bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 12782: Predicting One-Year Survival in LVAD Patients Using Different Predictive Models
Authors: Fabry Nicholas J , Byku Mirnela , Tessmann Paul B , Li Quefeng , Watkins Randall , Chang Patricia
Published: April 2024

Introduction:
Left ventricular assist device (LVAD) support improves quality of life and survival in patients with end-stage heart failure (HF), but predicting which patients benefit most remains a challenge. The Penn Columbia Risk Score (PCR) and pretransplant risk stratification score (RSS) have predicted 1-year mortality in LVAD and transplant patients, respectively. We sought to compare the PCR and RSS in our single center’s LVAD population and evaluate additional predictors of survival at 1 year.

Methods:
Perioperative data were collected from 202 patients who received an LVAD (HVAD, Heartmate II, or Heartmate III) from 2014-2020. The logistic regression model assessed goodness-of-fit of the PCR and RSS in our population. The PCR model is based on age, creatinine, total bilirubin (tbili), body mass index, right ventricular dysfunction, aortic insufficiency while the RSS score is based on age, prior sternotomy, HF etiology, eGFR, tbili, and mechanical support. Logistic regression models were used to identify additional predictors of 1-year mortality.

Results:
In our 202 patients, the RSS was more predictive of 1-year mortality (R
2
=0.14) than PCR (R
2
=0.02). In addition to age, tbili, inotrope score, pulmonary artery pulsatility index (PAPi), right ventricular dysfunction, mechanical support (defined as intra-aortic balloon pump, ECMO, or temporary LVAD), and albumin were each associated with 1-year mortality (p <0.05). A multivariate model including age, tbili, PAPi, right ventricular dysfunction, and albumin, had higher correlation with 1-year mortality than the RSS (R
2
=0.21). The addition of inotrope score and mechanical support to this model did not significantly change the association (R
2
=0.20).

Discussion:
In our patient population, the PCR and RSS were poorly predictive of 1-year survival showing almost no association. Our novel model showed higher association, while still being suboptimal. Further research is needed to refine which clinical characteristics will best predict success and survival in LVAD patients.
Abstract 12794: CD14+ CD16++ Monocytes Predict Clinical Outcomes in Patients With ST-Elevation Myocardial Infarction
Authors: AboAly Mohamed , Shokri Elica , anwer mohammed , Arshad Samiullah , Chelvarajan Lakshman , Abdel-latif Ahmed
Published: April 2024

Introduction:
Nonclassical monocytes (CD14+CD16++) play different roles in cardiovascular disease progression. CD14+CD16++ cells can have both proinflammatory functions and atheroprotective properties.

Hypothesis:
The predictive value of CD14+CD16++ cells to clinical outcomes in patient with STEMI has not been well studied.

Methods:
We recruited 100 patients with STEMI who underwent primary PCI. Blood samples were collected at the time of presentation to the hospital (within 6 hours from onset of symptoms) then at 3, 6, 12 and 24 hours after presentation. Monocytes were defined as CD45+/HLA-DR+ and then subdivided based on the expression of CD14, CD16, CCR2, CD11b and CD42. The primary endpoint was a composite endpoint of all-cause death, hospitalization for heart failure, stent thrombosis, in-stent restenosis, and recurrent myocardial infarction. Univariate and multivariate cox proportional hazards models were performed, including age, sex, body mass index, diabetes mellitus, hypertension, congestive heart failure, and troponin-I.

Results:
The mean age of our cohort was 58.9 years old and 25% of our patients were females. Patients with high level (above the median) of CD14+CD16++ monocytes showed increased risk for the primary endpoint in comparison to patients with low level; adjusted hazard ratio (aHR) for CD14+/ CD16++ cells is 4.3 (95% confidence interval [95%CI] 1.2-14.8, p= 0.02), aHR for CD14+/ CD16++/CCR2+ cells is (95%CI 1.06-13.7, p= 0.04), aHR for CD14+/ CD16++/CD42b+ cells was 3.3 (95%CI 1.07-10.6, p=0.03), aHR for CD14+/ CD16++/CD11b+ is 5.1 (95%CI 1.4-18.0, p=0.009), and aHR for CD14+ HLA-DR+ is 7.5 (95% 2.0 -28.5, p=0.002).

Conclusions:
Our study shows that CD14+ CD16++ Monocytes and their subsets expressing CCR2, CD42 and CD11b could be important predictors of clinical outcomes in patients with STEMI. Further studies with larger sample sizes and different coronary artery disease phenotypes are needed to verify our findings.
Abstract 12797: Mitochondrial Dysfunction in a Large-Animal Model of Peripheral Artery Disease
Authors: Ismaeel Ahmed , Papoutsi Evlampia , Li Feifei , Hoffman Carson , Sasaki Maiko , Zarge Joseph , Brewster Luke P , Koutakis Panagiotis
Published: April 2024

Introduction:
Our group recently developed an endovascular porcine model of ischemic myopathy from peripheral artery disease (PAD). We previously demonstrated that this model results in persistent ischemia that is accompanied by a severe myopathy. Herein, we attempted to study the effect of this model on mitochondrial function.

Methods:
A total of 9 Yorkshire swine were exposed to acute right hindlimb ischemia (HLI) by endovascular occlusion of the external iliac artery. The left hindlimbs served as control, non-ischemic limbs, and 2 pigs were used as absolute controls with no ischemia induction. Animals were terminated between 4 to 6 weeks. Mitochondrial respiration and reactive oxygen species (ROS) production in permeabilized gastrocnemius fiber bundles were simultaneously measured by high-resolution respirometry. Relative mRNA expression was measured using PCR Arrays and protein expression was measured by western blot.

