bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 11699: In Hospital Outcomes of Acute Coronary Artery Dissection and Obesity
Authors: Orji Richard , Okoro Kelechukwu U , Markson Favour , Ezeh Ebubechukwu , Iddrisu Muftawu-Deen , Ilelaboye Ayodeji , Ukenenye Emmanuel , Horoub Ali , Okoronkwo Emeka
Published: June 2023

Introduction:
Coronary artery dissection is an emergency condition due to a tear in the coronary arterial wall, and it’s an uncommon cause of acute coronary syndrome. The Effect of Obesity on the outcome of acute coronary artery dissection is poorly documented. Hence, our study sought to estimate the impact of Obesity on clinical outcomes of hospitalizations of patients with acute Coronary artery dissection using the national database.

Methods:
We queried the National Inpatient Sample (NIS) database from 2016 to 2019. The NIS is the largest inpatient hospitalization database in the United States. The NIS was searched for hospitalization of adult patients with acute Coronary artery dissection as a principal diagnosis with and without Obesity as a secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality. The secondary results were Acute kidney injury (AKI), Cardiogenic shock (CS), Cardiac arrest (CA), Total hospital charge (THC), and length of stay (LOS). Multivariate logistic and linear regression analyses were used accordingly to adjust for confounders.

Results:
About 2440 patients were admitted for acute Coronary artery dissection; 17.4% (425) had underlying obesity. Cohorts with obesity vs No obesity had a mean age of 52.9 years [CI 50.4 - 55.5] vs 55.9 years [CI 54.5 - 57.4]; male (20% vs 25.8%), female (80% vs 74.2%); white (71.3% vs 73.3%), black (21.3% vs 12.0%), and Hispanic (6.3% vs 7.8%). Compared to patients without obesity, patients admitted with coexisting obesity had similar inpatient mortality (7.1% vs 3.2%, AOR 3.22, 95% CI 0.74 - 13.88, P=0.118), AKI (15.3% vs 9.9%, P 0.357), CS (9.4% vs 11.2% P=0.098), CA (5.9% vs 5.0% P=0.530), THC (IRR 0.94, 95% CI 0.64 - 1.37, P=0.738), and LOS (IRR 0.79, 95% CI 0.59 - 1.05, P=0.107).

Conclusions:
Patients admitted primarily for acute Coronary artery dissection with co-existing Obesity had similar inpatient mortality, AKI, CS, CA, THC, and LOS compared to patients without Obesity.
Abstract 11717: Expression of Tumor Endothelial Marker 1 in Cardiac Fibroblasts is Associated With Atrial Fibrosis and Regulates Cell Behaviors of Cardiac Fibroblasts
Authors: Li Yi-Heng , Huang Ting-Chun , Huang Mu-Shiang , Hu Yu-Ning , Chung Hsing-Chun
Published: June 2023

Background:
Tumor endothelial marker 1 (TEM1 or CD248) is a transmembrane protein that expresses in mesenchymal lineage-derived cells only during embryogenesis. Re-upregulation of TEM1 in fibroblasts has been found in hepatic fibrosis, renal fibrosis and wound healing. Atrial fibrosis plays an important role in atrial fibrillation (AF) and stroke. We evaluated TEM1 expression in atrial fibrosis and its physiological significance.

Methods and Results:
All data were presented as mean ± standard error. In 10 patients (pts) with AF undergoing indicated cardiac surgery and Maze procedure, left atrial (LA) appendage was excised. Immunofluorescence staining showed TEM1 expressed in LA cardiac fibroblasts (CFs) in AF pts but not in normal LA tissue purchased from the US Biomax, Inc. Sirius Red staining showed more LA fibrosis in AF than normal LA tissue (7.51±0.40% vs. 3.80±0.51%, p<0.01). In AF pts, higher LA TEM1 expression detected by western blotting was associated with larger LA fibrosis. In 20 AF pts (15 men, mean age 57.5 ± 2.8 yrs) undergoing catheter ablation, LA blood samples were taken and soluble TEM1 (sTEM1) was measured by ELISA. Peak atrial longitudinal strain (PALS) measured by speckle tracking echocardiography before ablation was used as an atrial fibrosis marker. There was a significantly negative correlation of the sTEM1 levels in LA with PALS (ρ=-0.453, p<0.05) indicating increased sTEM1 was associated with atrial fibrosis.
In vitro
study showed recombinant TEM1 protein (rTEM1) increased proliferation of cultured CFs (saline vs rTEM1 10, 50 and 100 nM, BrdU absorbance: 0.55±0.02 vs. 0.62±0.04 vs. 0.73±0.04 vs. 0.74±0.04, p<0.05) and reduced starvation-induced apoptosis (cell death ELISA absorbance: 1.06±0.09 vs. 0.61±0.05 vs. 0.49±0.11 vs. 0.33±0.02, p<0.05). Transwell assay showed rTEM1 induced increased CFs migration.

Conclusions:
The study results indicate that TEM1 upregulation in CFs is associated with atrial fibrosis and TEM1 changes the cell behaviors of CFs. Further studies are undergoing to clarify if TEM1 knockdown could alleviate atrial fibrosis.
Abstract 11723: Defects in the Branch-Chain Amino Acid Pathway is Associated With Doxorubicin-Induced Cardiotoxicity and Preventable With a BCKDK Inhibitor or Metformin
Authors: Castrillon Jessica , Huang Yin , Hou Yuan , Zhou Yadi , Smith Jonathan D , Chung Mina K , Cheng Feixiong
Published: June 2023

Background:
High exposure to doxorubicin (DOX) chemotherapy is associated with an 18-49% incidence of heart failure in cancer patients. However, the mechanism of cardiotoxicity remains elusive. Emerging evidence suggests that branched-chain amino acid (BCAA) catabolic defect is also a major metabolic hallmark in diseased hearts. However, to our knowledge, the role of cardiac BCAA in developing cardiotoxicity following chemotherapy is unknown.

