bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 12673: An Unsupervised Machine-Learning-Based Approach Elucidates the Prognostic Value of Symptom Clusters in Heart Failure Patients Evaluated in the Emergency Department
Authors: Kraevsky-phillips Karina , Bouzid Zeineb , Ahmad Abdullah , Faramand Ziad , Al-Zaiti Salah S
Published: April 2024

Introduction:
Heart failure (HF) patients experience symptoms in clusters and growing evidence suggests that these clusters are predictive of future events. We sought to study the prognostic value of symptom clusters in HF patients seeking emergency care.

Methods:
This was a secondary analysis of a prospective observational cohort study of consecutive patients seen for chest pain (CP) or equivalent symptoms in the emergency department (ED) of three UPMC-affiliated tertiary care hospitals. Analysis included only patients with known HF. An independent reviewer extracted key data elements from electronic health records, including 12 subjective symptoms reported by patients at time of initial evaluation. Primary outcome was 30-day major adverse cardiac events (MACE) adjudicated by two independent reviewers (NCT04237688, clinicaltrials.gov). Secondary outcome was HF exacerbation. L2 norm and sign function were applied to the data matrix to standardize and normalize data. Principal component analysis (PCA) was used to reduce symptom dimensionality and resulting eigenvalues were fed into a k-means clustering algorithm to derive group centers. Association between cluster membership and outcome data was assessed using logistic regression. Analyses were completed using Python 3.8.

Results:
The sample included 438 patients (age 66 ± 14; 45% females, 49% Black, 18% HF exacerbation, 32% MACE). PCA identified seven main components that were mapped by k-means to two patient clusters: cluster A (n=204, 47%) and cluster B (n=234, 53%). Compared to cluster A, cluster B exclusively included patients with dyspnea (100% vs 0%), more patients with cough/flu-like symptoms (15% vs 4%), and diaphoresis (14% vs 9%). Those patients were significantly more likely to be Black (53% vs 43%), diabetic (53% vs 42%), and have COPD (44% vs 30%). They were also triaged at higher risk with HEART score >4 (64% vs 56%), translating into longer median length of stay (2.3 vs. 1.6 days). Patients in cluster B were more likely to have HF exacerbation (OR = 1.8, 95% CI 1.1-3.0) and to experience 30-day MACE (OR = 1.8, 95% CI 1.2-2.7).

Conclusion:
Clusters indicate HF patients seen in the ED for CP who report dyspnea should be triaged as high risk and evaluated for more aggressive care and closer follow up.
Abstract 12771: HDAC Inhibition With Quisinostat Reduces Pulmonary Vascular Remodeling in Experimentally Induced Pulmonary Arterial Hypertension
Authors: Sun Xiaoqing , Hagdorn Quint , Van Der Feen Diederik , Peters Eva L , Schalij Ingrid , Schilders Kim A , Dijke Peter , vonk noordegraaf anton , De Man Frances S , Berger Rolf M , Goumans Marie Jose , Bogaard Harm , Kurakula Kondababu
Published: April 2024

Introduction:
Histone deacetylases (HDACs) expression and activity are increased in pulmonary arterial hypertension (PAH). Although inhibiting HDACs has been promoted as a treatment for PAH, results from preclinical studies were equivocal and raised concerns regarding safety. Quisinostat is a “second generation” HDAC inhibitor, which is highly potent against HDAC1 and elicits a prolonged pharmacodynamic response.

Hypothesis:
Quisinostat may exert therapeutic effects in experimentally-induced PAH.

Methods:
HDAC1 expression was measured in lungs and microvascular endothelial cells (MVECs) from control donors and PAH patients. HDAC activity, proliferation and inflammation were measured after quisinostat treatment of PAH MVECs. Chronic quisinostat treatment was tested in three PAH rat models: the Sugen + hypoxia (SuHx), the Monocrotaline shunt flow (MF) and pulmonary artery banding (PAB) model.

Results:
HDAC1 expression is increased in lungs of PAH patients. Quisinostat decreased proliferation and mitigated inflammatory cytokine expression in MVECs. Conditioned medium from quisinostat treated PAH MVECs inhibited the growth of healthy pulmonary artery smooth muscle cells.
In vivo
, quisinostat treatment reduced right ventricular (RV) systolic pressure, RV afterload and total pulmonary resistance in SuHx rats. Further analysis by histology revealed that quisinostat reduced pulmonary vascular remodeling in both SuHx and MF rat models by reducing proliferation and perivascular inflammation. The PAB rat model demonstrated that quisinostat had no independent effect on RV function or remodeling.

Conclusions:
Quisinostat can partly reverse RV afterload and pulmonary vascular remodeling in established experimental PAH and may be a promising intervention for PAH.
Abstract 13095: Persistent Impairment in Peripheral but Not Cerebral Vascular Function in Young Healthy Adults With Long-Term Symptoms From COVID-19
Authors: Nandadeva Damsara , Young Benjamin E , Stephens Brandi Y , Grotle Ann-Katrin , Skow Rachel J , Middleton Angela J , Haseltine Florence P , Fadel Paul J
Published: April 2024

