bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 13169: Serum Calcium is Positively Associated With Right Ventricular Function as Assessed by Hemodynamics and Echocardiography
Authors: Lynes Carlos , Thayer Timothy E , Defilippis Andrew P , Brittain Evan
Published: April 2024

Introduction:
The physiologic role of calcium for cardiomyocyte contractility is well established. Post cardiac surgery, maintaining normocalcemia is associated with improved right ventricular (RV) function as compared to hypocalcemia.

Hypothesis:
We hypothesize that lower serum ionized calcium (iCa) is associated with RV dysfunction in non-surgical subjects.

Methods:
From a de-identified electronic health record, we extracted demographic, laboratory, echocardiographic, and first right heart catheterization (RHC) data to perform a cross-sectional analysis. iCa, obtained within 2 days of RHC, was tested for association with hemodynamics and pulmonary artery pulsatility index (PAPI; pulmonary artery pulse pressure / right atrial pressure) as a measure of RV function. We tested the association of iCa with reader-assessed RV dysfunction by echocardiography. RV dysfunction was coded as 0=none, 1=mild, 2=moderate, and 3=severe. All analyses were performed using ordinal regression adjusted for age, sex, and self-declared race.

Results:
From the 1,658 participants identified: median age 61 years, 42% female, 76% white, 18% black, 82% with mean pulmonary artery pressure ≥20mmHg, and 28% with pulmonary vascular resistance ≥3 Wood units. We observed a positive association between iCa and PAPI (Figure 1A, P<0.0001, n=1,658). Higher iCa was positively associated with systemic pressures and negatively associated with pulmonary pressures (P<0.01). By echocardiography, lower iCa was associated with higher prevalence of RV dysfunction (Figure 1B, P<0.0001, n=1,355).

Conclusion:
In a clinical population referred for RHC, we concluded that higher iCa was associated with better RV function assessed by invasive hemodynamics and echocardiography. Further studies are needed to assess whether there is an etiologic relationship between iCa and RV function.
Abstract 13176: Impact Of Cardiac Shock Wave Therapy On Myocardial Perfusion And Left Ventricular Ejection Fraction In Patient With Angina: A Meta-analysis
Authors: Latif Azka , Ahsan Muhammad J , Mirza Mohsin , Thandra Abhishek , kapoor vikas , Ahsan Muhammad Zoraiz , Smer Aiman
Published: April 2024

Introduction:
Cardiac shock wave therapy (CSWT) using low-intensity shock waves is a non-invasive therapeutic option in the management of chronic refractory angina. This meta-analysis aimed to review the available studies on CSWT and observe its anti-anginal efficacy.

Methods:
PubMed, Embase, Cochrane, ClinicalTrials.gov, and Google Scholar were searched for studies evaluating the efficacy of CSWT in patients with refractory angina from January 1, 2000, until March, 2021. The primary outcome was the assessment of left ventricular ejection fraction (LVEF) before and after CWST. The secondary outcome was myocardial perfusion before and after CSWT. The analysis was performed using a random-effects-model using the Mantel-Haenszel method and results presented as 95% confidence interval using STATA version 15.1 software.

Results:
Twenty-four studies (20 observational and 4 Controlled Trails) with a total of 503 patients were included in the meta-analysis. The mean age was 64.92 ± 9 years and 25% were females. In patients undergoing CSWT, left ventricular ejection fraction improved significantly in patients undergoing CSWT (SMD: 0.31, 95% CI: 0.14 to 0.48, P = 0.0003, I
2
= 41%, Figure 1B). Likewise, myocardial perfusion improved significantly in patients undergoing CSWT (SMD: 0.74, 95% CI: 0.39 to 1.090, P = <0.05, I
2
= 84%, Figure 1A).

Conclusions:
Based on our results, CSWT is a promising noninvasive modality for the management of refractory angina in patients with stable coronary artery disease and on optimal medical therapy.
Abstract 13197: Increased Cardiac and All-Cause Mortality After Percutaneous Coronary Intervention in Subclinical Hypothyroidism: A Meta-Analysis
Authors: Sachdeva Sonali , Desai Rupak , Patel Nirmit , SAEED TAHA , Jain Akhil , Khandait Harshwardhan , Aggarwal Ankita , Jain Anubhav
Published: April 2024

Background:
Subclinical hypothyroidism (elevated TSH with normal thyroid hormone levels), is associated with an increased risk of cardiovascular diseases like atherosclerosis and coronary artery disease. However, its impact on long-term outcomes after percutaneous coronary intervention (PCI) remains understudied.

Methods:
PubMed, EMBASE, and Web of Science databases were screened through June 2021 for studies reporting long-term PCI outcomes in patients with subclinical hypothyroid state vs. Euthyroid state. Random effects models were used for the meta-analysis. I2 statistics were used to interpret heterogeneity with I
2
>75% indicating substantial inter-study variation. A sensitivity analysis was performed using the leave one out method. A p-value <0.05 was considered statistically significant.

Results:
A total of 6 studies including 11,664 patients who had undergone PCI were identified with a median follow-up period of 3.75 years. There were 987 patients identified with subclinical hypothyroidism and the mean age of the cohort was 67.15 ± 9.9 years. It consisted of 48% males, the most common comorbidities were hypertension (70%) followed by diabetes mellitus (33%). In-hospital outcomes were reported only in one study while long-term outcomes were reported in all 6 studies. Pooled analysis for long-term adverse events showed that subclinical hypothyroidism was associated with increased all-cause (OR 1.78, 95%CI: 1.16-2.72, p<0.01, I
2
=50.67%) and cardiac mortality (OR 1.41, 95%CI: 1.09=1.81, p<0.01, I
2
=0%) over long-term follow-up following PCI

Conclusions:
Subclinical hypothyroidism at times remains undiagnosed or underdiagnosed, however, it predicts significantly higher all-cause and cardiac mortality in the long term following PCI compared to controls. Therefore, it is recommended to regularly screen and manage high-risk patients undergoing PCI with underlying subclinical hypothyroidism.
Abstract 13199: Generalizability and Prognostic Implications of Dapagliflozin and Finerenone in a Community-Based Cohort of Individuals With Diabetes and Chronic Kidney Disease
Authors: Segar Matthew W , Khan Mohammad S , Tang Wai Hong W , Butler Javed , Fonarow Gregg C , McGuire Darren K , Pandey Ambarish
Published: April 2024

Introduction:
Dapagliflozin (DAPA-CKD) and finerenone (FIDELIO-DKD) have shown to improve renal and cardiovascular (CV) outcomes in patients with type 2 diabetes (T2D) and chronic kidney disease (CKD).

