bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 14759: Combining High-Sensitivity Cardiac Troponin and Donor-Derived Cell-Free Dna to Diagnose Acute Heart Transplant Rejection, on Behalf of the Graft Investigators
Authors: Shah Palak , Agbor-Enoh Sean , Bruce Scott , De Lemos James A , McNair Erick , Sinha Shashank , Kong Hyesik , Henry Lawrence , Tchoukina Inna , Shah Keyur B , Najjar Samer S , Hsu Steven , Rodrigo Maria E , Jang Moon K , Marboe Charles , Berry Gerald J , Drazner Mark , Valantine Hannah , Defilippi Christopher
Published: June 2023

Introduction:
Donor-derived cell-free DNA (%ddcfDNA) is a reliable non-invasive biomarker of acute rejection (AR). High-sensitivity cardiac troponin T (hs-cTnT) has been shown to be an easy to perform, low-cost, biomarker of myocyte injury.

Hypothesis:
We hypothesized that hs-cTnT correlates with %ddcfDNA in heart transplant patients and complements %ddcfDNA to improve the non-invasive diagnosis of AR.

Methods:
The Genomic Research Alliance for Transplantation (GRAfT) is a multicenter, prospective, longitudinal cohort study of heart transplant patients transplanted between 2015 and 2021. The %ddcfDNA was quantitated with shotgun sequencing; hs-cTnT was measured on the Roche instrument. AR was ISHLT grade ≥2R acute cellular rejection (ACR) or pAMR ≥1 antibody-mediated rejection (AMR).

Results:
This analysis included 171 patients from the GRAfT cohort (mean age 52.3±12.4 yrs; 41% Black; 31% Female). Of the 1,030 simultaneous measurements of hs-cTnT and %ddcfDNA, 662 were paired with an endomyocardial biopsy. Median hs-cTnT was 1451 ng/L (IQR: 865-1931) on post-operative day 1 and decayed to 26 ng/L (IQR: 18-56) at approximately 90-days. The Spearman correlation between %ddcfDNA and hs-cTnT was ρ=0.52 (p<0.001). After 28 days, AR occurred in in 22% of patients (26 ACR and 17 AMR episodes). From day 28 on, %ddcfDNA and hs-cTnT detected AR with an area under the curve (AUC) of 0.88 (95%CI:0.84-0.92) and 0.74 (95%CI:0.63-0.84), respectively. When both biomarkers were combined, the AUC improved to 0.91 (95% CI:0.86-0.96, Figure).

Conclusions:
%ddcfDNA and hs-cTnT correlate moderately after heart transplant. Performance of hs-cTnT at diagnosing AR was inferior to %dd-cfDNA. When both biomarkers were combined, the overall diagnostic performance improved beyond that provided by %ddcfDNA alone.
Abstract 14799: Sex Differences in Health Status Decline of Patients With Aortic Valve Stenosis: Results From the Progressa Study
Authors: Tastet Lionel , Shen Mylene , Capoulade Romain , Abdoun Kathia , Fleury Marie-Ange , Arsenault Marie , Bédard Elisabeth , Pibarot Philippe , Clavel Marie-Annick A
Published: June 2023

Introduction:
The assessment of symptoms status is pivotal to optimize the timing of aortic valve intervention in aortic stenosis (AS). However, little is known about the effect of sex on health status decline (i.e. functional status and quality of life) in AS patients. We evaluated the change in health status according to sex in patients with mild to moderate AS.

Methods:
Two hundred eighty-five patients with AS (peak aortic jet velocity [V
peak
]≥2.0 m/s) prospectively recruited in the PROGRESSA study (NCT01679431) were included in this analysis. Health status was evaluated using the New York Heart Association (NYHA) classification and the Duke Activity Score Index (DASI).

Results:
At baseline, men were older (67±12 vs 61±17 yr; p=0.001), had more comorbidities including hypertension, coronary artery disease, and atrial fibrillation (all, p≤0.01), and more severe AS compared to women (2.8±0.5 vs 2.6±0.4 m/s; p=0.01). However, women had more symptoms (class I, II, III: 44%, 53%, 3% versus 63%, 36%, 1%; p=0.02) and significantly lower DASI (38±14 vs 43±13; p=0.006). During a mean follow-up of 3.9±2.4 years, despite faster AS progression rate in men (V
peak
increase: 0.16±0.2 vs 0.12±0.2 m/s/year; p=0.02), the worsening of symptoms (NYHA ≥I class; n=70) and decline in DASI score were comparable according to sex (Figure). However, for the same hemodynamic AS progression rate, women had significantly faster decline in DASI score (Figure). In linear mixed analysis adjusted for several clinical and echocardiographic risk factors, female sex remained significantly associated with the worsening of NYHA class (odds ratio: 3.9; 95% CI: 2.1 to 7.2; p<0.0001) and the decline in DASI score (coeff.: -9; 95% CI: -11 to -6; p<0.0001).

Conclusion:
Despite a better clinical profile and less severe AS, women generally had worse symptomatic status compared to men, and this difference was accentuated throughout follow-up. These findings raise the question of symptoms minimisation in women.
Abstract 14802: Influence of Coronary Artery Anomalies on Left Ventricle Function After Arteries Switch Operation: A Two-Dimensional Speckle Tracking Echocardiography Study
Authors: Wang Shuyuan , Zhang Yanting , Sun Wei , Zhang Li , Lv Qing , Xie Mingxing
Published: June 2023

Background:
This study aimed to assess the influence of the complexity of coronary arteries (CA) anomalies and high-risk CA on Left ventricular (LV) function after arterial switch operation (ASO) using two-dimensional speckle-tracking echocardiography.

Methods:
Sixty patients with transposition of the great arteries after ASO who underwent echocardiography performed between January 2007 and June 2021 and thirty controls were studied. Patients after ASO were categorized into three subgroups: usual CA group (
n
= 30), low-risk CA group (
n
= 22), and high-risk CA group (
n
= 8). LV longitudinal strain (LS) at the apical four-chamber view was analyzed.