Vascular dysfunction and inflammation are precursors to cardiovascular disease (CVD). Notably, young adults who were symptomatic from COVID-19 during the acute phase of illness (within 4 weeks from diagnosis) have shown to exhibit peripheral vascular dysfunction. Importantly, many young adults report persistent symptoms from COVID-19 for several months, including cognitive difficulties. However, it remains unknown whether vascular dysfunction persists beyond the acute phase of COVID-19 in symptomatic young adults. We tested the hypothesis that peripheral and cerebral vascular function would be blunted in symptomatic (SYM) young adults who are beyond 4 weeks from a COVID-19 diagnosis, compared to asymptomatic adults (ASYM). Since COVID-19 causes inflammation that may negatively impact vascular function, we also hypothesized that serum hsCRP would be elevated in SYM compared to ASYM. We studied 15 otherwise healthy adults (age = 23 ± 1 years; mean ± SE) with a positive lab diagnosis of COVID-19. Eight were SYM (14 ± 1 weeks from diagnosis) while seven were ASYM (13 ± 2 weeks from diagnosis) at time of testing. Brachial artery flow-mediated dilation (FMD; duplex Doppler ultrasound) was performed, and macro- and microvascular function were quantified as FMD% and peak blood velocity after cuff release, respectively. Cerebral vasomotor reactivity (CVMR) was quantified as percent increase in middle cerebral artery blood velocity (transcranial Doppler ultrasound) to rebreathing induced hypercapnia. Serum hsCRP level was measured. FMD was lower in SYM (3.81 ± 0.60%) compared to ASYM (7.10 ± 0.94%, P = 0.010). Likewise, peak blood velocity after cuff release was lower in SYM (47 ± 3 cm/s vs. ASYM: 65 ± 8 cm/s, P = 0.037). However, CVMR was not different between the two groups (P = 0.91). Serum hsCRP was higher in SYM (3.4 ± 1.0 mg/L vs. ASYM: 0.7 ± 0.1 mg/L, P = 0.036). These preliminary results indicate that peripheral macro- and microvascular function remain blunted beyond the acute phase in young adults with persistent symptoms from COVID-19, whereas cerebral vascular function appears unaffected. The extent to which this sustained vascular impairment and elevated hsCRP contributes to increased CVD risk in these otherwise healthy young adults remains to be determined.
Abstract 13096: The Impact of Left Ventricular Outflow Tract Calcium on Hemodynamics and Clinical Outcomes in Patients Undergoing Transcatheter Aortic Valve Replacement With a Contemporary Self-Expanding Valve
Authors: Medranda Giorgio A , Rogers Toby , Case Brian C , Ali Syed , Zhang Cheng , Wang John , WEISSMAN Gaby , Satler Lowell F , Ben-Dor ITSIK , Waksman Ron
Published: April 2024

Introduction:
Left ventricular outflow tract (LVOT) calcium remains a challenge for transcatheter aortic valve replacement (TAVR). Initial data suggests that self-expanding transcatheter heart valve (THV) confer a lower risk. Data on contemporary self-expanding THVs are lacking. We report the results of the CoreValve Evolut Pro Prospective Registry (EPROMPT), which sought to evaluate the real-world performance of the CoreValve Evolut PRO THV in a multi-center prospective observational registry.

Hypothesis:
We hypothesized that the CoreValve Evolut PRO THV would perform well across the entire spectrum of LVOT calcium.

Methods:
The EPROMPT registry (NCT03423459) examined patients across the entire surgical risk spectrum who underwent TAVR using the CoreValve Evolut PRO/PRO+ THV system. Patients were dichotomized based on the degree of their LVOT calcium (none/mild vs. moderate/severe). Patients were followed with 30-day clinical assessment and echocardiography.

Results:
Of the 238 patients included, 151 (63.4%) had CT-defined none/mild LVOT calcium and 87 (36.6%) had moderate/severe LVOT calcium prior to TAVR. Device success was numerically lower in patients with moderate/severe LVOT calcium (98.0% vs. 94.3%; p=0.121). Acute annular rupture occurred in two patients, one with mild and one with severe LVOT calcium. Rates of stroke were very low in both cohorts, with a trend towards more stroke in the moderate/severe LVOT calcium cohort (in-hospital: 2.0% vs. 4.6%; p=0.251 and 30-day: 2.1% vs. 4.9%; p=0.244). Patients with none/mild LVOT calcium saw higher rates of PPM implantation in-hospital (21.2% vs. 9.2%; p=0.017) with a trend at 30 days (22.2% vs. 13.4%; p=0.105). At 30 days there was a trend towards higher rates of >mild PVL in patients with moderate/severe LVOT calcium (1.3% vs. 3.4%; p=0.271). Mean gradients were low and similar in both cohorts (in-hospital: 8.6 vs. 8.2mmHg; p=0.663 and 30 day: 7.6 vs. 7.7mmHg; p=0.797).

Conclusions:
The presence of and degree of LVOT calcium did not significantly impact outcomes using the CoreValve Evolut PRO/PRO+ THV with high device success, excellent clinical outcomes, and hemodynamics.
Abstract 13120: Short-Term Outcomes of Transcatheter Aortic Valve Replacement in Very Low Gradient Severe Aortic Stenosis
Authors: Medranda Giorgio A , Schwartz Richard , Green Stephen
Published: April 2024

Introduction:
Hemodynamic improvements following transcatheter aortic valve replacement (TAVR) have been show to correlate with outcomes. TAVR in patients with severe aortic stenosis (AS) and low mean gradients (MG) (<40mmHg) have demonstrated significant improvements in their MG post-TAVR. However, data on low, intermediate and high-risk patients with severe AS and very low MGs (<20mmHg) are lacking.

Hypothesis:
We hypothesized that patients with very low gradient severe AS see smaller improvements in MG but similar outcomes following TAVR using contemporary transcatheter heart valves (THV).

Methods:
This was a retrospective, observational study of 1114 low-, intermediate- or high-risk patients who underwent TAVR at our institution between 2015-2020. We trichotomized our population based on their pre-TAVR MG (cohort 1 (n=71): <20mmHg, cohort 2 (n=506): 20-39mmHg, cohort 3 (n=537): >40mmHg). We examined pre-TAVR and post-TAVR echocardiographic data. We examined in-hospital, 30-day and 1-year outcomes. Statistical analysis of outcomes was performed using two-sided t-test and one-way ANOVA.

Results:
Among the 1114 who underwent TAVR, 776 utilized the SAPIEN 3 or SAPIEN 3 Ultra THV and 338 utilized the CoreValve Evolut PRO THV. The patients had a mean age of 80.9 years with a mean Society of Thoracic Surgeons score of 6.4%. Patients in cohort 1 (15.4mmHg to 8.4mmHg, p<0.0001), cohort 2 (30.3mmHg to 9.6mmHg, p<0.0001) and cohort 3 (53.4mmHg to 11.6mmHg, p<0.0001) all saw significant improvement in their MG post-TAVR. Patients saw similar rates of death and stroke out to 1 year (Table 1).

