bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 18828: Generation and Characterization of a Novel
Myh11
Knock-In Smooth Muscle Cell-Specific CreEr
T2
Mouse Model
Authors: He Xiangqin , Dong Kunzhe , Hu Guoqing , Fulton David , Cai Chenleng , Zhou Jiliang
Published: December 2023

Background:
MYH11 is the most specific and robust marker for differentiated smooth muscle cells (SMCs) and its proximal promoter has been used as a SMC Cre-driver to investigate SMC-specific roles of floxed target genes. Two distinct

Myh11-CreER
T2

(

Myh11-CreER
T2
-Off

and
-RAD
) mouse lines have been used widely for inducible SMC-specific Cre/loxP-mediated recombination in conditional mutagenesis or lineage tracing. However, both mouse lines were generated using bacterial artificial chromosome (BAC), which were randomly integrated into the genome, potentially resulting in multiple copies of the transgene and the unpredictable disruption of endogenous genes. An additional limitation of the

Myh11-CreER
T2
-Off

mouse is its only works on the male mice. To address these limitations, we generated and characterized a new

Myh11-CreER
T2

mouse (

Myh11-CreER
T2
-KI

), which results from integration of a CreER
T2
cassette into the endogenous
Myh11
gene locus, enabling faithful SMC-specific lineage tracing or specific gene knockout in SMC
in vivo
in both sexes.

Method:
A tamoxifen-inducible, CreER
T2
cassette was inserted into one of the
Myh11
gene alleles after the initiation codon of
Myh11
. To validate the

Myh11
CreERT2/+

-mediated gene recombination in SMCs,

Myh11-CreER
T2
-KI

mice were crossed with mTmG dual reporter mice or the lncRNA
Carmn
GFP knock-in reporter/knockout mice to trace SMC lineages or generate SMC-specific inducible
Carmn
knockout mice. The recombination specificity in SMCs was analyzed by GFP fluorescence analysis.

Results:
The CreER
T2
cassette inserted into the
Myh11
gene locus negligibly affects endogenous MYH11 protein expression. In
mTmG
/

Myh11-CreER
T2
-KI

reporter mice, GFP expression was detected specifically in both vascular and visceral SMCs in various tissues after tamoxifen mediated Cre activation. Moreover,

Myh11-CreER
T2
-KI

-mediated
Carmn
SMC-specific deletion in adult female mice recapitulated the lethal intestinal pseudo-obstructive phenotype observed in male

Myh11-CreER
T2
-Off Carmn

KO mice.

Conclusions:
Our new

Myh11-CreER
T2
-KI

mouse model provides an additional genetic tool using the fidelity of an endogenous SMC gene locus to trace SMC lineages and delete genes in the SMC of both sexes of mice.
Abstract 18860: Molecular Pathways Altered in Pediatric Dilated Cardiomyopathy Hearts Are Dependent on Disease Etiology
Authors: Leroux Zoe N , Karimpour-Fard Anis , Neltner Bonnie , Taylor Matthew , Stone Matthew , Stauffer Brian L , Miyamoto Shelley D , Sucharov Carmen
Published: December 2023

Introduction:
Dilated cardiomyopathy presents a significant clinical burden in pediatric patients due to limited effective treatment options. This study hypothesizes molecular alterations in the heart of pediatric dilated cardiomyopathy (DCM) patients are dependent on specific etiologies. By understanding the molecular mechanisms underlying different etiologies, we aim to enhance diagnostics and guide future targeted therapies. An advanced understanding of the molecular mechanisms of DCM holds potential to transform pediatric cardiovascular care.

Methods:
RNA was extracted from the IRB approved University of Colorado's pediatric cardiac tissue bank. Samples included non-failing (NF), idiopathic dilated cardiomyopathy (IDCM), myocarditis, and left-ventricle non-compaction (LVNC) hearts. RNA-seq was performed using the Illumina HiSeq 4000 platform, and aligned using the TOPmed RNA-seq pipeline. Statistical analysis between NF and each etiology was performed to identify fold changes and q-values. Gene expression analysis was further examined using Ingenuity Pathway Analysis (Qiagen).

Results:
Demographics of patient samples were as follows: NF (N=23, % male=61%, Median age=13.65 years, Interquartile range (IQR)=8.6), IDCM (N=20, % male=55%, Median age=9.83 years, IQR=8.98), myocarditis (N=4, % male=75%, Median age=0.35 years, IQR=0.1), LVNC (N=3, % male=33.3%, Median age=0.27 years, IQR= Undetermined). Comparisons between NF versus IDCM, NF versus myocarditis, and NF versus LVNC hearts revealed noteworthy differences in gene expression patterns. Pathways associated with IDCM related to inflammation and immune response trends, whereas DNA repair and cellular damage were strongly associated with myocarditis. Lastly, analysis of LVNC hearts suggest pathways associated with ischemic remodeling.

Conclusions:
In conclusion, our study provides insights into gene expression patterns associated with different etiologies of DCM in pediatric patients. Distinct patterns were observed between non-failing and IDCM, myocarditis, or LVNC hearts. These findings have implications for improving diagnostics and guiding targeted therapies in pediatric DCM management.
Abstract 18862: Optimal High Sensitivity Troponin “Delta” for Prediction of 30-Day Mace
Authors: Garg Ria , Hussain Muzna , Matsumura Martin
Published: December 2023

Introduction:
High-sensitivity troponin (hsTnT) values are used extensively in clinical practice to determine acute myocardial infarction (MI). Most hsTnT algorithms use an accelerated diagnostic protocol based on ranges of hsTnT and time-based changes within those ranges. Little is known about the performance of a protocol based on absolute change with time regardless of absolute values. Research question: Is there a level of hsTnT change (dTnT) that can be used as a single decision factor in the triage of chest pain? Goals/Aims: To assess the diagnostic value of dTnT in ruling out 30-day MI or 30-day death and to identify optimal cut-off values.

