bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 9331: Adverse Maternal Fetal Environment Partially Mediates Disparate Outcomes in Hispanic and Non Hispanic Black Infants With Critical Congenital Heart Disease
Authors: Santana Stephanie , Peyvandi Shabnam , Costello John M , Baer Rebecca J , Collins James , Branche Tonia , Jelliffe-Pawlowski Laura , Steurer Martina A
Published: April 2024

Introduction:
Etiologies of racial and ethnic disparities in critical congenital heart disease (CCHD) outcomes are not fully understood. We sought to determine whether differential exposure to an adverse maternal fetal environment (AMFE) partially explains disparate outcomes.

Methods:
We included infants with CCHD in a population-based administrative California database (2011-2017). Primary exposure was race/ethnicity. Primary mediator was AMFE, defined as maternal metabolic syndrome (MMS: any diabetes, abnormal BMI, or hyperlipidemia) or maternal placental syndrome (MPS: pre-eclampsia/ eclampsia, gestational hypertension, or placental abruption). Outcomes: days alive out of hospital in first year of life (DAOOH); composite of 1-year mortality or severe morbidity (e.g., ECMO, cardiac arrest, BPD, etc.). Mediation analyses (CCHD severity-adjusted) determined % contribution to outcome for each mediator on pathways between race/ethnicity and outcomes.

Results:
Included were 2,747 Non-Hispanic (NH) White [REF group], 5,244 Hispanic, and 625 NH Black infants. Hispanic and NH Black infants had higher risk for composite outcome (crude OR, 1.18; crude OR, 1.25 respectively) and fewer DAOOH (-6 & -12 days, respectively). Relative to NH White infants (MMS 28%; MPS 12%), Hispanic infants had higher MMS exposure (43%, OR, 1.89), while NH Black infants had higher MMS (44%, OR, 1.97) & MPS exposure (18%, OR, 1.66). Both MMS exposure (OR, 1.21) and MPS exposure (OR 1.56) were related to composite outcome and fewer DAOOH (-25 & -16 days, respectively). AMFE explained 25% of relationship between NH Black race and composite outcome, and 18% of relationship between Hispanic ethnicity and composite outcome. AMFE explained 16% (NH Black race) and 21% (Hispanic ethnicity) of the association with DAOOH (Table).

Conclusions:
Increased exposure to AMFE contributes to disparate outcomes in NH Black and Hispanic infants with CCHD. This novel finding merits clinical attention.
Abstract 9349: The Relationship Between Combat-related Traumatic Injury and Cardiometabolic Risk
Authors: Boos Christopher J , Schofield Susie , Cullinan Paul , Dyball Daniel , Nicola Fear T , Bull Anthony M , Pernet David , Alexander Bennett N
Published: April 2024

Introduction:
The relationship between combat-related traumatic injury (CRTI) and cardiovascular risk is uncertain. Available data are largely derived from small retrospective or cross sectional studies.

Hypothesis:
This study was designed to investigate, prospectively, the link between CRTI and both metabolic syndrome (MetS) and arterial stiffness

Methods:
From March 2016 to August 2020, 1144 male combat veterans (UK-Afghanistan War 2003-14) were recruited into the ADVANCE cohort; they comprised 579 men with CRTI and 565 uninjured participants frequency-matched for age, service, rank, regiment, deployment period and role-in-theatre. Investigations included quantification of injury severity (New Injury Severity Scale [NISS]), whole body composition (dual-energy X-ray absorptiometry), arterial stiffness (heart rate-adjusted central augmentation index [cAIx] and pulse wave velocity [PWV]), fasting venous blood glucose, lipids and high sensitivity C-reactive protein (hs-CRP). Insulin resistance was quantified using the estimated glucose disposal rate. The relationships of CRTI to MetS and cAIx were examined using modified Poisson and multiple linear regression analyses respectively.

Results:
The participants were aged 34·1±5·4 years, which was similar in the CRTI and uninjured groups; the mean time from injury or relevant deployment was 8·3±2·1 years. MetS prevalence (18·0% vs 11·8%; adjusted IRR 1·46; 1·10, 1·94) and cAIx (17·61±8·79 vs 15·23±8·19: p<0·0001) were higher among the CRTI than uninjured group. Abdominal waist circumference, visceral fat area, triglycerides, insulin resistance and hs-CRP were higher and HDL-cholesterol lower with CRTI. There were no significant between-group differences in blood glucose, blood pressure or PWV. CRTI, its severity (↑NISS), lower age and socioeconomic status (SEC) were independently associated with both MetS and cAIx.

Conclusions:
CTRI is associated with an increased prevalence of MetS and arterial stiffness which are also influenced by age, injury severity and SEC. The longitudinal impact of CRTI on clinical cardiovascular events needs further examination
Abstract 9358: Individualizing Cardiovascular Benefits of Canagliflozin Based on Multidimensional Computational Phenomaps of the CANVAS Trials
Authors: Oikonomou Evangelos K , Suchard Marc A , McGuire Darren K , Khera Rohan
Published: April 2024

Introduction:
Sodium-glucose cotransporter-2 (SGLT2) inhibitors have well-documented cardioprotective effects in broad groups of patients with type 2 diabetes mellitus (T2DM) but are underused, in part due to high cost. Individualized prediction of the magnitude of cardiovascular risk reduction may allow more targeted use.

Hypothesis:
A machine learning decision support tool can predict ASCVD effect of canagliflozin therapy in T2DM based on each patient’s unique phenotypic profile.

Methods:
We constructed a topological representation of the Canagliflozin Cardiovascular Assessment Study (CANVAS) using 75 baseline variables collected from 4327 patients with T2DM randomly assigned to canagliflozin (n=2886) or placebo (n=1441). Within each patient’s 5% topological neighborhood, we calculated age- and sex-adjusted risk estimates for major adverse cardiovascular events (MACE: cardiovascular death, myocardial infarction, stroke). An extreme gradient boosting algorithm was trained to predict the personalized MACE effect of canagliflozin using features consistently associated with benefit in topological analyses and was validated in the independent CANVAS-R trial (n=5808, randomized 1:1 to canagliflozin or placebo).

