66 patients (35.5%). Abnormal LV dysfunctions included global hypokinesis in 32 patients (17.2%), regional wall motion abnormalities (RWMA) in 25 patients (13.4%), and abnormalities like stress-induced cardiomyopathy in 9 patients (4.8%). There were no differences in etiology (p=0.275), duration of cardiac arrest (p=0.078), cumulative dose of epinephrine (p=0.336), and hospital mortality (p=0.140) according to the pattern of post-cardiac arrest myocardial dysfunction. In subgroup analysis of the patients with shockable rhythm, cumulative defibrillation energy (joules) was lower in patients without LV dysfunction (101±41) than in patients with RWMA (200±74) or global hypokinesis (408±131) (p=0.011). Cut-off value of 220 J had 21% of sensitivity and 91% of specificity for development of LV dysfunction (AUC=0.572).

Conclusion:
Post-cardiac arrest myocardial dysfunction occurs in one thirds of patients resuscitated from cardiac arrest. Echocardiographic patterns of post-cardiac arrest LV dysfunction include global hypokinesis, regional wall motion abnormalities, and abnormalities like stress-induced cardiomyopathy.
Abstract 12888: Risk of Sudden Cardiac Death and Coronary Heart Disease Mortality in Postmenopausal Women With History of Weight Cycling
Authors: Rasla Somwail , Garas Marina , Roberts Mary B , Waring Molly E , Albert Christine M , Laddu Deepika , Stefanick Marcia L , Garas David K , Eaton Charles B
Published: April 2024

Introduction:
Elevated midlife body mass index (BMI) is associated with sudden cardiac death (SCD) and coronary heart disease (CHD) mortality. However, it is not known whether weight cycling across adulthood increases risk of SCD and CHD mortality.

Hypotheses:
Weight cycling will be associated with risk of SCD and CHD mortality. This association will vary by baseline BMI.

Methods:
Prospective cohort study of 158,063 post-menopausal women from the Women’s Health Initiative (WHI). Self-reported weight history during adulthood was categorized as stable weight, steady gain, maintained weight loss, and weight cycling. SCD was defined as a sudden loss of consciousness within one hour of the onset of symptoms with a documented loss of pulse in a previously stable individual without evidence of non-cardiac cause of the arrest. CHD mortality was determined by physician-adjudicated review of medical record reviews. Cox proportional hazard models estimated age- and multivariate-adjusted hazards ratios (HRs) and 95% confidence intervals (CIs).

Results:
Over 11.4 years of follow-up (1,798,063 person-years), 2526 CHD deaths occurred and 83 SCDs were adjudicated by strict criterion. Compared to stable weight, weight cycling was associated with greater risk of SCD and CHD mortality among women who were normal weight at WHI enrollment (HR=3.44 95% CI: 1.25-9.45 for SCD; HR=1.66, 95% CI: 1.38-2.01 for CHD mortality). Weight cycling was not associated with SCD or CHD mortality among overweight or obese women (Table). Neither steady weight gain nor weight loss were associated with risk of SCD or CHD mortality (Table).

Conclusions:
Weight cycling during adulthood in post-menopausal women may increase the risk of SCD as well as CHD mortality. This association appears strongest in normal BMI women.
Abstract 12891: Creating a Gateway Into Digital Health for Older Patients who are Technology Impaired
Authors: Milani Richard V , Lavie Carl J , Bober Robert M , Milani Alexander R
Published: April 2024

Introduction:
Older patients with chronic disease such as hypertension (HTN) may benefit from utilizing home based technology (tech) to monitor and improve disease control, but may forgo these opportunities due to concerns and/or fears over lack of tech skills. Reducing these concerns by providing a free service where use of newer technologies can be introduced and taught may provide opportunities for better HTN management and patient engagement.

Purpose:
To evaluate whether tech impaired patients with uncontrolled HTN could actively participate and achieve BP control similar to those without tech limitations as part of a digital HTN program.

Methods:
We created a free health tech “genius bar” called the “O Bar” where patients could be taught how to use a wireless BP unit that transmitted data automatically to the electronic medical record. Patients were assessed at entry as to their tech “savviness” based on capability to email, shop on-line, and use text. All patients were instructed how to take their BP using a smartphone app as well as use of a basic patient portal app. The O Bar was available to all patients for free instruction on the use of health apps and home based monitoring.