Results:
Compared with controls, age at echocardiography examination (5.5 ± 3.1 years
vs.
7.5 ± 3.9 years,
P
= 0.008) and body surface area (median 0.8 m
2
vs.
1.0 m
2
,
P
= 0.033) were smaller in ASO group. Patients after ASO had significantly lower septal e’ (10.9 ± 1.3 cm/s
vs.
13.7 ± 2.2 cm/s,
P
< 0.001), a’ (5.3 ± 0.8 cm/s
vs.
7.2 ± 1.6 cm/s,
P
< 0.001), and s’ (5.9 ± 0.9 cm/s
vs.
8.4 ± 1.5 cm/s,
P
< 0.001), and greater E/e’ (10.3 ± 2.4
vs.
8.0±1.7,
P
< 0.001) than controls. Patients after ASO had normal and comparable LV ejection fraction (63.3 ± 4.7%
vs.
63.0 ± 5.1%,
P
= 0.771), while LV LS were significantly lower (-20.9 ± 2.4%
vs.
-24.2 ± 2.0%,
P
< 0.001) to controls. LV ejection fraction was similar among usual, low-risk, and high-risk CA groups (64.2 ± 4.6%
vs.
62.3 ± 4.8%
vs.
62.9 ± 4.8%,
P
= 0.557), while LV LS was significantly lower in high-risk CA group (-18.3 ± 2.6%
vs.
-21.5 ± 2.1%
vs.
-21.1 ± 2.2%,
P <
0.001). LV LS was negatively correlated with the level of complexity of CA anatomy (
r
= -0.288,
P
= 0.026) and positively correlated with septal E/e’ (
r
= 0.268,
P
= 0.038).

Conclusion:
LV systolic and diastolic function were generally normal, however, significantly lower in patients at 5 years after ASO than in healthy peers. Patients with high-risk CA are associated with greater impairment of ventricular systolic myocardial deformation.
Abstract 14807: Effect of Psychiatric Illnesses on the Stress Induced Cardiomyopathy Readmission
Authors: Bandyopadhyay Dhrubajyoti , malik aaqib , Goel Akshay , Gupta Rahul , Hajra Adrija , Aronow Wilbert S
Published: June 2023

Introduction:
Stress-induced cardiomyopathy (SIC) is a form of transient non-ischemic cardiomyopathy that is precipitated in the setting of acute emotional or physical stress. Postulated hypothesis implicated catecholaminergic excess and a role of the brain-heart axis behind its pathogenesis. The impact of different psychiatric illnesses on the outcomes of SIC is not clear.

Method:
We conducted a retrospective study using National Readmission Database (NRD) from 2011 to 2019 using ICD-10-CM (International Classification of Diseases, 10th Edition, Clinical Modification) and ICD-9-CM codes to identify the admissions with the discharge diagnosis of SIC and stratified them based on the presence of psychiatric illnesses. The primary outcome was six-month readmission and predictors of readmission.

Result:
We included a total of 98,721 admissions with a diagnosis of SIC. Among them, 12.9% had major depression, 1.8% had bipolar disorder, 17.6% had an anxiety disorder, and 0.6% had schizophrenia. Overall, patients with psychiatric illnesses were younger. Patients with psychiatric illnesses had a higher burden of comorbidities. Patients with schizophrenia had higher in-hospital mortality. Patients with psychiatric illnesses had a higher likelihood of getting readmitted within six months (p<0.001). The significant independent positive predictors of readmission within 6 months were history of diabetes [odds ratio (OR):1.21, confidence interval (CI):1.16-1.26], heart failure (OR:1.31, CI:1.26-1.36), CKD/ESRD (OR: 1.44, CI:1.37-1.51), AF (OR: 1.25, CI:1.20-1.31), anemia (OR:1.24, CI: 1.15-1.34), peripheral arterial disease (OR: 1.25, CI:1.18-1.33), chronic obstructive pulmonary disease (OR: 1.35, CI:1.29-1.40), and prior stroke (OR: 1.10, CI: 1.02-1.18).

Conclusion:
We witnessed that psychiatric illnesses were associated with a higher likelihood of six-month readmission in patients with SIC.
Abstract 14808: Clinical Characteristics and Outcomes of Myocardial Infarction (MI) Among Patients With Chronic Kidney Disease (CKD): A National Inpatient Analysis
Authors: Eromosele Oseiwe 'Benjamin' B , Adefuye Mayowa , Alshami Abbas , Ebengho Ikponmwosa G , Udongwo Ndausung
Published: June 2023

Introduction Cardiovascular disease, including myocardial infarction, is a common cause of morbidity and mortality among patients with chronic kidney disease (CKD), independent of other common cardiovascular disease risk factors. CKD has been linked to a systemic proinflammatory state contributing to myocardial and vascular remodeling resulting in atherosclerotic lesions, vascular calcification, and senescence. The clinical characteristics and outcomes of MI among patients with CKD has not been extensively studied nationally. Objectives To evaluate the clinical characteristics, including gender, race, and age; and outcomes, including in-hospital mortality (IHM), length of hospital stay (LOS), and complications post-MI among those with CKD. Methods Adults diagnosed with myocardial infarction and had background CKD were identified from the National In-Patient Sample (NIS) dataset for the year 2019 using the International Classification of Disease (ICD-10) codes. Weighted multivariable logistic regression models were used as appropriate. Various sociodemographic and clinical factors were adjusted for in the analysis. Results Of the 23,590 patients identified with MI and CKD; 65.1% were male, 69.6% were White, while the median age was 62 years (Inter-Quartile Range (IQR): 54-71) and 72 years (IQR: 63-81) in the non-CKD and CKD population respectively. The median LOS was 2 days (IQR: 2-4) and 3 days (IQR: 2-7) in the non-CKD and CKD group, respectively. The incidence of new intracardiac thrombus was lower at 0.2% among CKD patients vs. 0.4% among those without CKD (p: 0.108). Conversely, IHM was higher among those with CKD at 13.9% compared to those without CKD, who had an IHM of 6.7% (p: 0.0001). The incidence of heart failure was 49.3% among those with CKD, almost twice that of those without CKD at 23.6% (p: 0.0001). Conclusion This study highlights critical clinical characteristics and outcomes of MI in the CKD population. The results, especially regarding the age of onset of MI and the incidence of intracardiac thrombi, warrant further studies to unravel the reason(s) behind these findings.
Abstract 14818: Precision Nanomedicine Targeting Novel Endothelial Mechano-Sensing Mechanisms and Treating Vascular Complications in vivo
Authors: Fang Yun
Published: June 2023

Introduction:
Endothelial mechano-transduction mechanisms are instrumental to vascular health and disease. Novel strategies targeting disease-causing mechano-sensitive pathways in dysfunctional endothelial cells could revolutionize future cardiovascular therapeutics. Vascular complications such as atherosclerosis and stenosis preferentially develop at arterial curvatures and bifurcations where endothelial cells are activated by local disturbed blood flow, leading to peripheral artery disease, carotid artery disease and ischemic stroke.

