bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 11215: Comparative Effectiveness of Alcohol Septal Ablation versus Septal Myectomy on Mortality in Patients With Hypertrophic Cardiomyopathy
Authors: Osawa Itsuki , Zhao Yanling , Goto Tadahiro , Hasegawa Kohei , Maurer Mathew S , Tower Rader Albree , Fifer Michael , Reilly Muredach P , Takayama Hiroo , Shimada Yuichi J
Published: June 2023

Introduction:
Alcohol septal ablation (ASA) and septal myectomy (SM) are two options of septal reduction therapy (SRT) for patients with medication-resistant symptomatic obstructive hypertrophic cardiomyopathy (HCM). The 2020 AHA/ACC HCM Guideline recommends SM as the first-line choice and ASA as the second-line option to be conducted only if SM is contraindicated or surgical risk is high. However, little is known about the effectiveness of ASA versus SM for HCM on mortality in the real-world settings.

Objective:
To compare mortality between patients with HCM who underwent ASA and those who had SM using population-based databases.

Methods:
We identified patients with HCM who underwent an SRT from 2007 through 2014 using the SPARC database — a comprehensive, all-payer claims database that includes record of every inpatient stay and outpatient visit in New York State. We compared mortality at 15, 30, 180, and 360 days after SRT between the ASA group and the SM group (the reference group) using unadjusted analysis, propensity score matching (PSM), and inverse probability weighting (IPW). In the PSM and IPW models, we adjusted for age, sex, race/ethnicity, insurance type, and each item in the Elixhauser Comorbidity Index.

Results:
We identified 755 patients with HCM who underwent an SRT, including 348 in the ASA group and 407 in the SM group. In the unadjusted analysis, mortality in the ASA group was lower than that in the SM group (crude mortality at 360 days, 3.7% vs. 7.4%;
Figure
). Using the PSM method, mortality was lower in the ASA group in the 180-day and 360-day post-SRT periods (adjusted odds ratio [aOR] = 0.31 at 360 days; 95% confidence interval [CI], 0.09-0.93; P = 0.049). The IPW model showed consistent findings with the PSM model (aOR = 0.44 at 360 days; 95% CI, 0.21-0.88; P = 0.02).

Conclusions:
Patients with HCM who underwent ASA had lower mortality than those who had SM during a 1-year post-SRT period in this population-based study.
Abstract 11284: Predicting Thermal Injury by Machine Learning Analysis of Luminal Esophageal Temperature Patterns in Atrial Fibrillation Ablation
Authors: Chahine Yaacoub , Afroze Tanzina , Bifulco Savannah , Macheret Fima , Jafarvand Mahbod , Boyle Patrick M , Akoum Nazem W
Published: June 2023

Introduction:
Luminal esophageal temperature (LET) monitoring during catheter ablation for atrial fibrillation (AF) is widely used to reduce the incidence of esophageal thermal injury (ETI). We sought to assess whether specific patterns of LET variation are associated with ETI.

Methods:
The CIRCA-S multi-sensor probe was used to record LET in AF patients undergoing radiofrequency (RFA) or cryoballoon ablation (CBA) (
Fig A
). Patients underwent upper endoscopy one day after ablation. LET data was analyzed for patterns associated with ETI (
Fig B
). A random forest classifier with 5x stratified cross validation was trained to predict ETI, and SHapley Additive exPlanations (SHAP) analysis was used to assess feature importance in the prediction of ETI.

Results:
A total of 90 patients (63% paroxysmal AF; 27% female) were included. Among them, 68 patients underwent RFA, and 22 patients CBA. ETI was detected in 11 patients (10 RFA and 1 CBA). In case of RFA, the highest LET recorded was similar between patients who had an ETI and those who did not (40.4 [39.1, 41] vs 40.6 [40.1, 41], p=0.4); however, the rate of LET rise for the highest recorded peak was higher (0.08 [0.03, 0.12] vs 0.02 [0.01, 0.05]; p=0.02) and area under the curve (AUC) for highest peak was smaller (412.5 [206.8, 634.1] vs 545.5 [369.9, 855.1]; p=0.066) in patients who had ETI. In case of CBA, the patient with ETI had a faster LET decline (0.12 vs 0.07 [0.02, 0.14]), and a smaller AUC for the lowest trough (2491.3 vs 2629.3 [1712.6, 5283.2]) compared to patients who had no ETI. SHAP analysis revealed that for the overall population, rate of LET change was the most important feature in the prediction of ETI (
Fig C
), and that a rate of LET change >0.1°C/s is most predictive of ETI (
Fig D
).