Results:
Of the 247 patients enrolled into the digital HTN program, 18% (44) were labeled as tech impaired. Patients were asked to submit 3-5 BP readings per week from home and intervention consisted of lifestyle and medication management by a clinical pharmacist and a health coach.

Conclusions:
1. Tech impaired patients were older and had lower health literacy but were able to successfully submit weekly BP measurements and achieve BP control, similar to tech savvy patients.

2. Older patients with poor tech skills should not be dissuaded from enrolling into a digital tech management program provided health systems are willing to provide basic tech education.
Abstract 12924: Morphological Mechanisms Underlying Efficacy of Paclitaxel-Coated Balloon Against Repeated In-Stent Restenosis
Authors: Nagamatsu Suguru , Tsujita Kenichi , Mitsuse Tatsuro , Yamashita Takayoshi , Oimatsu Yu , Ishii Masanobu , Tabata Noriaki , Miyazaki Takashi , Akasaka Tomonori , Sueta Daisuke , Ikemoto Tomokazu , Kojima Sunao , Kaikita Koichi , Hokimoto Seiji
Published: April 2024

Background:
In-stent restenosis (ISR) has been an important issue even after percutaneous coronary intervention (PCI) with drug-eluting stents (DES). Recently, paclitaxel-coated balloon (PCB) has emerged as a potential alternative to the conventional treatment of ISR (plain balloon angioplasty [PBA]) with lower incidence of re-ISR. However, detailed mechanisms underlying the clinical efficacy of PCB have been still unknown morphologically.

Methods:
Consecutive 32 patients whose in-stent restenotic lesions were treated by intravascular ultrasound (IVUS)-guided PBA (n=15) or PCB (n=17). Optical coherence tomography (OCT) and angiographic follow-up was done at 9 months after PCI for ISR, and the detailed IVUS/OCT and angiographic findings were compared to elucidate the differences in qualitative and quantitative characteristics of in-stent intima between the groups.

Results:
Compared with PBA group, re-ISR rate was significantly lower in PCB group (24% vs. 80%, p=0.005). Although post-PCI minimum lumen angiographic diameter (MLD) and IVUS area (MLA) were comparable between the groups (2.9±0.8mm vs. 2.8±0.8mm, p=0.7; 3.5±1.1mm
2
vs. 4.1±1.0mm
2
, p=0.9, respectively), MLD and MLA at follow-up were kept significantly larger in PCB group (2.7±0.9mm vs. 1.3±1.0mm, p=0.02; 4.3±2.8mm
2
vs. 2.1±0.9mm
2
, p=0.02, respectively), mainly attributable to smaller intimal area at MLA site (1.2±0.6mm
2
vs. 4.1±2.9mm
2
, p=0.03). Interestingly, post-PCB intima was significantly regressed in spite of the progression of post-PBA intima (-1.0±1.4mm
2
vs. 0.5±1.6mm
2
, p=0.01,

Figure

). In terms of OCT-derived tissue characteristics of in-stent intima, post-PCB intima was more homogeneous rather than heterogeneous/layered (homogeneous/heterogeneous/layered: 60%/27%/13% vs. 18%/41%/41%, p=0.04).

Conclusion:
Clinical usefulness of PCB for DES-ISR might be based on not only smaller intimal area but also more stable intimal tissue of the regressed post-PCB intima.
Abstract 13055: Cardiac Structure and Function in US Latinos of Diverse Backgrounds With and Without the Metabolic Syndrome: The Echocardiographic Study of Latinos (Echo-SOL)
Authors: Burroughs Peña Melissa , Swett Katrina , Scheiderman Neil , Spevack Daniel M , Ponce Sonia G , Talavera Gregory A , Kansal Mayank M , Daviglus Martha , Cai Jianwen , Hurwitz Barry E , Llabre Maria M , Rodriguez Carlos J
Published: April 2024

Background:
Hispanics/Latinos with heart failure are younger with more co-morbidities compared to non-Hispanic whites, yet the role of metabolic syndrome (MetS) as a risk factor for cardiac dysfunction in this population has not been well described.