Results:
In CANVAS (mean age 60.9±8.1 years, 33.9% women) 1605 (37.1%) patients had a neighborhood hazard ratio lower (more protective) than the overall effect estimate of 0.86 for the primary composite outcome of time to MACE (
A
). A 15-variable tool, INSIGHT, was developed in CANVAS (
B
), and subsequently tested in CANVAS-R (mean age 62.4±8.4 years, 2164 (37.3%) women) where it identified patient phenotypes with higher MACE benefit of canagliflozin (adj. HR 0.60 [95% CI: 0.41-0.89] (
C
) versus 0.99 [95% CI: 0.76-1.29] (
D
); P-value for interaction=0.04).

Conclusions:
We present an evidence-based, machine learning-guided algorithm to personalize the prescription of SGLT2 inhibitors for cardiovascular benefit in patients with T2DM.
Abstract 9392: Cardiovascular, Metabolic and Safety Outcomes With Semaglutide by Age: A
Post Hoc
Analysis of SUSTAIN 6 and PIONEER 6
Authors: Petrie Mark , Bain Stephen , Hoff Soren Tetens , Johansen Nicklas , Rasmussen Søren , Vilsboell Tina , Husain Mansoor
Published: April 2024

Introduction:
For older patients with type 2 diabetes, treatments that minimize the risk of hypoglycemia and provide benefits in terms of comorbidities, while optimizing glycemic control, are particularly important. Semaglutide, a glucagon-like peptide-1 receptor agonist available as a once-weekly (OW) subcutaneous and once-daily oral formulation, reduces HbA
1c
and body weight with a low risk of hypoglycemia. In addition, major adverse cardiovascular events (MACE) were reduced in SUSTAIN 6 (OW semaglutide; significant) and PIONEER 6 (oral semaglutide; not significant) vs placebo. The aim of this
post hoc
analysis was to evaluate cardiovascular (CV), metabolic and safety outcomes with semaglutide according to age.

Methods:
Subgroup analyses for semaglutide vs placebo by age as quartiles (≤60 years; >60 years to ≤65; >65 years to ≤70 years; >70 years) were performed for pooled SUSTAIN 6 and PIONEER 6 data in relation to: CV (3-point and individual MACE components), metabolic (change in HbA
1c
, body weight) and safety (severe hypoglycemia, serious adverse events [SAEs]) outcomes.

Results:
In patients treated with semaglutide (n=3,239) vs placebo (n=3,241), the reduction in MACE and individual components of MACE was consistent across age subgroups (p
interaction
>0.05 for all;
Table
). Minor heterogeneity for change in HbA
1c
from baseline was observed with semaglutide vs placebo across the four age subgroups (p
interaction
=0.01). Weight reduction with semaglutide vs placebo did not differ across age subgroups. Semaglutide (vs placebo) did not result in an increase in severe hypoglycemia or SAEs in any of the age subgroups (
Table
).

Conclusions:
This
post hoc
combined analysis of SUSTAIN 6 and PIONEER 6 indicates that the CV and metabolic benefits and the safety profile of semaglutide (vs placebo) align with the drug class and were consistent across age subgroups.
Abstract 9396: Evaluation of the ABC Pathway for Comprehensive Management of Atrial Fibrillation in 20,933 Patients from the ENGAGE AF-TIMI 48 Trial
Authors: Patel Siddharth M , Murphy Sabina A , Antman Elliott M , Braunwald Eugene , Lip Gregory Y , Giugliano Robert P , Ruff Christian T
Published: April 2024

Introduction:
Pts with atrial fibrillation (AF) are at high risk of morbidity and mortality beyond ischemic stroke. The ABC (Atrial Fibrillation Better Care) comprehensive care approach was devised to improve overall care and is endorsed by the 2020 ESC AF Guideline. The impact of the ABC pathway in a large, well-phenotyped population is unclear.

Methods:
ENGAGE AF-TIMI 48 was an RCT of edoxaban vs. warfarin in pts with AF and CHADS
2
score ≥2. In this exploratory analysis, pts were classified as treated according to the ABC pathway if they met all components depicted in
Fig 1
. CV outcomes were compared between pts whose care was vs. was not concordant with the ABC pathway using a Cox proportional hazards model including CHA
2
DS
2
-VASc score. Randomized treatment interaction was assessed using interaction p-values.

Results:
Of 20,933 pts, 35% were treated concordant with the ABC pathway. These pts were younger (age <75y: 61.9% vs. 56.5%), had less frequent prior CAD (23.3% vs. 38.8%), DM (30.3% vs. 39.4%), and stroke/TIA (18.6% vs. 33.7%). Treatment consistent with the ABC pathway was associated with lower rates of stroke/SEE (HR 0.58, 95% CI 0.50-0.67), major bleeding (HR 0.71, 95% CI 0.62-0.81), MACE (HR 0.57, 95% CI 0.52-0.62), and CV death (HR 0.57, 95% CI 0.50-0.64; p<0.001 for each;
Fig 2
). Lower rates of CV events in patients treated according to the ABC pathway were generally consistent by randomized treatment.

