bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 14316: Genetic Cardiomyopathy Heart Transplant Outcomes
Authors: John Sonya , Hong Kimberly
Published: April 2024

Introduction:
Data evaluating heart transplant (HT) outcomes in patients with genetic cardiomyopathies is limited. Cardiac features are prominent in these genetic disorders, resulting in progressive heart failure that may be lethal without cardiac transplantation. However, no single center has accumulated enough experience to investigate post-HT outcomes for these rare cardiomyopathies. The primary aim of this review is to synthesize literature investigating if HT is a viable treatment option for genetic cardiomyopathies including Duchene Muscular dystrophy (DMD), Becker’s (BMD), Limb-Girdle (LGMD), Emery Dreifuss (EDMD); mitochondrial disorders, Friederich’s ataxia (FA), Barth’s disorder and fatty acid oxidation disorders (FAOD).

Methods:
We performed a systematic literature search of PubMed, EMBASE, and Google Scholar identifying studies reporting HT outcomes published up to June 2021.

Results:
A total of 42 articles were selected for review with 118 patients reported. Patient data with age at HT, gender distribution, mean follow-up, reported survival data, and post-operative outcomes are reported in Table 1. Patients with DMD, BMD, LGMD, and EDMD had HT during the second and third decade of life and were reported to have favorable survival outcomes at one and five years. In FA, 11 patients underwent cardiac transplantation at mean age 21.2 years with reported survival of 100% at one and five years. Patients with Barth syndrome received HT at younger ages with mean age 1.6 years. Mortality in these patients as well as mitochondrial disorders were low even with longer reported follow-up time. Cardiac transplants in FAOD were rare with one female receiving HT at the age of 27 months and was reported to be complication-free after 12 years.

Conclusions:
This review suggests that post-transplantation outcomes in genetic cardiomyopathy patients with multisystem involvement are generally favorable, with high survival and few post-operative complications.
Abstract 14318: Sex Differences in Treatment Responses to NP-6A4, a Cardiomyopathy Drug With the FDA Designation, in Heart Disease Induced by Untreated Obesity
Authors: Pulakat Lakshmi , Mahmood Abuzar , Belenchia Anthony , Gavini Madhavi , Liu PIe , Mooney Brian , Tang Yinian , Mehm Alexander , Demarco Vincent G
Published: April 2024

Introduction:
Obesity affects 42% of the US population and exacerbates heart disease. Currently there are no effective treatments for obesity-induced cardiac pathology. We reported that NP-6A4, a peptide agonist of the Angiotensin receptor AT2R mitigates cardiac dysfunction and damage in male rats with untreated obesity. Since cardiac pathology of male and female rats with untreated obesity differ, we hypothesized that there can be differences in their cardiac response to NP-6A4.

Methods and Results:
Echocardiographic analysis was performed in 15-week old male and female healthy Wistar (N=8) or Zucker lean (N=7) rats treated with saline, and obese and pre-diabetic Zucker rats treated with saline or NP-6A4 (1.8-10mg/kg/day in saline) for four weeks (N=8/group for females, N=7/group for males; subcutaneous delivery). Compared to healthy males, obese males showed significant (P<0.05) reduction in heart rate and increase in anterior wall thickness and left ventricular (LV) filling pressure (E/E’) suggesting concentric hypertrophy. Compared to healthy females, obese females showed significant (P<0.05) reduction in relative wall thickness, heart rate, and ejection fraction (although preserved) and increase in LV internal diameter at both diastole and systole indicating eccentric hypertrophy. NP-6A4 treatment suppressed the pathologic changes in both obese males and females (P<0.05). In another cohort of obese female rats NP-6A4 treatment from 13-to 17-weeks significantly (P<0.05) reduced abnormal E/A ratio and isovolumic contraction and relaxation time, and improved myocardial radial strain. Treatment with AT2R antagonist PD123319 (N=8: 5mg/kg/day delivered subcutaneously) abolished NP-6A4 effects. Cardiac proteome analysis of 18 tissue samples from this cohort using data independent acquisition (DIA) resulted in a total proteome of 4520 proteins and 296 differentially expressed proteins that were significant (P<0.01). Ingenuity pathway analysis predicted that inhibition of NP-6A4-mediated signaling by PD123319 may increase infection of cells (P=<0.001).

Conclusion:
NP-6A4 attenuated cardiac pathology induced by untreated obesity by altering different cardiac parameters in male and female rats.
Abstract 14350: Cost Effectiveness Analysis of the HEART Pathway as a Clinical Decision Support Tool for Chest Pain in Emergency Department
Authors: Gilbert Olivia N , Mahler Simon A , Machado Sara , Hanchate Amresh , Lefebvre Cedric
Published: April 2024

Background:
The History Electrocardiogram Age Risk factor Troponin (HEART) Pathway clinical decision support tool was designed to assist emergency department providers with chest pain risk stratification. Prior studies have demonstrated its safety and ability to reduce hospitalizations. However, cost effectiveness data is lacking. We performed a cost effectiveness analysis of the HEART Pathway compared with Standard Care.

Hypothesis:
The value of the HEART Pathway exceeds that of Standard Care as measured by cost effectiveness.

Methods:
A pre-planned economic analysis of the HEART Pathway Implementation Study was conducted. This prospective interrupted time-series accrued adults with possible acute coronary syndrome from 3 sites (11/2013-1/2016). The construct for the current analysis was a 1000-member Cohort (Deterministic) Markov model with two different time periods - one with a cycle length of 30 days run over the course of 1 year and one with a cycle length of 1 year run over the course of 10 years. Transition probabilities were obtained from patient encounter data from the original trial. A smaller subset of patients had direct costs available from the hospital perspective, including resources consumed and professional fees.

