bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 17104: Characterization of a Novel, Clinically Relevant Mouse Model of Peripartum Cardiomyopathy
Authors: Andre Veronica , Ashton Anthony W
Published: December 2023

Pregnancy requires significantly increased cardiac output (~30%) achieved through peripheral vasodilation and increased stroke volume, due to increased end-diastolic volume. Most women resolve these physiological changes within 6 months of delivery; however, some women progress to heart failure late in pregnancy or in the immediate post-partum period. Peri-partum cardiomyopathy (PPCM) is a rare condition of largely unknown etiology which, at its most-severe and life-threatening, requires cardiac transplantation. Pre-eclampsia occurs at much higher rates in the PPCM population (~40%) compared with the generally pregnant population (~2-5%). We have previously shown that transgenic mice expressing the human-specific isoform of the TBXA2R gene (TPβ) spontaneously develop pre-eclampsia accompanied by all the associated hallmarks expected from the human disease. We now show TPβ transgenic (TPβ-Tg) mice are a model of PPCM. Using trans-thoracic echocardiographic imaging, TPβ-Tg mice had no basal phenotype; however, unlike C57/Bl6J (WT) mice that resolved the pregnancy-induced cardiac remodeling, TPβ-Tg mice had exaggerated cardiac dilatation at term (E18.5; P<0.01) which increased in severity over the subsequent 6 months (P<0.005). In addition, TP-Tg mice exhibited reduced ejection fraction (22±13% vs 67% in WT), significant LV wall thinning (1.12±0.16 mm vs 1.6±0.17 mm WT), and loss of LV mass (66.55±9 mg vs 95±11mg WT). Analysis of myocardium of human PPCM patients undergoing heart transplant (n=12) compared to healthy myocardium from non-diseased donors (n=42) by RT-PCR and IHC showed highly expressed TPβ in PPCM patients. In human PPCM samples, there was a significant (p<0.01) dysregulation of genes associated with circadian rhythm as determined by RNAseq analysis. Quantitative PCR analysis of hearts from non-pregnant (WT=8; TPβ-Tg=4) and pregnant (WT=10; TPβ-Tg=13) mice found similar dysregulation of multiple genes associated with circadian rhythm compared to WT mice (p<0.01). This indicates that PPCM may be associated with failure to terminate CLOCK signaling as a result of TPβ activation. Our results support dysregulation of TBXA2R splicing as part of the pathogenesis of PPCM and identify new therapeutic targets for this condition.
Abstract 17121: Elevated Aortic Stiffness and Impairments in Cerebrovascular Regulation in Cancer Survivorship
Authors: Scheuermann Britton , Hammond Stephen , Turpin Vanessa-Rose , Parr Shannon , Kunkel Olivia , Smith Kayla , Ade Carl J
Published: December 2023

Background:
Approximately 46% of cancer survivors report cognitive impairments across many types of cancer, which has been associated with anti-cancer therapy and often results in reduced quality of life. Pre-clinical studies suggest that predictors of cognitive decline may involve vascular dysfunction. We aimed to characterize local (cerebrovascular reactivity and cerebral autoregulation) and global (aortic arch stiffness) vascular regulation in cancer survivorship.

Methods:
Cerebral autoregulation was determined using Mx, a moving 10s-windowed correlation between finger plethysmography-derived blood pressure and cerebral blood velocity of the middle cerebral artery. Higher Mx values represent pressure-passive cerebral blood flow, indicating poor cerebral autoregulation. In addition, cerebral blood velocity, blood pressure, and end-tidal CO
2
were collected during a rebreathing task. MAP was used to calculate an index of cerebrovascular conductance (CVCi). Cerebrovascular reactivity was calculated as the change in cerebral blood velocity or CVCi over the change in end-tidal CO
2
. Aortic arch stiffness, as pulse wave velocity (aaPWV), was calculated from ultrasound scans of the aortic valve and the descending aorta. Differences between groups were assessed with Mann-Whitney tests.

Results:
Eleven women were recruited (5 controls and 6 cancer survivors who had received treatment). Cancer types included melanoma, lymphoma, and breast cancer. Age and resting MAP were similar between groups. Mx values were higher in cancer survivors (-0.13 ± 0.14 vs. 0.14 ± 0.11, p < 0.05). Cerebrovascular reactivity, both absolute (2.8 ± 1.1 vs. 1.6 ± 0.8, p = 0.05) and as CVCi (16.8 ± 2.4 vs. 2.3 ± 9.4, p < 0.05), were lower in cancer survivors. aaPWV was higher in cancer survivors (2.7 ± 0.8 vs. 3.8 ± 0.6, p < 0.05). Across the entire study sample, aaPWV trended towards an association only with absolute cerebrovascular reactivity (Spearman r = -0.6, p = 0.054).

Conclusion:
Aortic stiffness was elevated and both cerebrovascular regulatory functions were impaired in cancer survivors compared to healthy controls. Present findings highlight the importance of monitoring cerebral and global vascular function in cancer survivors at high-risk for cognitive decline.
Abstract 17122: Role of a Dedicated Program in Early Recognition and Treatment of Transthyretin Cardiac Amyloidosis
Authors: Pillai Ashwin , Arora Sabeena , Jaiswal Abhishek
Published: December 2023

Introduction:
Clinical recognition of Transthyretin Cardiac amyloidosis(ATTR-CA) is rising. Lack of treatment options with disease reversing agents makes early diagnosis and institution of treatment crucial to clinical improvement. A dedicated ATTR-CA program might facilitate such goals.
Aim:
We report our early experience with initiation of a cardiac amyloidosis program on diagnostic and therapeutic intervals and clinical outcomes.

