bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 12133: Real-World Adherence to Mavacamten in Patients With Obstructive Hypertrophic Cardiomyopathy in the United States
Authors: Masri Ahmad , Maksabedian Hernandez Ervant J , Wang Yan , Gao Weihua , Wu Aozhou , Han Xu
Published: December 2023

Background:
There are no data on adherence to mavacamten in the real world. The first month of mavacamten treatment could be provided by the manufacturer for free before the drug is dispensed from commercial specialty pharmacies.

Research Question:
What is the adherence to mavacamten in patients with obstructive hypertrophic cardiomyopathy (HCM) in the real world?

Aims:
To assess the adherence to mavacamten in real-world patients with obstructive HCM.

Methods:
This was a retrospective cohort study of adult patients using the Symphony Integrated Dataverse that captured dispensing of commercial specialty pharmacies. Patients were included if they had ≥1 approved claim for mavacamten (the date of the first claim was the index date) from 4/28/2022 - 4/4/2023 and had continuous claims activity during the 12 months (baseline) before the index date. Discontinuation (defined as a gap ≥ 95 days in mavacamten treatment) and adherence (measured as proportion of days covered [PDC], modified medication possession ratio [MPRm], and compliance ratio [CR]) were evaluated during the follow-up that ended with the end of continuous claims activity or the end of the database, whichever was earlier. The use of background therapy was described at index. Subgroup analyses were conducted in patients with ≥2 approved mavacamten claims.

Results:
A total of 659 patients (mean ± SD age 64.2 ± 13.1 years, 63.0% female) were included (
Table
). During an average of 118 ± 76 days follow-up, 4.1% of patients discontinued mavacamten who were on treatment for an average of 56 ± 44 days. The PDC (mean ± SD) was 95.6 ± 7.1%, with 94.7% of patients having a PDC ≥ 80%. Overall, 22.8% of patients received mavacamten as a monotherapy without any background therapies at index. The subgroup analysis showed similar results and a MPRm (mean ± SD) of 99.5 ± 11.8%.

Conclusion(s):
Adherence to mavacamten over a mean of 118 days in the real world was high. Further follow-up is undergoing to understand adherence in a longer term.
Abstract 12149: Vericiguat May Improve Conduit Vessel Function and Exercise Functional Capacity in Heart Failure With Reduced Ejection Fraction
Authors: Takase Toru , Matsumura Koichiro , Nakazawa Gaku
Published: December 2023

Background:
The treatment of heart failure with reduced ejection fraction (HFrEF) has advanced considerably in recent years with the advent of novel agents; however, limitations, such as blood pressure and renal dysfunction, limit the number of patients who can benefit from this treatment in practice. Vericiguat, a novel heart failure treatment, has been found to be efficacious in patients with HFrEF while maintaining a good safety profile. Unfortunately, its mechanisms remain largely unknown.

Objective and Methods:
A total of 11 patients with HFrEF who were determined to be inadequately treated underwent right heart catheterization, echocardiography, flow-mediated dilatation (FMD) testing, 6-min walking distance (6MWD) test, and blood sampling at a median interval of 70 ± 13 days before and after vericiguat treatment.

Results:
Participating patients were 73 ± 9.3 years old with a mean of 2.5 repeated heart failure hospitalizations, ejection fraction (EF) of 31.2% ± 8.7%, BNP of 328.7 ± 282, and New York Heart Association classification of mostly II. No significant changes in systolic blood pressure or pulse rate were observed before and after vericiguat introduction (115 ± 64 vs. 105 ± 52 mmHg and 70 ± 5 vs. 75 ± 12 bpm; P = 0.533 and 0.960, respectively). No significant changes in the mean pulmonary artery pressure and pulmonary artery wedge pressure were also observed before or after drug administration (19 ± 5 vs. 17 ± 10 mmHg and 7 ± 5 vs. 9 ± 3 bpm; P = 0.177 and 0.240 respectively). However, cardiac output was significantly increased and vascular resistance was significantly decreased after vericiguat treatment (4.0 ± 1.0 vs. 4.3 ± 1.1 L/min and 1719 ± 462 vs. 1467 ± 377 dynes·sec·cm-5; P = 0.016 and 0.002, respectively). FMD test results improved significantly after treatment (4.5 ± 5% vs. 8.1± 8%: P = 0.027), with the 6MWD increasing significantly by 42 m (311 ± 100 vs. 353 ± 50 m; P = 0.035). BNP also decreased significantly, whereas eGFR remained unchanged (317 ± 274 vs. 221.5 ± 200 pg/mL and 51.7 ± 21 vs. 51.5 ± 25.3 mL/min/1.73 m
2
; P = 0.015 and 0.967, respectively).

Conclusion:
Vericiguat may improve exercise tolerance by improving vascular endothelial function and cardiac output.
Abstract 12186: A Challenging Case of Acute Superior Mesenteric Artery Embolism Diagnosed by Gastroscopy
Authors: Tomura Nobunari , Nakagami Takuo , Hamaoka Tetsuro , Fukai Kuniyoshi , YAMAGUCHI Shinichiro , Matoba Satoaki
Published: December 2023

Introduction:
Acute superior mesenteric artery (SMA) occlusion is one of the most lethal causes of acute abdomen that we often experience but mistake for gastrointestinal diseases. The golden time for revascularization in cases of SMA main trunk occlusion is within 5 hours of onset, requiring prompt diagnosis and treatment. We describe a challenging case of acute SMA embolism diagnosed by gastroscopy.

