bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 14084: Empagliflozin in Hospitalized Patients With Heart Failure
Authors: Ahuja Tania , Park Joshua , Anwar Purnata , caraccio thomas , Lachmann Justine , Brejt Shelley , Webster Tyler , Katz Gregory , Pashun Raymond A , Jung Albert
Published: December 2023

Introduction:
The sodium-glucose cotransporter-2 inhibitors (SGLT2i) are recommended as part of guideline-directed medication therapy (GDMT) for those with heart failure (HF) and New York Heart Associated (NYHA) class II-IV symptoms. The 2022 AHA/ACC/HFSA HF guidelines recommend SGLT2i in those with HF and reduced ejection fraction (HFrEF), and to consider in those with mid-range or preserved ejection fraction (HFmrEF and HFpEF).

Hypothesis:
We aimed to evaluate the initiation of empagliflozin in patients hospitalized with HF to prove tolerability over other GDMT and continuation at discharge.

Methods:
This was a multi-center, retrospective review of empagliflozin initiation at 2 campuses of the same health system (NYU Langone Hospital-Long Island and NYU Langone Health) from November 2021 -October 2022. We included patients > 18 years of age with HF that received empagliflozin during hospitalization. Data collection included patient characteristics, empagliflozin dose, ejection fraction (EF), BNP, estimated glomerular filtration rate, and other GDMT including beta-blockers (BB), angiotensin converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARB), angiotensin receptor/neprilysin inhibitor (ARNI), and mineralocorticoid receptor antagonists (MRA). The primary outcome was empagliflozin initiation per EF. Secondary outcomes included evaluation of GDMT and continuation of therapies at discharge.

Results:
In total 434 medical records were reviewed, with 244 patients continued empagliflozin from home and 190 new initiations. When evaluated by EF, 73% of empagliflozin initiation occurred in patients with HFrEF, 22% in HFpEF and 5% in HFmrEF. The median age was 68 years (60-78), with a median BMI of 28 (24-34), and 64% were male. Concomitant GDMT included BB in 56%, ACEi/ARB in 33%, ARNI in 12%, MRA in 14% and loop diuretics in 48% of patients. The majority of these patients (87%) were able to continue empagliflozin at discharge. Out of the 13% that did not continue empagliflozin, the most common reason for discontinuation was lack of insurance coverage.

Conclusions:
Empagliflozin was safely initiated in patients hospitalized with a HF exacerbation and led to greater tolerability over other GDMT at hospital discharge.
Abstract 14088: Impact of Social Determinants of Health on Blood Pressure and Cholesterol Control in a Smartphone-Based Cardiovascular Risk Self-Management Program
Authors: Pargaonkar Vedant S , Roach Brian , Paz Edo E
Published: December 2023

Background:
Social determinants of health (SDOH) are environmental factors that have an impact on one's health, outcome, and quality of life. SDOH like language, income, healthcare access, race/ethnicity, and neighborhood characteristics can manifest in inequalities in cardiovascular disease (CVD) and its risk factor burden, resulting in inequitable CVD related morbidity and mortality. Limited data are available on effects of SDOH on CVD risk factor control among users of digital health technology. Aim: To study the impact of SDOH like primary language, household income, access to healthcare and urban/rural residential type on blood pressure (BP) and total cholesterol (TC) control in participants of a smartphone-based cardiovascular risk self-management program with AI-based digital coaching.

Methods:
Participants’ data were matched with Agency for Healthcare Research and Quality’s 2020 SDOH database by ZIP code. Changes in systolic BP (SBP), diastolic BP (DBP) and TC were evaluated from baseline to 6 months follow up. The SDOH variables- primary language, median household income, distance to healthcare facility and urban/rural residential type - were used to predict changes in BP and TC via regression models adjusted for age, gender, and baseline BP/TC.

Results:
In 27,553 participants (age 55 ± 0.1 y, 48.5% women), overall reduction in BP and TC were observed (p<0.001). Of those with baseline stage 2 hypertension, 80.5% reduced SBP at follow up, and 82.9% of those with baseline high TC (≥240 mg/dL) reduced TC at follow up. Median household income was associated with change in SBP (β -1.6E-5, p < 0.001) and DBP (β -4.8E-6, p < 0.001), but not TC. This association was not clinically significant as each $62,535 increase in the median household income was associated with an additional 1 mm Hg in BP reduction. No difference in BP or TC change was found based on primary language, distance to healthcare facility, and urban/rural residential type (p > 0.05).

Conclusion:
In a smartphone-based cardiovascular risk self-management program, the majority (>80%) of high-risk participants reduce BP and TC across various SDOH factors. These results highlight the potential use of this technology to bridge health inequity gaps in prevention and control of CVD risk.
Abstract 14117: Home Operated Ultrasound Exam for Detection of Worsening Heart Failure
Authors: Prenner Stuart B , Dougherty Kevin , Shofer Frances S , Goldberg Lee R , Panebianco Nova
Published: December 2023

Introduction:
Acute Decompensated Heart Failure (ADHF) is associated with a high degree of morbidity and mortality. Dynamic lung ultrasound artifact called B-lines directly correlate with pulmonary vascular congestion (PVC) and can be seen on a limited lung ultrasound.

Hypothesis:
We assessed the ability of a recently hospitalized patient with ADHF to self-perform a lung ultrasound using a hand-held ultrasound and store images for physician interpretation.

Methods:
This was a prospective observational convenience sample of patients with known chronic heart failure admitted to an urban academic tertiary care center. The patient was educated on a 6 lung-zone image protocol, how to use the cloud archival system, and given a hand-held ultrasound transducer and iPad. The patients were asked to upload images three times a week, for 3 weeks. A B-line score for each interpretable lung zone was calculated.