Conclusion:
Rate of LET change and AUC for the recorded temperature are more important predictors of ETI compared to absolute peak temperatures. Prospective studies guided by these parameters are needed to demonstrate their efficacy in reducing ETI.
Abstract 11334: Validation of Deep-Learning-Based Retinal Biomarker in the Prediction of Cardiovascular Disease: Data From AREDS
Authors: Kang Hyun Goo , Rim Tyler Hyungtaek , Chen Qingyu , Lu Zhiyong , Lee Chan Joo , Tham Yih-Chung , Thakur Sahil , Nusinovici Simon , Peng Qingsheng , Yu Marco , Lee Geunyoung , Park Sung Ha , Kim Sung Soo , Keenan Tiarnan , Wong Tien Y , Chew Emily , Cheng Ching-Yu
Published: June 2023

Background:
In our previous study, we developed a deep-learning-based novel cardiovascular disease (CVD) risk stratification system based on retinal photographs, Reti-CVD. This study aims to further validate Reti-CVD in the US population of the Age-Related Eye Disease Studies (AREDS).

Methods:
Our testing cohort comprises of AREDS participants who have undergone retinal photography. We evaluated the ability of Reti-CVD to predict atherosclerotic CVD (ASCVD) events (non-fatal and fatal events, and fatal events) using Cox proportional-hazards models. Reti-CVD scores were then calculated and stratified into three groups based on optimized cut-off values from AREDS. Upon further stratifying Reti-CVD scores, we evaluated whether adding Reti-CVD to traditional risk factors could improve risk prediction.

Results:
Among 3,555 participants, 282 (7.9%) had non-fatal and fatal ASCVD events, and 84 (2.4%) had fatal ASCVD during the 13-year follow-up. Reti-CVD was significantly associated with an increased risk of ASCVD, demonstrating an adjusted hazard ratio (HR) trend of 1.13 (95% CI, 1.03-1.24) for non-fatal and fatal ASCVD events, and an adjusted HR trend of 1.27 (1.07-1.52) for fatal ASCVD events. Reti-CVD significantly improved the overall predictive performance of traditional risk models with a continuous net reclassification index (NRI) of 0.247 (0.106-0.364) for non-fatal and fatal ASCVD events, and 0.232 (0.107-0.359) for fatal ASCVD events. In heatmaps, traditional risk features such as arteriovenous nicking and arteriolar narrowing were well-detected by the Reti-CVD algorithm.

Conclusions:
A deep-learning-based, retinal photograph-derived new CVD biomarker, Reti-CVD, can be utilized as a risk stratification tool in predicting ASCVD risk in the US population. With the improvements observed on the current risk stratification by traditional risk models, Reti-CVD has considerable potential as an enhanced CVD risk stratification tool applicable in the general US population.
Abstract 11343: Unique Phenotypes of Three-Dimensional Aortic Growth in Genetic Aortopathy
Authors: Burris Nicholas S , Lu Yanglong , Knuer Heather A , Spahlinger Gregory , Hatt Charles R
Published: June 2023

Introduction:
Patients with genetically-mediated thoracic aortic aneurysm (TAA) are at high risk of progressive aortic growth, although growth is highly variable and often difficult to accurately define using conventional diameter measurements. An emerging image analysis technique, vascular deformation mapping (VDM), provides accurate, three-dimensional (3D) mapping of aortic growth.

Hypothesis:
3D growth mapping of the thoracic aorta will reveal unique patterns/phenotypes of growth in patients with genetically-mediated TAA.

Material and Methods:
We included adult (>18) patients at our center with GM-TAA and at least 2 CT angiograms >1 year apart. 3D aortic growth was measured by VDM. The longest CT interval with was used for analysis.