Case Summary:
A 66-year-old man with a history of hypertension presented to the emergency department for marked epigastric pain after eating raw seafoods. On arrival, electrocardiogram showed atrial flutter with no significant ST-segment changes. Despite the elevation of white blood cell count and lactate dehydrogenase in blood exam, computed tomography (CT) indicated no findings to cause his symptoms. Emergency gastroscopy performed on suspicion of anisakiasis demonstrated pallor findings with hematologic material in the duodenum, suggesting intestinal ischemia (Figure A). Since contrast-enhanced CT revealed an occlusion of SMA (Figure B), we diagnosed acute SMA embolism based on the finding of atrial flutter without anticoagulation. After discussion among cardiologists and gastroenterology surgeons, we selected to perform endovascular treatment. The epigastric pain was improved after reperfusion using a self-expandable stent, but flared up as oral intake progressed. Follow-up CT suggested ischemic enteritis of the proximal jejunum, leading to conduct laparoscopic partial jejunectomy. He was discharged 18 days after the operation with the ability to eat a normal diet.

Conclusions:
This case highlights that we should keep in mind SMA embolism when examining acute abdomen patients with atrial fibrillation or flutter without anticoagulation.
Abstract 12291: Impact of History of Mental Health Disorder on In-Hospital Mortality in Patients With Heart Failure. A Population-Based Cohort Study
Authors: Al-Ayyubi Rami , Gonzalez Reyes Laura , Parepalli Divya , Mata Andres , Qudrat Ullah Muhammad , Sanivarapu Raghavendra , Garza John , Malik Muhammad Jehangir
Published: December 2023

Introduction:
Mental health disorders are associated with lower life expectancy and patients with mental disorders are at an increased risk of heart failure. Data on the prognostic impact of mental disorders on heart failure outcomes is limited and inconclusive.

Hypothesis:
Mental health disorders are associated with increased risk of in-hospital mortality in patients with heart failure.

Methods:
The study population were patients aged ≥18 years in acute care hospitals with heart failure as principal diagnosis in Texas for years 2016 through 2021. Three prespecified models were applied to estimate the association between mental disorders and in-hospital mortality. Multilevel, multivariable logistic regression with propensity adjustment was the primary analysis approach with propensity score matching and multivariable logistic regression without propensity adjustment applied as alternative analyses. Additional analyses were completed for patient subgroups, categories of mental disorders, and classifications of heart failures.

Results:
Out of 513,565 heart failure hospitalizations, 103,675 (20.2%) had mental disorders. Heart failure hospitalizations with vs without mental disorders were more commonly female (61.3% vs 46.0%), white (55.3% vs 46.9%), and obese (31.6% vs 26.4%), but had less frequent need for mechanical ventilation (1.8% vs 2.1%); p < 0.0001 for each. Unadjusted in-hospital mortality among heart failure hospitalizations with and without mental disorders was 1.7% vs 2.2%. On adjusted analyses, mental disorders remained associated with lower odds of in-hospital mortality (adjusted odds ratio 0.8650 [95% CI 0.8149-0.9183]). The results were similar for the alternative modeling approaches, subgroup analyses, and classifications of heart failure.

Conclusion:
Mental disorders were associated with substantially lower risk of in-hospital mortality for patients with a principal diagnosis of heart failure.
Abstract 12340: Association of Liver Enzymes With Incident Cardiovascular Disease Events and All-Cause Mortality in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)
Authors: Trejo Mario J , Floyd James S , Massera Daniele , Daviglus Martha L , Garcia-Bedoya Olga , Cai Jianwen , Schneiderman Neil , Talavera Gregory A , Tamayo-Murillo Dorathy E , Labovitz Daniel L , kaplan robert
Published: December 2023

Introduction:
Metabolic associated fatty liver disease (MAFLD) is a significant contributor to chronic liver disease on a global scale, encompassing a broad range of systemic impacts, including an increased risk of cardiovascular disease (CVD). Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels are commonly utilized indicators of liver injury in this context. Despite the high prevalence of MAFLD among Hispanic/Latino populations, there is a scarcity of research focusing on this specific demographic.

Aim:
To investigate the relationship between liver disease, incident CVD, and mortality in a representative Hispanic/Latino population, using non-invasive markers.

Methods:
A total of 14,149 participants recruited between 2008-2011 in HCHS/SOL aged 18-74 years with no pre-existing CVD at study baseline were included in this study. The outcome of interest was a composite of adjudicated incident CVD and all-cause mortality. Participants who had liver function tests (LFTs) AST > 37 IU/mL or ALT > 40 IU/mL for men, and AST or ALT > 31 IU/mL for women were classified as having elevated LFTs. MAFLD was defined as a fatty liver index score >60 and: type 2 diabetes, body mass index>25 kg/m
2
or at least two metabolic risk abnormalities. Survey-weighted cox proportional hazards models estimated hazard ratios (HR) and 95% confidence intervals (CI) for our composite outcome by elevated LFTs. Interaction terms assessed the relationship between elevated LFTs and MAFLD.

Results:
The study population was 40 years old on average, 53.4% female and had 403 weighted CVD and all-cause mortality events. Elevated LFTs and MAFLD alone were not associated with incident CVD and all-cause mortality (HR: 1.24; CI: 0.89-1.71). MAFLD modified the relationship between elevated LFTs and CVD (P=0.04). Among those with MAFLD, elevated LFTs were not associated with CVD (HR: 1.01; CI:0.70-1.46), but among those without MAFLD, elevated LFTs were associated with CVD (HR: 2.05; CI:1.17-3.58).

Conclusions:
Among Hispanic/Latinos without MAFLD, elevated LFTs were associated with CVD and all-cause mortality. Additional research is needed to elucidate the relationship between liver disease and CVD in the Hispanic/Latino population.
Abstract 12398: Prognostic Impact of Early Ablation in Patients With Decompensated Heart Failure Accompanied by Atrial Fibrillation
Authors: Okahara Arihide , kawai Shunsuke , Tokutome Masaki , Matsuura Hirohide , okabe kosuke , Sada Masashi , Itonaga Junpei , Koga Eiichi , Kisanuki Hiroshi , Hara Ayano , Ogawa Kiyohiro , Matsukawa Ryuichi , Mukai Yasushi
Published: December 2023

Introduction:
Atrial fibrillation (AF) and heart failure (HF) frequently coexist, which leads to worse clinical outcomes. Catheter ablation (CA) of AF in younger patients with HF with reduced EF (HFrEF) has become an established treatment option. However, clinical impact of early CA of AF in patients hospitalized for acute decompensated heart failure (ADHF) is uncertain.