Hypothesis:
Current vascular therapies mainly target systematic risk factors (e.g. hypercholesterolemia and hypertension) but not the diseased vasculature, distinct molecular/cellular signatures of which can be targeted by innovated precision nanomedicine approaches.

Methods:
We first elucidated novel mechano-sensitive molecular mechanisms in endothelium activated by disturbed flow (DF) and then engineered rationally-designed nano-materials with purposed-constructed functionalities to deliver therapeutic nucleotides to DF-activated endothelial cells.

Results:
Our results elucidated previously unrecognized endothelial mechano-sensitive pathways in endothelial activation, with emphasis upon cellular metabolism (DF-induced glycolysis), human genetic variants (DF-induced suppression of PLPP3, a CAD GWAS gene), miRNA, protein stability (DF-induced NOS3 protein degradation via TXNDC5) and mRNA chemical modification/epi-transcriptome (DF-induced suppression of m7G). VCAM1-targeting nanoparticles were engineered to deliver therapeutic nucleotides such as mRNA, miRNA inhibitor, or CRISPR/Cas9 constructs specifically to inflamed endothelial cells to intervene aforementioned mechano-sensitive pathways, effectively reducing atherosclerosis and stenosis in mice. Similar approaches were very effective to promote endothelial health and lessen acute respiratory distress syndrome (ARDS) in mice induced by influenza or SARS-CoV-2 viruses.

Conclusions:
These results elucidate novel endothelial mechano-sensing mechanisms and provide a proof of concept of innovative targeted nanomedicine approaches, addressing an unmet medical need in vascular therapies.
Abstract 14822: Lipoprotein (a) is a Residual Risk Factor of Aortic Valve Calcification in Patients With High Risk of Atherosclerotic Disease
Authors: Yagi Shusuke , Tserensonom Munkhtsetseg , Sata Masataka
Published: June 2023

Introduction:
The number of patients with aortic valve stenosis which results from aortic valve calcification (AVC), has been increasing in the elderly population. The risk factors of AVC include diabetes, dyslipidemia, and hypertension. However, control of these risk factors has not resulted in a decreased incidence of AVC. Increased Lipoprotein (LP) (a) and oxidized low-density lipoprotein (LDL), or decreased omega 3-fatty acids, are the candidates for serum biomarkers of residual risk factors. However, the most contributable risk factors for AVC has not been identified.

Methods:
We enrolled a total of 618 patients who underwent coronary angiography by computed tomography because of suspicion of coronary artery disease (CAD). Calcium scores were calculated using imaging software (3mensio Medical Imaging) and existence of coronary stenosis was evaluated. Patients who were suspected of having significant coronary stenosis underwent coronary angiography to confirm the existence of ischemic heart disease. Patients were evaluated for residual risk factors including Lp(a), oxidized LDL, omega 3- and 6-fatty acids, and C-reactive protein in addition to markers of conventional risk factors.

Result:
The calcium score in patients who received aortic valve replacement was significantly higher than that in patients who did not undergo AVR. There were no difference between the calcium scores in patients with CAD and those without CAD. Univariate analysis showed that the calcium score was associated with levels of Lp(a) (P<0.01) but not with omega 3- and 6-fatty acids, oxidative LDL, hemoglobin A1c, LDL- and HDL-cholesterol, triglycerides, and C-reactive protein. Multivariate analysis showed that increased Lp(a) and age were independently correlated with the calcium score (P<0.01), but sex and the existence of other conventional risk factors including hypertension, dyslipidemia, and chronic kidney disease were not.

Conclusion:
Serum Lp(a) is a potent risk factor for AVC in patients with high risk of atherosclerosis. Lowering Lp(a) may be a potential strategy for prevention of AVC. Intervention studies involving methods of lowering Lp(a) are needed to confirm the results.
Abstract 14841: Perm1 is a Novel Regulator of O-GlcNAcylation in the Heart
Authors: SREEDEVI KARTHI , Shankar Thirupura S , Yedla Shreya , James Amina , arowa sumaita , Zaitsev Alexey V , Saijoh Yukio , Drakos Stavros G , Warren Junco S
Published: June 2023