Hypothesis:
We hypothesize individuals in a community-cohort who meet trial criteria will have higher rates of adverse outcomes.

Methods:
Adults with CKD from the Chronic Renal Insufficiency Cohort (CRIC) study were included. The inclusion criteria from each trial were applied to participants with T2D. Differences in characteristics and composite kidney and CV outcomes were assessed between trial eligibility groups. The estimated number of events prevented (NEP) over 3 years were calculated based on relative risk reduction estimates.

Results:
Among 2816 participants (mean [SD] age 62 [10], 41% female, 48% Black), 1545 (54.9%), 1458 (51.8%), and 1314 (46.7%) met DAPA-CKD, FIDELIO-DKD, and both inclusion criteria, respectively. Participants who met DAPA-CKD but not FIDELIO-DKD enrollment criteria were more likely to be Black and have higher CV, T2D, and kidney disease severity. Participants who met DAPA-CKD criteria (vs. ineligible) had higher rates of composite kidney (17.6% vs. 14.6%; p=0.006) and CV (15.5% vs. 12.6%; p=0.03) outcomes. Conversely, FIDELIO-DKD eligible participants had lower incidence of composite kidney outcomes (12.6% vs. 19.4%; p<0.001) and no differences in CV outcomes (14.2 vs. 14.2%; p=0.99). The estimated NEP per 1000 patients with dapagliflozin was 60 and 43 for kidney and CV outcomes, respectively, compared with 21 and 19 for finerenone (
Fig
). Notable differences in NEP were observed between races for dapagliflozin but not finerenone treatment, with Black patients having significantly higher kidney and CV NEP (
Fig
).

Conclusions:
In a community-based registry of CKD patients, approximately half of patients would be eligible for dapagliflozin or finerenone. The estimated NEP was higher with dapagliflozin compared to finerenone.
Abstract 13650: Prognostic Significance Of Atrial Arrhythmias In Pulmonary Hypertension: A Meta-analysis
Authors: Sebastian Joseph , Deneve Daniel , Sebastian Sreya , Sarvepalli Swara , Mohamed Abdel-Rhman , Akers Katherine , Kaur Ramanjit , Abidov Aiden
Published: April 2024

Background:
Atrial arrhythmias (AA: atrial tachycardia, atrial fibrillation, and atrial flutter) are common in patients (pts) with pulmonary hypertension (PH) due to increased right atrial pressure and increased sympathetic tone. AA occurrence in PH may lead to clinical deterioration and affect prognosis. Whether mortality in pts with PH is increased with comorbid AA compared to those without AA is not well established. The aim of this meta-analysis is to investigate published evidence of AA role in predicting outcomes of pts with PH.

Methods and Results:
We searched available literature across PubMed, EMBASE and Cochrane Library databases, and 11 observational studies with a pooled population of 2763 pts were included in this meta-analysis. Among the pooled population of pts with PH, there were 561 pts with AA (20%). We compared the outcomes of all-cause mortality among PH pts with and without AA. All-cause mortality was significantly higher in PH pts with AA compared to those without AA (odds ratio, OR=1.78; 95% confidence interval, 1.46-2.18;
P
<0.01). No AA-driven differences were found among WHO groups of PH (p=0.75) or gender (p=0.42).

Conclusion:
Our results indicate that overall mortality is higher in PH pts presenting with AA as compared to those without AA. Further research needed in evaluating the effect of AA therapy with restoration and maintenance of sinus rhythm on mortality in PH.
Abstract 13656: Outcomes of Vaccine Preventable Diseases and Heart Failure With Reduced Ejection Fraction
Authors: Del Cid Fratti Juan Daniel , Argueta Erwin
Published: April 2024

Background:
Over five million Americans suffer from Heart Failure (HF), and this is associated with multiple chronic comorbidities and recurrent decompensations. Currently, there is an increased incidence of vaccine-preventable diseases (VPDs). We aim to investigate the impact of VPDs on hospitalization outcomes in patients with heart failure with reduced ejection fraction (HFrEF).

Methods:
A retrospective analysis from all hospital admissions from the 2016-2018 National Inpatient Sample (NIS) using the ICD-10CM codes for patients admitted with a primary diagnosis of VPDs with HFrEF and those without reduced ejection fraction. Outcomes evaluated were in-hospital mortality, length of stay (LOS), health care utilization, frequency of admissions, and in-hospital complications. Multivariate regression analysis was conducted to adjust for confounders.

Results:
Out of 317,670 VPDs discharges, we identified 12,130 (3.8%) patients with HFrEF as comorbidity. The most common admission diagnosis for VPDs was influenza virus (IV) infection (75.0% vs 64.1%; P:<0.01), followed by Pneumococcal pneumonia (PNA) (13% vs 9.4%; P:<0.01). After adjusting for confounders, patients with HFrEF had higher odds of being admitted due to a diagnosis of IV (aOR 1.42; P:<0.01) and PNA (aOR 1.27; P:<0.01). Patients with VPDs and HFrEF had significantly higher odds of mortality (aOR 1.76; P:<0.01), LOS, respiratory failure requiring mechanical ventilation, and mechanical ventilation for less than 96 hours.