Hypothesis:
This study aims to investigate the prognostic impact of early CA of AF in patients who were hospitalized for ADHF.

Methods:
Consecutive 234 patients with ADHF requiring in-hospital care accompanying with AF were retrospectively analyzed 2 years after discharge. Patients who underwent CA within 3 months after HF admission (CA group; n=51) and those who did not (optimal medical therapy [OMT] group; n=183) were compared with regards to clinical outcomes.

Results:
The median age of the studied population was 83 year-old; 72±12 in the CA group and 84±9 in the OMT group. Persistent AF was observed in 92.2% in the CA group and 63.9% in the OMT group. During 2 years after admission, recurrence of AF was observed in 19.6% in the CA group and 82.0% in the OMT group. In the crude study, all-cause mortality and HF mortality were significantly lower in the CA group than in the OMT group (all-cause: hazard ratio (HR) [95%CI]: 0.07 [0.01-0.53], p=0.00074; HF: HR 0.19 [0.07-0.48], p=0.000078; respectively) (Figure A and Figure B). Since the OMT group had severer characteristics including age, sex or NYHA class, a propensity-matched analysis was performed (n=33, each group). All-cause mortality tended to be lower in the CA group (HR 0.19 [0.02-1.67], p=0.13) (Figure C), however, it did not reach to a statistical significance. On the other hand, HF readmission rate was still significantly lower in the CA group even after the propensity-matched analysis (HR 0.17 [0.04-0.59], p=0.0054) (Figure D).

Conclusions:
CA of AF early after ADHF admission was associated with a better long-term prognosis in patients with HF and AF.
Abstract 12759: Thymidine Phosphorylase Enhances SARS-CoV-2 Spike Protein and Platelet Factor 4 Complex Formation: A Potential Novel Mechanism That May Account for COVID-19-Associated Thrombosis
Authors: Roytenberg Renat , Yue Hong , DeHart Autumn , Denning Krista , Li Wei
Published: December 2023

Introduction:
Scattered studies suggest that SARS-CoV-2 spike protein (SP) promotes platelet activation, though the exact mechanism is unknown. Thymidine phosphorylase (TYMP), which facilitates platelet activation and thrombosis, is significantly increased in the plasma and lungs of COVID-19 patients, suggesting that TYMP may play a role in the COVID-19 milieu.

Hypothesis:
We hypothesize that TYMP enhances SP/platelet factor 4 (PF4) complex formation and inhibition of TYMP attenuates SP-induced thrombosis and/or inflammation.

Methods:
BEAS-2B cells were treated with SP- or its receptor binding domain (RBD)-containing COS-7 cell lysate, or control cell lysate (p3.1) and TYMP and STAT3 expression were determined by western blot. The effect of SP on thrombosis was examined in K18-hACE2 and K18-hACE2/

Tymp
-/-

mice using the ferric chloride-induced carotid artery injury thrombosis model. SP-, TYMP-, or PF4-encoding plasmids were co-transfected into COS-7 and their protein interactions were assessed using co-IP, Blue Native-PAGE, and immunocytochemistry.

Results:
SP increased expression of TYMP and pY705-STAT3 in BEAS-2B. siRNA-mediated knockdown of TYMP reduced STAT3 activation. SP significantly enhanced thrombosis in the K18-hACE2 mice, which was inhibited by simultaneously treating mice with tipiracil, a selective TYMP inhibitor (
Figure
). K18-hACE2/

Tymp
-/-

mice were resistant to SP-enhanced thrombosis. For the first time, we found that SP, PF4, and TYMP form a complex whose formation is dose-dependently enhanced by TYMP.

Conclusions:
Our studies suggest that SARS-CoV-2 SP enhances TYMP expression and is prothrombotic and proinflammatory. TYMP inhibition, either via genetic knockout or by its chemical inhibitor, attenuates SP-enhanced thrombosis. TYMP promotes the formation of a PF4/SP complex, which provides a novel insight into COVID-19-associated thrombosis. TYMP could be a novel therapeutic target for COVID-19-associated sequelae.
Abstract 12780: Impact of Target Vessel on the Procedural Techniques and Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention
Authors: Kostantinis Spyridon , Rempakos Athanasios , Simsek Bahadir , Karacsonyi Judit A , Allana Salman S , Alexandrou Michaella , Alaswad Khaldoon , Basir Mir B , Davies Rhian , Benton Stewart , Krestyaninov Oleg , Khelimskii Dmitrii , Jaber Wissam , Rinfret Stephane , Nicholson William , Frizzell Jarrod , Jaffer Farouc A , Khatri Jaikirshan , Poommipanit Paul , Choi James , Chandwaney Raj H , jefferson brian , Patel Taral , Al-azizi Karim M , Potluri Srini , Aygul Nazif , Elguindy Ahmed M , Abi Rafeh Nidal , GOKTEKIN OMER , Mastrodemos Olga , Rangan Bavana V , Sandoval Yader , Burke M Nicholas , Brilakis Emmanouil S , gorgulu sevket
Published: December 2023

Introduction:
There is limited information on the impact of the target vessel on the procedural techniques and outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI).

Methods:
We analyzed the baseline clinical and angiographic characteristics and procedural outcomes of 11,580 CTO PCIs performed between 2012 and 2022 at 44 centers.