Background.
Perm1 is a striated-muscle specific protein that is predominantly expressed in cardiac and skeletal muscle. We recently demonstrated that Perm1 is downregulated in the human and mouse failing hearts. However, whether and how Perm1 regulates cardiac function remains unknown. Beta-O-linkage of N-acetylglucosamine (O-GlcNAc) post-translational modification plays a role in stress response, and the excessive O-GlcNAc in the heart leads to the development of heart failure. We hypothesize that Perm1 regulates cardiac function through O-GlcNAcylation.
Methods and Results.
Our newly generated Perm1-knockout (KO) mice exhibited reduced cardiac function as compared to their wild-type (WT) littermates (50.1% vs. 34.7% in ejection fraction, p<0.05, n=15/group), which was associated with a significant increase in the total levels of O-GlcNAcylated proteins (139% from WT, p<0.05, n=6 in WT, n=8 in KO). To determine whether Perm1 downregulation increases the vulnerability to pressure overload, WT and Perm1 heterozygous (Perm1
+/-
) mice were subjected to transverse aortic constriction (TAC) surgery for 1 week. The total O-GlcNAcylated protein levels were markedly increased in Perm1
+/-
-TAC mice as compared to WT-TAC mice (549% vs. 173% from non-TAC WT, p<0.05, Fig.1A, B), concurrent with lower ejection fraction than WT-TAC mice (50.0% vs. 41.5%, p=0.06, n=5 in WT-TAC, n=3 in Perm1
+/-
-TAC). The excessive O-GlcNAc in Perm1
+/-
mice was associated with upregulation of O-GlcNAc transferase (OGT, the enzymes that adds O-GlcNAc to proteins, p<0.05, Fig1A, C), while there was no significant difference in the expression of O-GlcNAcase (OGA, the enzyme that removes O-GlcNAc from proteins) in WT vs. Perm1
+/-
mice in post-TAC (Fig.1A, D).
Conclusions.
These data suggest that Perm1 suppresses excessive O-GlcNAcylation occurring in a stressed heart through regulating OGT expression. Hence, the maintenance of Perm1 expression may be protective in the failing heart.
Abstract 14861: Decisional Factors Affecting Genetic Testing Uptake Among Black Adults With Hypertrophic Cardiomyopathy
Authors: Arabadjian Milla E , wong agnes , Reuter Maria , Wu Woon , Massera Daniele , Sherrid Mark , Aouizerat Bradley E , Dickson Victoria V
Published: June 2023

Introduction:
Black adults are underrepresented in hypertrophic cardiomyopathy (HCM) research and experience disparities in HCM - related variant interpretation due to a lack of diversity in genomic reference databases. This is compounded by lower HCM genetic testing utilization among this population. The objective of the qualitative study was to explore decisional factors affecting genetic testing use among a sample of Black adults with HCM.

Methods:
We used purposive sampling to recruit adults with clinical HCM and had undergone clinical genetic testing for HCM, self-identified as Black/African American, and were receiving care at a large urban academic center. Semi-structured individual interviews were conducted and inductive qualitative content analysis was performed to identify themes related to decisional factors for HCM genetic testing utilization. Quantitative descriptive analysis included demographics and genetic literacy evaluation via the Rapid Estimate of Adult Literacy in Genetics (REAL-G)

Results:
The sample included 30 individuals (15, 50% women), mean (SD) age 48.8 (17.2) years. Ten (33.3%) individuals had likely-pathogenic/pathogenic variants on clinical genetic testing. REAL-G scores were median (IQR) 62.5 (61;63), signifying a high-school literacy level. Almost half (46.7%) of participants reported finding at least some difficulty paying for basic necessities. The most common themes in decision-making regarding genetic testing utilization included out-of-pocket test costs and a positive relationship with HCM providers, followed by self-care and family concerns. Additional themes emerged concerning individual paths to an HCM diagnosis, including seeing multiple providers and navigating layers of the healthcare system, prior to evaluation by an HCM specialist.

Conclusions:
This study identified decisional facilitators regarding genetic testing use among a cohort of Black adults with HCM. Future work may focus on identifying barriers and designing interventions to improve genetic testing utilization in this population.
Abstract 14871: Ambulatory Cardiac Rhythm Monitoring in Individuals With Chronic Kidney Disease
Authors: Deo Rajat , Yang Jingrong , Marchlinski Francis E , Soliman Elsayed Z , Yang Wei , Shou Haochang , Xie Dawei , Chen Hsiang-Yu H , Weir Matthew R , Lash James , Mehta Rupal , Meza Natalie , Shah Vallabh , unruh mark L , Nelson Robert , Chen Jing , He Jiang , Appel Lawrence J , Jaar Bernard , Bansal Nisha , Go Alan S
Published: June 2023

Introduction:
Chronic kidney disease (CKD) is associated with arrhythmias such as atrial fibrillation (AF) and sudden cardiac death, but limited rigorous data exist on the prevalence of AF, ventricular tachycardia (VT), nonsustained VT (NSVT), and high-degree atrioventricular (AV) block in a CKD cohort.

Hypothesis:
In participants with CKD, worse kidney function is associated with a higher burden of atrial and ventricular arrhythmias.

Methods:
We evaluated the prevalence of AF, VT, NSVT, and high degree AV block in participants in the Chronic Renal Insufficiency Cohort (CRIC) Study who underwent monitoring using the ZIO XT patch, a noninvasive, 14-day continuous single-lead electrocardiogram monitor. We evaluated patient characteristics and the association between kidney function and each arrhythmia.

Results:
Among 1182 participants (mean age 69±9 years; 48% women), mean patch wear time was 11.9±3.8 days, and mean analyzable time was 95±11%. AF was detected in 82 (7.4%) participants, with AF burden (% time spent in AF) ranging from 0.1% to 100%, and the majority had long-standing, persistent AF. Participants with AF were older (74 vs 69 years, p<0.001), had a higher prevalence of cardiovascular disease including prior MI and heart failure (48% versus 34%, p<0.05); and had a higher body mass index (34 vs 32 kg/m
2
; p<0.05) than those without AF. NSVT occurred in 31% of participants, while no participant experienced sustained VT. High-degree AV block was present 2 participants (<1%). Overall, pre-monitoring mean estimated glomerular filtration rate was 51±18 ml/min/1.73m2, and median urine albumin-to-creatinine ratio was 9.2 [4.4 - 44.6] mg/g. Kidney function or proteinturia were not independently associated with any of the arrhythmias.

Conclusions:
In adults with CKD undergoing 14-day continuous monitoring, AF was present in 1 in 14 indivduals, and nearly one-third had evidence of NSVT. Worsening kidney function was not independently associated with the prevalence of arrhythmias in this cohort. Future studies will need to assess the signficance of NSVT on cardiovascular events across the spectrum of CKD severity.
Abstract 14873: Analysis of Heart Failure Re-Admissions and In-Hospital Outcomes in Patients With Takotsubo Syndrome
Authors: Bandyopadhyay Dhrubajyoti , Malik Aaqib H , Goel Akshay , Gupta Rahul , Maitz Theresa , Aronow Wilbert S , Kuno Toshiki , Briasoulis Alexandros , Spevack Daniel , Lanier Gregg M , Panza Julio A
Published: June 2023

Background:
Takotsubo Syndrome (TTS) is characterized by transient reduction in left ventricular function with in the absence of obstructive coronary artery disease. Clinical presentation often mimics acute myocardial infarction (AMI). Patients with TTS have comparable long-term mortality with AMI patients. However, data on the burden of heart failure (HF) readmissions in patients with TTS are scarce.