Results:
61 patients (average follow-up 5.4 ± 3.6 years, cumulative 331 years) were included, with etiologies: Marfan (n=41), Loeys-Dietz (n=2), vascular Ehlers-Danlos (n=5), and familial TAA (n=13). Average age was 54.8 ± 16.6 years and 42.6% were female (n=26). The majority (n=38, 62%) had a history of open root/ascending aortic repair. Among post-surgical patients, three patterns emerged from VDM growth maps: 1)
“One-and-done”
- prior repair of diseased segment with no further aortic growth (n=14); 2)
Adjacent segment
- growth limited to native aortic segment adjacent to a surgically repaired segment (n=9); 3)
Diffuse growth
- significant growth involving all native aortic segments (n=15). Among non-surgical patients (n=23, 38%) there were similarly three growth patterns by VDM: 1)
Stable
- no growth (n=9); 2)
Heterogeneous growth
- multi-focal growth with intervening regions without growth (n=7); 3)
Diffuse growth
- contiguous growth involving all segments (n=7).

Conclusion:
Growth in genetic aortopathy is highly variable in extent and degree both before and after aortic repair. Unique phenotypes of 3D growth identified by VDM may have important implications for risk stratification and surgical planning.
Abstract 11344: 30-Day Rate of Readmission and Economic Burden Among Patient With Spontaneous Coronary Artery Dissection
Authors: Udongwo Ndausung , Ezeaka Charles , Alshami Abbas , egbujiobi tochukwu , Mararenko Anton , Kozlik Ann , Odak Mihir , Orji Richard , Aryal Sarthak , Amoah Joseph , Selan Jeff , Fatuyi Michael
Published: June 2023

Introduction:
Spontaneous coronary artery dissection (SCAD) is a non-traumatic and non-iatrogenic separation of the coronary arterial wall and is an infrequent cause of acute myocardial infarction. SCAD most commonly affects women in their 40s and 50s, though it can occur at any age and can occur in men.

Hypothesis: T
here is limited data on readmission for SCAD. Therefore, we sought to determine the 30-Day Readmission rate (30-DRr) for SCAD & its impact healthcare utilization in the United States.

Methods:
Using the 2017 & 2018 National Readmission Database, a retrospective study of patient discharges with Spontaneous Coronary Artery dissection diagnosis according to ICD-10 codes. Readmission was defined as the first admission to any hospital for any non-trauma diagnosis within 30 days of the index discharged alive. The primary outcome was 30 DRr, while secondary outcomes were readmission mortality rate, most common diagnoses for readmission, & resource utilization defined by total patient charge (TPC), & hospital cost (THC).

Results:
A total of 479 index hospitalization for SCAD; mean age of 54.4years (SD±14.6), female 74.8%, with an in-hospital mortality rate for index admission of 4.4% (21). 30-DRr was 7.7% (35). The mean age for readmitted patient was 53.8yrs (SD±17.8), female 73.3%, with an in-hospital mortality rate was 5.7% (n=2), which was not statistically significant compared to index mortality. The total in-hospital cost associated with readmission was $ 320,401 & TPC of $ 1,320,662.

Conclusions:
We observed 1 in 13 are readmitted within 30 days among patient with SCAD
.
SCAD patients are a vulnerable subset requiring additional outpatient care. Improved clinical care and management of SCAD with guideline-based therapeutics may help reduce readmission, mortality & cost.
Abstract 11354: Role of PCSK9 Inhibitors in Acute Coronary Syndromes - A Pilot Study
Authors: Abdelnabi Mahmoud , Benjanuwattra Juthipong , Saleh Yehia , Del Rio-Pertuz Gaspar , Leelaviwat Natnicha , Almaghraby Abdallah
Published: June 2023

Introduction:
The proprotein convertase subtilisin/Kexin type 9 (PCSK9) inhibitors have been guideline-approved for intolerant patients to statin therapy or unable to achieve target LDL levels with maximally tolerated therapies. The study aimed to determine whether early initiation of PCSK9 inhibitor with statin therapy in acute coronary syndromes (ACS) patients is beneficial in relation to low-density lipoprotein (LDL) reduction and short-term cardiovascular outcomes.