Conclusions:
Our study of 1114 low-, intermediate- and high-risk patients who underwent contemporary TAVR demonstrated significant improvements in post-TAVR MGs across all variants of severe AS which translated to excellent short-term outcomes.
Abstract 13148: Cardiometabolic Risk Factors Partially Mediate the Association of Physical Inactivity With MRI Markers of Brain Aging
Authors: Spartano Nicole L , Wang Ruiqi , Yang Qiong , Chernofsky Ariel , Murabito JoAnne M , Ramachandran Vasan S , Beiser Alexa S , Seshadri Sudha
Published: April 2024

Introduction:
Physical inactivity is associated with a higher risk of dementia, and has also been associated with unfavorable brain morphology. It is also clear that cardiometabolic risk factors accelerate the brain aging process.

Hypothesis:
Cardiometabolic risk factors mediate the association of physical inactivity with unfavorable brain morphology.

Methods:
Our investigation included participants from the Third Generation (exam 2) and Offspring (exam 9) cohorts of the Framingham Heart Study who wore an accelerometer for >e10 hours on >e3 days (to measure moderate to vigorous physical activity [MVPA] and steps walked per day), underwent brain MRI scans, and had no dementia, stroke, or missing cardiometabolic risk factor data (n=2416, 54% women, mean age 54.1 years). Higher levels of brain peak width of skeletonized mean (white matter) diffusivity, higher free water, and lower total cerebral brain volume were measured by MRI as markers of brain aging. We examined mediation by the 2017 revised version of the Framingham Stroke Risk Profile (FSRP, using weights for age, prevalent cardiovascular disease, atrial fibrillation, diabetes and smoking status, antihypertension medications and systolic blood pressure) and the homeostatic model of insulin resistance (HOMA-IR) in models of the association of MVPA and steps with brain volume, white matter diffusivity, and free water, adjusting for age, age-squared, sex, wear time, smoking status (for HOMA-IR mediation analysis only), cohort, time from exam to MRI, and season of exam.

Results:
The associations of lower MVPA and steps with lower brain volume, higher white matter diffusivity, and higher free water were partially mediated through FSRP, accounting for 14.1-25.7% (p<0.05) of the total association of physical inactivity with brain aging. The association of fewer steps (but not MVPA) with lower brain volume was mediated by HOMA-IR (20.1% of the total association, p<0.05).

Conclusions:
Our results suggest that the associations of physical inactivity with lower brain volume, poorer white matter microstructure and aggregation of free water in the extracellular compartments of the brain are partially mediated by cardiometabolic risk factors.
Abstract 13179: Rates and Reasons for Emergency Department Use Among US Adults With Congenital Heart Disease
Authors: Hong Jessica M , Sabanayagam Aarthi , Harris Ian S , kouretas peter , Mahadevan Vaikom S , Sano Shunji , Agarwal Anushree
Published: April 2024

Introduction:
The adult congenital heart disease (ACHD) population is growing and highly comorbid, requiring increasing emergency department (ED) use. Data on the rates and characteristics of ED visits can inform appropriate care pathways for ACHD patients.

Methods:
We performed a retrospective study of 16,946 commercially insured beneficiaries with ACHD in the 2016 IBM MarketScan database. Main outcome measures were rates and types of ED visits. Exposures included age, gender, primary beneficiary status, employment status, ACHD severity, cardiovascular (CV) and non-CV comorbidities.

Results:
Mean age was 35.2±14.2 years, 48.8% were female, and 30.5% had severe CHD. 21.1% had at least one ED visit (23.0% for severe vs. 20.3% for non-severe CHD, p<0.001) while 8.1% had >1 ED visit. Patients with ED visits were more likely to be ≥40 years old (41.0% vs 39.1%, p=0.035), female (53.4% vs 47.6%, p<0.001), have severe CHD (33.2% vs 30.0%, p<0.001), CV (33.0% vs 21.8%, p<0.001) and non-CV comorbidities (38.2% vs 23.6%, p<0.001), and less likely to be the primary beneficiary (56.6% vs 51.4%, p<0.001) or employed (29.0% vs 25.6%, p<0.001). The top five conditions for ED visits for all ACHD patients were CV (33.9%), followed by symptoms, signs, and ill-defined (25.4%), injury and poisoning (25%), respiratory (20.8%), and nervous system issues (14.5%). Compared to adults with non-severe ACHD, severe ACHD patients had more ED visits for CV (36.5% vs. 32.6%, p=0.023) and respiratory conditions (24.0 vs. 19.2%, p=0.001). Variables independently associated with ED visits are listed in the table.

Conclusions:
One in five ACHD patients had an ED visit, with cardiac and respiratory conditions being more common among adults with severe than non-severe ACHD. Our findings about the factors associated with ED visits provides information about potential interventions and care pathways that might help reduce the burden of ED visits in this high-risk population.
Abstract 13665: Dapagliflozin Does Not Affect Left Ventricular Remodeling in Patients With Type 2 Diabetes. A Meta-Analysis of Phase IV Randomized Controlled Trials
Authors: Bilal Haris , Saleem Naira , farooqui arafat , Uddin Syed Mohammad Mazhar , Maheshwari Sanjay , Hollander Gerald , Shani Jacob
Published: April 2024

Introduction:
Dapagliflozin is a sodium-glucose co-transporter 2 (SGLT-2) inhibitor approved for the treatment of Type-2 DM. Proposed mechanisms for its cardiovascular benefits include natriuresis, reduction in preload and afterload, and improved cardiac metabolism.

Hypothesis:
Dapagliflozin can reverse left ventricular remodeling in type-2 diabetics.

Methods:
Systematic review was performed to identify phase IV randomized controlled trials (RCTs) evaluating dapagliflozin vs placebo. Mean Difference (MD) of multiple parameters (along with 95% confidence intervals; CI) was extracted to compute pooled MD using RevMan v.5.3. Random effects model was employed when there was significant heterogeneity (>40%, as assessed by I-squared).

