bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 15021: Kinetics and Prognosis Value of Rantes (ccl5) at the Acute Phase of Stemi
Authors: leboube simon , Brun Camille , Moulin Florentin , Hayek Ahmad , Abousaleh Iyad , Paccalet Alexandre , Rioufol Gilles , PRIEUR Cyril , BONNEFOY-CUDRAZ Eric , Mewton Nathan O , Bidaux Gabriel , Paillard Melanie , Crola Da Silva Claire , Ducreux Sylvie , Bochaton Thomas
Published: June 2023

Introduction:
CCL5 or RANTES is a chemokine that mediates chemotaxis and activation of T cells, monocytes, granulocytes, mast cells and dendritic cells. It is involved in the pathogenesis of several diseases including atherosclerosis but little is known about its role at the acute phase of myocardial infarction (MI).

Hypothesis:
We questioned whether the serum level of RANTES might be a marker of the severity of acute MI.

Methods:
We prospectively enrolled 251 consecutive STEMI patients who underwent PCI into a prospective cohort. Blood samples were collected at 5 time points: admission, 4, 24, 48 hours and 1 month after admission (H4, H24, H48, M1). RANTES serum levels were assessed using an ELISA assay. Patients underwent cardiac magnetic resonance imaging at one month. Clinical outcomes were prospectively recorded over 12 months.

Results:
Mean age of the study population was 59±12 years and 54.6% patients exhibited anterior MI. Serum RANTES level raised from 12.6 [7.6-20.8] ng/mL at H0 to 13.9 [7.6-20.8] ng/mL at H4 and decreased gradually until 1 month at 9.3 [4.9-13.6] ng/mL (Kruskal-Wallis test, p<0.0001). RANTES area under curve (AUC) level was not correlated with IS (r =-0.03, p=0.70) or LVEF assessed by MRI (r=0.02, p=0.80). Patient with a RANTES AUC serum level below the first tertile value of the population (411.0 ng.h.mL
-1
) were more likely to have a MACE during the first 12 months after STEMI (hazard ratio at 2.9 (1.3-6.6), p=0.01). In a multivariable Cox regression analyses with a model including age, gender, troponin peak, and TIMI flow grade after PCI, RANTES AUC serum level below the first tertile remained associated with an increased risk of experiencing MACE during the 12 months of follow-up (adjusted HR = 2.6 (1.2-5.8), p=0.02)

Conclusion:
A low level of circulating RANTES at the acute phase of STEMI was independently associated with an increased risk of experiencing MACE in our population. Serum RANTES might be a valuable prognostic marker in STEMI patients.
Abstract 15026: The Use of Artificial Intelligence Guidance for Rheumatic Heart Disease Screening by Novices
Authors: Peck Daniel , Sable Craig A , Nakagaayi Doreen , Rwebembera Joselyn , Minja Neema , Pulle Jafesi , Klein Jennifer , Adams David , Martin Randolph , Koepsell Kilian , Beaton Andrea Z
Published: June 2023

Introduction:
A novel technology utilizing artificial intelligence (AI) to provide real-time image-acquisition guidance, enabling novices to obtain diagnostic echocardiographic (echo) images holds promise to expand the reach of echo screening for rheumatic heart disease (RHD). We evaluated the ability of non-experts to obtain diagnostic quality images in patients with RHD using AI guidance (Caption Health) with color Doppler.

Methods:
This study was performed in Kampala, Uganda at the Uganda Heart Institute. Nurses and nursing students with no prior echo experience underwent one-day training in the use of AI guidance, which included a 7-view screening protocol with 2D and color Doppler images. Following training, all participants scanned 8-10 patients using AI guidance, half RHD and half normal. The same patients were scanned by two expert sonographers without the use of AI guidance. Each echo was evaluated by a panel of 4 expert echocardiographers blinded to the identity of the scanner (novice/exert) and diagnosis of the patient to provide quality assessment including (1) diagnostic quality to determine presence/absence of RHD, (2) more detailed valvular assessment, and (3) ACEP score 1-5 for each view.

Results:
Thirty-six novice scanners scanned a total of 50 patients, 25 with RHD and 25 controls. A total of 462 echocardiogram studies were obtained, 351 obtained by non-experts using AI guidance and 111 obtained by expert sonographers without AI guidance. Preliminary analysis of 394 interpretations showed that 95% of non-expert studies were of diagnostic quality to assess for RHD and mitral valve disease (vs 100% by experts, p=0.03), but only 56% of non-expert studies were of diagnostic quality to assess aortic valve disease (vs 97% by experts, p<0.0001). The ACEP scores of non-expert images were highest in the parasternal long axis images (mean 3.62, 84% ≥ 3) compared to lower scores for apical 4 (mean 3.28, 73% ≥3), and apical 5 images (mean 2.52, 46% ≥ 3).

Conclusions:
AI guidance with color Doppler is feasible to enable rheumatic heart disease screening by non-experts, performing significantly better for assessment of the mitral than aortic valve. Further refinement is needed to optimize acquisition of color Doppler apical views.
Abstract 15030: Hidden Sources of Inequity in Heart Failure Care Transitions: A Mixed-Method Network Analysis of Clinical Notes
Authors: Wei Sijia , McConnell Eleanor , Corazzini Kirsten N , Moody James , Pan Wei , Granger Bradi B
Published: June 2023

Introduction:
Fragmentation in heart failure (HF) care transitions occur disproportionately among those adversely affected by social drivers of health. Social network analysis (SNA) may provide new insights into barriers to equitable care.
Purpose:
To assess the nature and structure of clinician networks across health system settings of care during care transitions.

Methods:
An explanatory sequential mixed-methods design was used. We stratified a purposeful sample (n=11) from a cohort of adults (n=1269) first hospitalized for HF between 2016 and 2018 by race, Medicaid use, and Area Deprivation Index, adjusting for risk (3M Clinical Risk Groups Severity of Illness Score and Charlson Comorbidity Index). EHR clinical notes were used to construct patients' clinician networks 1-year before, during, and after the index hospitalization using patient-sharing (2-mode) SNA. Patients' clinician positional and structural network measures were integrated with qualitative analyses of clinical notes.