Methods:
Retrospective review of patients with chest pain (CP) who presented to the ED of a single tertiary medical center between September 2017 to September 2019. Patients were included if they had at least 2 hsTnT measurements. dTnT was calculated using the difference between the first and second readings. Presence or absence of MI or death at 30 days from this ED presentation was also recorded from chart review. ROC analysis was performed to determine cut-off values for predicting each event. Statistical analysis was performed using SPSS.

Results:
dTnT was available in 488 patients and predicted 30-day MI (4/488) with a high AUC of 0.864 (p=0.01). The Cut-off value range of 12.5 to 20.5% had a similar sensitivity of 75% but the specificity increased as the cut-off increased to 20.5%, highest specificity being 87%.dTnT was not sensitive in predicting 30-day death, the AUC was 0.524 (p=0.9).

Conclusion:
Without compromising on sensitivity, the specificity of this test may increase as the cut-off value is increased. The use of troponin change as a risk marker for MACE in pts with CP has optimal sensitivity and good specificity in predicting 30-day MI and its diagnostic utility should be evaluated further.
Abstract 18875: Using the Proteome to Detect Biomarkers of Cardiovascular Comorbidities
Authors: Hagar Yolanda , Chadwick Jessica
Published: December 2023

Introduction:
Concomitant non-cardiovascular disorders in individuals with cardiovascular disease contribute to morbidity and mortality. However, commonly used statistical approaches for identifying biomarkers of disease typically only examine the relationship between the biomarker and one endpoint at a time, ignoring potential correlation across diseases. Use of more advanced statistical tools that model two endpoints simultaneously can provide additional insight beyond what is provided by commonly used methods.

Hypothesis:
Biomarker identification can be made more powerful through the use of Gaussian Process (GP) Bayesian analyses. This method quantifies how one or more biomarkers may predict two biological endpoints (which may or may not be correlated) simultaneously. It is hypothesized that this will allow for the detection of additional biomarkers of comorbidities that cannot be detected using standard univariate approaches.

Methods:
Plasma from 5,281 participants with cardiovascular disease and with or without at least one comorbidity (CKD and/or T2D) from the Atherosclerosis Risk in Communities study visit 5 were assayed for 5,284 proteins using the SomaScan® assay. The GP model was applied in a univariate context, quantifying the relationship between each individual protein and cardiovascular disease plus one either comorbidity (CKD or T2D), characterizing the relationship using t-tests and AUC. Results from the univariate Gaussian process models were compared to results from standard univariate logistic regression models.

Results:
The GP method identified an additional 283 proteins that were significant for
both
CVD and CKD simultaneously. These proteins were not identified using logistic regression. Similarly, in addition to the 969 found significant using logistic regression models, the GP method identified an additional 190 proteins that were significant for
both
CVD and T2D. Among all additional proteins identified, the average AUC increased 25-30%.

Conclusions:
Utilizing GP and the proteome, we can discover biomarkers and characterize their signal for comorbid endpoints associated with cardiovascular disease.
Abstract 18886: Rare but Fatal: Thrombus Formation and Cerebral Infarction Following Atrial Fibrillation Ablation
Authors: Udani Kunjan , Kosaraju Ateet , Subramanian Lakshmi , Srikanth Sashwath , Ardhanari Sivakumar
Published: December 2023

Introduction:
Atrial fibrillation (AF) ablation has become increasingly common as a first line treatment for young, healthy patients and recurrent AF. While the procedures are effective and safe with a mortality rate of <0.1%, it can be associated with fatal complications.

Case Presentation:
A 74-year-old male with a history of AF status post epicardial ablation, ascending and thoracic aortic aneurysm, hypertension, dilated cardiomyopathy, sick sinus syndrome and alcohol use presented with left hemiparesis and left sided facial droop. He had undergone radiofrequency ablation about 3 weeks prior. Initial evaluation for stroke with computed tomography (CT) of head and CT angiography (CTA) of head/neck was negative. He was intubated for airway protection. Upon insertion of the nasogastric tube, it had dark blood concerning for an upper gastrointestinal bleed. The hospital course was complicated by sinus bradycardia and severe hypotension requiring dopamine and norepinephrine infusions. Repeat CTA head/neck demonstrated new evolving infarcts in the left middle cerebral artery (MCA), left posterior cerebral artery and right MCA territories. During an esophagogastroduodenoscopy to rule out atrioesophageal fistula, patient had a vasovagal episode which resolved with epinephrine. Subsequent transesophageal echocardiogram (TEE) demonstrated an echogenic long protruding thrombus extending across the iatrogenic atrial septal defect from the right atrium to the posterior wall of the left atrium, attached near the ostium of the right lower pulmonary vein. Repeat CT head multiple new areas concerning for developing infarctions and pneumocephalus. Given his overall grim prognosis, the patient was transitioned to comfort care.

Conclusions:
As ablative procedures for management of AF become more prevalent, it is imperative to maintain a high clinical suspicion for rare but fatal complications which require prompt diagnosis and early aggressive management.
Abstract 18891: Frequency of Abnormal Cardiac Screens in US High School Athletes: Analysis of a National Cardiac Youth Registry
Authors: Fox Nicholas , Fox Nolan , Farrehi Clara , Dikdan Sean , Hajduczok Alexander , Shipon David M
Published: December 2023

Introduction:
Sudden cardiac arrest affects thousands of children annually, and many heart conditions go undetected by standard child health screens. Cardiac screening of adolescents can identify symptoms suggestive of abnormal cardiac conditions. Despite this, the benefit of cardiac screens in healthy adolescents remains equivocal.
Question:
At what rate do guideline based cardiac screens identify symptoms suggestive of cardiac abnormalities in the physically active youth?