Results:
The HEART pathway and Standard Care cohorts included 3713 and 4761 patients with costing data respectively available for 140 and 139 patients. In both the 1-year and 10-year models, the HEART pathway had reduced costs and increased quality adjusted life years (QALYs) compared to Standard Care, making the HEART pathway strongly dominant in terms of cost effectiveness. Accordingly, an incremental cost effectiveness ratio is not defined. From the Markov models, mean cost per patient was projected to be lower for the HEART Pathway compared to Standard Care at 1 year ($6,225.31 versus $8,138.06) and at 10 years ($11,107.00 versus $13,322.76). Also, QALYs for the HEART Pathway were superior to Standard Care at 1 year (10.43 versus 10.20) and 10 years (7.73 versus 7.40).

Conclusions:
Compared to Standard Care, the HEART pathway was strongly dominant in terms of cost effectiveness using Markov modeling with 1-year and 10-year termination points.
Abstract 14357: Increased Left Atrial Volume Index is Associated With Syncope in Hypertrophic Cardiomyopathy Patients
Authors: Martinez Armando R , Silva Enciso Jorge
Published: April 2024

Introduction:
Syncope in hypertrophic cardiomyopathy patients (HCM) is associated with high risk for sudden death, presence of fibrosis and LV structural changes. However, it is unclear if left atrial structural changes associate with syncope. Our aim is to evaluate changes in left atrial volume index (LAVI) and occurrence of syncope in HCM patients.

Methods:
Retrospective study of 123 HCM patients identified at our institution from 2016-2019. Syncope was identified by chart review of ICD codes, past medical history, and keyword search. Left atrial volume index was determined by tracing the LA endocardial border from standard views in two-dimensional echocardiography. HCM subtypes were classified as obstructive (oHCM) and non-obstructive (noHCM).

Results:
A total of 123 patients, 29 (23.6%) had syncope. No difference in age, gender, or BMI was found between those with syncope and without syncope. More ventricular arrhythmic events and stroke events occurred in those with syncope vs. without syncope. LAVI showed a correlation with syncope in HCM patients (p<0.05). Mean LAVI was larger in those with syncope compared to those without syncope (43.8±12.6 mL/m2 vs. 37.7±14.3 mL/m2). Each 1 mL/m2 increase in LAVI corresponded to a 1.03 OR risk for syncope. ROC analysis showed a LAVI threshold of 31.8mL/m2 for predicting syncope in all HCM (sensitivity 89.7%, specificity 40.4%)

Conclusions:
Syncope showed a strong correlation in those with larger LAVI with incremental risk of syncope for each 1 mL/m2 added to LAVI size. Additionally HCM patients with syncope had worse outcomes. Our findings suggest LAVI may have utility as a marker to stratify HCM patients at risk for syncope. Further studies in HCM patients are needed to assess the impact of changes in LAVI size over time on cardiovascular outcomes.
Abstract 14375: Maternal Outcomes in Subsequent Pregnancies After Peripartum Cardiomyopathy
Authors: Jaisingh Keerthish C , Pachariyanon Pavida , Bogabathina Hari , Shi Runhua , Singireddy Sampath , Modi Kalgi A
Published: April 2024

Introduction:
Peripartum cardiomyopathy (PPCM) is a rare cardiomyopathy associated with pregnancy and has a high maternal morbidity and mortality during both index and subsequent pregnancies. Data to help guide women with subsequent pregnancies is sparse. The purpose of this large retrospective study is to perform a comparative analysis of maternal outcomes in women with recovered left ventricular ejection fraction (LVEF) and persistent left ventricular (LV) dysfunction during subsequent pregnancies after PPCM.

Methods:
We identified 46 patients who had a subsequent pregnancy and an echocardiogram prior to their subsequent pregnancy in our registry of 121 patients with PPCM. Data in the registry was gathered by retrospective chart review. LVEF recovery was defined as improvement to >50%. We divided patients into a recovered group (RG) (n=16) and non-recovered group (NRG) (n=30).

Results:
Total maternal mortality among women with PPCM and subsequent pregnancy was 19%. Mortality in the RG was 22% compared to 25% in the NRG. Mortality among African Americans (AA) was 83% when compared to other ethnic groups (17%).

Discussion:
Maternal mortality related to PPCM in the US ranges from 7% to 20%. In our study, we found that the risk of maternal mortality among women who had one or more subsequent pregnancies was 19%. It is well known that women with non-recovered LV function before subsequent pregnancy carries a worse maternal outcome when compared to women who enter the subsequent pregnancy with recovered LV function. Our findings reaffirm this, as we found that mortality rate in the NRG was higher when compared to the RG. Our findings also align with previous studies in that, AA women had a higher mortality rate when compared to other ethnic groups.

Conclusion:
Recovery of LVEF predicts a better prognosis but is not an absolute protection from the risk of mortality and/or recurrent PPCM. Hence close monitoring of LVEF with serial echocardiograms is still indicated during a subsequent pregnancy. African ethnicity carries a worse maternal prognosis.
Abstract 14378: Implantable Cardioverter-Defibrillator Use in Nonischemic Cardiomyopathy - A Bayesian Analysis
Authors: Kim Joonseok , Parcha Vibhu , Li Peng , Brar Vijawant , Han Jingnan , Arora Garima , Arora Pankaj
Published: April 2024

Background:
Prophylactic implantable Cardioverter-Defibrillator (ICD) therapy has been a cornerstone of sudden cardiac death prevention in patients with left ventricular systolic failure. While the benefit of ICD in ischemic cardiomyopathy has been well established, its benefit in nonischemic cardiomyopathy (NICM) is debated.

Methods:
We conducted a post-hoc Bayesian analysis of the DANISH randomized clinical trial (N=1,116) to estimate the probability of clinical benefit of ICD compared with medical therapy (control) to reduce all-cause mortality among participants with NICM and who were not on cardiac resynchronization therapy (N=471). Bayesian modeling was used to ascertain the posterior probability of a reduction in all-cause mortality of ICD compared with medical therapy using 1) a noninformative prior (Beta[1,1] distribution), and 2) using an informative prior (derived from the random-effect meta-analysis comparing ICD versus control in the NICM cohorts of the SCD-HeFT, CAT, and DEFINITE trials, N=1,354).