Results:
Socioeconomically advantaged patients used fewer acute care services and lived longer. They tended to have higher network density and clinicians more centrally located in the health system network earlier and across settings and frequent telephone notes between visits that indicated reciprocal communication patterns among patients and clinicians shown in contents. Close care relationships and early involvement of influential providers measured by high Eigenvector centrality may be vital for smooth care transitions.

Conclusions:
Barriers to care coordination may result from variability in clinician networks. Well-connected clinician teams and consistent and reciprocal communication between patients and outpatient care teams are associated with more effective care coordination. Patients with clinicians in central and bridge positions within a health system network may receive higher quality care due to greater social capital and influence.
Abstract 15047: Survival With Favorable Neurological Outcome and Quality of CPR Following In-Hospital Cardiac Arrest in Children With Cardiac Disease Compared to Non-Cardiac Disease
Authors: Federman Myke , Palmer Chella , Berg Robert A , Franzon Deborah , Graham Kathryn , Huard Leanna L , Kirkpatrick Theresa , Nadkarni Vinay M , Maitoza Laura A , Morgan Ryan W , Sharron Matthew , Wolfe Heather , Sutton Robert M , Naim Maryam Y
Published: June 2023

Introduction:
Children with cardiac disease have higher rates of in hospital cardiac arrest (IHCA) compared to non-cardiac disease. We aimed to determine differences in survival in children with medical and surgical cardiac compared to non-cardiac disease following IHCA and to assess whether CPR quality was different between groups.

Hypothesis:
We hypothesized: 1) medical cardiac have worse and surgical cardiac have improved outcomes compared to non-cardiac patients, and 2) CPR quality is similar between groups.

Methods:
A secondary analysis of the
ICU-RESUS
citation project (
ICU-RESUS
; NCT02837497) was conducted. The primary outcome was survival to hospital discharge with favorable neurological outcome defined as a Pediatric Cerebral Performance Category score of 1 - 3 or no change from baseline. Secondary outcomes included physiologic measures of intra-arrest quality.

Results:
Of 1100 children with IHCA, 273 (25%) were medical cardiac, 383 (35%) were surgical cardiac, and 444 (40%) were non-cardiac. The medical cardiac group was less likely to survive with favorable outcome compared to the non-cardiac group (48% vs. 55%, aOR 0.59, CI 95 0.40, 0.88). There was no difference in outcome between the surgical cardiac (58%) and non-cardiac group. There were no differences in chest compression (CC) rate, CC fraction, ventilation rate, intra-arrest average target diastolic blood pressure or average target systolic blood pressure between medical cardiac vs. non-cardiac and surgical cardiac vs. non-cardiac groups. The surgical cardiac group was less likely to achieve target CC depth compared to non-cardiac group (OR 0.15, CI 95 0.02, 0.52). There was no difference in CC depth in medical cardiac vs. non-cardiac groups.

Conclusions:
In this large study of pediatric IHCA, medical cardiac patients had lower survival with favorable neurologic outcome compared to non-cardiac patients. Surgical cardiac patients had similar outcome to non-cardiac patients. CPR quality was similar in medical-cardiac and non-cardiac patients, however delivered CC depths were lower in surgical cardiac compared to non-cardiac patients.
Abstract 15056: Cardiac P62/sqstm1 Deficiency Exacerbates Hypoxic Stress vi
a
Impaired Hypoxia Inducible Factor 1α Signaling
Authors: Ghosh Rajeshwary , Fatahian Nima , Hathaway Marissa , Stephens Sophie , Chung Siu-Lai Desmond , Cao Isaac D , Symons John D , Boudina Sihem
Published: June 2023

Ischemic heart disease (IHD), a major cause of heart failure, is characterized by metabolic dysfunction and myocardial cell death. Cellular hypoxia activates hypoxia inducible factor 1α (HIF1α) to initiate metabolic, angiogenic, and growth-factor related responses. Under normoxia, HIF1α is degraded by prolyl hydroxylase (PHD) domain-containing proteins via the proteasome. Due to the short half-life of HIF1α (<5mins), PHD inhibitors are utilized to stabilize HIF1α and improve cardiac function in pre-clinical models of ischemia/infarction. However, evidence exists that PHD inhibitors exert off-target effects. Based on prior studies in cancer cells demonstrating that the autophagy adaptor protein p62 prevents HIF1α degradation, we hypothesized that p62 stabilizes cardiac HIF1α and provides cardioprotection from hypoxia. We generated mice with tamoxifen-inducible cardiomyocyte-specific p62 deletion (p62icKO mice; 8 week male and female) and exposed them to 7% O
2
for 6h. Hypoxia increased cardiac mRNA expression of
Sqstm1
,
Bnip3
, and
Hmox1
in wild-type (WT) but not p62icKO mice. Underscoring functional relevance, ejection fraction and fractional shortening were less, oxidative stress was elevated, and apoptosis was greater, in p62icKO vs. WT mice exposed to hypoxia. Mechanisms were evaluated using cultured H9c2 cardiomyoblasts exposed to 21% (normoxia) or 1% (hypoxia) O
2
for 24h. Hypoxia increased both HIF1α and p62 protein expression. To determine the role of p62, H9c2 cells were transfected with p62 or scrambled (ctrl) siRNA for 48h, followed by 24 h hypoxia. Hypoxia-induced HIF1α protein accrual and expression of HIF1α downstream targets
Egln1
,
Vegfa
,
Bnip3
and
Hmox1
mRNA was attenuated in H9c2 cells transfected with p62 vs. control siRNA. These data indicate p62 stabilizes cardiac HIF1α and regulates its transcriptional activation. Thus, p62 could be a novel therapeutic target for treatment of IHD.
Abstract 15069: The Rna M
6
A Demethylase, Fto, Regulates Vascular Remodeling in the Pathogenesis of Pulmonary Arterial Hypertension
Authors: Dai Jingbo , Peng Yi , Zhu Maggie M , Zhao Youyang
Published: June 2023

Introduction:
Pulmonary arterial hypertension (PAH) is a devastating disease characterized by obliterative pulmonary vascular remodeling and progressive elevation of pulmonary vascular resistance that leads to right heart failure and premature death. RNA modifications such as N6-methyladenosine (m
6
A) has have recently been discovered as essential regulators of gene expression but its function in regulating the development of PAH remain unclear.

