bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 15465: Associations Between Adherence to the Physical Activity Goal and Body Fat Changes in a MHealth Weight Loss Trial
Authors: Bizhanova Zhadyra , Sereika Susan M , Brooks Maria M , Rockettewagner Bonny , Kariuki Jacob K , Burke Lora E
Published: June 2023

Introduction:
To date, few studies have examined the effectiveness of using wearable devices for promoting physical activity (PA) and improving body composition.

Hypothesis:
Adherence to the study-defined PA goal would be associated with greater body fat loss at 12 months than 6 months among adults with overweight or obesity during a weight loss intervention.

Methods:
SMARTER was a 12-mo, 2 arm weight loss trial with random assignment to (1) self-monitoring (SM, n=251) of diet, PA and weight, (2) self-monitoring plus ≤3 tailored feedback messages/day (SM+FB, n=251). The primary outcome was percentage of body fat % change assessed using Tanita scales and a body fat analyzer at 6 and 12 months relative to baseline. Adherence to the study-defined PA goal was assessed using weekly Fitbit moderate- and vigorous-intensity PA equivalents relative to ≥300 min/week PA goal and multiplied by 100%. Linear mixed modeling was used to estimate the effect of the percentage of adherence to the PA goal on the percentage of body fat % change at 6 and 12 months.

Results:
Participants (N=502) were mainly female (79.5%), White (82.5%), mean (± SD) age of 45.0 ± 14.4 years and BMI of 33.7 ± 4.0 kg/m2. Changes in the percentage of body fat % were similar at 6 and 12 months (time: F=3.48, P=.06) or by treatment assignment (treatment x time: F=1.33, P=.25). Overall, percentages of adherence to the PA goal were associated with greater percentages of body fat % loss (b [95% CI] -0.06 [-0.09, 0.03], F=18.61, P<.0001), which did not vary over time (PA adherence x time: F=2.88, P = .09). Finally, percentages of adherence to the PA goal moderated treatment effects (PA adherence x treatment: 0.05 [0.01,0.09], F = 4.69, P = .03), which did not vary over time (PA adherence x treatment x time: F = 0.29, P = .59).

Conclusions:
PA adherence was associated body fat loss, which did not vary at 6 and 12 months in adults with overweight or obesity. Future studies need to examine the effect of using wearable devices on body composition when targeting behavior changes.
Abstract 15467: Bi-Leaflet Tricuspid Valve in Children With Hypoplastic Left Heart Syndrome is Rarely Incompetent, While Bi-Leaflet With a Cleft Results in Tricuspid Valve Regurgitation
Authors: zamzami sultan , Allawati Tuqa , Lin Lily , Moran Martha , Eckersley Luke , Freed Darren H , Jonker Devilliers , Al Aklabi Mohammed , Khoo Nee Scze
Published: June 2023

Introduction:
Tricuspid valve (TV) regurgitation in Hypoplastic Left Heart Syndrome (HLHS) increases the risk of death/transplantation by 2 to 3 times. Abnormalities in TV annular shape, leaflets expansion and subvalve apparatus position, have been associated in HLHS with subsequent tricuspid regurgitation (TR). As TV morphological variation is increasingly recognized, its role on tricuspid valve function remains unknown. This study aims to describe and examine the relationship between the TV leaflet morphologies in HLHS and its association with TV repair.

Methods:
Cross sectional study of selected 38 “classic” HLHS patients from a prospective longitudinal 3DE study of HLHS TV. TV leaflet morphology from 3DE datasets were reviewed (S.Z and N.S.K) blinded to TR grade. We adapted a previously proposed nomenclature to describe the TV leaflets (Figure 1). Using the Chi-squared test, we compared the frequencies of TV morphological types of HLHS with mild or less TR (n = 23) vs. HLHS who had TV repair (n = 15) at latest follow up.

Results:
Incidence of TV morphological type is summarized in Figure 2. Bi-leaflet TV was the second most common, followed by bi-leaflet with a cleft. When comparing HLHS with mild or less TR vs. HLHS with TVR, only 1 of 9 bi-leaflet TV had subsequent TVR, while
all
bi-leaflet TV with a cleft, underwent TVR (p<0.05).

Conclusion:
HLHS has considerable TV leaflet variations with bi-leaflet TV being the second most common variation. While bi-leaflet TV is more likely to be found in a competent TV, those with a bi-leaflet TV with a cleft, all required TVR. Bi-leaflet TV with a cleft, warrants further study to assess its relationship and relative role with TVR.
Abstract 15478: Obscure Back Pain - A Case of Spontaneous Retroperitoneal Bleed
Authors: Anjum Zauraiz , Rehman Saif ur , Javed Ayesha , Liu Hongli , Rai Devesh , Samdani Abdul Jawwad , Ali Shaharyar , Lee Elizabeth , Khodjaev Soidjon , Feitell Scott , Parikh Vishal
Published: June 2023

Introduction:
We present a case of spontaneous retroperitoneal bleed that presented as back pain until it required multiple transfusions.

Case presentation:
A 66-year-old gentleman with past medical history of only dyslipidemia, presented with chest pain and was found to have an anterior wall ST-elevation myocardial infarction. He underwent stenting to proximal LAD and was found to be in cardiogenic shock with elevated biventricular filling pressures and ejection fraction of 5-10%. IABP was inserted, which had to be upgraded to axillary Impella 5.5 the next day, and LVAD workup was initiated. He gradually improved with decreasing Impella needs when he started complaining of back pain 5 days into his admission. At the same time, his Impella requirements started to go up. He went on to develop sweating, pallor & hemodynamic compromise. Since he was on anticoagulation due to Impella, a CT scan was obtained, which showed a spontaneous left-sided retroperitoneal bleed (F1) (IABP had been on the right side) and drop in hemoglobin from 15.8 mg/dl on admission to 7.2 mg/dl. He went on to develop hemorrhagic shock requiring massive blood product transfusion with subsequent vessel embolization by interventional radiology. Afterwards, he continued to improve, and Impella was eventually removed. Later in the course, he had another drop in hemoglobin & was taken back for CT, which showed expanding retroperitoneal hematoma (F2). Hematology team was consulted due to 2 spontaneous bleeds; however, no underlying bleeding disorder was suspected. He stabilized; was weaned off of Impella and, was subsequently discharged on milrinone infusion.