Conclusions:
In this non-randomized analysis, comprehensive management of AF consistent with the ABC pathway as outlined by the 2020 ESC Guideline on AF is associated with lower adjusted rates of multiple CV outcomes including CV mortality.
Abstract 9815: Role for Btg1 and Btg2 in Postnatal Cardiomyocyte Cell Cycle Arrest and Maturation
Authors: Velayutham Nivedhitha , van Leeuwen Frank N , Scheijen Blanca , Yutzey Katherine E
Published: April 2024

Background:
Adult mammalian cardiomyocytes (CM) are predominantly post-mitotic and cannot proliferatively repair the heart following myocardial infarction (MI). Overexpression of the transcription factor Tbx20 in adult mouse CMs promotes proliferative cardiac repair post-MI, via mechanisms including direct repression of anti-proliferative genes
p21
,
Meis1
, and
Btg2
. Btg2 (B-cell translocation gene 2), a tumor suppressor and transcriptional co-regulator, exhibits high structural and functional similarity with Btg1. However, both Btg1 and Btg2 (Btg1/2) are virtually uncharacterized in the heart. Here, we investigate the role of Btg1/2 in postnatal cardiac maturation.

Methods and Results:
By immunostaining in embryonic, neonatal, and adult C57BL/6 mouse hearts, the highest expression of Btg1/2 was observed in late fetal and early neonatal ventricles, concurrent with upregulation of other CM cell cycle inhibitors. In neonatal mouse CMs
in vitro,
siRNA-mediated loss of Btg2 leads to increased CM proliferation.
In vivo
, Btg1/2 constitutive single- and double- knockout (SKO and DKO respectively) mice exhibit normal heart weight-to-body weight ratios compared to age-matched wildtype (WT) controls, at postnatal day (P)7, P30, and 1 year after birth. Interestingly, at P7, DKO mice have significantly higher CM mitotic activity, as indicated by pHH3 staining, compared to WT. In addition, DKO mice also exhibit significantly smaller CM cross-sectional area at P7 compared to WT. However, by P15, CM mitotic activity and cell size are comparable between WT and Btg1/2 KO mice. Currently, siRNA-mediated knockdown of Btg1/2 in neonatal rat ventricular cardiomyocyte cultures and RNAseq studies are being performed, to assess the transcriptional regulatory roles of Btg1/2 in rodent CMs.

Conclusions:
Here, we highlight two novel regulators of postnatal CM maturation, Btg1 and Btg2, which are upregulated coincident with CM mitotic arrest in mice. Similar to p21 and Meis1, Btg1/2 depletion in mice induces a brief period of increased CM proliferative activity before onset of CM cell cycle arrest. Our results provide evidence for Btg1/2 working in tandem with other cardiac transcription factors and cell cycle regulators, to control CM mitotic arrest after birth.
Abstract 9821: Fully Automated Measurements of Right Ventricular Strain in Children: Validation Using Conventional Manual Technique
Authors: Matsubara Daisuke , Kauffman Hunter L , Convery Michael J , Miller Karren , Quartermain Michael D , Banerjee Anirban
Published: April 2024

Introduction:
Fully automated strain measurements have been developed for the left ventricle. However, they have not been studied in the right ventricle (RV) of adults or children.

Hypothesis:
Automated strain measurements of RV will be comparable with manual strain measurements.

Methods:
We prospectively enrolled 94 patients, who underwent clinically indicated echocardiograms (mean age: 13.0±4.4 years). Strain measurements included RV free wall longitudinal strain (RVFWLS) and RV “global” longitudinal strain (RVGLS), both measured from the RV-focused apical 4-chamber view. Strain parameters were measured using three methods: 1) Fully automated (AutoStrain, Phillips Medical Systems), 2) Semiautomated (manual correction after automated measurements), 3) Manual measurements (2D-CPA, Tomtec). We also recorded the time required for measurements in all patients. Automated measurements relied on an anatomical intelligence program that was trained by adult datasets.

Results:
Fully automated measurements were feasible in all cases. However, 40% of patients required manual correction after automated measurements, mostly at the apex and RV lateral annulus at endsystole. The results are depicted in Table 1. Fully automated RVFWS showed moderate to good correlation with manual measurements (r=0.71, p<0.001). Semiautomated measurements showed a stronger correlation (r=0.78, p<0.001) and less bias than fully automated measurements (
Figure 1
). The time needed for fully and semi-automated analyses were 9±2.6 and 68±25 seconds, respectively (p<0.001).

Conclusions:
Automated strain may provide rapid and clinically feasible means to assess RV function in children. Presently, a significant number of patients need manual correction, especially at endsystole. We speculate that accuracy of AutoStrain may improve in the future with inclusion of pediatric training datasets, as the anatomical intelligence program currently relies on adult datasets.
Abstract 9832: Automated Electrocardiographic Detection of Pulmonary Hypertension Using Deep Learning
Authors: Aras Mandar A , Abreau Sean , Mills Hunter , Radhakrishnan Lakshmi , Klein Liviu , Mantri Neha , Rubin Benjamin , Barrios Joshua , Chehoud Christel , Kogan Emily , Gitton Xavier , Nnewihe Anderson , Quinn Deborah , Bridges Charles , Butte Atul J , Olgin Jeffrey E , Tison Geoffrey H
Published: April 2024

Introduction:
Pulmonary hypertension (PH) is a progressive, life-threatening disease, often diagnosed late in its course. Treatments are available for some subtypes, including pulmonary arterial hypertension (PAH).

Hypothesis:
Deep learning applied to interpretation of electrocardiograms (ECGs) can detect PH and clinically important subtypes.

Methods:
Adults with either right heart catheterization (RHC) or an echocardiogram (echo) within 90 days before or after an ECG at the University of California, San Francisco from 2012 to 2019 were retrospectively identified and defined as PH (mean pulmonary artery pressure [mPAP] >20 mmHg) or non-PH (mPAP ≤20 mmHg) by RHC or by echo, if RHC unavailable (peak tricuspid regurgitation velocity >3.4 m/s or ≤2.8 m/s). A convolutional neural network (CNN) to detect PH was developed and tested using patients’ 12-lead ECG voltage data. Patients were divided into training, validation, and test sets in a ratio of 7:1:2. The ability of the CNN to detect pre-capillary PH (defined by RHC), PAH (defined as presence of any PAH-specific medication over the 3 months prior and 6 months following mPAP >20 mmHg by RHC), and Group 3 PH (identified by Group 3-consistent International Classification of Disease codes in the 3 months before or after RHC) was also tested. CNN performance was assessed by calculating the area under the receiver operating characteristic curve (AUC), sensitivity, specificity and positive and negative predictive values.