Results:
Using a noninformative Beta[1,1] prior, Bayesian analysis of the DANISH trial indicates that there is a 74.2% probability of a reduction in all-cause mortality (ARR

[absolute risk reduction]: -2.6% [-10.5 to 5.3%]; RRR [relative risk reduction]: 0.90 [0.67-1.22]) among NICM patients receiving an ICD compared with control. Using an informative prior, Bayesian analysis of the DANISH trial indicates a 99.7% probability of a reduction in all-cause mortality (ARR: -5.2% [-9.0 to -1.4%]; RRR: 0.80 [0.67-0.95]) and a 98.6% probability of an ARR<1% among NICM patients who received an ICD compared with control.

Conclusion:
Using a Bayesian approach, our post-hoc analysis of the DANISH trial provides probabilities of reducing the all-cause mortality in NICM patients using ICD compared with medical therapy.
Abstract 14387: Impact of Bariatric Surgery on Mortality and Heart Failure Readmissions in Heart Failure With Reduced Ejection Fraction
Authors: Patel Harsh P , Thakkar Samarthkumar J , Sheth Aakash , Munshi Rezwan , Victor Varun , Patel Smit , Patel Bhavin , baibhav bipul , Gandhi Alok , Feitell Scott , Parikh Vishal
Published: April 2024

Introduction:
Real-world data on the impact of bariatric surgery in patients with acute heart failure with reduced ejection fraction (HFrEF) is limited.

Hypothesis:
Bariatric surgery in patients with HFrEF is associated with a reduction in mortality and HF readmissions at 1 year.

Methods:
We identified patients with HFrEF that underwent bariatric surgery by analyzing the nationwide readmission database from September 2015 to December 2018 and using the validated ICD-10 CM codes. Propensity score matching was performed to adjust for the confounders. Kaplan Meier curves were utilized for time to event analysis. Cox proportional hazard regression was used to generate hazard ratios. The primary outcome was all-cause mortality at 1 year. Secondary outcomes were readmission due to HF and any other cause at 1 year.

Results:
Out of 348668 patients with HFrEF, 1519 underwent bariatric surgery. After propensity match, we identified 1519 patients with bariatric surgery and 1544 patients without bariatric surgery. At 1 year, there was no significant difference in all-cause mortality between both the groups (4.01% vs. 3.14%, HR: 0.62, 95% CI: 0.31-1.26, p=0.19). Moreover, regarding the secondary outcomes, there was no significant difference in HF readmissions (20.92% vs. 22.16%, HR: 1.06, 95% CI: 0.89-1.25, p=0.48) as well as readmission due to any other cause (46.24% vs. 46.78%, HR: 0.97, CI: 0.87-1.09, p=0.97) among both the groups at 1 year.

Conclusions:
Bariatric surgery in patients with HFrEF did not reduce the mortality, HF readmissions, or readmissions due to any cause at 1 year. We need more data looking at larger sample size, long-term follow-up, and quality of life.
Abstract 14416: The Redox Effect of Stem-Cell Derived Extracellular Vesicles on Normal and Diabetic Human Coronary Artery Endothelial Cells
Authors: Karbasiafshar Catherine , Ahsan Nagib , Blume Corssac Giana , Teixeira Rayane , Sellke Frank W , Abid Ruhul
Published: April 2024

Introduction:
Cardiovascular disease continues to be the leading cause of death globally, necessitating the study of novel therapeutic modalities. Following the lack of success with stem-cell based therapies, their extracellular vesicles (EVs) have emerged as a promising strategy.

Hypothesis:
We hypothesized that EVs will reduce oxidative stress in normal and diabetic human coronary artery endothelial cells (HCAEC).

Methods:
Human bone marrow-derived stem cells (HBMSC) were grown to passage 7 and subject to 24 hours of preconditioning by serum starvation media. EVs were then isolated via ultracentrifugation and submitted for LC-MS/MS for proteomics. Normal HCAEC and diabetic HCAEC (DM-HCAEC) were starved for 12 hours then treated with vehicle (1% DMSO in PBS) or EVs (1x108 particles/ml) for 6 hours. Following treatment, mitochondrial (mito) ROS using mitosox, total ROS using DCF-DA, and protein expression using Western blots were analyzed by 2-way ANOVA with Bonferroni multiple-comparisons correction.

Results:
A total of 473 EV proteins were identified, among which were antioxidants catalase, thioredoxin, peroxiredoxins, SOD1, and ferritin. EV-treatment reduced mito-ROS levels significantly in HCAEC, but not in DM-HCAEC. Basal (ambient) levels of total ROS in DM-HCAEC were significantly higher compared to HCAEC (p=0.0393), however, EV treatment reduced total ROS in both cell types significantly (p=0.002). Western blot analysis revealed that EV increased mitochondrial antioxidant MnSOD (SOD2) levels in HCAEC but not in DM-HCAEC. Catalase expression was unaffected by EV treatment in both cell types.

