bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 11647: Association of Breast Arterial Calcification With Clinical Outcomes and Mortality
Authors: Bui Quan M , Sykes Alexandra V , Allen Tara , Belrose Nora , Nerlekar Nitesh , Mantey Richard , Wang Junhao , Eghtedari Mohammad , Daniels Lori
Published: June 2023

Introduction:
Breast arterial calcification (BAC), seen on mammography, has emerged as a risk stratification tool and surrogate marker of cardiovascular disease (CVD). Studies evaluating the association of BAC with clinical outcomes are limited.

Methods:
This single-center, retrospective study included 14,544 women who had a digital mammogram from 2008-2016. BAC was quantified with the Bradley score using an automated algorithm based on a trained, deep neural network (CureMetrix). The presence of BAC was defined as Bradley score >10. Clinical outcomes were collected via medical records using ICD-10 diagnoses. Cox regression models were used to evaluate the association between BAC (continuous and binary) and clinical outcomes including mortality and composite outcome (mortality, stroke, and myocardial infarction). Models were adjusted for age, diabetes, medications, race, current smoking, systolic blood pressure, total & HDL cholesterol, and prior CVD diagnosis.

Results:
The mean age was 54.7 ±11.0 years with 8% diabetes, 30% hypertension, 30% hyperlipidemia and 5% smokers. BAC was present in 13%. Over a mean follow-up of 4.2 years, there were 1,687 deaths (6.8%) and 2,113 composite outcomes (8.5%). On multivariable analysis, each 10-point increase in BAC score was significantly associated with clinical outcomes: mortality (aHR 1.05 [95% CI 1.02-1.08], p < 0.001) and composite outcome (aHR 1.07 [95% CI 1.04-1.09], p < 0.001). With BAC as a binary variable, women with BAC had a 1.52 (95% CI 1.22-1.89) higher risk of mortality and a 1.72 (95% CI 1.40-2.11) higher risk of composite outcome compared to those without BAC.

Conclusion:
BAC is significantly associated with clinical outcomes, including mortality and CVD. Further study is needed to confirm these findings.
Abstract 11654: Bundled Payments for Care Improvement Advanced and Cardiac Rehabilitation Participation After Acute Myocardial Infarction
Authors: Heindl Brittain , Bittner Vera A , Clarkson Stephen , Jackson Elizabeth A , Joynt Maddox Karen E , Brown Todd , Li Mei , Huang Lei , Levitan Emily B
Published: June 2023

Introduction:
Cardiac rehabilitation (CR) improves outcomes after acute myocardial infarction (AMI). The Bundled Payments for Care Improvement Advanced (BPCI-A) program holds participating hospitals accountable for all costs incurred within 90 days of discharge. There is concern that this financial incentive will lead participants to cut back on high-value care, including CR, in order to meet cost targets. We examined whether patients discharged from BPCI-A participating hospitals after an AMI had lower CR utilization compared to non-participating hospitals.

Methods:
We included patients from a 100% sample of fee-for-service Medicare beneficiaries discharged home after a hospitalization for AMI during a baseline period (January 1, 2016 to December 31, 2017) or an intervention period (October 1, 2018 to September 30, 2019). Our exposure was discharge from a hospital participating in BPCI-A. Our outcomes were the proportion attending ≥1 CR session and the mean number of CR sessions attended within 90 days of discharge. We adjusted for hospital, market, and patient level factors, including medical comorbidities. We performed difference-in-change analyses for both outcomes using linear mixed effects models, before and after adjustment for all confounders.

Results:
The baseline period included 50,274 discharges, with 33.7% from BPCI-A participating hospitals. The intervention period included 27,268 discharges, with 32.9% from participating hospitals. Overall, CR use was 11.3% in the baseline period and 11.7% in the intervention period. There were no differential changes between BPCI-participating and nonparticipating hospitals for either outcome over time (
Table
).

Conclusions:
Among Medicare patients discharged after an AMI, CR utilization was low, and we observed no difference in utilization associated with hospital participation in BPCI-A.
Abstract 11656: Preoperative Cardiac Risk Assessment for a Patient With an Intracardiac Shunt Undergoing Laparoscopic Surgical Intervention
Authors: Gupta Tanuj , Jamaleddine Nader
Published: June 2023

Introduction:
In this case, we discuss the intraoperative risk of air cardioembolic stroke in patients with intra-cardiac shunts undergoing laparoscopic surgery due to CO
2
insufflation of the abdomen in conjunction with provoked right-to-left shunting from anesthesia.

Case Presentation:
27-year-old Female with Down Syndrome and asymptomatic VSD presented with abdominal pain. CT Abdomen performed revealed Acute Cholecystitis and patient was admitted for urgent laparoscopic cholecystectomy. Cardiology was consulted for preoperative risk assessment. Echocardiogram recommended and redemonstrated known VSD with predominant left-to-right shunting and occasional flow reversal (right-to-left) at baseline. Upon discussion with Anesthesia, the concern arose for anesthesia induced flow reversal of the shunt with a risk of possible paradoxical air embolism from CO
2
insufflation during laparoscopy. This concern was presented to the General Surgery team for consideration of conversion of procedure to open cholecystectomy. Open cholecystectomy was performed without complications.

