bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 14203: Speckle Tracking Analysis During Dobutamine Stress Echocardiography in Patients Undergoing Percutaneous Coronary Intervention for Chronic Total Occlusion
Authors: Onishi Toshinari , Iwakura Katsuomi , Tanaka Kota , Koyama Yasushi , Iwamoto Mutsumi , Watanabe Satoshi , Yamasaki Keita , Tanaka Koji , Hirao Yuko , Tanaka Nobuaki , Sumiyoshi Akinori , Kawahira Masatsugu , Watanabe Heitaro , Okamura Atsunori
Published: December 2023

Background:
Dobutamine stress echocardiography (DSE) is often used as a non-invasive diagnostic modality for detection of myocardial ischemia and viability. A “biphasic response” in DSE can occur, in which contractility improves in dysfunctional segments with low dose stage and then becomes dysfunctional again at higher doses due to ischemia. We investigated if speckle tracking analysis during DSE can evaluate patients undergoing percutaneous coronary intervention (PCI) for chronic total occlusion (CTO).

Methods:
DSE was performed one day before CTO-PCI in consecutive 30 patients (18 female, age=71±11 years). Since 27 patients had 1 vessel, and 3 patients had 2 vessel CTO lesions, total of 33 regions were analyzed. Global (GLS) and regional longitudinal strain (RLS) were calculated as an averaged value of peak longitudinal strain in the apical 4-, 2-chamber, and long axis views at baseline echo, at low-dose, at high-dose DSE, and 6 months after CTO-PCI using available software (QLAB, Philips Medical Systems).

Results:
CTO-PCI was successfully done in all patients. GLS and RLS were feasible in all regions. Overall, GLS (-15.5±2.8 at baseline v.s. -17.3±3.8, p<0.001) and left ventricular ejection fraction (LVEF) (56±6% v.s. 58±7%, p<0.01) significantly improved 6 months after CTO-PCI. There was also significant improvement of RLS for the obstructed CTO regions (-13.8±3.6 v.s. -16.5±4.2, p<0.005). Although in 24 patients (26 regions) with biphasic response during DSE (Figure), GLS (-15.7±2.5 v.s. -17.9±3.6, p<0.01), LVEF (54±6% v.s. 56±7%, p<0.05), and RLS (-13.8±3.5 v.s. -16.8±4.0, p<0.01) improved significantly, GLS (-14.9±4.2 v.s. -15.8±5.0, p=n.s.), LVEF (59±3% v.s. 60±3%, p=n.s.), and RLS (-13.9±4.5 v.s. -15.5±5.7, p=n.s.) didn’t change in 6 patients (7 regions) without biphasic response.

Conclusion:
Speckle tracking analysis is feasible during DSE. CTO-PCI may improve both global and regional cardiac functions in patients with myocardial viability.
Abstract 14208: New Artificial Intelligence Algorithms of Electrocardiogram Detection for Patients With Heart Failure
Authors: Park Youngjun , Kim Kyung Geun , Joo Sunghoon , Chang Mineok , Lee Yeha
Published: December 2023

Introduction:
Heart failure (HF) is a global pandemic with an increasing prevalence. The burden of HF-related hospitalizations and costs are increasing. Artificial intelligence(AI) algorithms applied to electrocardiograms have shown promise in diagnosing HF, but they require a large amount of training data, which is scarce and costly. Transfer learning addresses this challenge by utilizing knowledge from previous tasks, resulting in superior performance with limited data compared to conventional AI algorithms

Hypothesis:
AI algorithms using transfer learning can be accurately diagnose heart failure with reduced ejection fraction(HFrEF) using electrocardiograms compared to conventional AI algorithms.

Methods:
All patients aged 18 years older from the two hospitals with at least one ECG were included in the study. Electrocardiogram, transthoracic Echocardiogram (TTE), and demographic data were collected. The AI algorithm consisted of two phases: conventional AI algorithms, pre-training with a large-scale ECG dataset and transfer learning for HFrEF detection. Performance evaluation was conducted using various metrics, including AUROC, sensitivity, specificity, accuracy, F1 score.

Results:
The dataset consisted of 687,911 ECGs from 259,943 patients. Testing the conventional model on the HFrEF resulted in a sensitivity of 63.8%, specificity of 96.2%, accuracy of 93.6%, area under the receiver operating curve (AUC) of 0.93 (95% CI, 0.92 - 0.94), and F1 score of 61.6%. Testing the transfer learning model on the HFrEF increased the sensitivity of 75.1%, accuracy of 93.7%, area under the receiver operating curve (AUC) of 0.952 (95% CI, 0.93 - 0.96), and F1 score of 65.6%. but lowered the specificity of 95.3%

Conclusions:
A New AI-enabled ECG algorithm for identifying patients with HFrEF can be more accurately diagnosed than conventional AL algorithms.
Abstract 14220: Establishing Dosing Parameters for the Use of Maternal Hyperoxygenation to Affect Fetal Cardiovascular Physiology
Authors: Kaplinski Michelle , Tandel Megha D , Weng Yingjie , Phillips Aaron , Thorson Kelly , Stauffer Katie Jo , Tacy Theresa , Maskatia Shiraz A
Published: December 2023

Introduction:
Maternal hyperoxygenation (MH) has been used to aid in the prognosis of fetal abnormalities. No data exist on the dose-response relationship or washout time of short-term MH administration related to fetal cardiovascular effects.

Hypothesis:
There may be a dose-response to MH with effect on pulmonary vascular resistance as measured by pulmonary artery pulsatility index (PAPI) and combined cardiac output (CCO).

Aims:
The aims of this study were: to determine the appropriate MH dose to obtain a physiologic response (i.e. decrease in PAPI), to evaluate the change in CCO, and to identify the washout period.