Results:
Two RCTs were finalized (n=122; dapagliflozin 60, placebo 62). All patients (males 75, females 47) had type-2 DM and were more than 60 years old. Pooled analysis did not show significant difference in left ventricular remodeling with dapagliflozin as compared to placebo; (LV Mass Index reduction (g/m
2
): MD -0.14, 95% CI -1.12 to 0.85; p=0.78, I
2
=0%). Dapagliflozin reduced systolic (MD -3.66; -7.29 to -0.02; p=0.05, I
2
=0%) and diastolic BP (MD -3.04; -5.75 to -0.32; p=0.03, I
2
=84%). Reduction in weight upto 3.4 kgs (MD -3.42; -4.48 to -2.36; p<0.05, I
2
=59%) and HbA1c up to 3.7% (MD -3.76; -7.35 to -0.17; p=0.04, I
2
=14%) was observed with dapagliflozin. Dapagliflozin use improved hemoglobin (Hb) (MD 1.08; 0.50 to 1.66; p<0.05, I
2
=95%) and hematocrit (Hct) (MD 2.90; 1.99 to 3.80; p<0.05, I
2
=0%). No significant difference in ejection fraction (MD 0.77; -0.97 to 2.51; p=0.87, I
2
=0%), LV End-systolic volume (LV-ESV) (MD -1.02; -3.38 to 1.34; p=0.40, I
2
=0%), LV End-diastolic volume (LV-EDV) (MD -1.08; -6.40 to 4.24; p=0.69, I
2
=0%), stroke volume (SV) (MD 1.19; -1.66 to 4.04; p=0.41, I
2
=0%) and heart rate (MD -2.15; -5.14 to 0.85; p=0.16, I
2
=0%) was seen between two groups. Similarly, no change in creatinine (MD 2.14; -0.53 to 4.82; p=0.12, I
2
=0%) or eGFR (MD -1.34; -5.02 to 2.35; p=0.48, I
2
=24%) was observed.

Conclusion:
Dapagliflozin had no statistically significant effect on cardiac remodeling. However BP, weight, HbA1c, Hb and Hct improved significantly with dapagliflozin as compared to placebo over one year.
Abstract 13669: Secondary Prevention Aspirin Trends in the Upper Midwest, 2015-2019
Authors: Vant Hof Jeremy R , Duval Sue , Eder Milton , Oldenburg Niki C , Finnegan John , Luepker Russell
Published: April 2024

Introduction:
Secondary prevention (SP) aspirin use after a cardiovascular disease (CVD) event is strongly recommended and supported by consistent guidelines. Aspirin recommendations for primary prevention have varied over time, recently becoming more restrictive after clinical trials published in 2018.

Hypothesis:
Negative scientific and media attention regarding primary prevention aspirin would result in unintentional decline in SP aspirin use.

Methods:
We conducted random telephone surveys of adults aged 45-79 years in the upper Midwest in 2015, 2017, and 2019. We queried participant demographics, CVD history and risk factors and aspirin use. Using logistic regression, we evaluated i) the trend in SP aspirin use over the 3 surveys and ii) characteristics associated with SP aspirin non-use, adjusting for other antithrombotic use.

Results:
A total of 1907 adults with history of CVD provided data for analysis, median age 70 years, 38% female. There was no significant change in SP aspirin use in the total sample, nor by age, sex, or CVD risk factors. SP aspirin use was significantly lower among participants with 0-1 CVD risk factors compared with those diagnosed with ≥2 (Figure). Younger participants also used aspirin less frequently (67% for <60 years vs 76% for 60+ years). Respondents who talked with their healthcare provider about aspirin had much higher aspirin use than those who did not (87% vs 60%). In the 2019 survey, 11% of participants stopped aspirin. Stoppers were more likely to be on another antithrombotic medication (61% vs 43%) and less likely to have the diagnosis of hypertension (78% vs 81%) or hyperlipidemia (68% vs 72%) compared with those on aspirin. Stoppers also had fewer aspirin discussions with their provider (45% vs 69%).

Conclusions:
It is reassuring that SP aspirin use did not drop during a time of negative messaging for primary prevention aspirin. Unfortunately, underuse remains evident in younger adults and those with fewer CVD risk factors.
Abstract 13698: Prognostic Value of Left Atrial Volume and Reservoir Function at 3-months Post-Procedure in 792 Patients Undergoing Catheter Ablation for Atrial Fibrillation
Authors: Wen Songnan , Pislaru Sorin , Lin Grace , Asirvatham Samuel , Kane Garvan , Pislaru Cristina
Published: April 2024

Introduction:
The predictive value of left atrial (LA) volume and reservoir function (ResF) post-atrial fibrillation (AF) ablation has been scarcely studied.

Hypothesis:
Abnormal LA volume and ResF post-ablation are associated with adverse cardiovascular events.

Methods:
We analyzed LA maximum (LAVImax) and minimum (LAVImin) volume index, and 2 measures of ResF, emptying fraction (LAEF) and expansion index (LAEI), prospectively measured at 3-month post-procedure in patients in sinus rhythm who underwent AF ablation between 2007-2016. Composite endpoint (CE) at follow up was all-cause mortality, cardiac hospitalization (heart failure or acute ischemic event) and stroke.

Results:
792 patients were studied
(
age 60±10 years, 25% women
; Table 1)
. Over 7.5 years [IQR 3.0-9.7], 96 (12%) patients experienced CE, which was more prevalent in patients with enlarged LA and reduced ResF. Impaired LA volumes and ResF were each independently associated with CE (
Fig.1
), even after adjustment for clinical, demographic and echo characteristics (Model A,
Fig.2
) (LAVImax ≥35 ml/m
2
: HR 2.15 [95% CI, 1.35-3.43], p=0.001; LAVImin≥20.5 ml/m
2
: HR 2.88 [1.77-4.69], p<0.0001; LAEF<39%: HR 2.00 [1.31-3.05], p=0.001; LAEI<65%: HR 1.95 [1.27-3.01], p=0.003). ResF measures (LAEF and LAEI) were incremental to LAVImax (all p<0.05), but not LAVImin (all p>0.05;
Fig.2
). In patients with normal LA (LAVImax <35 ml/m
2
; n=408), increased LAVImin (≥20.5 ml/m
2
) remained associated with CE (HR 3.11 [1.45-6.67], p=0.004) and cardiac hospitalization (HR 5.81 [1.87-18.01], p=0.002). These findings were independent of AF recurrence.