Conclusions:
We conclude that providers highly suspect retroperitoneal bleeds in the proper clinical setting for optimum patient care.
Abstract 15507: The Role of Obesity in Covid-19 Pathogenesis and Inflammation
Authors: currey joshua M , Qin Xuebin , Blair Robert , Midkiff Cecily , Rappaport Jay , Kolls Jay , Mauvais-Jarvis Franck , Maness Nicholas
Published: June 2023

SARS-CoV-2 has caused a global pandemic unseen for nearly a century. To date hundreds of millions of people have been diagnosed and millions more have died from COVID-19 disease; many of which are in groups with comorbidities. Obesity is associated with a 3.07 times higher risk of hospitalization and a 1.42 times higher risk of severe illness. However, our understanding of obesity-accelerated severity of COVID-19 is limited. To model the increased disease severity of obese individuals with COVID-19, we used a humanized ACE2 (hACE2) transgenic mouse model, in which hACE2 is under the cytokeratin-18 promoter (K18). Modeling the effects of obesity on COVID-19 in K18-hACE2 mice will help us better understand the mechanisms underlying obesity-accelerated severity of COVID-19 disease and inflammation. We have developed a study in which K18 hACE2 mice infected with SARS-CoV-2 were fed both a normal standard diet as well as a western high fat and carbohydrate diet that causes them to gain excess weight and become obese over a period of 3 months. K18-hACE2 obese mice lose a signifyingly more percentage body weight over both a 7 (acute) 14 day (long-term) period than normal diet fed mice do after infection with SARS-CoV-2. H&E staining analysis of lung histological changes indicated a dramatic increase in inflammation in our K18 hACE2 obese mice infected with SARS-CoV-2 . Subgenomic qPCR and IHC staining was used to quantify virus (viral titer) which indicated that in both of our diet groups after infection did not have a significantly different SARS-CoV-2 viral load. No significant difference in the SARS-CoV-2 viral load was detected at either 7 or 14 dpi with SARS-CoV-2 . We further measured adipokines with an ELISA on two of the most notable adipokines: leptin and adiponectin. Levels of leptin were significantly higher in our obese K18-hACE2 mice but not in our normal mice after infection. There was no difference however in the levels of adiponectin. Obese K18-hACE2 mice show a more severe COVID 19 phenotype than normal diet mice after infection and can be used to further study the underlying mechanism of how SARS-CoV-2 infection in obese individuals causes a more severe disease phenotype.
Abstract 15554: Smooth Muscle Cells Specific Gene Inactivation of Lysyl Oxidase Reduces Atherosclerosis Burden and Plaque Calcification in Hyperlipidemic Mice
Authors: Stoyell Conti Filipe F , Rojas Miguel , Zigmond Zachary , Rauf Mohdahmar , Martinez Laisel , Vazquez-Padron Roberto I
Published: June 2023

Aim:
Dissect the mechanisms by which LOX increases atherogenesis and plaque calcification in hyperlipidemic mice.

Methods:
LOX conditional knockout [LOX
f/f
Myh11-CreER
T2
ApoE
-/-
] and control littermate [LOX
wt/wt
Myh11-CreER
T2
ApoE
-/-
] mice were injected with tamoxifen before high fat diet (HFD) feeding for atherosclerosis and calcification assessment and molecular analyses.

Results:
scRNA sequence showed full
Lox
gene inactivation in 72.5% of the aortic SMCs without any significant
Loxl
compensatory regulation. Gene deletion in SMCs decreased global arterial LOX deposition by ~3-fold in relation to control mice. Surprisingly, the loss of vascular LOX neither promoted aneurysm nor affected the aorta's stiffness. However, it reduced atherosclerosis burden (WT: 23±1 vs. KO: 13±2 %, p ≤0.01) and calcium deposition (11.8±3 versus 5±0.4%, p≤ 0.05) within the plaque after 16 weeks of high fat diet (HFD). Using bulk RNA sequencing, we further demonstrated that
Lox
gene inactivation leads to a marked decrease in Frizzled Related Protein-3 (FRZB) gene expression (127-fold and p≤0.0001), a biphasic modulator of the proatherogenic Wnt signaling that facilitates the association of β-catenin with TCF4 in the nucleus. The compromised FRZB /β-catenin/TCF4 signaling axis reduced the downstream production of Bone Morphogenetic Protein 2 (BMP2), which is responsible for the osteogenic transition of SMCs. Further scRNAseq analysis of atherosclerotic aortas from conditional KO and control mice also showed a reduction of BMP2 in SMCs. Interestingly, genetic inactivation of LOX increased the number of contractile SMCs (KO: 40 vs. WT: 7 %), characterized by the high expression of ACTA2 and TAGLN, in the aorta of HFD fed mice when compared to the control group. BAPN, an irreversible inhibitor of LOX activity, was not able to reduce BMP2 expression and protein levels nor reduce calcium deposition in vitro, suggesting that the pro-calcification effect of LOX is not activity dependent.

