bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 15178: Cardiac Power and the Association With Heart Failure and Cardiovascular Death in the General Population
Authors: Bøgh-Sørensen Sofie , Dons Maria , Shabib Ali , Javier Olsen Flemming , Vesterlev Ditte , Davidovski Filip Soeskov , Espersen Caroline , Lassen Mats , Skaarup Kristoffer G , Johansen Niklas , Schnohr Peter , Boje Jensen Gorm , Mogelvang Rasmus , Biering-Sørensen Tor
Published: December 2023

Introduction:
Cardiac power (CP) integrates echocardiographic and clinical parameters of hemodynamics, but the prognostic value of CP in the general population remains to be established.

Hypothesis:
This study investigates the association between CP and incident heart failure (HF) and cardiovascular (CV) mortality in the general population

Methods:
A total of 4,022 participants without known HF from a general population cohort study was included in the study. CP was calculated by cardiac output x mean blood pressure x 0.222. CP was expressed in W/100 g of LV myocardium. The composite outcome was incident HF or CV death. Cox regression models were used to determine the association of cardiac power with the risk of the composite outcome. Cumulative incidence curves were constructed to visualize the risk of outcome throughout the follow-up period, while accounting for non-cardiovascular death as a competing event. The association was additionally explored in a restricted cubic spline model.

Results:
During a median follow-up of 3.5 years (IQR 2.6;4.4 years), 134 (3.3%) participants reached the composite outcome. The risk of the composite outcome was significantly increased in those with CP <0.84 W/100 g throughout the follow-up period, while accounting for non-cardiovascular death as a competing event. We found significant interaction between LVEF and CP (p
interaction
<0.001). When stratifying the population according to LVEF, CP had no prognostic value in LVEF >50% (p=0.74) but in individuals with LVEF < 50%, CP remained an independent prognostic marker after multivariable adjustment (HR 1.20 per 0.1 W/100 g decrease in cardiac power (95% CI: 1.04-1.37, p=0.01) (Figure 1).

Conclusion:
CP was associated with incident HF and CV death in the general population, however, LVEF significantly modified the relationship between CP and the composite outcome. CP was only independently associated with incident HF and cardiovascular death in participants with LVEF<50%.
Abstract 15180: Inhibition of Tgfβ Signaling Enables Durable Ventricular Pacing by TBX18 Gene Transfer
Authors: Fan Jinqi , Kim Nam Kyun , Kim Tae Yun , Wolfson David , Ramirez Rafael , Cho Hee Cheol C
Published: December 2023

Introduction:
Somatic gene transfer of an embryonic transcription factor, TBX18, could directly reprogram ventricular myocytes to induced pacemaker myocytes. We and others have previously reported that direct myocardial gene delivery of TBX18 created ventricular pacing in heart block animals in vivo. However, the de novo biological pacing was short-lived, diminishing its translational value.

Hypothesis:
Our preliminary RNAseq and mass spec data indicate pronounced Tgfβ signaling in TBX18-transduced cardiomyocytes. Tgfβ signaling induces fibrosis in multiple organs including the heart. We hypothesized that TBX18 triggers Tgfβ signaling and results in fibrosis, leading to loss of durable ventricular pacing.

Methods:
Adenoviral vectors expressing TBX18 or GFP was delivered to neonatal rat ventricular myocytes (NRVMs) in vitro or to the left ventricular apex of adult rats with complete atrioventricular block (CAVB).

Results:
In vitro experiments showed increased population of vimentin+ fibroblasts and alpha smooth muscle actin+ myofibroblasts in TBX18-NRVMs compared to GFP-NRVMs at 2 weeks after gene transfer. Single cell transcriptome data indicated that TBX18 triggered substantial changes in extracellular matrix-related gene expression and Tgfβ signaling. Quantitative RT-PCR and ELISA validated scRNA-seq data, indicating fibroblast activation. TBX18-NRVMs showed faster automaticity than that control did, but their automaticity began wavering after day 7. Treatment of TBX18-NRVMs with a Tgfβ signaling inhibitor, A83-01, mitigated fibroblast activation by TBX18 and preserved their automaticity.

Direct delivery of TBX18 into ventricular myocardium resulted in focal fibrosis as well as expansion of vimentin+ fibroblasts at day 7. TBX18 gene transfer initiated ventricular pacing in a rat model of CAVB, but ventricular pacing diminished after one week. In contrast, treating TBX18-injected animals with A83-01 enabled sustained biological pacing beyond three weeks of after gene delivery, accompanied by reduced fibrosis in situ.

Conclusions:
Inhibition of Tgfβ signaling is sufficient to achieve durable cardiac pacing by TBX18-induced biological pacemakers.
Abstract 15190: Association of Initiating SGLT2i and GLP1Ra Therapeutics on Insulin Utilization and MACE Outcomes Among Patients With Diabetes in an Integrated Healthcare System
Authors: Le Viet T , May Heidi T , Bair Tami L , Knight Stacey , Horne Benjamin D , Knowlton Kirk U , Anderson Jeffrey L
Published: December 2023

Background:
Nearly 10% of US adults diagnosed with diabetes (DM) begin using insulin within 1 year (yr) of the diagnosis. A third of all patients (pts) with DM experience an atherosclerotic cardiovascular (CV) event. SGLT2is and GLP1Ras, have been shown to reduce major adverse CV events (MACE). Meta-analyses show a reduction in insulin utilization when these medications are initiated individually or concurrently. This study evaluated the real-world impact on MACE and insulin usage among pts with DM initiating SGLT2is and GLP1Ras.

Methods:
Intermountain pts (n=6,476) ≥18 years of age with ≥3 encounters and on insulin at time of initiation of SGLT2i, GLP1-RA, or combined therapy from January 1, 2012 to November 30, 2021 were studied. Pts were stratified by whether they stopped-insulin (st-in) within 90 days of having started SGLT2i, GLP1Ra, or both or continued-insulin (co-in). MACE was defined as death, MI, CVA, or HF hospitalization and was assessed at 1- and 3-yrs.