Conclusions:
EVs displayed differential effects on the mito-ROS, but reduced total ROS in both HCAEC and DM-HCAEC. EV-induced reduction in mito-ROS in non-diabetic HCAEC plausibly resulted from corresponding increase in MnSOD expression. Data from our ongoing studies will be presented at the meeting demonstrating whether the above changes in redox states by EVs correspond to differential proliferation, migration and angiogenesis in HCAEC vs. DM-HCAEC.
Abstract 14422: Molecular Pathogenesis of Cardiac Microthrombi in Fatal Covid-19: Insights from Clinico-histopathologic and Single Nuclei RNA Sequencing Analyses
Authors: Fukuma Nobuaki J , Brener Michael , Hulke Michelle , Fukuma Nobuaki , Golob Stephanie , Zilinyi Robert , Zhou Zhipeng , Tzimas Christos , Russo Ilaria , McGroder Claire , Chong Alexander , Pfeiffer Ryan , Geping Zhang , Uhlemann Anne-Catrin , Moses Jeffrey , Leon Martin , Burkhoff Daniel , Maurer Mathew , Redfors Bjorn , Uriel Nir , Szabolcs Matthias , Marboe Charles C , Baldwin Matthew , Tucker Nathan R
Published: April 2024

Cardiac microthrombi are postulated to underlie cardiac injury in critical COVID-19. To determine pathogenic mechanism(s) of cardiac injury in fatal COVID-19, we conducted a single-center prospective cohort study of 69 consecutive COVID-19 decedents. Microthrombi was the most commonly detected acute cardiac histopathologic feature (n=48, 70%). We tested associations of cardiac microthrombi with biomarkers of inflammation, cardiac injury, and fibrinolysis and with in-hospital antiplatelet therapy, therapeutic anticoagulation, and corticosteroid treatment, while adjusting for multiple clinical factors, including COVID-19 therapies. Higher peak ESR and CRP during hospitalization were independently associated with higher odds of microthrombi (ESR, P
non-linearity
0.015, P
association
=0.008; CRP per 20mg/L increase, OR 1.17, 95%CI 1.00-1.36). Using single nuclei RNA-sequence analysis, we discovered an enrichment of prothrombotic, anti-fibrinolytic, and extracellular matrix signaling amongst cardiac fibroblasts in microthrombi-positive COVID-19 hearts, compared with microthrombi-negative COVID-19 hearts and non-COVID-19 donor hearts. Our cumulative findings identify these specific transcriptomic changes in cardiac fibroblasts as salient features of COVID-19-associated cardiac microthrombi.
Abstract 14423: A Retrospective Analysis of a Single-Center Experience With the Tempo Temporary Pacing Lead in Management of Bradyarrhythmia and Other Cardiac Electrophysiology Procedures
Authors: Stelzer Mitchell , Fu Eugene , Kleman James , Chopra Nagesh , Padmanabhan Sandosh , Kidwell Gregory A , amin anish
Published: April 2024

Introduction:
Acute temporary pacing lead dislodgment may result in cardiac perforation, loss of pacing capture and proarrhythmia by means of under-sensing or mechanical stimulation. We report the results of a single-center retrospective study of the safety and efficacy of the Tempo® Temporary Pacing Lead (BioTrace Medical, Menlo Park, CA), which has a novel active fixation mechanism designed to enhance pacing stability and a soft tip to mitigate perforation.

Methods:
Twelve consecutive patients (83% male, mean age 71.3 ± 10.1 years) who underwent Tempo Lead placement for temporary pacing (75% symptomatic bradyarrhythmia, 25% other indication) were retrospectively reviewed. Safety (including perforation, new pericardial effusion, and sustained device-related arrhythmias) and efficacy (clinically acceptable pacing thresholds with stable pace capture over the temporary implant duration) data were assessed. The study also evaluated post-procedural practices such as ambulation.

Results:
The Tempo Lead was successfully positioned and fixed in the right ventricle in all 12 cases with no perforations, pericardial effusions, or device-related arrhythmias. Access was femoral in 8 patients (67%) and jugular in 3 patients (25%), with one access point not indicated. Procedural mean pace capture threshold (PCT) was 0.96 ± 0.74 mA (n=10). Mean lead indwelling duration was 53.5 hours with a range of 20.9 hours to 5.9 days (n= 11). Three patients were ambulatory (at least bed-to-chair) with the Tempo Lead in place without complications and with maintenance of thresholds <1mA.

Conclusions:
This single-center retrospective analysis demonstrates that the Tempo Lead is safe and effective for temporary pacing and early ambulation in cardiac electrophysiology procedures.
Abstract 14432: Cardiac Arrest Death in the United States, 1999 to 2009
Authors: Venepally Nithin F , Dang Thao , Venepally Nithin R , Sierra Juan G , Jha Govind , Bakhati Bibek , Modi Rangesh
Published: April 2024

Introduction:
Cardiac arrest (CA) remains an important health issue in the United States. Mortality trends of CA death from 1999 to 2018 has been previously published by the American Heart Association. We aim to update the age-specific mortality rates for 2019 and temporal trend in mortality of any-mention cause of CA death from 1999 to 2019. Additionally, we sought to describe the temporal trends of gender and race.

Methods:
The United States statistics mortality data from 1999 to 2019 were analyzed. A retrospective population-based study was conducted through a search within the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database. This was performed using the ICD-10 Codes: I46.0, I46, I46.9 and I49.0. Mortality rate was calculated for all the group of ages. Age-adjusted rate was reported for gender and race, crude rate was stated for age group. Poisson regression was used to calculate incidence rate ratio and analyze the temporal trend. Negative binomial regression was used for over dispersed data.

Results:
We identified 7 435 677 subjects with any-mention of cardiac arrest death from 1999 to 2019. The age-adjusted mortality rate for 1999 was 91.2 compared to 94.7 in 1998. Furthermore, from 1999 to 2019, the trend continues to decrease in CA-related deaths depicted by a gradual decline in the age adjusted mortality rate per year (IRR 0.97 95 % CI 0.95 to 0.99]). Gender age-adjusted mortality rate was higher in males compared to females (126.7 vs 91.3 [IRR 1.39 95 % CI 1.27 to 1.52]). The black/African American population had higher death rates for CA than white (156.9 vs 101.5 [IRR 1.57 95% CI 1.43 to 1.73]) followed by Asian/Pacific Islander (100.5) and American Indian/Alaska Native (80.5).