Methods:
Retrospective review of patients who are being treated with Tafamidis in our cardiac amyloidosis management program(CAMP) from March 2019 through May 2022

Results:
55 patients with ATTR-CA (47-male) aged 80±9 years; 45 with clinical HFpEF and NYHA class 2-3 limitations and at least one prior hospitalization related to heart failure(HF) were seen in our CAMP(Figure). Initial mean LVEF was 50±12%. 42 had LVH and 11 had biventricular hypertrophy. Mean LV septal & posterior wall thickness were 1.54±0.37cm & 1.44±0.29cm respectively. The median interval between onset of HF and diagnosis, and from diagnosis to initiation of Tafamidis were 4 months (Inter Quartile Range[IQR] 1-9) and 1 month (IQR 0-3) respectively. For HF management, 35 patients were maintained on loop diuretics, 34 on mineralocorticoid receptor antagonists, 21 on SGLT2 inhibitors, 12 on beta blockers, 7 on ARNIs, 6 on ACEI/ARBs, and 1 on digoxin. Medications were tolerated well with no reported adverse effects. At follow-up, 16 patients reported NYHA class 1, 15 class 2, 14 class 3 limitations. 3 patients required PCI after enrollment in the program. Follow-up echocardiograms were available for 36 patients with a mean EF of 50±11%.

Conclusions:
Given the irreversible nature of ATTR-CA, early diagnosis and initiation of treatment is vital to improving long-term outcomes. Instituting a dedicated CAMP results in shorter diagnostic and therapeutic lag times than those historically described.
Abstract 17144: Pi3 Kinase Activation by Platelet-Derived Purified Exosome Product to Induce Angiogenesis
Authors: Rizzo Skylar A , Mahlberg Ryan , Amontree Ashley , Peterson Timothy E , Witt Tyra A , Nagel Mary , Bagwell Monique , Becher Laura , Park Sungjo , Sabbah Michael , Arrell D. Kent K , Li Mark , Kargaran Parisa , li jialun , Kim Yoha , LUCIEN Fabrice , Stalboerger Paul , Terzic Andre , moran steven , Behfar Atta
Published: December 2023

Introduction:
Platelets are heavily implicated in angiogenesis; however, the underlying mechanism remains relatively uncharacterized. The goal of this study was to evaluate the angiogenic potency of a platelet-derived regenerative exosome product (PEP) in an effort to develop a novel treatment for peripheral arterial disease. Here, we evaluated the mechanistic basis of PEP in angiogenesis and it’s use In Vivo in a rodent hind limb ischemia model.

Methods/Results:
Under Current Good Manufacturing Practices, conditioned medium from apheresis platelet cultures was purified to acquire the exosomes. PEP, enriched in exosome markers CD63, CD9 and Flotillin, induced human umbilical vein endothelial cell (HUVEC) proliferation, migration, and vascular tube formation In Vitro. Proteomic evaluation of PEP highlighted receptor tyrosine kinase (RTK) pathways and western blot validation demonstrated induction of phospho-MAPK and phospho-AKT following PEP treatment of HUVECs. Systematic evaluation of RTK receptor involvement was performed using small molecule inhibitors and receptor knock-down in HUVECs, ruling out RTK activation as a mode of action. However, small molecule inhibition of PI3 kinase demonstrated elimination of PEP-induced AKT phosphorylation and reduction in PEP-induced angiogenesis In Vitro measured by HUVEC proliferation and migration. In Vivo, evaluation of angiogenesis was performed in a rodent model of hindlimb ischemia treated with PEP embedded in fibrin glue (PEP/TISSEEL). Blood flow was evaluated by SPY angiography on day 0 pre- and post-operation, day 21, and day 28. Animals treated with PEP/TISSEEL showed a significant increase in blood flow compared to sham and TISSEEL treated animals (percent perfusion at 28 days: sham 40.9%, TISSEEL 44.3%, PEP/TISSEEL 100.2%), with significant increase in vascular area on histology (at 28 days vascular area (μm
2
)/muscle area(μm
2
): healthy control 12.71, sham 4.66, TISSEEL 4.76, PEP/TISSEEL 15.54).

Conclusions:
Exosome driven activation of PI3 kinase can induce angiogenesis both In Vitro and In Vivo. PEP provides a novel, clinical-grade, off-the-shelf therapy to promote angiogenesis for the treatment of peripheral arterial disease.
Abstract 17170: Association of Plasma Homocysteine Levels in Cancer Survivors - Data From Framingham Heart Study Offspring Cohort
Authors: Turpin Vanessa-Rose G , Scheuermann Britton C , Ade Carl J
Published: December 2023

Introduction:
Cancer survivors experience a high prevalence of vascular remodeling from their anti-cancer therapies, which can lead to arterial stiffness. High plasma homocysteine (Hcy) is associated with increased cardiovascular disease risk via its role in decreasing nitric oxide bioavailability and impairing vascular function. However, there is limited work on its role in cancer survivorship. We, therefore, hypothesized that survivors of breast, gastrointestinal, and prostate cancer with elevated plasma Hcy values have higher arterial stiffness and lower endothelial function compared to those with low plasma Hcy.

Methods:
We evaluated cardiovascular disease-free cancer survivors in the Framingham Heart Study Offspring Cohort (n=196, 66±8 years old, 55.1% women, 26.4±1.2 years from cancer diagnosis, Range: [23.8 - 29.6 years]) with plasma Hcy measurements. The cohort median plasma Hcy was used to define low (<8.16 μmol/L) and high Hcy (≥8.16 μmol/L) groups. Arterial stiffness was assessed via carotid-femoral pulse wave velocity (cfPWV). Peripheral vascular endothelial function was assessed via endothelium-dependent brachial artery flow-mediated dilation (FMD). Differences in cfPWV, FMD, and cardiovascular risk factors were assessed via independent sample t-test or chi-square test. Differences in cfPWV and FMD were further assessed via one-way ANCOVA with age, sex, and cardiovascular medications included as covariates.

Results:
cfPWV was significantly higher in the high Hcy (9.9±1.5m/s) vs. low Hcy group (8.5±1.9m/s, p=0.005); however, there were no differences in FMD between groups (2.4±1.7 vs. 2.7±2.0%, p=0.42). After controlling for our covariates, cfPWV was still significantly higher in the high Hcy group (Mean[95% CI]): (9.8[9.0-10.61]) compared to the low Hcy group (8.5[8-9.1]) (p=0.015).