Methods:
From 2014 to 2021, Simon’s Heart performed guideline-based heart screenings in youth athletes in Southeastern Pennsylvania. Cardiac screens included a health questionnaire, physical exam (height, weight, blood pressure, cardiac murmur findings), a 12-lead echocardiogram (ECG) read by cardiologists utilizing the international criteria, and echocardiography where recommended. An abnormal cardiac screen was classified as having any of the three abnormalities of hypertension (systolic ≥130 or diastolic >80), heart murmur, or ECG abnormality.

Results:
7425 students were screened during a seven-year period. Ages ranged from 12-20 (median of 15) and 61% were male. 1073 of the screened youth athletes (14.5%) had abnormal cardiac screens, 461 (6.2%) had hypertension, 268 (3.6%) had a murmur, 412 (5.5%) had an ECG abnormality and 234 were referred to cardiology for follow up (3.2%).

Conclusions:
This registry provides evidence that judicious youth athlete screening can uncover significant abnormalities which may require lifelong monitoring. Large registry data are needed to assess the efficacy of such programs.
Abstract 18892: Sleep Duration is Linked to Cholesterol Levels Among Hispanics: Findings From the National Health Interview Survey
Authors: Carrasco Mary , Moore Jesse , Blanc Judite , Locklear Clarence , Chung Debbie , Rogers April , Jean Louis Girardin , Seixas Azizi A
Published: December 2023

Introduction:
Short sleep duration is associated with unhealthy cholesterol levels, a significant cardiovascular risk marker. Precious epidemiological studies indicate that cardiovascular disease (CVD) accounts for 20% of deaths among Hispanics, and 75% have at least one risk factor associated with cardiovascular health. Little is known about whether sleep duration contributes directly to cholesterol levels among Hispanics.

Objectives:
1) Examine whether sleep duration predicts cholesterol levels; 2) Examine whether this relationship differs in Hispanics in comparison to non-Hispanics.

Methods:
This study was based on the 2020 National Health Interview Survey. Cholesterol, the outcome, is defined as whether an individual had high cholesterol during the last 12 months. Sleep quantity was categorized as follows: short sleep (< 7 hours), healthy sleep (7-8 hours), and long sleep (≥9 hours). For stratified analyses, we investigated whether the relationship between sleep duration and cholesterol differed between Hispanics and non-Hispanics. We performed unadjusted and fully adjusted binary logistic regression analyses, with age, sex, education, income, and BMI as covariates.

Results:
Among 37,558 participants, the mean age was 46.64 (SD=23.22 years; female= 53.2%); 9.5% of the sample was Hispanic and 90.5% was non- Hispanic. The inferential analysis was split into 3 groups: Full sample, Non-Hispanic only, and Hispanic only. Multivariate-adjusted regression analyses indicated that there’s a stronger association between short sleep and high cholesterol among the Hispanic only group (OR=1.50, p=.001) when compared to Non-Hispanic only (OR=1.15, p=<.001).

Conclusions:
Short sleep duration (≤6 hours) predicted high cholesterol for all three groups. Hispanics who suffer from short sleep are more vulnerable to having high cholesterol. Long sleep (≥9 hours) did not predict high cholesterol in any of the groups. Further research should look at if these findings are relative to cholesterol or other CVD risk factors, as well as what is the contribution of sleep, vs. diet, vs. exercise in reference to high cholesterol.
Abstract 18906: Post-COVID Hemodynamic Pathophysiology: Prevalence of Dysfunctional Breathing and Preload Insufficiency Using Novel Invasive Cardiopulmonary Exercise Testing
Authors: Honnekeri Bianca , Gupta Mohak , Paul Deborah , Mayuga Kenneth A , Tonelli Adriano
Published: December 2023

Introduction:
The pathophysiologic mechanisms underlying persistent post-COVID cardiorespiratory symptoms remain understudied, despite the significant worldwide prevalence. Invasive cardiopulmonary exercise testing (iCPET) is a novel investigation that can inform our understanding of underlying hemodynamic abnormalities.

Research Question:
What is the prevalence of dysfunctional breathing (DB) and preload insufficiency (PI) in post-COVID patients who undergo iCPET?

Methods:
We studied hemodynamic characteristics in a cohort of 52 post-COVID patients who underwent iCPET in a sitting bicycle. The protocol augments CPET with continuous hemodynamic and laboratory data from pulmonary artery catheterization and arterial line. PI is defined as abnormally low right atrial pressure during exercise and reduced peak cardiac output percentage of predicted. DB is characterized by exercise-induced oscillatory ventilation.

Results:
The study cohort had a mean age of 40.8 years, and 36 of the 52 patients (69.2%) were female. iCPET revealed the prevalence of only DB as 15.4%, only PI as 34.6%, both DB and PI as 34.6%, and neither DB nor PI as 15.4%. These 4 sub-groups were subsequently compared for analysis. Notably, the cardiac output percentage of predicted at peak exercise was significantly different between the 4 groups (95.4%, 81.2%, 85.1%, 102.9%; p=0.007). The differential between baseline (sitting) and peak (maximal exercise) right atrial pressure was also significantly different between the 4 groups (0.00, 0.056, 0.333, 4.875; p=0.026). Our study suggests that PI and DB are common entities noted in symptomatic post-COVID patients, and may co-occur.