Conclusions:
In the period between 1999 and 2019, CA age adjusted mortality rate showed a significant gender and racial disparity. The significant difference in death rates among different racial groups warrants additional investigation. The present surveillance data demonstrates a gradual 10-year decline of CA-related mortality. The increased awareness of CA through public health education, social media and bystanders trained, are thought to play an important factor in the decline of CA deaths.
Abstract 14437: Mental Health and Substance Abuse Patterns Within the Adult Congenital Heart Disease Population
Authors: Peterson Louis , Mizrahi Michelle , Well Andrew , Lamari-fisher Alexandra , Johnson Gregory , Patt Hanoch , Mery Carlos M , Fraser Charles D , Beckerman Ziv
Published: April 2024

Background:
With the advancement in medical and surgical care, most children born with congenital heart disease survive into adulthood. The adult congenital heart disease (ACHD) population has increased incidence of mental health disorder (MHD) over the general population (20.6%), which has been shown to negatively impact health outcomes. This study evaluates the prevalence and associations of MHD and substance abuse (SA) in a large, clinic-based ACHD population.

Methods:
Retrospective chart review of ACHD patients from a large congenital cardiology practice. All patients ≥18 years of age at most recent visit were included. SA and MHD were classified if documented in the most recent clinic note or if treated with psychiatric medications. Congenital heart disease (CHD) lesions were classified by the American College of Cardiology/American Heart Association lesion severity score (LSS). Descriptive and univariate analyses were used.

Results:
The study population included 817 patients, 395 (48.3%) females, mean age of 28.0±9.9 years. Of the 817 patients, 27 (3.3%) had documented SA and 173 (21.2%) had MHD. Of those, 62 (35.8%) had only psychiatric medications listed and 56 (32.4%) had only MHD listed. MHD increased with increasing LSS: 14% in LSS1, 34% in LSS3 (p<0.001). SA had a similar increase from 1.3% to 5.7% (p=0.058). The anatomic lesions with the highest prevalence of MHD and SA were: single-ventricle population (39.7%), transposition of the great arteries (31.4%), and tetralogy of Fallot (26.7%) (p<0.001).

Conclusions:
MHD and SA are prevalent in the ACHD population, particularly among the more complex lesions. Given the prevalence and impact on clinical outcomes, more consistent documentation is needed for both MHD and SA. As ACHD patients are recommended to have regular follow-up, this presents an important opportunity for screening, identifying, and providing resources for MHD and SA in this population.
Abstract 14442: The Risk vs. Benefit Calculus of Anticoagulation in Patients With Ibrutinib-Related Atrial Fibrillation
Authors: Patel Ruchi N , Singh Arushi , Akhter Nausheen
Published: April 2024

Introduction:
Ibrutinib increases risk of atrial fibrillation (AF) as well as bleeding from platelet dysfunction. Among patients with ibrutinib-related atrial fibrillation (IRAF), there is no data on embolic or hemorrhagic stroke risk with anticoagulation use, and no specific guidelines regarding anticoagulation given the concern for bleeding risk. We sought to describe rates of stroke, bleeding and anticoagulation use among IRAF patients.

Methods:
We performed a single-center retrospective review of 169 patients who were treated with ibrutinib. Patients were followed from 2013 to 2021 using manual chart review.

Results:
Of 169 patients, 43 developed IRAF (25.4%), 4 developed other SVTs (2.4%), 50 were female (30.0%), 31 had or developed CHF (18.3%), and 112 had or developed HTN (66.3%). Mean age at ibrutinib initiation was 66.0 years. Over a mean follow-up of 4.5 years, 2 IRAF patients developed ischemic or embolic strokes (4.7%), one of whom was on anticoagulation (CHA2DS2-VASc of 7) and 2 developed hemorrhagic stroke (4.7%), one of whom was on anticoagulation (CHA2DS2-VASc of 7). Two IRAF patients developed gastrointestinal bleeding requiring transfusions (4.7%), one of whom was on anticoagulation (CHA2DS2-VASc of 4). Of the 43 IRAF patients, 20 were on anticoagulation (CHA2DS2-VASc range: 1-7), and 7 patients were on antiplatelet therapy, 4 of which were on both anticoagulation and antiplatelet therapies. Table 1 describes CHA2DS2-VASc and HASBLED scores and anticoagulation use across our population.

Conclusions:
In this single-center experience of IRAF, after a 4.5-year follow-up, anticoagulation practices varied among patients across a range of CHA2DS2-VASc and HASBLED scores but there were only 2 embolic or ischemic strokes (4.7%). However, the incidence of major bleeding including hemorrhagic stroke and gastrointestinal bleeding was 9.3% (4/43). The necessity of anticoagulation in the IRAF population needs further study.
Abstract 14447: Increased Autophagy Flux May Underline Cardiomyocyte Remodeling in Atrial Fibrillation
Authors: Zhang Wenwei , Burrell Amy , Geist Elizabeth , Yoo Shin , Knight Bradley P , Passman Rod S , Arora Rishi
Published: April 2024