Conclusions:
Our findings suggest an association between elevated Hcy and an increase in arterial stiffness in cancer survivors. This supports the potential adverse consequences of vascular stiffening following cancer diagnosis and treatment which could have long-term cardiovascular health implications.
Abstract 17174: New Criteria for Block Across Anterior Mitral Line That Includes Bachmann’s Bundle in Patients With Scar Perimitral Flutter
Authors: Jabri Ahmad , Buddhavarapu Sivacharan , Gruber Megan , Alayan Dina , Ahmad Ela , Soltero Enrique , Sukhon Fares , Ziv Ohad , Almahameed Soufian
Published: December 2023

Background:
The recurrence rate of scar perimitral flutter (SMF) after anterior mitral line (AML) ablation remains high. Epicardial connections from high right atrium (HRA) to high lateral left atrium (HLA) including the Bachmann bundle (BB) plays a significant role in perimitral flutter recurrence.

Hypothesis:
We hypothesize that block across BB (BBB) during endocardial anterior line ablation reduces recurrence of atrial tachycardia (AT) and SMF.

Methods:
Patients undergoing left atrial ablation with SMF that were treated with AML were retrospectively enrolled. Pulmonary veins isolation and bidirectional AML block achieved in all patients. Baseline HRA-HLA, final HRA-HLA, and delta HRA-HLA intervals measured. Changes in HLA activation sequence determined. BBB identified when HRA-HLA interval increased with change in HLA activation sequence and confirmed with differential pacing. (Figure 1). The primary endpoint was recurrence of AT/SMF

Results:
We identified 101 patients, 51% comprised of women, with a mean age of 69. Patients who had AML without evidence of BBB were 48 compared to 53 patients who had AML with evidence of BBB. The mean baseline, final and delta HRA-LAA were 123 ± 42ms, 219 ± 45 ms and 96± 21 ms respectively in patients with BBB. After median follow up of 48 months, AT/SMF recurred in 43 % of patient without BBB vs 15 % in patient with BBB (p<0.008) (Figure 2). In patients with BBB, delta HRA-HLA >107ms discriminated between recurrence and no recurrence (p<0.023ms and 93% negative predictive value)

Conclusion:
During endocardial AML ablation for SMF, bidirectional block with evidence of BBB is associated with significant reduction in AT/SMF recurrence.
Abstract 17180: Association of Arterial Return Cannula Size With Survival in Adults Undergoing Venoarterial Extracorporeal Membrane Oxygenation: An ELSO Registry Analysis
Authors: Aguilar Franco Laura , Delgado Alvaro A , Hincapie Tabares Daniela , Sriwattanakomen Roy , fleming lisa , Quintero Pablo A , Ho Jen , Sabe Marwa , kennedy kevin , Garan Arthur Reshad , Grandin E. Wilson
Published: December 2023

Introduction:
Peripheral venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used to support critically ill adults with cardiogenic shock (CS), but the impact of arterial cannula size on survival remains poorly understood.

Hypothesis:
A smaller arterial return cannula will be associated with similar survival.

Methods:
We queried the ELSO registry for adults undergoing VA-ECMO from 2017-2022 and stratified them into small (<16 Fr) versus large (≥16Fr) arterial cannula size. We restricted the cohort to patients with body surface area (BSA) 1.8-2.2 m
2
and excluded patients with a concomitant left ventricular venting device, central cannulation, and multiple ECMO runs. The primary outcome was 30-day in-hospital mortality and secondary outcomes included 24-hour lactate clearance and rates of on-support acute renal and liver injury.

Results:
Among 2963 adults receiving peripheral VA-ECMO without a concomitant left ventricular venting device, 491 (16.6%) patients had a small arterial cannula and 2,472 (83.4%) had a larger cannula. Patients with a larger cannula were more often male, had marginally higher BSA, a higher incidence of pre-ECMO organ failures, and more often had a distal perfusion cannula (Figure, panel A). There was no difference in 30-day mortality between patients with small (40.3%) versus large (42.9%) arterial cannula, p= 0.295 (Figure, panel B), which persisted after multivariable modeling: adjusted hazard ratio 0.97 (95% CI: 0.79-1.19, p= 0.78). Lactate clearance at 24 hours of ECMO support (Figure, panel C) and the rates of acute renal injury (37% vs 41%, p = 0.024) and hyperbilirubinemia (4.3% vs 4.3%, p = 0.96) were similar between the two arterial cannula size cohorts.

Conclusion:
For adult patients undergoing peripheral VA-ECMO support, the use of a smaller (<16F) versus larger (≥16F) arterial return cannula was associated with similar rates of in-hospital mortality and metrics of end-organ perfusion.
Abstract 17182: A Case of Purulent Pericarditis in the Setting of Streptococcal Pneumonia
Authors: Adelkhanova Alla , Shtembari Jurgen , Shrestha Dhan B , Huh Alexander
Published: December 2023

Introduction:
Purulent pericarditis was a prevalent complication of streptococcal pneumonia prior to antibiotic era, but uncommon in the modern age. Purulent pericarditis is characterized by gross pus or microscopic purulence localized in the pericardial space.

Case Presentation:
A case of a 68-year-old male presenting with dyspnea, chest pain, left knee pain and edema. Medical history was significant for hypertension, diabetes, hypothyroidism. He developed respiratory failure due to pneumonia and was treated in intensive care unit. S. pneumoniae bacteremia and septic arthritis with isolation of the same pathogen from synovial fluid were diagnosed. Initial ECG showed diffuse ST elevations suggestive of pericarditis, so TTE was obtained. It showed a small, free flowing pericardial effusion along RV free wall with no evidence of hemodynamic compromise. Serial TTEs were done showing increasing size of pericardial effusion. On day 7 of hospitalization patient had several episodes of atrial fibrillation with RVR complicated by hypotension. A subsequent TTE showed a large, free-flowing pericardial effusion with signs of early tamponade. Patient underwent urgent pericardiocentesis with drainage of one liter of purulent fluid and placement of pericardial drain. Fluid analysis confirmed purulent pericarditis, gram stain and cultures were negative. Repeat TTE showed a trivial pericardial effusion and a 2.7mm mass suspicious for vegetation on the mitral valve with moderate MR, confirmed by TEE. CT surgery recommended 6 weeks of antibiotics with no surgical intervention. Patient was discharged to a skilled nursing facility for a prolonged IV antibiotic course with a follow up with cardiology.