Hypothesis:
Fat mass and obesity-associated protein (FTO), as a major m
6
A eraser, acts as a key regulator of endothelial cell (EC) dysfunction and pulmonary vascular remodeling and, thus, is a novel therapeutic target for PAH.

Methods:
To determine the FTO expression on the idiopathic PAH (IPAH) patients, we performed Western blotting and immunofluorescence on lung tissue from IPAH patients. A novel mouse model with Tie2-Cre-mediated deletion of Fto in endothelial cells was generated and treated with hypoxia for 3 weeks to induce experimental PAH. Measurement of right ventricular systolic pressure (RVSP) and weight ratio of right ventricular versus left ventricular plus septum (RV/LV+S), an indicator of RV hypertrophy were determined. To evaluate the translational potential of targeting FTO in PAH, rats were exposed to monocrotaline to induce pulmonary hypertension and then were treated with FTO inhibitor FB23-2. RVSP, RV/(LV+S) ratio and histology assessment were measured subsequently.

Results:
FTO expression level is markedly elevated in the endothelial cells of IPAH patients. The Tie2-Cre-Fto (CKO) mice exhibited inhibited PAH under hypoxia treatment as evident by reduced RVSP and lower RV/(LV+S) ratio. Histological and immunofluorescent staining showed that media layer of pulmonary arteries had less cell proliferation and reduced pulmonary vascular remodeling. Moreover, preclinical MCT-rat PAH model showed attenuated PAH phenotype as well as pulmonary vascular remodeling with pharmacological inhibition of FTO.

Conclusions:
These studies demonstrate that FTO expression markedly elevates in the EC of IPAH patients. Tie2-Cre mediated loss of FTO protects mice from hypoxia-induced PAH. Thus, targeting FTO is a promising therapeutic strategy for PAH.
Abstract 15079: Sildenafil Promotes Mitochondrial Protein Deacetylation and Improves Mitochondrial Bioenergetics in Single Ventricle Congenital Heart Disease
Authors: Pietra Ashley E , Jonscher Raleigh , Sparagna Genevieve , BAYBAYON-GRANDGEORGE ANGELA N , Stauffer Brian L , Sucharov Carmen C , Miyamoto Shelley D , Garcia Anastacia M
Published: June 2023

Introduction:
Heart failure (HF) remains the leading cause of death and indication for transplant in single ventricle congenital heart disease (SV). Phosphodiesterase-5 inhibitors (PDE5i) are commonly used for the treatment of SVHF, with the primary target being the pulmonary vasculature. We have previously demonstrated that the failing SV heart is characterized by increased PDE5 activity and impaired mitochondrial function. We hypothesize PDE5i-mediated deacetylation of mitochondrial proteins via activation of sirtuin-3 (SIRT3) promotes enhanced mitochondrial bioenergetics.

Methods:
Mitochondrial bioenergetics were assessed using an Oroboros O2k high resolution respirometer on freshly explanted permeabilized myocardial tissue from 12 biventricular non-failing controls (BVNF), 21 SVHF, and SVHF hearts treated with PDE5i (n=14) or honokiol (a SIRT3 activator, n=5) for 40 minutes. We examined cardiac lysine acetylation in 8 explanted BVNF and 11 SVHF hearts and mitochondrial lysine acetylation in 2 SVHF samples +/-PDE5i via western blot. Statistical analysis was performed using unpaired Mann-Whitney tests between 2 groups and a Welch ANOVA with post-hoc Dunnett’s T3 multiple comparisons test for 3 group comparisons.

Results:
Mitochondrial function is impaired in SVHF compared to BVNF, but is rescued by treatment with PDE5i (A) and the SIRT3 activator honokiol (B). SVHF myocardial proteins are hyperacetylated compared to BVNF (representative blot, C, p=0.02). Treatment with PDE5i promotes deacetylation of mitochondrial proteins in failing SV hearts (representative blot, D).

Conclusions:
Mitochondrial bioenergetics may represent a novel therapeutic target for SVHF. Our data shows that failing SV hearts are typified by impaired mitochondrial function and protein hyperacetylation, and suggests that PDE5i improves mitochondrial function in SVHF through SIRT3 mediated deacetylation of mitochondrial proteins.
Abstract 15084: One- versus Three-Month DAPT in Diabetic Patients With High Bleeding Risk Undergoing PCI: Results From the Xience Short DAPT Global Program
Authors: Spirito Alessandro , Mehran Roxana , Sartori Samantha , Snyder Clayton , hermlller James , Makkar Raj , Bangalore Sripal , Angiolillo Dominick J , Nicolas Johny , Ge Junbo , Vogel Birgit , Saito Shigeru , Cao Davide , Neumann Franz-Josef , Bhatt Deepak , Valgimigli Marco
Published: June 2023

Introduction:
In patients at high bleeding risk (HBR), a short dual antiplatelet therapy (DAPT) duration after coronary stenting has been associated with fewer bleeding events and preserved ischemic protection. Whether these effects are maintained in diabetic patients is unclear.
Purpose:
To assess the safety and efficacy of 1- versus 3-month DAPT after percutaneous coronary intervention (PCI) with stent implantation among HBR patients with or without diabetes.

Methods:
We included patients from three prospective, international, single-arm studies (XIENCE Short DAPT Program), which enrolled HBR patients successfully treated with a fluoropolymer-based cobalt-chromium everolimus-eluting stent (XIENCE, Abbott). Subjects were eligible for DAPT discontinuation at 1 month (XIENCE 28 USA and Global) or at 3 months (XIENCE 90), if free from ischemic events and adherent to DAPT. The primary endpoint was the composite of all-cause death or any myocardial infarction (MI). The key secondary endpoint was Bleeding Academic Research Consortium (BARC) type 2 to 5 bleeding. Outcomes were assessed between 1 and 12 months after index PCI using propensity score adjustment.