Hypothesis:
We posit that dysfunction of branch chain amino acid catabolic flux is associated with doxorubicin-induced cardiotoxicity, and pharmacologic restoration of BCAA catabolic flux will restore cardiomyocyte function.

Results:
We generated a rat model of doxorubicin-induced heart failure. Using targeted metabolomic profiling, we observed branch chain amino acids (BCAA) are highly correlated with elevated levels of BNP and low ejection fraction. We have utilized human-induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) to study the mechanism of DOX-induced toxicity. Our findings suggest that DOX significantly decreases mitochondrial activity. Specifically, we observed reduced activity of the mitochondrial enzyme BCKDH, a key regulator of BCAA flux. BCAA catabolism is restored following metformin treatment. Furthermore, we observe the inhibition of BCKDK with the allosteric inhibitor, BT2 (3,6-dichlorobenzo[b]thiophene-2 carboxylic acid), or metformin rescues cell toxicity.

Conclusion:
We have provided compelling evidence for targeting the BCAA pathway as a strategy for preventing cardiotoxicity. Further work is required to evaluate transcriptional changes driving DOX-mediated toxicity.
Abstract 11728: Predictors of Secondary Pulmonary Hypertension-Related Hospitalizations and Subsequent Mortality in Adults With Obstructive Sleep Apnea
Authors: Mondal Avilash , Kanagala Sai Gautham , Mohammed Adil S , Katukuri Nishanth , Gurram Priyatham , Ashfaque Mariam , Sofia Amara , Kauser Humaira , Arepalli Satya Sai Venkata Lakshmi , Sayyeda Qudsia , Desai Rupak
Published: June 2023

Background:
Secondary pulmonary hypertension (SPH) is a predictor of poor outcomes in obstructive sleep apnea (OSA) patients. In this study, we examined sex/racial disparities, predictors and inpatient mortality in SPH-related hospitalizations among OSA patients.

Methods:
We used the National Inpatient Sample (2019) and ICD-10 codes to identify OSA-related hospitalizations with SPH. The burden of SPH and disparities by sex/race were assessed. We also compared the odds and predictors of in-hospital mortality in OSA patients with vs. without SPH.

Results:
Of total adult OSA hospitalizations (n=2317136, median age 66[56-74] years, males: 57.2%), 9.4% (218795/2317136) had SPH. Females vs Males (11.3% vs. 8.1%) and Blacks vs. other race groups (13.5%) with OSA had a higher prevalence of SPH
[Fig. 1]
.
The SPH cohort often consisted of females (51 vs 41.9%), blacks (20.9 vs 14.0%), patients from lowest income quartile (29.7 vs 27.6%), Medicare insured (73.4 vs 60.6%), and non-elective admissions (89.2 vs 74.4%) vs. non-SPH cohort. SPH cohort also had a higher burden of complicated HTN (52.9 vs 36.3%), DM with complications (42.7 vs 32.4%), hyperlipidemia (59.4 vs 57.6%), COPD (52.5 vs 36.9%), history of prior MI (11.4 vs 9.6%) and venous thromboembolism (10.4 vs 8.4%). However, in-hospital mortality was more likely to be in males (OR 1.12 95%CI 1.00-1.25, p=0.048) vs Females, and OSA patients with metastatic cancer (OR 2.73 95%CI 2.04-3.65), solid non-metastatic tumors (OR 1.65 95%CI 1.26-2.15) (p<0.001). Our analysis also showed black ethnicity, hyperlipidemia, obesity, tobacco use, and history of venous thromboembolism and TIA were protective against inpatient mortality in SPH-OSA patients.

Conclusions:
The prevalence of SPH with OSA was greater in females and blacks, whereas males and whites had higher subsequent inpatient mortality. More prospective studies are needed to understand the role of co-morbidities on survival outcomes.
Abstract 11739: Cardiac Magnetic Resonance Imaging Derived Inferior Vena Cava Cross-Sectional Area Correlates With Measures of Fontan Associated Liver Disease
Authors: Gunsaulus Megan , Wang Li , Christopher Adam , Feingold Brian D , Squires James , Horslen Simon , Hoskoppal Arvind , Rose-felker Kirsten , WEST Shawn C , Trucco Sara , Squires Judy , Olivieri Laura , Kreutzer Jacqueline , Goldstein Bryan H , Alsaied Tarek
Published: June 2023

Background:
There is currently no clear consensus on appropriate screening techniques to evaluate the presence or severity of Fontan-associated liver disease (FALD). Cardiac MRI (CMR) is used routinely for post-Fontan surveillance, but CMR-derived measures that relate to the severity of FALD are yet to be defined.

Methods:
This was a cross-sectional single-center study of post-Fontan patients who underwent a CMR. CMR exams were re-analyzed by a single pediatric cardiologist. The inferior vena cava cross-sectional area (CSA) was measured on CMR and indexed to height (indexed IVC-CSA). Other CMR measurements included ventricular volumes and systolic function, ascending aorta flow, Fontan CSA, and pulmonary artery CSA. Surrogates of FALD included Gamma-Glutamyl Transferase (GGT), Fibrosis-4 laboratory score (FIB-4), and imaging findings. Findings consistent with cirrhosis on liver ultrasound included increased liver echogenicity and/or nodularity. Statistical analyses were performed to investigate potential relationships between CMR parameters and markers of FALD.

Results:
Sixty-one patients were included. The median age was 2.7 years at the time of Fontan surgery and 17.0 years at the time of CMR. A larger indexed IVC-CSA was significantly associated with a higher FIB-4 score (Spearman’s ρ = 0.28,
P
= 0.04), a higher GGT level (Spearman’s ρ = 0.40,
P =
0.02), and findings consistent with cirrhosis on liver ultrasound (OR 1.17, 95% CI: (1.01, 1.35),
P
= 0.04). None of the other measured CMR parameters were associated with markers of FALD. A larger indexed IVC-CSA on CMR was associated with higher systemic ventricle end-diastolic pressure (EDP) on cardiac catheterization (Spearman’s ρ = 0.39,
P
= 0.018) as well as older age (Spearman’s ρ = 0.46,
P
= <0.001).