Methods:
Expectant mothers with normal fetal echocardiograms were prospectively recruited from 3/2019 to 6/2023. A research echocardiogram with MH was performed after 31 weeks gestation. Fetal cardiac abnormalities and other comorbidities were excluded. Patients were randomly assigned to either; 2 liters (L) nasal cannula (NC), 4L NC or 8L facemask, all at 100% Fi0
2
. Measurements of PAPI and CCO were performed at baseline, at 1 minute (min) and at 5 min intervals to 20 mins. The same time points were repeated off oxygen. Differences in PAPI were compared between doses and between time points using a mixed effects model.

Results:
We recruited 29 patients at a mean gestational age of 32.9 (± 0.9 weeks). On oxygen, there was a statistically significant decrease in the PAPI at 8L (-0.18 per min, 95% CI -0.32, -0.05), with the largest decrease occurring between baseline and 5 mins, and PAPI stabilizing after 10 mins (figure). During the washout period, starting at 1 min off oxygen, PAPI values normalized, with no statistically significant changes with 2L, 4L or 8L compared to baseline. No effect on CCO was seen from MH administration.

Conclusions:
An oxygen dose of 8L is needed for an appropriate PAPI response, with the largest effect occurring before 10 mins. After oxygen is removed, PAPI values normalize by one min. Changes in CCO were not seen with MH in this normal population.
Abstract 14234: Fast Track Use of PCSK9i in Acute Coronary Syndromes in Real World Practice. Insights From the AT-TARGET-IT Registry
Authors: Basile Christian , Gargiulo Paola , Marzano Federica , Catalano Angelo , Musumeci Giuseppe , Galasso Gennaro , Ciccone Marco M , CALABRO' PAOLO , muscoli saverio , VARBELLA FERDINANDO , Merlini Piera Angelica , De Luca Leonardo , Indolfi Ciro , Crisci Mario , Brunetti Natale D , Porto Italo , Paloscia Leonardo , Paolillo Stefania , Perrone Filardi Pasquale F
Published: December 2023

Introduction:
In patients with recent acute coronary syndrome (ACS), PCSK9 inhibitors (PCSK9i), alirocumab and evolocumab, intensively decrease LDL-C and determine reduction of ischemic events. Yet, scant data are available on the initiation of PCSK9i in ACS patients in real-world setting.

Aim:
AT-TARGET-IT is an Italian multicenter prospective phase 4 registry involving 23 centers, designed to assess efficacy, safety and adherence of PCSK9i, as well as clinician’s behavior on lipid lowering therapies (LLT) in patients at very high CV risk. Aim of the current analysis is to report efficacy and safety in patients suffering ACS who received early prescription of PCSK9i during hospital stay, according to national reimbursement rules.

Methods:
From March 2020 through May 2023, we enrolled patients receiving PCSK9i as part of their optimal medical therapy. Clinical, laboratory and demographic characteristics and concomitant therapies were recorded at the time of first prescription and in subsequent follow-up.

Results:
We report 405 patients (22% female, age 61 years, 60% chronic coronary syndromes). Median LDL-C was 142 mg/dL at hospital admission, reached 45 mg/dL at first control (time 37 days, 67% reduction, 97 mg/dl absolute reduction) and remained unchanged at latest lipid control (time 11 months, 66% reduction, 94 mg/dl absolute reduction). Of 405 patients enrolled, 252 patients (62%) were receiving LLT at time of hospital admission, of them 91 (36%) were on ezetimibe, 48 (19%) on statin and 113 (45%) were on a statin and ezetimibe combination. LDL-C target according to the ESC guidelines was reached in 272 patients (67%), with differences based on LLT (Figure 1-A). Also LDL-C percentage reduction was influenced by background LLT (Figure 1-B). No serious adverse reactions were reported.

Conclusions:
Early PCSK9i administration effectively reduces LDL-C in ACS patients in the real-world setting. However, concomitant LLT is needed to optimize early LDL.values.
Abstract 14252: Redefining the Blanking Period After Cryoballoon Ablation for Atrial Fibrillation: From Korean Cryoballoon Ablation Registry
Authors: park jinsun , Cha Myung-Jin , Kwon Chang Hee , Oh Il-young , Lee Sung Ho , Park Junbeom , Yang Pil-sung , Shim Jaemin , Lim Hong Euy , Lee So Ryoung , Kim Ki-Hun , KIM JUN HYUNG
Published: December 2023

Background:
Early recurrence (ER) of atrial arrhythmia in blanking period (<3 months) after radiofrequency ablation for atrial fibrillation (AF) has been considered as benign episode. Recently, there were controversies of long-term outcome of ER in radiofrequency ablation. the evidences of long-term impact of ER in cryoballoon ablation was still lacking.

Hypothesis:
There would be a significant impact of ER in patients with cryoballoon ablation on late recurrence of atrial tachyarrhythmia. Thus, this study sought to evaluate long-term outcome according to presence and timing (<1 month, 1-2 months, 2-3 months) of ER after cryoballoon ablation.

Methods:
Using the data from a multicenter registry of cryoballoon ablation for AF in Korea between May 01, 2018, and June 30, 2022, we identified 2,654 eligible patients. The primary outcome was late recurrence of atrial tachyarrhythmia including atrial fibrillation, atrial flutter, or atrial tachycardia longer than 30 seconds, excluding a blanking period of 3 months. A multivariable Cox proportional hazard model was performed to evaluate the impact of ER for late recurrence of AF.

Results:
Among 2,654 patients, 763 (28.7%) patients experienced ER of atrial arrhythmia after cryoballoon ablation. During mean follow-up periods (21.2 ± 10.3 months) after 3-month blanking period, 874 (32.9%) patients developed late recurrence of atrial arrhythmia. The 1-year freedom from late recurrence were 85.5% in patients without ER, 44.1% in those with ER <1 month, 32.4% in those with ER of 2-3 month, and 39.0% in those of ER with 2-3 month, respectively (
p
= 0.0001). In multivariable Cox proportional hazard model, ER was significantly associated with late recurrence (hazard ratio: 3.98; 95% confidence intervals: 3.47-4.57) (
p
= 0.001).