Conclusion:
This study is a first step towards understanding the altered hemodynamics that drive common symptoms in post-COVID patients. iCPET yields physiologic mechanistic information that could inform targeted interventions.
Abstract 18911: Ventriculo-Atrial (VA) Interval as a Measure of Proof of Capture of the Left Bundle
Authors: Jiwani Sania , Nadkarni Ninad , Reddy Vivek , Noheria Amit , Sheldon Seth
Published: December 2023

Introduction:
Left bundle branch area pacing (LBBAP) has provided a safe and effective method of capturing the conduction system for physiologic pacing. Given direct capture of the conduction system, we hypothesized that in patients with retrograde conduction, capture of the left bundle would result in shortening of the interval from ventricular activation to atrial activation (VA interval). To our knowledge, proof of shortening of the VA interval has only previously described as a diagnostic method of confirming left bundle capture in one published case report. In our proof-of-concept study we demonstrate VA interval shortening in 3 patients with intact retrograde conduction noted intraoperatively.

Hypothesis:
Capture of the left bundle will result in shortening of the VA interval and can be used as a method to confirm LBB capture in patients with intact retrograde conduction.

Methods:
VA interval measurements were made in patients with intact retrograde conduction. VA interval measurements were performed with capture of the RV septum only and with capture of the left bundle branch. Measurements were all made during implantation and occurred either during active lead deployment, or after left bundle branch area pacing results were obtained. If left bundle branch area pacing results were obtained first, then pacing unipolar from the ring was used as a surrogate for RV septal capture and pacing unipolar from the tip was used for left bundle capture.We did not distinguish between selective and non-selective left bundle branch pacing in this study.

Results:
In all three patients, capture of the left bundle resulted in shortening of the VA interval. Changes in VA interval were noted to be: 208 ms to 186 msec, 239 msec to 189 msec and 245 msec to 191 msec. The image in Figure 1 illustrates shortening of the VA interval.

Conclusions:
In patients with retrograde VA conduction, VA interval shortening may serve as an additional useful criterion of left bundle branch capture.
Abstract 18923: Associations of Park Access With Physical Activity Levels During 1 Month Period After Acute Coronary Syndrome
Authors: Wu Clark Adriana , Murdock Margaret , Jurado Ammie , Sanchez Gabriel J , Diaz Keith , Duran Andrea
Published: December 2023

Introduction:
Physical activity (PA) is an important predictor of recovery after an acute coronary syndrome (ACS) event, and research has demonstrated the importance of neighborhood walkability on PA. Walkability is shaped by land use, density, and the development of parks and pedestrian spaces, which may be particularly important in urban areas. However, it is unclear whether discrete components of walkability, such as park access, independently impact PA levels in ACS survivors. The purpose of this study was to investigate how residential park proximity and percentage of park land use impact PA levels during the month following a suspected ACS event.

Methods:
This sample included patients (n=374, 49% female, 63 ± 11.9 y) who presented to the emergency department for suspected ACS. PA data (sedentary behavior [SB], light intensity [LPA], moderate-vigorous intensity [MVPA]) were collected using a wrist worn GENEActiv accelerometer for 30 days post-discharge. Park access was assessed using Geographic Information System and operationalized to include count of parks and percentage of land use covered by parks within a 1km radius area around each geocoded home address. Multiple linear regressions were conducted to determine the relationship between park access factors (count and land use), PA levels, and SB.

Results:
Models adjusted for demographics, comorbidities, and disease severity indicators (Grace risk score, length of hospitalization) found a statistically significant positive association between park land use and MVPA (B [95% CI]= 44.25 [4.55-83.94], p-value=0.029). Additionally, there was a statistically significant positive association between park count and SB (B [95% CI]= 1.97 [0.42-3.53], p-value=0.013).

Conclusions:
We found that residential park land use was positively associated with MVPA in the first month following suspected ACS. Additionally, there was a positive association between park count and SB. These findings suggest that greater park access in neighborhoods may play a significant role in activity levels during ACS recovery. Future research is needed to understand which aspects of urban park design/environment should be modified to enhance physical activity and reduce sedentary behavior in ACS survivors.
Abstract 18931: A PCSK9 and APOB Double Heterozygote Presenting Phenotypically Similar to Homozygous Familial Hypercholesterolemia
Authors: Haynes Tiffany M , Kukuc Laura , Proute Matthew , Fishberg Robert
Published: December 2023

Introduction:
Familial hypercholesterolemia (FH) is an inherited disorder associated with mutations in APOB, PCSK9 and LDLR genes. Heterozygous FH (HeFH) generally has one gene mutation. Homozygous FH (HoFH) has two mutations in the same gene and is characterized by vastly elevated plasma LDL-C, accelerated ASCVD and resistance to standard lipid-lowering therapy. Combinations of mutations can present with a phenotype similar to HoFH. We present a double heterozygous patient with unreported mutations in PCSK9 and APOB genes, exhibiting clinical features of HoFH.

Hypothesis:
Patients with multiple gene mutations for FH can present clinically similar to HoFH and would benefit from novel lipid lowering therapies

Methods:
73-year-old female with a history of diabetes and hyperlipidemia presented in 2018 with dyspnea on exertion. Cholesterol (TC) and triglycerides (TG) were 430 and 715 mg/dl respectively, on rosuvastatin 40 mg and omega 3 fatty acids. Physical exam showed arcus senilis. A nuclear stress test showed ST depressions in inferolateral leads but normal scintigraphy. Genetic testing revealed APOB and PCSK9 mutations. She was then treated with rosuvastatin, icosapentyl ethyl, ezetimibe and fenofibrate. TC, LDL, TG and ApoB levels were 463, 236, 747 and >240 mg/dl respectively. Evolocumab was added, with reduction of TC, TG and ApoB levels to 326, 432 and 182mg/dl, despite maximal available therapy.