Conclusions:
In these patients, enlarged LA and impaired ResF at 3-month post-ablation were strongly associated with adverse cardiovascular outcomes, regardless of AF recurrence. Measures of LA ResF were incremental to LAVImax. Notably, LAVImin showed the strongest associations and even identified a high-risk subgroup among patients with non-dilated LA.
Abstract 13744: Carotid Sinus Syndrome With Symptomatic Bradycardia Due to Papillary Thyroid Cancer
Authors: Nagamine Todd , Yeo Jihun , Choi Horyun , Huynh Jason , Chanavuth Kanitsoraphan
Published: April 2024

The patient is a 45-year-old male with no significant past medical history who presents to the hospital for an elective surgical neck mass biopsy. The patient started noticing a slow-growing neck mass six years ago, although he did not seek medical attention. While he was monitored in preoperative room, he developed symptomatic bradycardia. Telemetry showed a complete heart block rhythm. Upon further questioning, he had been having increasing episodes of near syncope for the past two months. Physical examination was significant for bradycardia without an audible murmur. A neck exam revealed a fixed right neck mass palpable across the midline to the left with a prominent thyroid isthmus. Carotid pulses were palpable bilaterally with no bruits. A temporary transvenous pacemaker was placed and the patient was admitted to the hospital for observation. Upon further workups, CT images 1 and 2 in supplemental section. A cervical lymph node biopsy eventually revealed metastatic papillary thyroid carcinoma. The patient was diagnosed with carotid sinus syndrome secondary to papillary thyroid cancer with a vasovagal component. He was discharged with a plan for radiation and close follow-up with an electrophysiologist to evaluate permanent pacemaker eligibility after receiving treatment for thyroid cancer.
Abstract 13751: Association Between Demographics of Cardiovascular Disease Fellowship Program Directors and Fellow Recruitment: Insights From Association of American Medical Colleges Database
Authors: Kalra Ankur , Majmundar Monil , Kumar Ashish , Foley Jeff D , Rawlley Bharat , moond vishali , Kandi Sneha , Aikhionbare Itohan , Datla Sanjana , Chanamolu Meghana , Zala Harshvardhan , Nasir Khurram , Puri Rishi , Kapadia Samir R , Reed Grant W , Menon Venu
Published: April 2024

Introduction:
We sought to investigate trends in cardiovascular (CV) disease fellows’ demographic characteristics over the past decade, and the association between fellow recruitment and demographics of fellowship program directors (PD).

Methods:
We procured de-identified demographic data pertaining to first-year CV fellows and fellowship PDs from the Association of American Medical Colleges from 2010-2019 and 2019/2020. In the cross-sectional study, we analyzed trends in demographics of fellow recruitment using the Jonckheere-Terpstra trend test, and the association between demographics of fellows and PDs using multivariate logistic regression. We used fellow characteristics such as age, gender, medical school, US citizenship, fellowship program location, and PD gender in the multivariate model.

Results:
We included 9,153 fellows from 243 fellowship programs from 2010 to 2019. The characteristics of demographics of fellows and their trends are extrapolated in
Figure
. We found an increasing trend of female fellows (p=0.003), and fellows with non-US citizenship (p=0.021), and a declining trend of fellows with Asian ethnicity (p for trend 0.033) without a change in trends for other races. There was an association between race of PD and fellow recruitment [White: adjusted odds ratio (aOR) (95% confidence interval (CI)): 1.30 (1.19-1.43), p<0.001; Black: aOR (95% CI): 2.03 (1.22-3.39), p=0.007; Asian: aOR (95% CI): 1.29 (1.17-1.42), p<0.001; Hispanic: aOR (95% CI): 4.14 (3.18-5.39), p<0.001].

Conclusions:
Over ten years in CV fellowship recruitment, fellows’ demographic profiles have changed; however, the racial profile has remained constant. We found an association between the race of fellowship PDs and their respective fellow recruitment, irrespective of the type of race/ethnicity.
Abstract 13757: Prior SARS-CoV-2 Infection is Associated With Subclinical Changes in the Cardiovascular Morphology, Function, Energetics and Exercise Capacity
Authors: Chamley Rebecca R , Collins Jonathan , Pierce Kayleigh , Watson William , Green Peregrine , O'Brien David , Barker-Davies Robert , Neubauer Stefan , Bennett Alexander , Nicol Ed D , Rider Oliver J , Holdsworth David A
Published: April 2024

Background:
COVID-19 has documented multisystem effects. Whether clinically significant cardiac involvement is related to severity of disease in a working age military population remains unknown, but has implications for occupational grading and ability to deploy.

Aims:
To determine in the military population 1) whether prior SARS-CoV-2 infection causes clinically significant cardiac disease and 2) whether changes are related to disease severity.

Methods:
105 military personnel were recruited, 85 with prior SARS-CoV-2 infection (39±10 years, 87% male; 50 mild (community), 35 severe (hospitalized) and 20 healthy volunteers (mean age 39 ±8.4 years, 90% male) underwent comprehensive cardiopulmonary investigations including; cardiopulmonary exercise test, exercise echocardiography, cardiac MRI and
31
P-MR spectroscopy (rest and dobutamine stress).

Results:
Prior SARS-CoV-2 infection was related to lower VO
2
max (110±18.2 vs 133±6.7% predicted, p<0.05), anaerobic threshold (45±10 vs 56±14% of peak VO2, p<0.05), VO2/HR (102±21 vs 128±24% predicted, p<0.05) and VE/VCO2 slope (28.3±5.0 vs 25.8±2.7, p<0.05) and an increase in average E/e’ change from rest to exercise stress (+1.49±2.4 vs -0.16±3.6, p<0.05). Whilst resting myocardial energetics were similar, prior SARS-CoV-2 infection was associated with a fall in PCr/ATP during stress (by 8%, p=<0.01) which was not seen in healthy controls. When groups were ordered normal> mild> severe disease, RVEDVi, RV stroke volume, VO
2
peak, VO
2
pulse and VE/VCO
2
slope were reduced (Jonckheere-Terpstra, all p<0.05).