Discussion/Conclusion:
Laparoscopic surgery requires CO
2
insufflation of the abdomen to cause pneumoperitoneum (Fig 1A), following which a gas embolism can result (Fig 1B). Consequently, in the absence of a pre-existing cardiac defect, patients can develop a pulmonary embolism (Fig 1C). However, individuals with right-to-left intracardiac shunting (Fig 1D), or Eisenmenger Syndrome, confer the additional risk of cardioembolic stroke (Fig 1E). In the preoperative assessment, right-to-left shunting is easily identified by TTE and managed accordingly. However, less intuitively, it can also occur transiently from the intraoperative use of certain anesthesia medications such as Propafol, which is known to decrease SVR. Therefore, if the evaluating clinician is unaware of this mitigated risk, it may go undetected, the result of which can be fatal.
Abstract 11659: Comparing Rates of Acute Myocardial Infarction Between Cancer Therapies in Patients With Non-Small Cell Lung Cancer
Authors: Abdelhamid Ahmed , Girotra Saket , Ferguson Heidi , Vaughan Sarrazin Mary S
Published: June 2023

Introduction:
The prevalence of cardiovascular disease (CVD) has increased in patients with cancer, contributing significantly to mortality among cancer survivors. Cardiotoxicity of anti-cancer drugs may play a role in the development of CVD among cancer survivors, including incidence of acute myocardial infarction (AMI). We analyzed AMI rates in patients with non-small cell lung cancer (NSCLC) treated with one of four cancer regimens.

Methods:
We used national data from the Veterans Affairs (VA) Corporate Data Warehouse and VA Cancer Registry. We identified 9,619 veterans diagnosed with NSCLC during 2015-2019 who initiated one of four oncological therapies: chemotherapy, immune checkpoint inhibitors (ICI) with chemotherapy, ICI monotherapy, or tyrosine kinase inhibitors monotherapy (TKI). Patients were categorized according to the first therapy received. We identified subsequent hospitalizations for AMI within two years of initiating the oncological treatment. We estimated AMI rates per 100 patient-years and risk adjusted relative hazard ratio (HR) of AMI by treatment type using Cox Regression Model to adjust for age, AMI history, comorbidities, malignancy stage, and histology.

Results:
Among 9,618 veterans identified, 5,510 (57.3%) initiated treatment with chemotherapy, 2,820 (29.3%) ICI with chemotherapy, 829 (8.6%) with ICI monotherapy, and 459 (4.8%) with TKI. Over a follow-up period of 2 years, 158 (1.6%) patients experienced an AMI and 5,917 (61.5%) died. The incidence of AMI per 100 patient-years (95% CI) was as follows; chemotherapy 0.86 (0.70-1.06), ICI with chemotherapy 0.77 (0.58-1.03), ICI monotherapy 0.91 (0.52-1.60), and TKI 0.43 (0.16-1.15). When compared to chemotherapy alone, adjusted HR (95% CI) for ICI with chemotherapy, ICI monotherapy, and TKI were 1.09 (0.91-1.31), 1.02 (0.75-1.38), and 1.50 (0.94-2.37), respectively. When compared to TKI or ICI with chemotherapy, the ICI monotherapy cohort did not have a statistically significant adjusted HR for AMI risk.

Conclusion:
Among Veterans with NSCLC, the incidence of AMI was low and there was no difference in risk between the initial oncological regimens. The high competing risk of mortality in our cohort may also have contributed to the lack of between-group differences.
Abstract 11665: Mediation of Sterile Inflammation Through Ca
2+
/ Calmodulin-Dependent Protein Kinase in Macrophage is Essential for Pressure Overload-Induced Adverse Cardiac Remodeling
Authors: Suetomi Takeshi , Tateda Satomi , Okamoto Yoko , Uchinoumi Hitoshi , Oda Tetsuro , Kobayashi Shigeki , Yamamoto Takeshi , Yano Masafumi
Published: June 2023

Introduction:
There is evidence that inflammation is associated with pressure overload induced cardiac remodeling and heart failure, as well as evidence for a role of Ca
2+
/ Calmodulin-dependent protein kinase II (CaMKII) in remodeling and heart failure development. Pressure overload triggers inflammatory gene expression and the activation of the NOD-like receptor pyrin domain containing protein 3 (NLRP3) inflammasome in cardiomyocytes. These responses provide signals for macrophage recruitment, fibrosis, and myocardial dysfunction in the heart. However, the downstream mechanism is not elucidated.

Methods and Results:
Macrophage specific CaMKIIdelta knockout (mKO) mice were subjected to transverse aortic constriction (TAC). Cardiomyocyte mRNA levels for pro-inflammatory chemokines and cytokines increased and peaked with 5 to 10 folds vs sham in both control and mKO mice. Priming and activation of the NLRP3 inflammasome, assessed by measuring NLRP3 mRNA and caspase-1 activity, were increased by TAC in isolated cardiomyocytes of both control and mKO. In contrast, caspase-1 activation in isolated macrophage were attenuated in mKO. CD68 positive cell accumulation and cardiac fibrosis in cardiac tissue in response to pressure overload were also attenuated in mKO vs control (CD68 41 ± 9 cells/mm
2
vs 78 ± 13 cells/mm
2
, fibrotic area 8.5 ± 1.2 % vs 4.1 ± 0.9 %). Subsequent cardiac dysfunction in response to pressure overload were less impaired in the mKO vs control (ejection fraction 44 ± 3% vs 35 ± 6%).

Conclusions:
Activated CaMKIIdelta in response to pressure overload triggers inflammatory signals including NLRP3 inflammasome cascade in cardiomyocytes. It also contributes amplification of inflammasome signal in macrophages leading fibrosis and consequent cardiac dysfunction. CaMKIIdelta in cardiomyocytes and macrophages could be a therapeutic anti-inflammatory and anti-fibrotic target for preventing adverse cardiac remodeling and heart failure.
Abstract 11669: Quantitative and Automated Breast Arterial Calcification Score is Associated With Traditional Cardiovascular Risk Factors
Authors: Allen Tara S , Bui Quan M , Sykes Alexandra V , Belrose Nora , Nerlekar Nitesh , Mantey Richard , Wang Junhao , Eghtedari Mohammad , Daniels Lori B
Published: June 2023

Introduction:
Breast arterial calcification (BAC) is gaining acceptance as a CVD risk factor (RF), though overlap with traditional RFs remains unclear. We tested the hypothesis that BAC, assessed via the Bradley score, is associated with CVD RFs.