Results:
The oxygen consumption rate was significantly reduced in ischemic muscle during Complex I, Complex III, and Complex IV respiration compared to control hindlimb muscles. ROS production was significantly elevated during the respiration of all complexes. The mRNA and protein expression of several mitochondrial energy metabolism components, including NDUFB8, SDHB, UQCRC2, MTCO1, and ATP5A were significantly reduced in ischemic muscle. Oxidative stress markers NOX2 and NOX4 were significantly upregulated in ischemic muscle as well.

Conclusions:
These data suggest that this porcine model may be a suitable preclinical model to study the pathophysiology of mitochondrial dysfunction associated with PAD. We demonstrate that this model also results in a mitochondrial metabolic myopathy similar to that seen in PAD patients. This model may be useful for testing novel therapeutics targeting mitochondrial dysfunction.
Abstract 13017: An Innovative Clinical Decision Support Alert to Increase Utilization of ARNIs Among HFrEF Patients
Authors: Sturzoiu Tudor , Katzianer David , Frankel Eitan , D'Angelo Ryan , Stocker Reid , Lev Yair
Published: April 2024

Introduction:
After PARADIGM-HF showed a significant reduction in cardiovascular death and heart failure hospitalizations in patients treated with sacubitril-valsartan, an angiotensin receptor blocker-neprilysin inhibitor, the ACC/AHA/HFSA guidelines for management of HFrEF included a class I recommendation for ARNI therapy in these patients and recommended replacement of ACE-Is/ARBs with ARNI in patients with NYHA class II or III chronic HFrEF. A 2021 update recommends initiation of ARNI over ACEi or ARB when possible.

Intervention:
At Thomas Jefferson University Hospital, 2,322 unique patients with a history of HFrEF were admitted between January 2019 and August 2020. Of these, 217 were discharged on sacubitril-valsartan - an individual utilization rate of only 9.3%. Working with the electronic medical record (EMR) team, we devised a set of clinical decision support (CDS) alerts to facilitate transition to ARNI in patients with HFrEF. The first alert fires if an ACE-I is ordered, to encourage switching to an ARB for washout. A second alert fires if an ARB is ordered, suggesting ARNI as a therapeutic alternative.

Results:
Between December 2020 and May 2021, the alert fired 569 times for 143 unique patients. 102 (71%) were discharged on RAAS blockade. Major reasons for no RAAS blockade included hypotension (51%) and AKI/CKD (20%). Of patients who were discharged on RAAS blockade, 17 (16.7%) were discharged on sacubitril-valsartan. During the intervention period, sacubitril-valsartan use on discharge increased from 9.3% to 16.7% for patients with a history of HFrEF.

Conclusion:
This project demonstrates how an innovative CDS tool within the EMR can increase adherence to guideline directed medical therapies in HFrEF. While not possible to directly implicate this alert with increased ARNI usage, chart review implies that it at least spurred discussion around the topic and triggered follow-up actions to further investigate the feasibility of prescribing them.
Abstract 13024: Excessive Slow Flow and Thick Boundary Layers Cause Non ST Segment Elevation in Patients With Patent Coronary Arteries
Authors: Nguyen Thach N , Le Phuc X , Le Thoa , Tran Nghi V , Minh Le H , Nguyen Thu Q , Cao Thinh , Rigatelli Gianluca , Ho Dung T , Pham Hung N , Nguyen Thuong Nghia T , Zuin Marco
Published: April 2024

Introduction:
Many patients arrived to emergency room with atypical chest pain, borderline ST segment elevation, troponin level significantly elevated however the coronary angiogram was normal. Why?

Hypothesis:
Based on damages by flow disturbances in pipes, our research is built on the hypothesis that flow abnormalities disrupt delivery of oxygenated blood to the myocardium. Our strategy is to use today’s practice of fluid mechanics to unlock the mechanism of non-ST Segment elevation myocardial infarction (non-NSTEMI) and patent coronary arteries. What coronary flow abnormalities were the culprit?

Methods:
Patients with non-STEMI were enrolled if the coronary arteries were patent. In our new dynamic angiographic protocol, contrast was injected until the index coronary artery was completely opacified. Once the manual injection stopped, the blood moved in, displacing the contrast. The movements and directions of the blood flow in “white” color on top of a “black contrast” background could be clearly analyzed. The main focuses were the types of flows and their duration, direction and length.

Results:
12 patients with non-STEMI and patent coronary arteries were enrolled. 100% patients had severe slow flow with prolonged arterial phase (>1.8secs) compared with historical control (0.72 secs) (p<0.05). 83% patients had retention flow with thick stagnant boundary layers at the proximal and mid segment of right coronary artery. The retrograde flow was short (0.18secs). Two patients showed excessive contraction of left ventricle. 4 patients revealed history of intense emotional stress however no sign of adrenergic excess (elevated blood pressure, heart rate or extreme peripheral vasoconstriction). All patients recovered and remained asymptomatic after one year follow-up.

Conclusions:
In non-STEMI and patent coronary arteries, severe slow flow and prolonged retention of thick boundary layers were the culprits. Besides the ischemia caused by delayed delivery of new blood to myocardium, the prolonged retention of thick boundary layers could prevent the intima from absorbing new oxygenated blood and provoked local ischemia. These new discoveries open new management and preventive options for patients with non-STEMI and patent coronary arteries.
Abstract 13035: A Potent Protective Vascular Endothelium Property of
Garcinia mangostana
L. Extract in High-Risk Framingham Score Patients With Type 2 Diabetes: A Prospective Randomized Control Trial
Authors: Handayani Olivia
Published: April 2024

Background:
Endothelial dysfunction is the hallmark of vascular complications in cardiovascular disease with type 2 diabetes as the comorbid.
Garcinia mangostana
L., or mangosteen, has been known as the queen of fruits from Southeast Asia that owns anti-inflammatory and anti-oxidant properties for years.