Methods:
This retrospective analysis utilized the US Nationwide Readmission Database for the years 2012-2019 to identify hospitalizations for TTS or AMI. The primary outcome of interest was 6-month readmission due to HF. Secondary outcomes included in-hospital mortality.

Results:
There were 30,926 hospitalizations with TTS and 2,535,025 hospitalizations with AMI. The proportion of women was 90% among TTS patients and 37.7% among AMI patients (p<0.001). Overall comorbidities were similar between the two groups, but in-hospital mortality during index admission was higher in the AMI arm (6.5% vs 1.5% in TTS, p <0.01) accompanied with increased in-hospital complications. All-cause readmission rates were lower among TTS than among AMI patients (21.9% vs. 29.4%; p <0.01). HF readmissions were also lower among TTS than AMI patients (3.7% vs. 6.7%; p <0.01). After propensity matching, all-cause readmission rate remained lower among TTS than among AMI patients (21.9% vs. 27.9%; p <0.01). HF hospital readmissions rates were also lower among TTS patients (3.7% vs 5.7%; p <0.01). Independent predictors of HF

readmission in TTS population included comorbidities such as diabetes mellitus, atrial fibrillation, chronic kidney disease, peripheral vascular disease, and chronic pulmonary disease.
Conclusion
A substantial proportion of patients (>20%) with TTS suffer a hospital readmission within 6 months, although less than 5% are readmitted with HF. Compared with AMI, all-cause and HF readmission rates are lower in TTS patients.
Abstract 14878: Natural Language Processing of Unstructured Medical Record Can Predict Cardiac Arrhythmia by Quantifying Chronic Disease Burden
Authors: Huang Andy , Liu George , Lee Paul C
Published: June 2023

Introduction:
Prediction of atrial fibrillation (AF) and sick sinus syndrome (SSS) is difficult. CMS Hierarchical Condition Categories scores (CMS-HCC) is a risk adjustment score used by CMS to account to risk adjust quality and cost metrics by quantifying the burden of chronic disease and patient complexity. Its calculation is based on patient’s demographics and ICD10 diagnostic codes. We have created an algorithm (MYTH) that can determine ICD10 diagnostic codes from unstructured medical chart using Natural Language Processing through syntax analysis, knowledge graph and regular expressions. The ICD-10 codes can then be used to calculate CMS-HCC. Because chronic disease burden may increase the probability of cardiac arrhythmia, we hypothesize that CMS-HCC can predict the onset of atrial fibrillation and sick sinus syndrome.

Methods:
We used MYTH to automate ICD10 coding and HCC score calculation based on textual outpatient cardiology records of 926 patients. The algorithm was additionally applied to calculate CHA2DS2-VASc scores. These were applied to predict the diagnosis of AF and SSS on clinical follow-up retrospectively.

Results:
CMS-HCC scores outperforms CHA2DS2-VASc scores in the prediction of onset of AF: (AUC: CHA2DS2-VASc 0.703, CMS-HCC 0.778, difference P=0.0006, individually P<0.0001). While HCC score is predictive of the onset of SSS (P<0.001), its improvement over CHA2DS2-VASc score does not reach statistical significance (AUC: CHA2DS2-VASc 0.702; CMS-HCC 0.744, difference: P=0.297, individually P<0.001).

Conclusions:
Natural Language Processing algorithms can understand unstructured medical text, automate ICD coding and automate CMS-HCC score calculation. The burden of chronic diseases, as reflected by the CMS-HCC score, is highly predictive of future atrial fibrillation and modestly predictive of sick sinus syndrome.
Abstract 14883: Non-Vitamin K Oral Anticoagulants versus Warfarin After Watchman Device Implantation: A Systematic Review and Meta-Analysis
Authors: Felix Nicole , Melo Soares Pinho de Carvalho Lara , Zuquello Isadora Maria , Vale Cora , Cardoso Rhanderson
Published: June 2023

Introduction:
Postprocedural anticoagulation is indicated for at least 45 days in patients who undergo percutaneous left atrial appendage occlusion with the Watchman device. The relative efficacy and safety of non-vitamin K oral anticoagulants (NOACs) to warfarin for postprocedure anticoagulation in this setting is not well known.

Methods:
We conducted a systematic review and meta-analysis to compare NOACs with warfarin in patients who underwent left atrial appendage occlusion with Watchman. PubMed, Cochrane, and EMBASE were systematically searched. We included randomized and observational studies with at least 45 days of follow-up following Watchman implantation comparing anticoagulation with NOACs vs. warfarin for thrombotic and hemorrhagic outcomes.

Results:
We included 11 studies with 2,325 patients who underwent Watchman device implantation and were anticoagulated with NOACs (n=1,194; 51.35%) or warfarin (n=1,131; 48.65%). NOACs were associated with a lower incidence of major bleeding (OR 0.49; 95% CI 0.28-0.89; p=0.02; Fig. 1A) and device-related thrombosis (OR 0.44; 95% CI 0.21-0.93; p=0.03; Fig. 1B). There was no significant difference between NOACs and warfarin with regards to stroke or transient ischemic attack (OR 0.43; 95% CI 0.15-1.28; p=0.13; Fig. 2).

Conclusions:
In this meta-analysis, NOACs were associated with lower risks of device-related thrombosis and major bleeding relative to warfarin in patients who undergo Watchman implantation.
Abstract 14886: Utilization Patterns and Outcomes of Home Health Care After Coronary Artery Bypass Grafting
Authors: Thompson Mike P , Hou Hechuan , Likosky Donald S , Pagani Francis D , Falvey Jason , Bowles Kathy , Sterling Madeline R
Published: June 2023

Introduction:
Home health care (HHC) use after discharge may improve short-term outcomes and reduce expenditures for patients undergoing coronary artery bypass grafting (CABG), but there is limited data describing utilization patterns of HHC and its association with longer-term outcomes. Thus, we investigated the utilization patterns of HHC and its impact on 1-year outcomes among Medicare beneficiaries who underwent CABG.