Methods:
This is a cross-sectional analysis of Echo-SOL, a population-based cohort of 1818 US Hispanics/Latinos. Nondiabetic participants without coronary artery disease or severe valve disease were included. MetS was defined by the AHA/NHLBI 2009 Joint Scientific Statement. Survey multivariable linear regression analyses using sampling weights were used to model the relationship between MetS and echocardiographic measures of cardiac structure and function, adjusting for covariates (age, sex, study site, tobacco use, alcohol use, physical activity, years of education). Additionally, individuals with a body mass index (BMI) <25 without MetS were compared with the following: BMI<25/ +MetS; BMI>25/ -MetS; and BMI>25/+MetS.

Results:
Among 1260 nondiabetics (59% female) high waist circumference and elevated triglycerides were associated with worse GLS; high waist circumference and elevated blood pressure were associated with higher left ventricular mass index and worse E/E’ ratio. Compared with individuals without MetS, individuals with MetS had lower medial and lateral E’ velocities (-0.4 cm/s, [Standard Error 0.1], p=0.0002; -0.5 cm/s [0.2], p=0.02, respectively), greater E/E’ (0.5 [0.2], p=0.01), and worse 2-chamber global longitudinal strain (GLS) (0.9%, SE 0.3, p=0.009). Individuals with BMI<25/ +MetS (N=22) had the greatest reduction in left ventricular function with worse 4-chamber, 2-chamber and average GLS (2.1% [0.9], p=0.02; 2.3% [0.7], p=0.001; 2.3% [0.7], p=0.002, respectively), reduced medial and lateral E’ velocities (-1.7cm/s [0.4], p<0.0001; -1.6cm/s [0.5, p=0.002], respectively) and lower ejection fraction (-3.5% [1.4], p=0.007) compared with those with a BMI <25 without MetS.

Conclusions:
In a sample of US Hispanics/Latinos, MetS was associated with worse left ventricular systolic and diastolic function, even among normal weight individuals.
Abstract 13059: Diagnostic Performance of Left Ventricular Contractile Entropy in Patients With Heart Failure: Analysis by Quantitative Gated Semiconductor-SPECT
Authors: Setoguchi Masahiko , Shimizu Masato , Taomoto Yuta , Amemiya Miki , Yamakami Yosuke , Sato Yoshikazu , Iiya Munehiro , Nakamura Rena , Nakano Kuniaki , Shimada Hiroshi , Fujii Hiroyuki , Yamawake Noriyoshi , Nishizaki Mitsuhiro
Published: April 2024

Background:
Left ventricular (LV) dyssynchrony is considered as an important cause of congestive heart failure (CHF) admission. However, among the parameters of dyssynchrony, the prognostic value of LV contractile entropy is not elucidated.

Hypothesis:
Left ventricular contractile entropy can predict early re-hospitalization of heart failure patients.

Method:
Ninety-eight consecutive patients with first onset CHF who underwent quantitative gated demiconductor SPECT (QGS) before discharge were investigated retrospectively. Patients with re-hospitalization after discharge within 30-days were assigned to Group A, and patients without re-hospitalization were assigned to Group B.

Data regarding electrocardiogram, and parameters of QGS including LV remodeling, systolic function, diastolic function and phase analysis (Phase SD, bandwidth, entropy) were collected automatically, and compared between Group A and B. Kaplan-Meier survival curves were used to compare variables between the patients, as appropriate. Multivariate analysis was performed on variables with a value of P < 0.05 using the stepwise regression approach.

Result (See figure and table):
Of 98 patients, 92 patients did not readmit and other 6 patients readmitted within 30-days. ROC analysis showed that the cut-off value 0.785 predicted Group A (95% CI: 0.563-0.894) with 0.652 specificity and 0.833 sensitivity. Multivariate analysis showed that ‘entropy > 0.785’ was a significant and independent predictor with a high odds ratio (OR:9.375, 95%CI :1.050-83.724). The Kaplan-Meier survival curve revealed a significant difference between the patients of ‘entropy ≧ 0.785’ and ‘entropy < 0.785’ in 30-days re-hospitalization rate (Log-rank test, p=0.016).

Conclusion:
The LV contractile entropy was a powerful indicator of early phase re-hospitalization in patients with CHF, rather than ejection fraction or other parameters of LV dyssynchrony.
Abstract 13077: Impact of Age on the Morphology of Left Atrial Appendage in Atrial Fibrillation
Authors: Hirata Yukia , Yamada Hirotsugu , Kusunose Kenya , Shimizu Rikuto , Torii Yuta , Nishio Susumu , Seno Hiromitsu , Saijo Yoshihito , Hayashi Shuji , Soeki Takeshi , Wakatsuki Tetsuzo , Sata Masataka
Published: April 2024

Background:
Left atrial appendage (LAA) is the main location of thrombus formation in patients with atrial fibrillation (AF), which has a variety of structure. Recent studies reported that “non-chicken wing” LAA morphology had a significantly higher risk of stroke compared with “chicken wing” morphology. However, LAA morphology might be affected by aging or AF. Thus, we evaluated the relationship between age and frequency of LAA morphology in patients with AF and sinus rhythm (SR).