Results:
Out of 3,352 patients, 1,299 (38.8%) had diabetes. The rate of death or MI at 12 months was higher in diabetic than in non-diabetic patients (10.1% vs 6.6%) while the rate of BARC 2-5 bleeding was similar (9.5% vs 9.2%). A one v. three months of DAPT duration resulted in a borderline reduction in death or MI (adj. HR 0.70, 95% CI 0.47-1.05) in diabetic but not in non-diabetic patients (adj. HR 1.24, 95% CI 0.86-1.79; p-interaction=0.016) and fewer BARC 2-5 bleeding in both groups (adj. HR 0.67, 95% CI 0.45-1.01 and adj. HR 0.77, 95% CI 0.56-1.06, respectively; p-interaction=0.950).

Conclusions:
Among HBR patients undergoing everolimus-eluting stent implantation, diabetic patients derive important benefit in reducing death and MI and bleeding events from a one month compared with three-month DAPT duration.
Abstract 15085: Modest Reduction in Ankle-Brachial Index Measurements and Risk of Major Adverse Limb Events Among 133,373 Veterans
Authors: Aday Aaron W , Eden Svetlana K , Alcorn Charles W , Tindle Hilary A , Beckman Joshua A , Freiberg Matthew S
Published: June 2023

Introduction:
Low resting ankle-brachial index (ABI) serves as a non-invasive biomarker of poor limb outcomes. Whether modest decrements in ABI translate into higher risks of major adverse limb events (MALE) are unclear, particularly among women and minorities, because prior studies are small or lack racial diversity and incident outcomes.

Methods:
We analyzed data from participants in the Veterans Affairs Birth Cohort, a prospective, longitudinal cohort of veterans born between 1945-1965 with no clinical history of PAD prior to ABI testing. Participants were enrolled on or after 1/1/2000 and followed through 12/31/2016. The exposure was resting ABI and the outcome was MALE defined as limb revascularization or amputation based on VA and Medicare ICD-9/10 and CPT codes. Cox proportional hazards models assessed the association between ABI and MALE among black and white men and women. Models were adjusted for demographics and PAD risk factors (
Figure Legend
).

Results:
The analysis included 23,733 black men, 1,257 black women, 96,220 white men, and 2,813 white women. There were 14,431 MALE events. Risk for MALE across the ABI spectrum followed a j-shaped distribution (
Figure
). Both low and high ABIs were associated with an increased risk of MALE for black and white men and women (
Figure
). When we analyzed each sex/race group separately, as compared to a normal ABI measurement (1.11-1.20), a modestly reduced ABI (0.81-0.90) was associated with a significantly increased risk of MALE: black men HR
adj
, 2.17; 95% CI, 1.67-2.80; black women HR
adj
, 3,24; 95% CI, 1.21-8.69; white men HR
adj
, 3.04; 95% CI, 2.68-3.46; white women HR
adj
, 4.56; 95% CI, 1.73-11.99.

Conclusions:
In a large, diverse cohort of people free of prior PAD, a modest reduction in ABI was associated with a greater than two-fold increased risk of MALE for all sex/race groups. Further studies are needed to better understand why MALE occurs in this patient population despite only mildly reduced limb perfusion.
Abstract 15088: Cholesterol-Induced Suppression of Kir2.1 Contributes to the Development of Atherosclerosis
Authors: Granados Sara T , Do Couto Natalia , Fancher Ibra , Levitan Irena
Published: June 2023

Introduction:
Our recent studies demonstrated that cholesterol sensitivity of inwardly-rectifying K
+
channels (Kir2.1) contributes to the impairment of flow-induced vasodilation (FIV) in resistance arteries.

Methods:
In this study we developed a new CRISPR mouse model, originated from our molecular dynamics research for the Kir 2.1 channel. This model Kir2.1
L222I
, has a point mutation (L222I) that renders the channel cholesterol insensitive. We also crossed our new CRISPR model with a dyslipidemic ApoE
-/-
mice resulting in a ApoE
-/-
Kir2.1
L222I
. We evaluated Kir2.1 channel function with patch clamp for both models. We then placed our mice on a high fat (42% kcal from fat) diet (HFD) from 12 -14 weeks and analyzed atherosclerotic lesions with Oil Red O in
En Face
aortas and cross sections of carotid arteries for both female and male mice. We also documented weight gain, food consumption and blood biochemistry.

Results:
A lack of cholesterol sensitivity of Kir2.11
L222I
was functionally confirmed in endothelial cells freshly isolated from mesenteric arteries of Kir2.1
L222I
and ApoE
-/-
Kir2.1
L222I
mice. We found that ApoE
-/-
Kir2.1
L222I
mice have significant reduction in the area of atherosclerotic lesions in their aortas, as compared to ApoE
-/-
mice. This phenomenon was observed both in the aortic arch and in the descending aorta. Specifically, the lesion areas in the arch were 37.2± 1.87% (n:8) vs. 20.3 ±2.3% (n:8) in ApoE
-/-
vs. ApoE
-/-
Kir2.1
L222I
mice respectively. The effect on the lesion area in the descending aorta was even more pronounced: 16.5 ±2.1% (n:8) in ApoE
-/-
to 5.6± 1.3% (n:8) in ApoE
-/-
Kir2.1
L222I
. The same effect was observed in males and females. In addition, we also analyzed the lesion areas and stenosis in carotid arteries of the same mice and found that ApoE
-/-
Kir2.1
L222I
mice are also partially protected, as compared to ApoE
-/-
. However, no differences were found in the levels of LDL, HDL and total cholesterol between these mice.