Results:
Fifteen patients were enrolled, all of whom completed 7 or more scans. Average patient age was 60 years (range: 28- 86 years), 73% male, 60% white, and 47% obese. Five patients had ejection fraction >50%, and average length of hospital stay was 6.3 days. Of the 792 potential images, 784 were obtained (99%) and 637 (81%) were interpretable. The right upper zone was most often interpretable (97%), whereas the left lateral zone was least (70%). Median patient B line score when indexed to 6 interpretable scans was 3.00. Indexed B line scores are shown for all 15 patients (Figure 1). Patient survey data identified the left lateral zone as the most challenging to obtain.

Conclusions:
This pilot study shows that patients with ADHF can be taught how to use a hand-held portable ultrasound device and obtain and upload lung ultrasound images to a cloud. Compliance with the study protocol was excellent. Further studies are needed to determine if patient-performed lung ultrasound can be useful to clinicians to detect and manage PVC in this patient population.
Abstract 14119: Association of Electrophysiologic Characteristics of Extra Pulmonary Vein Triggers With Atrial Fibrillation Recurrence
Authors: Lee Young Shin , Kim Daehoon , Pak Hui-Nam
Published: December 2023

Introduction:
The objective of this study was to investigate the mechanisms underlying the effects of extra pulmonary vein triggers (ExPVTs) on atrial fibrillation (AF) recurrence after catheter ablation (AFCA). We aimed to assess whether there are differences in electrophysiologic characteristics based on the location of ExPVTs and whether the location of ExPVTs is associated with AF recurrence.

Methods:
Among 2,625 patients who underwent de novo AFCA and subsequently underwent isoproterenol provocation tests, ExPVTs were identified in 311 cases. We categorized the location of ExPVTs as left atrium (LA), right atrium (RA), or septum, and vascular or non-vascular origins.

Results:
Patients with ExPVTs in the LA exhibited a larger LA diameter (42.2±6.8 vs. 40.4±6.9, p=0.035), a higher LA volume index (LAVI) (43.1±17.1 vs. 37.9±12.2, p=0.006), as well as significantly higher LA wall stress (193.2±106.7 vs. 154.9±74.6, p=0.001) compared to patients with ExPVTs in the RA. Multivariable logistic regression analysis revealed that male sex (p=0.032), diabetes mellitus (p=0.008), and higher LAVI (p=0.021) were associated with the presence of ExPVTs in the LA. No significant difference was observed in AF recurrence rate based on the location of ExPVTs when categorized as LA, RA, or both (Log-rank p=0.087), or when categorized as vascular versus non-vascular origin (p=0.528). However, when ExPVTs were classified as LA, RA, or septum, a significant difference in AF recurrence among the three groups was observed (p=0.047), with a higher recurrence rate in patients with ExPVTs in the LA compared to those with ExPVTs in the RA (p=0.018).

Conclusions:
Categorizing the location of ExPVT as LA, RA, or septum revealed a significantly higher AF recurrence rate in patients with ExPVTs in the LA compared to those with ExPVTs in the RA.
Abstract 14130: Efficacy and Safety of Endovascular Therapy in Stroke Patients With Large Ischemic Core in Comparison to Medical Management: Meta-Analysis of Randomized Control Studies
Authors: Alameh Anas , jabri ahmad , Sukhon Fares , Alhuneafat Laith , Khader Safwan , divincenzo lola , Soltero Enrique , nasser farhan , Siraj Aisha
Published: December 2023

Introduction:
Endovascular therapy (EVT) is a treatment recommended for stroke patients with large vessel occlusion and an Alberta Stroke Program Early Computed Tomography Score (ASPECTS) ≥6. However, the utility of EVT in patients with large core ischemic stroke has not been well established.

Methods:
This meta-analysis assesses EVT's efficacy and safety using available trials comparing EVT to medical management (MM) in stroke patients with large ischemic core. Eligibility criteria: 1) were randomized controlled trials, 2) compared EVT with MM alone, 3) studied patients presenting with LIC cerebrovascular events, and 4) reported outcomes of interest. We extracted data for the major imaging inclusion criteria, the National Institutes of Health Stroke Scale (NIHSS) score, pre-stroke mRs score, and occlusion site. We also extracted outcome data for the EVT groups vs MM groups, including measurement of early neurological recovery, and definition of sICH.

Results:
Our primary end point was the mean modified Rankin scale score (RSS) at 90-day follow up. EVT was associated with higher odds of significant improvement in functional status with reduction in mean mRS by -0.31 [-0.47; -0.14]) compared to MM. The odds of achieving mRS 0 to 2 was higher in the EVT arm compared to the MM arm (2.53 [1.59; 4.02]). There was no difference in achieving mRS 0 to 3, early neurologic improvement defined according to NIHSS score, overall 90-day mortality and risk of symptomatic ICH between patients treated with EVT or MM in our analysis.

Conclusions:
Our study suggests that EVT may lead to improved outcomes in stroke patients with large core ischemia.
Abstract 14144: Higher Burden of Cardiovascular Risk Factors in Schizophrenia Patients: Results From All of Us Study
Authors: Eun Yong , Anwer Fatima , Kwak Ha Rim , Raiszadeh Farbod
Published: December 2023

Background:
Patients with schizophrenia experience a higher risk of mortality and morbidity from physical health issues, including cardiovascular disease, diabetes, and metabolic syndrome. The literature suggests that patients with schizophrenia have a higher prevalence of metabolic syndrome than the general population. However, there is limited research examining the prevalence of hypertension (HTN), hyperlipidemia (HLD), and types 2 diabetes mellitus (T2DM) among patients with schizophrenia in large biobank data. Therefore, this study aims to investigate the prevalence of three disorders among patients with schizophrenia enrolled in All of Us database.