Conclusions:
Vascular gene inactivation of
Lox
protects mice against atherosclerosis by reducing β-catenin/TCF4/BMP2 proatherogenic signaling.
Abstract 15560: Mitophagy Dysfunction and Activation of the Inflammasome Cause Aortic Stiffness in Low Aerobic Capacity Aged Rats
Authors: Canugovi Chandrika , Stevenson Mark , Vendrov Aleksandr E , Lozhkin Andrey , Koch Lauren G , Britton Steven , Runge Marschall , Madamanchi Nageswara R
Published: June 2023

Aging and low aerobic capacity are associated with an increased risk of cardiovascular events and mortality. We reported that a polygenic rat model selectively bred for low aerobic capacity (LCR) showed aortic stiffness and dysfunction with age compared to rats bred for a high aerobic capacity (HCR). We observed increased aortic mitochondrial ROS and extracellular mtDNA DAMPs levels, activation of AIM2 inflammasome and its downstream effectors and increased collagen content in old LCR rat aortas. However, the molecular mechanisms linking low aerobic capacity to inflammation in aging have not been elucidated. In order to decipher the changes in genetic networks in low aerobic capacity and aging-associated aortic stiffness, a global transcriptome analysis was performed by RNA-Seq and gene ontology analysis of aortas from young (4 month) and old (27 month) LCR and HCR rats. Down-regulated pathways in old LCR aortas include mitochondrial biogenesis and mitophagy and up-regulated pathways include pro-inflammatory pathways, apoptosis/necroptosis/ferroptosis pathways, in contrast to HCR aortas which have higher levels of pathways regulating longevity, oxidative phosphorylation, and mitophagy and autophagy. In line with that, old LCR rats displayed a 54% reduction in mitophagy (colocalization of mitochondrial marker protein TOM20 with lysosomal marker protein LAMP1) in aortic media and a 76% reduction in cultured VSMCs in comparison to older HCR rats. Mitophagy levels did not differ significantly between young LCR and HCR rats. The autophagic vacuole formation rate was a 12-fold lower in old LCR than in old HCR aortic VSMCs, suggesting that impaired mitophagy may be responsible for accumulation of mtDNA-derived damage associated molecular patterns (mtDNA DAMPs). Treatment with various inducers of mitophagy (rapamycin, deferiprone, and MitoTEMPO) significantly increased mitophagy and decreased mtDNA DAMPs levels in old LCR VSMCs. This was also associated with a reduction in inflammasome activation, mitochondrial dysfunction, and ROS levels. We conclude that impaired mitophagy causes accumulation of DAMPs and inflammasome activation, inducing aortic stiffness and dysfunction in old age LCR rats.
Abstract 15567: Pulmonary Artery Catheter Use is Associated With Lower Mortality in Cardiogenic Shock, Especially in Heart Failure Related Shock
Authors: Kanwar Manreet , Blumer Vanessa , Sinha Shashank S , Hernandez-Montfort Jaime , Garan Arthur Reshad , Zhang Yijing , LI BORUI , Baca Paulina , Dieng Fatou , Mahr Claudius , Harwani Neil , Burkhoff Daniel , Kapur Navin K
Published: June 2023

Introduction:
Recent analyses have shown an increase in the use of pulmonary artery catheter (PAC), with an associated survival benefit in patients with cardiogenic shock (CS). The impact of PAC use on clinical outcomes among patient with CS due to heart failure (HF-CS) versus acute myocardial infarction (AMI-CS) remains unclear.

Methods:
The Cardiogenic Shock Working Group (CSWG) registry contains real-world data from patients hospitalized with CS across 17 clinical sites between 2016-2020. For this analysis, outcomes in CS patients were analyzed based the presence or absence of PAC, severity of CS (Society for Cardiovascular Angiography and Interventions or SCAI staging) and underlying shock etiology (AMI-CS or HF-CS).

Results:
Of the 1,890 CS patients included in this analysis, 1473 (77.9%) received a PAC during hospitalization, 593 (31.4%) had AMI-CS (PAC: 485 [81.8%], No PAC: 108 [18.2%]) and 1055 (55.8%) had HF-CS (PAC: 834 [79.1%], No PAC: 221 [20.9%]). Use of PAC was associated with greater drug/device utilization, mechanical ventilation and hospital length of stay, regardless of CS etiology (all p<0.001). Patients with a PAC had significantly less in-hospital mortality in the overall (31% vs 41%, p<0.001) and HF-CS cohort (21% vs 38%, p<0.001), with more significant differences seen in SCAI stages C (p<0.001) and D shock (p=0.01). Presence of PAC was not associated with in-hospital mortality among AMI-CS patients (43% vs 41%, p=0.63), regardless of SCAI stage (all p>0.1). PAC patients were more likely to undergo heart replacement therapy (HRT) when compared to those with no PAC (p<0.05)
(Table).

Conclusions:
Using a large contemporary real-world dataset of CS, we identified that PAC use is associated with less in-hospital mortality and greater HRT compared to patients not receiving a PAC, particularly among HF-CS patients. Further, prospective efforts to define which CS populations derive the greatest benefit from PAC-guided interventions are needed.
Abstract 15601: Optimal Virtual Monoenergetic Settings for Spectral Ct With a Dual-Layer Detector: A Breakthrough in Evaluating the Patency of the Coronary Arterial Lumen With a Metallic Stent in a Real-World Study
Authors: Funabashi Nobusada , Misumi Kazuo
Published: June 2023

Introduction:
Evaluation of the patency of a metallic stent in coronary arteries using CT is difficult because the metallic stent causes a blooming artifact. The CT values of metallic stents are influenced by tube kilovoltage (kV). Recent spectral CT with a dual-layer detector can generate CT images at any kiloelectron voltage (keV) (range: 40-200) after ordinary acquisition using virtual monoenergetic settings (VMS).

Hypothesis:
Using a new spectral CT, we can determine the optimal VMS for evaluating the patency of stents in coronary arteries.