Methods:
We analyzed baseline cross-sectional data from 16,217 women who underwent screening digital mammography between 2008-2016 at a single center. BAC was quantified using an algorithm from a trained, deep neural network (CureMetrix), resulting in an automated and continuous Bradley score; >10 was considered BAC positive. CVD RFs were obtained via medical records. We calculated odds ratios (OR) for RFs per Bradley score quartile and created distribution plots.

Results:
At baseline (mean age 55 ± 11 yrs; 70% White, 45% Black, 25% other), 8% had diabetes, 30% hypertension, 30% hyperlipidemia, and 5% smoked; 22% and 6% took lipid-lowering and anticoagulant medication, respectively. There were 1,904 women (13%) with BAC (median Bradley score 42). BAC prevalence increased with age, and those in the highest quartile of the Bradley score, compared to lowest, were significantly more likely to have hypertension (OR 4.1, 95% CI 3.3-5.0; p<0.001), diabetes (OR 2.8, 95% CI 2.2-3.6; p<0.001), and hyperlipidemia (OR 2.4, 95% CI 2.0-3.0; p<0.001) (
Figure).
Additionally, 492 women (7%) with zero traditional RFs had BAC (
Table
).

Conclusions:
BAC prevalence on mammography is robustly associated with traditional CVD RFs, however BAC was present in 7% of women without RFs. Future studies are needed to determine the significance of BAC among women without RFs, as it may provide insight and opportunity for prevention before traditional CVD RFs develop.
Abstract 11687: Diagnosis and Management of High-Risk Pulmonary Embolism in a Term Neonate
Authors: Valle Christopher W , Kheir John , Ronai Christina , Thomas Alyssa , Sullivan Anne , Allan Catherine K
Published: June 2023

Case Presentation:
A 5 day old, term infant born to a 39-year-old G1P0 with a history of diet-controlled gestational diabetes mellitus presented with hypernatremic dehydration in the setting of poor feeding. On hospital day 2, the infant suffered a bradycardic cardiac arrest requiring 2 minutes of CPR prior to return of spontaneous circulation. An echocardiogram (Figure 1A) revealed moderately depressed right ventricular (RV) function, elevated RV pressure and a large mobile mass extending from the main pulmonary artery (PA) into the left PA with obstruction of flow. D-dimer was markedly elevated at 2740 ng/mL. A subsequent CT angiogram revealed acute pulmonary emboli in the distal left and right branch PAs (Figure 1B). Additional imaging was obtained and showed dural venous sinus, left portal vein and right cephalic vein thromboses. The infant was managed with a heparin infusion and supportive therapy for the RV dysfunction and pulmonary hypertension including mechanical ventilation, inhaled nitric oxide as well as epinephrine and milrinone infusions. Over the course of two weeks, the infant improved clinically with normalization of RV function.

Discussion:
Neonatal pulmonary arterial thrombosis is an exceedingly rare phenomenon. The majority of cases described in the literature are associated with either an inherited thrombophilia or with underlying congenital heart disease, which were not found to be present in this case. However, this patient presented with severe dehydration and a history of maternal diabetes, both of which are risk factors for neonatal thrombosis. Fortunately, this patient responded to treatment with anticoagulation alone and did not require more invasive therapies, such as surgical thrombectomy or systemic and catheter-directed thrombolysis. Although rare, neonatal pulmonary arterial thrombosis can occur and delays in recognition and treatment may lead to significant RV dysfunction, morbidity, and even death.
Abstract 11706: Association of Left Atrial Function With Incident Chronic Kidney Disease: Atherosclerosis Risk in Communities (ARIC) Study
Authors: Reyes Jorge L , Oyenuga Abayomi , EATON ANNE , Wang Wendy , Parikh Romil , Inciardi Riccardo M , Alonso Alvaro , Lutsey Pamela L , Soliman Elsayed Z , Herzog Charles , Ishigami Junichi , Matsushita Kuni , Coresh Josef , Shah Amil M , Solomon Scott , Chen Lin Y
Published: June 2023

Introduction:
Echocardiographic measures of left ventricular (LV) structure and function are associated with incident chronic kidney disease (CKD). Reduced left atrial (LA) function is an emerging novel risk factor for cardiovascular disease but its association with incident CKD is unknown.

Hypothesis:
Lower LA function is independently associated with incident CKD in older adults in the ARIC study, a prospective community-based cohort.

Methods:
We included ARIC participants without prevalent CKD (as defined by eGFR<60ml/min/1.73m
2
) who underwent echocardiographic exam at visit 5 (2011-13). LA function measures included LA reservoir strain, contractile strain, and conduit strain. Incident CKD was defined as a composite outcome of >25% decline to eGFR <60 mL/min/1.73m
2
, hospitalization with CKD diagnosis, or incident end-stage kidney disease through 2017. Cox proportional hazards model was used.

Results:
Among the 3,970 participants (mean [SD] age, 75 [5] years; 58% women; 20.9% Black individuals), 382 cases of incident CKD were ascertained over a median follow-up of 5.5 years. Lower LA reservoir and contractile strain were significantly associated with higher risk of CKD (HR [95% CI] lowest vs highest quintile: 2.76 [1.91-3.98], and 2.56 [1.79-3.65], respectively) (Table). The associations remained significant after accounting for other major echocardiographic parameters (model 2) including left atrial volume index (model 3). LA conduit strain was not significantly associated with CKD.

Conclusions:
Lower LA function is significantly associated with incident CKD, independent of CKD risk factors, LV size and function, and LA size. These findings indicate that impaired LA function is a novel predictor marker for CKD.
Abstract 11708: Giant Myxoma Causing Severe Pulmonary Hypertension
Authors: Bernstein Hannah , Fong Hee Kong , Atreja Surabhi
Published: June 2023

Introduction:
Myxomas are the most common primary cardiac tumor, with clinical manifestations depending on tumor size and location. We present a case of giant left atrial (LA) myxoma causing functional mitral stenosis and associated severe pulmonary hypertension.