Atrial fibrillation (AF), the most common progressive tachyarrhythmia, results in structural remodeling that impairs electrical activation of the atria. Studies have shown that mitochondrial dysfunction underlies cardiomyocyte remodeling. Here, we report a 50% reduction in total mitochondrial DNA in the atria tissue of RAP dogs as compared to control dogs, as assessed by qPCR the levels of mitochondrial DNA including mt-NT-1, mt-NT-4, mt-NT 5, mt-NT 6. This reduction in mitochondrial DNA suggests reduced mitochondria number in RAP dogs. Autophagic flux (LC3 II protein levels) was markedly increased in the atria tissue of the AF dog model (vs control dog).Furthermore, we examined autophagy flux in isolated cardiomyocytes. Results showed that LC3II was remarkably activated when subject to electrical stimulation for 6 hours under 3 Hertz condition, suggesting the direct effect of electrical stimulation on increasing autophagy. There was no change in the mRNA levels of autophagosome genes including Belin 1, ATG8, LC3, Lamp1 in the RAP dog tissue as compared to control, however, ATG7 increased by 2 fold and GNG2 increased by 5 fold. In conclusion, our study suggests that electrical stimulation-induced autophagy, and reduced mitochondria number and function, may underlie cardiomyocyte remodeling in AF. Targeting the autophagy pathway may present new therapeutic targets for AF. Ongoing AAV-mediated knockdown experiments in isolated cardiomyocytes will further elucidate the mechanism of electrical stimulation-induced autophagy.
Abstract 14448: National Adherence to Guideline-Directed Medical Management of Aortic Disease
Authors: Patrick William L , Khurshan Fabliha , Bavaria Joseph E , Groeneveld Peter W , Yarlagadda Siddharth , Rosen Jake , Grimm Josua C , Szeto Wilson Y , Desai Nimesh D
Published: April 2024

Introduction:
Guidelines for the medical management of aortic (AD) and coronary artery disease (CAD) recommend treatment for hypertension (HTN), hyperlipidemia (HLD), and tobacco use (TU) (Class 1).

Hypothesis:
Adherence to guidelines for the management of AD is low, and inferior to CAD.

Methods:
Adults in the Clinformatics Data Mart database diagnosed with AD or CAD and concomitant HTN, HLD, and/or TU between 2004 and 2019 were included. Those with less than six months of continuous enrollment or prior cardiovascular procedures were excluded. Adherence was calculated as the proportion of patients with a given comorbidity (or combination thereof) who received a prescription for the appropriate intervention. Any beta-blocker, ACEi, or ARB for HTN. Any statin for HLD. Bupropion, varenicline, or referral to counseling for TU. Composite adherence for patients with AD and CAD was compared using a Z-test. Temporal trends were analyzed using a Chi-square test for trend.

Results:
There were 354,851 patients with AD and 907,997 with CAD who met the inclusion criteria. Composite adherence was 50% for those with AD compared to 59% for CAD (p<0.01). No clinically-significant changes in composite adherence overtime occurred for either group (Figure 1A). Among those with AD, adherence was highest among those with HTN alone (73%), followed by combined HTN/HLD (58%) and HLD alone (45%). Diagnosis of TU was associated with lower adherence across all risk factor combinations. There has been a significant improvement in adherence for TU overtime (p<0.01) (Figure 1B).

Conclusions:
Adherence to guidelines for medical management of AD is low, and significantly lower than for CAD.
Abstract 14467: Machine Learning for Identifying Salient Regions on the Coronary Artery on CT for Radiomic Feature Extraction and Characterization of CAD
Authors: Dhamdhere Rohan , Modanwal Gourav , Madabhushi Anant , Desai Milind Y , Viswanathan Vidya Sankar
Published: April 2024

Introduction:
Radiomics is a quantitative approach that allows for high throughput extraction of image features such as texture. It has been used for characterization of coronary artery disease (CAD). However, the reliability of radiomic features (RFs) varies with the image segmentation quality. We present a new strategy to establish a segmentation confidence map spatially across the coronary arteries in the dataset. We then evaluate the quality of RFs in salient (high confidence) and non-salient (low confidence) regions in the coronary artery.

Purpose:
To identify salient regions in the coronary artery, providing high segmentation certainty as well as a site for informative radiomic feature extraction, useful in CAD characterization.

Methods:
In our approach, we first applied a deep learning-based segmentation model (U-Net with ResNet backbone) to segment the coronary arteries (Fig. 1a). Next, we constructed a mean probability atlas from the segmentation probability maps, using fiducial registration (Fig. 1b). Finally, we identified salient and non-salient regions within the segmentation (Fig. 1c) by masking the mean probability atlas with the predicted segmentation and then thresholding them. Human expert-generated manual segmentation was used as ground truth. RFs—shape (26), first order (19) and second order (75)—were extracted from salient and non-salient regions for comparative correlation analysis with features from ground truth segmentation. A higher correlation implies that these features are equally informative as those from the manual segmentation.

Results:
The model achieved a dice score of 79.8% on the hold-out set. The RFs extracted only from the salient regions (Proximal portion of RCA and LAD) of the coronary artery display strong correlations with RFs extracted from manual segmentations (Fig 1d).

Conclusion:
We present a framework to identify regions for optimal extraction of RFs for improved CAD characterization.
Abstract 6929: Acute Echocardiographic Effects of Exogenous Ketone Administration and Relationship to Myocardial Glucose Uptake on Fdg-pet
Authors: Selvaraj Senthil , Hu Ray , Vidula Mahesh K , Dugyala Supritha , Tierney Ann , Margulies Kenneth B , Ky Bonnie , Shah Svati H , Kelly Daniel P , Bravo Paco E
Published: April 2024

Background:
Interest in therapeutic applications of exogenous ketones has grown significantly, spanning endurance athletes to heart failure (HF) patients. Exogenous ketones engender significant effects on cardiac function in HF and provide an ergogenic benefit in athletes. We sought to assess the effects of exogenous ketones on cardiac function and metabolism in healthy participants.

Methods:
Twenty healthy participants completed echocardiograms before and 30 minutes after administration of ketone ester (KE), followed by FDG-PET imaging. We used mixed effects linear regression to assess the association between regional left ventricular (LV) strain on the post-KE drink echocardiogram with regional myocardial glucose uptake (SUV myocardium/blood pool) on FDG-PET (N=176 myocardial segments).