Conclusion:
This case shows purulent pericarditis in the setting of pneumonia complicated by bacteremia, infective endocarditis, and septic arthritis. Although rare, purulent pericarditis is a life-threatening disease, so timely diagnosis and treatment are of essence.
Abstract 17192: Characterization and Localization of Focal Atrial Tachycardia in Adult Congenital Heart Disease
Authors: OConnell Christine , Arps Kelly , Carlisle Matthew A , Schwennesen Hannah , Idriss Salim F , Kanter Ronald , Piccini Jonathan P
Published: December 2023

Introduction:
Patients with adult congenital heart disease (ACHD) often develop atrial arrhythmias, including focal atrial tachycardia (FAT). In non-ACHD patients, algorithms using surface ECG P-wave morphology are helpful to predict FAT location to assist in planning targeted ablation procedures, but similar algorithms have not been fully developed for ACHD patients with complex anatomy, including prior surgical correction and other anatomic differences.

Methods:
In this single-center retrospective cohort study, 29 patients with ACHD who underwent catheter ablation for FAT were included. FAT P-waves from 12-lead electrocardiograms obtained in clinic or the electrophysiology laboratory were classified as 1) positive, 2) negative, 3) isoelectric, or 4) biphasic. FAT ablation sites identified by electroanatomic mapping were grouped by region: right atrium (RA), paraseptal (PS), and left atrium (LA). Accuracy of P-wave classification criteria to predict FAT region were determined.

Results:
Thirty FATs were assessed in 29 patients (mean age 47 +/- 16 yrs, female 55%). RA FAT sites: crista terminalis (14), Fontan baffle (3) non-septal tricuspid annulus (1). PS FAT sites: PS tricuspid annulus (2), coronary sinus ostium (3), foramen ovale (1). LA FAT sites: mitral annulus (2), right superior pulmonary vein (1), left atrial appendage (3). Based on previously reported P-wave morphology localization criteria in normal hearts, sensitivities and specificities were analyzed in these ACHD patients and are shown in the Table. Additional algorithms were also tested. We determined that a biphasic (+/-) or negative P-wave in lead V1 was associated with a 100% specificity for the RA compared to PS or LA.

Conclusions:
P-wave morphology may be useful in predicting atrial location of FAT in ACHD patients. Similar to patients with normal hearts, lead V1 P-wave morphology in ACHD patients provides the most useful information for localizing FAT with a high degree of specificity.
Abstract 17199: A Case of Ventricular Fibrillation Arrest After Immune Checkpoint Inhibitor Therapy
Authors: McKay Kelly R , Jilani Mohammad Hashim H , Moseley Alex
Published: December 2023

Description of Case:
Our patient is a 65-year-old male who suffered sudden cardiac arrest due to ventricular fibrillation while receiving his second cycle of therapy for non-small cell lung cancer, which consisted of carboplatin, pemetrexed, nivolumab, and ipilimumab. Initial symptoms included sudden onset chest pain and dyspnea during infusion, which then rapidly progressed to ventricular fibrillation, and he was successfully defibrillated with ROSC. Subsequent coronary angiogram revealed patent coronary arteries, and cardiac MRI (CMR) was consistent with acute myopericarditis. Our patient was treated with high dose steroids and colchicine.

Discussion:
Immune checkpoint inhibitors (ICI) are a novel drug class with an emerging role in treatment of various tumors, including lung cancer. ICIs prevent the interaction between host checkpoint proteins and tumor partner proteins, allowing the immune system to appropriately attack tumor cells. Two such ICI include nivolumab and ipilimumab, which are frequently administered together. ICI therapy is linked with very rare but potentially life-threatening cardiac side effects including malignant arrhythmias, such as ventricular fibrillation and polymorphic ventricular tachycardia, along with risk of myocarditis and pericarditis. The risk is highest in the first 30 days; patients who received nivolumab and ipilimumab in combination and those treated for non-small cell lung cancer were found to have a higher risk of cardiac side effects. The timeline of events in our patient with subsequent CMR findings make the diagnosis of sudden cardiac arrest secondary to ICI therapy the most likely cause. Patients receiving ICI therapy should be monitored appropriately with algorithms in place for prompt detection and triaging of such patients who develop these side effects.
Abstract 17210: Re-Defining Antibody Mediated Rejection With Donor-Specific Antibodies and Graft Dysfunction, on Behalf of the GRAfT Investigators
Authors: Goldberg Jason F , Xu Yifei , Tian Xin , Gerhard Eleanor , Brower Ruth , Jang Moon , Kong Hyesik , Andargie Temesgen , Park Woojin , Najjar Samer S , Tchoukina Inna , Shah Keyur B , Hsu Steven , Rodrigo Maria , Marboe Charles , Berry Gerald , Valantine Hannah , Shah Palak , Agbor-Enoh Sean
Published: December 2023

Introduction:
Heart transplant recipients with donor-specific antibodies (DSA) have increased risk for antibody-mediated rejection (AMR). However, many patients with graft dysfunction and DSA do not show AMR by endomyocardial biopsy (EMB).

Hypothesis:
We hypothesized that, similar to EMB-defined AMR, AMR defined as DSA presence + graft dysfunction on echocardiography is associated with 1) graft injury via elevated donor-derived cell-free DNA (dd-cfDNA) and 2) risk for long-term adverse outcomes.