Methods:
In this cross-sectional study, we included participants from All of Us dataset version 6. Schizophrenia cohort was defined as having at least one ICD diagnosis code for schizophrenia and one or more antipsychotic exposure for schizophrenia. Patients with HTN, HLD, T2DM were identified using diagnosis codes, blood pressure measurements, medication history, and laboratory results (HbA1C, fasting, and random blood glucose). The prevalence of each disease was identified in schizophrenia cohort as well as all participants enrolled in the database, and odds ratios were calculated.

Results:
Of 258,188 individuals with available electronic health records data, 3,246 had schizophrenia. The median age was 51.8 (SD 13.1). 1,687 (52.0%) were males, 1,407 (43.3%) were African American, and 1015 (31.3%) were White. The prevalence of HTN, HLD, T2DM in participants with schizophrenia was 38.9%, 34.6%, 16.5%, respectively, compared to 21.6%, 22%, and 7.9% in all participants. The unadjusted odds ratios of HTN, HLD, T2DM in participants with schizophrenia compared to all participants were 2.344 (95% CI 2.182-2.561), 1.889 (95% CI 1.756-2.032), 2.336 (95% CI 2.125-2.563), respectively.

Conclusion:
Our analysis shows that the prevalence of HTN, HLD, T2DM is higher in individuals with schizophrenia compared to all participants in All of Us database. This highlights the importance of regular screening and prevention of cardiovascular disease risk factors in patients with schizophrenia. Future studies regarding the impact of these disorders on schizophrenia patients need to be undertaken.
Abstract 14165: Left Atrial Appendage Emptying Velocity as a Predictor of Energy Required for Successful DC Cardioversion in Patients With Atrial Fibrillation
Authors: Raxwal Bhuvi , Patel Sujal , Tongar Yash , parekh dipak M , Samir Amir
Published: December 2023

Background:
Atrial fibrillation (AF) is a prevalent cardiovascular disease in the elderly population. Restoring sinus rhythm in AF often involves antiarrhythmic drugs, direct current (DC) cardioversion, and ablation. The predictive value of left atrial appendage (LAA) emptying velocity in determining the energy required for successful DC cardioversion remains uncertain.

Aim:
To study the association between LAA emptying velocity and the amount of energy required for cardioversion in patients with AF undergoing DC cardioversion.

Methods:
A total of 79 consecutive AF patients were enrolled in the study. Transesophageal echocardiography was performed to exclude the presence of clot formation, after which patients underwent DC cardioversion using escalating biphasic energy levels of 100 joules, 200 joules, and 360 joules to restore sinus rhythm. Patients were stratified into two groups based on LAA emptying velocity: the low-velocity group (≤30 cm/sec) and the high-velocity group (>30 cm/sec). Clinical characteristics were compared between the groups.

Results:
Of the 79 patients, 49 had a low LAA emptying velocity (LAAEV). The low-velocity group was older, with a mean age of 75 years compared to 70 years in the high-velocity group. The severity of mitral regurgitation was similar between the two groups. Patients with reduced LAA emptying velocity required significantly higher joules for successful cardioversion compared to the high-velocity group (192 joules vs. 155 joules, p-value = 0.02). Sleep apnea was more prevalent in the high-velocity group. The utilization of antiarrhythmic medications did not differ significantly between the groups (55% vs. 63%, p-value = 0.25).

Conclusions:
The study showed AF patients with low LAA emptying velocity require higher energy levels for successful cardioversion, suggesting that LAA emptying velocity may serve as a predictor of energy requirement in DC cardioversion for restoring sinus rhythm in AF patients.
Abstract 14213: A Retrospective Natural History Study of Danon Disease
Authors: Hong Kimberly N , Khedro Tarek , Eshraghian Emily , Attias Jennifer , Storm Garrett , Tsotras Melina , Jackson Isaiah , Ahmad Elijah , Bui Quan M , Graw Sharon , Mestroni Luisa , Adler Eric , Taylor Matthew
Published: December 2023

Introduction:
Danon disease (DD) is a rare X-linked dominant cardioskeletal myopathy caused by mutations in the lysosome-associated membrane protein-2 (LAMP2) gene. The purpose of this study is to characterize disease progression and outcomes in males and females with DD.

Methods:
Data were from the International Danon Disease Registry that includes patients from the United States and Europe consented between 2005 and 2022. Records were obtained from the first episode of care to the date of enrollment and included demographics, clinical characteristics and outcomes. Chi square and Wilcoxon testing were used for cross-sectional and mixed effects models used for longitudinal analyses. Data were censored after TXP or LVAD.

Results:
This study included 112 patients with a median follow up of 6.8 yrs (IQR: 2.5-12.8 yrs). Demographics and outcomes are in Table 1. Males were more likely to experience the combined heart failure outcome. At least mild ventricular dysfunction occurred in 30% of patients, and almost all patients had LV hypertrophy. Regarding arrhythmias, WPW and CIED placement were common. Over time, LVEF decreased in both sexes and LV wall thickness did not increase, although LV mass increased in males only. BNP, CPK and AST did not change. [Table 2]

Conclusions:
DD is a multisystem and progressive disease with potential for cardiac arrhythmias, progressive hypertrophy and ventricular dysfunction. Currently, there are no disease modifying therapies for DD, although gene therapy trials are underway. Understanding the natural history of DD is critical for informing patient selection of therapies, including heart transplantation and new gene modifying therapies.
Abstract 14218: Trends in Prevalence of Hypertension and Untreated Hypertension Before and During the COVID-19 Pandemic Period in Japan
Authors: Tsuji Hisako , Oishi Yohei , Akita Yuzo , Sueyoshi Hiroyuki , Shiojima Ichiro
Published: December 2023

Background:
To examine influence of the COVID-19 pandemic on blood pressure in a general population, trends in prevalence of hypertension and untreated hypertension before and during the COVID-19 pandemic period were examined.