Methods:
We performed enhanced 128 slice Spectral CT 7500 scans with a dual-layer detector in 35 patients with CAC who underwent implantation of a metallic stent in coronary arteries (tube voltage: 120 kV). After scanning, VMS images at various keV values were created from the spectral-based images. We measured the mean CT values of the metallic stent, coronary artery calcification (CAC), lumen in the left coronary artery (LCA), and fat tissue around the coronary arteries in the axial images at each keV in the early phase with contrast.

Results:
Lower keV values were associated with markedly increased mean CT values of the metallic stent and CAC. The CT values of the lumen in the LCA were moderately increased. Conversely, the CT values of fat tissue were slightly decreased. The greatest differences in mean CT values between the metallic stent and lumen in the LCA were observed at 40-50 keV, however, those between the metallic stent and CAC were observed at 110-180 keV. The optimal keV for achieving the best contrast between the CT values of the metallic stent, CAC, and the lumen in the LMA at each patient was influenced by age, male sex.

Conclusions:
The metallic stent, CAC, lumen of the LCA, and fat tissue exhibit unique characteristics. When conventional rather than spectral CT is used to evaluate the patency of a metallic stent in coronary arteries, it is necessary to determine the optimal tube voltage based on the age and male sex of the patient.
Abstract 15610: Long Term Health Related Quality of Life Outcomes Across the Therapeutic Spectrum in Patients With Congenitally Corrected Transposition of Great Arteries
Authors: Salim Hammoud Miza , Gupta Sohini , McCloskey Olivia , Chen Lin , Tucker Dominique L , Doh Chang Yoon , Barrios Paola , Komarlu Rukmini , Najm Hani K , Karamlou Tara
Published: June 2023

Introduction:
Congenitally corrected transposition of the great arteries (ccTGA) encompasses a diverse morphologic cohort with multiple treatment pathways. We characterized long term health related quality of life (HR-QoL) outcomes in adult patients with ccTGA across the therapeutic spectrum.

Hypothesis:

Methods:
Between 1995-2020, 240 ccTGA patients were treated at the Cleveland Clinic. Of these, 59 adults were prospectively assessed with a hybrid PROMIS-10 and MacNew HR-QoL questionnaire at median follow-up of 10 years. Mental and physical scores were captured utilizing PROMIS 10 questionnaire, and social score from MacNew instrument. One-sample non-parametric sign tests evaluated deviations from referenced normative values. Differences among anatomic (AR) and physiologic repairs (PR) were assessed with Wilcoxon rank-sum test. Confidence intervals (95%) around measured means were generated from 1000 bootstrap samples.

Results:
Thirty one (18%) patients were female with median presentation age 26.3 years. Sixteen (27%) patients had PR, 12 (20%) had AR, 12 (20%) were medically managed, 5 (8.5%) had heart transplant and 3 (5.1%) underwent Fontan. Social scores were higher than the population norms (median= 6,
P
=.0002) for the overall cohort, but physical scores were lower than normative values (median = 44,
P
=.0183).Mental functioning was equivalent to normative values (median = 50,
P
=.9). AR and PR scores across domains were similar (Table 1).

Conclusions:
Adult patients living with ccTGA across the treatment spectrum have lower physical functioning than population norms. Despite these perceived physical impediments, social and mental functioning are unaffected. PR and AR had equivalent HR-QoL, providing important data to inform patient selection and triage.
Abstract 15618: Contemporary and Emerging Training Pathways for Acute Care Cardiology: A Systematic Review
Authors: Rose Scott , Mehta Aryan , Bansal Mridul , Vallabhajosyula Saraschandra
Published: June 2023

Introduction:
Several studies have described trends toward increasing complexity and illness-severity of patients admitted to the cardiac intensive care units (CICU). This has necessitated the development of training pathways in critical care cardiology (CCC). Hybrid training in combinations of interventional cardiology (IC), advanced heart failure and transplant cardiology (AHFTC), and CCC have also gained interest. This review sought to outline current and proposed pathways for hybrid training in acute cardiovascular care.

Methods:
We performed a systematic review of articles describing training pathways for dual certification in CCC, as well as hybrid models for training in a combination of IC, CCC, and AHFTC. PubMed, EMBASE, and CINAHL were searched from 01/01/2000 to 04/28/2022. Pathways through pediatric and adult non-internal medicine specialties were excluded.

Results:
Of 2,236 citations, 18 studies were included in the final analysis. Most pathways included sequential CCC training, i.e. traditional cardiovascular fellowship and 1-2 additional years of critical care medicine, although integrated 4-year programs were noted to be emerging. Hybrid models for advanced training in two or more complementary subspecialties, including CCM, AHFTC, and IC, have been described, each with their own strengths and limitations. Additional expertise in advanced therapies such as mechanical circulatory support, the longitudinal AHFTC practice, and the combination of procedural and intensivist skills for management of diseases such as acute coronary syndromes were the stated benefits of these combined models. Alternatively, some advocate for incorporating focused CC training into a single year of IC or AHFTC fellowship. However, this may limit the time required to gain expertise in all areas of advanced training and is insufficient for board certification in CCM.

Conclusion:
Despite the growing need, there are limited dedicated pathways to train the contemporary acute care cardiologists. Further study is needed to consolidate training to encourage the growth and development of this field.
Abstract 15631: Predictors of Functional Mitral Regurgitation Progression vs Regression in Patients With Non-Ischemic Cardiomyopathy: A Multi-Modality Study
Authors: Turkmani Mustafa , Wang Tom Kai Ming K , Liu Gui Ting , Salam Donna , Kapadia Samir R , Krishnaswamy Amar , Griffin Brian P , Flamm Scott D , Tang Wai Hong W , Kwon Deborah H
Published: June 2023

Background:
Functional mitral regurgitation (FMR) is associated with poor prognosis, however the determinants of FMR progression are not well understood. We aimed to determine clinical and cardiac magnetic resonance imaging (CMR) factors associated with FMR progression in patients with non-ischemic cardiomyopathy (NICM) who underwent baseline and follow-up echocardiography.