Methods:
Adult heart transplant recipients from the Genomic Research Alliance for Transplantation (GRAfT, a prospective, multicenter study from 2015 to 2020) had DSA, echocardiogram, and dd-cfDNA evaluated at time of EMB. AMR was defined by EMB (pAMR ≥ 1), DSA/EF (DSA presence + LVEF drop by ≥ 10% to an LVEF ≤50%), or a composite of EMB or DSA/EF criteria. The composite long-term endpoint was death or long-term EF reduction ≤ 50% for >90 days.

Results:
216 patients (29% Female, 39% Black race, mean age 52 ± 12 years) had 1489 EMB, 1959 DSA, 1821 echocardiogram, and 1190 dd-cfDNA evaluations. DSA were present in 71 patients (34%), predominantly class II (69%). AMR was detected by EMB in 16 subjects and by DSA/EF in 10 subjects. Median %dd-cfDNA for subjects with AMR by EMB was 0.63% (IQR 0.23-2.0), by DSA/EF was 0.40% (IQR 0.36-1.24), and for controls was 0.01% (IQR 0.001-0.10). There were 18 deaths and 10 subjects with long term EF reduction. As compared to controls, development of each AMR definition was associated with the composite long-term endpoint: AMR by EMB, HR=3.6,
P
=0.010; AMR by DSA/EF, HR=23.4,
P
<0.0001; composite AMR, HR=7.6,
P
<0.0001, Figure.

Conclusions:
Heart transplant recipients with EMB and EF/DSA AMR have similar evidence of graft injury via dd-cfDNA as well as risk of long-term adverse outcomes, as compared to those without AMR. Therefore, a composite definition of AMR, including EMB or DSA/EF may better allow for identification of patients at risk for graft failure.
Abstract 17211: Barriers and Predictors of Physical Activity Maintenance: The STRRIDE I Reunion Cohort
Authors: Collins Katherine A , Johnson Johanna L , Slentz Cris A , Ross Leanna M , Huffman Kim M , Kraus William E
Published: December 2023

Introduction:
STRRIDE I (Studies of Targeting Risk Reduction Interventions through Defined Exercise) was an 8-month exercise intervention conducted from 1998-2003. Participants were randomized to an inactive control group or one of three exercise groups differing in amount and intensity. Ten years later, participants returned for follow-up assessments as part of the STRRIDE I Reunion study.
Hypothesis/Research Questions:
1) What barriers influence physical activity (PA) maintenance ten years following a supervised exercise intervention? 2) What factors predict PA maintenance ten years following a supervised exercise intervention?

Methods:
At baseline and post-intervention STRRIDE I assess clinical markers including height, weight, blood pressure, waist circumference, body composition, peak V˙O
2
, glucose, insulin, and lipids. For the Reunion study, 104 participants completed a 3-month PA recall questionnaire, which included self-reported barriers to current PA participation. For the clinical variables, baseline, post-intervention, and change scores (post minus baseline values) were used to generate three separate predictive models. Models were generated using a backward bootstrap variable selection algorithm followed by multiple linear regression.

Results:
Ten years after completing STRRIDE I, the mean self-reported PA was 77.9
+
76.5 minutes/week. The most commonly reported barriers to PA maintenance were lack of self-motivation (41%), time constraints (33%), illness or injury (29%), and family obligations (23%). The model utilizing baseline variables as predictors of PA maintenance had an adjusted R
2
value of 0.05, while the model utilizing post-intervention variables had an adjusted R
2
of 0.12. The model utilizing change scores to predict PA maintenance had an adjusted R
2
of 0.17; changes in mean heart rate explained the greatest variance in PA maintenance (partial R
2
= 0.10).

Conclusions:
Continued PA participation beyond a structured exercise intervention setting continues to be challenging for individuals. When trying to predict PA maintenance, where you start or how you finish the intervention may not be as imperative; rather, how you respond in certain variables may be the most important predictors of PA maintenance.
Abstract 17212: Arterial Cannula Size and 30-Day Mortality in Adults With Cardiogenic Shock Supported With Venoarterial Extracorporeal Membrane Oxygenation and Concomitant Left Ventricular Mechanical Unloading: An ELSO Registry Analysis
Authors: Delgado Alvaro A , Aguilar Franco Laura , Hincapie Tabares Daniela , Sriwattanakomen Roy , Fleming Lisa , Quintero Pinzon Pablo , Ho Jennifer E , Sabe Marwa , Kennedy Kevin , Garan A. Reshad , Grandin E. Wilson
Published: December 2023

Introduction:
VA-ECMO with left ventricular mechanical unloading (LVMU), including intra-aortic balloon pump (IABP) or percutaneous left ventricular assist device (pVAD), is commonly used to support patients with cardiogenic shock (CS). The impact of arterial return cannula size on short-term mortality in the presence of LVMU is unknown.

Hypothesis:
The 30-day inpatient survival in patients with VA-ECMO and LVMU will be the same with a small vs large arterial cannula.

Methods:
We queried the ELSO Registry from 2017-2022 for adults with CS receiving VA-ECMO and concomitant LVMU, with either IABP or pVAD placed within -24h to +2h of ECMO initiation. We restricted to patients with body surface area (BSA) 1.8-2.2 m2 and excluded those with central cannulation, multiple ECMO runs, and ECPR. The primary outcome of 30-day inpatient mortality was compared using time-to-event analysis. Secondary outcomes included 24h lactate clearance and rates of acute renal and hepatic injury.

Results:
Among 2055 patients supported with VA-ECMO and LVMU (54.3% IABP; 45.7% pVAD), 292 (14.2%) patients received a small cannula and 1763 (86.8%) patients a large arterial cannula. Patients with a small cannula were less likely to be male, had smaller BSA, less often had a distal perfusion cannula, and had a lower incidence of pre-ECMO concomitant organ failures (Figure, A). There was no difference in 30-day inpatient mortality between the cannula size groups (Figure, B), which persisted in multivariable modeling with adjusted hazard ratio 0.94 (95% CI: 0.72-1.23), p=0.65. Patients with a small arterial cannula had no significant difference in 24h lactate clearance (Figure, C) or in the rates of acute renal injury (37.3% vs 39.8%, p = 0.42) or hyperbilirubinemia (5.5% vs 6.5%, p=0.52).