Methods:
We studied subjects aged 40 to 79 who had the annual health checkup offered to adult citizens of Moriguchi city, Osaka, Japan from 2015 to 2022. Sex-specific age-standardized prevalence rates of hypertension (systolic blood pressure (BP)
>
140 mmHg, diastolic BP
>
90 mmHg, or receiving antihypertensives) and those of untreated hypertension to the WHO reference population with 95% confidence intervals (CI) were calculated. Statistically significant difference was determined by 95% CI compared to the 95% CI of the prevalence of 2015.

Results:
Number of subjects and trends in prevalence of hypertension and untreated hypertension with 95% CI are presented in the figure. From 2015 to 2019 (before the COVID-19 pandemic period) prevalence of hypertension and untreated hypertension did not change both in men and women. However, from 2020 to 2022 (during the COVID-19 pandemic period), prevalence of hypertension and untreated hypertension significantly increased compared to 2015, except for prevalence of hypertension in women in 2020 and that of untreated hypertension in men in 2022.

Conclusions:
During the COVID-19 pandemic period, higher prevalence of hypertension and untreated hypertension was observed in a general population in Japan.
Abstract 14229: Cost-Effectiveness of a Multicomponent Intervention for Hypertension Control in Public Sector Primary Healthcare Services in Singapore
Authors: Chay Junxing , Jafar Tazeen H , Su Rebecca , Shirore Rupesh M , Tan Ngiap Chuan , Finkelstein Eric A
Published: December 2023

Introduction:
Recently the SingHypertension cluster-randomized controlled trial investigated integrating a multicomponent intervention (MCI) into Singapore public sector primary care clinics for patients with uncontrolled hypertension. MCI consisted of physician training in risk-based treatment, antihypertensive medication subsidies, nurse-delivered motivational conversations and telephone follow-ups. While MCI improved blood pressure control and cardiovascular disease (CVD) risk scores relative to usual care (UC), the cost-effectiveness of MCI is unknown.

Aim:
We evaluated the incremental cost-effectiveness of MCI over a ten-year period following the intervention, from Singapore’s health system perspective.

Methods:
We used a Markov model to simulate the risks and outcomes associated with heart attacks and strokes for a hypothetical cohort of patients based on the trial profile. Costs included MCI administration and oversight, antihypertensive medications, consultations, diagnostics, and hospitalizations. Effectiveness was calculated in terms of disability-adjusted life years (DALYs) averted. Due to differences in outcomes by risk-group, we reported incremental cost effectiveness ratios (ICERs) separately for patients with low and high baseline risk of CVD, as well as an overall ICER. We also assessed the robustness of our results with deterministic and probabilistic sensitivity analyses.

Results:
Based on a willingness-to-pay threshold of USD 55,600 per DALY, MCI was incrementally cost-effective to UC for both low- (ICER: USD 35,700 per DALY averted) and high-risk patients (ICER: USD 55,500 per DALY averted), with a combined ICER of USD 45,400 per DALY averted. ICERs were most sensitive to the effectiveness of MCI; a reduction in QCVD
TM
3 score of at least 0.56 for low-risk patients and 1.00 for high-risk patients was needed for cost-effectiveness. MCI had a 99% and 50% probability of being cost-effective for low- and high-risk patients respectively.

Conclusions:
MCI is likely cost-effective in reducing the incidence of heart attacks and strokes, especially for lower risk hypertensive patients. Wide-scale implementation of this intervention should be considered to improve blood pressure control in Singapore and beyond.
Abstract 14237: Anticoagulation Strategies After Transcatheter Aortic Valve Implantation in Patients Without an Indication of Oral Anticoagulants, Network Meta Analysis of Randomized Controlled Trials
Authors: K. Awad Ahmed , Elbadawy Merihan A , K. Awad Ayman , Abuelazm Mohamed T , Ali Shafaqat , Abdelazeem Basel
Published: December 2023

Introduction.
Transcatheter aortic valve implantation (TAVI) is currently the mainstay treatment for aortic valve diseases, yet postoperative anticoagulation strategies after TAVI is still debatable. Thus, we aim to investigate the safety and efficacy of direct oral anticoagulants (DOACs) vs. single-antiplatelet therapy (SAPTs) vs. dual-antiplatelet therapy (DAPT) vs. Vitamin K antagonists (VKAs) in patients undergoing TAVI and without an indication of OACs.

Methods:
PubMed, Web of Science, Scopus, and Embase were systematically searched up to December 2022. A frequentist network meta-analysis has been conducted using a random-effects model calculating the odds ratio (OR) with a 95% confidence interval (CI).

Results:
We included 9,087 patients from 11 studies. Compared to DOACs, DAPT, SAPT, and VKAs were associated with significantly lower odds for short-term all-cause mortality (OR: 0.62; 95% CI [0.46-0.86]), (OR: 0.42; 95% CI [0.29-0.60]), (OR:0.54; 95% CI [0.31, 0.94]), respectively. DAPT was also associated with higher short-term major bleeding risk (OR:2.66; 95% CI [1.46-3.86]). Furthermore, both DAPT and SAPT were associated with significantly higher long-term bleeding rates with (OR: 1.78; 95% CI, [1.15-2.41]) and (OR:2.32; 95% CI, [1.29-3.35]), respectively. However, VKAs were associated with lower long-term bleeding rates (OR: 0.61; 95% CI, [0.24-0.98]). No intervention showed a significant difference over DOACs in terms of long-term all-cause mortality, cardiovascular mortality, and stroke, except for DAPT which showed higher odds of long-term all-cause mortality (OR: 1.83; 95% CI, [1.29-2.37]).