Objective:
This study was aimed to evaluate the role of
G. mangostana
extract as a potent protective vascular endothelium in patients with type 2 diabetes and high-risk Framingham score.

Method:
This is a prospective, randomized, single blind, placebo-controlled trial in subjects with type 2 DM and high-risk Framingham score. Subjects were randomly divided into two groups: the treatment group of
G. mangostana
extract, administered 2,175 mg/day in divided dosage for 90 days, and control group receiving placebo. The primary endpoint was the changes in endothelial progenitor cells (EPCs) and circulating endothelial cells (CECs) levels. We also evaluated the levels of NO, IL-1, IL-6, TNF-α, fasting blood glucose and HbA1c. Study had been approved by local ethics committee. Statistical analysis was done and p<0.05 was considered significant.

Results:
From 90 subjects with high-risk Framingham score, there were 49 (54.4%) subjects with type 2 diabetes, which randomly divided into two groups. The treatment group (n=23) received
G. mangostana
extract and control group (n=26) received placebo. Statistical analysis showed that increase of EPC and decrease of CEC levels were significant in treatment group, compared to control (p=0.000 and p=0.002, respectively). The levels of NO increased significantly (p=0.027) and levels of IL-1, IL-6, TNF-α decreased significantly in comparison to placebo (p=0.003, p=0.002, p=0.000, respectively). Analysis also showed that HbA1c decreased significantly (p=0.002) compared to placebo; however, it was insignificant for fasting blood glucose reduction (p=0.336).

Conclusion:
Garcinia mangostana
L. extract, as an adjuvant therapy, plays a role in improving endothelial dysfunction by significant increase in EPCs and decrease in CECs, in patients with type 2 diabetes and high-risk Framingham score.
Abstract 13041: Differences In Systemic Fatty Acids Between Coronary Heart Disease Patients And Controls From The Middle East Favors Inflammation
Authors: Ullah Ehsan , Kunji Khalid , El-Menyar Ayman , Elsousy Reem , Al-Nesf Maryam , Beotra Alka , Al-Maadheed Mohammed , Mohamed-Ali Vidya , Saad Mohamad , Al Suwaidi Jassim
Published: April 2024

Introduction:
Fatty acids (FAs) have been of interest as biomarkers and as mechanistic signaling modulators of inflammation for the progression of coronary heart disease (CHD). Short chain FAs (SCFA) play a role in two inflammation mediating signaling mechanisms: inhibition of histone deactylase and activation of G-protein-coupled receptors. The omega-3 FAs are important in the generation of resolvins, which are active in the resolution of inflammation. Medium chain FAs (MCFA) play an important role in decreasing cholesterol by inhibiting bile acid reabsorption. In this study we investigated changes of FAs in CHD.

Methods:
Samples from the Qatar Cardiovascular Biorepository and Qatar Biobank (CHD n=1,001, controls n=2,999) were used for the quantitative analysis of serum FAs by liquid chromatography-mass spectrometry. Data were curated by Metabolon Inc. Standard quality control steps were performed. Logistic regression, adjusting for age, BMI, and sex, was conducted to test association between CHD and FAs.

Results:
Overall 289 lipid metabolites including 27 long chain FAs (LCFA), 9 MCFA, and one SCFA (caproate) were analyzed. The significant metabolites at
P
<0.05 were 25 LCFA (20 were higher in CHD), 7 MCFA (4 were higher in CHD), and one SCFA (higher in CHD,
P
=1.64х10
-87
). MCFA heptanoate (7:0,
P
=1.67х10
-26
), LCFA erucate (22:1n9,
P
=5.5х10
-8
) and docosadienoate (20:2n6,
P
=1.25х10
-5
) were higher in CHD than controls. Among the FAs that were lower in CHD, there were the long chain omega-3 FAs eicosapentaenoate (EPA, 20:5n3,
P
=1.6х10
-3
), docosahexaenoate (DHA, 22:6n3,
P
=1.45х10
-10
), and docosapentaenoate (DPA, 22:5n3,
P
=1.64х10
-11
), and the MCFA 5-dodecenoate (12:1n7,
P
=3.5х10
-4
) and 10-undecenoate (11:1n1,
P
=3.79х10
-11
).

Conclusions:
Our results show that changes in the FAs profile of the CHD patients in this study may mechanistically contribute to the increased prevalence of inflammatory diseases such as CHD in the Middle East.
Abstract 13049: Peripheral Artery Disease In Patients Undergoing Transcatheter Aortic Valve Replacement In Northern New England
Authors: Furman Deborah , Ng Spencer , Iribarne Alexander , Henkin Stanislav , Devries James T , Young Michael
Published: April 2024

Background:
Transcatheter aortic valve replacement (TAVR) is now more common than surgical aortic valve replacement (SAVR) for severe aortic valve stenosis. In the general population, the prevalence of peripheral artery disease (PAD) in patients undergoing transfemoral TAVR is 25%, with higher risk of adverse outcomes including bleeding, readmission, myocardial infarction, and all-cause mortality. The objective of this study was to examine the prevalence of peripheral artery disease in patients undergoing TAVR at Dartmouth-Hitchcock Medical Center (DHMC).

Methods:
We performed a retrospective observational study of 569 patients undergoing TAVR between 1/1/2012-4/8/2020. PAD was defined as presence of aorto-iliac, femoral-popliteal, below-knee tibial, reno-vascular, mesenteric, cerebrovascular, aortic disease, or upper extremity arterial disease noted in the patient’s chart prior to TAVR.