Results:
Genetic testing revealed APOB variant NP_000375.2:p.Gln3378His and PCSK9 variant NP_777596.2:pAla544Thr, which were unreported mutations with unknown clinical significance. Genetically, this patient is a double heterozygote but expresses a phenotype similar to HoFH due to a poor response to maximum therapy.

Conclusions:
Although usually genetically defined, the phenotype of HoFH can present with different genetic variations. Chaudhry et al established genetic diagnosis of HoFH in 0.9% of patients initially diagnosed as HeFH, of which 3 were true homozygotes and 3 were compound heterozygotes. These findings support the idea that various heterozygous combinations of mutations in the genes for LDLR, APOB and PCSK9, may present clinically similar to HoFH. Patients with these mutations could benefit from novel agents such as evinacumab.
Abstract 18949: Bariatric Surgery is Associated With Improved Coronary Microvascular Function and Cardiorespiratory Fitness in Patients With Ischemia and Non-Obstructive Coronary Arteries (INOCA)
Authors: do Amaral Henrique de Souza Ana Carolina , Moura Filipe A , Divakaran Sanjay , Sirianni Karla , Sheu Eric G , Di Carli Marcelo F , Redline Susan , Tavakkoli Ali , Taqueti Viviany R
Published: December 2023

Introduction
- Severe obesity is associated with cardiometabolic disease and coronary microvascular dysfunction, as reflected by impaired coronary flow reserve (CFR). Bariatric surgery promotes sustained weight loss and lower incidence of diabetic microvascular complications, but its effect on the coronary microcirculation is unclear. In this ongoing pilot study, we aimed to investigate the impact of bariatric surgery on CFR, endothelial function, and cardiorespiratory fitness in patients with severe obesity and INOCA.

Methods
- Consecutive patients (N=19) with severe obesity (BMI≥35 kg/m
2
), exertional dyspnea and planned bariatric surgery were enrolled. Patients underwent cardiac stress positron emission tomography (PET), peripheral arterial tonometry (PAT), echocardiogram and cardiopulmonary exercise testing (CPET) at baseline and after a median of 6.2 months post-surgery (N=9 completed to date). CFR was quantified as stress/rest myocardial blood flow (MBF) from PET. Reactive hyperemia index (RHI), a marker of endothelial function, was calculated as the ratio between PAT signal post and pre-occlusion in the corresponding arm.

Results
- Median age was 50 (Q1-Q3 42-54) years and 63% were female. At baseline, median BMI was 43 (40-54), LVEF was 0.62, and %LV visual ischemia was 0. Higher BMI inversely correlated with CFR (r= -0.53, p=0.02). As compared to baseline, patients post-surgery (78% sleeve gastrectomy, 22% gastric bypass) had significantly decreased BMI (45.2 vs. 34.3, p=0.008) and improved stress MBF [1.8 (1.3-2.2) vs. 2.4 (1.8-2.8), p<0.02], CFR [2.3 (1.9-2.6) vs. 3.1 (2.4-3.6), p<0.02] and peripheral endothelial function [RHI 1.5 (1.4-1.8) vs. 2.4 (1.8-2.8) vs. p=0.04]. These changes were accompanied on CPET by significantly higher exercise workload [112 (84.2-146) vs. 124.5 (90.5-149) W, p=0.046] and relative peak VO
2
[12.5 (11.9-14) vs. 15.2 (12.6-17) mL/kg/min, p=0.028]. Higher stress MBF directly correlated with relative peak VO
2
(r=0.53, p=0.04).

Conclusion
- In this pilot clinical study, bariatric surgery was associated with significant improvements in coronary microvascular function, peripheral endothelial function, and cardiorespiratory fitness in symptomatic patients with severe obesity after six months.
Abstract 18956: Knowledge of and Attitude Towards Clinical Trials Among Women in Rural Areas: A Survey-Based Study
Authors: Skuk Moatamn , Al-Jorani May S , Farhan Hasan A , Al-Agele Farqad R , Dakhil Zainab A
Published: December 2023

Introduction:
In evidence-based era of cardiology with emerging of potential therapies, it is crucial to include diverse population in terms of (geography, gender, race, and economic status) in clinical trials (CT) to enhance generalizability of trials results. Such inclusion necessitates exploring barriers and motivators of diverse population for participation in CT. There is lack of data from Middle Eastern countries regarding perspectives of population about CT. Furthermore, there is no data about perceptions of Iraqi population in general and women in particular regarding CT.

Research question:
We aim to explore knowledge and perceptions of female patients about CT.

Methods:
Paper-based survey was filled by investigators during face-to-face interview with women attending healthcare facilities in a rural area in Iraq.

Results:
n=50, mean age=28.7 year, 50% had primary education level. 36% defined CT as experiments to test a new drug or procedure. Main concerns to participate in CT was safety 62%. 32% said they would participate in CT if they were asked to. 20% said they will participate in CT involving surgery or procedure if were asked to. 80% reported they would participate in education CT (CT involving telemedicine/video programs as intervention). Although all participants never participated in CT before, 80% had concerns about CT in general. 34% of women thought that family duties could prevent them from commitment with trials. 70% agreed to participate in clinical trials if drug safety was ensured, while 90% refused to participate in trials if the drug had unknown safety. 86% of participants agree to participate in trials if it was open label.