Conclusion:
Despite the long-term higher rates of major bleeding, SAPT was effective in preventing both short and long-term all-cause mortality compared to DAPT, which has both short, long term major bleeding and higher long-term all-cause mortality. Further RCTs are still required to confirm SAPT superiority compared to other strategies.
Abstract 14259: Contractile Effects of Glucagon in Atrial Preparations From Transgenic Mice and Men
Authors: Neumann Joachim , Hußler Wilhelm , Hofmann Britt , Gergs Ulrich
Published: December 2023

Glucagon, a peptide composed of 29 amino acids, produced mainly in the pancreas can also stimulate cardiac function. Glucagon might contribute to hyperglycemia in diabetes mellitus type 2 and is thus of clinical relevance. There is controversy in the literature whether glucagon affects force and beating rate in the human atrium and which receptor is involved. Hence, we studied the effect of glucagon on atrial preparations of wild type mouse hearts (WT), from transgenic mice with cardiac overexpression of the human glucagon receptor (GR-TG) and for comparison in human right atrial preparations. We noted that glucagon exerted concentration- and time-dependent positive chronotropic effects in atrial preparations from WT and GR-TG starting at 0.1 nM glucagon and amounting to 25 % of pre-drug value at 3 nM glucagon (n=8, p<0.05). These effects were antagonized by the glucagon receptor antagonist SC203973 (1 μM), the inhibitor of cAMP dependent protein kinase H89 (1 μM), by the M-cholinoceptor agonist 1 μM carbachol, by the A1-adenosine receptor antagonist R-phenylisopropyladenosine (1 μM) and the inhibitors of hyperpolarization-activated cyclic nucleotide gated channels namely ivabradine (1 μM) or cesium chloride (2 mM) (n=5-6, p<0.05). In left atrial preparations from GR-TG but not WT, glucagon exerted starting at 1 nM a positive inotropic effect. Interestingly, in human atrial preparations glucagon at 1 μM in the additional presence of the phosphodiesterase III inhibitor cilostamide (1 μM) increased force of contraction by 34 % (n=5, p<0.05). We conclude that glucagon can exert contractile effects in mammalian hearts via GR, but they exhibit considerable regional and species differences. The physiological and therapeutic relevance of glucagon in the human heart needs to be fully elucidated.
Abstract 14262: Cancer - A Driver of Heart Failure in People With Diabetes
Authors: Wong Joshua , Magliano Dianna J , Chen Lei , Morton Jedidiah I , Shaw Jonathan E , Marwick Thomas H
Published: December 2023

Introduction:
Despite the risk of heart failure (HF) in the survivorship phase of some cancers, the risk is not high enough to justify HF screening. However, people with diabetes mellitus (DM) have an increased risk of both HF and cancer. Examining this at-risk population may allow for better understanding of the effect cancer has on the development of HF.

Hypothesis:
Among people with DM, HF is more common in those with than without prior cancer.

Methods:
Data from the Australian National Diabetes Services Scheme (NDSS; 1,114,356 DM, types 1 and 2) from 2010 to 2019, was linked with public hospital data, the National Death Index and national Pharmaceutical Benefits Scheme (PBS) database. People with cancer were identified by the prescription of chemotherapy agents on the PBS dataset or a hospital admission with cancer. Incident HF was detected via first hospitalisation with HF as the primary diagnosis or death due to HF. The model was adjusted for age and sex.

Results:
Of the total cohort (1,114,356 people with DM), 48,014 experienced HF during 6,663,046 person-years of follow up from 2010-2019. Specifically, of 175,656 people with DM and cancer, 8,464 experienced HF during 644,620 person-years of follow up. The HF incidence rate ratio (IRR) of people with DM and cancer was 1.63 (95%CI: 1.59-1.67), compared to people with DM but no cancer. Cancer admission alone had an IRR of 1.97 (1.90-2.05), with an IRR of 1.50 (1.46-1.54) in DM treated with chemotherapy with or without admission.

Conclusion:
Cancer diagnosis is associated with an increased incidence of HF among people with DM. The higher IRR of people with cancer admission alone supports the association of cancer with HF irrespective of chemotherapy. Further studies controlling for confounders of cardiovascular risk and refinements by age are required to justify grounds for HF screening.
Abstract 14263: Comparison of Catheter Ablation versus Antiarrhythmic Therapy in Patients With Atrial Fibrillation and Heart Failure With Preserved Ejection Fraction
Authors: DeLuca Marisa , Verma Beni R , Tarabichi Yasir , Karim Saima
Published: December 2023

Introduction:
The differences in outcomes between catheter ablation (CA) versus antiarrhythmic drugs (AAD) for atrial fibrillation (AF) in the setting of heart failure with preserved ejection fraction (HFpEF) are not known.

Hypothesis:
We hypothesize that patients with AF and HFpEF who undergo CA will have lower morality, stroke/TIA, and acute HF compared to those treated with AAD.

Methods:
TriNetX, a national retrospective electronic database, was used to identify patients aged 18-80 years with AF and HFpEF from 2017-2023. Patients with a prior diagnosis of systolic HF or cross overs from AAD to CA were excluded. Patients who underwent CA were compared to those treated with AAD (amiodarone, flecainide, dronedarone, dofetilide, propafenone, sotalol). Baseline group comparison was performed using student’s t-test. Age, sex, chronic kidney disease, COPD, hypertension, type 2 diabetes mellitus, obstructive sleep apnea, and stroke/TIA were used for 1:1 propensity matching. Kaplan Meier curves were calculated to compare all-cause mortality, stroke/TIA, acute diastolic and systolic HF.

Results:
Patients who received CA (n=1468) and AAD (n=7426) were propensity matched yielding 1008 patients per cohort. Compared to AAD, CA demonstrated significantly lower all-cause mortality (9.13% vs. 23.7%; HR=2.6; 95% CI [2.038,3.315]; log-rank p<0.0001), lower stroke/TIA risk (5.12% vs. 7.69%; HR=1.6; 95% CI [1.056,2.28]; log-rank p=0.02), and less frequent hospitalization for acute diastolic HF (12.1% vs. 18.8%; HR=1.6; 95% CI [1.185,2.152]; log-rank p=0.0018). Rate of acute systolic HF was similar for both cohorts with 7.76% for CA and 6.90% for AAD (HR=0.88; 95% CI [0.63,1.222]; log-rank p=0.4395).