Conclusions:
A larger indexed IVC-CSA was the only finding on CMR that was associated with markers of FALD. This measure has the potential to serve as an additional non-invasive tool for risk stratification of FALD.
Abstract 11750: Disparities Among Covid-19 Mortality in Patients With Concurrent Cancer and Cardiovascular Disease in 2020: A Nationwide Analysis
Authors: Vuong Jacqueline T , Addison Daniel , Branch Mary , Brown Sherry-Ann A , Akhter Nausheen , Ganatra Sarju , Okwuosa Tochi , Mamas Mamas , Van Spall Harriette G , Yang Eric H
Published: June 2023

Introduction:
The COVID-19 pandemic has highlighted important socioeconomic health disparities in the United States. Both cardiovascular disease (CVD) and cancer are associated with worse COVID-19 outcomes. We describe racial or ethnic, sex, and rural disparities in mortality rates from COVID-19 in the US cardio-oncology (C-O) population with concurrent cancer and CVD.

Methods:
Using the multiple causes of death data files within CDC WONDER, we assessed survival outcomes from March to December 2020 (most intense for COVID-19 deaths) by race or ethnicity, sex, and rural status. C-O populations were defined as having ICD 10 codes C00-C97 for “malignant neoplasms” and ICD 10 codes I10-I15 for “hypertensive heart disease”, I20-I25 for “ischemic heart disease” I30-I51 for “other forms of heart disease” encompassing valvular disorders, cardiac arrythmias, myocarditis, and heart failure & cardiomyopathies, or I70 for peripheral atherosclerosis listed as contributing causes of death. In this population, those with ICD 10 code U07.1 for “COVID-19” listed as an underlying cause of death were included. Age-adjusted mortality rates (AAMR) were calculated based on contemporary US population standards.

Results:
Overall, there were 6,311 deaths from COVID-19 among 16,282 all-cause deaths in the C-O population (AAMR 5.17 deaths/1,000,000 person-years; 95% CI 5.04-5.29). These deaths comprised 1.80% of all COVID-19 deaths (total 350,831) in the study period. Mortality rates were higher in men than women (AAMR 7.35 vs 3.44 deaths/1,000,000; HR 2.13, p<0.0001). Among racial or ethnic groups, mortality rates were highest among African Americans (AAMR 9.31 deaths/1,000,000; 95% CI 8.75-9.88), and higher among Hispanic than non-Hispanic Americans (AAMR 7.10 vs 4.86 deaths/1,000,000; HR 1.46, p<0.0001). Mortality rates were higher in rural areas than metropolitan areas (crude mortality rate 9.15 vs 6.20 deaths/1,000,000; HR 1.48, p <0.001).

Conclusion:
Among cancer patients with concurrent CVD, COVID-19 deaths were disproportionately higher in male, African American, Hispanic, and rural patients. Further research is needed to understand socioeconomic factors underpinning these disparities and design interventions to improve patient outcomes.
Abstract 11760: Depression Paradox for In-Hospital Cardiovascular Outcomes in Obstructive Sleep Apnea - A National Population-Level Analysis
Authors: Desai Rupak , Pannala Sai Shanmukha Sreeram , Nathani Pratiksha Shankarlal , Raja Sager Avinaash , Shahnawaz Warda , Prem Anand Dharshana , Miguel April Kristine , Lekkala Sai Prasanna , Rahman Aleen , Srikanth Sashwath
Published: June 2023

Background:
​​Depression is a frequently encountered comorbidity in patients with Obstructive Sleep Apnea (OSA), with a higher prevalence than the general population. However, there is limited data on the impact of psychiatric comorbidities on the outcomes of OSA.

Methods:
We identified OSA hospitalizations using the National Inpatient Sample (2018) and relevant ICD-10 codes. After propensity score matching, demographics and comorbidities were compared between the two groups of OSA with (OSA-D+) vs without depression (OSA-D-). The odds of in-hospital outcomes between them were analysed using multivariable regression analyses.

Results:
Of the 2169730 OSA hospitalizations, 20.1% had comorbid depression. Matched cohorts included 846150 admissions in both groups - OSA-D+ and OSA-D-.The OSA-D+ cohort often consisted of younger (median age, 64 vs 65); females (55.5% vs 55.2%) with both cohorts predominantly including white, Medicare enrollees. The OSA-D+ cohort had significantly higher rates (all p<0.001) of comorbidities such as Hypertension (68.6% vs 64.6%); Diabetes (48.4% vs 47.4%); Hyperlipidemia (59.2% vs 53.5%); Congestive Heart Failure (21.7% vs 20.6%); Peripheral Vascular Disease (6.7% vs 6.3%); Anemia (22.4% vs 19.7%); Smoking (44.6% vs 41.8%); Substance abuse, prior MI,TIA/Stroke and Venous Thromboembolism compared to the OSA-D- group. Paradoxically, there was decreased all-cause mortality (OR:0.79, 95%CI 0.73-0.86), major adverse cardiac and cerebrovascular events (OR:0.83, 95%CI 0.80-0.87), acute MI (OR:0.80, 95%CI 0.76-0.85), dysrhythmia/AF (OR:0.81, 95%CI 0.79-0.83) and cardiac arrest including VF (OR:0.65, 95%CI 0.73-0.82) in the OSA-D+ cohort cohort during hospitalization (p<0.001).

Conclusion:
Despite having more comorbidities, OSA patients with depression were found to have better in-hospital outcomes. Further studies are required for a conclusive reason for this paradoxical effect of co-morbid depression.
Abstract 11772: Prevalence of Pathogenic Variants in Dilated Cardiomyopathy-Associated Genes in Patients Evaluated for Cardiac Sarcoidosis
Authors: Reza Nosheen , Levin Michael , Vidula Mahesh K , Bravo Paco E , Damrauer Scott M , Ritchie Marylyn , Cntr Regeneron Genetics , Chahal Anwar A , Owens Anjali T
Published: June 2023

Introduction:
There is phenotypic and mechanistic overlap between arrhythmogenic right ventricular cardiomyopathy and cardiac sarcoidosis (CS). Whether CS and arrhythmogenic left ventricular cardiomyopathy (ALVC) similarly overlap has not been investigated. We aimed to evaluate the difference in proportions of disease-causing variants in ALVC-associated genes in patients with high clinical suspicion for CS.