Results:
The most common CTO target vessel was the right coronary artery (RCA) (53.1%) followed by the left anterior descending artery (LAD) (26.0%) and the left circumflex artery (LCX) (19.8%). RCA CTO lesions were longer and more complex with higher J-CTO score compared with LAD or LCX CTO lesions. Technical success was higher among LAD (88.8%) lesions when compared with RCA (85.7%) or LCX (85.8%) lesions (p<0.001). The incidence of major adverse cardiovascular events (MACE) was overall 1.9% (n=220) and was similar among target vessels (p=0.916). There was a tendency towards more frequent utilization of the retrograde approach for more proximal occlusions in all three target vessels. When compared with all other RCA lesions combined, distal RCA lesions had higher technical success (87.7% vs. 85.3%; p=0.048). Technical success was similar between various locations of LAD CTOs (p=0.704). First/second/third obtuse marginal branch had lower technical success when compared with all other LCX lesion locations (82.7% vs. 86.8%; p=0.014). There was no association between MACE and CTO location in all three target vessels.

Conclusions:
LAD CTO PCIs had higher technical and procedural success rates among target vessels. The incidence of MACE was similar among target vessels, and also among various locations within the target vessel.
Abstract 12798: Cardiovascular Function and Prognostic Relevance of Cardiac Cachexia in Patients With Cancer; a Systematic Review and Meta Analysis
Authors: Shrestha Abhigan Babu B , Mainali Nischal , Adhikari Lukash , Umar Tungki Pratama , Shrestha Sajina , Rijal Rishikesh , SHRESTHA SHUMNEVA , Asija Ankush , Sedhai Yub Raj , Thapa Pratima , KC Sabin , Jaiswal Vikash
Published: December 2023

Introduction:
Cardiac cachexia (CC), a severe muscle-wasting condition prevalent in advanced cancers, poses significant implications for heart health.

Hypothesis:
To evaluate the specific alterations in clinical and imaging parameters and assess their prognostic value.

Methods:
A systematic search was conducted on PubMed, Cochrane, and Embase, covering articles available until June 1, 2023. The outcomes were pooled using a random-effects model, and mean differences (MD) with 95% confidence intervals (CI).

Results:
Our analysis included a total of 873 patients (670 cancer patients and 203 controls) from five studies. Cancer patients exhibited a significant reduction in LV Ejection Fraction [MD, 2.61 (95% CI: 0.29 to 4.93), I2=82.05%, p=0.03], LV Mass [MD, 26.59 (95% CI: 13.57 to 39.61), I2=0.00%, p<0.001], Left Ventricular Mass Index for height [MD, 8.028 (95%CI: 4.257-11.800), I2=0.00%, p<0.001] and LV Mass Index for Body Surface Area [MD, 9.684 (95%CI: 4.233-15.135), I2=0.00%, p=0.0005] for cancer patients. However, no statistically significant differences were found in Right Ventricular Wall Thickness [MD, -0.065 (95%CI: -0.246 to 0.115), I2=9.88%, p=0.4770], LV Wall Thickness [MD, 0.511 (95% CI: -1.027 to 2.049), I2=78.48%, p=0.5150], Intraventricular Septal thickness [MD, 0.420 (95% CI: -0.804 to 1.644), I2=76.71%, p=0.50], and LV End-Diastolic Volume Index [MD, -0.186 (95% CI: -7.222 to 6.849), I2=74.09%, p=0.9586]. Qualitative analysis: CC causes remodeling and hence, alters cardiac parameters. It is associated with chemo- and radiotherapy, and tumor progression. Furthermore, it is also linked to increased all-cause mortality.

Conclusions:
The presence of CC is associated with notable changes in various parameters, detectable through routine imaging techniques. Screening for these alterations may hold clinical importance in guiding the selection of appropriate cancer regimens for affected patients.
Abstract 12815: The Effect of Altitude on Cardiovascular Disease Mortality: Insights From a National Database in Ecuador
Authors: Nicolalde Bryan , Serpa Frans , Velez Arteaga Deisy Muriel , Caputi Zuniga Angelo Nicolas , Arias Ximena , Anazco Diego
Published: December 2023

Introduction:
Cardiovascular disease (CVD) is a leading cause of mortality worldwide. European population studies have shown a protective effect of high altitude on CVD mortality, but the applicability of these findings to Latin population remains to be explored. We aim to compare the mortality rates from ischemic heart disease (IHD), heart failure (HF), and cardiac arrhythmias between low- and high-altitude regions in Ecuador.

Hypothesis:
CVD mortality might be influenced by altitude

Methods:
We collected nationwide mortality data on different CVDs for each canton in Ecuador from 2017 to 2021 by using pre-defined ICD-10 codes. Then, we collected the mean altitude in meters above sea level (ASL) for each specific canton and classified them into low-(<2500 meters ASL) and high-altitude (>2500 meters ASL) cantons. We estimated the aggregated mortality rates per 100.000 persons and 95% confidence interval for high- and low-altitude regions at each timepoint.

Results:
From 2017 to 2021, 69.002 deaths due to CVDs occurred in Ecuador (IHD: 77.0%, HF:19.8% and cardiac arrhythmias: 3.2%). Mean age at death across different pathologies ranged between 76 and 81 years old, and most participants identified as multi-ethic (Table 1). There was a significantly higher mortality rate for HF and cardiac arrhythmias in high-altitude cantons than in low-altitude cantons at almost all timepoints (Figure 1). The mortality rates for IHD were lower for high-altitude cantons than low-altitude cantons at all timepoints.

Conclusions:
High-altitude cantons in Ecuador had higher mortality rates for HF and cardiac arrhythmias, but lower mortality rates for IHD when compared to low-altitude cantons.
Abstract 12858: Myocardial Infarction Promotes Breast Cancer Growth Through the Nerve Growth Factor/Tropomyosin Receptor Kinase A Pathway
Authors: Tani Tetsuya , Oikawa Masayoshi , Misaka Tomofumi , Ishida Takafumi , Takeishi Yasuchika
Published: December 2023

Background:
Epidemiological studies have suggested that patients with heart failure due to myocardial infarction (MI) have a higher cancer incidence. Nerve growth factor (NGF) plays a pivotal role in sympathetic nerve remodeling after MI, but several studies have suggested that NGF also plays a significant role in cancer progression. However, the impact of NGF on cancer progression in the setting of MI remains to be elucidated.