Results:
A total of 24,470 patients and ECGs were identified (5,016 PH and 19,454 non-PH). CNN performance is shown in the
Table
. When the algorithm was applied to ECGs from PH patients up to 2 years before RHC or echo diagnosis, AUC was ≥0.79 to detect PH.

Conclusions:
A deep learning ECG algorithm can detect PH and performs well to identify subtypes of PH. The CNN can also detect PH using ECGs up to 2 years before RHC or echo diagnosis. This approach has the potential to reduce delays in the diagnosis and management of PH.
Abstract 9849: Self-Reported Health Care Utilization Patterns in Type 2 Diabetes Adults with and without Comorbid Heart Failure in Ethiopia
Authors: Aga Fekadu , Dunbar Sandra B , Higgins Melinda , Kebede Tedla , Guteta Senbeta , Gary Rebecca
Published: April 2024

Introduction:
Health care utilization (HCU) is an important outcome measure in type 2 diabetes (T2D) management. Little is known concerning differences in HCU patterns between T2D adults with and without heart failure (HF).

Aim:
This cross-sectional study compared differences in sociodemographic, clinical characteristics and self-care behaviors on HCU patterns between T2D adults with and without HF.

Methods:
Participants included 210 T2D adults (105 without HF and 105 with HF) from Tikur Anbessa Specialized Referral Hospital in Ethiopia. The Diabetes Health Care Utilization (DHCU) tool was adapted to measure self-reported HCU. It consists of 5 questions asking about the frequency of visits to provider, emergency room, foot examination, total days in hospital in the past 6 months, and last month(s) of eye examination. The score range from 0 (no HCU) to 7 (high utilization) with high score indicating higher utilization in all dimensions except for eye examination. The Mann-Whitney U and Kruskal-Wallis tests were used for data analysis.

Results:
HCU ranged from 0 to 7 visits to provider, 0 to 3 emergency room visits, 0 to 6 foot examinations, 0 to 11 days in hospital, and 0 to 96 months since previous eye examination. T2D adults with HF had significantly higher emergency room visits (
p
= 0.03) and total days in hospital (
P
= 0.021). In T2D adults with HF, persons who lived alone had significantly higher provider visits (
p
= 0.023), emergency room visits (
p
= 0.007), and total days in hospital (
p
= 0.015) but lower months since previous eye examination (
P
= 0.024). Men had a higher frequency of foot examination than women (
p
= 0.028). In T2D adults without HF, unmarried persons had higher days in hospital (
p
= 0.009). Participants who performed blood glucose self-monitoring more often had a higher frequency of foot examinations (
p
= 0.036).

Conclusions:
Findings show that HF increases HCU in T2D adults and is higher among those who live alone. Future studies should examine strategies to provide social support on HCU.
Abstract 9850: Association Between Matrix Metalloproteinase-2 Activity, Heart Failure and Adverse Cardiac Remodeling: The Atherosclerosis Risk in Communities Study
Authors: Buckley Leo F , Agha Ali M , Dorbala Pranav , Claggett Brian , Yu Bing , Hussain Aliza , NAMBI VIJAY , Matsushita Kuni , Hoogeveen Ron C , Ballantyne Christie M , Shah Amil M
Published: April 2024

Introduction:
MMP-2, an extracellular matrix regulator, is overexpressed in the myocardium of patients with dilated cardiomyopathy and predicts adverse outcomes in patients with heart failure (HF). Whether circulating MMP-2 associates with incident HF with reduced and preserved ejection fraction (HFrEF, HFpEF) and with cardiac structure and function among persons free of HF remains unclear.

Methods:
Among 4471 participants in the community-based ARIC study who were free of HF, had aptamer-based MMP-2 measurements (SomaLogic), and underwent echocardiography at Visit 5 (2011-2013), we assessed the association of MMP-2 with adjudicated HF, HFrEF (LVEF<50%) and HFpEF using multivariable Cox proportional hazards regression and with cardiac structure and function using multivariable linear regression. MMP-2 levels and echocardiographic parameters were standardized before analysis. All models adjusted for demographics, field center, coronary artery disease, diabetes, hypertension, atrial fibrillation, smoking status, body mass index and eGFR, and, in linear regression models, systolic blood pressure and heart rate.

Results:
The mean age was 75±5 years and 57% were women. Higher MMP-2 level associated with older age, male sex, and coronary artery disease, and with lower BMI, higher eGFR, and lower diabetes and hypertension prevalence. Higher MMP-2 levels associated with larger LV volume (standardized β=0.13; P<.001), mass (β=0.08; P<.001), E/e’ (β=0.12; P<.001) and LA volume index (β=0.19; P<.001). Over a median follow-up of 7 (IQR 6-8) years, 204 HFpEF, 180 HFrEF, and 55 unknown LVEF events occurred. Higher plasma MMP-2 level associated with greater risk of HF (HR per 1 SD: 1.30 [1.18-1.43]; P<.001), HFrEF (1.23 [1.06-1.43]; P=.007), and HFpEF (1.33 [1.16-1.54]; P<.001) post-Visit 5 (
Figure
).

Conclusions:
Higher circulating MMP-2 is independently associated LV remodeling and diastolic dysfunction, and with risk of incident HFrEF and HFpEF.
Abstract 9859: Secondhand Smoke Exposure is Associated with Abnormal P-Wave Axis
Authors: Skipina Travis M , Patel Nikhil , Upadhya Bharathi , Soliman Elsayed Z
Published: April 2024

Introduction:
Secondhand smoke exposure (SHSE) is associated with increased risk of cerebrovascular accident (CVA). Abnormal p-wave axis (aPWA) is a marker for atrial disease that is also associated with CVA risk.