Conclusions:
Safety was a major concern of respondents for participation in CT. Establishing patient public involvement is essential step towards initiating CT ecosystem in Iraq. Being aware of population perceptions and concerns are critical to include this under-represented population in cardiovascular CT.
Abstract 18984: Artificial Intelligence-Based Automated Left Ventricle Mass Quantification From Non-Contrast Cardiac CT Scans: Correlation With Contrast CT and Cardiac MRI
Authors: Han Donghee , Shanbhag Aakash , Killekar Aditya , Waechter Parker B , Kwok Nicholas , Berman Daniel , Slomka Piotr J
Published: December 2023

Background:
Non-contrast CT scans are currently not used to assess left ventricular myocardial mass (LV mass), which is usually evaluated with contrast CT or cardiac magnetic resonance (CMR). We aimed to assess the feasibility of LV mass estimation from non-contrast CT calcium scans using an artificial intelligence (AI) approach and compare it to measurements from contrast CT and CMR.

Methods:
A total of 316 patients (Age: 57.1±16.7, 53.2% male) who underwent coronary CT angiography (with non-contrast calcium CT and contrast CT) and CMR were included. The median interval between CT and CMR was 22 days (IQR: 3-76). An nn-Unet AI model (Total Segmentator), previously trained on data from independent sites, automatically segmented non-contrast CT structures including the myocardium. LV mass was also measured from contrast CT and CMR by experts during routine clinical reporting.

Results:
The AI segmentation took ~22 seconds per case. There was no significant difference in LV mass between the AI and contrast CT (136.5±55.3 vs. 139.6±58.0 g, p=0.114). An excellent correlation was observed between AI and contrast CT (r=0.84, p<0.001) (Figure). Bland-Altman analysis showed a minimal bias of 3.15. Compared to CMR, both AI and non-contrast CT showed higher LV mass (136±55.3, 139.6±58.0 vs. 127.1±53.1 g, respectively, both p<0.001). The correlations of AI and contrast CT with CMR were excellent with no significant differences. (r= 0.86 and 0.85, both p<0.001). Bland-Altman analysis indicated small bias toward higher LV mass with AI and contrast CT (-9.35 and -12.5, respectively) compared to CMR.

Conclusions:
The AI-based automated LV mass from non-contrast CT showed excellent correlations and minimal biases when compared to LV mass measured from contrast CT and CMR. This fully automated measure could be applied for routine LV mass evaluation in patients with a non-contrast CT scan, providing an additional biomarker previously thought not measurable by this modality.
Abstract 19021: Metabolomic Characterization of Responses to Angiotensin Peptides in Human Brain Microvascular Endothelial Cells
Authors: Diaz-Valencia Andres C , Cala-Molina Monica P , Pena-Silva Ricardo A
Published: December 2023

Introduction and hypothesis:
Metabolomics offers a robust platform for dissecting the intricate molecular responses of biological models under distinct stimulation scenarios. The mechanism by which Angiotensin 1-7 modulates Angiotensin II signaling in endothelial cells is unclear and may involve events at the cellular membrane or downstream signaling pathways. We hypothesize that metabolomics can help us identify shared and distinct metabolic responses induced by these two molecules.

Methods:
hCMEC/D3 cells were cultured and then subjected to stimulation with Ang-II and Ang 1-7 during their logarithmic growth phase. Subsequent metabolomic profiling incorporated both RP-LC-QTOF-MS and GC-QTOF-MS analytical techniques. Our data analysis strategy was multilayered, implementing quality control alongside various multivariate statistical methods, such as principal component analysis (PCA), partial least squares discriminant analysis (PLS-DA), and hierarchical clustering.

Results:
Our results underscore a discernible pattern of decreased and increased metabolite expression in response to angiotensin treatments, with noteworthy variations observed in the expression of glycerophospholipids, sterol lipids, and sphingolipids amongst the Ang-II, Ang 1-7, and control groups. Intriguingly, an "ON/OFF" pattern for numerous metabolites emerged across the experimental groups, hinting at shared biological activity provoked by both angiotensin treatments. The compounds Erucamide, Dihydroxy-chol-en-oic Acid, and LPE O-19:0;O significantly contributed to the discrimination between Ang-II and Ang 1-7 treatment groups when compared with controls.

Conclusions:
These findings offer a novel perspective on the distinct metabolic responses induced by Ang-II and Ang 1-7 treatments in hCMEC/D3 cells, and may shed light on the cellular mechanisms that underlie the impact of these angiotensins, and other vasoactive peptides, on the blood-brain barrier. Overall, our study reaffirms the value of metabolomics as a powerful tool for gaining new insights into the molecular effects of vasoactive peptides on endothelial cells.
Abstract 19026: Racial and Socioeconomic Disparities Among Inpatients With Pulmonary Hypertension: A Nationwide Study
Authors: Asafu-Adjaye Frempong , Somoza-Cano Francisco , Asafu-Adjaye Sedina , Amoah Joseph , Akamah Joseph A
Published: December 2023

Introduction:
Healthcare-associated racial disparities have become a significant public health concern. Due to the increase in morbidity and mortality associated with pulmonary hypertension (PH), we sought to explore whether race and socioeconomic status impact the disease’s burden.

Methods:
We identified adults 18 and above, with primary or secondary diagnoses of PH (all groups) using 2020 National Inpatient Sample (NIS) database. The ICD-10-CM codes were used. Data were analyzed using Stata 18.