Conclusions:
Patients with AF and HFpEF had lower mortality, risk of stroke and acute diastolic HF when they received CA versus AAD. Randomized clinical trials are needed to better understand their short and long-term outcomes.
Abstract 14279: Improved Pressure-Flow Relationship With Sacubitril/Valsartan: A 6-min Walk Stress Echocardiographic Study
Authors: Yamaguchi Natsumi , Kusunose Kenya , Hirata Yukina , Nishio Susumu , Takahashi Tomonori , Saijo Yoshihito , Kadota Muneyuki , Ise Takayuki , Yamaguchi Koji , Yagi Shusuke , Yamada Hirotsugu , Soeki Takeshi , Wakatsuki Tetsuzo , Sata Masataka
Published: December 2023

Background:
In the clinical setting, there are various techniques for stress echocardiography, of which the 6-minute walk (6MW) test is a straightforward and utilized one. An abnormal hemodynamic response to exercise is indicated by a ΔmPAP/ΔCO slope of greater than 3 mmHg/L/min between rest and exercise. This response is associated with impaired prognosis in patients with exercise dyspnea and several cardiovascular diseases.

Hypothesis:
Our hypothesis was that pressure-flow relationship of the pulmonary circulation obtained by 6MW stress echocardiography would be enhanced with treatment.

Aims:
The aim of this study was to assess the effects of administration of Sacubitril/Valsartan on cardiac function in heart failure.

Methods:
We prospectively enrolled 39 patients with heart failure. The 6MW test was performed indoors in a flat, straight corridor. The peak tricuspid regurgitation jet, early diastolic transmitral flow velocity and early diastolic mitral motion were obtained by echocardiography post-6MW. We calculated the slope of ΔmPAP/ΔCO as a parameter of pulmonary hypertension. Follow-up echocardiographic studies were performed after 1 year.

Results:
Left ventricular diameter and volume were significantly reduced (LVDd; 59.3±7.7mm vs 56.0±8.6mm, P<0.001, LVEDV; 160.7±49.6ml vs 136.0±54.3ml, P<0.001), and LVEF was significantly improved (37.6±11.3% vs 44.9±11.5%, P<0.001). Among the 31 patients who underwent 6MW stress echocardiographic study at baseline and 1 year later, 6MW distance increased after treatment (380m vs 430m, P=0.003). The ΔmPAP/ΔCO by 6MW stress decreased with treatment (6.9mmHg/L/min vs 2.8mmHg/L/min, P=0.002).

Conclusions:
Initiation of Sacubitril/Valsartan was associated with improvement of left ventricular size and LVEF. Additionally, the 6MW distance increased and the ΔmPAP/ΔCO was improved to within normal range with treatment. Sacubitril/Valsartan distinctly improved cardiac reactivity to exercise.
Abstract 14283: Brain-Mediated Cardioprotective Actions of Leptin: Potential Role of Brown Adipose Tissue and Its Release of Extracellular Vesicles
Authors: Omoto Ana C , Vechetti Ivan , Rule Blake , Docarmo Jussara M , Da Alexandre A , Zenun Sumaya , Tosta Odecio , Larson Kylie , Aitken Nikaela , Nelson Benjamin , Wang Zhen , Li Xuan , Mouton Alan J , Hall John E
Published: December 2023

Background:
We recently demonstrated that leptin has powerful central nervous system (CNS) actions that dramatically improve cardiac function following ischemia/reperfusion (IR) injury. How the brain communicates with the heart during CNS leptin infusion to improve cardiac function is unknown. One potential mechanism is activation of brown adipose tissue (BAT) which may be an important source of extracellular vesicles (EVs) carrying cardioprotective microRNAs (miR), including miR-125b-5p.

Hypothesis:
We investigated whether BAT contributes to the cardioprotective effect of CNS leptin infusion and the potential role of EVs carrying the miR-125b-5p in this protection.

Methods:
Male Sprague-Dawley rats were submitted to interscapular BAT ablation (iBATx) and instrumented with an intracerebroventricular (ICV) cannula in the brain lateral ventricle. After recovery and baseline assessment of cardiac function by echocardiography (ECHO), myocardial IR was induced by temporary ligation of the left anterior descending coronary artery. Vehicle (saline, 0.5 μL/hr) or leptin (0.62 μg/hr) was infused ICV chronically for 28 days using osmotic pumps. Cardiac function was assessed weekly by ECHO. Another set of animals with intact iBAT was treated with ICV leptin or vehicle for 4 weeks and had their iBAT collected for EVs isolation and quantification. Expression of the miR-125b-5p was measured in the heart of leptin treated rats with intact iBAT or iBATx.

Results:
Compared to vehicle-treated animals, ICV leptin infusion increased iBAT-derived EVs and removal of iBAT prevented leptin’s CNS-mediated cardioprotective effects after IR injury as indicated by a lack of improvement in ejection fraction (26±6 vs 41±3%) and stroke volume (162±31 vs 275±19μL) at week 4 post-IR. Expression of the mature miR-125b-5p was increased in the heart of ICV leptin treated rats and iBATx abolished this effect.

Conclusion:
These results indicate that the BAT plays an important role in mediating the cardioprotective effect of CNS leptin administration after IR injury and suggest that iBAT-derived EVs may be involved in delivering the miR-125b-5p to the heart during central leptin infusion. AHA 835218, 1R01HL163076, P20GM104357, and P20GM104320-07
Abstract 14288: α1-Antichymotrypsin Complex (SERPINA3) is an Independent Predictor of Long-Term All-Cause Mortality, but Did Not Predict CVD Events
Authors: Nilsen Dennis W , Poenitz Volker , Aarsetoey Reidun , Ueland Thor , Aukrust Pal , Michelsen Annika , Brugger-Andersen Trygve , Staines Harry , Grundt Heidi
Published: December 2023

Introduction:
SERPINA3 is an acute phase protein triggered by inflammation. It inhibits neutrophil cathepsin which cleaves protease-activated receptor 4 (PAR-4) via a thrombin-independent pathway, and mast cell chymase which mediates the production of angiotensin-II via an ACE-independent pathway. SERPINA3 is upregulated after an acute myocardial infarction (MI), but data on its long-term prognostic value in MI patients are scarce.