Methods:
Medicare beneficiaries undergoing CABG between July 2016 and December 2018 were identified using 100% Medicare files. Beneficiaries were excluded if they were <65 years old, died during the inpatient stay, or used inpatient post-acute care before or after the index procedure. Use of HHC (yes versus no) was defined as the presence of a home health claim within 0-1 days of discharge. Clinical outcomes included 1-year mortality and all-cause readmission. We created a matched sample using a multivariable probit regression model (1:1) and balanced HHC users to non-users by demographic, clinical, and hospital factors to compare clinical outcomes.

Results:
Among the 91,166 beneficiaries in our sample, 54,169 (59.4%) used HHC after discharge, and were more likely to be older, female, White, have dual-eligibility status, comorbid, have had a non-elective, a concomitant valve procedure, and longer hospital length of stay. With respect to hospital characteristics, HHC users were more likely to be admitted to hospitals that were major teaching, larger bed size, not-for-profit, and not system-affiliated. Use of HHC varied from 0% to 100% across 976 hospitals, with a median of 66.2% (IQR=44.2%). After matching and adjustment for covariates, there was no significant difference in 1-year mortality among HHC users and non-users (2.2% vs. 2.5%, -0.3%, p=0.029), although 1-year readmission rates were 7.9 percentage points higher (29.4% vs. 21.5%, p<0.001) for HHC users vs. non-users.

Conclusions:
Over half of Medicare beneficiaries undergoing CABG used HHC after discharge, with significant differences across patients and hospitals and mixed impact on clinical outcomes. While unmeasured severity may account for some of our findings, more research is needed to understand utilization patterns and impact of HHC after CABG.
Abstract 14899: Ten Year Performance of Convergent Cryoballoon Hybrid Ablation With Left Atrial Appendage Exclusion in Persistent and Long Standing Persistent Atrial Fibrillation: A Trac-Af Registry Outcome Study
Authors: Pickmans Franccesca , Sherman Spencer , Sherman Andrew , Makati Kevin J
Published: June 2023

Introduction:
Catheter ablation (CA) efficacy in persistent and long standing persistent atrial fibrillation (AF) remains poor. The Convergent procedure with endocardial cryoballoon and left atrial appendage exclusion (LAAE) addresses multiple epicardial/endocardial targets offering a comprehensive approach. We report clinical outcomes in a prospectively collected registry supplemented by continuous device monitoring in a diseased AF patient population.

Methods:
Single center patient data were retrospectively analyzed in the TRAC-AF registry (NCT05111015) between November 2011-November 2021. Epicardial ablations were performed by cardiothoracic surgeon and endocardial CA performed by electrophysiologist. Clinical follow up was performed at 3, 6, and 12 months and every 6 months thereafter. AF burden was determined from patients with ≥30 days of 24 hr continuous rhythm monitoring following a 90 day blanking period.

Results:
A total of 228 patients (69% male) received hybrid Convergent ablation. Mean age was 66 yrs, mean BMI was 30.2 ± 6.2, and in 70% of patients, CHA2DS2-VASc was ≥2. Baseline AF types were paroxysmal (7%), persistent (43%), and longstanding persistent (50%). Mean AF duration was 5.1 ± 6.2 yrs. Fifty-seven percent of patients had failed CA prior to hybrid ablation and 30.6% had LAAE with an epicardial clip. Of 228 patients, 114 (50%) had continuous rhythm monitoring. Mean residual AF burden was 5.2 ± 16.3% and of those, 77% had ≤1% mean residual AF burden, and 88% had ≤5% mean residual AF burden. A repeat CA after hybrid Convergent occurred in 23% (53/228) of patients at a mean 645.8 ± 511.4 days from the index procedure with 4.4% requiring >1; 88.5% of all repeat ablations included a mitral annular line.

Conclusions:
The hybrid Convergent ablation with endocardial cryoballoon and LAAE provides long term sustainable low AF burden despite rigorous endpoint surveillance in a significantly diseased AF population which includes prior failed CA patients over a decade of follow up.
Abstract 14901: Risk Factors for Cardiotoxicity in Cancer Patients Receiving Immune Checkpoint Inhibitors: A Systematic Review With Meta-Analysis
Authors: Huang Chin-Hsuan , Abdul-lattif Eahab , Azmat Muneeba , Chang Yu , LIN YU SHIUAN , Nanna, MD, FACC Michele , Chi Kuan Yu
Published: June 2023

Introduction
Although immune checkpoint inhibitors (ICI) have reshaped the treatment landscape for cancer patients, they carry potential risk for the development of cardiovascular adverse events (CVAEs).

Objectives
We attempted to identify risk factors for CVAEs in cancer patients receiving ICI.

Methods
Two investigators (C.H.H. and Y.C.) independently reviewed Medline, PubMed, and Embase from inception to May 20, 2022 to identify high quality studies. We included randomized controlled trials, prospective or retrospective cohorts that reported the risks factors for any new onset or worsening CVAEs, including cardiomyopathy, arrhythmia, heart failure, acute coronary syndrome, myocarditis, and pericarditis, in cancer patients receiving ICI. Two investigators (E.A. and M.A.) independently extracted data from included studies. Any discrepancy was resolved through discussion with senior reviewers (K.Y.C and M.N.). We performed random-effects meta-analyses on risk factors for CVAEs after the initiation of ICI. We used I-statistics (I
2
) to quantify the statistical heterogeneity.

Results
12 observational studies involving 21,912 patients (CVAEs=2,897) of any cancers were included for final qualitative and quantitative analyses. 11 covariates, including age, gender, body mass index, ever-smoking history, hypertension, type II diabetes, coronary artery disease (CAD), congestive heart failure, chronic kidney disease (CKD), chronic obstructive pulmonary disease, and stroke, were available for the meta-analyses. Our meta-analyses (Table 1) demonstrated that male gender, hypertension, CAD, and CKD were associated with increased odds for the development of CVAEs in patients taking ICI.