Conclusion:
Anytime ER after cryoballoon ablation is a significant predictor of late recurrence of atrial arrhythmia.
Abstract 14266: Is the Association Between Coronary Artery Disease and Adverse Brain Health Causal? A Combined Observational and Mendelian Randomisation Study
Authors: Topriceanu Constantin-Cristian , Hussain Resham , Dale Caroline , Park Chloe M , Chaturvedi Nishi , FATEMIFAR Ghazaleh , Garfield Victoria
Published: December 2023

Introduction:
Although coronary artery disease (CAD) is associated with worse brain health in observational studies, whether this is causal remains elusive.

Aim:
To examine observational associations between CAD and brain health, and use Mendelian randomisation (MR) to test for causal relationships.

Methods:
472,120 UK Biobank participants were included. Outcomes were divided into brain morphology (white matter hyperintensity volumes [WMHVs] and hippocampal volumes [HVs]) and cognitive outcomes (reaction times [RTs] and visual memory [VM]). Generalized linear models were employed to explore the association between CAD and these brain health outcomes after adjusting for demographics, cardiometabolic risk factors and medications. To determine whether the observed associations were causal, we fitted MR inverse-variance weighted models, alongside sensitivity analyses for horizontal pleiotropy.

Results:
Observational analyses showed that CAD participants had 1.8% (95% confidence interval [CI] =[1.5, 2.0]) longer (worse) RTs but this was attenuated to 1% after adjusting for antihypertensives, diabetes or lipid-lowering drugs; 15.9% [7.0, 25.8] greater WMHVs but this was attenuated to the null after controlling for cardiometabolic risk factors; and 1.7% [1.0, 2.5] lower HVs (1% after adjusting for antihypertensives). There was no association between CAD and VM. MR analyses showed that individuals with greater CAD genetic liability made 1.01% [1.00, 1.01] more errors on VM tests but there was no evidence of causal associations with RTs, WMHVs and HVs.

Conclusion:
Observational analyses showed that CAD was associated with worse brain health, and addressing cardiometabolic risk factors was beneficial. However, MR analyses suggested a causal association only between genetic liability to CAD and worse VM. Future research should explore non-cardiometabolic factors (e.g., glutamate toxicity) to reduce cognitive impairment risk in individuals with CAD.
Abstract 14276: Using Artificial Intelligence and Natural Language Processing on Electronic Health Records of Heart Failure Patients to Examine the Impact of Estimated Glomerular Filtration Rate Trend on Mortality
Authors: Beles Monika , Moya Ana , Oeste Clara L. , Masuy Imke , verstreken sofie , Dierckx Riet , Heggermont Ward , Bartunek Jozef , Hens Dries , Vanderheyden Marc
Published: December 2023

Introduction and Hypothesis:
Heart failure (HF) often leads to an imbalance between heart and kidney function, with a poor prognosis in HF patients linked to dynamic changes in renal function as well as chronic kidney disease (CKD). This study aimed to determine the incidence of reduced renal function upon HF diagnosis and to explore the potential for dynamic changes in kidney function to predict short- and long-term outcomes in a real-world cohort of HF patients.

Methods:
Clinical data of patients with a diagnosis of HF (index event) were gathered retrospectively using natural language processing. Patients were classified as having CKD based on their eGFR (<60 mL/min/1.73m2) and a history of CKD and/or dialysis. eGFR trajectories were analyzed using linear mixed effects models. Cox proportional hazard models were used to analyze the relationship between baseline variables and mortality. Joint modeling was employed to assess the relationship between the eGFR trend and mortality.

Results:
There were 1986 patients in the study population, with a mean (SD) age of 74.8 ± 11.7 years and 58% of males. At the index event, 58% (n = 1156) had CKD, and 17% (n = 339) had HF with preserved ejection fraction (HFpEF). Median follow-up was 3.16 years. After 2 years, 10% (n = 198) of the patients had passed away. The proportion of CKD at index was considerably lower in the 2-year survivors group (55% vs 76%, p < 0.001) in this group. The calculated mean annual eGFR reduction was 4.2 mL/min/1.73m
2
. Age, CVA, diastolic blood pressure, hemoglobin, HDL, potassium, and NT-proBNP levels in blood serum were found to be the primary predictors of mortality in multivariate Cox PH model. Joint modeling revealed that a current eGFR value that was 10 mL/min/1.73m
2
lower between patients corresponded with a higher mortality hazard of 1.22 ± 0.05 (p < 0.001). In addition, a drop in eGFR of 10 mL/min/1.73m
2
over the previous year showed an the elevated mortality hazard of 1.97 ± 0.16 (p < 0.001).

Conclusions:
We show that the prevalence of CKD is significant in a real-world population of HF patients, and CKD is a standalone predictor of mortality. Current eGFR value and the eGFR slope from the previous year have a potential to be used for individual mortality hazard assessment in the clinical follow-up of HF patients.
Abstract 14281: Association of Sleep Apnea Prevalence and Severity With H
2
FPEF Score and Echocardiographic Markers of Heart Failure With Preserved Ejection Fraction
Authors: Connolly John E , Genuardi Michael V , Mora Jorge I , Prenner Stuart B
Published: December 2023

Background:
While heart failure with preserved ejection fraction (HFpEF) is highly associated with the presence of sleep apnea, few studies have examined the association between diagnostic scoring systems used to predict HFpEF risk, such as the H
2
FPEF score, and OSA prevalence and severity.