Aim:
To assess the utility of SERPINA3 as a prognostic marker in patients hospitalized for chest pain of suspected coronary origin.

Methods:
A total of 871 consecutive patients were included (ClinicalTrials.gov Identifier: NCT00521976). Stepwise Cox regression models, applying continuous log
e
-transformed values, were fitted for each of the biomarkers with all-cause mortality and cardiac death within median 24-months (mo) and all-cause mortality within median 7 years (y) as the dependent variables, adding an analysis of 1) all-cause mortality or MI, and 2) all-cause mortality or MI or stroke at 7 y follow up (FU). The hazard ratio (HR) (95% CI) was assessed in a univariate and multivariable model, adjusting for traditional clinical cardiovascular risk factors, adding BNP, hsCRP, TnT.

Results:
Plasma samples from 847 patients were available. At 24 mo FU, 138 (15.8%) patients had died, of which 86 were cardiac deaths. The univariate analysis showed a positive, significant association between SERPINA3 and total death [HR 1.42 (95% 1.19-1.68), p =0.000], but was not significant for cardiac death. Associations after multivariable adjustment were statistically non-significant. At 7 y FU, 332 (38.1%) patients had died. After adjustment, SERPINA3 was independently associated with all-cause mortality [HR 1.14 (95% CI, 1.02-1.28), p=0.022], but not for MI (n=203), and stroke (n=55), respectively, and remained essentially unaffected for all-cause mortality or MI combined (n=404) [HR 1.12 (95% CI, 1.01-1.24), p=0.031], slightly weakened when stroke also was added (n=422) [HR 1.10 (95% CI, 1.00-1.22), p=0.060].

Conclusions:
SERPINA3 predicts long-term all-cause mortality, but had no prognostic bearing on short-term cardiac death. Introducing non-fatal CVD events during long-term FU did not improve its prognostic value.
Abstract 14303: COVID-19 and the Gender Impact on Sudden Cardiac Death
Authors: Saleh Jimmy , Muhyieddeen Amer , Abdullah Khaled M , Harb Ahmad
Published: December 2023

Background:
Sudden Cardiac Death (SCD) is an unexpected death attributed to a cardiac cause that occurs within one hour of symptom onset. Males have a higher likelihood of experiencing sudden cardiac arrest compared to females, as evidenced by previous studies indicating a substantial disparity in mortality rates between the genders. The outbreak of the COVID-19 pandemic has had a profound impact on cardiovascular population health patterns. Therefore, our study aimed to assess the influence of the pandemic on the gender-related variation in SCD rates among males and females.

Methods:
We used the National Inpatient Sample (NIS) to identify all patients admitted to hospitals in 2019 and 2020 with a primary diagnosis of sudden cardiac arrest. To analyze associations, we employed both logistic and linear regression methods, adjusting for potential confounding variables. We set the threshold for statistical significance at a 2-tailed p-value of 0.05.

Results:
Between 2019 and 2020, a total of 27,430 individuals were admitted to hospitals with a primary diagnosis of sudden cardiac arrest, with 11,705 (42.7%) of these patients being female. When factors such as age, race, hospital bed size, location and teaching status, insurance, and income level, as well as Elixhauser comorbidities and COVID-19 status were considered through multivariate regression analysis, a distinct trend emerged. In the year 2020, which was marked by the COVID-19 pandemic, there was a significant increase in in-hospital mortality among female patients (adjusted Odds Ratio aOR 1.34, 95% Confidence Interval CI 1.04 - 1.79). This trend was not present in the previous year, 2019, prior to the pandemic (aOR 1.03, 95% CI 0.87 - 1.22).

Conclusion:
Our study revealed a significant increase in mortality among female patients presenting with sudden cardiac arrest during the Covid-19 pandemic. We attribute this increase to the intricate interplay between Covid-19 and the healthcare system. While a direct association between SCD and Covid-19 is possible, it is crucial to acknowledge the indirect ramifications such as the impact of lockdown measures, alterations in behavior, and challenges faced by the healthcare system, all of which may be contributing factors.
Abstract 14310: Evaluation of Ventricular Pacing Suppression Algorithmsin Dual Chamber Pacemaker: Results of 'Leader' Study
Authors: Hwang Jongmin , Han Seongwook , park Hyoung-Seob , Chung Tae Wan , park seung-jung , Lee Chan-Hee , Ahn Jinhee , Choi Eue-keun , Bae Myung Hwan , Lee Young Soo , Park Sang Won , Lee Dae In , Ahn Minsoo , Kim Yoo Ri R , Shim Jaemin
Published: December 2023

Introduction:
Several algorithms have been proposed to reduce unnecessary right ventricular (RV) pacing, and their operations are based on two different mechanisms: (i) atrioventricular (AV) hysteresis (AVH) and (ii) DDD to AAI pacing mode change.

Hypothesis:
The purpose of our study was to evaluate the efficacy and safety of two ventricular pacing suppression algorithms: Intrinsic Rhythm Support (IRS) plus algorithm (using AVH, IRSplus) and VP suppression (DDD to AAI mode change) algorithm (VpS).