Conclusion:
Our data suggest that cholesterol-induced suppression of Kir2.1 is an important contributor to the development of atherosclerosis.
Abstract 15093: Elevated Risk of Recurrent Ablation in Black Compared to White Patients With Atrial Fibrillation: Another Paradox of Atrial Fibrillation in Blacks
Authors: Ali Asgar Juzer , Duhan Sanchit , Kundan Parshotam , Walia Naval , KRAFT DANIELLE , Bliden Kevin , Tantry Udaya , Shah Paresh , Gurbel Paul , Kanjwal Mohammed
Published: June 2023

Introduction:
Lower prevalence of atrial fibrillation (AF) despite a higher prevalence of risk factors in blacks compared to whites (AF paradox) has been reported. However, less information is available about recurrent ablation events in blacks compared to whites.

Methods:
Demographic characteristics and one-year recurrent ablation events were analyzed in AF patients admitted to a community hospital from 2018 to 2021.

Results:
Recurrent AF ablation occurred in 3.7% (16/435) of the study population and was significantly higher in black compared to white patients [9/86 (10.5%) vs. 7/349 (2.0%), respectively, p=0.0001]. Black race and history of atrial flutter were predictors of recurrent AF ablation (p<0.05) within one year of initial ablation. Black patients were younger (p=0.03) with a significantly higher prevalence of hypertension, diabetes, cardiomyopathy/heart failure, thyroid disease, renal disease, sleep apnea, COVID-19, pacemaker/AICD placement, and history of Ventricular tachycardia (Table). Concomitant medications were similar between races besides higher use of antihypertensive medications in black patients (Table).

Conclusions:
In our community hospital setup, black patients with AF had a higher prevalence of comorbidities and significantly higher incidence of one-year recurrent ablation events despite similar therapy compared to white patients. These observations should be explored in a larger prospective study to understand the differential association of comorbidities in black AF patients and associated higher risk for recurrent events.
Abstract 15100: Relationship Between Obstructive Sleep Apnea and Acute Coronary Syndrome: A Cross-Sectional Study
Authors: Alagha Zakaria , Ghallab Muhammad , Nassar Mahmoud , Yazied Yasser , Alastal Maha , Aabdelmoteleb Salma , Kandil Hossam , Mahmoud Kareem
Published: June 2023

Introduction:
Obstructive sleep apnea (OSA) is a common and underestimated chronic condition recognized as a risk factor for cardiovascular diseases. OSA and acute coronary syndrome (ACS) have been reported in several cases. This study aims to assess the prevalence of the OSA among patients with ACS.

Hypothesis:
We hypothesize that there is a correlation between OSA and ACS.

Methods:
This study is a cross-sectional, descriptive study that included 110 patients with ACS at the Cairo University Hospitals in Egypt between December 2018 and July 2019. We included patients diagnosed with ACS over the age of 40. We excluded patients who had disturbed consciousness levels, were intubated/mechanically ventilated, were on psychiatric medications, or used drugs. Furthermore, we excluded individuals with CKD or liver disease. We collected patients’ demographic characteristics, and chronic medical conditions, and performed a sleep assessment. Every patient had a detailed workup for ACS. We assessed OSA based on the STOP-BANG score. The significance of baseline and clinical characteristics, laboratory and imaging findings, and the severity of ACS and its outcome were studied.

Results:
The mean age of the patients was 58.2±9.6. The majority of patients were male (74.5%). 70.9% of the patients had metabolic syndrome. The mean body mass index was 28.6±4.8; the majority of patients presented with STEMI (60.9%), while only 26.4% and 12.7% presented with NSTEMI and unstable angina respectively. The prevalence of OSA among ACS patients was 63.6%, and of them, 55.7% presented with STEMI, while only 32.9% and 11.4% presented with NSTEMI and unstable angina respectively. Also, the study revealed a statistically significant relationship between OSA and NSTEMI patients (OR: 2.77 [95% CI 1.02-7.55], p=0.041), while there was no statistically significant relationship between OSA and unstable angina patients (OR: 0.73 [95% CI 0.2-2.3], p=0.579) and between OSA and STEMI patients (OR: 0.54 [95% CI 0.2-1.2], p=0.14).

Conclusion:
To the best of our knowledge, this is the first study to study the prevalence of OSA in ACS patients in the region of Africa. The study indicated a high prevalence of OSA among ACS patients, with a more significant correlation between OSA and NSTEMI patients.
Abstract 15123: Post-Infarction Inflammation Influences Diastolic Function After STEMI
Authors: Leboube Simon , Filip Smaranda , HAYEK AHMAD , Paccalet Alexandre , Brun Camille , Crola Da Silva Claire , PRIEUR Cyril , BONNEFOY-CUDRAZ Eric , Thibault Helene , Bergerot Cyrille , Mewton Nathan , Rioufol Gilles , MECHTOUFF Laura , Bochaton Thomas
Published: June 2023

Introduction:
Diastolic dysfunction after STEMI is under documented despite its impact on cardiovascular events. We focused on inflammatory biomarkers within hours after STEMI and their association with diastolic dysfunction at one month post STEMI.

Hypothesis:
Our aim was to identify an inflammatory profile promoting diastolic dysfunction in STEMI patients.

Methods:
We prospectively included STEMI patients admitted in our hospital from 2016 to 2019. We collected sera at 5 time points (admission (H0), 4 hours (H4), H24, H48 an 1 month). Inflammatory biomarkers serum levels were assessed using ELISA assays (cytokines, chemokines and endothelial activation biomarkers). Transthoracic echocardiogram and cardiac MRI to assess diastolic function and infarct size were carried out at one month post STEMI. We used last guidelines from the EACVI to grade diastolic function. Patients were followed for 12 months.