Results:
Of 569 TAVR patients, 19% (n=109) had concomitant PAD. Of these, 70 patients (64%) were established with a vascular specialist and 54 (50%) had a prior intervention relating to their disease. Figure 1 characterizes the distribution and location of PAD among patients.

Conclusion:
In a Northern New England population, 1 in 5 patients undergoing TAVR had concomitant PAD. Cerebrovascular and peripheral vascular disease were most common. Understanding PAD epidemiology is of paramount importance with respect to vascular access and longitudinal management in a vulnerable aortic stenosis population.
Abstract 13063: Utilization and Diagnostic Yield of Cardiovascular Imaging in Hospitalized COVID-19 Patients
Authors: Manla Yosef , Khalouf Amani , Bonilla Maria-Fernanda , Khalil Mohammed , almahmeed wael , Bader Feras , Al Badarin Firas
Published: April 2024

Background and Aims:
Whereas several cardiovascular imaging (CVI) modalities can uncover cardiac involvement with COVID-19, judicious use of CVI in this population is crucial to avoid unnecessary exposure to hospital staff. Describing utilization patterns and diagnostic yield of CVI in COVID-19 patients will support rational utilization of CVI in this setting.

Methods:
Data on consecutive hospitalized COVID-19 patients at a single center (Feb-July 2020) were retrospectively collected. Baseline characteristics and outcomes were compared between those who did and did not receive CVI during index admission (defined as either transthoracic echocardiography, cardiac CT angiography, cardiac MR, or invasive coronary angiography). Predictors of detecting any abnormality with CVI were determined using multivariable logistic regression.

Results:
A total of 694 patients were hospitalized, of whom 242 (34.9%) received at least one CVI study. Echocardiography was the most commonly used modality (78.9%), followed by CT angiography (38%). Patients who underwent CVI were older with a greater burden of comorbidities and worse hospital outcomes (
Table
). An abnormality was detected in only 27.3% of patients who underwent CVI, while the studies were normal in the rest. ICU admission, history of coronary artery disease, elevated high-sensitivity troponin, and hypotension during hospitalization were independent predictors of detecting an abnormality with CVI. Patients with ≥ 3 risk factors were more likely to have abnormalities with CVI compared with those with no risk factors (50% vs. 9.3%, Figure)

Conclusion:
Imaging was frequently used in this cohort of COVID-19 patients. However, only 1 in 4 patients was found to have significant cardiac abnormalities. If validated in future studies, the current findings support selective utilization of CVI based on presence of clinical factors associated with higher CVI yield.
Abstract 13084: Occurrence of Infective Endocarditis After Transcatheter versus Surgical Pulmonary Valve Implantation: Results of a Nationwide Administrative Database
Authors: Fischer Alicia Jeanette J , Enders Dominic , Baumgartner Helmut , Diller Gerhard P , Kaleschke Gerrit
Published: April 2024

Background:
It is unclear if the risk of infective endocarditis (IE) differs between transcatheter (TPVI) and surgical (SPVR) pulmonary valve implantation. We sought to address this question using administrative data including a large nationwide patient population.

Methods:
All congenital heart disease (CHD) patients ≥4 years of age who underwent isolated pulmonary valve implantation were identified in the BARMER Health Insurance Company database (≈9 million members, representative of the German population). Data from 01/2005 to 12/2018 were analyzed with regard to overall survival and complications particularly focusing on IE.

Results:
Overall, 461 pulmonary valve implantations were performed in 413 patients (59.4% male, median age 18.6 years (IQR 12.8-31.3)). Of those, 38.4% (n=177) underwent TPVI, while 61.6% (n=284) were treated with SPVR. Overall, IE was diagnosed in 8.0% (n=37) of cases after a median of 1.3 years (IQR 0.2-3.7). In the TPVI cohort, IE occurred in 10.2% (n=18) of cases, while IE was diagnosed in 6.7% (n=19) of cases with SPVR (
p
=0.217). Furthermore, 5.0% (n=23) of all patients died during follow-up (of those n=4 within 90 days after diagnosis of IE). On multivariable Cox-regression analysis, previous diagnosis of IE was associated with a higher risk of re-IE (
p
=0.025), but no association between IE and age (
p
=0.17), sex (
p
=0.34) or type of CHD was found (
p
=0.71). While the overall rate of IE was not dependent on the treatment modality, there were significant time-dependent differences: Within the first year of follow-up, freedom from IE or death was significantly higher in the TPVI cohort (HR 5.26 [95% CI 1.59-16.67],
p
=0.006) compared to SPVR), but within the 3-10 year period the probability reversed in favor of the SPVR cohort (HR 10.07 [95% CI 3.41-29.76],
p
<0.001) compared to TPVI).

Conclusion:
In a cohort of 413 patients undergoing pulmonary valve implantation, infective endocarditis occurred in 8.0% of cases. The overall rate of infective endocarditis was not significantly different between surgical and interventional pulmonary valve procedures. However, while early endocarditis was more often related to surgical procedures, the mid-term IE risk was significantly lower in surgically treated patients.
Abstract 13097: Diabetes and Obesity Are Causally Associated With Pulmonary Hypertension and Right Ventricular Function
Authors: Bagheri Naraghi Minoo , Agrawal Vineet , Annis Jeffrey S , Ferguson Jane F , Mosley Jonathan D , Brittain Evan L
Published: April 2024

Background:
Observational studies have shown overlap between pulmonary pressure, right ventricular (RV) function, and metabolic function, but causality has not been established. We used genetic variants associated with metabolic phenotypes to test for causality between metabolic function, pulmonary pressure, and RV function.