Case:
A 75-year-old woman with newly diagnosed heart failure and atrial fibrillation presented to the emergency department with 2-months of chest pain and shortness of breath. She had left-sided chest pain during exertion and at rest, dyspnea, and 3-pillow orthopnea. She was normothermic, blood pressure of 93/57 mm Hg, HR 63 bpm, respiratory rate of 21, and 91% oxygen saturation on room air. Cardiovascular exam revealed no murmurs, elevated JVD and bilateral lower extremity edema. Chest CT revealed a large mass, measuring 9x4 cm, in the LA extending into the left ventricle. TTE demonstrated a large mobile mass in the LA measuring 9.4x3.9 cm. The mass extended through the mitral valve into the left ventricle, causing functional mitral stenosis with mean inflow gradient of 10 mmHg. Severe tricuspid regurgitation was demonstrated with a peak regurgitant velocity of 4.89 m/s, with estimated right ventricular systolic pressure of 101 mmHg. Pre-operative pulmonary artery systolic pressure was 100 mmHg. She underwent surgical excision. Histology confirmed diagnosis of myxoma, and the mass measured 7.2 x 5.0 x 4.7 cm. At follow up, she had no heart failure symptoms or additional episodes of atrial fibrillation. Repeat TTE demonstrated normal RVSP.

Discussion:
Symptoms of myxoma include cardiovascular, embolic and constitutional symptoms. While obstructive symptoms are common in large myxomas, only 10% have severe functional mitral stenosis. Despite this, sequela of pulmonary hypertension and tricuspid regurgitation is not well documented. Diagnosis is made by TTE, which also allows assessment of valvular and hemodynamic changes. Treatment requires surgical resection, with low rates of recurrence.
Abstract 11715: Valve-in-Valve Transcatheter Aortic Valve Implantation for Early Valve Degeneration
Authors: Gupta Nikhil , Dia Abdulrahman , Singh Nikhil , Plana Alejandro , Siddiki Mikail , Prabhu Nicole , Alsaad Ali , Nathan Sandeep , Shah Atman , Blair John
Published: June 2023

Case Presentation:
A 64-year-old woman with presented to the hospital with chest pain and hypotension during hemodialyis. Three months prior to presentation, she had underwent transcatheter aortic valve implantation (TAVI) and received a 26 mm CoreValve Evolut Pro (Medtronic, MN) for severe aortic stenosis. She was admitted to the cardiac intensive care unit and underwent diagnostic testing. Transthoracic echocardiography demonstrated a new mean transaortic valve gradient of 55 mm Hg (Figure 1A), increased from her post-procedural gradient of 12 mm Hg. Despite empiric treatment with heparin anticoagulation and antibiotics, the patient did not improve clinically. CT imaging did not reveal valve thrombosis, endocarditis, or any other structural deformities (Figure 1B), and the patient’s mean transaortic valve gradient worsened to 73 mm Hg. After a multidisciplinary discussion, a decision was made to offer a valve-in-valve TAVI for early valve degeneration with a 23 mm Sapien S3 (Edwards, CA) valve (Figure 1C). After her procedure, the patient’s symptoms resolved and she was discharged from the hospital. The patient’s mean transaortic valve gradient improved to 12.6 mm Hg at her 4 month follow up visit (Figure 1D).

Discussion:
Early TAVI valve dysfunction is typically attributed to thrombus or infection of the valve. Here we present a case of valve dysfunction that was not related to either of these etiologies. Delineating the cause of her valve dysfunction was vital to her therapeutic decision making. Since the patient was not a surgical candidate, valve-in-valve TAVI was offered when thrombus and endocarditis were eliminated as the etiology of her valve dysfunction.
Abstract 11716: A Systematic Review on Cardiac Papillary Fibroelastoma Presenting With Cerebrovascular Events
Authors: Neupane Gagan , Sharma Raksha
Published: June 2023

Introduction:
Cardiac papillary fibroelastomas (CPF) are rare, benign endocardial tumors with embolic complications like cerebrovascular events. The objective of this systematic review is to identify the clinical profile, diagnostic approach, tumor characteristics, and treatment modalities of patients with CPF presenting with stroke or TIA.

Methods:
We performed a systematic review using PUBMED and EMBASE databases involving all the published case reports and case series of CPF with TIA or stroke as presentation until April 2022. Viewpoints, editorials, and review articles were excluded.

Results:
A total of 161 cases were identified from 133 case reports and 11 case series. The mean age was 54.8 ± 15.6 years with 53.4% females. The proportion of patients with TIA and stroke was 32.3% and 67.8% respectively. Neuroimaging demonstrated the involvement of multiple sites (36.6%) and middle cerebral artery territory (35.6%) as major sites of stroke. The primary imaging tool for the diagnosis of CPF was echocardiogram. The size of the tumor varied from 2 to 47 mm (mean 11.8 ± 7.1). Left-sided valves were the most common location of the tumor (73.2%). Mitral valve was the most common valve involved (38.9%) with the anterior leaflet being the more common site (61.3%). The aortic valve was involved in 32.5% with non-coronary cusp being the more common site (37.5%). About 10.6% of cases were missed by TTE (mean size of valvular tumors missed by TTE was 5.6 ± 1.9 mm). Most of the tumors (91.4%) showed independent mobility. Surgical excision was performed in 89.5% cases with histopathological confirmation. Medical management prior to surgery included antiplatelets (87.9%) and anticoagulation (12.1%). Simple excision, excision with valve repair and excision with valve replacement were done in 66.7%, 16.7% and 16.7% respectively. Most patients (97.8%) had uneventful post-operative course.