Conclusion:
In a young military population, prior SARS-CoV-2 infection is associated with subclinical cardiovascular changes including; lower right ventricular volumes, reduced markers of exercise capacity and reduced myocardial energetics during stress.
Abstract 13784: Thrombopoietin Restores Megakaryopoiesis By Protecting Bone Marrow Endothelial Progenitor Cells Of Patients With Hematologic Malignancies Undergoing Chemotherapy
Authors: Chen Hui , Kong Huimin , Ye Jieyu , chen chun , Xue Hongman , Li Liang , Zhang Hua , Yang Mo
Published: April 2024

Introduction and Objective:
Thrombocytopenia is the most common side effect of patients with hematologic malignancies undergoing chemotherapy. Platelet production depends on a good bone marrow (BM) microenvironment, especially the endothelial progenitor cells (EPC), which play an important role in angiogenesis and thus supporting megakaryopoiesis. However, little is known regarding the function of EPC in patients with hematologic malignancies. Therefore, the present study aimed to examine the role of EPC in angiogenesis and megakaryopoiesis, and the effect of thrombopoietin (TPO) on EPC in patients with hematologic malignancies.

Methods:
Twenty-three patients with ALL or AML, and ten age-matched healthy donors were recruited in the present study. EPCs were isolated from BM mononuclear cells. The cell count, proliferation, migration, and tube formation assays were conducted. Megakaryocytes were quantified by flow cytometry after coculturing with EPC in the absence and presence of TPO (100 ng/ml). In addition, transgenic zebrafish with vascular endothelial cells expressing EGFP [Tg(fli-1:EGFP)] were used to examine the angiogenic effect of TPO. Simvastatin was used to induce vascular defects in zebrafish embryos. The embryos were then treated with or without TPO (10
-3
U/μl) by intravenous injection before fluorescent images were captured.

Results:
The number of BM EPC was significantly smaller in patients with ALL and AML than in healthy donors. The BM EPCs from patients showed significantly reduced proliferation, migration and tube formation when compared to those from healthy donors. TPO (100 ng/ml) significantly improved those functions of EPC, and significantly increased the number of megakaryocytes after coculture. In Tg(fli-1:EGFP) zebrafish embryos, TPO (10
-3
U/μl) significantly increased the SIV vascularized area in the presence of simvastatin.

Conclusion:
The present study shows that dysfunctional BM EPC contributes to the pathogenesis of thrombocytopenia in patients with hematologic malignancies undergoing chemotherapy; and such impaired functions of BM EPC could be restored by TPO. In addition, TPO increases the number of megakaryocytes after coculture with EPC in vitro and promotes angiogenesis in zebrafish embryos.
Abstract 13802: J Waves Observed in More Than 3 Electrocardiographic Leads Predict the Presence of Organized Myocardial Fibrotic or Fat Change in Non Ischemic Survivors of Ventricular Fibrillation
Authors: Funabashi Nobusada , Nakamura Kohki , sasaki takehio , Naito Shigeto , Kobayashi Yoshio
Published: April 2024

Introduction:
The distribution of J waves and the presence of organized left ventricular (LV) myocardial damage may be related in non ischemic survivors of ventricular fibrillation (VF).

Hypothesis:
We hypothesize that the distribution of J waves can predict the presence of myocardial damage such as fibrotic or fat change in non ischemic survivors of VF.

Methods:
We conducted a retrospective analysis of 16 survivors of VF (12 males; 60±15 years) without any histories of previous myocardial infarction and underwent cardiac CT in which no significant coronary stenosis were observed and/or MRI before implantation of a cardioverter defibrillator.

Results:
On ECG, 3 patients had atrial fibrillation and 12 had J waves. On CT and/or MRI, 7 patients had organized LV myocardial fibrotic and/or fat change. The mean corrected QT interval was 451±47 and 415±5 msec in patients with and without J waves (P=0.147) and 458±32 and 429±48 msec in patients with and without myocardial fibrotic and/or fat change (P=0.202), respectively. The distribution of J waves was presented in the table. Presence of the J waves observed more than 3 ECG leads (N=4) and presence of myocardial fibrotic and/or fat change (N=7) significantly correlated each other in the Fisher's exact test (P=0.019). Presence of myocardial fibrotic and/or fat change were significantly greater in patients with J waves observed more than 3 ECG leads than those with J waves observed less than 4 ECG leads (100% vs 25%, P=0009). Presence of J waves observed more than 3 ECG leads were also significantly greater in patients with myocardial fibrotic and/or fat change than those without (57% vs 0%, P=0009).

Conclusions:
In non ischemic survivors of VF, if J waves were observed more than 3 ECG leads, the frequency of LV myocardial fibrotic and/or fat change was significantly higher than those without. The distribution and numbers of ECG leads with J waves and the presence of myocardial fibrotic and/or fat change may be useful to predict non ischemic VF.
Abstract 13932: Association Between Layer-Specific Global Longitudinal Strain and Cardiovascular Events After Coronary Artery Bypass Grafting
Authors: Davidovski Filip Soeskov , Lassen Mats H , Skaarup Kristoffer G , Sengelov Morten , Lindberg soeren , Olsen Flemming , Ravnkilde Kirstine , Fritz-Hansen Thomas , Pedersen Sune H , Iversen Allan , galatius soeren , Gislason Gunnar , Mogelvang Rasmus , Biering-Sørensen Tor
Published: April 2024

Introduction:
Sectionalized quantification of layer-specific global longitudinal strain (GLS) has recently become available with new technological advancements. We sought to investigate the prognostic value of layer-specific strain in patients undergoing coronary artery bypass grafting (CABG).

Methods:
This retrospective cohort study comprised patients undergoing isolated CABG between 2006 and 2011. The patients were followed through nation-wide registries for the composite endpoint of heart failure (HF) or cardiovascular death (CVD) (HF/CVD). Multivariable Cox regression models adjusted for clinical and echocardiographic baseline characteristics, as well as European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) were used to assess the association between layer-specific GLS and the endpoint.