Results:
Complete echocardiographic data were available for 236 patients. There were 163 patients with normal diastolic function and 73 patients with diastolic dysfunction. As expected, patients with diastolic dysfunction had higher BNP level (197.0 ng/L versus 68 ng/L, p<0.001) and were more likely to have a MACE during the first 12 months after STEMI compared to patients normal diastolic function (HR = 3.0 CI [1.1-7.9], p = 0.01). Patients with diastolic dysfunction at one month had higher inflammatory biomarkers within the first 48h post STEMI compared with patient with normal diastolic function: CRP AUC (660.2 mg.h.L
-1
vs 361.4 mg.h.L
-1
p=0.02), IL-6 AUC (206.0 pg.h.mL
-1
vs 173.1 pg.h.mL
-1
p=0.03) sTNFR1 AUC (27.6 ng.h.mL
-1
versus 24.1 ng.h.mL
-1
, p=0.03), sTNFR2 AUC (44.7 ng.h.mL
-1
vs 43.5 ng.h.mL
-1
, p=0.03) sST2 AUC (30.4 pg.h.mL
-1
vs 27.3 pg.h.mL
-1
, p=0.046), GDF15 AUC (10.8 ng.h.mL
-1
vs 8.1 ng.h.mL
-1
, p=0.050) and IL-10 AUC (174.6 pg.h.mL
-1
vs 122.8 pg.h.mL
-1
, p=0.02). There was no significant difference in infarct size (13 versus 17% of left ventricular mass, p = 0.06) or LVEF (58 versus 54%, p = 0.0523) between the two groups.

Conclusions:
Diastolic function seems influenced by the early post STEMI inflammatory environment. These results should be considered in future mechanistical study and in patients’ care.
Abstract 15129: The Impact of Frailty Status on Clinical Outcomes in Middle Aged Adults Hospitalized for Heart Failure
Authors: Wang Jeffrey , Okoh Alexis K , Steinberg Rebecca , Gangavelli Apoorva , Patel Krishan , Morris Alanna A
Published: June 2023

Introduction:
The burden of frailty is high among older patients hospitalized for heart failure (HF); however, little is known about frailty in younger patients with HF. The purpose of this study is to investigate the prevalence of frailty and its association with clinical outcomes in middle aged adults hospitalized for HF.

Methods:
We included patients <65 years old hospitalized for acute HF within a university affiliated network between 2015 to 2020. The Hospital Frailty Index was used to assess frailty risk based on ICD-10 codes. Patients were categorized into low (score < 5), intermediate (score 5-15) and high (score >15) risk for frailty. We investigated the association between frailty status and clinical outcomes (prolonged hospitalization [length of stay ≥ 7 day]), 30d-readmission, and 30d-mortality using multivariable logistic regression models.

Results:
Out of 10,170 patients (mean age 51.8±10.5 years) who were hospitalized for HF, 1129 (11.1%) were categorized as low, 3718 (36.6%) as intermediate, and 5323 (52.3%) as high risk for frailty. The proportion of patients experiencing prolonged hospitalization, 30-day readmission, and 30-day mortality was highest in the high-risk frailty group (Table). Compared to patients with low-risk frailty status, high-risk frailty status was significantly associated with prolonged hospitalization (adjusted odds ratio [aOR] 9.2, 95% Confidence Interval [CI] 7.3 - 11.5), 30-day readmission (aOR 3.7, 95% CI 2.9 - 4.7), and 30-day mortality (aOR 6.1, 95% CI 3.2 - 11.5). Compared to low risk frailty status, intermediate risk frailty status was associated with prolonged hospitalization (aOR 3.7, 95% CI 3.0 - 4.7) and 30-day mortality (aOR 3.4, 95% CI 1.8 - 6.6), but not 30-day readmission (aOR 1.34, 95% CI 0.88 - 2.05).

Conclusions:
Among middle aged adults hospitalized for HF, there is a high burden of frailty. We found a significant association between high-risk frailty status and worse clinical outcomes in this age group.
Abstract 15133: Matricellular Protein CCN1 Regulates Cardiac Fibroblast ECM Synthesis and Alignment
Authors: Fischer Annalara G , Poole Andrea R , Elliott Erin M , Moore Joseph B
Published: June 2023

Introduction:
Cellular communication network (CCN) proteins constitute a 6-member family of extracellular matrix (ECM)-associated signaling proteins that have important roles in wound healing and tissue fibrosis. Though their function in the heart is not fully explicated, CCN1 is often indicated as an antifibrotic factor. Yet, CCN1 levels correlate with infarct size and ventricular dysfunction in myocardial infarct patients—signifying a pro-fibrotic role for this factor in the heart.

Objective:
To determine the contribution of endogenous CCN1 to fibroblast (FB) ECM synthesis and organization.

Methods:
In vitro
murine cardiac FB ECM synthesis, activation, proliferation, and matrix organization was evaluated in cells treated with CCN1 or non-target (NT) siRNA, by qPCR/immunoblotting for collagens and synthetic enzymes, EdU incorporation, and type I collagen immunostaining of decellularized matrices, respectively. CCN1-dependent integrin pathways modulating FB collagen synthetic enzyme expression were identified and interrogated via
in vitro
immunoprecipitation and RNAi-mediated depletion.

Results:
CCN1-deficient FBs showed reduced expression of type I collagen and collagen processing enzymes (
P4ha1
,
P4hb
,
Plod1
,
Plod2
,
Loxl2
). siRNA-mediated knockdown of CCN1 did not impact FB activation (α-SMA), but significantly reduced the expression of collagen synthetic/processing enzymes (
P4ha1
,
Plod1
,
Plod2
,
Loxl2
). Deficiency of CCN1 in both unstimulated and TGFβ1-stimulated FBs resulted in reduced proliferative capacity (7.17%, p=0.0205 and 5.34%, p=0.0428, respectively, relative to NT, n=3). CCN1 depletion promoted the alignment of FB-derived collagen fibers (0.30 ± 0.03 vs. 0.58 ± 0.04; mean ± SEM, p<0.0001, n=6). An interaction between CCN1 and integrin αvβ3 was validated; moreover, knockdown of integrin β3 reduced the expression of enzymes associated with collagen cross-linking (
Plod1
,
Plod2
,
Loxl2
), partly phenocopying CCN1 depletion.