Results:
Mean age was 307 years, 50% were female, 45% were non-white, and average BMI was 24.33.1 kg/m
2
. Ketone ingestion acutely elevated beta-hydroxybutyrate levels (median, 25
th
-75
th
percentile) from 0.12 (0.10-0.32) to 3.23 (2.40-4.97) mmol/L (p<0.001). After KE consumption, LV/RV/LA function strain all augmented, while systemic vascular resistance decreased (
Figure
). Specifically, LV ejection fraction (3.5±2.1%, p<0.001), global longitudinal strain (2.0±1.5, p<0.001), cardiac output (1.1±0.8 L/min, p<0
.
001), right ventricular S’ velocity (1.1±1.4, p=0.004), LA reservoir strain (7±11%, p=0.005) and LA contractile strain (4±5%, p=0.001) increased. After multivariable regression, each halving of regional glucose uptake was independently associated with a 2.2% increase in regional strain (p=0.016).

Conclusions:
KE ingestion acutely augments even in healthy participants, mirroring many hemodynamic effects seen in HF. The ability of KE to augment myocardial function was directly associated with reducing myocardial glucose uptake, supporting myocardial metabolic modulation as a mechanism of benefit.
Abstract 6933: Mapping the Global Trends of Heart Failure Burden and its Contributing Factors from 1990 to 2019
Authors: Aryan Zahra , Saeedi Moghaddam Sahar , Farzadfar Farshad
Published: April 2024

Introduction:
This study aims to provide global, regional, and national estimates of the trend of heart failure (HF) prevalence and its etiologies.

Methods:
Using the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 methodology, we estimated the prevalence, and disability-adjusted life years (DALYs) because of stage C or D of HF according to AHA/ACC. The prevalence and etiologies of HF were estimated using cause-specific mortality rates from redistribution algorithms for 204 countries and territories, stratified by sex and Socio-demographic Index (SDI) from 1990 to 2019.

Results:
Globally, there were 56.2 million (95% uncertainty interval [UI] 46·5-67·8) prevalent cases of HF in 2019, a +106% (99-114) increase from 1990. Globally, DALY rate of HF increased by +29.4% (27.4 to 31.3), since 1990. The highest burden of HF was observed in high SDI regions including the United States, and China. The leading etiologies of HF were ischemic heart disease (IHD), followed by hypertensive heart disease (HHD), and chronic obstructive pulmonary disease contributed to 265.7 (197.2-346.4), 233.8 (170.5-312.9), and 65.6 (45.3-94.1) prevalent cases per 100,000 population, respectively. Although HF because of IHD is decreasing worldwide, the age-standardized prevalence rate of HF due to IHD has increased in low SDI regions since 1990, by +9% (6 to 12).

Conclusions:
Currently, HF is a big health issue in high SDI regions including the United States and China. The trend of HF prevalence rates and its contributing etiologies supports a transition in epicenter of IHD and subsequently HF epidemic to low SDI regions.
Abstract 6936: American versus Canadian National Funding for Immigrant Cardiovascular Health
Authors: Bedrouni Wassim , Bedrouni Mahdi , HUYNH Thao
Published: April 2024

Introduction:
The high number of immigrants in North America underscores the need for cardiovascular (CV) health and promotion in these racially and ethnically diverse populations. Although some immigrant races/ethnicities have high cardiovascular mortality, it remains unclear whether there are investments in cardiovascular health promotion and prevention for immigrants for both the United States and America. We aimed to compare American and Canadian national investments cardiovascular health promotion and prevention for immigrants.

Methods:
We queried the National Institute of Health (NIH) and the Canadian Institute of Health Research (CIHR) databases from 2006 to 2019 for grants supporting projects in diseases prevention and promotion targeting immigrants. We compiled annual funding and normalized the annual data for the number of immigrants and Gross Domestic Product (GDP). We completed normalized descriptive statistics for comparative analysis and presented funding trends over a 14-year period.

Results:
There were 74 and 50 project grants awarded by the NIH and CIHR, respectively. Between 2007 to 2013, the NIH spent relatively less per immigrant than the CIHR. From 2014 onward, funding trends reversed as the NIH outspent the CIHR. Over the 14-year period, the NIH and the CIHR funded an annual mean of $59.8/1000 immigrants and $79.1/1000 immigrants, respectively.

Conclusion:
Although the number of immigrants is rising, the relative national funding for CV health promotion and prevention in the USA and Canada is generally decreasing over the last 5 years. Absolute CIHR funding is progressively decreasing since 2008, while NIH grant expenditure has demonstrated an overall pattern of increase over the last 14 years. Policymakers should consider more comprehensive investment in CV health promotion and prevention for immigrants.
Abstract 6948: Barriers to Obtaining a Home Aed for Pediatric Patients With Primary Arrhythmia Syndromes
Authors: Dechert-Crooks Brynn E , LaPage Martin J
Published: April 2024

Introduction:
Guidelines for primary arrhythmia syndromes (PAS) recommend the presence of automatic external defibrillator (AED) at least during athletic participation. Studies have shown a cost-effective and life-saving benefit to these patients having a home ED.

Objective:
To evaluate the challenges in obtaining a home AED.

Methods:
A single center retrospective chart review identified pediatric patients with a PAS in which the obtention of an AED was discussed during a clinical evaluation. These families were then surveyed by telephone regarding the method, ease, and challenges of securing a home AED.

Results:
Home AED discussion was documented for 28 patients of which 27 (96%) participated in the survey. Nearly all (25 of 27) attempted to obtain an AED; though only 15 (55%) were ultimately successful. Most, 17/25 (68%) initially attempted via insurance; while 4 purchased independently, 2 received a donated AED, and 2 abandoned due to cost. For patients utilizing insurance, only 7 (41%) were successful, with 5/7 utilizing a 3
rd
party facilitator of insurance approval (LifeSure). LifeSure successfully gained coverage in 5 of 6 (83%) attempted cases. Of the 10 failing to obtain insurance coverage, 6 do not have an AED, 3 self-purchased one, and 1 received a donated AED. On a difficulty scale of 1-5 (1=easy; 5=very challenging), families perceived the mean difficulty score to obtaining an AED through insurance at 3.5 vs. 1.16 for those not attempting insurance. Insurance was viewed as a major barrier (scale score >3) for 9 of the 17 (53%) families attempting to use it. Mean difficulty score when using LifeSure vs. not, was 1.8 vs 4.5. Families able to afford a self-purchased AED perceived minimal challenges, mean scale score 1.5.