Methods
This pilot study included eighty ACS patients randomized to receive either PCSK9 inhibitor (Evolocumab) with statin therapy (n=40) or statin monotherapy (n=40). Patients were followed up for 6 months to assess for LDL levels, left ventricular ejection fraction (LVEF), and major adverse cardiovascular events (MACE) (a composite of myocardial infarction, heart failure, and cardiovascular death).

Results
Eighty patients with ACS (mean age 59±11 years, 66.3% male) had LDL and LVEF measured at baseline, 3 months, and 6 months. There was no difference between baseline LDL levels (153.1±39.5 vs 146.1±32, p=0.39). LDL levels in PCSK9 inhibitor/statin group were significantly lower at 3 months and 6 months compared to statin monotherapy (76.2±27.7 vs 118.6±31, p<0.0001 and 78.2±22.1 vs 103.7±22.5, p<0.0001, respectively). There was no significant difference between incidences of cardiovascular death (1 vs 3, p=0.31) and MACCE (4 vs 6, p=0.5) between both groups at 6-month follow-up.

Conclusion
The early initiation of PCSK9 inhibitors/statin combination therapy in ACS patients was associated with a significant reduction of LDL levels at 3 and 6 months yet there was no significant difference in relation to short-term cardiovascular outcomes at a 6-month follow-up. Further research is required to determine whether early initiation of PCSK9 inhibitors in combination with statins or as monotherapy in ACS patients can be associated with improved short or long-term cardiovascular outcomes.
Abstract 11368: Weight Gain in Young Adults During the Covid-19 Pandemic
Authors: Goitia Jesse , Nayak Rohith , Chen Aiyu , Lee Mingsum S
Published: June 2023

Introduction:
During the COVID-19 pandemic, measures taken to prevent the spread of the coronavirus have led to significant changes in the lifestyle and habits of young people. The pandemic led to poor dietary patterns, reduced physical activities, and increased mental stress, which are all risk factors for weight gain. The goal of this study was to investigate the pattern of weight gain among young adults between age 18-50 years during the pandemic, and to identify factors associated with significant weight gain of 20 pounds of more.

Methods:
We included young adults between ages 18 to 50 years with at least one documented weight in their electronic health records before the start of the COVID-19 pandemic shelter-in-place orders (3/19/2019 to 3/19/2020) and at least one documented weight after COVID-19 vaccines became available (12/14/2020 to 12/14/2021). Multivariable logistic regression analysis was used to identify factors associated with greater than 20 pounds of weight gain. Odds ratios (OR) and 95% confidence intervals (CI) were calculated.

Results:
The study cohort included 133,750 young adults aged 18-50 years (median age 43 years. 39.7% men). The cohort is racially and ethnically diverse, with 22.6% self-identified as White, 7.2% Black, 48.1% Hispanic, and 17.3% Asian. During the pandemic, 53866 (40.3%) lost weight or had no weight gain, 50662 (37.9%) gained 0-9 pounds (lbs), 19422 (14.5%) gained 10-19 lbs, and 9800 (7.3%) gained 20 lbs or more. Individuals who gained 20 lbs or more were younger and more likely to reside in low-income neighborhoods. Multivariable logistic regression demonstrated the following factors to be associated with significant weight gain: male sex (OR 1.10, 95% CI 1.05-1.15), Black race (OR 1.14, 95% CI 1.05-1.23), low income (OR 1.16, 95% CI 1.16-1.35), and history of depression (OR 1.64, 95% CI 1.56-1.73).

Conclusions:
In this cohort of young adults, 59.7% experienced weight gain during the pandemic, with 7.5% gaining 20 lbs or more. Factors associated with significant weight gain included male sex, black race, low income, and a history of depression. Intervention strategies to promote healthy lifestyle may be particularly important for patients with depression, and young adults from low-income neighborhoods.
Abstract 11398: Prevalence and Characteristics of Systemic Inflammation in Adults With Atherosclerotic Cardiovascular Disease and Chronic Kidney Disease: Results From the National Health and Nutrition Examination Survey
Authors: Nanna Michael , Sloan Lance , Faurby Mads , Husemoen Lise Lotte N , Tombak Gamze , Yerragolam Deepak , Sattar Naveed
Published: June 2023

Introduction:
Systemic inflammation is linked to the development of atherosclerosis and the risk of major adverse cardiovascular events and mortality in adults with atherosclerotic CVD (ASCVD) and chronic kidney disease (CKD). Despite this, the epidemiology of systemic inflammation in this high-risk population has not been well described. Here, we estimate the prevalence of systemic inflammation in US adults with ASCVD with CKD, and characterize this population.