Conclusions:
CPFs are potential differential diagnosis for cryptogenic stroke. TEE serves as a better diagnostic modality for cardiac workup of cryptogenic stroke if the initial TTE is negative. While the consensus for CPF management remains controversial, the results of our study support surgical management as the primary approach for left-sided tumors presenting as stroke/TIA.
Abstract 11733: Racial Disparities in Cardiometabolic Risk Factors Among Pregnant Women in the United States
Authors: Farhat Maya , Rabeeah Sana , Al-Kindi Sadeer
Published: June 2023

Background:
Pregnancy-related mortality has notably increased in the United States over the past 3 decades, with cardiovascular disease as the leading cause of mortality post-partum. Significant racial disparities have been noted in pregnancy-related mortality in the US. We sought to study contemporary trends and disparities in cardiometabolic risk factors (CMRFs) among pregnant women in the US.

Methods:
We used the 2016-2020 natality database maintained by the CDC. We identified pregnant women with first live birth and known self-reported race (Black vs White). We explored overall prevalence (aggregated 2016-2020) and relative changes (between 2016 and 2020) in CMRFs: pre-pregnancy diabetes (Pre-DM), gestational diabetes (G-DM), pre-pregnancy hypertension (Pre-HTN), gestational hypertension (G-HTN), smoking, and obesity.

Results:
A total of 3,141,830 pregnancies in White women and 436,895 pregnancies in Black women were noted. Overall, Black mothers had higher rates of Pre-DM, Pre-HTN, G-HTN, and obesity, but lower rates of smoking and G-DM. From 2016-2020, there were significant increases in all CMRFs, except smoking, which decreased. There was a more significant increase in Pre-DM and G-HTN in Black mothers, while there were more significant increases in Pre-HTN and obesity in White mothers. A 15% relative increase in the prevalence of any CMRF was seen in both races.

Conclusions:
In this large analysis of pregnant mothers in the US, cardiometabolic risk factors were present in 35% of White mothers and 43% of Black mothers, with significant increases from 2016 to 2020 in both races. Future studies should focus on identifying mechanisms of the observed associations.
Abstract 11735: Single-Nucleus RNA Sequencing Analysis Reveals Subpopulation of Endothelial Cells Activation in Hearts of Porcine Double Injury Model
Authors: Nguyen Thanh M , Wei Yuhua , Nakada Yuji , Zhang Jianyi J
Published: June 2023

Pigs underwent a double injury model: neonatal day 1 apical resection (AR
P1
) and postnatal day 28 LAD ligation (MI
P28
) can remuscularize the AMI by postnatal day 56 (P56) with little evidence of myocardial scarring, which is accompanied by increased cardiomyocytes (CMs) cell-cycle activity. The vascularization that occurred to support remuscularization has not been studied. Therefore, we analyze the single-nucleus RNA sequencing (snRNA-seq) data collected from the MI-border zone of AR
P1
-MI
P28
, MI
P28
(without AR
P1
), naïve, and fetal pig endothelial cells (ECs) using the Artificial Intelligence autoencoder and cluster analyses. Three clusters of EC were identified. Among them, vascular and lymphatic EC clusters (EC1 and EC2) were presented in all postnatal hearts. Besides expressing vascular EC gene signatures, the remaining cluster, named ‘EC3’, also upregulated Transforming grow factor-beta (TGFβ) and Bone Morphogenetic Proteins (BMP) signaling markers. The signaling indicated EC3 was still under development. EC3 strongly presented in the fetal heart (31% of ECs); then, EC3 proportions decreased as the pig matured and virtually dismissed (<2%) in the naïve heart from P28 to later. Up to 1-week following MI
P28
injury, EC3 proportions remained low (<2%) in MI
P28
-only hearts; meanwhile, EC3 proportions significantly increased (>7%) in the regenerative AR
P1
-MI
P28
hearts. Thus, in the AR
P1
-MI
P28
injured hearts, the subpopulation of EC3 is activated to support remuscularization.

Figure. SnRNA-seq analysis identifies a cluster of under-development endothelial cells (EC3). A) UMAP: three EC clusters. B) UMAP: vascular EC marker PLVAP expressesed (calculated using Seurat) in EC1 and EC3. C) UMAP: lymphatic EC marker CCL21 expressesed in EC2. D) Heatmap: TGFβ and BMP signaling upregulated in EC3. C) Bargraph: proportions of EC3 in naïve and injured hearts on postnatal days P28, P30, and P35; P-value and Fold-change (FC) were calculated using Fisher’s exact test.
Abstract 11736: Role Alteration Predicts Post-Traumatic Stress, Anxiety and Depressive Symptoms in Parents of Infants With Congenital Heart Disease
Authors: Lisanti Amy J , Demianczyk Abigail , Ryan Quinn , Chittams Jesse , Medoff-Cooper Barbara
Published: June 2023

Background:
Parents of infants born with congenital heart disease (CHD) are at increased risk for mental health problems, including anxiety, depression, and post-traumatic stress (PTS). Few studies have examined to what extent the hospital experience influences these mental health symptoms over time. The purpose of this pilot study was to determine hospital factors predicting parent anxiety, depression, and PTS at 3 months post-discharge.

Methods:
A convenience sample of 28 biological mother-father dyads was enrolled consecutively from August 2018 to October 2019 from one children’s hospital in the Northeast, US. Parents were instructed to complete questionnaires, including valid and reliable instruments for mental health symptoms, within one week of their infant’s surgery and 3 months post discharge. Associations between hospital factors and each mental health symptom at 3 months post discharge were assessed using linear mixed effects models, accounting for the anticipated correlation between parents of the same infant using an unstructured covariance matrix. Separate linear mixed effects models were constructed for each mental health symptom using backward selection method.

Results:
For each one unit increase in parental role alteration, anxiety symptoms were estimated to be increased by 5.98 (SE
+
1.60; p=0.002). Parents with at least a college education were estimated to have greater anxiety symptoms compared to parents with high school/technical school or less (10.89
+
3.75; p=0.009). For each one unit increase in role alteration, depressive symptoms were estimated to be increased (4.41
+
1.72; p=0.02). PTS was also significantly predicted by role alteration (5.06
+
1.91; p=0.02) along with timing of CHD diagnosis, with postnatal diagnosis estimated to increase PTS symptoms by 21.80 (SE
+
10.07; p=0.04) units compared to prenatal diagnosis.