Conclusion:
Influenza and PNA were the most common VPDs admitted to the hospital in patients with HFrEF. They were associated with increased mortality and in-hospital complications.
Abstract 13671: Return to Play After COVID-19 Infection in Collegiate Competitive Athletes
Authors: Ko Willis , Manongi Ngoda , Classie Justin , Weinsaft Jonathan W , Pontone Gregory , Parmar Yuvrajsinh
Published: April 2024

Introduction:
COVID-19 infection has placed significant healthcare and economic burdens on society. Recent studies of patients recovered from COVID-19 infection demonstrate highly variable rates of cardiac involvement. A German cohort reported 78% cardiac involvement as defined by abnormalities seen on cardiac magnetic resonance imaging (CMR) while more recent data suggests rates of cardiac involvement between 0.3% and 3%. Competitive athletes represent a unique population as they may pose greater risk for sudden cardiac death during competition due to myocarditis as a sequela of COVID-19 infection.

Hypothesis:
We hypothesize that among athletes with non-severe COVID-19 infection, a symptom driven clinical pathway would lead to a safe and cost-effective return to sports.

Methods:
A retrospective analysis was conducted in a cohort of collegiate athletes with non-severe COVID-19 infection returning to competitive sports. The primary outcomes were the prevalence of cardiac involvement based on symptoms and abnormalities with electrocardiograms (ECG), troponin, or transthoracic echocardiogram (TTE). CMR were performed for ongoing cardiopulmonary symptoms or abnormal cardiac test results. Evaluation for myocarditis using CMR was based on the updated Lake Louise criteria. Athletes without evidence of cardiac involvement were permitted to participate in a graduated protocol to return to play.

Results:
A sample size of 83 athletes (mean age 20 years; female athletes 34%) diagnosed with COVID-19 infection by PCR was analyzed. Abnormal findings suggestive of cardiac involvement were detected by symptoms [82%, Standard Error of Mean (SEM) 0.04], ECG (2.5%, SEM 0.04), troponin (0%, SEM 0), and TTE (0%, SEM 0). CMR was clinically indicated in 7 patients and there were no abnormal findings. No patients were hospitalized and during a clinical surveillance period (median follow up of 105 days), there were no adverse cardiac or non-cardiac events.

Conclusions:
There is a low prevalence of cardiac involvement among collegiate athletes with non-severe COVID-19 infection. In this cohort, safe progression to competitive athletics using a symptom driven clinical pathway was demonstrated in a cost-effective manner.
Abstract 13682: Remote Hypertension Management During the COVID-19 Pandemic
Authors: Blood Alexander , Chaney Kira , Zelle David , Gordon William , Gaziano Thomas A , Cannon Christopher P , Scirica Benjamin M , Fisher Naomi D
Published: April 2024

Introduction:
During the COVID-19 pandemic, much of routine chronic disease monitoring and management via outpatient visits was deferred, revealing a disruption in care delivery. We demonstrate that an established remote care delivery program enabled delivery of uninterrupted, effective care.

Methods:
The team-based Digital Care Transformation (DCT) program remotely manages hypertension via monitoring home blood pressure (BP) readings that are automatically transmitted, using a team of navigators who follow expert-designed titration algorithms. We examined all patients enrolled in this program during the first six months of the health emergency in Boston (3/15- 9/15/2020) to assess outcomes at a cutoff one year into the pandemic (3/15/2021). We also assessed healthcare utilization by analyzing monthly PCP and non-PCP visits, as well as BPs measured, in the year prior to enrollment compared to the study year 3/15/2020 - 3/15/2021.

Results:
651 patients were enrolled and transmitted a home baseline BP during the first week. 475 patients (73%) had sustained hypertension according to home BPs. PCP visits decreased by 50% and non-PCP visits by 40% over this period (both p<0.001.) The weekly mean BP at program baseline was 145/84
+
15/9 mmHg, and at program exit was 135/79
+
15/10 mmHg (p<0.001.) Assessing the 240 patients who completed all follow-up, maintenance BP was 125/73
+
7/7 mmHg (p<0.001.) Control was reached with a mean 2.3 medication titrations. While in the program, patients received an average of 8.2 phone calls/month and recorded 32.4 individual BP measurements monthly.

Conclusions:
While in-person clinical care delivery during the COVID-19 pandemic decreased dramatically, an established remote health delivery program continued to deliver effective BP reduction and achieve clinical targets. Further study is warranted to understand the role remote care can play in hypertension management as we exit the pandemic.
Abstract 13684: The Function Of S100A8 In Human Primary Alveolar Epithelial Cells In Emphysema
Authors: Lin Chih-ru , Bahmed Karim , Criner Gerard , Marchetti Nathaniel , Bolla Sudhir , Kosmider Beata
Published: April 2024

Pulmonary emphysema is characterized by the destruction of alveolar septa and impaired gas exchange. Cigarette smoking induces oxidative stress and is the main risk factor of lung injury and this disease development. There are limited therapeutic strategies for emphysema. Furthermore, cardiovascular diseases are the major cause of mortality in these patients. Alveolar type II (ATII) cells have stem cell potential to self-renew and regenerate the alveolar epithelium after damage. We isolated ATII cells from control nonsmoker and smoker organ donors and patients with emphysema to determine the nuclear role of S100A8. S100A8 is a small protein of 93 amino acids involved in cell growth and cytoprotection. We also used human alveolar epithelial A549 cells treated with cigarette smoke extract. Our results show increased oxidative stress as determined by 4-hydroxynonenal levels in A549 cells. We isolated cytoplasmic and nuclear fractions and observed that this exposure reduced S100A8 protein levels in the nucleus using Western blotting. This corresponded to our data using lung tissue and ATII cells obtained from smokers and emphysema patients. Moreover, we examined S100A8 nucleocytoplasmic shuttling and its stability using proteasome inhibitor and cycloheximide chase assay to determine protein function in the cytoplasm and nucleus in A549 cells. We immunoprecipitated S100A8 in A549 cells exposed to cigarette smoke and detected decreased S100A8 interaction with nuclear proteins by mass spectrometry analysis. We generated a stable A549 cell line with S100A8 knockout using the CRISPR/Cas9 strategy to determine its function. S100A8 ubiquitination and proteasomal degradation were also evaluated in human ATII cells isolated from control non-smokers, smokers, and emphysema. The findings improve our knowledge of the nuclear role of S100A8 in emphysema pathophysiology.
Abstract 13689: The Center-Volume Effect on Congenital Heart Surgery Revised: Is It Time to Consider Regionalization of Care?
Authors: Zmora Rachel , Knight Jessica , Thomas Amanda S , Bass John , St Louis James , Spector Logan , Kochilas Lazaros
Published: April 2024