Results:
Of 641 patients included (mean age 67 years, 84% male), 62 experienced the composite of outcome (HF: n=30, CVD: n=38) during a median follow-up of 3.8 years. Patients who developed the outcome during follow-up had reduced layer-specific GLS in all layers (GLSendo: -14.3% vs. -16.3; GLSww: -12.2 vs. -13.9; GLSepi: -10.7 vs. -12.2). Additionally, all layer-specific GLS parameters were predictors of outcome in unadjusted models (GLSendo: HR=1.11 (1.05-1.17); GLSww: HR=1.13 (1.06-1.21); GLSepi: HR=1.15 (1.07-1.24), per 1% absolute decrease). The risk of the endpoint increased linearly with decreasing absolute GLS for all layers (
Figure 1
). These findings were unchanged in multivariable models. Patients with reduced GLS in any layer had a higher risk of HF/CVD, however, the risk was highest for those with reduced epicardial GLS (HR=2.60 (1.46-4.66), p=0.001).

Conclusions:
Layer-specific GLS is an independent prognosticator of cardiovascular events after CABG. Reduced epicardial GLS poses the highest risk of HF/CVD.
Abstract 13969: Investigation of Comparative Lesion Dimension Between Abbott TactiFlex™ and TactiCath™ SE RF Ablation Catheters
Authors: Tranter John H , Geurkink Christopher , Thamavong Zada , Fish Jeffrey M
Published: April 2024

Introduction:
This study considers bench tissue ablation with the TactiCath™ Contact Force Ablation Catheter, Sensor Enabled™ (TCSE) and TactiFlex™ Ablation Catheter, Sensor Enabled™ (TFSE) catheters. The TactiFlex™ catheter combines the force-sensing technology of the TactiCath™ SE catheter with a handle and therapy circuit similar to FlexAbility™ Ablation Catheter, Sensor Enabled™. The purpose of this testing was to create models to aid in comparing lesion dimensions (maximum width and depth) between the TactiCath™ and TactiFlex™ catheter designs.

Methods:
Bovine ventricular tissue was used for ablation; tissue was placed in a saline bath with simulated pulsatile flow across the catheter tip/tissue interface. Ablations (N=512) were conducted at various RF power/duration combinations (20-50W, 5-60s) in parallel and perpendicular orientation, with contact forces of 5g or 15g.

Results:
A nonlinear regression model was applied to characterize lesion size vs. RF power and duration for both catheters. There is no significant difference in achieved width between catheter designs; however, TFSE produced significantly shallower lesions (p<0.001) for a given RF power/duration combination. The aspect ratio (width divided by depth) of lesions created with TFSE was also found to be significantly greater than with TCSE (p=0.002). The models allow for a translation of conditions to be made between catheter designs. At an RF power of 40W and target force of 15g, a 6mm-deep lesion can be created with TCSE in 18s; a lesion of the same depth can be created with TFSE in 24s (see Figure).

Conclusions:
At a given RF power, duration and contact force, the TactiCath™ catheter created deeper lesions compared to the TactiFlex™ catheter; however, there was no significant difference in width between the two designs. The higher aspect ratio with TFSE suggests that the shallower lesions may decrease the risk of adverse events (e.g., esophageal fistula) without compromising continuity.
Abstract 13983: Beta-Blocker Adherence Among Patients With Congenital Long QT Syndrome: A Nationwide Study
Authors: Kroell Johanna , Jensen Henrik , Tfelt-hansen Jacob , Torp-Pedersen Christian , Fosbøl Emil , Koeber lars , Kanters Jorgen , Jespersen Camilla , Gislason Gunnar , Butt Jawad , Bundgaard Henning , Weeke Peter E
Published: April 2024

Introduction:
Beta-blocker treatment represents a cornerstone in reducing risk of malignant ventricular arrhythmias among cLQTS patients (class Ib recommendation). We examined long-term beta-blocker adherence, risk factors associated with poor beta-blocker adherence, and its potential impact on mortality among cLQTS patients.

Methods:
All Danish cLQTS patients claiming a prescription for a beta-blocker within the first year after the cLQTS diagnosis were identified using nationwide registries and specialized inherited cardiac disease clinics (1995-2017). Patients were followed for up to five years. Treatment breaks >30 days, >60 days, and >90 days were identified. Risk factors of treatment breaks >60 days (i.e. proxy for poor adherence) and mortality, after cLQTS diagnosis, were assessed using multivariable cox regression.

Results:
Overall, 431/633 (68%) cLQTS patients claimed a prescription for a beta-blocker within the first year after cLQTS diagnosis (median age=38 years, IQR: 17-50 years; and 63.8% female). During follow-up, cLQTS patients with treatment breaks >30 days, >60 days, and >90 days comprised 50.1%, 40.0%, and 31.6%, respectively. Overall, 10/431 (2.3%) cLQTS patients in beta-blocker treatment died (median age=63 years, IQR: 49-79 years). Of these, ≤3 had a treatment break >30 days before time of death (HR=0.4, 95%CI: 0.03-2.9). Risk factors significantly associated with treatment break >60 days were self-reported beta-blocker side effects (HR=3.0, 95%CI: 1.9-4.7) and psychiatric disease (HR=1.8, 95%CI: 1.1-2.9) (figure).

Conclusion:
More than one-third of cLQTS patients had at least one beta-blocker treatment break >60 days. Moreover, cLQTS patients experiencing beta-blocker side effects or having known psychiatric disease were more likely to display poor beta-blocker adherence. Treatment breaks were not readily associated with mortality, but numbers were low.