Methods:
From a cohort of individuals with whole exome sequencing (WES) with linked electronic health record data in the Penn Medicine BioBank, we identified those who had and had not been referred for FDG-PET and cardiac MRI to evaluate for CS and compared demographics and carrier rates of predicted loss of function (pLOF) variants in genes causal for dilated cardiomyopathy (DCM) and ALVC.

Results:
Among 43,724 unrelated individuals with WES data, we identified 94 who had been referred for imaging to evaluate for CS. Those who had been referred for imaging were more often of self-reported Black race (50% vs. 25%, p<0.001) and had atrial arrhythmias (62% vs. 30%, p<0.001) and systolic heart failure (61% vs. 17%, p<0.001). Among these 94 individuals, six (6.4%) carried a pLOF variant in at least one of 19 genes known to have strong causal evidence for DCM/ALVC, compared with 1.2% of the participants not referred for imaging. After adjustment for age, sex, and five genetic principal components of ancestry, individuals referred for FDG-PET and MRI were more likely to carry a pLOF variant in a DCM gene of interest compared with the remaining PMBB participants (OR 5.96; 95% CI 2.31, 12.6; p<0.001).

Conclusion:
Individuals at high clinical suspicion for having CS have 6-fold higher odds of having a pLOF variant in a gene causal for DCM. There is under-recognized overlap between the clinical presentations of genetic ALVC/DCM and CS, and as such, the differential diagnosis for CS and inflammatory cardiomyopathy should be expanded to include these entities.
Abstract 11774: Heart Failure With Preserved Ejection Fraction Secondary to Coronary Endothelial Dysfunction and Microvascular Disease
Authors: Ajmal Muhammad , Kubba Saad , Lee Kwan Seung S , Lerman Amir , Corban Michel
Published: June 2023

A 41-year-old female with hyperlipidemia presented with typical exertional angina, dyspnea, and pre-syncope of 6 months duration. Physical examination was unremarkable. ECG showed low voltage QRS
(Figure A),
and Chest CTA was negative for obstructive-CAD, pulmonary emboli, aortic, and lung disease. Cardiac MRI was negative for myocarditis/pericarditis
.
Resting TTE was unremarkable with normal systolic and diastolic function. NT-Pro BNP, hs-CRP, serum/ urine protein electrophoresis, and free light chains ratio were normal. Regadenoson PET myocardial perfusion test showed a medium-sized area of stress-induced ischemia in mid/apical segments
(Figure B)
. Resting right heart Cath showed mean RA pressure (9mmHg) and RVEDP (10mmHg), mean PA pressure (19mmHg), and PCWP (15mmHg) with large v-waves, PCWP increased to 28mmHg with limited supine bike exercise, diagnostic of HFpEF
(Figure C)
. Angiography showed normal coronary arteries while coronary reactivity testing was diagnostic of severe epicardial and microvascular endothelial dysfunction (60% mid/distal LAD constriction and 19% decreased blood flow in response to intracoronary (IC) acetylcholine), and endothelial-independent microvascular dysfunction (coronary flow reserve 2.4 in response to IC adenosine), diagnostic of HFpEF due to coronary endothelial and microvascular disease
(Figure D)
. The patient’s symptoms improved at 2 weeks follow-up after initiation of furosemide, diltiazem, isosorbide mononitrate, and atorvastatin.
Abstract 11787: Impact of Estimated Plasma Volume Status on Clinical Outcomes in Lower Extremity Artery Disease Patients Who Underwent Endovascular Therapy
Authors: Kurokawa Tasuku , Otaki yoichiro , Takahashi Hiroki , Watanabe Tetsu , Shikama Taku , Tamura Harutoshi , Kato Shigehiko , Nishiyama Satoshi , Arimoto Takanori , Watanabe Masafumi
Published: June 2023

Introduction:
Lower extremity artery disease (LEAD) is an arterial occlusive disease associated with high morbidity and mortality. Estimated plasma volume status (ePVS), a marker of plasma volume expansion and contraction, is gaining attention in the field of cardiovascular disease. However, it remains undetermined the impact of ePVS on clinical outcome in patients with LEAD.

Methods:
We calculated two ePVS using Kaplan-Hakim and Duarte formula in 288 LEAD patients who underwent first endovascular therapy and retrospectively followed during a median follow-up period of 617 days. The primary and secondary endpoints were composite events including all-cause death and major adverse limb events (Death/MALE) and major adverse cardiovascular events (MACE), respectively.

Results:
ePVS significantly increased with advancing Fontaine class. All patients were divided into two groups based on the median ePVS value. Kaplan-Meier analysis demonstrated high ePVS group had higher incidence of composite events and MACE compared to low ePVS group. A multivariate Cox proportional hazard analysis revealed that ePVS was an independent predictor of Death/MALE and MACE after adjustment for confounding risk factors. Prognostic ability for Death/MALE was significantly improved by addition of ePVS to the basic predictors. These results are consistent with each formula.

Conclusions:
ePVS was associated with severity of LEAD and clinical outcome, suggesting ePVS could be an additional risk factor for Death/MALE and MACE in LEAD patients who underwent endovascular therapy.
Abstract 11790: Behavioral Interviewing for Graduate Medical Education Programs in the Covid/Virtual Interviewing Era
Authors: Banerjee Dipanjan , Khan Zia , Seto Todd B , Singh David , Leon Ted , Tsai Peter , Kemble Anne
Published: June 2023

Introduction:
Coronavirus pandemic restrictions have affected social interactions, and the process of interviewing candidates for positions in graduate medical education (GME) programs is no exception. The threat of such restrictions is that candidates and programs may have less ability to achieve the best mutual fit. However, the pandemic also allows opportunities to rethink how we approach the interview process, and potentially optimize it. Behavioral interviewing (BI) techniques are one approach to both constructively address pandemic restrictions, and potentially improve recruitment to GME programs.