Methods:
NICM patients undergoing CMR between 12/2002-12/2017 with baseline (within 90 days of CMR) and follow-up echocardiography were evaluated. Progressive FMR was assessed by echocardiography based on reported FMR severity (none, mild, moderate, moderate-severe, severe). Associations between clinical and CMR parameters (left ventricular and left atrial (LA) size and function, late gadolinium enhancement, and mitral valve (MV) geometry quantification) and progressive FMR were assessed by univariable and stepwise multivariable linear regression.

Results:
Amongst 311 NICM patients (age 53±15.7 years, female 121 (38.9%)). A total of 17 patients (5.5%) had at least 1-grade of deterioration in FMR, while 66 patients (21.2%) had at least 1-grade of improvement. Univariable and multivariable analyses results are listed in the table. Mean baseline mitral regurgitant fraction by CMR was 14% ± 13%, while the mean of mitral regurgitation severity by echo was in the mild range (1.28 ±1). Baseline FMR grade by TTE (P<0.001), CMR-LA volume indexed (P=0.003), sphericity ratio (P=0.005), MV annular mean indexed (P=0.027), and BMI (P=0.044) were independently associated with significant change in FMR.

Conclusion:
CMR-derived remodeling, LA and MV geometry parameters predicted progressive vs regression in FMR. Further studies are needed to determine if CMR predictors of FMR progression vs regression can improve selection criteria for procedural intervention vs guideline-directed medical therapy.
Abstract 15644: Health-Related Quality of Life in Survivors of Cardiac Arrest: A Community-Based, Age-Stratified Analysis
Authors: Bhanji Ziana , Norby Faye L , Sorenson Chad , Dizon Bernadine , Seifer Madison , Uy-Evanado Audrey , Sargsyan Arayik S , Jui Jonathan , Salvucci Angelo , Chugh Sumeet S , Reinier Kyndaron
Published: June 2023

Introduction:
Health-related quality of life (HRQoL) is affected after out-of-hospital cardiac arrest (OHCA), but HRQoL scores in OHCA survivors are largely reported as a homogenous group. We performed a community-based evaluation of HRQoL scores in OHCA survivors and report the results stratified by age.

Methods:
We captured all residents of Multnomah Co., OR, and Ventura Co., CA who survived an OHCA during 2015-2021. We consented 197 survivors into our study and asked survivors to complete the Short-Form-36 Health Survey Version 1 (SF-36) to assess HRQoL at the time of the interview. The median time from OHCA to SF-36 interview date was 10 months. Scores for the 8 health domains of the SF-36 were calculated, and we used an independent sample t-test to compare the continuous scores of OHCA survivors to age-and-sex-standardized scores in the general population.

Results:
Of the 185 adult survivors who completed the SF-36 interview data (94% of those consented), the mean (SD) age was 60 (15) years and 58% were male. Overall, survivors had lower physical (p=0.0002) and emotional (p=0.01) health scores and lower social function (p=0.05) compared to the general population. We observed several age-domain interactions and split our sample into 3 age categories to explore HRQoL by age. Younger individuals (age 18-44, n=23) had similar HRQoL compared to the same ages in the general population. Older individuals (age 65+, n=78) also experienced similar HRQoL but reported better general health compared to the general population. Middle-aged survivors (age 45-64, n=84) reported lower physical function (p=0.05), physical problems (p=0.0009), emotional health (p=0.04), and social function (p=0.05) scores compared to the general population (Figure).

Conclusion:
HRQoL scores in survivors of OHCA were affected by age and were observed to be lowest in the middle-age subgroup. Targeted interventions in middle-aged survivors may have the greatest impact on improved HRQoL following OHCA.
Abstract 15645: Posterior Mediastinal Hematoma as a Rare Complication of Anti-Coagulation Use - A Case Report and Literature Review
Authors: arshad verda , Akbarshahi Nataly , Ahmad Saad S
Published: June 2023

Introduction:
Posterior mediastinal hematoma (PMH) is a rare complication of anti-coagulation (AC) use. We present a complex case of a patient with a sub-massive pulmonary embolism (PE) whose care was complicated by PMH causing airway obstruction following thrombectomy.

Case:
A 60-year-old male with a history of prostate cancer in remission presented after a syncopal event. On admission, he was afebrile, mildly tachycardic (100bpm), normotensive (135/91), with no oxygen requirement. Laboratory data showed high sensitivity troponin 244 ng/L and BNP 82 pg/ml. CTPA revealed a saddle PE with right heart strain (PESI score 100). He was initiated on anticoagulation and underwent successful mechanical thrombectomy using a Penumbra aspiration catheter. He had acute respiratory failure later that evening, necessitating intubation. Repeat CTPA showed increased clot burden and new onset PMH (Figure 1). Of note, his AC was continued due to clot burden. A repeat thrombectomy was performed using the FlowTriever System Device (Inari Medical, Irvine, CA). Despite this intervention, he continued to struggle with extubation, and a new stridor was noted. Bronchoscopy revealed external compression of proximal trachea correlating with the PMH location. He was deemed too high risk for evacuation of the PMH. Therefore, he underwent tracheostomy to bypass the area of compression. This subsequently allowed for successful extubation.