Conclusions:
In adults with CS receiving VA-ECMO with LVMU, the use of a smaller arterial return cannula was associated with no difference in 30-day inpatient mortality or metrics of end-organ perfusion.
Abstract 17220: Mathematical Modeling of Echocardiographic Underestimation of Right Ventricular Systolic Pressure in Severe Tricuspid Regurgitation
Authors: Smith Tyler J , Appadurai Vinesh , Gercek Muhammed , Maganti Kameswari , Lee Jeesoo , Markl Michael , Thomas James D
Published: December 2023

Background:
Echocardiography approximates right ventricular systolic pressure (RVSP) by the simplified Bernoulli Equation (SBE), adding mean right atrial pressure (mRA) to convective pressure (4v
2
), where v is maximal tricuspid regurgitant (TR) velocity. As TR worsens, the inertance of TR flow increases which may cause TR peak velocity to lag behind the maximal RVSP time point. As a result, using SBE may underestimate RVSP in patients with significant TR. Currently, inertance is not measurable by echo, but theory suggests it is linearly related to regurgitant orifice diameter (3 X ROD). We sought to confirm the principle of RVSP underestimation in ≥severe TR by comparing a lumped parameter model (LPM) of the heart to cath/echo data.

Methods:
In MATLAB, the LPM uses time-varying elastance of atria/ventricles and the complete Bernoulli equation to model pressure and flow in all chambers/vascular beds. LPM parameters for trace and torrential TR cases yielded convective, inertial, RA and RV pressure curves and critical TR variables: TR volume, mRA, and TR velocity, which were compared to simultaneous cath/echo data in clinical patients.

Results:
Trace TR pressure curves aligned with RVSP and convective pressure peaks, and near perfect echo prediction. Torrential TR pressure curves show earlier peak RVSP with up to 20mmHg of inertial pressure, resulting in predicted 3.1mmHg underestimation, closely matching the observed underestimation of 3.6mmHg. For modeling demonstration, we show (from 90 subjects) 1 patient with trace TR (ROD 1.1mm), A, and 1 patient with torrential TR (ROD=11.3mm), B, in Figure 1.

Conclusions:
Our analysis shows the importance of inertial pressure in ≥severe TR: earlier peak RVSP congruent with accelerating increased regurgitant mass and improved approximation of RVSP by inertial pressure quantification modeling. Further clinical study of RVSP underestimation in cases of ≥severe TR and its correction by including inertial forces is recommended.
Abstract 17236: Risk of Incident Atrial Fibrillation Associated With Recreational Cannabis Use
Authors: Teraoka Justin T , Tang Janet J , Delling Francesca N , Vittinghoff Eric , Marcus Gregory M
Published: December 2023

Background:
Cannabis use is increasing worldwide as legalization becomes more common. Prior studies have reported an association between cannabis use and increased risk of atrial fibrillation (AF). However, these have been cross-sectional and generally relied on diagnostic coding to identify cannabis users, which may not be representative of the typical recreational cannabis user.

Goals:
To examine the association between recreational cannabis use and AF risk.

Methods:
We utilized the UK Biobank, a prospective cohort study with serial assessments of lifestyle and medical diagnoses. Those who completed the cannabis use questionnaire and without prevalent AF were analyzed. Cannabis exposure was ascertained by self-reported lifetime use. AF events were identified using healthcare coding. Cox proportional hazard regression models were used to estimate the hazard ratios between the cannabis use groups and incident AF. Models were adjusted for age, sex, race, alcohol, coffee, smoking, education, and baseline cardiovascular comorbidities.

Results:
157,305 participants (mean age 55.9 ± 7.7 years, 57.0% female, and 22.1% having used cannabis at least once) were followed for a mean 13.5 ± 1.7 years. Before multivariable adjustment, AF risk was found to be lower among occasional cannabis users (hazard ratio [HR] 0.71, 95% confidence interval [CI] 0.66 to 0.75, p < 0.001) and frequent cannabis users (HR 0.63, 95% CI 0.53 to 0.75, p < 0.001) compared to never users. However, after multivariable adjustment and compared to no cannabis use, neither occasional nor frequent cannabis use was associated with statistically significant differences in incident AF (HR 0.98, 95% CI 0.91 to 1.05, p = 0.58 and HR 0.98, 95% CI 0.82 to 1.18, p = 0.86 respectively) (Figure).

Conclusions:
Contrary to previous evidence relying on healthcare coding of cannabis use, this large prospective cohort study failed to reveal any evidence that cannabis use was associated with an increased risk of AF.
Abstract 17256: Perturbations of Tryptophan Catabolism Through the Kynurenine Pathway Are Associated With Prolonged Mechanical Ventilation and Length of Stay After Stage 2 Palliation for Single Ventricle Heart Disease
Authors: Romanowicz Jennifer , Khailova Ludmila , Niemiec Sierra , Mitchell Max B , Morgan Gareth J , Twite Mark , DiMaria Michael V , Klawitter Jelena , Davidson Jesse A , Frank Benjamin S
Published: December 2023

Background:
Infants with single ventricle heart disease (SVHD) have perturbed kynurenine pathway (KP) function prior to stage 2 palliation. Buildup of kynurenic acid—a byproduct of this pathway—is linked to worse outcomes post stage 2. To date, perturbations along the entire KP have not been delineated in SVHD infants at the time of stage 2 operation.

Methods:
This is a single center prospective cohort study of 75 infants with SVHD undergoing stage 2 palliation and 50 controls. Targeted analysis of KP metabolites was performed on serum samples via tandem mass spectroscopy prior to stage 2 (baseline) and post-operatively at 2, 24, and 48 hours.