Methods and Results:
MI was induced by permanent ligation of the left anterior descending artery in female BALB/c mice. 4T1 cells, mammary tumor cells, were injected into the right mammary fat pad 2 weeks after surgery. Levels of NGF expression in the myocardium 3 days after surgery (1.40±0.17 AU vs. 1.00±0.09 AU, P=0.049) and serum NGF at 2 weeks after surgery (279±34 pg/ml vs. 173±16 pg/ml, P=0.044) were higher in the MI group than in the sham group. In addition, the tumor volume was significantly larger in the MI group than in the sham group 3 weeks after 4T1 cell injection (465.3±32.6 mm
3
vs. 292.1±28.3 mm
3
, P<0.001). The percentage of Ki67-positive cells in tumor tissue was higher in the MI group than in the sham group (37.1±5.7% vs. 16.5±3.6%, P=0.010). Moreover, phosphorylation activities of membranous tropomyosin receptor kinase A (TRKA, 1.54±0.04 AU vs. 1.00±0.09 AU, P<0.001) and AKT (1.56±0.18 AU vs. 1.00±0.08 AU, P=0.046) were higher in the MI group than in the sham group. Inhibition of TRKA by a TRKA inhibitor, GW441756 (20 mg/kg/week, I.P.), suppressed tumor volume in MI mice compared to DMSO-treated MI mice (281.6±34.8 mm
3
vs. 443.9±50.8 mm
3
, P<0.001). The percentage of Ki67-positive cells (31.9.1±2.8% vs. 42.2±2.0%, P=0.010), phosphorylation levels of TRKA (0.99±0.07 AU vs. 1.68±0.09 AU, P<0.001) and AKT (0.90±0.01 AU vs. 1.19±0.05 AU, P=0.001) in tumor tissues were decreased in GW441756-treated MI mice than in DMSO-treated MI mice.

Conclusion:
The NGF/TRKA pathway is involved in accelerated tumor cell growth under MI-induced heart failure.
Abstract 12869: Cardiac Intensive Care Unit Teams and Loved Ones Communicating (CICU TaLC) Intervention is Acceptable and Improves Interprofessional Clinician Communication and Teamwork in Pediatric Pre-Family Meeting Huddles
Authors: Walter Jennifer , Cetin Arzu , Quarshie William , Griffis Heather , DeWitt Aaron G , Feudtner Chris
Published: December 2023

Introduction:
Interprofessional teams often develop a care plan in pre-family meeting huddles before engaging with the family in the pediatric cardiac intensive care unit (CICU)—a process that can affect the course of the family meeting and alter team dynamics but often lacks optimal communication and teamwork.

Hypothesis:
An interprofessional team intervention for pre-meeting huddles in the CICU is acceptable and positively impacts teamwork.

Methods:
We enrolled and trained CICU clinicians in interprofessional communication skills with a focus on role clarity, then conducted a quasi-experimental pre-posttest study with clinicians participating in actual pre-family meeting huddles. Clinician acceptability was measured via survey and impact on team communication and teamwork in pre-meeting huddles was assessed using PACT novice, a TeamSTEPPS validated tool, on audio recorded and transcribed huddles. The tool evaluates the domains
Team Structure
,
Leadership
,
Situation Monitoring
,
Mutual Support
,
and Communication
on a five-point scale (1 = poor; 3 = average; 5 = excellent). Wilcoxon rank sum test assessed intervention impact on communication and teamwork at the meeting level comparing pre and post-intervention data.

Results:
24 Clinicians enrolled in the intervention (92% retention) with 100% completion of training. All trained clinicians recommend CICU TALC to others and 96% believe it improved their participation in family meetings. In 58 huddles (28 pre and 30 post), team performance in all 5 domains were significantly (p< 0.001) higher in post-intervention huddles than in pre-intervention. Median (IQR) comparisons: Team structure [pre 2.00 (1.75, 2.00) vs. post 5.00 (5.00, 5.00)], Leadership [pre 3.00 (2.00, 3.00) vs. post 5.00 (5.00, 5.00)], Situation Monitoring [pre 3.00 (2.75, 3.00) vs. post 5.00 (4.00, 5.00)], Mutual Support [pre 3.00 (2.00, 3.25) vs. post 5.00 (5.00, 5.00)], and Communication [pre 3.00 (2.00, 4.00) vs. post 5.00 (5.00, 5.00)].

Conclusion:
It is acceptable to implement an interprofessional team intervention to improve team communication and teamwork in interprofessional pre-family meeting huddles. Future research should assess broader impact of the intervention on clinicians, patients, and families.
Abstract 12990: Income and Outcomes in Atrial Fibrillation and Atrial Flutter: Insights From the National Inpatient Sample
Authors: Barrera Nelson I , Malik Mushrin , Elfert Khaled , Chamay Salomon , Gallegos Koyner Francisco J , Dhani Mohamed Angelina , Espiche Carlos A , Nazer Kamil , Cerrud-Rodriguez Roberto C
Published: December 2023

Background:
Socioeconomic factors are well-established, important determinants of cardiovascular health. In the United States, the association of personal income on the outcomes of patients with Atrial fibrillation (AF), and atrial flutter is unclear.

Hypothesis:
Lower socioeconomic status is associated with worse outcomes of patients with AF and atrial flutter.

Methods:
Utilizing the National Inpatient Sample (NIS), a retrospective descriptive study was conducted. We identified patients admitted for AF and atrial flutter from 2016-2020, our cohort was categorized based on patient income, which was determined using the median income for the patient's zip code. The low-income group(<$50000) included patients in the first quartile of income, while the high-income(≥$50000) group included patients in the second, third, and fourth quartiles of income. We excluded patients who were younger than 18 years of age. Baseline characteristics, presence of comorbidities, and outcomes of the two groups were described. Hypothesis testing for categorical variables was performed using Chi-Square. Continuous variables were tested with a t-test. Statistical significance was defined as a two-tailed
P
-value of <0.05. The clinical outcomes we evaluated included inpatient mortality, length of stay (LoS), total cost of hospitalization, acute kidney injury (AKI), blood transfusion, and cerebral vascular diseases.