Hypothesis:
We hypothesized that behavioral interviewing could be integrated into a virtual interviewing process.

Methods:
We reviewed the behavioral interviewing process, and described how we integrated it into our virtual program recruitment of 91 candidates in 2020 and 2021. We elicited interviewer and interviewee feedback regarding the behavioral interviewing process, and analyzed discrepancies between ranks by traditional and behavioral interviewers.

Results:
Behavioral interviewing was viewed as highly positive or positive by 100% of interviewers and 93% of interviewees in 2021. The average discrepancy between standard and behavioral interview rank placement was 2.67 (SD 2); with 11 (8%) candidates exhibiting a significant rank divergence (> 5 rank orders). The best agreement between behavioral and traditional interviewer rank orders was in the top tertile of candidates.

Conclusions:
Behavioral interviewing can successfully be implemented in a virtual GME recruitment format, and provides opportunities to optimize program and candidate cohesion.
Abstract 11802: Hypocretin/Orexin Receptor-2 Influences Mortality Risk After Myocardial Infarction
Authors: Wohlfahrt Peter , Jenca Dominik , Dlouhá Dana , Melenovsky Vojtech , Jarolim Petr , sramko marek , Kotrc Martin , Zelizko Michael , Mrazkova Jolana , Pitha Jan , Adamkova Vera , Kautzner Josef
Published: June 2023

Introduction:
Hypocretin/orexin system has been shown to play a role in heart failure. Whether this system also influences all-cause mortality in patients after myocardial infarction (MI) is unknown. The aim of the present study was to evaluate the effect of rs7767652 allele variants, upstream of hypocretin/orexin receptor-2, on prognosis of patients with MI.

Methods:
Data from a single-center prospectively designed AMBITION registry of consecutive patients hospitalized for MI at a large tertiary cardiology center were analyzed. Patients with type I MI, without previous history of MI or heart failure were included. A random population sample including 1,953 individuals was used to compare allele frequencies in the population.

Results:
Out of 1,593 patients in the registry, 1,009 fulfilled the inclusion criteria. In total, 6.1% patients were homozygotes and 39.4% heterozygotes for the minor allele. Allele frequencies in patients with MI did not differ from the general population (χ
2
p=0.62), suggesting no influence on the MI risk. During the median follow-up of 27 months (IQR 13-41), mortality rate was 8.4%. Homozygotes for the rs7767652 minor allele had a higher mortality risk as compared to heterozygotes (p=0.001) and homozygotes for the major allele (p=0.001) (
Figure
). After multivariate adjustment, minor allele homozygotes remained at increased mortality risk (HR 2.83, 95% CI 1.55-5.19). Minor allele homozygotes experienced more often ventricular fibrillation (12.9% vs. 4.8%, p=0.01) and required more often CPR (16.1% vs. 7.0%, p=0.02). Among patients with EF<40% at hospital discharge, minor allele homozygotes had a lower increase in EF during the follow-up (2.5±11.0 vs. 8.4±9.4, p=0.04).

Conclusions:
Our Mendelian randomization study shows that hypocretin/orexin system influences prognosis of patients with MI. This effect may be partially explained by the increased arrhythmic risk and the effect on the left ventricular systolic function recovery.
Abstract 11808: Association Between Weight Gain After Smoking Cessation and Future Hypertension
Authors: Ninomiya Yuichi , Kawasoe Shin , Kubozono Takuro , Tokushige Akihiro , ichiki hitoshi , Ikeda Yoshiyuki , Miyahara Hironori , Tokushige Koichi , Ohishi Mitsuru
Published: June 2023

Introduction:
While smoking cessation reduces the risk of ischemic heart disease and stroke, it may be associated with weight gain. However, literature on the association between weight gain after smoking cessation and future hypertension is scarce.

Methods:
Of the 234,596 individuals who visited our health checkup center, 1085 individuals (mean age 47.5 ± 10.6 years; 1005 men) with previous history of smoking and available data after 5 years of smoking cessation were included. We compared the relationship between weight gain after smoking cessation and future hypertension (changes in blood pressure [BP] from baseline to 5 years, following smoking cessation and prescription rate of antihypertensive drugs. Multiple regression analysis was performed to evaluate changes in systolic and diastolic blood pressures (SBP and DBP) using covariates affecting BP changes from baseline values, such as weight gain, age, baseline weight, sex, and habitual alcohol consumption.

Results:
Since a median weight gain of 1.7 kg was observed after 1 year of smoking cessation, we divided participants into two groups: high weight gain (547 individuals, ≥1.7 kg) and low weight gain (538 individuals, <1.7 kg). There was no significant difference in the prescription rate of antihypertensive drugs between the two groups (high weight gain vs. low weight gain), at the baseline (10.6% vs. 10.4%; p = 0.92) and 5 years following smoking cessation (25.4% vs. 28.4%, p=0.26). Nevertheless, the changes in SBP (high weight gain vs. low weight gain: 7.9±15.4 vs 3.8±15.4 mmHg, p<0.001) and DBP (high weight gain vs. low weight gain: 4.2±10.5 vs 1.1±10.8 mmHg, p<0.001) from baseline to 5 years following smoking cessation were significantly higher in the high weight gain group. Additionally, multiple regression analysis showed that changes in SBP were influenced by high weight gain (β=-0.13, p<0.001) and age (β=0.06, p<0.05), while changes in DBP were influenced by high weight gain (β=-0.14, p<0.001), age (β=-0.10, p<0.001), and baseline weight (β=-0.10, p<0.01).

Conclusions:
Our results suggest that weight gain following smoking cessation subsequently leads to hypertension, and weight loss guidance may be useful in such cases.
Abstract 11809: Role of Computed Tomography-Based Evaluation of Skeletal Muscle Area in Predicting Cardiovascular Outcomes in Patients With Chronic Heart Failure Following Cardiac Resynchronization Therapy
Authors: Harada Taisuke , Kondo Hidekazu , Yufu Kunio , Takahashi Masaki , Ishii Yumi , Abe Ichitaro , Akioka Hidefumi , Shinohara Tetsuji , Teshima Yasushi , Takahashi Naohiko
Published: June 2023

Introduction
: Sarcopenia, defined as skeletal muscle depletion, has been associated with poor cardiovascular outcomes in patients with chronic heart failure (CHF).