Conclusions:
The data suggest that CCN1 drives pro-fibrotic signaling and limits ECM organization in cardiac FBs. This may have implications for CCN1 in the infarcted heart by promoting scar establishment; however, long-term expression could lead to progressive detrimental remodeling.
Abstract 15142: Consistent Improvement in Utilization of Guideline Directed Medical Therapy Race for Traditionally Underserved Populations Using a Remote Intervention
Authors: Blood Alexander J , Bosque-Hamilton Joshua , Wagholikar Kavishwar , Matta Lina , Zelle David , Gaziano Thomas A , Plutzky Jorge , Scirica Benjamin M , Desai Akshay S
Published: June 2023

Background:
Heart failure (HF) disproportionately affects populations traditionally underserved in medicine. Remote healthcare delivery expands the reach of health care systems and providers, however some fear new models may pose challenges to equitable health care delivery. By building a remote HF clinic we aimed to increase equitable access to guideline-directed medical therapy (GDMT) optimization for HF.

Methods:
Patients with HF and a left ventricular ejection fraction
<
40% were identified by health record screening. Patients’ cardiologist was approached to participate in the remote intervention (RI) program, and those who declined their patient’s involvement served as a reference ‘usual care’ (UC) group. HF medications in the RI group were adjusted by pharmacists and patient navigators according to a GDMT titration algorithm. We examined differences in the efficacy of the intervention by race and separately by area deprivation index (ADI) - a validated method of stratifying neighborhood-level health determinants (higher scores indicate fewer resources).

Results:
Of 1131 eligible patients, 196 completed the 3-month follow-up in the RI group. The RI group included 16.8% Black individuals, 59.2% of patients in the low (1-5) ADI category and 29.6% in the high (6-10) ADI category. The UC group included 831 patients: 9.9% Black individuals, 54.0% in the low ADI category and 25.6% in the high ADI category. When compared to Black patients in UC, Black patients who participated in the RI program saw more medication titrations and rates of reaching target dosage for both ACE/ARB/ARNI & beta-blockers (BB). When compared across ADI, the RI group had increased rates of ACE/ARB/ARNI & BB titration and target dose achieved in the low and high ADI categories compared the UC group (Figure 1).

Conclusion:
A remote HF program was able to improve utilization of GDMT regardless of race and ADI. This care model may improve access to HF care for traditionally underserved populations.
Abstract 15144: Bmp10 is a Novel Marker of Rhythm Status in Atrial Fibrillation
Authors: Barney Miles , Darbar Dawood
Published: June 2023

Background:
Atrial fibrillation (AF), the most common cardiac arrhythmia requiring therapy, is associated with significant morbidity and increased mortality. A major challenge in assessing disease progression and efficacy of AF therapy is the rigor of AF identification and, despite a critical need, there is no effective biomarker that tracks burden of disease or response to therapy. BMP10, a critical signaling molecule during cardiac development, has emerged as a promising marker for response to catheter ablation, however it is unknown whether BMP10 tracks AF burden. To evaluate BMP10 as a potential biomarker for AF burden, I sought to determine whether plasma levels of BMP10 could track rhythm status.

Methods:
40 patients with an active history of AF were prospectively enrolled in a clinical biorepository and plasma samples were collected at the time of enrollment. Rhythm status at enrollment was determined by ECG. Plasma BMP10 levels were measured by ELISA (LSBio).

Results:
Of the 40 patients enrolled, 23 were in sinus rhythm (SR) and 17 were in an episode of AF. Baseline characteristics were similar across the two groups (Table 1). Patients who were in an active AF episode had higher levels of plasma BMP10 (1.94 ng/mL, SEM: 0.19) than patients in SR (1.44 ng/mL, SEM 0.11) (p= 0.04). (Figure 1)
CONCLUSION:
Blood plasma BMP10 is modulated by rhythm status in patients with AF, suggesting that BMP10 may be a promising biomarker for AF burden and response to therapy.

Table 1. Baseline Characteristics of Rhythm Status Groups

Figure 1. Plasma BMP10 Levels by Rhythm Status
Abstract 15146: A Flying Saucer- Asymptomatic Migration of an Atrial Septal Defect Occluder Device to the Aortic Arch - No Good Deed Goes Unpunished!
Authors: Aglan Amro , Parikh Rohan , cundiff michael , Dani Sourbha
Published: June 2023

Introduction:
Though safe, the transcatheter closure with an atrial septal defect for secundum atrial septal defect (ASD) is associated with complications, such as device dislodgement.

Case report:
A 51-year-old female with a complex fenestrated secundum ASD (16mm superior defect and 14mm inferior defect with insufficient aortic rim) with hemodynamically significant shunt causing right heart dysfunction underwent placement of two atrial septal defect occluder devices (Amplatzer). While there was no shunting noted on immediate post-procedure transthoracic echocardiogram (TTE), a follow-up TTE after a year showed residual left to right shunting across the ASD. Transesophageal echocardiogram (TEE) showed a single occluder device (inferior) in place and a second device (superior) lodged in the distal aortic arch at the level of the left common carotid and left subclavian artery with mild local flow acceleration (aortic velocity 2.6 ms/s) and no superimposed device thrombus. Her only complaint was recurrent headaches, which pre-dated the procedure and were attributed to ocular migraine by her neurologist. The patient underwent a transcatheter procedure to attempt the retrieval of the dislodged device. The proximal end of the device was found adherent to the aortic wall. Aortogram revealed excellent flow around the device. The procedure was aborted due to the risk of dissection. Since the device did not cause any adverse effects and would likely continue to endothelialization.

Conclusion:
Atrial septal occluder device dislodgement can occur several months after implantation. Careful monitoring is required particularly when the ASD rim is insufficient. In cases of migration and adherence to the aortic wall without hemodynamic consequences, the device can likely be safely left in place to endothelialize. Despite a faster recovery with percutaneous procedures, a surgical approach should be considered in younger patients to avoid such complications.
Abstract 15157: Prevalence and Burden of Concomitant Aortic Stenosis in Acute Myocardial Infarction Hospitalizations in the United States
Authors: Patlolla Sri H , Maqsood Muhammad Haisum , Vallabhajosyula Saraschandra
Published: June 2023

Introduction:
There are limited data on the prevalence, management and outcomes associated with concomitant aortic stenosis (AS) and acute myocardial infarction (AMI).