Methods:
We included all European ancestry subjects in Vanderbilt University’s de-identified DNA biobank (BioVU) with an echo reporting pulmonary pressure (RVSP) and RV function (TAPSE). To investigate causal relationships, two-sample univariate and multivariate Mendelian Randomization (MR) analyses were conducted using genetic variants associated with phenotypes and echo measures. Significant phenotypes by univariate MR were included in multivariable MR models. We also tested echo measures for associations with polygenic risk scores (PRS) for metabolic phenotypes [score threshold: 5x10
-8
].

Results:
We identified 17,221 men and women (mean age: 62yr) with RVSP and 6,209 men and women (mean age: 61yr) with TAPSE. Diabetes genetic risk was associated with higher RVSP (β=0.015, p=0.016) [Figure 1A] and lower TAPSE (β=-0.028, p<0.05) [Figure 1C]. BMI genetic risk was positively associated with RVSP (β=0.06, p=7.18 x 10
-6
) [Figure 1C] but not TAPSE. In multivariable MR models, genetic risk for diabetes and BMI remained directly associated with RVSP (p<0.05) and only diabetes genetic risk was inversely associated with TAPSE (β=-0.031, p=0.005). PRS for diabetes and BMI were associated with higher RVSP (β=0.01, p=0.001 for diabetes and β=0.01, p=2.04x10
-5
for BMI) but only PRS for diabetes was linked to lower TAPSE (β=-0.015, p=0.057).

Conclusions:
Genetic determinants of BMI and diabetes are causally associated with pulmonary pressure and RV function in a large, unselected population referred for echocardiography. These may be modifiable risk factors in the treatment and prevention of pulmonary hypertension and RV dysfunction.
Abstract 13101: Bleeding Complications in Patients Undergoing Percutaneous Coronary Intervention With Intra-Aortic Balloon Pump and/or Impella Support: A System Wide Analysis
Authors: Bhuiyan Md , Bimal Tia , Gandotra Puneet , Fishbein Joanna , Selim Samy , Ong Lawrence , Gruberg Luis
Published: April 2024

Background:
Mechanical circulatory support (MCS) devices are used to provide temporary hemodynamic support in patients undergoing percutaneous coronary interventions (PCI). Currently, the most used percutaneous devices are the intra-aortic balloon pump (IABP) and the Impella micro-axial flow device.

Aim:
To assess bleeding complications associated with IABP and/or Impella in patients undergoing PCI.

Methods:
Between 12/2010 and 03/2018 a total of 883 patient underwent PCI with MCS at 6 hospitals in our system. Patients were divided into three groups: IABP (n=679), Impella (n=171) and IABP with Impella (n=33). Bleeding complications were classified according to the Bleeding Academic Research Consortium (BARC). BARC Type 4 (coronary bypass grafting-related) and BARC Type 5 (fatal bleeding) bleeding events were excluded. Chi-square tests and logistic regression were utilized with p<0.05 significance level. Multiple pairwise comparisons using Bonferroni-adjusted p-value threshold of p<0.0167 for level of significance was also performed. A multiple variable analysis will be presented.

Results:
Clinical characteristics, bleeding complications and in-hospital outcomes are shown in the Table. There were significant differences in these variables except age and gender among the three groups. A minority of patients (4%) were treated simultaneously with both devices, however 45% of these patients had a significant bleeding event and 33% died in the hospital. No significant difference in bleeding complications between IABP and Impella (each alone) was found (p=0.38).

Conclusions:
In patients undergoing PCI, use of a combination of IABP and Impella was associated with significantly higher rate of intermediate or major bleeding complications when compared with patients treated with either device alone. Furthermore, these patients had significantly higher in-hospital mortality rates.
Abstract 13107: Effectiveness Of The Outpatient Pritikin Intensive Cardiac Rehabilitation Program In Patients With Heart Failure
Authors: Park Lauren K , McKenzie Kristin , Mckenzie Erin , Stranczek Natalie , Deych Elena , RACETTE Susan B , Peterson Linda R
Published: April 2024

Introduction:
The Pritikin intensive cardiac rehabilitation (ICR) program includes structured exercise sessions augmented by heart health education sessions for patients recovering from myocardial infarction, cardiac surgery, PCI, and stable angina. Medicare coverage for ICR expanded to include patients with heart failure (HF) with reduced ejection fraction (HFrEF, EF <35%). However, the efficacy of outpatient ICR on improvement of cardiovascular disease (CVD) risk factors in all patients with HF, regardless of EF, is unknown.

Hypothesis:
Patients with HF who participate in the outpatient Pritikin ICR program will have improvements in several clinically significant CVD risk factors, including cardiorespiratory fitness, strength, body composition, and lipid profiles.

Methods:
We performed a prospective cohort study of patients with HF enrolled in the outpatient Pritikin ICR program at Barnes Jewish West County Hospital in St. Louis, MO. Patients referred for ICR since 1/1/2017 were invited to participate in assessments at baseline (BL) and after completing 24 ICR visits. Each visit included a monitored exercise session plus a Pritikin education session focusing on dietary changes (low-fat, low-sodium, high-fiber foods) and stress management through a series of videos, cooking classes, and workshops. We measured body composition using bioelectrical impedance, cardiorespiratory fitness using a 6-min walk test, hand grip strength by dynamometry, and lipids by venipuncture. Values are presented as median difference, and interquartile range (IQR) from BL to visit 24.

Results:
84 patients with HF (68% HfrEF, 32% HfpEF; 70.2% also diagnosed with MI, CABG, or PCI; 40% women; mean age 69.9 [SD 9.6] y), completed BL and visit 24 assessments over an average of 9.9 weeks. Significant improvements (all
P
<0.01) were observed for whole-body fat (-1.2%, IQR -2.4, 0.8), trunk fat (-1.3%, -3.2, 0.5), fat free mass (+0.6 kg, -0.3, 1.7), 6-min walk distance (+45.7 m, 17.9, 68.9), hand grip strength (+1.0 kg, -0.4, 2.9), and LDL cholesterol (-3 mg/dL, -14, 6).