Results:
In-hospital mortality was observed in 1% of the low-income group and 0.8% in the higher-income group (
P
-value <0.0001). LoS was 3.57+/- 0.013 in the low-income group and 3.27+/- 0.008 in the higher-income group. Total cost was $15081.22 in the low-income group and $16307.40 in the higher-income group, AKI (13.8% vs 12.6% in high-income group
P
-value <0.0001), blood transfusions (1.4% vs 1.1% in the high-income group
P
-value <0.0001), cerebrovascular disease (4.7% vs 4.5% in high-income group
P
-value < 0.0006).

Conclusion:
Our cross-sectional study observed that patients in a lower socioeconomic population had higher mortality during hospitalizations, and increased risk of cerebrovascular disease.
Abstract 12991: Geographical Disparities in Cardiovascular Death in Sarcoidosis
Authors: Tan Min Choon , Mirza Noreen , Yeo Yong Hao , San Boon Jian , Tan Jian Liang , Lee Justin , Mazzarelli Joanne , Russo Andrea M
Published: December 2023

Background:
While cardiac involvement in sarcoidosis could be significant, data assessing geographical disparities in cardiovascular deaths (CVDs) among patients with sarcoidosis are limited.

Objective:
This study aims to determine the mortality attributed to CVDs with comorbid sarcoidosis in different geographic locations in the United States.

Methods:
We queried the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research database and performed serial cross-sectional analyses of national death certificate data for CVDs with comorbid sarcoidosis among patients aged 25 and above. Diseases of the circulatory system (ICD-10 I00-I99) were listed as the underlying cause of death, and sarcoidosis (ICD-10 D86) as contributing cause of death. We calculated age-adjusted mortality rates (AAMRs) per 1,000,000 individuals and compared the mortality among census regions and states.

Results:
In the 22-year study period, 5,630 CVDs with comorbid sarcoidosis in the United States were identified between 1999 and 2020. The South region had the highest AAMRs for CVDs with comorbid sarcoidosis (1.32 [95% CI, 1.26-1.37] per 1,000,000 individuals), followed by Northeast region (1.25 [95% CI, 1.18-1.32] per 1,000,000 individuals), Midwest region (1.24 [95% CI, 1.17-1.30] per 1,000,000 individuals), and West Region (0.92 [95% CI, 0.86-0.98] per 1,000,000 individuals). The AAMRs for CVDs with comorbid sarcoidosis were between 0.57 [95% CI, 0.43-0.75] per 1,000,000 individuals and 1.96 [95% CI, 1.73-2.19] per 1,000,000 individuals throughout the States, except Maryland and the District of Columbia, which recorded 2.79 [95% CI, 2.44-3.14] and 6.01 [95% CI, 4.44-7.94], respectively.

Conclusion:
The South region, particularly Maryland recorded the highest CVDs in sarcoidosis. Geographical disparities observed in CVDs with comorbid sarcoidosis highlight the need to improve public health measures at state-level.
Abstract 13055: Different Impact of Immunosuppressive Therapy on Disease Activity and Cardiac Outcome in Isolated Cardiac Sarcoidosis and Systemic Sarcoidosis
Authors: Masunaga Tomoka , Hashimoto Toru , Fujino Takeo , Ohtani Kisho , Ishikawa Yusuke , Shinohara Keisuke , Matsushima Shouji , Ide Tomomi , Yamasaki Yuzo , ISODA TAKURO , Baba Shingo , Ishigami Kosei , Tsutsui Hiroyuki , Kinugawa Shintaro
Published: December 2023

Introduction:
Sarcoidosis is a systemic granulomatous disease of unknown cause, and cardiac involvement impacts its prognosis. Isolated cardiac sarcoidosis (iCS) has increasingly been recognized; however, its prognosis and efficacy of immunosuppressive therapy remains undetermined. The aim of this study is to clarify the clinical features and outcomes of patients with iCS and systemic sarcoidosis including cardiac involvement (sCS) receiving immunosuppressive therapy.

Methods and Results:
We retrospectively reviewed the clinical data of 42 patients with sCS and 30 with iCS diagnosed at our institution between 2004 and 2022. We compared the characteristics, and the rate of adverse cardiac events including cardiac death, fatal ventricular tachyarrhythmia, and heart failure hospitalization between groups. The median follow-up duration was 1535 [630, 2555] days, without significant difference between groups. There were no significant differences in sex, NYHA class, and left ventricular ejection fraction between groups. Immunosuppressive agents were administered in 86% of sCS and in 73% of iCS. When analyzed only with patients receiving immunosuppressive therapy (sCS, n=36; iCS, n=21), the cardiac event-free survival was significantly lower in iCS patients than sCS patients (37% vs. 79%, p=0.002). Multivariate analysis showed that iCS was an independent determinant for predicting adverse cardiac events. We evaluated the disease activity in 26 sCS and 16 iCS patients by quantitative measures of FDG-PET including cardiac metabolic volume and total lesion glycolysis, representing accurate three-dimensional distribution and intensity of inflammation. Although iCS patients had lower baseline disease activity than sCS patients, immunosuppressive therapy did not attenuate disease activity in iCS patients in contrast to sCS.

Conclusions:
iCS showed poorer response to immunosuppressive therapy and worse cardiac prognosis than sCS.
Abstract 13354: Higher Severe Maternal Morbidity Rates at Delivery Hospitalization Among Racial and Ethnic Groups Related to Chronic Hypertension and Hypertensive Disorders of Pregnancy
Authors: Najem Michael , Greenberg Mara , Sun Baiyang , Alexeeff Stacey , Alexander Janet , Roberts James M , Nguyen-Huynh Mai N , Gunderson Erica P
Published: December 2023

Severe maternal morbidity (SMM) affects 0.5-3% of pregnancies in the United States, with risk varying for racial and ethnic groups. Studies have rarely evaluated how chronic hypertension (cHTN) and hypertensive disorders of pregnancy (HDP) affect differences in SMM risk.