Conclusions
In conclusion, male gender, hypertension, CAD, and CKD were identified as significant risk factors for CVAEs in patients taking ICI. Evidence supports a strategy of proper optimization of risk factors before, during, and after the ICI treatment.
Abstract 14907: Association Between Adverse Pregnancy Outcomes and N-Terminal Pro-Brain Natriuretic Peptide 2-7 Years After Delivery: Numom2b Heart Health Study
Authors: Freaney Priya M , Huang Xiaoning , Petito Lucia C , Grobman William A , Catov Janet , Hauspurg Alisse , Bairey Merz C. Noel , Bello Natalie A , Chung Judith , Lane-Cordova Abbi D , Haas David M , Levine Lisa D , McNeil Rebecca B , Miller Eliza C , Saade George , Theilen Lauren , Yee Lynn M , Greenland Philip , Khan Sadiya S
Published: June 2023

Introduction:
Adverse pregnancy outcomes (APOs), including gestational diabetes (GDM), hypertensive disorders of pregnancy (HDP), preterm birth (PTB), and small-for-gestational age (SGA), have been associated with increased risk of heart failure (HF), but mechanisms are poorly understood. We sought to examine the association between a history of APO and N-terminal pro-brain natriuretic peptide (NT-proBNP), a HF biomarker, after delivery.

Methods:
We included individuals from the NuMoM2b Heart Health Study who were recruited during their first pregnancy and followed longitudinally. We excluded individuals who had pre-pregnancy hypertension or diabetes. APOs were centrally adjudicated based on medical records. NT-proBNP was assessed at follow-up visit after delivery. We examined the association between a history of APO and elevated NT-proBNP (≥125 pg/mL) with logistic regression. We log-transformed NT-proBNP and also examined the association between history of APO and NT-proBNP with linear regression. Models were adjusted for demographic and cardiovascular risk factors at the time of NT-proBNP.

Results:
Of 4172 individuals, mean (SD) age was 30.7(5.6) years at 3 years follow-up after delivery and 170 (4%) had a history of GDM, 597 (14%) HDP, 321 (8%) had PTB, and 170 (4%) had SGA. Among the study population, 256 (6%) had elevated NT-proBNP. Individuals with GDM had a lower risk of elevated NT-proBNP levels (adjusted odds ratio 0.59 [95% confidence interval 0.38, 0.92]); while a history of HDP, PTB, or SGA was not associated with elevated NT-proBNP (
TABLE
). When NT-proBNP was examined as a continuous variable, a history of GDM (-0.20 [-0.35, -0.06] pg/mL) or HDP (-0.09 [-0.15, -0.02]) was associated with lower log-transformed NT-proBNP levels in adjusted models.

Conclusions:
In this cohort study, APOs were not associated with elevations in NT-proBNP, but GDM and HDP were paradoxically associated with lower NT-proBNP levels at 3 years post-delivery.
Abstract 14913: Renal Function Underpins Cox-2: Methylarginine Axis in Mouse and Man
Authors: Ferreira Plinio M , Kirkby Nicholas , Vaja Ricky , Lopes Pires Maria , Crescente Marilena , Liu Bin , Yu He , Chan Melissa , Nuesing Rolf , Zhou Yongbi , White William , Want Elizabeth , Warner Tim D , knowles rebecca , yaqoob magdi , Longhurst Hillary , Zhang Anran , Rickman Matthew
Published: June 2023

Introduction and Hypothesis:
Through the production of prostacyclin (PGI2), cyclooxygenase (COX)-2 protects the cardio-renal system. Restraining methylarginines (ADMA, SDMA), which are biomarkers of renal and cardiovascular disease and inhibitors (ADMA) of cardioprotective endothelial nitric oxide synthase (eNOS), has been suggested as a contributory pathway. However, the relationship between renal function, COX-2 and methylarginines remains unclear.

Methods:
Using plasma from genetically modified mice with germline global deletion of COX-2 or PGI
2
synthase (PGIS) and human plasma from a unique individual lacking COX-derived prostaglandins due to a loss of cPLA
2
, before and after receiving a cPLA
2
-replete transplanted donor kidney, we measured methylarginines, arginine and citrulline using UHPLC-MS/MS. Renal function was assessed by measuring cystatin C by ELISA. To eliminate the impact of renal function
in vivo
, methylarginine and PGI
2
release from organotypic kidney slices in culture were quantified by ELISA.

Results:
Plasma ADMA, SDMA, citrulline and cystatin C, were similarly elevated in samples from the patient lacking COX/PGI
2
capacity compared to levels in healthy volunteers. Renal function, ADMA, SDMA and citrulline returned towards normal range when the patient received a genetically normal kidney, capable of COX/PGI
2
activity. Cystatin C correlated with ADMA, SDMA and citrulline. Loss of COX-2 or PGIS in mice increased plasma levels of ADMA, SDMA and cystatin C. As in human, SDMA, ADMA and citrulline but not arginine positively correlated with cystatin C. Levels of analytes in conditioned media of kidney slices (24h) were not altered in tissue from COX-2 KO (6-keto=14.0±1.8, ADMA=1.0±0.06, SDMA=0.30±0.05; n=8) compared to wildtype mice (66-keto=15.0±1.7, ADMA=0.98±0.06, SDMA=0.24±0.01; n=12).

Conclusions:
COX-2 and PGI2 are critical regulators of renal function. Plasma methylarginines are integrally linked to renal homeostasis.
Abstract 14924: Gender Differences in Cardiac Rehabilitation Participation and Outcomes in a National Medicare Sample: An Instrumental Variable Approach
Authors: Thaler Christina , Hou Hechuan , Sukul Devraj , KETEYIAN Steven J , Quain Angela , Joynt Michael , McCullough Jeffrey , Thompson Mike P
Published: June 2023

Background:
Cardiac rehabilitation (CR) participation following percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) decreases patient morbidity and mortality. Many studies are underpowered to evaluate gender differences. We aimed to look at gender differences in CR use and short term outcomes including 1-year mortality in a national Medicare sample.