Conclusion:
Outpatient Pritikin ICR results in significant cardiovascular benefits in patients with HF by enhancing exercise capacity and strength, reducing adiposity, and improving lipid profiles.
Abstract 13116: The Association Between Depression and Mortality and Amputation Outcomes in Patients With Peripheral Artery Disease: A Systematic Review and Meta-Analysis
Authors: Scierka Lindsey E , Ahmed Zain V , Yousef Sameh , ARHAM AHMAD , Grimshaw Alyssa A , Harris Kristie , Burg Matthew , Mena-hurtado Carlos , Smolderen Kim G
Published: April 2024

Introduction:
Peripheral artery disease (PAD) is associated with significant morbidity and mortality. Part of its management requires optimizing adherence to medications and lifestyle changes. Depression may negative affect this goal and has been identified as a potential risk factor for PAD incidence and progression. To better understand this risk, we conducted a systematic review and meta-analysis to summarize the strength of the association between depression and mortality and amputation in patients with PAD.

Hypothesis:
Comorbid depression is associated with an increased risk of mortality and amputation risk in patients with PAD.

Methods:
We performed a systematic search of Cochrane Library, Embase, Google Scholar, Medline, Pubmed, PsychInfo, Scopus, and Web of Science Core Collection databases for studies that report the comorbidity of depression or depressive symptoms in patients with PAD. Databases were searched on December 16
th
, 2020. Risk of bias was assessed used Cochrane ROBINS-I. Funnel plot and Egger’s regression asymmetry test were used to assess publication bias. A random effects model was used to estimate the combined overall effect as odds ratio (OR) or hazard ratios (HR).

Results:
In the 6 studies included (n= 274,442 patients with PAD), 36,134 patients (13.2%) had comorbid depression. Depression was associated with an increased risk of mortality (HR 1.37, 95% CI 1.1-1.70, p-value: 0.003) and amputation (HR 1.21, 95% CI 1.02-1.45, p-value: 0.031). Risk of bias was moderate for all studies and Egger’s test was not statistically significant (p-value: 0.127 for mortality, 0.867 for amputation).

Conclusion:
There is a 21% increased risk of amputation and 37% increase in risk of mortality in PAD patients with comorbid depression. Future work will need to study explanatory mechanisms and directionality of the association, while clinical implications include realizing integrated care to address the depression burden in patients with PAD.
Abstract 13123: Global Knockout of LDLRAP1 Regulates Atherosclerosis, Adipose Metabolism, and Insulin Resistance
Authors: Leigh Tani , Kawai Tatsuo , Kelemen Sheri E , Okune Rachael , Corbett Cali , St Paul Amanda , Yu Jun , Scalia Rosario G , Autieri Michael
Published: April 2024

Introduction:
Atherosclerotic vascular syndromes account for 50% of all deaths in the United States, and are a considerable medical and socioeconomic problem contributing to mortality of several conditions, including myocardial infarction and stroke. It is accepted that atherosclerosis and symptoms of metabolic syndrome, such as obesity, insulin resistance, and hypercholesterolemia often coincide with and exacerbate one another, however the molecular events in common with these conditions are not yet fully understood. One event that may link these two disorders is lipid receptor trafficking and signaling of the LDL receptor (LDLR), which plays a key role in LDL uptake and regulation of plasma LDL concentration. Low-density lipoprotein receptor adaptor protein 1 (LDLRAP1) is a cytosolic adaptor protein which interacts with the cytoplasmic tail of the LDLR, mediating internalization of the LDL-LDLR complex and connecting it to the cell’s endocytic machinery. The purpose of this study was to characterize the effects of LDLRAP1 global knockout on atherogenesis and metabolic function in order to gain a better understanding of the molecular mechanisms that interconnect atherosclerosis and metabolic syndrome.

Results:
LDLRAP1 global knockout mice fed a high-fat western diet (HFD) for 16 weeks displayed increased atherosclerotic plaque burden (p<0.0001), serum cholesterol (p<0.0001) and triglyceride levels (p<0.01), and expression of lipid receptors SR-A1 and CD36 (p<0.05), and gained significantly more weight compared to controls (p<0.0001). LDLRAP1
-/-
adipose also displayed decreased glucose uptake (p<0.01) and pAKT and AKT protein levels (p<0.05). Both before and after a HFD, LDLRAP1
-/-
mice were also significantly insulin resistant (p<0.01) with concomitant dysregulated insulin signaling in adipose tissue, and displayed metabolic differences as quantified by metabolic cage analysis (p<0.05).

Conclusions:
These data suggest that in addition to a function in cholesterol internalization, LDLRAP1 participates in regulating adipose metabolism and insulin sensitivity. This implicates LDLRAP1 as a key molecule and potential therapeutic target in treatment of diseases which constitute metabolic syndrome.
Abstract 13141: Accumulation of Aggrecan at Sites of Increased Pulmonary Arterial Pressure in Idiopathic Pulmonary Arterial Hypertension
Authors: van der Have Oscar , Mead Timothy , Westoo Christian , Peruzzi Niccolo , Mutgan Ayse Ceren , Norvik Christian , Löfdahl Anna , Bech Martin , Struglics André , Hoetzenecker Konrad , Brunnstrom Hans , Westergren-Thorsson Gunilla , Kwapiszewska Grazyna , Apte Suneel S , Tran-lundmark Karin
Published: April 2024

Introduction:
Pulmonary arterial hypertension (PAH) is a lethal condition lacking curative pharmacotherapy. Expansion of the extracellular matrix occurs in early stages of pulmonary angiopathy, but the presence of individual matrix components warrants further investigation. Accumulation of the osmotically active matrix proteoglycan aggrecan has been associated with swelling and disruption of vessel wall integrity in systemic arteries. Whether aggrecan is present to any significant extent in PAH tissue, and what potential role it may have, is not known.