Discussion:
While thrombectomy can cause iatrogenic bleeding, no bleeding was seen on the post-procedure angiogram in our patient. Thus, these findings are attributed to PMH. PMH has been reported 6 times in literature (table 1), one associated with PE. Management options include hematoma evacuation or holding AC and performing serial follow up imaging. Our patient did not undergo evacuation of hematoma, and a tracheostomy was used instead to bypass the obstruction. This highlights the need to individualize management of these complex patients.
Abstract 15669: Frataxin Deficiency-Dependent Gene Expression in Friedreich Ataxia Ipsc-Neurons and Cardiomyocytes
Authors: Burgos Angulo Mariana , Bertalovitz Alexander V , Argenziano Mariana A , yang jiajia , Zesiewicz Theresa O , Patel Aarti , McDonald Thomas V
Published: June 2023

Introduction:
Friedreich's ataxia (FA) is an autosomal recessive disease where expanded GAA trinucleotide repeat expansion in the first intron of the
FXN
gene results in transcriptional repression of the encoded protein, frataxin. FA is a progressive neurodegenerative disorder, but a primary cause of morbidity and mortality is hypertrophic cardiomyopathy, occurring in 60% of the patients. Several functions of frataxin have been proposed, but none of them can fully explain why its deficiency causes the FA phenotypes nor why the most affected cell types are neurons and cardiomyocytes.

Hypothesis:
We hypothesize that frataxin deficiency plays unique roles in FA-affected neural and cardiac cells.

Methods:
We generated induced pluripotent stem cell (iPSC)-derived neurons (iNs) and cardiomyocytes (iCMs) from an FA patient and normalized FXN expression via lentivirus without altering genomic GAA repeats at the FXN locus. Then we performed transcriptional profile and differential expression analysis to identify the dysregulated genes and enriched pathways.

Results:
Differential expression analysis identified 127 differentially expressed genes between transduced and non-transduced iNs (37 upregulated and 90 downregulated). The most significant enriched processes and pathways for iNs were Glycolysis (GO:0006096, KEGG:00010), ATP generation (GO:0006757), and ADP and Pyruvate metabolic processes (GO:0046031, GO:0006090). 417 genes were differentially expressed between transduced and non-transduced iCMs (320 upregulated and 97 downregulated). Enrichment analyses for iCMs demonstrated that frataxin deficiency affected the extracellular matrix organization (GO:0030198), collagen fibril organization (GO:0030199), and extracellular matrix receptor interaction (KEGG:04512). Genes in these pathways were differentially expressed when compared to a control and restored to control levels when FA cells were supplemented with frataxin.

Conclusions:
These results offer novel insight into specific roles of frataxin deficiency pathogenesis in neurons and cardiomyocytes. Glucose metabolism appears preferentially perturbed in neurons while pathways leading to fibrosis may play an important role in cardiac tissue.
Abstract 15725: Non Existing Pacemaker: A Complication of Kyphoplasty
Authors: Ammari Nadim , Kovalenko Iuliia , Golubykh Konstantin , Patel Aashay
Published: June 2023

Introduction:
Diagnosis of cement emboli remains challenging due to heterogenicity of diagnostic findings. We describe a case of cement embolism interpreted as abandoned pacemaker leads.

Case description:
A 76-year-old female underwent lumbar kyphoplasty. In the post-anesthesia care unit, she developed multiple asymptomatic episodes of non-sustained ventricular tachycardia. Her lab work including basic metabolic panel, electrolytes, and troponin was unremarkable. A transthoracic echocardiogram (TTE) revealed intracardiac foreign body interpreted as abandoned pacemaker wires originating at the superior vena cava with one terminating in the right ventricular (RV) apex and the other in the right atrial (RA) appendage (Figure 1). Chest computer tomography (CT) confirmed intracardiac pacemaker wires. The patient denied any history of pacemaker placement. TTE and CT images were reviewed again with multiple other opinions stating that the foreign body represented dense cement from the vertebral body. It exited through a paravertebral vein into the inferior vena cava making its way to the right heart (Figure 2). Coronary angiography confirmed an elongated cement embolus. The patient underwent cement removal through sternotomy.

Conclusions:
Diagnosis of cement embolism may remain challenging as it can mimic any foreign bodies including pacemaker wires. Suspicion for the diagnosis should remain high in any patient who underwent kyphoplasty and developed cardiac arrhythmias or other cardiac symptoms.
Image 1.
A - Pacemaker lead passing through RA to the RV.
Image 2.
A- cement material in the right heart. B- Cement extravasating through right paravertebral vein.
Abstract 15756: The Beneficial Impact of Primary Care Providers’ Supply on the Cardiovascular Mortality Rates in the United States: A Nationwide Population Analysis 2011-2019
Authors: Abohashem Shady , Aldosoky Wesam , Sayed Ahmed , Abbasi Taimur , Dar Tawseef
Published: June 2023

Introduction:
United States is facing an increasing shortage of primary care physicians (PCP) and health care demands. However, data on the relationship between PCP availability and burden of cardiovascular mortality (CVM) and related disparities, is limited.

Hypothesis:
Herein, we evaluate the nationwide impact of county PCP levels on CVM in overall and within disparate populations stratified by age, sex, and race/ethnic subgroups.

Methods:
PCP is calculated as the ratio of PCPs to the population, using data from National Center for Health statistics. Age-adjusted CVM rates (ACVM) between 2011 to 2019, were obtained using CDC database. Behavioral Risk Factor Surveillance was utilized to acquire county characteristics and confounders. Poisson linear mixed model was employed.

Results:
Of 3143 U.S. counties, 2900 counties (62% white; 51% female; 14% aged ≥65) had data available on ACVM and PCP.In a multivariate model adjusted for demographics, CV risk, socioeconomic, and environmental factors, higher PCP levels significantly associated with lower ACVM (Standardized IRR: 0.979; 95% CI: 0.972 to 0.986), which translates to 4.8 fewer CV deaths each year (AYD). This effect was relatively higher in middle-aged [45-64] (IRR: 0.967) versus elderly [≥65] (IRR: 0.980), males (IRR: 0.981) versus females (IRR: 0.972), and within Whites (IRR: 0.976). Notably, the relative impact of PCP was greatest in [45-64] Whites (IRR: 0.963), while the absolute impact was highest amongst ≥65 males with 36 fewer CV deaths each year. (
Figure
).