Methods:
We enrolled 145 AF patients and 199 SR patients without any cardiovascular disease. LAA volume and morphology were assessed by contrast-enhanced multi-detector computed tomography. The morphology was visually classified “chicken wing” or “non-chicken wing” according to the previous report.

Results:
LAA volume index was significantly higher in the AF group than in the SR group (6.8±2.8 ml/m
2
vs. 4.4±1.8 ml/m
2
, p<0.001).There was no significant trend in frequency of non-chicken wing among ages in SR group (p=0.36 for trend), whereas it was negatively related to age in AF group (p=0.002 for trend). In multivariable logistic regression analysis, age (OR 0.95, p=0.021) and duration of AF (OR 0.97, p=0.002) were independent factors of non-chicken wing LAA morphology.

Conclusions:
LAA morphology is affected by age, especially in patients with AF. When we utilize LAA morphology (non-chicken wing type) as a stroke risk factor in patients with AF, we may have to pay attention to their age.
Abstract 13142: Implantable Cardioverter Defibrillators Continue to Offer Mortality Benefit After Improvement in Ejection Fraction to Above 35%: Results From the Sudden Cardiac Death in Heart Failure Trial
Authors: Adabag Selcuk , Patton Kristen K , Rector Thomas , Ensrud Kristin E , Vakil Kairav , Buxton Alfred E , Poole Jeanne E
Published: April 2024

Introduction:
Patients (pts) discovered to have low ejection fraction (EF ≤ 35%) frequently show increase in EF to > 35% over time. The efficacy of implantable cardioverter defibrillators (ICD) to improve survival is unknown in these pts.

Hypothesis:
Mortality benefit with ICD therapy is less in pts whose EF improves to > 35% than those whose EF remains ≤ 35%.

Methods:
A total of 1875 (74%) participants of the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) had a repeat assessment of EF 13.5 ± 6 months after randomization. We stratified them by EF ≤ 35% and > 35% based on the 1
st
repeat EF after randomization and compared all-cause mortality of 649 pts randomized to placebo vs. 624 pts randomized to ICD (602 pts randomized to amiodarone were not analyzed). Follow-up started at the time of 1
st
repeat EF assessment.

Results:
Repeat EF was > 35% in 186 (30%) pts in the ICD group and 185 (29%) pts in the placebo group (mean EF increased from 26±7% to 46±8%). The all-cause mortality rate was lower in the ICD group vs. placebo group, both in pts whose EF remained ≤ 35% and in those whose EF improved to > 35% (Table). Compared to placebo, the unadjusted hazard ratio for ICD effect on mortality was 0.72 (95% CI 0.55-0.95) in pts with repeat EF ≤ 35% and 0.58 (95% CI 0.29-1.17) in those with repeat EF > 35%. After adjustment for potential confounders, the estimated effect of ICD was 0.64 (95% CI 0.48-0.85) and 0.62 (95% CI 0.29-1.30) in patients with repeat EF ≤ 35% or > 35%, respectively (Table). We found no evidence of an interaction between treatment assignment and repeat EF for prediction of mortality (p=0.93), suggesting that the ICD effect was similar in patients with EF ≤ 35% or > 35%.

Conclusions:
Pts with an improvement in EF to > 35% accrued a similar relative reduction in mortality with ICD therapy as those whose EF remained ≤ 35%. However, the absolute benefit of ICD therapy was less in pts with repeat EF > 35% due to the lower mortality risk in this group.
Abstract 13150: The Economic Implications of Non-adherence to Aspirin in Patients With Prior Primary Cardiovascular Events
Authors: Lieberthal Robert D , Varga Stefan , Adams Suzanne , McCarey Melissa , Toroni Bridget , Whellan David
Published: April 2024

Introduction:
Adherence to medications for secondary prevention of cardiovascular events has been shown to be poor in both general and high risk populations. Non-adherent patients are at higher risk of experiencing another CV event, leading to adverse clinical events and high costs. Few prior studies have explored the economic and consequences of non-adherence to aspirin in relation to cardiovascular health.