Results:
Of 6,476 pts, 93.3% (n=6,039) st-in and 6.7% (n=437) co-in. St-in pts had less comorbidities, but were older (58.2 vs. 55.0 years), male (55% vs. 48.5%), weighed less (105.5 vs. 110.7 kg), and included fewer pts with DM I (18.5% vs 38.4%). Renal function and hemoglobin A1C were similar. Compared to co-in, pts with st-in were prescribed SGLT2i (30.0% vs 20.4%) or combination (SGLT2i/GLP1Ra) (16.2% vs 11.2%) more often. St-in vs co-in had a higher frequency of MACE, which persisted after adjustment by risk factors, comorbidities, and medications (Table).

Conclusion:
In pts with DM on insulin, adding SGLT2i, GLP1Ra, or both led to a change in insulin utilization, with >90% of pts stopping insulin entirely. However, we observed an increase in 1-yr and 3-yr MACE for st-in vs co-in pts. This suggests a need for caution when initiating these medications in those already on insulin with regards to insulin management, including a decision to discontinue insulin. More data are needed to further understand our observations.
Abstract 15206: Prevalence of Myocardial Adipose Tissue in Non-Ischemic and Ischemic Victims of Sudden Cardiac Death
Authors: Appel Henrik , Pakanen Lasse , Ahtikoski Anne , Holmstrom Lauri , Risto Kerkelä , Huikuri Heikki , Kaarteenaho Riitta , Junttila Juhani
Published: December 2023

Background:
Recent imaging studies have shown that patients with myocardial infarction scar who have ventricular arrhythmias show more adipose tissue around the scar. Similar changes are seen in ARVC.

Purpose:
The aim of this study was to determine the prevalence of myocardial adipose tissue that co-localize with fibrosis in non-ischemic and ischemic sudden cardiac death (SCD) victims.

Methods:
The ischemic and non-ischemic subjects were derived from the FinGesture cohort, consisting of autopsy verified consecutive victims of SCD in Northern Finland between years 1998-2017 (n=5,869). Total of 48 non-ischemic, 47 ischemic and 37 accidental/intoxication related death subjects were included in the study. Hematoxylin-eosin-stained slides were digitized and fibrofatty deposits was determined using virtual microscopy software.

Results:
Myocardial adipose tissue was present in 51% of ischemic cases, 29% of non-ischemic cases and 14% of controls (p< 0.001). In ischemic cases, BMI seems to be associated with the presence of myocardial adipose tissue. Mean BMI was higher in subjects with myocardial adipose tissue versus subjects without (29.2 vs 24.9. p=0.022).

Conclusions:
The findings suggest that adipose tissue might have an influence in creation of fatal arrhythmias in SCD as it does in scar related ventricular arrhythmias. In addition, it seems that obesity is associated with ischemic scar related adipose tissue metaplasia.
Abstract 15214: The Benefits of Wearable Physical Activity Tracking Devices and Wellness Initiatives
Authors: Davis Kristen
Published: December 2023

Introduction:
The recommended amount of physical activity (PA) for adults is 150 minutes of moderate or 75 minutes of vigorous activity(1). 33% of the adults meet the appropriate amount of weekly PA (2). The health benefits of regular PA include a reduced risk of cardiovascular disease, type 2 diabetes, certain cancers, depression, and early death. The healthcare expenses of physical inactivity are nearly 79 billion annually in the United States. Wearable PA tracking devices can motivate people to be active and improve their overall wellness. Wearable devices like Fitbit, Garmin, and smartwatches can track activity progress and participation in wellness initiatives.

Hypothesis:
Increasing PA among employees and members within the Health Plan by implementing incentivized challenges that promote PA tracking, provide behavior change techniques, and grow the number of connected wearable devices.

Methods:
Through our proprietary database, data was collected from the UPMC Health Plan Health Risk Assessment questionnaire showing members (average n=52,165) participating in PA year over year compared to the national average from 2015-2021 and connected devices from 2015-2021.

Results:
The questionnaire revealed 150+ minutes of aerobic PA percent from year to year for 2015 (35%), 2016 (35%), 2017(37%), 2018 (32%), 2019 (36%), 2020 (38%), and 2021 (33%); all the years were above the national average percent except 2018 by offering accessible physical activity challenges. The number of connected devices increased from 3,729 in 2015 to 15,473 in 2021, which was a 296% increase year over year by providing convenient ways to connect devices.

Conclusions:
Wearable tracking devices in conjunction with wellness initiatives that incorporate incentives, influence behavior change and increase minutes of PA. Continuing to offer PA wellness programs will support the goals of our evaluation of member behavior and participation. Future directions include enhancing wellness initiatives and wearable devices providing a high-value strategy for sustained PA behavior change.
Abstract 15222: Slowly Conducting Anatomic Isthmuses of Repaired Tetralogy of Fallot: A Role for “Prophylactic VT Ablation”
Authors: Johnson Bryce V , Pistner Andrew , Hanna Bishoy , Bevan Graham H , Cai Amanda , McDonagh Rosemary , Krieger Eric V , Akoum Nazem W , Chatterjee Neal A , Robinson Melissa , Nazer Babak
Published: December 2023

Background:
Ventricular tachycardia (VT) is common in patients with repaired tetralogy of Fallot (rToF) and involves 5 slowly conducting isthmuses (SCAI) bound by the right ventriculotomy, ventricular septal defect (VSD) patch, tricuspid valve, and pulmonic valve.

Aims:
We aim to study the safety and efficacy of a strategy in which rToF patients undergo prophylactic radiofrequency ablation of any SCAI to prevent incident VT.