Methods:
Paraffin-embedded lung tissue from 11 patients with idiopathic PAH was imaged using synchrotron-based phase contrast micro-CT at the TOMCAT beamline, Swiss Light Source. Image analysis was performed in Fiji and Amira. Imaged blocks were subsequently sectioned for histology, immunohistochemistry with an aggrecan core protein antibody and RNAscope in situ hybridization. qPCR was performed to investigate gene expression. Failed donor lungs were used as controls.

Results:
Aggrecan core protein was identified in vascular lesions of all 11 patients with idiopathic PAH, localized to cellular rather than fibrotic or collagenous lesions. RNAscope in situ hybridization confirmed local production of
ACAN
mRNA in diseased vessels. Quantification of repeated immunohistochemistry demonstrated significantly increased accumulation of aggrecan in patients with idiopathic PAH compared to failed donor lung controls.
ACAN
and
ADAMTS15
mRNA were also found to be up-regulated in pulmonary arteries from patients with IPAH, indicating ongoing proteolytic turnover. Image analysis and three-dimensional renderings of pulmonary arteries identified aggrecan in lumen-reducing lesions containing cellular connective tissue, at sites of intrapulmonary bronchopulmonary shunting and at sites of elevated pulmonary blood pressure.

Conclusions:
Our findings indicate local production and accumulation of aggrecan in pressure-related lesions of idiopathic PAH. This work strengthens the hypothesis that aggrecan plays a role in arterial adaptations to altered hemodynamics and is the first to suggest a role for aggrecan in pulmonary arterial homeostasis and idiopathic PAH.
Abstract 13144:
18
F-NaF Positron Emission Tomography Imaging Detects Femoral Artery Microcalcification in Patients With Type 2 Diabetes Mellitus and Macroalbuminuria. An Early Marker for Vascular Disease?
Authors: Reijrink Melanie , Sluiter Judith K , Te Velde-Keyzer Charlotte A , de Borst Martin H , Van Praagh Gijs D , Greuter Marcel , Pol Robert A , Hillebrands Jan-Luuk , Van Dijk Peter R , Hoogenberg Klaas , MULDER Douwe J , Slart Riemer
Published: April 2024

Background:
Although albuminuria is an established risk factor for progression of kidney disease and cardiovascular outcomes, its association with subclinical arterial disease is unclear. [
18
F]-sodium fluoride ([
18
F]NaF) positron emission tomography (PET) imaging allows detailed early visualization of arterial microcalcification. This study aims to compare non-invasive imaging markers of subclinical arterial disease measured by microcalcification, macrocalcification, and aortic stiffness in patients with type 2 diabetes mellitus (T2DM) with and without macroalbuminuria.

Methods:
Participants without cardiovascular history were age and sex matched in three groups: nonT2DM controls, patients with T2DM without albuminuria (MA-), patients with T2DM with macroalbuminuria (MA+). [
18
F]NaF activity was scored visually (in the aorta and femoral arteries) and was quantified as background activity (blood pool) corrected mean standardized uptake value of the abdominal aorta, and iliac arteries, expressed as target-to-background ratio (TBR). Arterial macrocalcification was assessed with computed tomography (CT) and arterial stiffness with carotid-femoral pulse wave velocity (PWV).

Results:
Three groups with comparable estimated Glomerular Filtration Rate were included (n=10 per group); controls 91 [81-104] vs MA- 87 [84-93] vs MA+ 85 [60-103] (median [IQR] mL/min*1.73m
2
). Femoral [
18
F]NaF uptake was significantly increased in the MA+ group (228 [100-446] vs 33 [0-93] in MA- (p=0.002) and vs 75 [0-200] in controls (p=0.052)), while other imaging markers were not. PWV was significantly higher in the MA+ group compared with MA- group (11.15 vs 8.86 m/s (p=0.009)) while no differences in pulse pressure were found. The [
18
F]NaF activity in femoral arteries correlated with PWV (r=0.516, p=0.020) and pulse pressure (r=0.508, p=0.012).

Conclusions:
This study suggests that the presence of macroalbuminuria in patients with T2DM is an indication of early phased arterial disease prior to the development of irreversible macrocalcification. Although larger [
18
F]NaF PET studies are needed, these results underline the importance of macroalbuminura in T2DM for detecting subclinical arterial disease at an early potentially reversible stage.
Abstract 13151: Shared Genetic Architecture Between Adiposity and Right Ventricular Structure
Authors: Agrawal Vineet , Bagheri Minoo , Vaitinadin Nataraja Sarma , Shi Mingjian , Ferguson Jane F , Brittain Evan , Hemnes Anna R , Wells Quinn , Gupta Deepak K , Mosley Jonathan
Published: April 2024

Introduction:
Right ventricular (RV) enlargement has been associated with increased mortality, regardless of the etiology. Pathophysiologic determinants of RV structure, however, are under characterized. Examining genetic architecture underlying variation in RV size may identify etiologic risk factors contributing to RV enlargement. Therefore, we interrogated a polygenic predictor for RV size to identify etiologic drivers of RV structure.