Hypothesis:
Improved adherence to aspirin will lead to lower healthcare costs and improved long-term survival rates.

Methods:
We developed a generalizable Markov model to estimate the cost-effectiveness of aspirin adherence. The rates of aspirin adherence, events and costs were gathered from published literature. We applied the model separately to a general (low-risk) population with no comorbidities and a high-risk population with type II diabetes. Outcomes of interest included fatal and nonfatal events, including secondary myocardial infarction (MI), stroke, other clinical CV events including PAD-related amputation as well as aspirin-related side effects (gastrointestinal bleeding). All costs were inflated to 2016 U.S. dollars to reflect the current cost of treatment.

Results:
The aspirin adherence rates for the low-risk and high-risk model were 85.8% and 76.5%, respectively. Both models demonstrated neutral average 5-year cost per member when comparing adherent to non-adherent population. The average 5-year survival was 0.26 years or 3.1 months longer amongst the adherent population in the low-risk model and 0.37 years or 4.4 months longer in the high-risk model. As a result, the ICER is $23 for low risk population while adherent strategy is dominant (lower cost, higher effectiveness) for high risk population.

Conclusions:
Adherence to aspirin therapy after experiencing a primary CV event is critical for patients’ well-being and can facilitate better health outcomes. This study demonstrates that aspirin adherence is essentially cost neutral and extends survival in low and high-risk patient populations, with a potentially cost saving outcome for patients with comorbid conditions such as diabetes.
Abstract 13161: Incremental Prognostic Utility of Left Ventricular Global Longitudinal Strain in Asymptomatic/minimally Symptomatic Patients With Severe Bioprosthetic Aortic Stenosis Undergoing Redo Aortic Valve Replacement
Authors: Naji Peyman , Shah Shailee , Sabik Joseph F , Svensson Lars G , Popovic Zoran B , Rodriguez Leonardo L , Griffin Brian P , Desai Milind Y
Published: April 2024

Introduction:
With improved survival of patients undergoing primary bioprosthetic aortic valve replacement (AVR), reoperation to relieve severe prosthetic aortic stenosis (PAS) is increasing. Timing of redo surgery in asymptomatic/minimally symptomatic patients remains controversial. Left ventricular global longitudinal strain (LV-GLS) is a marker of subclinical LV dysfunction. In asymptomatic/minimally symptomatic patients with severe PAS undergoing redo AVR, we sought to determine if LV-GLS provides incremental prognostic utility.

Methods:
We studied 191 patients with severe bioprosthetic PAS (63±16 years, 58% men) who underwent redo-AVR between 2000-12 (excluding mechanical PAS, severe other valve disease transcatheter AVR, LV ejection fraction <50%). Society of Thoracic Surgeons (STS) score was calculated. Standard echocardiography data was obtained. LV-GLS was measured on 2, 3 and 4-chamber views using Velocity Vector Imaging. Severe PAS was defined as AV area <0.8 cm
2
, mean AV gradient ≥40 mm Hg and/or dimensionless index <0.25. A composite outcome of death and congestive heart failure (CHF) admission was recorded.

Results:
At baseline, mean STS score, LV ejection fraction, mean AV gradients, right ventricular systolic pressure (RVSP) were 7±6, 58±6%, 54±10 mm Hg and 40±14 mm Hg, while 50% had >II+ aortic regurgitation (AR). Median LV-GLS was -14.2% [-11.4, -17.1%]. At 4.2±3 years, 41 (22%) patients met the composite endpoint. The results of the multivariable Cox analysis are shown in Table 1. Kaplan-Meier survival curves separated based on median LV-GLS are shown in Figure 1. Incremental prognostic utility of LV-GLS over established predictors is shown in Figure 2.

Conclusions:
In asymptomatic/minimally symptomatic patients with severe bioprosthetic PAS undergoing redo AVR, baseline LV-GLS provides incremental prognostic utility over established predictors; and could potentially aid in surgical timing and risk stratification.
Abstract 13168: High Morbidities in Hospitalized Adolescents With Both Single and Biventricle Congenital Heart Disease
Authors: Kulkarni Aparna , Zybert Patricia , Kutty Shelby , Neugebauer Richard , Anderson Brett
Published: April 2024

Introduction:
Quality of life in adolescents with single ventricle (SV) is known to be significantly impaired. In this study, we sought to quantify inpatient morbidities for single ventricle (SV) versus biventricle (BV) adolescents using data from the Pediatric Health Information System (PHIS).