Methods:
Patients underwent voltage and activation mapping in sinus rhythm. Abnormal isthmuses were identified by low voltage (≤ 1.5 mV) without pre-existing conduction block. Isthmuses with conduction velocity (CV) ≤ 0.5 m/s (SCAI) were then ablated. Post-ablation, ventricular programmed stimulation was performed with triple extrastimuli from two sites. Outcomes of prophylactic ablation patients were compared to rToF patients undergoing clinical VT ablation within the same period.

Results:
Indication for prophylactic SCAI ablation included pre-pulmonic valve replacement (77%), atrial arrhythmia ablation (11%), syncope (5%), and NSVT (5%). Of 44 prophylactic patients, 32 (73%) had at least one isthmus and 25 (57%) had at least one SCAI (mean 0.7 ± 0.7 SCAI/patient), with the most common being SCAI 3 (36%) and 4 (32%) (see figure). After prophylactic ablation, bidirectional block was achieved across all SCAI and no VT was inducible post-ablation. Over a median 10.5 [IQR 3, 20] month follow-up, there was no sustained VT, sudden cardiac death, or appropriate shocks. Among 18 patients undergoing clinical VT ablation, 16 (89%) had at least one SCAI (mean 1.5 ± 0.8 SCAI/patient, p=0.0002 compared with prophylactic group), most commonly SCAI 3 (83%). One (6%) VT patient had recurrent VT during follow-up of 15.5 [IQR 6, 33] months. There were no peri-procedural complications in either group.

Conclusions:
Prophylactic SCAI ablation for patients with rToF is safe, acutely successful, and associated with excellent short-term outcomes.
Abstract 15259: The Novel Antisense Oligonucleotide CDR132L Improves Cardiac Function in Heart Failure Across Different Species
Authors: Viereck Janika , Batkai Sandor , Genschel Celina , Rump Steffen , Hauke Wilfried , Gyongyosi Mariann , Traxler Denise , Hinkel Rabea , Kupatt Christian , Levin Arthur A , Thum Thomas
Published: December 2023

Introduction:
The chronic progressive condition of heart failure (HF) is, to date, largely irreversible and continues to impose global morbidity. MicroRNAs exert substantial roles in HF progression by orchestrating pathological genes and pathways. Medications directly tackling the roots of the disease are rare, but inhibition of miR-132, a microRNA that was shown to be upregulated upon cardiac remodeling and HF, is a promising approach. Thus, CDR132L, a clinical-stage synthetic antisense oligonucleotide miR-132 inhibitor, can be an innovative therapy for patients with HF.

Hypothesis:
To examine the effect of CDR132L, different studies were conducted, including in mice and pigs and in a first-inhuman phase 1b safety and tolerability study that revealed preclinical and exploratory efficacy data.

Results:
MiR-132 transgenic mice developed reduced left-ventricular ejection fraction (LVEF) and cardiac dilatation. CDR132L treatment significantly improved LVEF and reversed cardiac dilatation. The results were confirmed in a porcine transverse aortic constriction model, where the LVEF was significantly improved in the CDR132L treatment group compared to control animals (48.9% vs. 36.1%). In post-MI HF pigs subjected to different treatment and dosing regimens, resulted in a significant and dose-dependent improvement of the cardiac function, illustrated by an up to 10.4% improvement in LVEF to the placebo group at day 56. During a monthly treatment, 87.5% of the animals treated 5x 5 mg/kg with CDR132L showed a ΔLVEF of >7% compared to the placebo group. Additionally, CDR132L improved contractility and the diastolic function by reducing cardiac stiffness. A successful translation of these preclinical results into humans was performed in a CDR132L safety and tolerability Phase 1b clinical trial in HF patients. In an exploratory analysis, the combined endpoint, consisting of patients with a decrease in NT-proBNP levels and/or an absolute increase in LVEF, was significantly met by 79% of the patients in the pharmacodynamically active CDR132L group.

Conclusion:
Pharmacological miR-132 inhibition by CDR132L improved cardiac function in multi-species models of HF, highlighting the therapeutic potential for clinical use in HF patients.
Abstract 15263: Prognostic Impact of the Hyper-Polypharmacy on the Long-Term Outcomes in Patients With Chronic Heart Failure Following Cardiac Resynchronization Therapy
Authors: Ono Yuma , Harada Taisuke , Kondo Hidekazu , Yufu Kunio , Shinohara Tetsuji , Teshima Yasushi , Takahashi Naohiko
Published: December 2023

Introduction:
Optimal drug therapy improves long-term prognosis in patients with chronic heart failure (CHF) with reduced left ventricular ejection fraction, but it exposes patients to the risk of polypharmacy.

Hypothesis:
This study aimed to determine the association between hyper-polypharmacy and adverse events in patients with CHF after cardiac resynchronization therapy (CRT).

Methods:
This retrospective study evaluated 134 patients (90 male, mean age 70.6 ± 9.7 years; 31 (23%) old myocardial infarction, 57 (43%) dilated cardiomyopathy, 46 (34%) others) who underwent CRT implantation between 2004 and 2020 and were followed for at least one year after the operation (mean, 1071 ± 649 days). The hyper-polypharmacy group (n = 74) was defined as patients taking total of 10 or more medications at discharge. The primary endpoint was major adverse cardiovascular events (MACE) including cardiovascular death, hospitalization for heart failure (HHF), cerebral infarction, acute myocardial infarction, and cardiac arrest. The secondary endpoints include HHF and all-cause mortality.