Conclusions:
When clinically appropriate, families of pediatric patients with a primary arrhythmia syndrome successfully obtained an AED in about half of cases. Insurance was perceived as a major barrier. Use of a 3
rd
party service to facilitate insurance coverage was highly successful and relatively simple. Though shown to be life-saving and cost-effective, access to home AED is inequitable and disadvantaged by financial and insurance barriers.
Abstract 6970: Extracellular Vesicles Prevent Post-Operative Atrial Fibrillation
Authors: Parent Sandrine , Vaka Venkata Ramana , Risha Yousef , Davis Darryl R
Published: April 2024

Half of patients recovering from cardiac surgery experience a malignant form of atrial fibrillation that results from inflammation in the pericardial space surrounding the heart. Given that post-operative atrial fibrillation (POAF) increases mortality, effective measures to prevent or treat POAF are highly desirable. In this study, we built on previous work to see if extracellular vesicles (EVs) isolated from human atrial explant-derived cell conditioned media can prevent POAF.

Hypothesis:
Human EVs will reduce AF inducibility in a rat model of sterile pericarditis by reducing inflammation and the malignant pro-fibrillatory transformation of atrial fibroblasts.

Methods and Results:
Middle aged female and male Sprague-Dawley rats (6 months old) were randomized to sham operation (n=24; 12 females, 12 males) or induction of sterile pericarditis followed by intra-atrial injection of 10
8
human EVs (n=34; 17 females, 17 males) or vehicle (n=34; 17 females, 17 males). Three days later, all rats underwent invasive electrophysiological testing prior to sacrifice. As expected, pericarditis increased the probability of inducing AF (Figure Panel A). EV treatment reduced the probability of AF. Recipient sex did not alter this effect. Analysis of atrial tissue histology (H&E staining) and lysate (Luminex assays for IL-2, Il-18, MCP-1 and PDGF-AB) revealed that EV treatment abrogated the pro-inflammatory effects of pericarditis. As shown in Panel B, pericarditis increased both atrial fibrosis and mass while EV treatment limited the effect of pericarditis on atrial fibrosis and mass. These effects were attributable to the anti-fibrotic effect of EV treatment on atrial fibroblast proliferation profiled using in-vitro cultures exposed to pro-fibrillatory stimuli (i.e., IL-6 and TGFβ1).

Conclusion:
Intramyocardial injection of EVs at the time of open chest surgery may provide a facile acellular strategy to prevent POAF by reducing inflammation and fibrosis.
Abstract 6993: Electrical Storm in Patients Without an Implantable Cardioverter-Defibrillator is Associated With Higher In-Hospital All-Cause Mortality
Authors: Incognito Cameron , Parker Joshua , Hedley Jeffrey , Menon Venu , Wazni Oussama , Rickard John , Tang Wai Hong
Published: April 2024

Introduction:
Most data regarding electrical storm (ES) is retrospective from implantable cardioverter-defibrillator (ICD) interrogation, little is known about outcomes in those without an ICD.

Objective:
Primary outcomes include all-cause in-hospital and 6-month mortality of ES comparing patients with and without ICDs. Secondary outcomes include in-hospital complications. We hypothesize that ES patients without ICDs will have a worse short term prognosis with higher rates of in-hospital complications.

Methods:
Retrospective single center study including all patients admitted to the coronary ICU with ES between April 2014 - 2020. ES was defined as ≥ 3 isolated sustained ventricular arrhythmias (VA) or ICD therapies within 24 hours.

Results:
Of 214 patients admitted with ES, 37 did not have an ICD. For those with an ICD, the mean time from implantation to ES was 1101.1 ± 928.4 days. Those without ICD were less likely to be male (70.3% vs. 85.9%; p = 0.029), have known coronary artery disease (37.8% vs. 55.9%; p=0.049), or prior VA (5.4% vs. 84.7%; p<0.0001). Those without ICDs had a higher ejection fraction (39% ± 16% vs. 30% ± 12%; p=0.002), lower PAINESD risk score (14.3 ± 7.3 vs. 17.5 ± 6.2; p=0.004), and were more likely to present with out-of-hospital cardiac arrest (43.2% vs. 5.1%; RR 8.5, 95% CI 4.1 - 17.8; p<0.001).

Those without ICDs were more likely to develop complications including SCAI stage D-E cardiogenic shock (RR 2.58, 95% CI 1.9 - 3.5; p<0.001), multiorgan failure (RR 3.78, 95% CI 2.1 - 6.7; p<0.0001), and in-hospital cardiac arrest (RR 4.10, 95% CI 2.7 - 6.2; p<0.0001). Those without ICDs were more likely to have polymorphic ventricular tachycardia (PMVT; 62.2% vs. 23.2%; RR 2.68, 95% CI 1.9 - 3.9; p<0.0001) or ventricular fibrillation (VF; 56.8% vs. 24.9%; RR 2.28, 95% CI 1.6 - 3.3; p=0.0003).

In-hospital all-cause (29.7% vs. 13.0%; RR 2.29, 95% CI 1.2 - 4.3; p=0.023) and VA-induced (27.0% vs. 11.3%; RR 2.39, 95% CI 1.2 - 4.7; p=0.019) mortality was higher in patients without ICDs, although 6-month mortality was not significant (Log Rank X
2
1.24; p=0.27).

Conclusions:
Patients without ICDs were more likely to present following out-of-hospital cardiac arrest with underlying PMVT or VF morphologies. They had higher in-hospital complications and mortality.