Introduction:
Regionalization of congenital heart surgery (CHS) has been debated in the U.S. and other countries. Previous reports demonstrated a variable effect of a center’s volume on in-hospital postoperative mortality. However, the volume-outcome relationship for CHS remains incompletely understood without considering outcomes beyond hospital discharge.

Hypothesis:
We sought to determine, whether procedure-specific center volume predicts postoperative mortality for infants undergoing three complex benchmark procedures (Norwood procedure, arterial switch operation and complete atrioventricular canal repair) and used ventricular septal defect (VSD) closure as a simple benchmark procedure comparison.

Methods:
We used data from the Pediatric Cardiac Care Consortium, a multi-center U.S.-based clinical registry of CHS, enriched with post-discharge death data after linkage with the National Death Index. We used generalized estimating equations to assess the association between procedure-specific volume and mortality from the time of CHS and up to three years after CHS. Models were adjusted for patient age and weight at CHS, presence of a chromosomal abnormality, and surgical era and accounted for clustering at the center-level.

Results:
Analysis included 6,656 infants operated at 42 centers between 1982 and 2003. We found an absolute reduction in post-operative risk of death ranging from 6-12% for every additional surgery performed in the same center for Norwood, ASO, and CAVC repair and at all time points examined (Table). There was no statistically significant association between VSD center volume and mortality at any time point.

Conclusions:
In-hospital and longer-term survival after infantile CHS is improved with increased center case volume for complex CHS. These findings support the regionalization of complex CHS in the U.S.. Decision-makers should consider feasibility of such regionalization to improve outcomes after complex CHS.
Abstract 13693: Tachyarrhythmias in COVID-19 Patients Admitted to the Intensive Care Unit
Authors: Mughal Mohsin , Kaur Ikwinder , Mazzaferro Natale , Ghani Ali , Gandhi Haresh , Greenberg Patricia , Sirpal Vishaka , Khakwani Muhammad , Shah Ajay , Levitt Howard , Alam Mahboob , Mar Philip L , Waxman Sergio
Published: April 2024

Introduction:
The SARS-CoV-2 infection has been associated with new-onset arrhythmias. New-onset tachyarrhythmias including atrial fibrillation, atrial flutter, and ventricular tachycardias (VT) have been reported from different retrospective studies. It is proposed that new-onset arrhythmias are likely associated with systemic illness, and not only triggered by SARS-CoV-2 infection.

Hypothesis:
We hypothesized that patients who were admitted to the ICU/CCU level of care were more likely to have new-onset tachyarrhythmias vs hospitalized patients who were not admitted to the ICU/CCU.

Methods:
This is a multi-center retrospective study. The RT-PCR confirmed adult COVID-19 patients consecutively admitted from March 1st to April 30, 2020, were included. Demographic characteristics, comorbidities, and the onset of new arrhythmias were manually extracted from EMR. Categorical variables are shown in percentages; continuous variables are shown in mean (SD). Data were extracted manually using the hospital’s electronic medical record. Categorical variables were compared using the chi-square test; continuous variables were compared using the t-test (with equal variance assumption). P-value <0.05 was considered significant.

Results:
A total of 720 patients were admitted to the hospital. Of these, 11% had new-onset tachyarrhythmias. The onset of new tachyarrhythmias was significantly high in patients who were admitted to ICU/CCU vs non-ICU setting (p-value, <0.001). 13% of patients admitted to ICU/CCU developed new-onset atrial fibrillation vs 7% in the non-ICU setting. 1.5% developed new-onset atrial flutter in ICU/CCU setting vs 1% in the non-ICU setting. Incidence of VT and VF were also higher in ICU/CCU settings. Table1

Conclusions:
Patients who were hospitalized with COVID-19 and received ICU/CCU level care were more likely to develop new-onset tachyarrhythmias.
Abstract 13695: Neighborhood Perception is Associated With Physical Activity and Nutrition Self-Efficacy Among African Americans: The Washington, DC Cardiovascular Health and Needs Assessment
Authors: Osei Baah Foster , Neally Sam , Mitchell Valerie , Wallen Gwenyth R , Powell-wiley Tiffany
Published: April 2024

Background:
Although environmental factors influence cardiovascular (CV) health behaviors, like physical activity (PA) and nutrition, relationships between neighborhood environment (NE) perception and self-efficacy related to these health behaviors is unclear.

Methods:
We explored associations between NE perception and self-efficacy for performing nutrition and PA behaviors aimed at weight loss in the Washington DC CV Health and Needs Assessment, a community-engaged CV health evaluation in lower-resourced DC areas. Participants completed the PA and Nutrition Self-Efficacy (PANSE) scale (higher score=greater self-efficacy) and validated NE perception questions about violence, physical/social environment, social cohesion, and safety (higher scores=more favorable perception). Linear regression models were performed to assess relationships between each neighborhood perception construct and self-efficacy, adjusting for covariates.