This study sought to evaluate cHTN and HDP as contributors to racial disparities in SMM rates.

Retrospective cohort study of 263,518 patients aged 18-46 years who received prenatal care ≤14 weeks' gestation and delivered a stillborn or live singleton birth ≥20 weeks’ gestation at a Kaiser Permanente Northern California hospital (2009-2019). We evaluated the relation of cHTN and HDP [preeclampsia (PE), gestational hypertension (GH) and superimposed preeclampsia (s_PE)] to SMM at delivery hospitalization, defined as the presence of at least 1 of 21 conditions meeting CDC criteria. Modified Poisson regression models estimated the adjusted relative risk (aRR) of SMM associated with cHTN and HDP among self-reported racial and ethnic groups [Asian, Black, Hispanic, Native Hawaiian Pacific Islander (NHPI), White] adjusted for covariables.

There were 13,626 women (5.2%) with cHTN, in whom 4297 (31.5%) developed s_PE. For patients with no cHTN, 11,744 (4.7%) developed PE and 11,514 (4.6%) developed GH. The overall SMM rate (number of cases/10,000 births) was 219.7. SMM rates were higher for patients with cHTN vs no cHTN (417.6 vs. 208.9, p<.0001), and for PE (934.3) and s_PE (898.3) vs no cHTN + no HDP (165.9), p<0.001. SMM rates differed for racial and ethnic groups. Compared to White patients with No cHTN or HDP, aRRs of SMM associated with PE and s_PE increased in order for White, Asian, Hispanic, Black, and NHPI groups (Table 1).

Preeclampsia was 6 times more prevalent among those with cHTN than no cHTN. Preeclampsia was strongly associated with higher SMM rates in both women with cHTN and without cHTN, especially among NHPI and Black groups. Preeclampsia may contribute substantially to racial disparities in SMM.
Abstract 13447: Political Orientation of Online Media Sources and Reporting of COVID-19 Vaccine Myocarditis
Authors: Hussain Muzna , Matsumura Addison , Garg Ria , Matsumura Martin E
Published: December 2023

Background:
Political orientation has played a role in patients' perceptions of risk associated with COVID-19 vaccination, including COVID-19 vaccine myocarditis (CVM). We examined the relationship between political orientation of popular online media outlets and reporting of CVM.

Methods:
Media sites were classified as “left” or “right" biased using the Allsides media bias rating report. For each site “COVID vaccine myocarditis” was searched in articles posted 5/21-12/22. Each search return was reviewed for the following: 1) Did it contain numerical data or reference the source of numerical data regarding CVM risk? 2) Did it report benefits of covid vaccination? 3) Did it mention covid
infection
-related myocarditis? Monthly reports of vaccine-related adverse events were obtained directly from the Vaccine Adverse Events Reporting System (VAERS). Correlations of reports of left- vs. right-leaning media were performed using Pearson Product Moment Correlation.

Results:
A total of 520 unique online reports regarding CVM were reviewed. Comparison of report volumes from left vs. right biased media sources by month during the assessment period demonstrated modest correlation (r=0.546, p=0.013), suggesting that monthly reporting volumes were driven by availability of information regarding CVM rather than media political alignment. Peak reporting across both left and right biased media was temporally proximate to peak volume of VAERS reporting. Left biased media sources were significantly more likely to include numerical data and/or links to source data vs. right biased sources (76.6% vs. 24.3%, p<0.001) and likewise were more likely to include data supporting benefits of covid vaccination (85.1% vs. 21.7%. p<0.001). In contrast, there was no difference regarding mention of COVID-19 infection-related myocarditis (24.5% vs. 24.3%, p=0.957).

Conclusion:
Political orientation of online news sites was not associated with frequency of CVM reports but was significantly related to report content, most notably whether reports included numerical vs verbal representations of CVM risk. These bias-related reporting characteristics may contribute to the relationship between political orientation and patient understanding of risk of CVM.
Abstract 13450: Clinical Outcomes With GLP-1 Receptor Agonists in Patients With Heart Failure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: Liu Yang , Zhao Huilei , Liu Menglu , Lin Weichun , Yu Peng , Liu Xiao , Wang Jingfeng
Published: December 2023

Background:
Glucagon-like peptide 1 receptor agonists (GLP-1 RAs) reduce the risk of major adverse cardiovascular events (MACE) in patients with type 2 diabetes mellitus (T2DM). However, there remains uncertainty about the efficiency of GLP-1 RAs in patients with heart failure (HF).

Methods:
Randomized controlled trials (RCTs) that reported the effect of GLP-1 RAs on prognosis in patients with HF were identified by searching databases.

Results:
There were nine RCTs involving 8,920 patients with HF included. GLP-1 RAs significantly reduced the risk of MACE compared with placebo (HR [hazard ratio]: 0.87, 95% CI [confidence interval] 0.77-0.98) in patients with HF and T2DM. The benefit was not observed in all-cause death (HR: 0.99, 95% CI 0.84-1.15), hospitalization for HF (HR: 1.04, 95% CI 0.89-1.22), cardiovascular death (HR: 0.95, 95% CI 0.79-1.16), myocardial infarction (HR: 0.88, 95% CI 0.71-1.08), stroke (HR: 1.03, 95% CI 0.75-1.43) and death or hospitalization for HF (HR: 1.07, 95% CI 0.78-1.46). GLP-1 RAs did not improve the change in LVEF (MD [mean difference]: -0.86, p=0.12, LVEDV (MD: 3.54, p=0.11), LVESV (MD: 2.78, p=0.07) or NT-proBNP (MD: -140.36, p=0.08). However, GLP-1 RAs significantly increased the change in the 6-MWT (MD: 19.74, p=0.002). In the subgroup analyses, human GLP-1 RAs, but not nonhuman GLP-1 RAs, reduced the risk of MACE (p interaction=0.11). Grading of Recommendations Assessment, Development and Evaluation (GRADE) showed moderate certainty for MACE, all-cause death and hospitalization for HF. Trail Sequential Analysis (TSA) revealed that there may be a high possibility of false positive results for MACE.