Methods:
We studied 10,522 adult subjects of European ancestry in Vanderbilt University Medical Center’s de-identified DNA biobank (BioVU) who had undergone an echocardiogram including measurement of RV diameter. Bayesian Sparse Linear Mixed Modeling (GEMMA v0.95) was used to create a polygenic predictor of RV diameter. A PheWAS using logistic regression was then conducted to determine clinical diagnoses significantly associated with genetically-determined RV diameter. Further associations between identified clinical factors and RV diameter were examined using 2-sample bivariate and multivariable Mendelian randomization (MR).

Results:
PheWAS identified obesity-related clinical diagnoses as the most significantly associated with RV diameter (Figure 1). Univariate MR for body mass index (BMI), waist circumference, fat mass, and body impedance all demonstrated a causal and positive association with RV diameter. Multivariable MR demonstrated the association between measures of adiposity and RV diameter persisted even after accounting for the effect of pulmonary pressure.

Conclusions:
Genetic architecture is shared between adiposity and RV structure. Measures of adiposity are causally associated with genetically predicted larger RV diameter. Common pathophysiologic mechanisms may regulate adiposity and right heart structure, suggesting adiposity may represent an intervenable therapeutic target for RV failure.
Abstract 13153: Vascular Function and the Gut Microbiome in Liver Transplant Recipients
Authors: Carper Moriah , Chavez Domenico , Bohmke Natalie , Martin Linsey , Bhati Chandra , Wolver Susan , Siddiqui Mohammad , Kirkman Danielle L
Published: April 2024

Introduction:
Cardiovascular disease (CVD) risk is elevated in liver transplant (LT) patients. The underlying physiological mechanisms associated with LT related CVD are not yet fully understood. High levels of the gut microbiome metabolite trimethylamine N-oxide (TMAO) may contribute to an increased risk of atherosclerosis. The purpose of this study is to investigate if high circulating levels of TMAO contribute to vascular dysfunction in LT recipients.

Hypothesis:
We hypothesized that vascular dysfunction, including measures of conduit artery endothelial function, central systolic blood pressure and carotid intima media thickness (cIMT), would be correlated with higher TMAO levels.

Methods:
We enrolled 12 LT recipients (6 male; 6 female; Mean±SD: Age 58.75±8.45 yrs). Conduit artery endothelial function was measured via flow-mediated dilation with duplex ultrasound. Central aortic pressure waves were synthesized from radial artery waveforms acquired by applanation tonometry and the use of a generalized transfer function. Mean cIMT of the near and far wall was assessed via B mode ultrasound. Blood samples were analyzed for plasma TMAO by nuclear magnetic resonance spectroscopy.

Results:
As shown in Figure 1, conduit artery endothelial function (Mean±SD: 4.11±2.82%) was negatively associated with TMAO (10.94±9.65 μM;
r
= -0.87,
p
<0.001). There was no significant relationship between TMAO and central aortic pressure (131±17mmHg;
r
= 0.36,
p
=0.3) or cIMT (0.68±0.10mm;
r
= -0.08,
p
=0.8).

Conclusions:
Our results showed that LT recipients with higher levels of plasma TMAO had worse conduit artery endothelial function. Endothelial dysfunction is a well-established precursor to the development of atherosclerosis. Therefore, therapeutic strategies aimed at improving the health of the gut microbiome and subsequently reducing the levels of TMAO hold promise for preventing atherosclerosis in LT patients and should be investigated in future trials.
Abstract 13165: Increasing Incidence Rates and High Case Fatality Rates for Acute Myocardial Infarction in the Caribbean Island of Barbados
Authors: Sobers Natasha , Forde Shelly-ann , Hambleton Ian , Henry Ashley , Roachford Nicolette , Robinson Abigail , Forde Martinette , Delice rudolph , Rose Angela M
Published: April 2024

Introduction:
The Caribbean sub-region has the highest rates of cardiovascular disease in the Region of the Americas. We present data from one of the few population-based registries in the region - the Barbados National Registry for NCDs (BNR). We describe trends in incidence and case fatality rates for acute myocardial infarction(MI) in the high income small island developing state of Barbados.

Hypothesis:
Myocardial infarction age-standardized incidence rates (ASIRs) are increasing.

Methods:
Data from the BNR were collected prospectively from charts of patients diagnosed with acute myocardial infarction from all private and public hospitals for the period 2010-2019. Out-of-hospital deaths and in-hospital deaths within 24 hours, were identified through the national vital registration department. Cases are defined in accordance with the Universal Definition of Myocardial Infarctions published by the American Heart Association. Population estimates were obtained from the United Nation World Population Prospects. We calculated incidence rates by sex, age-standardized to the World Health Organization 2000 population and assessed trends in case fatality rates for those admitted to hospital.

Results:
For the period 2010-2019, 4065 cases of as myocardial infarction (MI) were registered by BNR. Numbers of cases ranged from 294 in 2011 to 547 in 2019. The 3-year average for 2014 - 2016 is 391 cases versus 499 cases for 2017 - 2019 - a 28% increase in new cases. ASIRs increased from 67 per 100,000 (95%UI 59 to 75) in 2011 to 123 per 100,000 (95%UI 113 to 135) in 2019. ASIRs were consistently higher in men ranging from 83 per 100,00 (95% UI 71 - 98) to 120 (95% UI 106 to 136) while rates in women ranged from 43 per 100,000 95% CI (35 - 53) to 83 per 100,000 (73 - 95). The in-hospital case fatality rate (CFR) was 25% in 2019, ranging from 15% in 2011 to 31% in 2014. Overall, CFR was higher in women (24%) versus men (19%) and this was true in 9/10 years.

Conclusions:
Despite its status as a high income country, ASIRs for MIs in Barbados are increasing while case fatality rates are more than twice as high as rates found in developed countries.