Results:
Participants (N=78) were African Americans (AA), predominantly women (84.6%), with an age range=23-84 (mean 59.5, SD±12.1) years. Perceived neighborhood violence, physical/social environment, social cohesion, and neighborhood safety were significantly and positively associated with self-efficacy (Table 1). After adjusting for socio-demographics, neighborhood violence and safety remained significantly associated with self-efficacy, where more favorable perceptions about violence and safety associated with greater self-efficacy. Perceptions of physical/social environment were marginally associated with self-efficacy.

Conclusion:
Favorable NE perceptions about violence and safety are associated with increased self-efficacy for performing PA and nutrition behaviors aimed at weight loss. Interventions and public health policies tailored for improving NE perceptions may enhance self-efficacy for nutrition and PA behaviors aimed at weight loss in AAs.
Abstract 13696: Temporal Trends In Chads2 And Cha2ds2vasc Comorbidities And Association With Outcomes In Atrial Fibrillation Patients Presenting With Acute Ischemic Stroke And Transient Ischemic Attack
Authors: Hanumanthu Balaram J , Rana Yesha , Sharma Apurva , Vargas Pelaez Alvaro , Misra Deepika
Published: April 2024

Introduction:
CHADSVASc and CHADS scores, developed early in the last decade, are used to predict risk of acute ischemic strokes and transient ischemic attacks(CVA/TIA) in Atrial fibrillation(Afib)

Hypothesis:
We wanted to study temporal trends of these scores and association with mortality and morbidity (defined as discharge to facility apart from home or to home with services).

Methods:
Admissions with CVA/TIA in Afib were identified using DRG codes from 2008 to 2017 from the National Inpatient Sample. Comorbidities were identified using ICD codes (ICD9 2008-2015 quarter3 and ICD10 from 2015 quarter 4-2017).

Results:
Total 66,280 admissions were identified. Mean CHADS and Mean CHADSVASC scores increased over time (4.01 ± 0.8) to (4.19 ± 0.8) and (5.88 ± 1.3) to (6.02 ± 1.3) in 2008 to 2017 respectively (p trend<0.001). Prevalence of heart failure, hypertension, diabetes and peripheral vascular disease increased significantly whereas mean age, proportion of patients ≥75 and female decreased significantly across the years (p trend for all<0.001). Inpatient mortality rates increased over the years (2.69 vs 2.90%) (p trend<0.001). Higher CHADSVASC score and CHADS score were independently associated with mortality (OR1.35,p<0.001;OR1.32,p<0.001 respectively), discharge to a facility apart from home(OR1.26,p<0.001;OR1.30,p<0.001 respectively) or to home with services (OR1.30,p<0.001;1.33,p<0.001 respectively).

Conclusions:
We found that CHADSVASC/CHADS scores increased, with an increase in the prevalence of all risk actors except age and female gender from 2007 to 2018. High scores correlated with mortality and morbidity in these younger patients.
Abstract 13697: Predictors of Prolonged Hospitalization (>48 Hours) and In-Hospital Mortality Among the Patients Admitted With Acute Pulmonary Embolism
Authors: Desai Parth V , Akhtar Tauseef , Patel Axi , Shah Parth , De Sirkar Sovik , Walsh Kevin , Krepostman Nicolas , Collins Matthew , Fareed Jawed , Darki Amir
Published: April 2024

Introduction:
Prolonged hospitalization leads to worse outcomes in patients admitted with acute pulmonary embolism (PE). However, there is a scarcity of data regarding the factors predisposing to prolonged hospitalization in such patients.

Hypothesis:
We aimed to identify the factors associated with the prolonged hospitalization and in-hospital mortality among patients admitted with acute PE.

Methods:
We identified all adults admitted with the primary diagnosis of acute PE from the National Inpatient Sample database (2017). We divided all the admissions into three cohorts based on their hospital length of stay (LOS) — short (sLOS) within 48 hours, medium (mLOS) 3-5 days, and extended (eLOS) >5 days. More than 48 hours of stay was considered prolonged hospitalization. Variables related to patient and hospital-related characteristics were analyzed using logistic regression.

Results:
A total of 1,87,770 patients (71,215 with sLOS, 72,755 with mLOS, and 43,800 with eLOS) with mean age of 60, 64 and 65 years respectively (p<0.001) were included in the study. Cohorts with mLOS and eLOS had a higher prevalence of females (53% both vs 49%, p<0.001). In multivariate analysis, patients with increasing age, non-white race, tobacco smoking, obesity, associated upper limb and lower limb deep vein thrombosis (DVT), insulin-dependent diabetes, systemic steroids use, recent falls, dementia, and prior chronic respiratory diseases were found to be associated with prolonged hospitalization. Similar factors were also the independent predictors of in-hospital mortality. Interestingly, in-hospital mortality was higher among sLOS (3.8%) and eLOS (4%) compared to mLOS (1.6%).

Conclusions:
Our study identifies factors independently associated with prolonged hospitalization and in-hospital mortality among patients admitted with acute PE. Knowledge of these factors could aid in treatment strategies and discharge planning.
Abstract 13709: TRPV4 Enhances Ca
2+
Transients and Promotes Arrhythmic Ca
2+
Signaling Following Hypoosmotic Stress and Ischemia-Reperfusion
Authors: Peana Deborah , Domeier Timothy
Published: April 2024

Introduction:
Transient Receptor Potential Vanilloid 4 (TRPV4) is an osmotically activated Ca
2+
channel which enhances cardiomyocyte Ca
2+
cycling and may contribute to arrhythmic Ca
2+
signals in hypoosmotic stress and Ischemia-Reperfusion (I/R).

Hypothesis:
TRPV4 overexpression enhances Ca
2+
transient (CaT) amplitude and arrhythmic Ca
2+
events in left ventricular (LV) cardiomyocytes exposed to hypoosmotic stress and Langendorff hearts following I/R.