Methods:
We performed a retrospective chart review on all patients (N = 434) who underwent both an echocardiogram and a sleep study at the University of Pennsylvania between July 1, 2020, and June 30, 2022. Associations between echocardiographic parameters and OSA severity, as well as between H
2
FPEF score and OSA severity, were examined using linear tests of trend. The association between H
2
FPEF score categorization and odds of prevalent OSA was examined with logistic regression.

Results:
OSA severity was associated with echocardiographic markers of diastolic dysfunction including greater LV mass index (p = 0.04), left atrial volume index (p = 0.03), and LV relative thickness (p = 0.008). Patients with intermediate H
2
FPEF risk scores had 4.3 times greater odds of prevalent OSA compared with those patients with low risk H
2
FPEF scores (95% CI 2.2, 8.7, p < 0.001). Patients with high H2FPEF risk scores had over 17-fold higher odds of prevalent OSA compared to those with low-risk scores (17.7, 95% CI 4.3, 120.7, p < 0.001) (Figure 1). Increasing risk of HFpEF according to H
2
FPEF categorization was strongly correlated with OSA severity as measured by apnea-hypopnea index (p < 0.001) and oxygen desaturation index (p = 0.002).

Conclusions:
In an ambulatory population referred for both sleep study and echocardiogram, markers of diastolic dysfunction were associated with OSA severity. OSA prevalence and severity were strongly associated with increased H
2
FPEF scores. Clinicians should have a low threshold for referring OSA patients with dyspnea for cardiac workup, as well as a low threshold for referring HFpEF patients for sleep study.
Abstract 14286: Rapid Involution of a Bioprosthetic Transcatheter Aortic Valve Replacement Presenting as Late Bioprosthetic Stenosis
Authors: Dixit Shiv , Shirani Jamshid , Field Patrick
Published: December 2023

A 65 year old male with a bioprosthetic 29 mm Edwards Sapien Ultra S3 TAVR implant for symptomatic severe aortic stenosis presented for evaluation after a 30-day transthoracic echocardiogram demonstrated bioprosthetic valve stenosis. Following TAVR deployment, TEE showed normal bioprosthetic valve function without evidence of significant paravalvular regurgitation. There were no procedural complications. Echocardiogram performed 1-day post-implantation demonstrated expected transvalvular gradients and valve area. The patient reported immediate symptomatic improvement following TAVR. At 30 days post-implant, TTE demonstrated a peak velocity of 3.37 m/s, mean gradient of 29 mmHg, dimensionless index of 0.29, and effective valve orifice area of 0.9 cm2. This was associated with a progressive decline in exercise capacity. At 57 days post-implant, TEE showed tissue growth of the aortic root anterior to the valve stent, causing deformation and under-expansion of the valve architecture from a circular to an ovoid shape. Notably, the bioprosthetic leaflets did not appear thickened or calcified, but exhibited restricted motion as a result of the abnormal valve architecture. Peak velocity had further increased to 4.6 m/s, with a mean gradient of 57 mmHg, dimensionless index of 0.21, and calculated effective orifice area of 0.52 cm2. Bioprosthetic aortic valve valve stenosis is an expected complication of valve replacement, though typically characterized by progressive leaflet calcification and pannus formation over several years or by valve thrombosis. Here, we present a rare case of rapidly progressive bioprosthetic TAVR stenosis identified at 30 days post-implantation after normal morphology and gradients on immediate and 1-day imaging. Stenosis was characterized by a process of tissue growth anterior to the stent with involution and underexpansion of the stent architecture and morphologically normal leaflet tissue.
Abstract 14287: Real-World Healthcare Resource Utilization Among Patients With Hypertension or Congestive Heart Failure and Comorbid Alcohol Use Disorder
Authors: Grebla Regina , Strand Lauren , Zhou Summera Qiheng , Zhao Xin , Keshishian Allison , McClain Monica
Published: December 2023

Introduction:
Excessive alcohol consumption has been associated with increased risk of cardiovascular (CV) disease. Hypertension (HTN) is a known risk factor for CV disease, in general, including congestive heart failure (CHF). Healthcare resource utilization (HRU) and costs associated with comorbid alcohol use disorder (AUD) among patients with HTN or CHF were evaluated.

Methods:
This retrospective cohort study identified adults with moderate-to-severe AUD from patients with ≥1 inpatient, or ≥2 outpatient claims on separate days, for HTN or CHF (MarketScan® and Medicare [1/1/2016-12/31/2020], Medicaid [1/1/2016-12/31/2019] databases), and ≥1 year of continuous healthcare enrollment prior to diagnosis (baseline) and 3 months after. Monthly HRU and costs were compared between propensity-score matched patients based on AUD presence using rate ratios in generalized linear models.

Results:
Of 4,015,785 patients with HTN, 1% were diagnosed with AUD. Use of HTN pharmacotherapy was similar for all patients, except for less frequent use of angiotensin receptor blockers (ARBs) in those with AUD. HTN patients with comorbid AUD had a higher risk of inpatient visits (89%), ED visits (39%), longer inpatient stays (98%), and outpatient visits (9%) relative to non-AUD patients. Of 294,892 patients with CHF, 2% had comorbid AUD. CHF pharmacotherapy use was similar for all patients, except for less frequent ARB use in those with AUD. CHF with comorbid AUD had a higher risk of inpatient visits (31%), ED visits (25%), and longer inpatient stays (34%) relative to non-AUD patients. Outpatient visits were 5% lower in CHF patients with AUD. AUD was associated with higher acute care costs, fewer pharmacy claims, and lower pharmacy costs in both HTN and CHF cohorts. Patients with AUD in both cohorts were more likely to be younger, male, enrolled in Medicaid, with a higher comorbidity burden.