Results:
MACE occurred in 62 (46%), HHF occurred in 55 (41%) and all-cause mortality occurred in 24 (18%) patients. Kaplan-Meier survival analysis demonstrated that hyper-polypharmacy group had a higher incidence of MACE (log-rank 8.29; P = 0.004), HHF (log-rank 8.55; P = 0.0035) and all-cause mortality (log-rank 7.83; P = 0.0051). Cox proportional hazards regression analysis also revealed that the hyper-polypharmacy group had a higher incidence of MACE (HR 2.15; 95% CI:1.28 - 3.75, P = 0.0036), HHF (HR 2.39; 95% CI:1.32 - 4.19, P = 0.0031) and all-cause mortality (HR 3.72; 95% CI:1.49 - 11.2, P = 0.0038). Multiple Cox proportional hazards analysis revealed that hyper-polypharmacy was an independent predictor of MACE (hazard ratio 2.00; 95% CI:1.18 - 3.50,
P
= 0.01).

Conclusions:
Hyper-polypharmacy may predict the occurrence of MACE in patients with CHF undergoing CRT implantation.
Abstract 15289: Phase-Specific Survival After Endovascular versus Open Surgical Repair of Descending Thoracic Aortic Aneurysm
Authors: Iyanna Nidhi , Ogami Takuya , Yokoyama Yujiro , Takagi Hisato , Serna-Gallegos Derek , Chu Danny , Sultan Ibrahim , Kuno Toshiki
Published: December 2023

Background:
Thoracic endovascular aortic repair (TEVAR) has gained preference over open surgical repair (OSR) as the intervention of choice for patients with descending thoracic aortic aneurysm (DTA). However, recent studies have suggested comparable or potentially favorable outcomes after OSR. This study aimed to compare the outcomes of patients with DTA undergoing OSR and TEVAR with contemporary findings.

Methods:
A comprehensive search of MEDLINE and EMBASE databases was conducted to identify relevant randomized controlled trials or studies utilizing propensity-score analysis or reporting risk-adjusted outcomes. The search was performed up until March 2023. All-cause mortality was analyzed in specific phases: within 1 year, 1-2 years, and beyond 2 years.

Results:
Eight studies met the inclusion criteria, including 4 studies using propensity-score matching and 4 studies reporting risk-adjusted outcomes, comprising 14,873 patients with DTA undergoing OSR (n=10,882) and TEVAR (n=3,991). No randomized controlled trials were identified. Operative mortality was similar between the two interventions (odds ratio 0.92, 95% CI 0.70-1.21, p = .57,
I
2
= 0%). However, overall long-term mortality was significantly higher after TEVAR compared to OSR (hazard ratio (HR) 1.30, 95% CI 1.05-1.59, p = .01,
I
2
= 0%). Phase-specific analysis revealed comparable risks of mortality within 1 year and between 1 and 2 years after interventions, while the risk of mortality was significantly higher after TEVAR compared to OSR beyond 2 years (HR 1.77, 95% CI, 1.19-2.63, p = .01.
I
2
= 0%).

Conclusion:
This study demonstrated comparable operative mortality between OSR and TEVAR, but higher long-term mortality associated with TEVAR in patients with DTA. The phase-specific analysis highlighted the survival advantage of OSR beyond 2 years after surgery compared to TEVAR. These findings suggest a need for reconsidering OSR indications in the management of DTA.
Abstract 15291: Early Outcomes With Left Cardiac Sympathetic Denervation for Medically Refractory Idiopathic Ventricular Fibrillation
Authors: Neves Raquel , Garmany Ramin , Bains Sahej , Bos Johan M , Asirvatham Samuel , Giudicessi John , Ackerman Michael J
Published: December 2023

Introduction:
Treatment options for patients with recurrent ventricular arrhythmias (VAs) refractory to pharmacotherapy and/or ablation are minimal. Although left cardiac sympathetic denervation (LCSD) is well established in long QT syndrome (LQTS) and catecholaminergic polymorphic ventricular tachycardia (CPVT), LCSD’s role in idiopathic ventricular fibrillation (IVF) is less clear. Here, we report our single-center experience regarding the early outcomes of LCSD in patients with IVF.

Hypothesis:
To determine the efficacy of LCSD on reducing VAs in IVF patients refractory to conventional therapy.

Methods:
A retrospective analysis of the electronic health record of patients with IVF between January 2000 to April 2023 was performed. Cardiac event rates [defined as arrhythmic syncope/seizure, appropriate implantable cardioverter defibrillator (ICD) therapy, sudden cardiac arrest (SCA), or sudden cardiac death (SCD)] before and after LCSD for each patient were calculated and a Wilcoxon signed rank test was performed.

Results:
In total, 94 patients (41% female) were classified as IVF. Overall, 15/94 patients (16%) had LCSD due to refractory VAs (60% male; mean age at LCSD 36 ± 20 years) despite beta-blocker treatment (100%) or combined drug therapy (67%). In total, 14 patients (15%) had an electrophysiology study performed before LCSD of which 10 (67%) had VAs ablation. All patients had a structurally normal heart and genetic testing performed in 14/15 patients (93%) confirmed absence of genetic cardiomyopathies and channelopathies. SCA was the sentinel event in 10 of 15 patients (67%); 14 patients (93%) had an ICD in place. The average follow-up time after LCSD was 3 ± 4 years. The VA event rate before LCSD was 4 ± 3 events per year and was reduced to 1 ± 3 per year (p<0.04) after LCSD. Patients had a median of 3.2 less events per year after LCSD (p=0.02) with 7 patients (47%) having no post-LCSD recurrences thus far while 3 (20%) patients were deemed LCSD non-responders with no reduction of event rate.

Conclusions:
LCSD represents a substrate-independent, anti-fibrillatory treatment option for patients with life-threatening, genetic arrhythmias. While not curative, the early outcomes of LCSD for patients with medically refractory IVF are promising.
Abstract 15293: Impact of Catheter on Central Venous Catheter Associated Right Atrial Thrombosis in Systemic Cancer Patients
Authors: Park Michael , Jain Raina , Liberman Nicole , Agoglia Hannah , Kim Jiwon , Liu Jennifer , Weinsaft Jonathan W , Chan Angel T
Published: December 2023

Introduction/Background:
Central venous catheters (CVC) are commonly utilized in cancer patients for prolonged systemic anti-cancer treatments but increased the risk of right atrial thrombosis (C
THR
). Cardiac MRI (CMR) tissue characterization is commonly performed to identify C
THR
based on absence of vascularity.