Results:
Of 5,533,733 adults admitted, 4516 (8%) were diagnosed with PH. Mean age was 64.99 (SEM: ± 0.40), and 2784 (61.6%) were females. The mean length of stay was 5.09 ± 6.61 (SD). Data was missing for 92 patients regarding race. Of the sample of 4424, the majority (2743) were Caucasians (62.0%). The other races were Blacks 1066 (24.1%), Hispanic 398 (9.0%), Asia/Pacific Islanders 89 (2.0%), Native American 14 (0.3%), and others 114 (2.6%). Regarding socioeconomic status, 547 (20.0% of Caucasians), 518 (48.6% of Blacks), 162 (40.7% of Hispanics), 8 (9.0% of Asia/Pacific Islanders), and 35 (27.3% others) had low median household income defined as < $50,000 (p <0.001). The median cost of care was $73,337 ± 156,008. Among these patients with primary or secondary diagnoses of PH, the mortality rate was 2.8% (126/4516). Blacks had higher odds (cOR 1.62, 95% CI: 1.10-2.40, p<0.05) of inpatient mortality compared to Caucasians. However, the multivariate logistic analysis revealed no significant association after adjusting for age, gender, length of stay, median household income, total charges, and Charlson index (comorbidities).

Conclusions:
Racial disparities exist regarding PH-related admissions, with a higher likelihood of mortality among Blacks and persons with low socioeconomic status. The cost of health care in this population was high. Additional research is needed to focus on reducing disparities in healthcare regarding PH.
Abstract 19031: Leveraging Electronic Health Records to Examine Blood Pressure Patterns Preceding Stroke Events
Authors: Lee Dana , Nene Aishwarya , Liu Yuntian , Lu Yuan , Spatz Erica S
Published: December 2023

Introduction:
Hypertension (HTN) is the primary modifiable risk factor for stroke, with blood pressure (BP) control being paramount. Yet only one-fourth of patients with HTN who are receiving medical care have controlled BP. Accordingly, we aimed to elucidate patterns of BP control prior to incident stroke.

Methods:
We analyzed electronic health record data from patients who were hospitalized for a first stroke within the Yale New Haven Health system between 2015 and 2021. Patients were included if they had ≥2 outpatient visits in the 2 years prior to stroke to capture those regularly seeking care. BP measurements for all ambulatory visits were extracted. Systolic BP (SBP) and diastolic BP (DBP) were categorized as the number of BP measurements that were elevated (SBP >140mmHg or DBP >90mmHg), moderately elevated (SBP >160mmHg or DBP >100mmHg), and severely elevated (SBP >180mmHg or DBP >120mmHg), and by age group, sex, race and ethnicity.

Results:
Among 6,047 patients with a first stroke, the mean age was 72 years, SD= 15; 52% were female; 17% were Black/African American; and 8% were Hispanic/Latino. Table 1 displays the proportion of patients with ≥2, ≥3, ≥ 4, and ≥5 BP measurements by category of BP elevation. Patients who were aged 55-64 years, of Black/African American race, and of Hispanic/Latino ethnicity were more likely to have severely elevated BP than their relative subgroups, with Black/African American patients having the highest proportion of BP elevation across all categories compared to other racial/ethnic groups.

Conclusion:
Despite receiving regular medical care, 75% of patients had ≥2 BP measurements >140/90mmHg in the 2 years prior to stroke; over 1 in 5 patients had >2 BP measurements ≥160/100mmHg. BP patterns were most elevated among middle-aged and Black/African American patients. New approaches are urgently needed to control BP and prevent stroke.
Abstract 19037: Metabolomics Reveals Aerobic Glycolysis and 1-Carbon Metabolism as Major Metabolic Signature During Human Platelet Activation
Authors: Nayak Manasa K , Ghatge Madankumar , Flora Gagan D , Chauhan Anil K
Published: December 2023

Introduction:
Evolving evidence suggests that besides signaling pathways, platelet activation involve a complex interplay between metabolic pathways to support thrombus growth. Selective targeting of metabolic checkpoints may inhibit platelet activation and provide a novel antiplatelet strategy. We examined global metabolic changes that occur during the transition of human platelets from resting to an activated state to identify metabolites and associated pathways that contribute to platelet activation.

Methods:
We performed metabolic profiling (through Metabolon Inc.) of resting and stimulated human platelet samples. The differential levels analysis, pathway analysis, and PCA were performed using Metaboanalyst. Metascape was used for metabolite network construction.

Results:
Of the 401 metabolites identified, 202 metabolites were significantly upregulated, and two metabolites were downregulated in activated platelets. Of all the metabolites, lipids scored highly and constituted ~50% of the identification. During activation, aerobic glycolysis supports energy demand and provides glycolytic intermediates required by metabolic pathways. Consistent with this, an important category of metabolites was carbohydrates, particularly the glycolysis intermediates that were significantly upregulated compared to resting platelets. We found that lysophospholipids such as 1-palmitoyl-GPA, 1-stearoyl-GPS, 1-palmitoyl-GPI, 1-stearoyl-GPI, 1-oleoyl-GPI were upregulated in activated platelets. We speculated that platelet activation could be linked to One-carbon (1C) metabolism, a set of biochemical pathways that involve transfer and use of 1C units from amino acids, for cellular processes, including nucleotide and lysophospholipid synthesis. In alignment, based on pathway enrichment and network-based prioritization, the metabolites from amino acid metabolism, including serine, glutamate, and branched-chain amino acids pathway were upregulated in activated platelets, which might be supplemented by the high levels of glycolytic intermediates.

Conclusions:
Metabolic analysis of resting and activated platelets revealed that aerobic glycolysis and 1-C carbon metabolism are vital to support platelet activation.
Abstract 19047: Comparison of Drug-Eluting Stent With Bare-Metal Stent Implantation in Femoropopliteal Artery Disease: A Systematic Review and Meta-Analysis
Authors: Chunawala Zainali , Goyal Aman , Jaiswal Vikash , Moussa Issam , Hassan Atif , Bhatia Kirtipal , Qamar Arman
Published: December 2023

Introduction:
Trials comparing drug eluting stent (DES) versus bare metal stents (BMS) in patients undergoing endovascular therapy for femoropopliteal artery disease (FPAD) have shown variable results. Data indicating clear patency benefit of DES has not been definitively demonstrated.