Methods:
Mouse LV cardiomyocytes from TRPV4 Overexpressors (OEX) and non-transgenic controls (CTL) were exposed to hypoosmotic stress (250 mOsm, 30min). CaT amplitude (paced 0.5 Hz) and arrhythmic Ca
2+
events (prolonged kinetics, spontaneous CaT, Ca
2+
waves) were monitored
via
confocal imaging (fluo-4, 100Hz). I/R (45min global ischemia, 30min reperfusion) experiments were conducted in OEX and CTL Langendorff hearts expressing the GCaMP6f Ca
2+
sensor (OEX-GCaMP, CTL-GCaMP). CaT and arrhythmic Ca
2+
signals (Ca
2+
waves, alternans, Ca
2+
overload) were monitored in the LV myocardium. Experiments were conducted in the absence and presence of TRPV4 inhibition by HC067047 (HC, 1uM).

Results:
Incidence of arrhythmic Ca
2+
signals during minutes 0-15 of hypoosmotic stress was increased in OEX cardiomyocytes
vs
CTL (78
vs
20%, P<0.05, N=9, 5) and prevented in OEX by HC (11%, P<0.05, N=9). Arrhythmia score was increased in OEX
vs
CTL (1.3±0.7 vs. 0.1±0.1, P<0.05, N=9, 5) and decreased in OEX by HC (0.2±0.2, P<0.05, N=9). Following hypoosmotic stress, CaT amplitude was elevated in OEX
vs
CTL (F/F
0
= 3.6±0.4
vs
2.1±0.4, P<0.05, N=7, 4) and this effect in OEX was prevented by HC (F/F
0
=2.4±0.4, P<0.05, N=8). Langendorff OEX-GCaMP hearts subjected to I/R demonstrated increased systolic Ca
2+
(F/F
0
=1.8±0.09
vs
1.3±0.1, P<0.05, N=5, 6) during minutes 10-30 of reperfusion, which was attenuated by HC (F/F
0
=1.4±0.08, P<0.05, N=4). OEX-GCaMP hearts were more likely to demonstrate arrhythmic Ca
2+
signals during minutes 15-30 of reperfusion than CTL-GCaMP (27/487
vs
0/415 cells, p<0.05 N=5, 6) and this effect in OEX-GCaMP was prevented by HC (0/633 cells, p<0.05, N=4).

Conclusions:
TRPV4 activation enhances Ca
2+
transients and promotes arrhythmic Ca
2+
signals, and may provide a novel anti-arrhythmic target in I/R.
Abstract 13710: Long-Term Survival After Stroke Hospitalisations in Australia and New Zealand, 2008-2017: A Population-Based Cohort Study
Authors: Peng Yang , Ngo Linh , Ranasinghe Isuru
Published: April 2024

Introduction:
There is a paucity of national data on the long-term survival after stroke in Australia and New Zealand. We assessed survival up to 10 years, and factors associated with survival, following a stroke hospitalisation.

Methods:
We included all adults with the first stroke hospitalisation in the study period at all public and most private hospitals in Australia and New Zealand during 2008-2017. All-cause mortality up to December 31, 2017 were assessed by linking to regional death registries. Incidence rates of mortality and hazard ratios (HRs) were calculated.

Results:
313,162 patients were included (mean ± SD age 73.0 ± 14.6 y, 52.0% were male) with ischemic stroke (175,547, 56.1%) is the most prevalent type, followed by haemorrhagic stroke (77,940, 24.9%) and unspecified stroke (59,675, 19.1%). Of these patients, 140,751 (44.9%) died in the follow-up period. The overall survival probability was 79.5% at 3 months, 73.0% at 1 year, 52.8% at 5 years and 38.8% at 9 years. The incidence rate of all-cause mortality declined with time post-stroke, from 986.6 per 1,000 person-years within 3 months to 76.7 per 1,000 person-years in 5-10 years. In the multivariable analysis, a haemorrhagic stroke (HR, 2.00; 95% confidence interval (CI), 1.97-2.03) and older age (85 years or older vs 18-54 years: aHR, 7.21; 95% CI, 7.00-7.42) was associated with a poorer prognosis. A history of congestive heart failure (aHR, 1.49; 95% CI, 1.46-1.52), acute coronary syndrome (aHR, 1.04; 95% CI, 1.01-1.07), vascular disease (aHR, 1.20; 95% CI, 1.17-1.24), and several non-cardiac conditions could also increase the mortality risk.

Conclusions:
Only 38.8% of stroke patients in Australia and New Zealand could survive over 9 years since their first stroke hospitalisations. Risk of death is especially high for the first few months after stroke. Further efforts are needed for those with increased risk of deaths.
Abstract 13716: Significance of Time in Use of Manual Thrombus Aspiration in Patients Undergoing Primary PCI for Achieving TIMI 3 Flow
Authors: KUMAR DILEEP , Saghir Tahir , Sial Jawaid , Hussain Afzal , Ahmed Khan Kamran , KHATTI SHAHZAD , Yasin Umamah , Qamar Nadeem
Published: April 2024

Background:
Primary percutaneous intervention is a life-saving procedure to open the occluded coronary artery. Most of these patients have either total occlusion of artery or have high thrombus burden.Therefore, timely use of thrombus aspiration catheters have a significant importance in terms of morbidity and mortality.

Purpose:
To assess the effect of timing of manual thrombus aspiration in patients undergoing Primary PCI on post procedure TIMI 3 Flow and in hospital outcomes of a tertiary care hospital.

Methods:
In this prospective observational study, patients with acute STEMI who underwent primary PCI and have totally occluded coronary artery (TIMI 0 flow) after passing the wire were selected. Time from the onset of chest pain to the use of export catheters (Export time) was calculated in these patients and subsequently in-hospital outcome was monitored.

Results:
251 patients were enrolled Cut off value for optimal timing of thrombus aspiration was determined to be 315 minutes with a sensitivity of 68% and specificity of 50%. 117 patients reached in 315 minutes in which Export was used, they achieved post procedure TIMI III flow in 87.2% of patients and 75.4% in which Export was used after 315 minutes.