Conclusion:
In this real-world study, the presence of AUD in patients with either HTN or CHF was associated with greater comorbidity burden, higher acute care utilization and costs, and lower outpatient pharmacy utilization relative to patients without AUD. These findings suggest that AUD impacts care for both HTN and CHF, which could be an opportunity for improved screening and treatment.
Abstract 14300: Biomarkers of Myocardial Injury, but Not Systemic Inflammation, Predict the Risk of Incident Ventricular Arrhythmia
Authors: Riveland Egil , Sourur Nur , Naesgaard Patrycja , Kjekshus Harald , Larsen Alf Inge , Rosjo Helge , Omland Torbjorn , Myhre Peder L
Published: December 2023

Background:
Cardiac troponins and biomarkers of inflammation are elevated in heart failure (HF) and predict cardiovascular risk. Whether these biomarkers associate with risk of ventricular arrhythmias (VA) is unclear.

Purpose:
To assess whether cardiac Troponin T (cTnT), growth differentiation factor 15 (GDF-15), interleukin-6 (IL-6), and C-reactive protein (CRP) concentrations are associated with incident VA.

Methods:
In a prospective, observational study of patients treated with implantable cardioverter defibrillator (ICD), cTnT, GDF-15, IL-6, and CRP were measured at baseline and after 1.4±0.5y, and associated with ICD-detected incident VA, HF hospitalizations and mortality.

Results:
We included 489 patients, aged 66±12y and 83% were men. Median (quartile 1-3) concentrations of cTnT were 15 (9-25) ng/L at inclusion, and higher concentrations were associated with higher age, male sex, diabetes mellitus, coronary artery disease (CAD), and HF. During 3.1±0.7y follow-up, 137 (28%) patients had ≥1 VA. cTnT concentrations were associated with an increased VA risk (HR 1.63 [95% CI 1.31-2.01] per log-unit, p<0.001), also after adjustment for age, sex, BMI, CAD, HF, renal function, and LVEF (p<0.001). GDF-15, IL-6, and CRP concentrations were not associated with incident VA, but all (including cTnT) were associated with HF hospitalization and mortality. Changes in cTnT, GDF-15, IL-6, and CRP from baseline to 1.4y were not associated with subsequent VA.

Conclusions:
Higher concentrations of cTnT, GDF-15, IL-6, and CRP associate with HF hospitalization and death, but only cTnT predicts incident VA. These findings suggest that myocardial injury rather than inflammation may play a pathophysiological role in VA and sudden cardiac death.
Abstract 14305: Experiences of Racism and Risk of Preeclampsia: Results From the Black Women’s Health Study
Authors: Ogunwole Michelle , Bertrand Kimberly A , Palmer Julie R , Bennett Wendy L , Zeng Yong , Jennings Jacky M , Boyer Theresa , Amoah Akua , Thorpe Roland J
Published: December 2023

Introduction:
In the United States (US) Black women have higher rates of preeclampsia than White women, which contributes to cardiovascular disease disparities. Differences in traditional cardiometabolic risk factors do not fully explain this disparity, and there is growing consensus that experiences of racism may be a root cause. Few studies have evaluated associations between racism and preeclampsia, and none have done so among a cohort of exclusively Black women.

Research Question:
Are daily and institutional racism associated with preeclampsia among Black women?

Methods:
We analyzed data from the Black Women’s Health Study, a follow-up study of approximately 59,000 US Black women beginning in 1995. We included 5,315 women who were nulliparous at baseline and had their first pregnancy between 1995 and 2009. Racism was measured as a total daily racism score (reported as daily exposure to interpersonal racism) and an institutional racism score (reported as ever treated unfairly due to race with respect to police, housing, or job). We used unadjusted and adjusted (age at first birth, total gravidity, baseline education attainment, health insurance, smoking, alcohol use, and Body Mass Index) logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for preeclampsia in quartiles of daily racism and domains of institutional racism. A sensitivity analysis examined associations for women with only one birth.

Results:
Among 5,315 participants, 9.2% had preeclampsia. [BK1] Compared to women in the lowest quartile of exposure to daily racism, those in the highest quartile had 53% increased odds of preeclampsia (adjusted OR 1.53; 95% CI 1.14, 2.05). Compared to women with no history of institutional racism, the ORs for preeclampsia in women who experienced institutional racism in two or three domains were 1.37 (95% CI 1.04, 1.80) and 1.27 (95% CI 0.085,1.86), respectively. Results were similar among women with only one birth: compared to the lowest quartile, women in the highest quartile of daily racism had an 89% higher risk (adjusted OR 1.89; 95% CI 1.31, 2.75).

Conclusion:
Racism is associated with an increased risk of preeclampsia in US Black women and may contribute to their disproportionately high prevalence of preeclampsia.
Abstract 14306: Immune Function Assay by Race/Ethnicity Within the First Year After Heart Transplantation
Authors: Ghoreshi Kayvon , Truby Lauren K , Grodin Justin L , Garg Sonia , Farr Maryjane , Hendren Nicholas
Published: December 2023

Introduction:
The immune function assay (IFA) is used in transplant recipients to measure the degree of lymphocyte-mediated cell immunity. Values <225 ng/mL are associated with an increased risk of infection and it is uncertain if race/ethnicity associates with differences in IFA values after heart transplantation. We tested the association between ethnicity/race with IFA results for heart transplant recipients for the first year after transplantation.

Methods:
A single-center cohort study of consecutive heart transplant recipients from 1/1/2014-8/31/2022 with an IFA obtained within 30-days prior to heart transplant and
>
1 assay within the first year afterwards. We described the change of IFA in 90-day increments by self-reported race/ethnicity. Multivariable logistic regression models tested the association of patient-level clinical factors (age, sex, race, ethnicity, BMI, creatinine) with IFA values <225 ng/mL.