Conclusion:
Role alteration experienced by parents during their infant’s hospitalization significantly predicts anxiety, depression, and PTS symptoms 3-months after discharge. Additional factors were identified that can inform mental health screening in this population. Future interventions to enhance the role of parents during infant hospitalization may support parent mental health post discharge.
Abstract 11740: Online Health Information for COVID 19 Vaccine Induced Myocarditis: Between the Myth and Truth
Authors: Abualenain Mohammed , De Leon Tejeda Andrea , Panjrath Gurusher S
Published: June 2023

Objective:
COVID-19 vaccine-induced myocarditis is becoming an important topic. As the internet is the leading source of information, it is crucial to evaluate the quality and readability of health information available to the general public as it has an impact on increasing awareness and encourage vaccinations.

Methods:
The top 30 websites of 2 different search engines (Google, Bing) were collected using the term “Covid vaccine induced myocarditis” on a newly installed Mozilla Firefox browser. Physician-oriented websites, non-relevant content (not connected to the search keyword), and duplicates were all excluded. The quality of the websites were evaluated using the DISCERN tool by two physician reviewers who are knowledgeable and were blinded to each other's findings. After that, the data was evaluated to come up with an aggregated score for each website. Readability was assessed using the Flesch-Kincaid Readability Ease (FKRE) and the Flesch-Kincaid Grade Level (FKGL) tool.

Results:
A total of 19 websites were assessed after exclusion criteria. The average overall quality for DISCERN was 3.4 out of 5 with a median of 3.46 while the average total DISCERN score was 48.2 out of 80: the highest total quality among them being 63 out of 80. The average FKRE was 48.5 out of 100, while the average FKGL was 8.7 out of 18 with the lowest grade being 6.2.

Conclusion:
Overall, the quality of the information was rated as moderate or “fair” with an average of 3.4 out of 5. Most of the websites were accurate in the information provided. However, those websites that were high quality did require a higher level of education to be able to comprehend. The average reading grade level was 8.7 grade, which is higher than the average American reads (8th grade). The highest quality website based on DISCERN was Health U.S news. All websites encouraged vaccinations and explained the rarity of getting myocarditis from COVID 19 vaccine.
Abstract 11743: Impact of Chronic Kidney Disease / End Stage Renal Disease on Aortic Dissection: Results From the Nationwide Readmission Database
Authors: Heaton Joseph , Singh Sohrab , Nanavaty Dhairya , Devarakonda Pradeep kumar , Khan Farrah , Singh Priyanka , Reddy Sarath , Dani Sourbha
Published: June 2023

Introduction:
Prior literature has shown that in-hospital and postoperative renal failure are independent mortality predictors in acute aortic dissection (AAD). However, there is limited data on chronic kidney disease (CKD) and end-stage renal disease (ESRD) as pre-existing outcome predictors with AAD

Methods:
The Nationwide Readmission Database was analyzed from 2016 to 2019 for adult patients admitted with a primary diagnosis of AAD. Patients were assessed for CKD and ESRD. Outcomes were measured for the effect of renal dysfunction on 30-day readmission, inpatient mortality, and length of stay (LOS).

Results:
Aortic dissection occurred in 45,481 patients over the study period, of which 4727 were readmitted. The mean age was 64 years, and logistical regression analysis revealed that patients with ESRD admitted with AAD were 58% more likely to be readmitted (95% CI [1.29 - 1.93], p<0.001) within 30 days than those without (Figure 1). Notably, ESRD patients had a 30% reduction (95% CI 0.57 - 0.86) in in-patient mortality (Figure 2). Mean LOS was also higher for ESRD patients (6.7 days, 95% CI 5.09 - 8.38) while lower for CKD stage 3-5 (-1.06 days, 95% CI -1.62 --0.50) compared with those without renal disease.

Discussion:
We observed that patients with ESRD and AAD have higher readmission rates and LOS. However, decreased mortality rates compared with patients with CKD stages 3-5 were observed that could be attributed to increased exposure to healthcare interventions secondary to frequent hemodialysis follow-ups, compared with CKD stages 3-5. Early stages of CKD were excluded, given the possibility of a lack of coding in electronic medical records.
Abstract 11755: Burden and Impact of Prediabetes on the Risk of Acute Myocardial Infarction and Subsequent Adverse Cardiovascular Outcomes in Smokers: A National Inpatient Sample Analysis, 2019
Authors: Vasavada Advait , Mahajan Kshitij , Raza Syed Mohammad Moosi , Surpur Swapnil , guddeti ananth vallabh , Patlolla Mani Chandan Reddy , Fatima Ehrima , Bambhroliya Zarna , Gbemudu Paul , Desai Rupak
Published: June 2023

Background:
The burden of prediabetes (pDM) in smokers remains unknown. We aimed to analyze the burden and impact of prediabetes on AMI [Type 1/Type 2] hospitalizations in smokers and outcomes using a nationally representative sample.

Methods:
We queried the National Inpatient Sample (2019) to identify AMI-related hospitalizations in adult non-diabetic smokers with vs without pDM using ICD-10 codes. Demographics, comorbidities, and outcomes including major cardiovascular and cerebrovascular adverse events (MACCE) were compared between two cohorts.