Methods:
We identified Medicare beneficiaries over 65 years undergoing PCI and CABG from 07/2016-12/2018. Primary exposures included female vs. male sex and CR use within one year of discharge based on outpatient claims. Clinical outcomes included 1-year mortality and readmissions. We analyzed differences in characteristics, CR use, and associated outcomes between females and males using multivariable and instrumental variable analyses using distance to CR facility as the instrument.

Results:
414,730 beneficiaries underwent PCI and CABG, of which 145,512 (35.1%) were female. Females were more likely to be older, Black race, dual eligible, live in distressed communities, and have a CR facility in their zip code, and were less likely to be Hispanic, elective procedures, or undergo CABG. CR use was lower for females than males (32.2% vs. 40.5%, p<0.001), which remained significant after adjustment for patient covariates (OR=0.91, 95% CI: 0.89-0.92, p<0.001). One-year mortality for CR users vs. non-CR users was 2.1% / 2.4% and 15.4% / 14.5% for women and men, respectively. One-year readmissions for CR users and non users was 34.3% / 31.2% and 52.8% / 45.0% for women and men, respectively. The adjusted and IV-adjusted average absolute effect of CR use on mortality was similar for females and males but was stronger on 1-year readmissions for females vs. males (Figure).

Conclusion:
Female Medicare beneficiaries attend CR following PCI and CABG at lower rates than men, but have increased benefit with CR participation on 1-year readmissions with similar mortality benefit relative to men.
Abstract 14929: Dedicator of Cytokinesis 2 Promotes Atherosclerosis Through Mediating Vascular Inflammation
Authors: Guo Xia , Qian Guoqing , Adeyanju Oluwaseun , Li Chenxiao , Chen Shiyou
Published: June 2023

Atherosclerosis is a leading cause of sudden death in patients with cardiovascular disease. It is the major risk factor of coronary artery disease and stroke. The pathophysiological mechanisms of atherosclerosis are complex and there is lack of effective pharmacotherapy for treating atherosclerosis. Dedicator of cytokinesis 2 (DOCK2) plays important roles in immune functions and inflammatory processes. This study aims to explore the role of DOCK2 in the development of atherosclerosis. We generated double knockout (DOCK2-/-;LDLR-/-) mice. The LDLR-/- and DOCK2-/-;LDLR-/- male mice were fed high-fat diet (HFD) for 4 weeks and/or 12 weeks followed by the collection of the aorta and aortic roots. IHC staining showed that DOCK2 was induced in atherosclerotic lesions with increased expression of ICAM-1, VCAM-1, and MCP-1 after HFD for 4 weeks in LDL-/- mice. DOCK2-/-;LDLR-/- mice exhibited a significantly decreased lesion formation compared to LDLR-/- mice after HFD for 12 weeks as shown by Oil-Red O (ORO) staining of the aorta. ORO staining of aortic roots confirmed the reduced lesion size in DOCK2-/-;LDLR-/- mice. DOCK2 deficiency also attenuated the induction of ICAM-1, VCAM-1, and MCP-1 expression by HFD for 12 weeks. These data indicate that DOCK2 is essential for the lesion formation by inducing the adhesion and invasion related molecule expression. Macrophages have been reported to contribute to atherogenesis. Therefore, we evaluated macrophage infiltration in aortic roots of LDLR-/- and DOCK2-/-;LDLR-/- mice fed with HFD for 12 weeks. The data show that there was significantly attenuated macrophage infiltration in aortic roots of DOCK2-/-;LDLR-/- mice compared with that in LDLR-/- mice, as shown by the decreased F4/80-positive cells. Together, our data demonstrate that DOCK2 deficiency attenuates atherosclerosis by alleviating vascular inflammation.
Abstract 14931: Frailty Status Modifies the Efficacy of ICD Therapy Among Patients With Chronic Heart Failure With Reduced Ejection Fraction
Authors: Segar Matthew W , Singh Sumitabh , Parsa Shyon , Reeves Gordon , Mentz Robert J , Forman Daniel E , Razavi Mehdi , Saeed Mohammad , Kitzman Dalane W , Pandey Ambarish
Published: June 2023

Introduction:
Frailty is common in patients with heart failure with reduced ejection fraction (HFrEF) and is independently associated with mortality. Implantable cardiac defibrillator (ICD) therapy is recommended to reduce mortality risk in patients with HFrEF. Whether baseline frailty modifies the efficacy of ICD therapy in HFrEF is not known.

Methods:
Stable outpatients with HFrEF randomized to ICD vs. placebo in the SCD-HeFT trial were included. Baseline frailty was estimated using Rockwood’s Frailty Index (FI) by dividing the number of deficits present by the number of variables considered (n=37). Participants were categorized into tertiles of FI. Multivariable adjusted Cox proportional hazard models with multiplicative interaction terms (frailty*treatment arm) were constructed to evaluate whether frailty modified the treatment effect of ICD therapy on the primary outcome all-cause mortality and secondary outcomes of cardiovascular (CV) mortality and sudden cardiac death (SCD).

Results:
Among 1,673 participants (age: 59±12 y, 23% women), the median [IQR] FI ranged from 0.19 [0.14-0.23] in tertile 1 (lower frailty burden) to 0.51 [0.47-0.56] in tertile 3 (higher frailty burden). Baseline frailty significantly modified the treatment effect of ICD therapy (P-interaction: 0.03) (
Fig. A
). Specifically, ICD therapy was associated with a lower risk of all-cause mortality in tertile 1 [HR (95% CI) = 0.55 (0.37-0.80)] but not in tertile 3 participants [HR (95% CI) = 0.90 (0.67-1.22)] (
Fig. B
). Among secondary outcomes, frailty status modified the association of both CV mortality and SCD (P-interaction = 0.007 and 0.04, respectively). Similar results were observed in landmark analyses at 12 months.

Conclusions:
Among patients with chronic stable HFrEF, baseline frailty modified the treatment effect of ICD therapy with a greater reduction in the risk of CV mortality and SCD in patients with a lower burden of frailty.