Conclusion:
Export time is a significant parameter that achieved better coronary intervention results in terms of post procedure TIMI III flow with the short Export time. Therefore, timely thrombus aspiration should be done for the maximum benefit.
Abstract 13727: Prediction of Pacemaker Implantation in Patients With Postoperative Heart Block: A Data Analytics Approach
Authors: Duong Son Q , Shi Yuan , Giacone Heather , Navarre Brittany , Gal Dana , Han Brian , Sganga Danielle , Ma Michael , Reddy Charitha , Shin Andrew , Dubin Anne M , Scheinker David , Algaze Claudia
Published: April 2024

Introduction:
Current guidelines recommend observation for AV node recovery until postoperative days (POD) 7 to 10 for patients with complete heart block (CHB) after congenital cardiac surgery prior to permanent pacemaker (PPM) placement. We created a predictive tool to identify patients at high risk of requiring PPM before POD 7 to aid in surgical decision making.

Methods:
Postoperative CHB cases from August 2009 to January 2019 were identified. We collected demographic, anatomic, and surgical details. Random forest, logistic regression, and decision tree models were trained and evaluated using 5-fold cross validation, then prospectively validated on data from January 2019 to April 2021. Separate models were developed for all patients on POD 0 and those without recovery on POD 4.

Results:
Of 101 cases of CHB (22 in validation cohort), 60 (59%) required PPM. Median days [IQR] to AVN recovery was 3 [1-7] and PPM was 10 [7-13]. A decision tree model was used for its performance and interpretability, and included: (1) aortic valve replacement, subaortic stenosis repair, or Konno incision; (2) ventricular L-loop; (3) atrioventricular valve replacement; (4) use of preoperative antiarrhythmic agent (in POD 0 model only; figure 1). The POD 4 model (table 1) had a positive predictive value (PPV) of 0.94 [95% CI 0.81-0.98], which was stable in prospective validation (PPV 1.0).

Conclusions:
Our decision tool identified patients requiring PPM with high specificity and PPV. On POD 4, patients with left ventricular outflow tract repair, AV valve replacement, or ventricular L-Looping could be considered for PPM placement before POD 7 to reduce risks of temporary pacing and improve care efficiency.
Abstract 13729: Monotherapy With a P2Y12 Inhibitor versus Aspirin for Secondary Prevention of Atherosclerotic Cardiovascular Disease (ASCVD) Events: A Meta-Analysis of Randomized Trials
Authors: Chunawala Zainali , Aggarwal Devika , Bhatia Kirtipal S , jain vardhmaan , Mukherjee Debabrata , Baber Usman , Bangalore Sripal , NAVARESE ELIANO , Levisay Justin p , Mishkel Gregory , Ricciardi Mark , Vaduganathan Muthiah , Furtado Remo , Zelniker Thomas A , Qamar Arman
Published: April 2024

Background:
Aspirin is the most frequently used antiplatelet monotherapy for secondary prevention in patients with established ASCVD. Trials comparing monotherapy with a P2Y12i versus aspirin have shown variable results.

Methods:
Medline, Embase, & Cochrane Central databases were searched to identify RCTs comparing monotherapy with a P2Y12i versus aspirin for secondary prevention in patients with established ASCVD (ischemic stroke, coronary, or peripheral artery disease). The primary outcome of interest was major adverse cardiac events (MACE). Secondary outcomes were myocardial infarction (MI), stroke, all-cause mortality, & major bleeding. The DerSimonian and Laird random-effects model was used to calculate risk ratios (RR) & the corresponding 95% confidence interval (CI). Heterogeneity among studies was assessed using the Higgins I
2
value.

Results:
9 eligible RCTs (5 with clopidogrel & 4 with ticagrelor) with 62,336 patients were included in our analyses. Monotherapy with P2Y12i significantly reduced the risk of MACE by 11% (0.89, 95% CI 0.84 - 0.95, I
2
=0), & MI by 19% (0.81, 95% CI 0.71 - 0.92, I
2
=0) as compared with aspirin monotherapy (Figure). There was no significant difference in the risk of stroke (0.85, 95% CI 0.73-1.01), & all-cause mortality (1.01, 95% CI 0.92 - 1.11) between the 2 treatment groups. There was no significant difference in the risk of major bleeding with P2Y12i monotherapy as compared with aspirin (0.97, 95% CI 0.66 - 1.43, I
2
=0). Results were consistent irrespective of the P2Y12i.

Conclusion:
P2Y12i monotherapy is associated with a significant reduction in atherothrombotic events as compared with aspirin alone without an increased risk of major bleeding.
Abstract 13740: QT Interval-Prolonging Drugs May Influence Risk for Sudden Cardiac Death in Patients With Chronic Obstructive Pulmonary Disease
Authors: Leitner Oliver , Chugh Nanki , Bloomfield Sol , Uy-Evanado Audrey , Chugh Sumeet S , Reinier Kyndaron
Published: April 2024

Background:
QT-prolonging drugs have been shown to increase risk of sudden cardiac death (SCD). Here we aimed to identify comorbidities that may influence risk for SCD when taking specific types of QT-prolonging drugs.

Methods:
From the ongoing Oregon Sudden Unexpected Death Study (ORESUDS), we identified individuals with SCD and geographically-matched control subjects (2002 – 2016) with pre-arrest medical history and data on current medication use (at the time of arrest for cases). QT prolonging drugs were categorized according to the four risk categories defined by crediblemeds.com (referred to as A (Known risk), B (Possible risk), C (Conditional risk), and D (Risk of TdP in congenital LQTS).

We utilized multivariable logistic regression models with backwards stepwise selection to identify significant comorbidities and QT risk categories or drug types associated with SCD. Models were adjusted for age, sex, history of MI, diabetes, congestive heart failure, hypertension, renal insufficiency, history of epilepsy, chronic obstructive pulmonary disease (COPD), and asthma. We evaluated two-way interactions between QT drugs and comorbidities.