Results:
In the cohort, (121/315) (38%) had an IFA within 30-days prior to heart transplant. Most patients were white (46%), and male (74%). All groups had decreases in IFA value post-transplant. White non-Hispanic patients had changes of -64, -131, -143, and -107 in IFA, respectively. White Hispanic patients had changes of -117, -119, -58, and -72. Asian patients had changes of -250, -241, -102, and -260. Black patients had changes of -95, -87, -118, and -113. Black patients had the greatest prevalence of an immune assay <225 ng/mL during days 270-360 after transplantation. White non-Hispanic, White Hispanic, and Asian patients had the greatest prevalence of an IFA <225 ng/mL 90-180 days after transplantation. In our adjusted models, race was not associated with IFA values <225 ng/mL during any quarter within the first year after transplant (P >0.05).

Conclusion:
In this small study, non-white heart transplant patients on average had lower IFA values over the first-year post-transplant compared with white non-hispanic patients.
Abstract 14315: Does Gender Moderate the Effect of Virtual Cognitive Behavioral Therapy Interventions on Depressive Symptoms in Rural Cardiac Patients? Preliminary Analysis of the Combat Study
Authors: Thompson Jessica H , Chung Misook L , Feltner Frances J , Mudd Martin Gia , Biddle Martha J , Miller Jennifer , Rayens Mary Kay , Lennie Terry , Wu Jia Rong , Okoli Chizimuzo , Fisher Mary Beth , Moser Debra K
Published: December 2023

Background:
Depressive symptoms are common in patients with coronary heart disease (CHD) and heart failure (HF) living in rural areas and are associated with worse health outcomes. Cognitive behavioral therapy (CBT) can effectively improve depressive symptoms in patients with CHD and HF, however, traditional CBT is not accessible to most rural individuals, and some, particularly males, may be reluctant to participate in traditional CBT even if available. Therefore, we developed and tested two types of virtual CBT, video conferences with a therapist (vCBT) and self-directed CBT (iCBT). Aim: To determine whether gender moderated the effect of vcCBT or iCBT interventions on depressive symptoms in rural people with CHD and HF.

Methods:
This is a preliminary analysis of 4-month outcomes in an ongoing 12-month randomized comparative effectiveness trial. Depressive symptoms were measured by the Patient Health Questionnaire-9 (PHQ-9). Gender was self-identified. Participants with at least mild depressive symptoms were enrolled. Participants were randomly assigned to either a 6-8 week vcCBT or iCBT without a face-to-face therapist. Repeated measures ANOVA was performed to determine whether gender interacted with either intervention to produce an effect on depressive symptoms at 4-months compared with baseline.

Results:
Participants (N=143) were on average 57 years old, 51% female, and 99.3 % non-Hispanic. At baseline, mean PHQ-9 score for males was 10 ± 5 and 12 ± 5 for females (p-value=0.002). Both intervention groups had a significant decrease in depressive symptoms over time (p<0.001 for group by time interaction). There was no between-group difference in improvement of depressive symptoms (p=0.415). There was no moderating interaction of gender by intervention group on depressive symptoms (p=0.502).

Conclusion:
Both interventions resulted in a significant decrease in depressive symptoms. The lack of a gender moderating effect demonstrates that both interventions were equally effective in males and females.
Abstract 14321: High Sensitivity C-Reactive Protein is Associated With Plaque Vulnerability and Increased Incidence of Adverse Events in Patients With Stable Coronary Disease
Authors: Katamine Masahiro , Minami Yoshiyasu , Nagata Takako , Asakura Kiyoshi , Muramatsu Yusuke , Kinoshita Daisuke , Fujiyoshi Kazuhiro , Ako Junya
Published: December 2023

Introduction:
Higher level of high sensitivity C-reactive protein (hsCRP) is associated with an increased risk of cardiovascular events in patients with coronary artery disease (CAD). However, the pathogenesis of the worse clinical outcomes in CAD patients with high hsCRP remains to be elucidated.

Hypothesis:
Higher hsCRP is associated with a higher prevalence of vulnerable characteristics in coronary plaques and an increased incidence of adverse events in patients with CAD.

Methods:
A total of 793 consecutive patients with stable CAD, who underwent intra coronary optical coherence tomography (OCT) imaging of the culprit vessel during percutaneous coronary intervention were included. Patients were classified into the higher hsCRP group (hsCRP ≥ 0.2 mg/dL, n=247) or the lower hsCRP group (hsCRP < 0.2 mg/dL, n=546). OCT characteristics and clinical outcomes were investigated according to the level of hsCRP.

Results:
The prevalence of thin-cap fibroatheroma (TCFA) (32.0% vs. 20.9%,
p
<0.001) and plaque with macrophage (53.9% vs. 46.2%,
p
=0.045) was significantly higher in the higher hsCRP group than in the lower hsCRP group (Panel A). The incidence of myocardial infarction was significantly higher in the higher hsCRP group than in the lower hsCRP group (log-rank
p
=0.006) during a median 938 days follow-up (Panel B) although the incidence of the composite of major adverse cardiac events was comparable (log-rank
p
=0.282). Among the four groups classified by the hsCRP level and the presence of TCFA, the incidence of myocardial infarction was the highest in the group with higher hsCRP and TCFA (log-rank
p
=0.017).

Conclusions:
Higher level of hsCRP was associated with a higher prevalence of vulnerable characteristics in coronary plaques and worse clinical outcomes in patients with stable CAD. The risk of recurrent myocardial infarction in patients with high hsCRP levels was further increased by the presence of TCFA.
Abstract 14368: FAPI-PET Imaging Detects Anthracycline-Induced Cardiotoxicity Before Echocardiography
Authors: Lee Chul-Hee , Rubinelli Luisa , Manzo Onorina , Jeitner Thomas , Carrasco Sebastian , Babich John , Di Lorenzo Annarita , Kelly James
Published: December 2023

Introduction:
We aimed to validate a PET imaging biomarker for the detection of incipient anthracycline-induced cardiotoxicity. This condition affects >5% of all pediatric cancer patients, leading to long-term health deficits. We hypothesized that fibroblast activation protein (FAP) would be a suitable candidate due to its role in extracellular matrix remodeling and fibrosis during early cardiac injury and the availability of high-affinity PET probes.