Hypothesis:
SHSE is independently associated with aPWA.

Methods:
This analysis included 5,986 nonsmokers (age 61.7±13.8, 45.8% men, 77.4% whites) from the Third National Health and Nutrition Examination Survey. SHSE was defined as serum cotinine ≥1ng/mL. Serum cotinine cut-points of ≥3ng/mL and ≥6ng/mL were used to assess dose-response. Multivariable logistic regression was used to examine the association between SHSE and aPWA. The consistency of this association was tested among subgroups stratified by demographics and comorbidities.

Results:
About 18.5% (n=1109) of the participants had SHSE. After adjusting for demographic and comorbid covariates, SHSE was associated with a 28% increased odds of aPWA (p-value=0.003). Serum cotinine cut-points of ≥3ng/mL and ≥6ng/mL were associated with 35% increased odds of aPWA (p-value=0.002) and 38% increased odds of aPWA (p-value=0.002), respectively. This association was stronger among those of white ethnicity [Odds Ratio (95% Confidence Interval): 1.36 (1.12-1.66), interaction p-value=0.04].

Conclusions:
SHSE is associated with aPWA with possible effect modification by ethnicity. This is a novel finding that further underscores the harmful effects of SHSE on cardiovascular health and merits a personalized risk assessment when counseling patients on SHSE. Further prohibition of smoking in public areas should be emphasized, especially in regions with less-stringent public health policies.
Abstract 9869: Adverse Effects of Smoking/Vaping of Several Types of Tobacco Products and Marijuana on Cardiac Function and Platelet Aggregation
Authors: Wang Xiaoyin , Qiu Huiliang , Han Daniel D , Tan Kelly , Derakhshandeh Ronak , Springer Matthew L
Published: April 2024

Tobacco and marijuana smoke contains ~7,000 chemicals that cause disorders in cardiac autonomic function, vascular biology, and platelet function. Along with marijuana, e-cigarettes (e-cigs) and heat-not-burn tobacco products (e.g., IQOS) are often viewed as being less harmful than smoking tobacco. However, there are many unknowns about how marijuana, e-cigs, and IQOS impact cardiovascular physiology and platelet function over the long term. To explore cardiovascular effects of smoking/vaping, we exposed conscious rats to single (one time) and multiple (one time daily for 10 days) pulsatile mainstream smoking/vaping of e-cigs (JUUL), IQOS (American and Russian HeatSticks), marijuana (~10% THC), and cannabinoid-depleted (“placebo”) marijuana, relative to regular tobacco (Marlboro Red) smoking and air controls. Cardiac function was assessed by echocardiography pre- and post- single exposure. Platelet aggregation was measured to determine changes in platelet response immediately post-single exposure and one day after the last of multiple exposures. Single exposure induced acute effects on echocardiographic function with reduced ventricular end-diastolic volume (EDV) in IQOS and marijuana groups of both genders (Fig. A), potentially indicating incomplete ventricular relaxation between heart beats after exposure. However, marijuana caused adjustments of end-systolic volume (ESV) and EDV without changes in ejection fraction (EF) in females, with smaller ESV and reduced EDV. Tobacco, marijuana, and placebo marijuana smoking immediately increased collagen-induced platelet aggregation post-single exposure in female rats. Tobacco smoking, JUUL, IQOS, and both kinds of marijuana significantly increased platelet aggregation post-multiple exposure as compared to air controls in mixed genders (Fig. B).
P
values ≤ 0.1 are shown.

Conclusion:
smoking/vaping causes clinically relevant adverse effects on cardiac function and platelet aggregation.
Abstract 9877: Burden and Predictors of Hypertensive Crisis-Related Hospitalizations and Outcomes in Young Cannabis Users: A Nationwide Multi-Center Analysis
Authors: Desai Rupak , Gandhi Zainab J , Jnaneswaran Geethu , Raju Athul Raj , Sultan Waleed , Agarwal Charu , Varughese Vivek Joseph , Mudgal Gaurav , Jain Akhil
Published: April 2024

Introduction:
With the increasing use of recreational cannabis in the youth and earlier reports suggesting its potential association with systolic hypertension, we planned to assess the burden with disparities, predictors and outcomes of hypertensive (HTN) crisis in young cannabis users vs. non-users.

Methods:
We queried the National Inpatient Sample (October2015-2017) to identify admissions among young (18-44 years) cannabis users with HTN crisis. Rates of HTN crisis admissions with racial/sex disparities were assessed in cannabis users vs. non-users. Multivariable analysis was performed adjusting for covariates to assess the predictors of HTN crisis in cannabis users and odds of inpatient mortality.

Results:
Of 623,715 admissions among young cannabis users, 4675 (0.7%) had HTN crisis. Among cannabis users, non-whites and females were more often admitted for HTN crisis cohort compared to non-users
(Figure 1).
Among young cannabis users, males (OR 1.12, CI 1.04-1.19), blacks (OR 3.28, CI 3.02-3.56), patients admitted non-electively (OR 3.09, CI 2.53-3.76) with comorbidities like chronic kidney disease (OR 8.83, CI 8.14-9.59), congestive heart failure (OR 3.35, CI 2.13-3.08), obesity (OR 2.83, CI 2.62-3.05), valvular diseases (OR 2.56, CI 2.13-3.08), fluid and electrolytes disorders (OR 2.25, CI 2.11-2.40), diabetes mellitus (OR 1.82, CI 1.67-1.97) and hyperlipidemia (OR 1.71, CI 1.56-1.87) predicted higher odds of HTN crisis (p<0.001). Interestingly, cannabis users admitted for HTN crisis had lower odds of in-hospital mortality (OR 0.67, CI 0.45-0.99, p<0.05) compared to non-users when adjusted for confounders.