Results:
Of the 9 KP metabolites, 7 were different between controls and SVHD at baseline (Figure 1A). SVHD infants had lower tryptophan and serotonin; and higher kynurenic acid, 3-hydroxykynurenine, anthranilic acid, picolinic acid, and 3-hydroxyanthranilic acid. After stage 2, there were time related changes in all KP metabolites except tryptophan (Figure 1B). Metabolite concentrations at baseline and 2 hours post-op were poorly correlated with outcomes. At 24 hours, decreases in tryptophan and serotonin along with elevations in kynurenine, kynurenic acid, 3-hydroxykynurine, and quinolinic acid concentrations correlated with outcomes (Figure 1C). At 48 hours, kynurenic acid remained positively correlated with all 3 outcomes (length of stay, hypoxia burden, and intubation length).

Conclusions:
We demonstrated numerous perturbations in the KP pathway at baseline in SVHD infants compared to controls. We also profiled the trajectory of each metabolite over the 48 hours post stage 2. The link between KP intermediates and poor outcomes post-operatively—but not at baseline—demonstrates that the acute, peri-operative changes in tryptophan catabolism in response to cardiopulmonary bypass are more important to tolerating new stage 2 physiology than chronic changes during the interstage period.
Abstract 17257: Aortopulmonary Collateral Burden in the Fontan Circulation: Longitudinal Changes and Relationship With Clinical Outcomes
Authors: Kongrat Surachai , Prakash Ashwin , Schidlow David N , Thatte Nikhil , Rathod Rahul , St. Clair Nicole , Lipsitz Stuart , Ghelani Sunil J
Published: December 2023

Background:
Aortopulmonary collaterals (APC) are a common source of volume load in patients with a Fontan circulation and their burden can be quantified by CMR. Longitudinal trends in APC flow and their relationship with outcomes have not been described.

Hypothesis:
Higher APC flow will be associated with worse clinical outcomes in Fontan patients.

Aims:
To assess longitudinal changes in APC flow in the Fontan circulation using CMR and their relationship with outcomes.

Methods:
Single-center retrospective analysis of Fontan patients who had at least 1 CMR with APC flow data. APC flow was estimated as the difference between aortic and systemic venous flows and also expressed as a percent of aortic flow. Primary outcome was a composite of death or heart transplantation; secondary outcomes included protein losing enteropathy, ascites, chylothorax, and hemoptysis. The baseline (time at Fontan=time 0) and trend in APC flow were estimated using a linear mixed model with a random intercept and slope for each patient.

Results:
Analysis included 758 CMRs from 356 patients; 123 of whom had ≥ 2 CMRs. Median age at first CMR was 14 y (IQR 10-19 y) and median CMRs per patient were 2 (range 1-12). Baseline APC flow was 0.6 (±0.5) L/min/m
2
or 17 (±10) % of aortic flow. Increasing APC flow over time correlated with increasing trend in ventricular dilation and decreasing trend in SaO
2
. Over a median follow-up of 17 years, 22 patients (6%) had the composite outcome. High baseline APC flow as well as an increasing trend in APC flow were associated with clinical outcomes including an independent association with death or heart transplantation (Table).

Conclusions:
APCs represent a significant hemodynamic burden in functional single ventricle hearts palliated to the Fontan circulation. Higher and increasing APC flow is associated with worse clinical outcomes. Factors contributing to APC development and whether APC occlusion results in a lasting reduction in the burden remain to be elucidated.
Abstract 17268: Gender Distribution Within Medicine and Cardiology Journal Editorial Boards
Authors: Shivani Prisha , Bhardwaj Anju , Vest Amanda
Published: December 2023

Introduction:
In the United States, 50% of medical students and over 40% of internal medicine (IM) residents are women. Despite a visible increase in representation of women in academics, studies have noted underrepresentation in academic leadership.

Hypothesis:
We sought to evaluate if women have near equal representation in editorial boards in major journals reflective of the proportion of women in Medicine.

Methods:
We evaluated two leading IM and Cardiology journals each to assess whether there was equity in representation of women in editorial roles. The editorial boards of these journals were reviewed as of April 2023. The gender distribution of editorial board members was displayed graphically using pie charts. The combined proportions of women in the two IM and Cardiology journals, respectively, were compared using Fisher’s exact test (Prism v9.5.1).

Results:
For the IM journals, the editorial board of
Journal of the American Medicine Association
was comprised of 18 women and 34 men (34.6% women) and the
New England Journal of Medicine
had 32 women and 44 men (42.2% women, Figure 1). For the Cardiology journals, the editorial board of Circulation was comprised of 90 women and 306 men (22.7% women) and the
Journal of the American College of Cardiology
had 46 women and 215 men (17.6% women, Figure 1). When comparing the combined proportions of women, the IM journals had a greater representation of women (39.1%) than the Cardiology journals (20.7%), p<0.0001.

Conclusions:
We observed that leading IM Journals have greater representation of women in editorial roles compared to Cardiology journals. This could be related to IM editorial boards drawing from a wider range of medical subspecialties, some of which may have greater representation of women. The ‘leaky pipeline’ in Cardiology may hinder gender-based parity at the highest academic ranks. Specific efforts to engage and mentor academic Cardiologists may help support diverse participation in editorial boards.
Abstract 17274: Frequency of Cardiology Follow-Up in Childhood Cancer Patients
Authors: Talwar Bhavya , Mehta Rittal , Dham Niti
Published: December 2023

Background:
Childhood cancer survivors (CCS) are at risk of early or late-stage cardiotoxicity, the third leading cause of death in CCS. American Heart Association Scientific statement stresses the importance of timely follow-up of CCS. Children's Oncology Group (COG) has also recommended serial cardiac testing based on therapy doses. However, compliance of cardiac follow-up is not known.

Hypothesis:
Cardiology follow-up in CCS is poor and needs improvement.
Goal:
Our goal is to identify factors that limit timely cardiology follow-up.