Research Questions/Hypothesis:
How do catheters affect thrombus formation?

Goals/Aims:
To evaluate predictors of thrombus formation in cancer patients with CVC.

Methods/Approach:
The population comprised of adult (≥18yo) systemic cancer pts with indwelling CVC who underwent contrast-enhanced CMR (0.2 mmol/kg gadolinium). C
THR
were defined using the reference of LGE-CMR via established criteria (absence of contrast enhancement). CVC depth was measured from CXR/CT. Clinical follow-up was obtained via chart review for embolic events.

Results/Data (descriptive and inferential statistics):
157 cancer pts with CVC (52±17 yo; 47% M; heme 29%
Abstract 15334: Laminin Alpha 2 Increases the Protective Effect of Exosomes in Human IPSC-Derived Cardiomyocytes During Ischemia-Reperfusion
Authors: Mesquita Fernanda , King Madelyn , Hochman Mendez Camila
Published: December 2023

Acute myocardial infarction (AMI) is a leading cause of death and disability worldwide. With early treatment, restoration of blood flow to ischemic myocardium can be achieved and therefore reduce mortality risk. Evidence suggests that mesenchymal stromal cell (MSC)-derived exosomes (EXO) promote myocardial repair after AMI due to paracrine activity. Laminin alpha 2 (LAMA2) is a major cardiac extracellular matrix (ECM) component and can be used to produce cardiac-specific EXO. Here we coated MSC-derived EXOs in LAMA2 to enhance their recognition by human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs). We hypothesized that LAMA2-coated MSC-EXO would confer protective effects on CMs during ischemia-reperfusion. The LAMA2-EXO had a similar yield of particles, with a size range of 130nm as the control (gelatin-EXO). No cytotoxic effect was observed in CMs after 3-day exposure to LAMA2-EXO. CMs were then treated with LAMA2-EXO two hours prior to 4h ischemia (1% O
2
, 5% CO
2
, and glucose-free media). LAMA2-EXO had a 2-fold protective effect compared to non-treatment, and after 1.5h of reperfusion (5% CO
2
, CM-enriched media) CMs treated with LAMA2-EXO recovered faster than the control group. Conversely, due to the laminin 511/411 ECM component of endothelial cells (ECs), we did not see a significant protective effect nor a difference between LAMA2-EXO vs. the control in the EC ischemia-reperfusion group. This is the first report of suggesting the specificity of LAMA2-EXO to treat CM post-exposure to ischemia-reperfusion injury. Overall, these results indicate that LAMA2-EXO can be a promising treatment to target CM survival in ischemic cardiovascular disease.
Abstract 15351: Characteristics of Veterans Enrolled in a Nationwide Home Telemonitoring Blood Pressure (BP) Program
Authors: Ishani AREEF , Nelson David , Nugent Sean , Taylor Brent , Margolis Karen L , Taylor Oliva , McPherson Jacob , Raju Srihari , Ibrahim Hanna , Rai Nayanjot K , Drawz Paul
Published: December 2023

Background:
Guidelines recommend home BP monitoring for the diagnosis and management of hypertension. The Veterans Affairs (VA) has a robust nationwide home BP monitoring telehealth (HT) program.

Aims: We aimed to determine factors associated with being enrolled in the VA’s HT program using a nationwide cohort.

Methods:
Veterans with hypertension and a primary care (PC) visit between 4/2013 and 9/2015 were identified and classified as telehealth if they enrolled in the HT program and were issued a home-telehealth BP monitor. Control patients were not enrolled. Patient characteristics including the care assessment needs (CAN) score (validated probability for mortality or hospitalization in the following year) were extracted from the electronic health record (EHR).

Results:
Over 33 months, 29,927 (2.5%) veterans were enrolled in the HT program and 1,160,506 (97.5%) veterans with hypertension were not enrolled. Compared to controls, HT patients were of similar age (median 66 years), were more likely to be female (5.6% vs 4.6%), be of Black race (28.7% vs 20.1%), have a higher index median systolic BP (158.4 vs 153 mmHg), have a greater number of PC visits in the 2 years prior (11 vs 7 visits), have a higher median probability of a mortality or hospitalization event within 1 year (13% vs 7%) and were on a greater number of antihypertensive medications than those not enrolled (Table). These veterans were seen by 9,301 PC providers, who enrolled the following percentages of their hypertensive patients (% of patients by % of providers): 0% by 22%, <2% by 24.1%, 2-5% by 28.9%, 5-10% by 16.4%, 10-20% by 6.9% and >20% by 1.7%.

Conclusion:
The VA’s HT program is used by a limited number of Veterans. Those enrolled are sicker and have a greater burden of hypertension than those not enrolled. Most providers have a small percentage of their panel of patients enrolled. This preliminary report comes from a study evaluating the effect of HT on BP control, cardiovascular events, and non-cancer mortality.
Abstract 15364: The Association of Exhaled Carbon Monoxide With Atrial Fibrillation and Left Atrial Size in the Framingham Heart Study
Authors: Eromosele Oseiwe 'Benjamin' , Shapira-Daniels Ayelet , Yuan Amy , Lukan Abdulkareem , Akinrimisi Olumuyiwa , Chukwurah Marius , Nayor Matthew G , Benjamin Emelia J , Lin Honghuang
Published: December 2023

Background:
Studies from the Framingham Heart Study (FHS) have reported that exhaled carbon monoxide (eCO) is associated with cardiovascular disease (CVD) and stroke. To our knowledge, no study has assessed the association between eCO with atrial fibrillation (AF) and left atrial (LA) size. We related eCO to AF and LA size.