Figure:
Risk factors associated with >60 days treatment break.
Abstract 13999: Atrial-Specific BetaM Protein is a Novel Transcriptional Regulator of Cardiac Hypertrophic Response and Myogenesis
Authors: Ahmad Nisar , Fan Xiaoming , Dube Prabhatchandra , Zhang Shungang , Kashaboina Esha , Kashaboina Eshita , Pestov Nikolay , Gupta Rajesh , masroor saqib , Kennedy David J , Haller Steven , Modyanov Nikolai
Published: April 2024

Background:
The ability to appropriately repair or regenerate functional cardiac tissue is the major force determining adverse outcomes after cardiac injury. We previously discovered an evolutionary transformation of the Na,K-ATPase BetaM-subunit (encoded by Atp1b4 gene) into a muscle specific transcriptional regulator where it resides in the inner nuclear membrane and regulates the TGF-β signaling pathway through direct interaction with nuclear transcriptional co-regulator Ski-interacting protein (SKIP) and augmentation of inhibitory Smad7 expression. We hypothesized that BetaM is a novel transcriptional regulator of genes involved in cardiac hypertrophy and myogenesis.

Methods/Results:
RT-PCR and western blot analyses demonstrated that cardiac BetaM is expressed exclusively in intact rat atrial myocytes. Using luciferase reporter assays, we demonstrated that expression of exogenous BetaM in C2C12 cells up-regulates cardiac transcription factors such as myocyte enhancer factor-2 (Mef2, 2 fold), Nkx2.5 (6 fold) and atrial natriuretic factor (ANF, 2 fold). Notably, BetaM also up-regulated endogenous MyoD (a master regulator of myogenesis) mRNA and protein. Furthermore, luciferase reporter assays showed that BetaM up-regulates the MyoD reporter activity (3 fold) in a dose dependent manner. Using chromatin immunoprecipitation (ChIP) and electrophoretic mobility shift assays (EMSA) in rat neonatal skeletal muscle, BetaM was identified as a component MyoD-transcriptional complex bound to specific E-box and CArG elements of the distal regulatory region (DRR) region of the MyoD promoter. To further characterize BetaM function
in vivo,
transcriptome analysis by RNA Seq was performed in myocytes from newborn Atp1b4 KO and WT mice and revealed strong changes in expression of components of the Ca
2+
-Calcineurin – NFATc2 signaling cascade involved in pathological cardiac remodeling and heart failure.

Conclusion:
Our studies reveal that BetaM regulates the activity of essential cardiac hypertrophic response genes and master regulators of myogenesis indicating that BetaM is a hitherto unknown transcriptional regulator of cardiac hypertrophic response and myogenesis and may represent a novel therapeutic target for cardiac disease.
Abstract 14144: Reproducibility of Myocardial Blood Flow Quantification With Low-Dose CT
Authors: Molloi Sabee , Zhao Yixiao , Hadjiabdolhamid Negin , Hubbard Logan C
Published: April 2024

Introduction:
Dynamic CT perfusion can be used for physiological assessment of coronary artery disease. However, it is limited by its high radiation dose and limited reproducibility.

Hypothesis:
A
single-volume
myocardial CT perfusion technique can reproducibly measure myocardial blood flow in mL/min/g at a low radiation dose.

Methods:
The reproducibility of a single-volume myocardial CT perfusion technique was assessed in 4 swine (54.5 ± 1.9 kg) under rest and stress (IV adenosine: 240 μg/mg/kg/min) conditions. Thirteen pairs of repeated CT measurements were made, with a 20-minute delay between each acquisition. Contrast (0.7 mL/kg; 370 mgI/mL) and saline chaser (0.35 mL/kg) were injected peripherally, each at 5 mL/s, followed by bolus tracking and acquisition of a single volume scan at 100 kVp and 200 mA with a 320-slice CT scanner. The timing for acquisition of the single volume scan was determined based on the contrast injection time. The bolus tracking and single volume scan data were then used as analytical inputs into a novel first-pass analysis model to derive perfusion in mL/min/g. The coronary artery centerlines from the volume scan were used for automatic assignment of the left anterior descending (LAD), left circumflex (LCx) and right coronary artery (RCA) perfusion territories. The reproducibility of myocardial blood flow measurement in each territory was then assessed via regression analysis.

Results:
The first (P
PRO1
) and second (P
PRO2
) prospective single-volume CT perfusion measurements were related by P
PRO2
= 1.04 P
PRO1
- 0.05 (Pearson’s r = 0.99; RMSE = 0.24 mL/min/g). The average CT dose index of the technique was only 140.3 mGy.

Conclusions:
The single-volume quantitative CT perfusion technique provides low-dose, reproducible, myocardial perfusion measurement in mL/min/g using only bolus tracking data and a single whole-heart volume scan. The technique can also provide simultaneous CT angiogram when acquired with appropriate radiation dose.
Abstract 14209: Natural History of Resolved Left Ventricular Thrombi
Authors: Saleh Yehia , Abdelnabi Mahmoud , Abdelkarim Ola , Eshak Nouran , Almaghraby Abdallah
Published: April 2024

Introduction:
Left ventricular thrombi (LVT) are associated with a significantly increased risk of systemic thromboembolism with its major clinical complications especially cerebrovascular stroke. Several societal guidelines recommend a duration of 3 to 6 months of anticoagulation (AC). However, evidence regarding LVT recurrence after AC discontinuation is lacking.

Hypothesis:
To determine the clinical characteristics associated with LVT recurrence in patients with resolved LVT after AC discontinuation.

Methods:
Follow-up data of 52 patients with resolved LVT derived from the Comparative Study of Oral Anticoagulation in Left Ventricular Thrombi (No-LVT Trial) was retrospectively analyzed.

Results:
47 patients (90.38%) had no recurrence of LVT while 5 patients (9.61%) had LVT recurrence at a mean follow-up duration of 86.17±20.54 and 81±26.08 days, respectively. There was no statistically significant difference in age, gender, diabetes, hypertension, smoking or etiology of heart failure between the two groups. Baseline and follow-up left ventricular ejection fraction (LVEF) were lower in patients with recurrent LVT (32.4±5.37% and 40.34±4.08% respectively) compared to the no recurrence group (39.36±4.68% and 54.24±5.09% respectively) which was statically significant (p=value of 0.003*, <0.0001* respectively).

Conclusions:
In patients with resolved LVT, low LVEF was the strongest predictor of LVT recurrence after AC discontinuation. Further research is required to determine clinical characteristics associated with LVT recurrence and indications for extended duration of AC in LVT treatment.