Results:
A total of 2,813 cases (64% male, mean age 67 years) and 1,547 controls (66% male, mean age 65 years) were included. After variable selection, COPD, among other clinical profile variables, was significantly associated with SCD (OR 3.00, 95% CI 1.99 to 4.64). QT type D drugs were negatively associated with SCD (OR .39, 95% CI .30 to .50), whereas type A drugs were associated with significantly increased risk of SCD (OR 1.48, 95% CI 1.17 to 1.89).

Two interactions between COPD and QT drug classes were observed. In one, the negative association of type D drugs with SCD was significantly attenuated in patients with COPD due to a positive interaction (interaction OR 1.90, 95% CI 1.19 to 3.04, p = .007). In the other, a stronger positive association with SCD was observed in patients with COPD taking type A drugs but not type D drugs (interaction OR 2.25, 95% CI .85 to 7.78, p = .14).

Conclusion:
These findings suggest the need for careful assessment of risk vs. benefit while considering QT-prolonging agents in patients with COPD. Further investigation is needed on the potential contribution of these agents on risk of SCD in COPD.
Abstract 13756: The Hematopoietic and Megakaryocytic Protective Effect of PDGF-BB on Radiation-Induced Myelosuppression Model
Authors: Kong Huimin , Li Liang , Chen Hui , zhao xiaocheng , zhang hua , Su Weiqing , Luo Yi , Yang Mo
Published: April 2024

Introduction:
Platelet-derived growth factors (PDGF) was initially purified from platelets and characterized as a mitogen for fibroblasts and smooth muscle cells. The PDGF family comprises four different genes that form at least five different dimers, including PDGF-AA, AB, BB, CC and DD. In the hematopoietic system, genetic studies have reported that knock-out mice for PDGF-BB show anemia and thrombocytopenia. PDGF also stimulates the proliferation of megakaryocytes, erythrocytes, leukocytes, and their progenitors, and enhances the expansion of megakaryocyte progenitors from human CD34+ cells.

Methods:
Blood counts, bone marrow histology, and CFU were performed to investigate the protective effect of PDGF-BB on mice bone marrow hematopoiesis. Flow cytometry was used to detect early apoptosis (Annexin V), mitochondrial membrane potential (JC-1) and Caspase-3 of Meg-01.

Results:
Peripheral blood count showed that PDGF stimulated the recovery of white blood cells and platelets on radiation-induced myelosuppression model (P<0.01, n=4). Bone marrow histology showed that the numbers of megakaryocytes and their progenitor cells were higher than that in PDGF-BB group. PDGF-BB significantly stimulated the formation of CFU-MK, CFU-GM, BFU-E and CFU-F (P<0.01, n=4). PDGF-BB had a dose-dependent effect on cell proliferation in the range of 5-50 μg/mL in vitro (P<0.001, n=4). Late apoptotic and necrotic cells (Annexin V +, PI +) and total dead cells (Annexin V +) were decreased in the PDGF-BB (50 μg/ml) group (P<0.01, n=4). The mitochondrial membrane potential in the PDGF-BB group was increased when compared with control group, which indicated that the number of apoptotic cells was decreased (P<0.01, n=4). Besides, the expression of Caspase-3 in PDGF-BB treatment group was also lower than that in control group (P<0.05, n=4).

Conclusions:
PDGF-BB has a hematopoietic protective effect on the myelopoietic mice model, especially on megakaryocytes and their progenitor cells. It has proliferative and anti-apoptotic effects on Meg-01, and the mechanism may be mediated through JC-1 and Caspase-3 pathway.
Abstract 13774: Comparison of His Bundle Pacing and Bi-Ventricular Pacing in Heart Failure Patients With Atrial Fibrillation Who Need Atrial-Ventricular Node Ablation: The ALTERNATIVE Study
Authors: Huang Weijian , Su Lan , Wang Songjie , Wu Shengjie , Zheng Rujie
Published: April 2024

Introduction:
Cardiac resynchronization therapy typically is attempted with biventricular pacing (BVP). As an alternative to BVP, his bundle pacing (HBP) can maintain electrical and mechanical synchrony in patients with atrial fibrillation (AF) and atrioventricular node ablation (AVNA). However, there is still a lack of prospective randomized studies to compare BVP and HBP.

Hypothesis:
For patients with heart failure (HF) and AF who need AVNA, HBP is not inferior to traditional BVP.

Methods:
ALTERNATIVE is a prospective multicenter randomized single blind crossover study. Fifty consecutive AF patients who received BVP or HBP in conjunction with AVNA between March 2016 and February 2019 were enrolled in 6 centers. Patients were implanted with a right apical pacing lead, left ventricular lead, and HBP lead. After successful implant, patients were randomized in single patient-blinded fashion to either HBP or BVP. After 9 months, patients were crossed over to the other pacing modality and followed for another 9 months. Pacing parameters, echocardiographic measurements were obtained at baseline and at each follow-up.

Results:
Fifty patients were enrolled from 6 centers in this study. 25 received BVP and 25 HBP at first stage. Thirty-eight patients completed the crossover analysis at 18 months. LVEF were significantly improved for both pacing modes compared with baseline (30.93±7.27% vs. 51.29±10.79%, p<0.001 in HBP; 33.43±9.40% vs. 51.94±10.97%, p<0.001 in BVP). HBP was superior to BVP in terms of post-implant QRS duration (103.33±12.00 ms vs. 132.42±15.25 ms). Moreover, HBP can lead to greater improvement in cardiac function than BVP (p<0.001 in LVEDd; p<0.001 in LVEF).

Conclusions:
HBP can be used as a favorable alternative to BVP in patients with HF and AF after AVNA whose QRS complex is less than 120 ms. Further long-term and large studies are warranted to compare the outcomes between HBP and BVP.