Methods:
Cardiotoxicity was established in male C57BL/6J mice by administering a cumulative 24 mg/kg dose of doxorubicin (DOX) intraperitoneally over 2 weeks [1]. The DOX mice were imaged serially with echocardiography and [68Ga]Ga-FAPI-04 PET over 12 weeks and compared to age- and sex-matched controls. Fractional shortening (FS) was determined from the echocardiograms, and cardiac uptake of [68Ga]Ga-FAPI-04 was quantified and expressed as percent injected dose per cubic centimeter (%ID/cm3). Heart tissue samples were collected and used for the analysis of bulk RNA-seq, RT-qPCR, Western blot, in situ hybridization (ISH), and histological staining. Finally, we used the DAVID tools and STRING database to confirm the relationship between PET signal and gene expression.

Results:
DOX mice exhibited decreased body weight (33% by 9 weeks after end-of-treatment) and heart weight-to-tibia length ratio (HW/TL, 39%). Cardiac [
68
Ga]Ga-FAPI-04 PET signal was significantly higher (1.7-fold) in DOX mice from 2 weeks through the study endpoint. By contrast, no cardiac dysfunction was evident by echocardiography until 10 weeks after end-of-treatment, at which point FS was significantly reduced relative to the control group (30%). Transcription and translation of FAP were elevated in the DOX hearts, in agreement with the PET data. In the heatmap generated from the RNA-seq data, genes related to cell adhesion and extracellular remodeling were significantly upregulated in the DOX mice relative to controls. The H-score of FAP ISH was linearly related to the cardiac signal of [
68
Ga]Ga-FAPI-04 PET (p = 0.001).

Conclusions:
FAP is a suitable imaging biomarker for cardiotoxicity and FAPI-PET is a promising tool for identifying patients at risk of cardiotoxicity during or after anthracycline chemotherapy.
Abstract 14455: Impact of Computer-Interpreted ECGs on the Accuracy of Medical Professionals
Authors: Kashou Anthony H , Noseworthy Peter A , Beckman Thomas , Anavekar Nandan S , Cullen Michael W , Angstman Kurt , Sandefur Benjamin , Shapiro Brian P , Wiley Brandon , Kates Andrew , Huneycutt david , Braisted Andrew , Beard John , Kerwin Scott , Young Brian , Rowlandson Ian , Baranchuk Adrian , O'Brien Kevin , Knohl Stephen , May Adam
Published: December 2023

Background:
The impact of computer ECG interpretation (CEI) on medical professionals’ performance is understudied. This study aims to assess the interpretation proficiency of diverse medical professionals with and without access to CEI reports.

Methods:
Medical professionals from diverse backgrounds interpreted 60 12-lead ECGs with urgent and non-urgent findings. The interpretation process involved two interpretation phases: (i) 30 ECGs with clinical statements and (ii) the same 30 ECGs and clinical statements in random order along with a CEI report. Diagnostic performance was evaluated based on interpretation accuracy, time per ECG, and self-reported confidence (rated 0 [not confident], 1 [somewhat confident], or 2 [confident]).

Results:
Among 892 participants, there were 44 (4.9%) primary care physicians, 123 (13.8%) cardiology fellows-in-training, 259 (29.0%) resident physicians, 137 (15.4%) medical students, 56 (6.3%) advanced practice providers, 82 (9.2%) nurses, and 191 (21.4%) allied health professionals. The inclusion of the CEI significantly improved interpretation accuracy by 15.1% (95% CI, 14.3 to 16.0; P<0.001), reduced interpretation time by 52 seconds (95% CI, -56 to -48; P<0.001), and increased confidence by 0.06 (95% CI, 0.03 to 0.09; P=0.003)
(Table 1)
.

Conclusions:
CEI integration improves ECG interpretation accuracy, efficiency, and confidence across medical professionals. Nevertheless, even with CEI, significant gaps in ECG interpretation proficiency remain.
Abstract 14466: Study Protocol: Heart Camp Connect - Promoting Adherence to Exercise in Adults With Heart Failure With Preserved Ejection Fraction
Authors: Alonso Windy W , Bills Sara , Lundgren Scott , Norman Joseph , Keteyian Steven J , Fisher Alfred , Kupzyk Kevin , Zheng Cheng , Wilson Fernando A. , Salahshurian Erin , Pozehl Bunny J
Published: December 2023

Background:
Heart failure with preserved ejection fraction (HFpEF) remains a challenge in cardiovascular care. A chief complaint in adults with HFpEF is fatigue, and regular exercise training is the only treatment shown to routinely improve this symptom. Adherence to exercise recommendations is difficult. We significantly improved 12-month adherence to exercise in adults with persistent HF using an in-person coaching intervention. Secondary analysis of our HFpEF subgroup showed promising long-term exercise adherence. These findings support our recently funded trial to test an intervention delivered in-person vs. virtually to achieve long-term exercise adherence in adults with HFpEF.

Aims:
We will: 1) Evaluate effects of in-person vs. virtual coaching and enhanced usual care on 12- and 18-month exercise adherence, 2) Determine the optimal minutes of moderate-intensity exercise that yields clinically meaningful change in patient-reported outcomes, 3) Evaluate interventional mechanisms and interim clinical events as mediators of adherence behaviors, and (4) Examine the cost of intervention delivery.