Hypothesis
: This study aimed to determine possible associations between sarcopenia and poor cardiovascular outcomes in patients with CHF after cardiac resynchronization therapy (CRT).

Methods:
This retrospective study evaluated 120 patients who underwent CRT implantation between March 2004 and June 2018. Only 58 patients who underwent computed tomography (CT) within 30 days of CRT were eligible for inclusion, and their data were analyzed (25 women; 33 men; mean age, 71.6 ± 8.7 years). The skeletal muscle area was measured at the third lumbar vertebra, and the skeletal muscle index (SMI) was calculated (Figure 1). Major adverse cardiovascular events (MACE) included cardiovascular death, hospitalization due to heart failure, cerebral infarction, acute myocardial infarction, and cardiac arrest.

Results:
During the follow-up period (mean, 868 ± 617 days), MACE occurred in 22 of 58 patients (38%). The patients were allocated to two groups according to sex-based tertiles of SMI. The lowest tertile was defined as the low SMI group. Kaplan-Meier survival analysis demonstrated that the low SMI group had a greater incidence of MACE (log-rank 4.38; P = 0.036, Figure 2). Cox proportional hazards regression analysis also revealed that low SMI was significantly associated with MACE (hazard ratio 3.08; 95% CI: 1.26-7.66, P = 0.014).

Conclusions:
Decreases in SMI on CT imaging may predict the occurrence of MACE in patients with CHF who underwent CRT.
Abstract 11816: Association of Increased Adiposity and Presentation and Outcomes for Kawasaki Disease versus Multisystem Inflammatory Syndrome in Children Associated With Covid-19
Authors: Khoury Michael , Venkataraman Aishwarya , Portman Michael A , Fabi Marianna , Dahdah Nagib , Jain Supriya , Jone Pei-Ni , Raghuveer Geetha , Lee Simon , Prasad Deepa , El Ganzoury Mona , Yetman Angela T , Friedman Kevin G , Martin Garrido Luis , Norozi Kambiz , Sehgal Anupam , Serrano Ryan M , Kutty Shelby , Farid Pedrom , McCrindle Brian W
Published: June 2023

Introduction:
Obesity is a pro-inflammatory state and may influence presentation and outcomes of both Kawasaki disease (KD) and Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19.

Methods:
From January 2020 to January 2022, n=2566 contemporaneous KD, MIS-C and acute COVID-19 pediatric patients from 39 sites in 8 countries were enrolled into the International KD Registry. The study population was confined to 1077 MIS-C patients meeting CDC criteria with confirmed or probable COVID-19 infection, and 657 KD patients meeting AHA guideline criteria without COVID-19 infection who had body mass index (BMI) recorded at presentation. BMI was converted to Z scores using WHO formulas for age and sex, and associated factors were sought using general linear regression modeling.

Results:
Mean zBMI was higher for MIS-C (+0.58) vs KD patients (-0.06; p<0.001), and MIS-C patients were more likely to be overweight (BMI 85
th
-<95
th
%ile; 18% vs 11%), obese (95
th
-<99
th
%ile; 14% vs 6%) or morbidly obese (
>
99
th
%ile; 8% vs 2%; p<0.001). MIS-C patients were significantly more likely to present with shock, and had higher peak troponin I and NTproBNP, with no association or interaction with adiposity. Higher adiposity was significantly associated with higher peak white cell count for MIS-C but not KD. Higher peak CRP for MIS-C and higher peak ESR for KD were not associated with adiposity. Higher peak creatinine was associated higher adiposity, more so for MIS-C. Both higher adiposity and MIS-C were significantly associated with lower LV ejection fraction, although there was no significant interaction (Figure A). Higher maximum coronary artery Z score was associated with KD but not with adiposity, with no significant interaction (Figure B).

Conclusions:
MIS-C patients have higher levels of adiposity than KD patients. Higher adiposity is associated with greater renal dysfunction in the setting of MIS-C, and greater cardiac dysfunction in both MIS-C and KD.
Abstract 11824: Chronic Kidney Disease, Type 2 Diabetes and the Risk of Major Cardiovascular Events in Coronary Artery Disease versus Peripheral Artery Disease Patients
Authors: Sprenger Lukas , Maechler Maximilian , Vonbank Alexander , Larcher Barbara , Mader Arthur , Leiherer Andreas , Muendlein Axel , Drexel Heinz , Saely Christoph H
Published: June 2023

Introduction:
Chronic kidney disease (CKD) is a paramount indicator of cardiovascular risk and is highly prevalent in patients with established cardiovascular disease, especially among those with type 2 diabetes (T2DM). Peripheral artery disease (PAD) confers an even higher risk than coronary artery disease (CAD).

Hypothesis:
We hypothesize that cardiovasculr risk compares between PAD and CAD when analyses are stratified by the presence of CKD.

Methods:
We prospectively recorded major cardiovascular events (MACE) over 10.0±4.7 years in 1356 patients who had stable CAD, of whom 18.4% had CKD, and in 382 patients with PAD, of whom 20.9% had CKD. Four groups were analyzed: CAD patients without CKD (CAD/CKD-; n=1106), CAD patients with CKD (CAD/CKD+; n=250), PAD patients without CKD (PAD/CKD-; n=316) and PAD patients with CKD (PAD/CKD+; n=66).