Results:
Overall prevalence of pDM in hospitalized non-diabetic smokers in 2019 was 1.2% (46770/3880640). AMI cohort with pDM often had males (59.4% vs 54.6%), blacks (23 vs 17.7%), Hispanics (8.7 vs 6.4%), Asian/Pacific Islanders (2.7 vs 1%), patients from higher-income quartile (16.4 vs 12.6%), and higher rates of modifiable CVD risk factors. Adjusted multivariable analysis revealed higher risk of overall (aOR 1.73 [1.60-1.88]), T1MI (1.86 [1.70-2.03]) and T2MI (OR 1.39 [1.16-1.67]). The risk of overall AMI was 1.73 times higher in patients with vs. without prediabetes, which was comparable in male (aOR 1.73) and female (aOR 1.72) smokers, however, female smokers with prediabetes had higher T2MI risk (aOR F:1.55, M:1.30) vs. males. Black smokers with prediabetes have the highest risk of overall (aOR 1.85), T1MI (aOR 2.03) and T2MI (aOR 1.77). Among Hispanics, prediabetes increased the risk of overall (aOR 1.69) and T1MI (aOR 1.92) but not T2MI. Prediabetes increased the risk of T1MI (aOR 1.74) in Asians without any association with overall or T2MI
[Table 1].

Conclusions:
Prediabetes independently increased the risk of overall AMI/T1MI/T2MI-related hospitalizations in non-diabetic smokers. Black smokers with prediabetes had the highest risk of AMI, T1MI and T2MI, and females had a higher risk of T2MI. This highlights the need for a tailored management of CVD risk by sex and race among smokers with prediabetes.

.
Abstract 11767: Alarmingly Rising Trends in Cardiovascular Disease Risk Factors and Atrial Fibrillation in Young [18-44 Years] Asian Patients: A Nationwide Analysis Between 2016 and 2019
Authors: Damarlapally Nanush , Rana Nishtha , Arote Dr. Vaishnavi , Vadiyala Mounika Reddy , Singh Pranjali , Singh Birgurman , Paidi Gokul , Tandra Rineetha , Patel Hardik , Mondal Avilash , Desai Rupak
Published: June 2023

Background:
Traditional cardiovascular disease (CVD) risk factors can increase the risk of Atrial Fibrillation (AF) even in young adults. With rising trends in CVD in the Asian population, we aimed to assess the prevalence and disparities of major modifiable risk factors for CVD and AF in the young Asians hospitalized in the US.

Methods:
The National Inpatient Sample (2016-2019) was used to estimate the temporal trends in modifiable CVD risk factors among young (18-44 years) Asian hospitalizations and evaluated disparities by sex. Also, we assessed the prevalence of AF in young Asians hospitalized with vs. without atleast one CVD risk factor.

Results:
From 2016 through 2019, a total of 1,324,259 young Asian admissions (Male 85%, age 18-44 years) were analyzed, the highest increase was noted for Obesity (1.8%) followed by Diabetes (1.3%). Males demonstrated the most prominent prevalence of Obesity (2.1%) and Hypertension (1.7%) as compared to the female population (1.7% and 0.4%), respectively. The incidence of AF in patients with at least one CVD risk factor increased by 0.4% (males 0.9% vs females 0.15%), (OR 2.80, 95%CI 2.44-3.21, p<0.001).

Conclusion:
The prevalence of modifiable risk factors for CVD are increasing at a steady pace in the young Asian population. There is a need for urgent preventive and curative strategies to decrease the overall burden of CVD in this population.
Abstract 11777: The Prognostic Impact of Living Alone on Long-Term Cardiac Mortality in Patients With Chronic Coronary Syndrome After Percutaneous Coronary Intervention
Authors: Kurosawa Yuta , Sato Akihiko , Shimizu Takeshi , Sakuma Yuya , Ohara Himika , Muto Yuki , Sato Yu , Kiko Takatoyo , Misaka Tomofumi , Yoshihisa Akiomi , Yamaki Takayoshi , Nakazato Kazuhiko , Ishida Takafumi , Takeishi Yasuchika
Published: June 2023

Background:
It has been reported that social frailty is associated with increased mortality in elderly patients with heart failure. However, the prognostic impact of social frailty on mortality in ischemic heart disease is unclear. Here we examined the relationship between living alone, which is one of the criteria for social frailty, and long-term mortality in patients with chronic coronary syndrome (CCS) who underwent percutaneous coronary intervention (PCI).

Methods and Results:
Consecutive 830 patients with CCS who underwent PCI were enrolled. Patients were divided into two groups according to whether they lived alone or not at the time of discharge. We compared clinical characteristics between two groups and followed cardiac mortality. Patients living alone were younger (66.3 vs. 69.9 years, P = 0.002). The prevalence of comorbidities such as hypertension, diabetes, dyslipidemia, chronic kidney disease, anemia, atrial fibrillation, heart failure, stroke and peripheral artery disease were comparable between two groups. In addition, the rates of medications such as beta-blockers, renin-angiotensin-aldosterone system inhibitors, statins and anti-thrombotic agents did not differ between two groups. In the Kaplan-Meier analysis (mean follow-up period of 1703.9 days), cardiac mortality was significantly higher in the group of patients who were living alone than those who were not (P = 0.008). In the multivariable Cox proportional hazard analyses after adjusting for confounding factors, living alone was an independent predictor of cardiac mortality (hazard ratio 2.44, 95% confidence interval 1.25 - 4.74, P = 0.009). Subgroup analysis which was performed adjusting for interactions between living alone and clinically important variables revealed no interactions.

Conclusion:
Among CCS patients who underwent PCI, living alone was associated with long-term cardiac mortality regardless of other comorbidities and medications.
Abstract 11779: Impinged RCA: Who's the Culprit?
Authors: Mishra Pooja , Ahmad Muhammad , Saeed Izza , Gonzalez Joaquin
Published: June 2023

Introduction:
Post-sternotomy chest pain (CP) has been widely reported in literature. The etiologies include myocardial infarction, pulmonary embolism, hypersensitivity reactions to foreign material, wound infection, sternal instability and dehiscence, neuropathic pain due to intercoastal nerve damage or sternal wire fracture leading to migration. Here, we report a rare case of a young patient who presented with chronic chest pain after an atrial septal defect (ASD) repair.