Conclusions:
Higher PCP supply is robustly associated with lower ACVM, and that beneficial effect is most evident amongst both age and sex subgroups as well as non-Hispanic whites. Moreover, this association is significantly independent of potential confounders that have a plausible association with CVM. Therefore, population-level strategies to promote primary care access, are imperative for reducing the burden of CVM and promoting health equity.
Abstract 15762: Model for Home-Based Physical Activity Program Utilizing Telemedicine for Fontan Patients
Authors: Fernie Julie , Wylie Lisette , Schafer Michal , Miyamoto Shelley D , Jacobsen Roni M
Published: June 2023

Introduction:
Fontan patients have decreased exercise capacity. The COVID-19 pandemic exacerbated the variable adherence to hospital-based physical activity programs, which improve exercise capacity and attenuate the expected decline in aging Fontan patients. A positive pediatric exercise capacity trajectory has been reported to predict better adult Fontan outcomes. We designed and implemented a reimbursable 12-month, home-based, individualized physical activity program for Fontan patients utilizing a telemedicine model.

Methods:
Eligible participants must be able to complete a cardiopulmonary exercise test (CPET) and demonstrate ability to adhere to a 12-month exercise prescription. Assent and consent are obtained. CPET and informal surveys of physical activity self-efficacy are completed at enrollment and graduation. An individualized exercise prescription is provided, with focus on skeletal and respiratory muscle strength training and aerobic activities. Participants receive a Garmin© device to monitor adherence. A cardiologist, nurse coordinator, and exercise physiologists comprise the team and regularly communicate with participants, starting with weekly check-ins that gradually space out to monthly as participants gain confidence.

Results:
Since program initiation, 9 participants have completed the program and 3 remain active. For the 9 graduates, all scheduled in-person and telehealth visits were completed. At completion of the 12-month program compared to baseline, there was no difference in maximal or submaximal oxygen consumption (VO2), peak heart rate, or oxygen saturation, but there was a significant increase in systolic blood pressure (144 ± 16 vs 162 ± 15, p-value 0.004) and minute ventilation (68.8 ± 19.3 vs 76.8 ± 22.1, p-value 0.012) at peak exercise. Per subjective report, all graduates had increased confidence related to exercise. There were no adverse events in any participant.

Conclusions:
A novel, home-based, 12-month individualized physical activity program using telemedicine was successfully implemented, with no adverse events. A larger study is needed to better assess change in VO2 and other qualitative and quantitative parameters, although the lack of decline in exercise capacity is encouraging.
Abstract 15828: Baseline Hs-ctnt Concentrations Within the Sex-Specific Reference Range and Index Mortality in Emergency Department Patients
Authors: Sandoval Yader , Lewis Brad , Gulati Rajiv , Jaffe Allan S
Published: June 2023

Background:
High-sensitivity (hs) cardiac troponin (cTn) assays quantifies cTn in most healthy men and women. Whether quantifiable cTn concentrations below the 99
th
percentile upper-reference limit have short term prognostic implications in emergency department (ED) patients remains uncertain.

Methods:
Multicenter (n=22) United States (US) cohort of ED patients undergoing at least one hs-cTnT measurement (CV Data Mart Biomarker cohort). For this assay, the lowest reportable concentration is <6 ng/L. Sex-specific 99
th
percentiles of 10 ng/L for women and 15 ng/L for men were used. The primary outcome was index hospitalization mortality.

Results:
A total of 85610 patients were examined, including 43043 women and 42567 men. A total of 775 index hospitalization deaths (0.91%) occurred, including 361 (0.84%) in women and 414 (0.97%) in men. Among women, baseline hs-cTnT concentrations were non-quantifiable (<LoQ) in 37.5%, quantifiable (LoQ-99
th
) in 21.6%, and increased >99
th
percentile in 40.9%. Among men, baseline hs-cTnT concentrations were non-quantifiable (<LoQ) in 20.0%, quantifiable (LoQ-99
th
) in 37.4%, and increased >99
th
percentile in 42.6%. Patients with higher concentrations were more likely to be older and had more comorbidities. Continuous baseline hs-cTnT (log) were associated with a higher odds of index hospitalization mortality (OR 1.26, 95% CI 1.24-1.28). Following multivariable analyses, quantifiable hs-cTnT (LoQ-99
th
) also were associated with index hospitalization mortality in all patients (OR 2.07, 95% 1.22-3.53), and in both women (OR 3.13, 95% CI 1.51-6.50) and men (OR 2.17, 95% 1.28-3.69) (Figure).

Conclusions:
Hs-cTnT concentrations within the reference range are more common in men than in women. Quantifiable hs-cTnT concentrations within the sex-specific reference range are associated with a higher risk of index hospitalization mortality, with a larger prognostic effect in women than in men.
Abstract 15837: Decreased Placental Blood Flow in Fetuses With Congenital Heart Disease is Associated With Placental Vascular Abnormalities and Impaired Fetal Growth
Authors: Josowitz Rebecca , Ho Deborah , Shankar Somya , Linn Rebecca , Tian Zhiyun , Gaynor James W , Rychik Jack
Published: June 2023

Introduction:
Studies suggest the placenta is abnormal in fetuses with congenital heart disease (CHD), possibly due to shared abnormal vascular developmental pathways. Umbilical venous volume flow (UVVF) is a validated Doppler-derived noninvasive imaging method to assess blood flow from placenta to fetus. We previously demonstrated that mid-gestational UVVF is decreased in fetuses with CHD compared to controls. We hypothesize that decreased UVVF in fetuses with CHD is associated with placental vascular abnormalities as well as impaired fetal growth.