Results:
The incidence of MACE was lowest in CAD/CKD- patients (27.2%) and significantly higher in CAD/CKD+ patients (49.6%; p<0.001), in PAD/CKD- patients (40.9%; p<0.001), and in PAD/CKD+ patients (56.9%; p<0.001), who in turn were at a higher risk than CAD/CKD+ or PAD/CKD- patients (p=0.015 and p<0.001, respectively). The risk of MACE did not differ significantly between CAD/CKD+ and PAD/CKD- patients (p=0.063). In Cox regression analysis after multivariate adjustment including gender, age, BMI, hypertension, history of smoking, LDL-C, and HDL-C the presence of PAD versus CAD (HR=1.51 [1.25-1.84]; p<0.001), CKD (HR=1.85 [1.51- 2.26]; p<0.001) and T2DM (HR=1.53 [1.29-1.83; p<0.001) were mutually independent predictors of MACE.

Conclusions:
We conclude that CKD, T2DM and the presence of PAD versus CAD are mutually independent predictors of MACE.
Abstract 11825: Reduction in Muscle Mass in the Left Atrial Wall is Associated With Atrial Fibrillation
Authors: Matsushita Satoshi , YAMAMOTO TAIRA , Endo Daisuke , Inaba Hirotaka , Minematsu Kazuo , Norihiko Yokoyama , Yayoi Shoji , Tohru Asai , Atsushi Amano , Minoru Tabata
Published: June 2023

Introduction
The left atrium (LA) plays a central role in the occurrence of atrial fibrillation (AF). Although many studies have demonstrated that the dilatation or alteration of the wall thickness of the LA, so called LA remodeling, was strongly associated with AF, the detailed mechanism is still unclear.

Materials and Methods
We retrospectively analyzed all samples of LA wall obtained during cardiac surgery in Juntendo University Hospital from 2014 to 2020. The samples were processed with Masson’s trichrome staining, then layer analysis was performed. The histological data was compared with the clinical background. Results A total of 60 patients’ samples were analyzed. The thickness of the LA wall was 1257 to 6905 μm. Layer analysis of the LA wall demonstrated that the wall thickness was not associated with the volume (R
2
= 0.0287, p = 0.098). Multiple regression analysis determined that the only factor associated with thinning of the LA was the existence of AF (p <0.05). Moreover, LA wall thickness was well correlated with muscle layer thickness (R
2
= 0.744, p <0.001). In addition, the patients who had AF for one year or more showed significant reduction in muscle mass compared to those with AF for less than one year (18.6% vs. 24.3%, p <0.05). Among 36 patients who underwent concomitant Maze procedure during surgery, 9 had recurrent AF at 1 year after surgery. Age (p <0.05), duration of AF (p <0.01), and muscle area (p <0.01) were detected as risk factors for recurrence.

Conclusion
AF was detected as the only factor associated with a reduction in the cardiac muscle mass in the LA wall. Chronic AF of more than one year’s duration enhanced the risk of reduction in the LA muscle mass. Furthermore, the reduction of the muscle mass was a comorbid factor for the recurrence of AF after the Maze procedure, along with age and duration of AF. Our results indicate that the muscle mass may be a novel predictor indicating the need for the Maze procedure.
Abstract 11841: Activation of Cardiac Fibulin-4 Protects Against Pressure Overload-Induced Cardiac Hypertrophy and Heart Failure
Authors: van Deel Elza , van Vliet Nicole , van den Bosch Thierry , van Spreeuwel Ariane , Bax Noortje , boontje nicky , Sasaki Takako , Van Der Velden Jolanda , Bouten C , von der Thüsen Jan , Danser Jan H , Duncker Dirk J , Van Der Pluijm Ingrid , Essers Jeroen
Published: June 2023

Cutis laxa is a rare disorder caused by mutations in the extracellular matrix (ECM) protein Fibulin-4 and patients are susceptible to stress-induced cardiac dysfunction. Mice with a 75% reduction in Fibulin-4 expression (Fibulin-4
R/R
) developed cardiac hypertrophy, dilation and dysfunction as well as aortic aneurysms. The prevailing view is that this is the result of aortic and/or valvular disease, given that Fibulin-4 is believed to be exclusively involved in arterial and valvular elastogenesis and collagen deposition. Yet mortality after cardiac pressure-overload through transverse aortic constriction (TAC) was also increased in haploinsufficient Fibulin-4
+/R
mice with a 50% reduced Fibulin-4 expression compared to wildtype animals. To determine whether the TAC-induced dilated cardiomyopathy in haploinsufficient Fibulin-4
+/R
mice is a primary manifestation resulting from ECM abnormalities we analyzed the hearts of these mice for the presence of Fibulin-4 expression. Fibulin-4 expression was found to be activated throughout the entire myocardium in TAC-exposed wildtype animals. TAC-exposed Fibulin-4
+/R
animals did not show this strong increase in myocardial Fibulin-4 expression but displayed emergence of altered physical properties of myocardial tissue, and biochemical evidence of chronic mechanical stress, including decreased focal adhesion kinase activity similar to TAC-exposed wildtype animals. Moreover, reduced Fibulin-4 expression aggravated TAC-induced cardiac fibrosis and pulmonary congestion. In microtissues derived from neonatal Fibulin-4 deficient hearts, Fibulin-4 deficiency decreased the beating frequency and contractile force of microtissues. It also reduced the maximal force-generating capacity of single membrane-permeabilized cardiomyocytes. Our findings demonstrate novel functions for Fibulin-4 in cardiac homeostasis, and show that reduced Fibulin-4 expression drives myocardial disease in response to cardiac pressure overload independent of aortic valvular pathology. These so far unrecognized effects of Fibulin-4 on myocardial function could have important implications both for patients with connective tissue disorders and for the general population in response to pressure overload.
Abstract 11846: Factors Influencing Survival in Adult Patients With Congenital Heart Disease Considered for Transplant: A Single Center Study
Authors: Ratnayake Charith , Hickey Gavin W , Hindes Morgan , Saraf Anita
Published: June 2023

Introduction:
Adult congenital heart disease (ACHD) patients pose unique challenges in identifying time for transplantation and factors influencing outcomes.

Hypothesis:
Survival outcomes in ACHD patients depend on hemodynamic, functional, and laboratory parameters.