Case:
A 28-year-old male with past medical history significant for an ASD (secundum) repair with autologous pericardial patch, hyperlipidemia, COVID-19 infection, known first degree AV block, and early repolarization changes, presented for a follow-up office visit three years after his ASD repair with complaints of typical anginal symptoms.

Diagnosis:
Vitals, physical exam, troponin, D-dimer and inflammatory markers were unremarkable. Chest x-ray (Figure 1A) showed sternal wires in place and no fractures of wires. EKG (Figure 1B) was unchanged. Echocardiogram showed LVEF 50% and no wall motion abnormalities. He underwent a coronary CTA which identified intermittent compression on the mid-RCA from the third bottom stainless steel sternal wire (Figure 1C), warranting removal.

Treatment:
He underwent explantation of all sternal wires and selective right coronary angiography (Figure 1D) was performed, which revealed intact and patent RCA without any complications. He continues to follow-up in our clinic without any CP.

Conclusions:
Chronic CP after any cardiac surgery remains a diagnostic dilemma and a source of anxiety for patients. We recommend comprehensive discussions with patients prior to surgery about these probable complications to alleviate the anxiety. Lastly, from research thus far, removal of sternal wires is a safe, simple, and effective procedure that should be offered to patients with persistent post-sternotomy CP after exclusion of serious complications.
Abstract 11782: Senolytic Therapy Improves Diastolic Cardiac Function in Aged Mice
Authors: Tuday Eric , Islam Torikul , Kim Johntaehwan , Lesniewski Lisa A , Donato Anthony
Published: June 2023

Introduction:
Cellular senescence, an irreversible arrest of the cell cycle, is a recognized hallmark of aging that contributes to age-related multi-organ dysfunction and diseases. Evidence suggests that cardiomyocyte senescence plays a critical role in the development of age-related cardiac dysfunction. We tested the hypothesis that targeting senescent cells via intermittent administration of the senolytic drugs dasatinib and quercetin (D&Q) will improve cardiac dysfunction in old mice.

Methods:
21-month-old C57Bl/6 mice were treated with D&Q or vehicle via oral gavage on a bi-monthly basis for three months. Systolic and diastolic cardiac function were assessed using echocardiography. Expression of inflammatory and matrix metalloproteinase genes was assessed using quantitative polymerase chain reactions. Cardiac tissue morphology was assessed by histological analysis.

Results:
D&Q treatment improved ejection fraction (EF) in old mice (60.3% vs. 64.5%, con vs. D&Q, p = 0.0207, n=18). Global longitudinal strain was improved by D&Q treatment (-13.99% vs. -17.03%, con vs. D&Q, p=.0005, n=18). Measures of diastolic function were improved after D&Q treatment (n=18 for all): E/E’ (27.60 vs. 20.08, con vs. D&Q, p<.0001), isovolumetric relaxation time (IVRT, 22.74ms vs. 14.99ms, con vs. D&Q, p<.0001), and reverse longitudinal strain rate (rLSR, 4.64 1/s vs. 13.41 1/s, con vs. D&Q, p<.0001). Expression of inflammatory and matrix metalloproteinase genes (
cd3e, foxp3, tnf-
α, mcp-1, mmp9
) was lower in hearts from D&Q treated compared to control mice (p≤0.05). Extracellular matrix collagen expression was lower in cardiac tissue from D&Q treated compared to control (p<0.01).

Conclusions:
For the first time we report a significant improvement in diastolic function in aged mice when treated long term with the senolytic therapy dasatinib and quercetin. Measurements of systolic function also improved, but not to the same degree as observed for diastolic function. Overall, senolytic therapy with D&Q represents an attractive option to explore for the treatment of diastolic heart failure in humans.
Abstract 11789: Exosomes Released by Human Cardiac Fibroblasts Promote the Maturation of Human Induced-Pluripotent Stem Cells Derived Cardiomyocyte via AMPK Signal Pathway
Authors: Qin Kele , Wu Xun , Xiang Kun , Yang Jinfu , Fan Chengming
Published: June 2023

Background:
Human induced-pluripotent stem cell derived cardiomyocytes (hiPS-CMs) is phenotypically less matured than adult cardiomyocytes. The aim of this study was to explore the potential mechanism by which human cardiac fibroblast-derived exosomes (hc-FB-EXOs) enhance the maturation of hiPS-CMs.

Method:
Exosomes were extracted from human cardiac fibroblasts (hc-FBs) which were cultured with exosome-free FBS medium. The cultured hiPS-CMs were randomly devided into two groups: co-culture with (EXO) and without (NC) hc-FB-EXOs. The morphology of hiPS-CMs was assessed via immunostaining. Mitochondrial functions assay were measured by Seahorse XF. Potential mechanism was assessed via mRNA-Seq, real-time PCR and western blot.

Results:
Morphologically, the cells treated in EXO group was significantly larger than the in NC group in terms of cell area and sarcomere length (Panel A). In cellular metabolism, the mitochondrial oxygen consumption rate of EXO group was significantly higher than that of NC group, including basal respiration, proton leak, maximal respiration and spare respiratory capacity (Panel B). The expression of cardiac Troponin I (cTnI), Myosin Heavy Chain 7 (MYH7), Cyclin Dependent Kinase Inhibitor 2C (CDKN2C or p18), phospho-WEE1 and CAV3 (caveolin3) were significant higher, while the expression of of Myosin Heavy Chain 6 (MYH6) was significant lower in EXO group than in NC group (Panel C). Furthermore, qPCR showed that TNNI1, TNNT2, TNNI3/TNNI1, total titin, N2B, MYH7, LPL, ND1, N2BA, and MYH6 were significantly upregulated in EXO group compared with the NC group. Furthermore, western blot validation of RNA-Seq data confirmed that significantly upregulated of phospho-AMPK and downregulated of ACC1 and SCD1 were detected in EXO group compared with the NC group (Panel D).

Conclusion:
hc-FB-EXOs could significantly facilitate maturation of hiPS-CMs via the phosphorylation of AMPK.