Methods:
Pregnant women carrying fetuses with CHD (n=38; n=29 single ventricle (SV); n=8 TOF, n=1 d-TGA) or without (n=38) were enrolled in a prospective case-control study. UVVF and combined cardiac output (CCO) were measured during second trimester fetal echocardiograms (echo). Postnatal placentas were analyzed and assigned a placental abnormality severity score (PASS) based on the degree of lesions associated with fetal vascular malperfusion (FVM) and chronic inflammation (CI). Biometrics were collected for all newborns. T-tests or Fisher’s Exact tests were performed to assess statistical significance.

Results:
Gestational age (GA) at time of fetal echo was slightly greater for the CHD group (Table). All CHD fetuses as well as subgroup analysis of SV only had decreased UVVF indexed to fetal weight (UVVF/Wt) and to CCO (UVVF/CCO). Placental PASS analysis demonstrated higher grade FVM and CI lesions in fetuses with CHD. Fetuses with CHD were born earlier and had decreased birth weight z-scores compared to controls.

Conclusions:
Fetuses with CHD demonstrate decreased placental blood flow in utero, higher grade placental lesions associated with FVM and CI, and decreased birth weight. UVVF reflects characteristics of abnormal placental pathology and may be a useful marker of placental malperfusion in fetuses with CHD. Future study looking at association of UVVF and clinical outcomes is warranted.
Abstract 15840: Comparison of Risk Factors for Single, Double, and Multivessel Coronary Artery Disease in a Cohort Undergoing Coronary Revascularization
Authors: Shabbir Muhammad Asim , Ehtesham Moiz , Amjad Waseem
Published: June 2023

Introduction:
Hypertension (HTN), dyslipidemia (HLD), smoking, obesity, and diabetes (DM), peripheral arterial disease (PAD) are known risk factors for coronary artery disease (CAD). However, it is not clear if one risk factor is related to causing higher plaque burden than others. We attempted to find relationship of these risk factors with number of occluded coronary arteries (>50% stenosis) to assess plaque burden.

Methods:
Retrospective analysis of patients admitted to a tertiary care center undergoing coronary revascularization (PCI or CABG) for acute myocardial infarction (AMI) from May 2019 - May 2021. Patients were classified based on the number of occluded coronary vessels: single vessel disease (SVD), 2 vessel disease (2VD), and >2 or multivessel disease (MVD). CAD risk factors were analyzed. CAD burden was assessed by number of vessels showing >70% stenosis angiographically. The relationship between CAD risk factors and CAD burden was analyzed via univariate and multivariate analysis.

Results:
A total of 434 patients were included. Mean age was 56 ± 11 years with 61% Caucasians, 33% African Americans (AA), and 6% Hispanics. Females were 39.4%. Patients with SVD, 2VD, and MVD, were 264 (60.8%), 101 (23.3%) and 69 (16%) respectively. Smoking and diabetes were more prevalent in SVD group, while AA race was associated with higher incidence of MVD (table 1). HTN, HLD, diabetes, obesity, smoking, PAD, CKD were statistically similar with respect to CAD burden. On multivariate analysis, AAs {OR 0.13 [0.07-0.23]} and Hispanics {OR 0.22 [0.09-0.54]} had a lower prevalence of SVD compared to Caucasians. AA had higher odds of MVD {6.2 [2.9-12.9]} shown in table 2. Mortality was higher in MVD group compared to SVD (24.6% vs. 40.6%, p=0.01).

Conclusions:
African American patients had a higher CAD burden when presenting with AMI. HTN, HLD, diabetes, obesity, PAD, smoking and CKD were statistically similar when compared for CAD burden.
Abstract 15870: Integrated Transcriptomic and Proteomics Analyses Identify Lipid Metabolism as a Key Regulator of RV Size and Function in a Porcine Pulmonary Artery Banded Model
Authors: Mendelson Jenna , Doyle Michelle , Hartweck Lynn , Mills Lauren , Kalra Rajat , Martin Cindy M , Prins Kurt W
Published: June 2023

Introduction:
Right ventricular (RV) dysfunction is the leading cause of death in pulmonary arterial hypertension (PAH), but the molecular determinants of RV dysfunction are not well defined. In addition, most molecular evaluations of RV dysfunction use small animal models, and data from large animal models is sparse.

Methods:
Control and pulmonary artery banded (PAB) male piglets were subjected to cardiac MRI to quantify RV ejection fraction (EF), mass, and end systolic volume (ESV). Total RNA was isolated from RV free wall specimens and subjected to Next Gene RNAsequencing. RV mitochondrial enrichments were analyzed with quantitative mass spectrometry to define RV proteome changes. Bioinformatics analyses integrated transcriptomics, proteomics, and MRI data to identified pathways associated with RV dysfunction, hypertrophy, and volume.

Results:
Both transcriptomic and proteomic profiling revealed significantly different molecular signatures when comparing control to PAB piglets. Both analyses identified metabolism of lipids, lysosome, and mitochondrial fatty acid beta-oxidation pathways were associated with RVEF, while dilated cardiomyopathy, and arrhythmogenic RV cardiomyopathy pathways correlated with RV mass, and metabolism, metabolic pathways, citric acid cycle, and respiratory electron transport pathways were associated with RVESV. Fatty acid metabolism was identified on our analyses, and ferroptosis, a nonapoptotic form of cell death initiated by lipid peroxidation, was associated with RVESV and RV mass. Finally, in addition to coding genes we identified 72 lncRNAs that were strongly (r>|0.85|) associated with RVEF.

Conclusions:
A combined proteomics and transcriptomics analysis identified multiple lncRNAs and lipid metabolism pathways associated with pathological RV remodeling and RV function. Future studies are needed to define how modulation of these pathways could impact modulate RV size and function in large animal models.