Conclusions:
Non-white and male cannabis users had higher odds of HTN-crisis admissions. Cannabis users with preexisting cardiovascular and metabolic comorbidities had higher odds of developing HTN crisis. Lower risk of inpatient mortality following HTN-crisis in cannabis users warrants future prospective studies.
Abstract 9881: Safety of Bariatric Surgery in Obese Patients with Hypertrophic Cardiomyopathy
Authors: Sun Daokun , Schaff Hartzell V , McKenzie Travis J , Nishimura Rick A , Geske Jeffrey B , Dearani Joseph A , Ommen Steve R
Published: April 2024

Introduction:
Obesity is an independent risk factor for heart failure in patients with hypertrophic cardiomyopathy (HCM). Bariatric surgery is associated with improved cardiac function in obese patients with heart failure, but the safety of this procedure has not been evaluated in HCM patients. In this study, we examined national trends and early outcomes in bariatric surgery for patients with HCM.

Methods:
Using the weighted discharge data from the National Inpatient Sample, we identified adult patients with HCM who underwent elective bariatric surgery for obesity between 2011 and 2017. Patients with a history of bariatric surgery or having malignant neoplasms in the esophagus, stomach, small intestine, or pancreas were excluded.

Results:
A total of 443 obese patients with HCM were identified, and 41.8% (n=185) had obstructive HCM. The annual number of patients increased from 18 in 2011 to 130 in 2017, and nearly half of the patients (48%) had bariatric surgery in 2016 and 2017. Overall, the median (IQR) age was 50 (43-57) years, and 85 (19%) patients were 60 years or older. Approximately 20% (n=90) of the patients had heart failure at the time of operation. Atrial fibrillation was present in 83 (19%) patients, and 22% (n=95) of the cohort had a pacemaker or automatic cardiac defibrillator implanted prior to the operation. Laparoscopic sleeve gastrectomy (72%, n=318) and laparoscopic Roux-en-Y gastric bypass (25%, n=110) were the most commonly performed bariatric procedures. Overall, patients stayed in hospital for a median (IQR) of 2 (1-2) days. During the hospital stay, 1% (n=5) of the patients had acute worsening of chronic heart failure, but there were no deaths, cardiac arrests, or cerebrovascular accidents post procedure.

Conclusions:
Bariatric surgery in patients with HCM is performed more frequently in recent years and is safe and associated with few perioperative complications. Given the impact of obesity on long-term survival, clinicians should strongly consider bariatric surgery for HCM patients who do not respond to conservative weight loss measures.
Abstract 9889: Novel Mechanisms of Cardiac Macrophage-Mast Cell Interactions in Radiation-Induced Myocardial Fibrosis
Authors: Sonkawade Swati D , Momeni Arezoo , Xu Shirley , Pokharel Saraswati , Sharma Umesh C
Published: April 2024

Introduction:
Both galectin-3 (gal3) and macrophages are implicated in myocardial fibrotic remodeling. Macrophages express gal3 on their surface, whereas mast cells express a high-affinity gal3 receptor, FcεRI. Understanding the mechanisms of their interactions will lead to highly targeted therapeutic approaches.

Hypothesis:
We hypothesize that a macrophage-expressed pro-fibrotic molecule, gal3, is a mediator of macrophage-mast cell interactions in a pre-clinical model of radiation-induced myocardial fibrosis.

Methods:
We studied myocardial fibrosis, cardiac macrophage-mast cell infiltration, and gal3 expression in a rodent model of thoracic radiation. We performed long-term culture of the bone-marrow cells isolated from gal3 KO (gal3
-/-
) and gal3 overexpression (gal3
+/+
) mice. Recombinant M-CSF co-cultured cells transformed to macrophages (F4/80
+
/CD11B
+
), whereas IL-3-treated cells transformed to mast cells (FCεR1
+
/c-kit
+
). Then, we used microfluidic and transwell systems to examine the gal3-dependent macrophage-mast cell interactions in the live cell culture.

Results:
Thoracic radiation exposure induced myocardial fibrosis (% fibrosis, radiation: 5±2, controls: 2±0.6; p=0.01, N=5-8), which was also associated with macrophage (cells/cm
3
, radiation: 114±28, controls: 81±0.3; p=0.05, N=8) and mast cell (cells/cm
3
, radiation: 14±5, controls: 9±0.3; p=0.05, N=5-8) infiltration, and cardiac gal3 expression (pg/ng, radiation: 85±15, controls: 14±8; p=0.001, N=7). Exogenous gal3 treatment led to increased mast cell tryptase activity confirming their activation [tryptase (ng/ml), untreated: 291±46, gal3: 494±191; p<0.01, N=3-8]. Quantitative macrophage-mast cell activity in a microfluidic system showed 7.5-fold increased macrophage-mast cell adhesion in gal3
+/+
cells suggesting increased interactions with gal3 overexpression [cell adhesion (cells/mm
2
), WT: 23±5.8, Gal3
+/+
:175±38; p<0.01, N=4].

Conclusion:
In a pre-clinical model of radiation-induced myocardial fibrosis, gal3 can mediate crucial macrophage-mast cell interactions. Our data provide possible mechanistic evidence of gal3 involvement in macrophage-mast cell interactions
en route
to myocardial fibrosis after radiation exposure.
Abstract 9894: Identifying Myocardial Infarction Using Clinical 12-Lead Electrocardiogram and Deep Learning
Authors: Xiao Ran , Yang Fan , Ding Cheng , Zegre-hemsey Jessica K , Hu Xiao
Published: April 2024

Introduction:
Early identification of myocardial infarction (MI) to activate rapid reperfusion therapies is linked to improved mortality and morbidity. Mounting evidence shows that electrocardiogram (ECG) markers are predictive of MI in the initial evaluation phase. Yet few studies have explored the feasibility of predictive modeling with deep learning, which has achieved promising performance in classifying cardiac arrhythmias. The pilot study aims to establish the baseline performance of deep learning in predicting MI.