Methods:
eCO was measured using an Ecolyzer instrument among participants who attended Exam 6 and Omni 1 participants who attended Exam 1. AF was assessed on electrocardiography (ECG) and LA size on echocardiography. We used Cox and logistic regression models in assessing the relationship between eCO and incident AF (primary model), and prevalent AF and LA size (secondary models). Participants were also analyzed according to tertiles of eCO concentration, and we also adjusted for current smoking, and other covariates - age, race, sex, height, weight, systolic blood pressure (BP), diastolic BP, diabetes, hypertension treatment, prevalent myocardial infarction (MI), and prevalent heart failure (HF).

Results:
Our study sample included 3814 participants, with a median age of 58 ± 10 years; 54.4% were women, and 11.6% of the study population was non-White. eCO was associated with incident AF after adjusting for known AF risk factors (HR=1.31, 95% confidence interval [CI] 1.09-1.58). Higher eCO levels were associated with an increased cumulative risk of AF, with the risk rising with increasing tertiles of eCO. The association remained significant after additionally adjusted for CRP and BNP, and interim MI and HF. In the stratified analysis, eCO remained associated with incident AF in the men-only analysis and in never or previous smokers (men: HR: 1.30, CI: 1.02-1.65, p = 0.03; never or previous smokers: HR: 1.39, CI: 1.31-1.72, p = 0.002), but not in women, current smokers and age-stratified (≤60 years and >60 years) analyses. eCO was not associated with LA size or prevalent AF in either age and sex adjusted models or multivariable adjusted models.

Conclusion:
We found an association between eCO and incident AF after adjusting for known AF-related risk factors. There is a need for more research to better understand how eCO mediates incident AF, how much it may contribute to the pathogenesis of AF, and potential therapeutic benefits it may offer.
Abstract 15371: Mice Lacking S-Nitrosoglutathione Reductase (GSNOR
-/-
), a Mouse Model of Preeclampsia, Exhibited Nitroso-Redox Imbalance and Deterioration of Cardiovascular Structure and Function in Postpartum Mothers
Authors: Dulce Raul A , Balkan Wayne , Hare Joshua M , Kulandavelu Shathiyah
Published: December 2023

Introduction:
Preeclampsia (PE), a leading cause of maternal mortality, is linked to persistent pathological changes in the heart, predisposing the mother to increased risk of chronic cardiovascular (CV) disease later in life. PE is characterized by increased S-nitrosylated (SNO) proteins and nitroso-redox imbalance. We recently showed that mice lacking S-nitrosoglutathione reductase (GSNOR
-/-
mice), a denitrosylase that regulates protein S-nitrosylation, exhibit the clinical features of PE including maternal hypertension, blunted increase in cardiac output, abnormal remodeling of left ventricular (LV) cardiac structure, dysregulation in nitrosylation and nitroso-redox imbalance.

Hypothesis:
The nitroso-redox imbalance seen during pregnancy in GSNOR
-/-
mice persists in postpartum (PP), leading to increased maternal susceptibility to CV injury.

Methods:
Pregnant control (WT [C57Bl/6J]) and GSNOR

-/-

mice (N=5) were examined at baseline, late-stage pregnancy (17.5 dpc) and 6 weeks PP. LV structure, cardiac output and stroke volume were determined using echocardiography (Vevo 2100). Cardiomyocytes (CM) were isolated at 6 weeks PP and ROS and peroxynitrite levels determined using fluorescent dyes.

Results:
In WT mice, all normal maternal CV adaptions to pregnancy, reverted to pre-pregnant levels 6 weeks PP. In contrast, GSNOR

-/-

mice exhibited increased cardiac output (+21% vs. -19% in WT), stroke volume (+21% vs. -41% in WT), and LV chamber dimension (+13% vs. -4% in WT) at 6 weeks PP, indicating high cardiac output LV cardiomyopathy. CM isolated from GSNOR

-/-

hearts showed ~5-fold more ROS generation (9.9x10
-4
±9x10
-5
vs. 2.1x10
-4
±1.5 x10
-4
ΔF/F
max
.min
-1
) and elevated peroxynitrite levels (0.318±0.011 vs. 0.243±0.012 ΔF/F
0
) compared to WT at 6 weeks PP, suggesting the presence of nitroso-redox imbalance. All changes P<0.05.

Conclusion:
Postpartum GSNOR

-/-

(preeclamptic) mothers exhibited cardiac dysfunction which was accompanied by the presence of of nitroso-redox imbalance. These changes may predispose the mother to higher risk for future CV injury.
Abstract 15375: Status of Cardiovascular Health and Early Carotid Artery Changes in Contemporary Young Adults From Disadvantaged Social Backgrounds: The Future of Families and Child Wellbeing Study (FFCWS)
Authors: Lloyd-Jones Donald M , Allen Norrina B , Goldman Noreen , Stein James H , Marma Amanda M , Tracy Russell , Ning Hongyan , Hou Lifang , Zheng Yinan , Joyce Brian , Van Horn Linda , Notterman Daniel
Published: December 2023

Background:
Effects of childhood social determinants of health (SDOH) on young adult cardiovascular health (CVH) are postulated, but few studies have measured both SDOH from birth and CVH status in young adulthood.

Methods:
In 1998-2000, FFCWS enrolled 4898 mother-baby dyads at delivery in 20 US cities, oversampling mothers who were unmarried, including a disproportionate number of minority and low-income families. In 2021-23, offspring were invited to an in-person exam for CVH measurement and carotid artery ultrasound. Individual CVH metrics (except sleep) and overall Life’s Essential 8 (LE8) scores (range, 0-100; higher = better CVH), as well as carotid intima-media thickness (IMT), were compared between self-identified sex and race/ethnicity groups. LE8 scores were also compared with a representative sample of US young adults aged 19-25 years from NHANES.