Conclusion:
Compared with placebo, GLP-1 RAs may reduce the risk of MACE in patients with HF and T2DM, with a more significant efficiency of human GLP-1 RAs.
Abstract 13473: 3D Fusion Between SPECT Myocardial Perfusion Imaging and Invasive Coronary Angiography to Guide Revascularization in Patients With Stable Coronary Artery Disease
Authors: Xu Zhihui , Malhotra Saurabh , Zhao Chen , li chunjian , ye zekang , Hua Rui , Wang Cheng , Zhou Weihua
Published: December 2023

Objective:
We evaluated the value of 3-dimensional (3D) fusion of SPECT myocardial perfusion imaging (MPI) with invasive coronary angiography (ICA) to guide revascularization.

Methods:
A retrospective observational study of 621 patients who underwent SPECT MPI and ICA. Based on the location of perfusion defect and stenosis on ICA, patients were classified into matched, unmatched, or normal groups via 3D fusion. The concordance between treatments was defined as, matched if there was revascularization in concordance with 3D fusion recommendation or if patient did not require revascularization; otherwise, they were classified as discordant. Major adverse cardiac events (MACE) (cardiac death, myocardial infarction, unstable angina requiring hospitalization or ICA, and unplanned revascularization) after revascularization of lesion recommended by 3D fusion were compared with those that the patients actually received.

Results:
Over a five-year follow-up period, 16% experienced MACE. Rates of MACE were 69% for matched findings, 22% for unmatched findings, 9% for normal findings (P<0.01). Among the 366 patients who had at least one vessel with a stenosis of >=50%, those whose treatments were concordant with the fusion had significantly better outcomes compared to those who were not (P<0.05), primarily observed in the intermediate stenosis group (stenosis: 50-79%) (P<0.01) (Fig. A). Further, in the intermediate stenosis patients, the revascularization ratio in the concordant group was significantly higher in the LCX (31.2% vs. 14.3%, P<0.01) than that in the discordant group. (Fig. B)

Conclusions:
3D fusion prior to coronary revascularization can guide coronary revascularization to improve outcomes, among patients with stable CAD patients and intermediate stenosis.
Abstract 13690: Diagnosis of Left Ventricular Hypertrophy on 12-leads Electrocardiogram by Historical Criterion and Machine Learning Models
Authors: Shimizu Masato , Tsunoda Takahiro , Sakai Eiko , Shimizu Atsuya , Misu Yoshiki , Ryo Tateishi , Yamaguchi Masao , Nobutaka Kato , Shimada Hiroshi , Isshiki Ami , Suzuki Hidetoshi , Fujii Hiroyuki , Suzuki Makoto , Nishizaki Mitsuhiro , Sasano Tetsuo
Published: December 2023

Introduction:
Diagnostic criterion of left ventricular hypertrophy (LVH) on 12-leads electrocardiogram (ECG) were established. We verified them comparing with artificial intelligence (AI) method.

Hypothesis:
Machine learning on 12-leads ECG show higher diagnostic performance comparing with historical criterion.

Methods:
First, consecutive 60 patients with LVH were recruited, and one to one matching with age and sex to patients with normal cardiac function was performed. Finally, 120 patients (69.6 ± 12.6years, 38men per group) were enrolled. LVH was defined as at least one LV wall (septum, posterior wall, apex) showed thickness over 15mm on ultrasound echocardiography. No sinus rhythm, and wide QRS cases were excluded.

Results:
By logistic regression analysis, 77 significant predictors were extracted. Among historical criterion, Cornell voltage showed high accuracy (0.783) and area under receiver operating characteristics curve analysis (AUROC; 0.808). Conversely, among AI methods, light gradient boosting machine demonstrated higher accuracy (0.843) and random forest method higher AUROC (0.882). V2/V2 S-wave amplitude and I/V5 T-wave amplitude played essential roles to build the AI models.

Conclusions:
AI diagnosis on ECG for LVH showed powerful diagnostic performance comparing historical criterion.
Abstract 13756: The Role of Glucagon Like Peptide-1 Receptor Agonists on Major Adverse Cardiovascular Events in Patients With Type 2 Diabetes Mellitus and Chronic Heart Failure: A Meta-Analysis From Cardiovascular Outcome Trials
Authors: KOMMU SHARATH
Published: December 2023

Introduction:
Meta-analyses on glucagon-like peptide-1 (GLP-1) receptor agonists have shown beneficial effects in reducing major adverse cardiovascular events (MACE) in patients with type 2 diabetes mellitus. However, it is unclear if they have similar beneficial effects in patients with type 2 diabetes mellitus and chronic heart failure.

Methods:
A search was performed on online databases - MEDLINE (via PubMed) and ClinicalTrials.gov, using the search words GLP-1 receptor agonist and cardiovascular outcomes. The references from the search results were also reviewed for potential studies that can be included. We identified four cardiovascular outcome studies with GLP-1 receptor agonists on patients with type 2 diabetes mellitus with data on patients with chronic heart failure, and included them in our meta-analysis.

Results:
6189 patients were evaluated in this meta-analysis, with 3053 in the GLP-1 receptor agonist group and 3136 in the placebo group. Among them, 475 (15.56%) major adverse cardiovascular events (i.e., cardiovascular death, stroke, or myocardial infarction) occurred in the GLP-1 receptor agonist group and 536 events (17.09%) in the placebo group with a hazard ratio (HR) of 0.90, 95% confidence interval (CI) of 0.79 to 1.01 and a p-value of 0.08, indicating a favorable effect with GLP1 agonists though statistically not significant.

Conclusion:
In patients with type 2 diabetes mellitus and chronic heart failure, GLP-1 receptor agonists may have a favorable effect in reducing major adverse cardiovascular events, though statistically not significant.