Methods:
The PHIS database was queried for all admissions in adolescents aged 12-18 years (1/1/2004–12/31/2013) coded for CHD. Patients were categorized as SV or BV based on their primary and secondary ICD-9 diagnostic and/or procedure codes. Patient characteristics, diagnoses, procedures, vital status and standardized costs were examined.

Results:
4,267 adolescents were admitted to 42 children’s hospitals over 10 years, accounting for 8,512 hospitalizations. Among patients, 24.6% were SV, 64.1% BV and 11.3% unclassifiable. Among hospitalizations, 29.5% were SV patients, 56.1% were BV patients, and 14.4% were unclassifiable. SV patients were more likely to have multiple hospitalizations than BV patients [51.0% vs 37.9%, p ≤ 0.001]. Mean age for adolescent admissions were similar for SV and BV hospitalizations [mean (SD) 15.0 (1.9) years vs 14.8 (1.9)]. Median lengths of stays (LOS) for BV hospitalizations were 2 days, [IQR 1-5] and 2 days [IQR 1-4] for SV hospitalizations, with a higher proportion of patients with LOS>2 days in the BV group [46.9%] than SV group [38.5%, p<0.001]. BV hospitalizations were more likely to entail ICU stays [36.6% vs 26.1%, p ≤0.001], to require mechanical ventilation [20.2% vs 8.8%, p ≤0.001] and had higher median total costs [$14,500, IQR $4140-$40,900 vs $8250, IQR $2,440-$23,300, p≤0.001]. There were no differences between SV and BV hospitalizations in use of one or more electrophysiological studies [16.4% vs 18.2%, p=0.062] or reporting of one or more tachyarrhythmias [7.5% vs 7.0%, p=0.505]. Procedure codes for pacemaker/intracardiac defibrillator were higher among SV hospitalizations [6.1% vs 4.1%, p≤0.001], as was an associated diagnosis of heart transplantation [2.3% vs 0.5%, p≤0.001].

Conclusions:
Adolescents with CHD requiring hospitalizations are resource intensive irrespective of their CHD classification.
Abstract 13207: Successful Catheter Ablation of Symptomatic Ventricular Arrhythmia After Left Ventricular Assist Device Implantation
Authors: Garbade Jens , Fischer Julia , Lehmann Sven , Meyer Anna , Arya Arash , Hindricks Gerhard , Mohr Friedrich-Wilhelm
Published: April 2024

Introduction:
Ventricular tachycardia (VT) is a common finding following implantation of a continuous-flow left ventricular assist device (LVAD). We report our experience, technical feasibility and efficacy of endocardial VT-ablation to treat symptomatic patients with LVAD.

Hypothesis:
Interventional ablation of VT after LVAD implantation can be performed effectively and safely.

Methods:
A retrospective analysis of all patients supported with a LVAD who were referred for catheter ablation to treat recurrent symptomatic VT was performed.

Results:
Between January 2012 and August 2014, 159 patients underwent implantation of a LVAD. In eight patients (all of whom had an ICD before LVAD implantation) an ablation was indicated due to recurrent episodes of VT, leading to ICD shock or recurrent hemodynamic instability. A total of 11 ablation procedures were performed. The first ablation was performed after an average of 142 ± 130 days after LVAD implantation. Between the implantation of the LVAD and the first ablation procedure 24 ± 18 appropriate shocks per patient were delivered. For catheter ablation the CARTO 3 mapping system was utilized. Nine clinical VT episodes were able to be induced in four patients. Seven of these VT epsiodes (77.8%) were successfully ablated after activation mapping in these patients. In two patients a monomorphic VT origin was located in the epicardium and could not be ablated successfully, but only in one patient was it inducible at the end of the procedure (12.5%). In six patients voltage mapping was conducted. The low voltage area in four patients extended to the implantation area of the inflow cannula, and of these, all were rendered non-inducible after ablation. All patients remained hemodynamically stable during the procedure. Although the majority had a reduction in VA frequency, in two patients clinical VT recurred, making a second ablation necessary. There were no complications associated with the ablation procedures. The patients were free from ICD shock for an interval of 209 ± 193 days.