Results:
Among 1211 offspring participants (ppts), mean age was 22y, 55% were female, 50.8% Black, 25.1% Hispanic, 20.5% White, and 3.6% Other; characteristics at birth and through childhood were similar between FFCWS ppts who were/were not examined. Diet, physical activity, nicotine exposure, and BMI scores were unfavorable in FFCWS ppts (Table). Overall LE8 scores did not differ significantly by sex, and ranged from 64.6 in Black ppts to 74.8 in ppts from Other racial/ethnic groups. LE8 scores did not differ between Black and Hispanic ppts, but both groups had significantly lower scores than ppts from White and Other groups (all P≤0.01). After adjustment for age, sex, and LE8 score, Black ppts had significantly greater mean-maximum and mean-mean carotid IMT. Mean LE8 scores were lower among FFCWS ppts compared with young adults from the same racial/ethnic groups in NHANES.

Conclusions:
In this novel cohort of young adults largely from disadvantaged social backgrounds, overall CVH status was sub-optimal, and ppts who identified as Black had the lowest CVH and highest carotid IMT measures, even at this young age.
Abstract 15404: Exercise and Sports Participation is Associated With Improved Quality of Life in Young Patients With Heritable Thoracic Aortic Disease
Authors: Millette Theodore J , Dean Peter N , Ramcharitar Randy K. , Monfredi Oliver , Thomas Matthew , Conaway Mark
Published: December 2023

Introduction:
Traditionally, patients with heritable thoracic aortic disease (HTAD) have been restricted from competitive sports due to concerns over acute aortic dissection. Patients with HTAD also exhibit lower quality of life (QOL) and physical fitness than general populations. Murine data suggests exercise improves aortic health and does not contribute to aortic enlargement.

Hypothesis:
Exercise and competitive sports participation will be associated with improved QOL in HTAD patients.

Aims:
Investigate the effect of lifetime exercise ‘dose’ and competitive sports participation on QOL in patients aged 15-35 with syndromic HTAD [Marfan syndrome (MS), Loeys-Dietz syndrome (LDS), vascular Ehlers-Danlos syndrome (vEDS)] and non-syndromic HTAD.

Methods:
This cross-sectional study employed a questionnaire to assess lifetime exercise exposure and utilized the PedsQL QOL Inventory. We developed an Exercise Score (ES) to quantify lifetime exercise exposure based on questionnaire results (3 points for competitive sports season, 1 point for recreational sport season. Questionnaires were completed via telephone interview with complimentary medical chart review.

Results:
Of the forty patients enrolled, the mean age was 26 years. The diagnosis was MS in 82.5%. Despite 87.5% of patients being restricted by their cardiologist, 65% reported competitive sports participation and 92.5% reported some lifetime recreational exercise. The median ES for our population was 19. Participants with an ES greater than the median had a significantly better total QOL score compared to participants with an ES below the median (78 vs 65, p=0.03). There was no difference in aortic size or need for surgical intervention between those above and below the median ES. This also held true for those who did and did not participate in competitive sports. There was a strong positive correlation between the amount of current exercise (days-per-week) and total QOL score (corr=0.55, p<0.001).

Conclusions:
Increased lifetime exercise exposure and current physical activity levels were associated with improved QOL in young adults with HTAD. There did not appear to be a detrimental effect of exercise on aortic size or need for surgical intervention.
Abstract 15412: Unusual Case of Cardiac Sarcoidosis Unmasked by COVID 19
Authors: Oberoi Mansi , Hyden Marshall
Published: December 2023

Background:
COVID-19 can present with a constellation of symptoms and cardiac dysfunctions. It can mimic cardiac sarcoidosis clinically which can lead to diagnostic challenges and treatment delays. We describe a case of cardiac sarcoidosis which was unmasked by a recent COVID-19 infection.

Case:
A 72-year-old Caucasian male with history of post-traumatic epilepsy as a child and otherwise no significant health issues until March 2022 when he had COVID-19 infection presented with worsening fatigue, dizziness, lightheadedness, abnormal eye movements, brain fog and inability to exercise since his COVID infection. Prior to this, he was very active and was riding his bike 50 miles a week. He underwent extensive neurological work up including CT head/neck/temporal bone, MRI brain and continuous EEG that was unrevealing. Echocardiogram showed normal left and right ventricular size and function with no significant valvular abnormalities. 2-week Holter monitor revealed bradycardia with HR 30 beats per minute and sinus pauses with longest of 3.9 seconds. Cardiac MRI was obtained which showed late gadolinium enhancement (LGE) in the basal septum (Image). Subsequent, PET scan revealed mid myocardial FDG uptake with preserved perfusion involving the proximal segments of the heart raising the possibility of early inflammation related to cardiac sarcoidosis or other inflammatory process. He underwent dual chamber pacemaker implantation for sinus pauses.

Decision making:
Cardiac MRI with LGE in basal septum and PET scan showing increased FDG uptake along with bradycardia and pauses leading to pacemaker implantation led to the diagnosis of cardiac sarcoidosis. He was treated with prednisone with repeat PET scan in 3 months.

Conclusion:
It remains unclear if COVID 19 plays a role in inducing inflammatory process of sarcoidosis. Further studies are required to understand the cardiac sequalae of COVID 19 infection and association with sarcoidosis.
Abstract 15419: Adiponectin’s Predictive Role in Long-Term Mortality and Major Adverse Cardiovascular Events in Patients With Stable Coronary Artery Disease: A Meta-Analysis of Prospective Studies
Authors: Jitta Sahas Reddy , Vatsavayi Priyanka , Tera Chenna reddy , Krishnamurthy Shobana , Adla Jala Saisree Reddy , Pasnoor Diksha Sanjana , Dasari Utheja , Farooq Aisha , Maramreddy Supriya , jammula kavya , Reddy Medha , Tripuraneni Sridevi , Desai Rupak
Published: December 2023

INTRODUCTION:
The relentless toll of cardiovascular disease in the United States demands a breakthrough in reliable and cost-effective prognostic markers. Amidst the limited knowledge surrounding the role of adiponectin in stable coronary artery disease (CAD), this study aims to unveil its power in predicting all-cause mortality and major adverse cardiovascular events (MACE) among patients with stable coronary artery disease (CAD).