Methods:
We retrospectively cross-referenced patients from the oncology clinic with our echocardiogram database, focusing on solid tumor survivors from 1996-2018 that received anthracyclines or cardiac field radiation. Excluding patients not requiring cardiac monitoring, we collected demographic, oncology history and treatment, and cardiac evaluation related data. Based on COG guidelines, we determined if each patient maintained their expected cardiology follow up. We then assessed whether follow up was associated with median household income, medical insurance type, gender, and age at diagnosis using chi square or t-test.

Results:
A total of 49 patients (24F/25M) met inclusion criteria included. Timely cardiology follow up was only seen in 50% of the patients, regardless of how far out the patients were from treatment. There was no correlation between follow up and median household income, medical insurance, gender, or age of diagnosis (p values >0.05).

Conclusions:
This data demonstrates there is a major gap in providing key cardiac care to CCS, as 50% of patients did not maintain expected follow up. This finding was irrespective of socioeconomic status or age at diagnosis. This suggests a greater emphasis must be placed on educating families about potential cardiac risks and the need for appropriate follow up care. This can be established through a stronger collaboration between cardiology and oncology programs.
Abstract 17281: Outcome of Stress-Induced Cardiomyopathy in Patients With Covid-19 Infection: A US Cohort Propensity-Matched Study
Authors: Wagle Pratik , SUBAHI AHMED , Mohamed Roaa , Hamid Osama , Abdelrahman Mohamed
Published: December 2023

Introduction:
COVID-19 has affected millions of people worldwide and is associated with cardiovascular complications like myocarditis, MI, pericarditis & stress-induced cardiomyopathy (Takotsubo cardiomyopathy).
Hypothesis and aim:
The aim of our study was to examine the outcomes of stress-induced cardiomyopathy in patients with COVID-19.

Methods:
Using TriNetX, which aggregates >100 million patients' charts, we identified adults (>18) between Jan. 2020 & Apr. 2023. We identified 2 groups: stress induced cardiomyopathy in the setting of COVID-19, & stress-induced cardiomyopathy without COVID-19. We performed 1:1 propensity score matching for demographics and co-morbidities like DM, HTN, HLD, IHD, CKD, obesity, PVD, COPD, liver cirrhosis, smoking & alcohol abuse. We conducted Kaplan-Meier survival analysis to assess all-cause mortality. Adjusted odds ratios (aOR) with 95% confidence interval (CI) were calculated to express the risk of each outcome.

Results:
We identified 1990 cases of stress-induced cardiomyopathy with COVID-19, and 27,702 patients with stress-induced cardiomyopathy without COVID-19. The majority were female gender and white race across the groups. Table 1 summarizes the demographics and characteristics of cohorts. After matching, stress-induced cardiomyopathy with COVID-19 were more likely to develop LV thrombus (aOR 1.41 [1.02-1.61]), cerebral infarction (aOR 1.25 [1.05-1.47]), acute respiratory failure (aOR 1.72 [1.53-1.94]), cardiogenic shock (aOR 1.37 [1.09-1.72]), and VTE (aOR 1.86 [1.61-2.14]). No difference was found in VT (aOR 0.89 [0.72-1.10]), or cardiac arrest (aOR [1.13 (0.88-1.45]), figure 1. All cause-mortality was worse in COVID-19 associated stress-induced cardiomyopathy (HR 1.17 [1.007-1.35]).

Conclusions:
Stress induced cardiomyopathy in the setting of COVID-19 was associated with a higher risk of adverse events and increased mortality compared to stress induced cardiomyopathy without COVID-19.
Abstract 17295: In Situ Recovery of Multiple Organs Using Venoarterial ECMO in a Murine Model of Uncontrolled DCD
Authors: Madrahimov Nodir , Mutsenko Vitalii , Radakovic Dejan , hassan mohamed , Rosenfeldt Mathias , Ergun Suleyman , Karnati Srikanth , Aleksic Ivan , Otto Christoph , Leyh Rainer , Bening Constanze
Published: December 2023

Introduction:
The utilization of extracorporeal membrane oxygenation (ECMO) for Donation after Circulatory Death (DCD) can substantially increase the donor pool, organ yield per donor, and organ shelf life. Clinical attempts to recover organs for transplantation after uncontrolled DCD are very complex and hard to reproduce. As a preliminary strategy for completing this endeavor, experimental protocols employing feasible animal models are strongly recommended.

Hypothesis:
The objective of the investigation was to develop a mouse model of ECMO-based cadaver management protocol for uncontrolled DCD donation after "out-of-hospital" death.

Methods:
Following 10 min after confirmed death, murine cadavers (C57BL/6 background) were administered with heparin-streptokinase and cannulated for veno-arterial ECMO. Cadaver bodies were connected to a murine ECMO machine 1 h post-mortem and subjected to extracorporeal circulation for subsequent 2 hrs. Blood gas parameters, cardiac activity, and general organ state were assessed using BGA analysis, ECG, and histology, accordingly. We have designed and incorporated into an ECMO circuit a previously unreported, miniaturized murine hemodialysis for the treatment of severe hyperkalemia and metabolic acidosis that arose following death.

Results:
Control BGA parameters recorded 1 h after death were incompatible with normal physiology: extremely low blood pH, profound negative base excess, and extraordinarily high lactate and K
+
levels. Two hours after ECMO support, blood pH values of a cadaver body restored from <6.5 to 7.3 ± 0.05, pCO
2
was lowered from >130 to 41.7 ± 10.5 mmHg, sO2, base excess, and HCO
3
were all elevated from below detection thresholds to 99.5 ± 0.6%, -4 ± 6.2 and 22.0 ± 6.0 mmol/L, respectively (Student T-test, p < 0.05). The implementation of hemodialysis resulted in a significant decrease in both hyperlactatemia and hyperkalemia.

Conclusions:
Our model presents novel opportunities for the management of cadaver organs in order to promote uncontrolled DCD donation, thereby contributing to the resolution of the organ shortage problem. Our approach enables the implementation of a variety of modern blood purification techniques in cadaveric organ recovery using ECLS.