Methods:
We performed a retrospective chart review of adult patients (>18y) with CHD evaluated for heart or heart+ transplant between November 2004 and July 2014 and evaluated outcomes until December 2020 at University of Pittsburgh Medical Center. Multiple clinical parameters were evaluated to identify factors influencing outcomes for up to 10 years after consideration for transplant. Kruskal-Wallis nonparametric analysis was conducted to compare differences between variables.

Results:
58 adult patients with congenital heart disease (CHD), age range 20-55 years were evaluated. D-TGA with atrial switch operation (20.7%), tetralogy of Fallot/pulmonary atresia (15.5%) and tricuspid atresia (13.8%) were the most common diagnosis for transplant. Of the 58 patients, 5 (8.6%) were deferred, 42 (72.4%) were listed for transplant and 11 (18.9%) were declined for transplant. Statistically significant factors affecting listing decision are included in table 1. Declined patients showed the highest 1-year mortality (18.2%), whereas waitlisted patients showed the highest 10-year mortality (84.2%). In the post-transplantation period, 30 day survival was 87.0%, 1-yr was 82.6%, and 5-yr and 10 year was 69.6%. 1-year post-transplant survival was influenced by pre-transplant end diastolic pressures, use of advanced life support, and right atrial pressure. There was no significant difference in post-transplant survival between single ventricle versus bi-ventricular patients.

Conclusions:
We have identified clinical factors that influence survival outcomes in ACHD patients considered for transplantation, These can applied while making transplant decisions and improve outcomes
Abstract 11848: Female Gender, Lower Household Income, Non-Medicare Beneficiaries, and Being a Resident of Small-Sized Population Areas are Associated With In-Hospital Mortality Among Patients Living With Human Immunodeficiency Virus (plwh) With Cardiac Arrest: A Retrospective Analysis of National Inpatient Sample Database From 2016 to 2019
Authors: Shoar Saeed , Ali Khaled , abdelrazek ahmad , Asadi Sadegh
Published: June 2023

Background:
Despite major scientific advances in contemporary resuscitation, survival outcome in both in-hospital and out-of-hospital cardiac arrest (CA) patients remain dismal.

Objective:
How do individuals’ demographic and socioeconomic status, insurance status, and hospital characteristics play a role in survival following CA in patients living with human immunodeficiency virus (PLWH)?
Methods:
Using the ICD10 codes B20-B24 for HIV and ICD10 code I46 for CA, we queried the national inpatient sample from 2016 to 2019 to identify admission cases of PLWH with CA. Weighted data was analyzed using logistic regression model.

Results:
Out of 475,910 admissions for PLWH from 2016 to 2019, 4,650 cases had CA. Of these, 3,065 patients died during the course of hospitalization (65.9%). Although mortality rate decreased for both genders over time, the decline was steeper for females (72% in 2016 to 62% in 2019) compared to the males (68% in 2016 to 64% in 2019). Female gender was however associated with an increased odds of death compared to male (OR: 1.2, 95%CI: 1-1.3, p=0.03). Asian or Pacific Islanders were associated with a lower odds ratio for mortality (OR: 0.6, 95%CI: 0.3-1, p=0.04). Additionally, beneficiaries of all the insurance types had higher odds of mortality compared to Medicare beneficiaries (OR between 1.8 and 3). The odds of death decreased with increasing household income (OR between 0.7 and 0.9). Patients admitted to the hospitals of West South Central (OR:1.6) and Pacific Regions (OR:1.7) had a higher mortality rate as had those residing in areas with less than 250,000 populaces (OR: 1.7).

Conclusion:
Despite declining trend in mortality from CA among hospitalized PLWH, more than 60% of the cases die during their hospital stay. Female gender, lower household income, non-Medicare beneficiaries, and being a resident of smaller size population areas were associated with higher mortality among PLWH hospitalized with CA.
Abstract 11853: Prevalence and Correlates of Pre-Heart Failure Longitudinal Change in a Hispanics/latino Population-Based Study: Insights From the Echocardiographic Study of Latinos
Authors: Kuno Toshiki , Vasquez Nestor , April-Sanders Ayana , Swett Katrina , Kizer Jorge R , Thyagarajan Bharat , Talavera Gregory A , Ponce Sonia , Shook-Sa Bonnie , Daviglus Martha L , Kansal Mayank M , Cai Jianwen , Kitzman Dalane W , Rodriguez Carlos
Published: June 2023

Background:
Hispanic/Latinos have a high heart failure (HF) risk factor burden. Pre-HF is an entity known to progress to symptomatic HF. We aimed to characterize pre-HF prevalence and incidence among Hispanics/Latinos.

Methods:
The Echocardiographic Study of Latinos (Echo-SOL), a population-based sub-study of the Hispanic Community Health Study/ Study of Latinos (HCHS/SOL), assessed cardiac parameters on 1,643 participants at baseline and serially 4.3 years later. Prevalent pre-HF was defined as the presence of any abnormal cardiac parameter (left ventricular (LV) ejection fraction <50%; absolute global longitudinal strain < 15%; grade 1 or more diasolic dysfunction; LV mass index >115 g/m
2
for men, >95 g/m
2
for women; or relative wall thickness >0.42). Incident pre-HF was defined among those without pre-HF at baseline. Sampling weights were utilized to account for the HCHS/SOL sampling design.

Results:
Among our study population (mean age: 56.4 years; 56% female), HF risk factors, including systolic blood pressure and glycosylated, worsened during follow-up. Significant worsening of cardiac parameters was evidenced from baseline to follow-up (p<0.01 for all parameters). The extent to which cardiac parameters changed during follow-up varied across Hispanic/Latinos background groups with Mexican and Dominican descent having the greatest worsening of LV systolic and diastolic function. Overall, the prevalence of pre-HF was 66.7% at baseline and the incidence of pre-HF during follow-up was 66.3%. Prevalent and incident pre-HF were seen more among those with HF risk factors (Figure 1) as well as with older age.

Conclusions:
Hispanic/Latinos in the Echo-SOL target population exhibited worsening of pre-HF characteristics over time, with important Hispanic/Latinos background differences. Incidence and prevalence of pre-HF are high and pre-HF is associated with HF risk factors in our target population.