METHODS:
We systematically screened PubMed, Scopus, and Google Scholar for articles until May 2023 to identify relevant studies. Random-effects model estimated the pooled odds ratio (OR) with 95% confidence intervals (CI), and I2 statistics assessed heterogeneity. The leave-one-out method was used for sensitivity analysis.

RESULTS:
Following the screening, five prospective studies involving 3225 patients with a median follow-up duration of 3.8 years were included. In the study population, hypertension, diabetes, hyperlipidemia, and smoking were prevalent risk factors, and common medications included angiotensin-converting enzyme inhibitors, beta-blockers, and statins. The pooled adjusted OR for all-cause mortality was 2.51 (95%CI: 1.36-4.62), with moderate heterogeneity (I2=65.51%, p=0.03), and the pooled adjusted OR for MACE was 1.04 (95%CI: 1.02-1.06), with no significant heterogeneity (I2=0%, p=0.68)
(Fig. 1)
. The leave-one-out sensitivity analysis showed that no single study significantly influenced the meta-analysis results, indicating robustness.

CONCLUSION:
Higher adiponectin levels were associated with higher odds of long-term mortality and MACE in stable CAD patients, highlighting its potential as a cost-effective marker for risk stratification and guiding management strategies. Further studies exploring the role of adiponectin can significantly impact clinical decision-making and resource allocation in cardiovascular care.
Abstract 15421: Cardiovascular Health of Middle-Aged US Adults by Income Level, 1999 to March 2020
Authors: Liu Michael , Aggarwal Rahul , Zheng ZhaoNian , Wadhera Rishi K
Published: December 2023

Introduction:
Cardiovascular mortality has increased among middle-aged US adults since 2011. Despite these alarming trends, it is unknown how the burden of cardiovascular risk factors has changed for this population by income level over the past two decades.

Methods:
We conducted a serial cross-sectional analysis of the NHANES to evaluate changes in the prevalence, treatment, and control of cardiovascular risk factors among low-income (<200% federal poverty threshold) and higher-income middle-aged adults (ages 40-64) between 1999 and March 2020.

Results:
Among 20,761 middle-aged adults, the prevalence of hypertension, diabetes, and cigarette use was consistently higher among low-income adults between 1999 and March 2020. Low-income adults experienced a significant increase in hypertension (37.2% [95% CI: 33.5-40.9] to 44.7% [95% CI: 39.8-49.5]) over the study period, but no changes in diabetes or obesity. In contrast, higher-income adults did not experience a change in hypertension but had significant increases in diabetes (7.8% [5.0-10.6] to 14.9% [12.4-17.3]) and obesity (33.0% [26.7-39.4] to 44.0% [40.2-47.7]). Hyperlipidemia decreased in both groups. Cigarette use was high and stagnant among low-income adults (33.2% [28.4-38.0] to 33.9% [29.6-38.3]) but significantly decreased among their higher-income counterparts (18.6% [13.5-23.7] to 11.5% [8.7-14.3]). Income-based inequities in cardiovascular risk factors persisted in recent years even after adjustment for insurance coverage, health care access, and food insecurity. Treatment and control rates for hypertension were unchanged in both groups (>80%), while diabetes treatment rates only improved among the higher-income group.

Conclusions:
The burden of several cardiovascular risk factors worsened among middle-aged adults (ages 40-64) over two decades with varying trends by income level. Income-based inequities in hypertension, diabetes, and smoking have not meaningfully narrowed.
Abstract 15438: Cardiovascular Diseases Are Associated With an Increased Incidence of Cancer Metastasis
Authors: Caller Tal , Fardman Alexander , Naftali Shani Nili , Leor Jonathan , Maor Elad
Published: December 2023

Background:
While heart diseases are associated with an increased incidence of cancer, the association between cardiovascular diseases (CVD) and cancer metastasis, the primary determinant of cancer prognosis, has never been studied. We aimed to determine the association between CVD and cancer metastasis.

Methods:
We evaluated 21,952 self-referred adults, free of cancer and CVD (ischemic heart disease/stroke) at baseline, who were screened in our preventive healthcare. Next, we implicated a 1-year blanking period at the start of the follow-up. Then, a Cox regression model with CVD as a time-varying covariate was used to evaluate the association between CVD and metastatic cancer. Finally, we implicated the same models in evaluating the risk of young (ages Q1-3) and old adults (ages Q4).

Results:
During a median follow-up of 7 years (IQR 3-13 years), 1359 subjects developed CVD, and 920 subjects developed metastatic cancer. Subjects who developed CVD were 71% more likely to develop cancer metastasis by a univariate model (HR= 1.33, 95% CI 1.05-1.69, p=0.02). The risk persisted after adjustment for risk factors by a multivariate model (95% CI 1.33-2.20, p<0.001), as well as landmark analysis (HR=1.84 95%CI 1.42-2.34, p<0.001) (
Fig-1)
. The association of CVD with the risk of metastatic cancer was age-dependent (p for interaction = 0.035): significant among younger adults (43±6 years, HR=1.57,95% CI 1.02-2.42, p=0.040), compared with older adults (60±6 years, HR=1.12, 95% CI 0.80-1.56, p=0.522). Notably, CVD emerged as a risk factor for metastatic cancer in younger adults despite a lower rate of common risk factors.

Conclusions:
We show, for the first time, that cardiovascular diseases are associated with an increased and independent risk of cancer metastasis. The risk is age-dependent and more significant among young adults. Understanding this association could promote early diagnosis, risk stratification, and better treatment of cardiovascular diseases and cancer.