Conclusions:
VT ablation is a feasible, safe and effective treatment option in patients with recurrent triggering of VT episodes leading to ICD shock after implantation of a LVAD.
Abstract 13218: Remodeling of High Density Lipoprotein Induced by CSL112: Structure and Function of the Remodeled Lipoproteins
Authors: Didichenko Svetlana A , Navdaev Alexei V , Spycher Martin O , Wright Samuel D
Published: April 2024

Introduction:
CSL112 is a novel formulation of human apolipoprotein A-I (apoA-I) suitable for intravenous infusion, currently in development for reducing the high rate of early recurrent events after acute myocardial infarction. Infusion of CSL112 into healthy volunteers causes HDL remodeling, with an immediate rise in lipid-poor apoA-I and a strong and immediate increase in the ABCA1-dependent cholesterol efflux capacity of plasma. Interaction of CSL112 with whole plasma or purified HDL gives rise to three new remodeled HDL species: large (L-HDL
rem
) and small (S-HDL
rem
) species, and lipid-poor apoA-I. Here we characterized the composition and morphology of remodeled HDL species and compared their ability to efflux cholesterol via different transporters.

Methods and Results:
CSL112 and HDL3, fluorescently labeled on protein or lipid, were incubated together for varying periods of time at 37°C. Resultant HDL particle size distribution was assessed by native gel electrophoresis followed by fluorescence imaging. Morphology of the individual purified products of HDL remodeling was examined by negative stain electron microscopy. We show that L-HDL
rem
is a large, spherical species composed of apoA-I and phospholipid from both native HDL and CSL112. S-HDL
rem
is a small, disc-shaped species composed of apoA-I from CSL112 that is smaller due to the loss of phospholipids. The smallest species, lipid-poor apoA-I, is composed of apoA-I from HDL and CSL112. Lipid-poor apoA-I and S-HDL
rem
were found to have the greatest ability to efflux cholesterol via ABCA1. While S-HDL
rem
and L-HDL
rem
showed comparable ability to efflux cholesterol via ABCG1, L-HDL
rem
mediated additional efflux via SR-B1 and by an aqueous diffusion process.

Conclusion:
The generation of these remodeled HDL species can account for the strong and immediate increase in cholesterol efflux capacity observed upon infusion of CSL112, and make CSL112 a promising approach for rapidly removing cholesterol from atherosclerotic plaque.
Abstract 13220: Distinct Disease Mechanisms Drive Pediatric and Adult Dilated Cardiomyopathy
Authors: Patel Meghna D , Schneider Caralin , Bajpai Geetika , Mohan Jayham , Canter Charles , Towbin Jeffrey , Lavine Kory
Published: April 2024

Background:
Numerous clinical studies have suggested that adult heart failure (HF) therapies are less effective in children with dilated cardiomyopathy (DCM). The mechanistic basis for this phenomenon is poorly defined. Collectively, adult HF therapeutics target a process termed adverse remodeling, a common pathway by which the adult heart responds to injury. We hypothesized that pediatric and adult DCM comprise distinct pathological entities in that children do not undergo adverse remodeling.

Methods:
LV specimens were obtained from donor pediatric and adult controls (24), pediatric DCM (31) and adult DCM patients (33). Pathological evidence of adverse remodeling including myocardial fibrosis, cardiomyocyte hypertrophy, and gene expression was examined using immunostaining, electron microscopy and RNA sequencing.

Results:
Consistent with the established pathophysiology of adult HF, adults with DCM displayed marked increases in myocardial fibrosis compared to donor controls (both p<0.01)(Figure). In contrast, pediatric DCM had minimal evidence of fibrosis compared to both aged-matched controls and adults with DCM. Examination of cardiomyocyte hypertrophy and capillary density demonstrated less extensive cardiomyocyte hypertrophy and capillary rarefaction in pediatric compared to adult DCM patients. Electron microscopy revealed similar sarcomere thickness and length between control and pediatric DCM specimens. RNA sequencing demonstrated that genes associated with adverse remodeling were not up-regulated in pediatric DCM specimens.

Conclusions:
These findings demonstrate that children with DCM display minimal evidence of adverse remodeling; suggesting pediatric and adult DCM may represent different pathological entities. Collectively, these data provide a mechanistic basis to understand why adult HF therapeutics may not work in children, and suggest the possibility that distinct therapies may be needed for pediatric DCM.