Methods:
All adult hospitalizations with a primary diagnosis of AMI were identified from the HCUP-NIS database (2000-2017). Admissions with a concomitant diagnosis of AS were compared to AMI admissions without AS. Outcomes of interest included prevalence of AS, in-hospital mortality, use of in-hospital cardiac procedures, hospitalization costs, length of stay, and discharge disposition.

Results:
During the study period, there were a total of 11,622,528 AMI admissions. Among these 513,688 (4.4%) were identified with concomitant AS. Adjusted temporal trends revealed an increase in prevalence of AS among STEMI (adjusted odds ratio [AOR] in 2017 vs 2000 1.15) and NSTEMI (AOR 2017 vs 2000 1.28) hospitalizations. AMI admissions with concomitant AS were on average older (78.8 ± 10.9 vs 67.1 ± 14.1), of female sex, had higher comorbidity, higher rates of NSTEMI (78.9% vs 62.1%), acute non-cardiac organ failure (13.4% vs 9.2%), and cardiogenic shock (5.1% vs 4.8%)(all p<0.001) when compared to those without AS. Concomitant AS was associated with significantly lower use of coronary angiography (45.5% vs 64.4%), percutaneous coronary intervention (20.1% vs 42.5%), coronary atherectomy (1.7% vs. 2.8%), and mechanical circulatory support (3.5% vs 4.8%) (all
p
<0.001), but had had higher rates of coronary artery bypass surgery and surgical aortic valve replacement (5.9% vs 0.1%) compared to those without AS. Admissions with AMI and AS had higher in-hospital mortality (9.2% vs. 6.0%; adjusted OR 1.12 [95% CI 1.10-1.13];
p
<0.001). Concomitant AS was associated with longer hospital stay (median [interquartile range] 5[3-8] vs 3[2-6]), more frequent palliative care consultations (6.5% vs 2.3%), and less frequent discharges to home (44.6% vs 63.3%) when compared to AMI admissions without AS.

Conclusions:
In this large nationwide study, an increase in prevalence of AS in both STEMI and NSTEMI hospitalizations was noted. AMI admissions with concomitant AS had lower use of guideline-directed therapies, higher in-hospital mortality, and longer hospital stays.
Abstract 15159: Association of Depression and Adherence to Oral Anticoagulants in Patients With Atrial Fibrillation
Authors: Lapa Matthew , Magnani Jared W
Published: June 2023

Introduction:
Depression may decrease adherence to cardiovascular medications. Depression has not been well studied in atrial fibrillation (AF). We examined the association of depression with adherence to direct-acting oral anticoagulants (DOACs) in AF, given their crucial role in stroke prevention. We hypothesized that individuals with depression would have decreased adherence to DOACs compared to those without.

Methods:
We used Optum’s de-identified Clinformatics® Data Mart Database to identify individuals with AF initiating anticoagulation with DOACs between 2013-2019. We identified depression, AF, and covariates using the claims data. We quantified adherence using proportions of days covered, categorized as limited (<80%), adequate (80 to <90%), or optimal (≥90%). We determined the multivariable-adjusted odds of 12-month adherence to DOACs in individuals with depression compared to those without. Covariates included demographics, medical and psychiatric comorbidities, household income, educational attainment, and insurance type.

Results:
We identified 68,800 individuals with AF who initiated DOACs (age 74.5±8.9, 50.6% female, 29.5% non-White). In those with depression (n=11,059) the odds of adequate adherence was 0.89 (95% CI, 0.85, 0.93) and optimal adherence was 0.87 (95% CI, 0.83, 0.91) compared to individuals without depression (
Figure
).

Conclusions:
We demonstrated that individuals with depression and comorbid AF were less likely to achieve either adequate or optimal 12-month adherence to DOACs compared to those without depression. Recognizing depression in patients with AF may guide measures to address adherence to oral anticoagulation.
Abstract 15181: PET/CT Imaging for Evaluating Inflammation in Rapamycin Coated Tissue-Engineered Arterial Grafts Implanted in an Ovine Model
Authors: Chou Ting-heng , Matsuzaki Yuichi , Iwaki Ryuma , Ulziibayar Anudari , breuer christopher , Shinoka Toshiharu , Stacy Mitchel R
Published: June 2023

Introduction:
Small diameter tissue-engineered arterial grafts (TEAGs) conjugated with rapamycin may improve TEAG outcomes by reducing early post-implant inflammatory responses, thereby improving rates of TEAG patency. Therefore, the objective of this study was to apply in vivo PET/CT imaging to compare inflammation and patency of TEAGs conjugated with or without rapamycin. We hypothesized that rapamycin-coated TEAGs would have reduced inflammation and improved patency rates that could be evaluated during a single imaging session using
18
F-FDG PET/CT imaging.

Methods:
Rapamycin coated (n=3) and non-rapamycin coated (n=3) TEAGs were unilaterally implanted in the carotid artery of juvenile lambs. Flourine-18 (
18
F)-fluorodeoxyglucose (FDG) PET/CT imaging was performed 8 weeks after TEAG implantation to quantify inflammation of the graft, which was expressed as the maximum standardized uptake value (SUV
max
) in the graft. Graft patency was assessed using co-registered CT angiography imaging. In vivo PET/CT imaging results were further evaluated by ex vivo gamma counting of
18
F-FDG uptake in TEAG tissue.

Results:
In vivo PET/CT detected qualitative and quantitative differences in inflammation between non-drug coated and drug coated TEAGs (SUV
max
: 6.18±1.67 vs, 4.25±0.81; p=0.1). Differences in inflammation between groups were significant when evaluating results of ex vivo gamma counting of
18
F-FDG uptake (% Injected dose/g: 0.86±0.10 vs, 0.50±0.010; p=0.003). Additionally, CT angiography demonstrated that all rapamycin-coated TEAGs were patent (3/3) at 8 weeks post-implant whereas only one non-drug coated TEAG remained patent (1/3).

Conclusions:
Conjugation of TEAGs with rapamycin prevents excessive inflammation in the early months after implantation and maintains graft patency. PET/CT offers a translatable imaging approach that allows for combined in vivo assessment of the functional and anatomical characteristics of TEAGs and may assist in optimizing scaffold design for next-generation TEAGs.