Approach:
This multi-site, 3-group randomized controlled trial will recruit 300 adults with stable HFpEF to compare an in-person coaching intervention to a virtual coaching, and both to enhanced usual care (UC). After a run-in period, all participants receive a medical fitness center membership (in-person or virtual) for 18 months and are randomized following a 2-2-1 strategy to in-person coaching and exercise (n=120), virtual coaching and exercise (n=120) or UC virtual exercise only (n=60). The primary outcome is adherence to ≥120 minutes of exercise/week measured using a heart rate monitor at 12 months, with a sustainability endpoint at 18 months. Secondary outcomes include health status, physical function and activity, HFpEF symptoms, and inflammatory biomarkers. Data are collected at baseline, 6, 12, and 18 months.

Conclusions:
Our findings will guide selection of the most efficacious and cost-effective delivery approaches to promote exercise adherence. Identifying active interventional mechanisms and the dose of exercise needed to elicit a response will help to achieve a clinically meaningful change in patient-reported outcomes in HFpEF.
Abstract 14474: Racial Disparities in Arrhythmias Among Patients With Cardiac Sarcoidosis in the United States From 2016-2020
Authors: Hassan Azeem , Ramphul Kamleshun , Ahmed Raheel , Hasan Ali , Farhan Muzammil , Ahmad Hasan , Okafor Joseph , Carver Caleb , Jadoon Ayesha , Amanullah Khadija , Mactaggart Sebastian , Jamil Yumna , Bilal Maham , Ahmed Sajeel , Memon Rahat A , Sakthivel Hemamalini
Published: December 2023

Background:
Cardiac sarcoidosis (CS) is frequently associated with conduction abnormalities and arrhythmias. In this study, we aim to evaluate racial disparities in the frequency of arrhythmias, and associated co-morbidities, among patients with CS.

Methods:
Caucasian and African American (AA) patients with a diagnosis of CS were identified and compared from the 2016-2020 National Inpatient Sample (NIS) database whilst adjusting for confounders via logistic regression models.

Results:
A total of 8825 patients with cardiac sarcoidosis comprising 44.1% Caucasian and 45.8% AA patients were included. Both cohorts had a male preponderance (Caucasian males: 64.3% vs. AA males 55.2%, p<0.01). AA patients had a longer mean length of stay (7.74 vs. 6.64 days, p<0.01), a higher mean Charlson Comorbidity Index score (3.36 vs. 2.63, p<0.01), a greater prevalence of cirrhosis (3.2% vs. 2.1%, p<0.01), diabetes (44.7% vs. 31.2%, p<0.01), alcohol abuse (4.0% vs. 2.2%, p<0.01), smoking (37.4% vs. 26.8%, p<0.01), obesity (31.1% vs. 27.9%, p<0.01) and chronic kidney disease (40% vs. 28.1%, p<0.01). Caucasian patients had a greater history of hypertension (17.1% vs. 14.5%, p<0.01) and prior percutaneous coronary intervention (6.2% vs. 3.1%, p<0.01). Moreover, AA patients had a lower incidence of various cardiac arrhythmias (vs. Caucasians) such as atrial fibrillation (31.3% vs. 36.2% vs, p<0.01), ventricular tachycardia (29.8% vs. 37.9% p<0.01), ventricular fibrillation (5.3% vs. 7.2%, p<0.01) and complete atrioventricular block (AVB) (6.4% vs. 14.6%, p<0.01). However, a higher incidence of complications such as cardiogenic shock, acute kidney injury and death were reported among AA patients (Table 1).

Conclusion:
Our study demonstrates a higher incidence of cardiac arrhythmias among Caucasian patients but higher complications and mortality among AA patients with cardiac sarcoidosis.

Keywords:
Cardiac sarcoidosis, arrhythmias, racial disparities.
Abstract 14483: Myeloid Cell Derived IL1b Contributes to Pulmonary Vascular Remodeling in Heart Failure With Preserved Ejection Fraction
Authors: Agrawal Vineet , Kropski Jon , Gokey Jason J , Kobeck Elizabeth , Murphy Matthew , Murray Katherine T , Fortune Niki , Moore Christy , Meoli David , Monahan Ken , Su Yan Ru , Blackwell Thomas , Gupta Deepak K , Talati Megha , Gladson Santhi , Carrier Erica J , West James , Hemnes Anna R
Published: December 2023

Introduction:
Pulmonary hypertension (PH) in heart failure with preserved ejection fraction (HFpEF) is a common and highly morbid syndrome, but mechanisms driving PH-HFpEF are poorly understood.

Hypothesis:
We sought to determine whether a well-accepted murine model of HFpEF also displays features of PH, and we sought to identify pathways that might drive early remodeling of the pulmonary vasculature in HFpEF. .

Methods:
Eight-week-old male and female C57BL/6J mice received either L-NAME and high fat diet (HFD) or control water and diet for 2, 5, and 12 weeks. Db/db mice were studied as a second model of HFpEF. Early pathways regulating PH were identified by bulk and single cell RNA sequencing. Findings were confirmed by immunostain in lungs of mice or lung slides from clinically performed autopsies of PH-HFpEF patients. ELISA was used to verify IL1β in mouse lung, mouse plasma, and also human plasma from PH-HFpEF patients obtained at the time of right heart catheterization. Clodronate liposomes and an anti-IL1β antibody were utilized to deplete macrophages and IL1β, respectively, to assess their impact on pulmonary vascular remodeling in HFpEF in mouse models.

Results:
L-NAME/HFD treated mice developed PH, small vessel muscularization, and right heart dysfunction. Inflammation-related gene ontologies were over-represented in bulk RNA sequencing analysis of whole lungs, with an increase in CD68
+
cells in both murine and human PH-HFpEF lungs. Cytokine profiling showed an increase in IL1β in mouse and human plasma. Finally, clodronate liposome treatment in mice prevented PH in L-NAME/HFD treated mice, and IL1β depletion also attenuated PH in L-NAME/HFD treated mice.

Conclusions:
We report a novel model for the study of PH and right heart remodeling in HFpEF, and we identify myeloid cell derived IL1β as an important contributor to PH in HFpEF.