Methods:
Medline, Embase, & Cochrane Central databases were searched to identify previous studies comparing efficacy of drug eluting stent versus bare metal stents in treatment of FPAD. The primary outcome of interest was risk of restenosis. Secondary outcomes included all-cause mortality, stent fracture, target vessel revascularization and primary patency. Odds ratios (OR) were pooled using a random-effect model while heterogeneity among studies was assessed using the Higgins I
2
value.

Results:
A total of 7 studies (5 RCTs and 2 retrospective cohorts) with 1786 patients were included in our analyses. The risk of target vessel revascularization was significantly reduced with the use of DES (OR: 0.69, 95% CI: 0.49-0.98, I
2
= 0) as compared with BMS. However, there was no significant difference observed in risk of restenosis (OR: 0.83, 95% CI 0.59-1.16), primary patency (OR: 1.09, 95% CI 0.91-1.29), stent fracture (OR: 0.84, 95% CI 0.27-2.67) and all-cause mortality (OR: 1.65, 95% CI 0.71-3.85).

Conclusion:
The risk of target vessel revascularization was significantly reduced with the use of DES implantation in patients with FPAD. However, DES does not seem to provide much benefit in terms of clinical outcomes. Further larger RCTs are needed to provide more evidence in the comparison between DES and BMS for FPAD.
Abstract 19059: Risk Factors for the First Cardiopulmonary Hospitalization Differ From Those of Recurrent Cardiopulmonary Hospitalizations in Patients With Cardiovascular Disease Vaccinated Against Influenza —
A Secondary Analysis of the INVESTED Trial
Authors: Behrouzi Bahar , Claggett Brian , Havighurst Thomas , Mao Lu , Joseph Jacob , Austin Peter , Lee Douglas , Vardeny Orly , Solomon Scott , Udell Jacob A
Published: December 2023

Background:
Influenza vaccines are recommended for patients with CVD due to their protective effects and favorable safety profile. Patients with recent MI/HF hospitalization are at high risk of multiple events, but it is not known which flu vaccine type can mitigate recurrent events.

Research Questions:
What are predictors of recurrent cardiopulmonary hospitalization and death in patients with CVD and does the high-dose trivalent flu vaccine reduce the rate of recurrent events compared with standard-dose quadrivalent vaccine?

Methods:
In this pragmatic, active comparator trial, patients with recent MI/HF hospitalization across 157 sites were randomized to either vaccine type and revaccinated each enrolled season (2016-2019). Recurrent event analysis with a Markov multistate model, negative binomial, and Lin-Wei-Yang-Ying regression models was applied, adjusting for clinical and sociodemographic factors, flu infection and vaccine history, with vaccine type as the main exposure. Cardiopulmonary hospitalization and all-cause death comprised the multistate model’s main states and the composite primary outcome for remaining analyses.

Results:
Among 5260 patients (mean age 65.5 years; 28% women; 63% with recent HF), 12% were readmitted ≥1 for cardiopulmonary causes, accounting for half of total cardiopulmonary hospitalization. In the multistate model, a history of comorbidities (e.g., low LVEF and COPD) was associated with recurrent hospitalization (Figure), whereas age and frailty primarily determined a higher rate of death, particularly after a first hospitalization. There were no significant differences between the vaccines on the rate of recurrent events and death in the multistate and negative binomial regression models.

Conclusions:
As hospitalizations accrue, the association of certain predictors changes in this population. Alternative strategies beyond vaccine type are needed to mitigate the total burden of cardiopulmonary disease.
Abstract 19062: Prognostic Impact of Coronary Microvascular Dysfunction on Diastolic Dysfunction and Cardiovascular Events in Patients With Acute Coronary Syndrome
Authors: Seo Chang Ok , Kim Moojun , Kim Hangyul , Kim Kyehwan , Koh Jin-sin , Hwang Seokjae , Hwang Jinyong , Kang Min Gyu
Published: December 2023

Introduction:
Coronary microvascular dysfunction (CMD) has prognostic value in coronary artery disease.

Hypothesis:
CMD could have an influence on progression of diastolic dysfunction and occurrence of cardiovascular events in acute coronary syndrome (ACS).

Methods:
We prospectively enrolled ACS patients who underwent successful percutaneous coronary intervention (PCI). CMD was defined by index of microcirculatory resistance (IMR >40) after PCI. Cardiac diastolic dysfunction was defined by echocardiographic parameters (early diastolic transmitral flow velocity/early diastolic mitral annular velocity, e’ velocity, tricuspid regurgitation velocity, and left atrial volume index). The primary end point was 1-year diastolic dysfunction and secondary end point was cardiovascular death or admission for heart failure during 5 years of follow-up.

Results:
Among 163 patients, 39 patients (23.9%) had CMD. Prevalence of 1-year diastolic dysfunction was increased during 1 year (baseline 29.4% vs. 1 year 46.0%). Progression rate of diastolic dysfunction during 1 year was significantly higher in CMD (40.3% vs. 64.1%, OR 2.64, p=0.008) (Figure). After adjustment with clinical variables, presence of CMD was strongly associated with progression of 1-year diastolic dysfunction (HR, 2.95, 95% CI 1.30 - 8.74, p=0.030). Risk of cardiovascular death or admission for heart failure was increased in CMD (37.9% vs. 7.1%; Log-rank test p=0.003)

Conclusions:
This study showed the association between presence of CMD and progression of diastolic dysfunction during 1 year, they might have synergistic influence on occurrence of cardiovascular events in ACS patients.