Methods:
The PTB-XL database includes over 20K records of 10s 12-lead ECG and diagnostic annotations. ECGs with labels of normal sinus rhythm (9,528 records) and MI (5,486 records) were entered into the study. The dataset was first divided into development and test sets with an 80%-20% split. The development set was further split into training and validation sets following a five-fold cross-validation setup. The first 2.5s ECGs organized by the standard 12-lead ECG layout were converted into 2D image samples for model training. Two deep learning models, LeNet and a more complex ResNet, were adopted to probe the impact of model complexity on predicting MI. The area under the ROC curve (AUC) was selected to evaluate the model performance.

Results:
The AUCs were 93.45% ± 0.67% and 96.80% ± 0.50% (mean ± SD) achieved by the LeNet and ResNet models, respectively. Between the two, the ResNet outperformed the LeNet with statistical significance (
p<0.05,
Wilcoxon rank-sum test).

Discussion:
By leveraging an unprecedented large-scale MI database and deep learning, our study demonstrated the feasibility of predicting MI using just 2.5s of standard 12-lead ECG and established the baseline performance. Results further show the more complex model offers additional performance gain. Our next step will be to evaluate the derived model's generalizability on a locally collected ECG dataset towards evaluation in clinical settings.
Abstract 9895: Acupuncture Shows Early Efficacy for Pain Reduction in Stable Angina
Authors: Devon Holli A , UWIZEYE GLORIEUSE , Briller Joan , Shroff Adhir R , Schlaeger Judith M
Published: April 2024

Introduction:
Despite a notable 32.7% decline in mortality from ischemic heart disease since 1999, the prevalence of stable angina has not decreased. Up to 30% of patients have suboptimal pain relief even though they receive guideline-directed care. The aims of this pilot study were to evaluate preliminary efficacy of a standardized 12-point acupuncture prescription for reduction of pain, and improved functional status and health-related quality of life (HRQoL) for individuals with stable angina.

Hypothesis:
Acupuncture therapy would result in a reduction in pain and associated symptoms in individuals with stable angina.

Methods:
We conducted a randomized attention-controlled trial. Participants were enrolled from a predominantly urban minority community. Eligibility criteria included a diagnosis of stable angina for ≥1 month and experiencing symptoms at least once per week. Patients received either the standardized acupuncture protocol, twice a week for 5 weeks, or viewed videos unrelated to pain or heart disease. Outcome variables were measured with the McGill Pain Questionnaire Average Pain Intensity and pain now (at each visit) scales, and the Seattle Angina Questionnaire. Descriptive statistics and multivariable analyses of variance tests were performed.

Results:
The sample (n=24) had a mean age 59
+
12 years, was predominantly female (63%), and minority (8% White, 46% Black, 38% Hispanic, and 8% other). At study completion, primary outcomes of average pain intensity, worst pain in the last 24 hours, and pain now, were significantly lower in the acupuncture group. There was a significant improvement in functional status, symptoms, and HRQoL for the acupuncture group (Table)
.

Conclusions:
A standardized acupuncture protocol shows promise as a complementary therapy for symptom control for individuals with stable angina who are receiving care in a cardiology clinic which serves urban minorities.
Abstract 9896: Demographics and Complications According to Amyloidosis Subtypes Light Chain Amyloidosis and Hereditary Transthyretin Amyloidosis
Authors: Ma Jennifer , Ream Sarah , Rodriguez Tayana , Sarabia-Gonzalez Alejandro , Alvarado Luis , Dwivedi Alok , Mukherjee Debabrata
Published: April 2024

Introduction:
Amyloidosis is a multi-system disorder characterized by accumulation of misfolded proteins. The more common types are light chain amyloidosis (AL) and hereditary transthyretin amyloidosis (ATTR). We assess the demographics and complications of AL and ATTR subtypes for prompt recognition and treatment of this clinical entity.

Methods:
Our retrospective observational study analyzed the 2016 - 2018 National Inpatient Sample Databases for demographics (age, race, and gender), comorbidities (diabetes, hypertension, heart failure (HF), liver disease, pulmonary disease, coronary artery disease (CAD), and outcomes renal failure (RF), end-stage renal disease (ESRD) and mortality based on ICD-10 codes. Proportions were calculated, and unadjusted and adjusted associations of covariates according to amyloidosis subtype were determined using weight adjusted relative risk regression analyses.

Results:
Of the total population, 0.17% (N=34,894) had amyloidosis. 733 patients were AL+, 118 ATTR+, and 34,043 were AL-, ATTR-. ATTR was more common in blacks, in older individuals and in males and had more CAD. However, HF, renal failure, ESRD (19.4% vs 2.54%, p<0.0001) and mortality (6.6% vs 5.9%, p=0.0003) was higher with AL type.