Methods:
This was a multicenter, randomized study conducted in 11 tertiary hospitals in South Korea. Patients with sinus node dysfunction and receiving dual-chamber permanent pacemaker implantation were included in this study. After the implantation, patients maintained a fixed AV interval for three months. The AV conduction time was determined as the "atrial pacing to ventricular sensing interval" observed from the marker channel during the PPM implantation was set as the sensed AV delay. The paced AV delay was set to be the sensed AV delay+30ms. Subsequently, patients were randomly assigned to either the VpS or IRSplus algorithm group and were followed for 12 months with assessments every 6 months.

Results:
A total of 118 patients were enrolled, and the total RV pacing percentage (Vp%) of the patients during the 3 months with a fixed AV interval was 10.9±16.0 on average. They were randomly assigned to VpS and IRSplus groups, with 62 and 56 patients in each group. Six months later, the average Vp% was 14.6±18.8 to 2.7±6.0, P<0.001 and 6.8±10.9 to 1.1±4.0, P<0.001 for the VpS and IRSplus groups, respectively. This trend was maintained for additional 6 months (VpS group: 4.6±9.5; IRSplus group: 1.2±3.8). The effects of algorithms were more pronounced in groups with an intrinsic PR interval of < 200ms, and the IRSplus showed better efficacy (Figure).

Conclusions:
The two ventricular pacing suppression algorithms were effective in reducing Vp% compared to the fixed AV interval.
Abstract 14346: The Cardiovascular Disease Associations and Genetic Determinants of Pericardial Adipose Tissue
Authors: Ramo Joel , Kany Shinwan , Hou Cody , Friedman Samuel , Roselli Carolina , Nauffal Victor , Koyama Satoshi , Karjalainen Juha ,   FinnGen, Maddah Mahnaz , Palotie Aarno , Ellinor Patrick T , Pirruccello James
Published: December 2023

Introduction:
While previous studies have reported associations of pericardial adipose tissue (PAT) with cardiovascular diseases such as atrial fibrillation (AF) and coronary artery disease (CAD), they have been limited in sample size or drawn from selected populations. Additionally, the genetic determinants of PAT remain largely unknown.

Hypothesis:
PAT is associated with cardiovascular diseases and genetic loci influence variation in PAT.

Methods:
A deep learning model was trained to quantify PAT area from four-chamber CMR images in the UK Biobank using semantic segmentation. Cross-sectional and prospective cardiovascular disease associations were evaluated, controlling for sex and age. A genome-wide association study was performed, and a polygenic score (PGS) for PAT was examined in 453,733 independent FinnGen study participants.

Results:
A total of 44,725 UK Biobank participants (51.7% female, mean [SD] age 64.1 [7.7] years) were included. PAT was positively associated with male sex (β = +0.76 SD in PAT), age (r = 0.15), body mass index (BMI; r = 0.47) and waist-to-hip ratio (r = 0.55) (P < 1x10
-230
for all). PAT was more elevated in prevalent heart failure (β = +0.46 SD units) and type 2 diabetes (T2D; β = +0.56) than in CAD (β = +0.22) or AF (β = +0.18). Baseline PAT was associated with incident heart failure (HR = 1.29 per +1 SD in PAT [95% CI 1.17-1.43]) and T2D (HR = 1.63 [1.51-1.76]) during mean (SD) 3.2 (1.5) years of follow-up; the associations remained significant when controlling for BMI. We replicated 2/2 known genetic loci and identified 5 novel loci, implicating transcriptional regulators of adipocyte morphology and brown adipogenesis (
EBF1
,
EBF2
and
CEBPA
) and regulators of visceral adiposity (
WARS2
and
TRIB2
). The PAT PGS was associated with T2D, HF, CAD and AF in FinnGen (ORs 1.03-1.06 per +1 SD in PGS, P < 2x10
-10
for all).

Conclusions:
PAT shares genetic determinants with abdominal obesity and is an independent predictor of incident T2D and heart failure.
Abstract 14364: Atrial Fibrillation With Rapid Ventricular Response Induced Ventricular Tachycardia Terminated by Intrinsic Anti-Tachycardia Pacing - A First in Literature Case Report
Authors: Alampoondi Venkatarmanan Sai Vikram , Tsai Shane
Published: December 2023

Background:
Intrinsic anti-tachycardia pacing (iATP) is a novel tailored algorithm that has shown increased efficacy against ventricular tachycardia (VT), including fast VT. We describe a case of atrial fibrillation (AF) with rapid ventricular response (RVR) induced VT terminated by iATP.

Case description:
A 71-year-old male with coronary artery disease, heart failure (EF 30-35%), atrial fibrillation, VT status post biventricular implantable cardioverter defibrillator and failed renal transplant presented with syncope during dialysis. His home medications included amiodarone, metoprolol, apixaban. He was hemodynamically stable on presentation. He had bilateral pitting edema with a systolic murmur and bilateral basilar crackles on exam. His labs were consistent with anemia and end stage renal disease. His device interrogation (Figure) showed AFRVR which degenerated to VT with final cycle length (CL) of 290 msec. First round of ATP with S1x10 burst pulses (88%, CL 250msec) and S2 extra stimuli (CL 230 msec) failed to terminate the VT. Post pacing interval (PPI) was 450 msec. Given calculated remote distance, another five rounds of adaptive iATP with similar S1 pulses but faster S2 and addition of S3 extra stimuli were delivered but were unsuccessful in terminating VT. Finally, the seventh round of iATP (S1x10 at CL 260 msec, S2 at 240 msec) was successful at conversion to sinus rhythm briefly before reverting to AF with controlled ventricular pacing.

Discussion:
ATP decreases ICD shocks but is programmed empirically and there is less success with fast VT. iATP analyses the PPI of the prior failed sequence to adjust the subsequent ATP therapy by altering the number of burst pulses (S1) and addition of ramp extra stimuli. Computational models and early clinical experience have shown increased efficacy of iATP in terminating fast VT without concomitant increase in VT acceleration. To the best of our knowledge, this is first case report of AFRVR induced VT terminated by iATP.