Conclusions:
Black individuals, older age and male gender were more often associated with ATTR subtype. Though CAD was more prevalent in ATTR, AL had more frequent and severe complications including heart failure, renal failure, ESRD and significantly higher mortality. There is a need for more effective therapies for AL type amyloidosis.
Abstract 9901: Double Cardiac Threat of Concomitant Spontaneouscoronary Artery Dissection and Takotsubo Cardiomyopathy
Authors: Echeverry Tatiana , Barrera Maldonado Christian Daniel , Fishberg Robert
Published: April 2024

Spontaneous Coronary Artery Dissection is an important cause of ACS in females with few atherosclerosis risk factors. SCAD accounts for 25% of ACS cases in women<50 years of age. Takotsubo Cardiomyopathy (TTC) is also a cause of ACS in this group with similar presentation to SCAD. The coexistence of SCAD and TTC has been reported in the literature, emphasizing the importance of an accurate diagnosis. The following case highlights the coexistence of SCAD and TTC and the importance of updated guidelines to identify concomitant TTC and SCAD. Multiparous 41-year-old female, eight days after delivery, was found in cardiac arrest. Patient was intubated, CPR was initiated and after delivery of three shocks, ROSC was achieved. Upon arrival to the hospital, patient underwent TTM. Initial EKG showed no acute ischemic changes and troponin of 27. Patient underwent ECHO EF 40-45% with antero-apical and infero-apical akinesia. On day three, EKG showed ST elevations in leads V2-V6 and following day underwent cardiac catheterization showing an area of dissection in the distal LAD. SCAD and TTC are non-atherosclerotic coronary artery diseases that account for ACS among females. In women <50 years of age, SCAD accounts for 25% of ACS cases. While TTC accounts for 2% of all ACS cases. The diagnosis of SCAD versus TTC could be difficult since both conditions present in similar ways. It is important to recognize that SCAD and TTC can coexist since accurate diagnosis changes treatment. TTC should improve with subsequent echocardiograms. Patients with SCAD should be started on DAPT and identify risk factors such as FMD or aneurysm in other vascular beds. In our patient, the distal LAD is dissected but appears to be a small vessel leading to the antero-apex. However, the distal LAD does not appear to supply the infero-apical area, and the infero-apical hypokinesis is best explained as a component of TTC. Currently, TTC is diagnosed by echo showing transient left ventricular dysfunction and based on clinical presentation, as described by InterTAK diagnostic criteria. However, the InterTAK criteria do not take into account the possible coexistence of TTC and SCAD. Cardiac catheterization should be strongly considered in all cases of TTC to clarify the diagnosis of concomitant TTC and SCAD.
Abstract 9904: Association of History of Bariatric Surgery and Outcomes of Primary Atrial Fibrillation Hospitalizations: Insights from National Inpatient Sample 2016-2018
Authors: Minhas Abdul , Jamal Shakeel , Ullah Waqas , Ijaz Sardar H , Wazir Muhammad Hisham Khan , Fudim Marat
Published: April 2024

Background:
Atrial fibrillation (AF) is the most prevalent arrhythmia in the United Sates. Obesity is a known adverse prognostic factor for several cardiovascular diseases. We aimed to evaluate clinical outcomes in patients hospitalized with AF with history of bariatric surgery versus morbid obesity.

Methods:
We conducted a retrospective analysis of adult discharges from the National Inpatient Sample (NIS) between 2016 and 2018. ICD Codes were used to identify primary AF hospitalizations. These were further divided into two groups 1. Body mass index (BMI) >/= 35; 2. History of bariatric surgery with BMI < 35. Prevalence estimates were weighted using NIS-provided discharge-level weights to reflect national estimates. Weighted multivariable logistic regression was used to assess the association of history of bariatric surgery vs morbid obesity on various other clinical outcomes in primary AF hospitalizations. These models were adjusted for several patient-level and hospital-level characteristics.

Results:
There were 7,340 primary AF related hospitalizations with history of bariatric surgery and 159,105 primary AF hospitalizations with morbid obesity. There was no significant difference in adjusted all-cause mortality, use of mechanical circulatory support, cardiac arrest, cardiogenic shock, invasive mechanical ventilation, pressors use or inflation-adjusted cost between the two groups. However, admissions with morbid obesity (in comparison to history of bariatric surgery) were associated with higher rates of acute kidney injury, disposition to short/long term care and length of stay.

Conclusion:
Our study did not show any difference in mortality and various other outcomes between the two groups. However acute kidney injury, disposition to short/long term care and length of stay were significantly higher for the admissions with morbid obesity.
Abstract 9914: Three Months vs 12-Months Dual Antiplatelet Therapy Duration in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention
Authors: Selvaraj Vijairam , Moustafa Abdelmoniem , Bavishi Chirag
Published: April 2024

Introduction:
Recent American Heart Association/American College of Cardiology guidelines on duration of dual antiplatelet therapy (DAPT) recommend DAPT for 12 months in patients presenting with an acute coronary syndrome (ACS) who underwent percutaneous intervention (PCI) (grade IIb recommendation). With the advent of newer generation stents, multiple randomized controlled trials (RCTs) have studied the role of short term -3 months DAPT compared to the guideline-indicated12 months DAPT. We aim to assess the evidence using a meta-analytic approach.

Methods:
PubMed, Embase and Cochrane Central databases were searched from inception until May 31, 2021. RCTs comparing short term (3 months) vs extended (12 months) DAPT in patients with ACS undergoing PCI were included. Outcomes assessed were MACE, cardiovascular mortality, all-cause mortality, myocardial infarction, stent thrombosis and bleeding events. A random-effects model was used to calculate pooled relative risk (RR) and 95% confidence intervals (CI).

Results:
We included 5 trials comprising 16,781 patients with an acute coronary syndrome that underwent percutaneous intervention. There was no significant difference in MACE (RR 0.92; 95% CI, 0.76-1.11), cardiovascular mortality (RR 1.26; 95% CI, 0.38-4.17), or all-cause mortality (RR 0.92; 95% CI, 0.48-1.77) between the 2 groups. In addition, there was no difference in rates of myocardial infarction (RR 0.98; 95% CI, 0.74-1.30), or stent thrombosis (RR 1.30; 95% CI, 0.55-3.05) between short-term and extended DAPT. However, compared with extended DAPT, 3-month DAPT showed significantly reduced risk of major bleeding (RR 0.53; 95% CI, 0.43-0.64).

Conclusions:
In patients with acute coronary syndrome undergoing PCI, short term DAPT may be reasonable for some patients, while extended DAPT may be appropriate for select others. An individualized approach on optimal DAPT duration should be used considering the risks of ischemic events and bleeding.