Methods:
Data were from the 2015-2020 pre-pandemic National Health and Nutrition Examination Survey (NHANES) cycles. Adults ≥ 20 years who completed the NHANES Medical Conditions Questionnaire and had non-missing serum creatinine and hsCRP levels, plus age, sex and ethnicity data, were included in this study. Systemic inflammation was defined as hsCRP ≥ 2 mg/L. To estimate prevalence in the US population, weighting was performed as outlined in the NHANES guidelines.

Results:
In total, 12 722 of 25 531 individuals met all the inclusion criteria. Based on weighted estimates, 8.4% of the general US population had ASCVD; of this group, 36.0% also had CKD and 22.1% had CKD stage 3/4. Systemic inflammation was present in 55.2% (95% CI, 49.8-60.6) of individuals with ASCVD, in 59.4% (53.4-65.2) with ASCVD and CKD, and in 62.1% (55.2-68.8) with ASCVD and CKD stage 3/4. The prevalence of individuals with systemic inflammation, ASCVD and CKD stage 3/4 among the US population was estimated at 1.2% (0.9-1.4). This group had a mean age of 72.1 years and a mean BMI of 31.9 kg/m
2
, 30.8% had type 2 diabetes and 38.9% had had an overnight hospital stay in the past 12 months (
Table
). A sensitivity analysis (patients with hsCRP 2-10 mg/L) had similar results.

Conclusions:
In this US survey, a large proportion of adults with ASCVD and CKD stage 3/4 had systemic inflammation. This group comprises an estimated 2.5 million adults who are likely to benefit from further targeted risk reduction efforts to help improve their cardiovascular outcomes.
Abstract 11425: Association of Glycemic Control With Cardiovascular Outcomes in Adult Cancer Survivors With Elevated Fasting Blood Glucose Level: A Population-Based Cohort Study
Authors: Kim Kyuwoong , Oh Sanghyun
Published: June 2023

Introduction:
Management of blood glucose level is recommended for prevention of cardiovascular disease (CVD) and other health outcomes by well-regarded guidelines. However, whether glycemic control is associated with incident CVD in adult cancer survivors with elevated fasting blood glucose (FBG) level remains unknown.

Hypothesis:
We hypothesized that adult cancer survivors with elevated FBG level (FBG≥100 mg/dL) whose FBG level was lowered to the normal range (FBG<100 mg/dL) would be at lower risk of incident CVD compared to those whose FBG level was persistently elevated.

Methods:
Population-based cohort study derived from the National Health Insurance Service database identified adult cancer survivors between January 1, 2002 and December 31, 2005 who underwent the two consecutive biennial national health screening program (2007-2008 and 2009-2010) in the Republic of Korea. Follow-up data for incident CVD and death from CVD or other causes was obtained from the medical claims records and death registry, respectively. Each survivor was followed-up from January 1, 2011 to December 31, 2019 until incident CVD, death from CVD or other causes, whichever came first. The risk estimates for CVD outcomes were computed with Cox proportional hazards model adjusted for age, sex, insurance premium, lipid profile, hypertension, obesity, cigarette smoking, and physical activity among adult cancer survivors with and without glycemic control.

Results:
A total of 4,959 adult cancer survivors with elevated FBG level was identified in the NHIS database. Among these survivors, proportion of those whose FBG level was lowered to the normal range was 36.2% (n=1,785). After adjusting for sociodemographic, lifestyle, and clinical characteristics, adult cancer survivors with lowered FBG level compared to those who had persistently elevated FBG level were less likely to be at risk of incident CVD (adjusted hazard ratio=0.69; 95% confidence intervals: 0.24-1.98).

Conclusions:
No statistically significant risk estimate was observed in this analysis, which is likely to be underpowered. Well-designed observational studies are needed to examine the association of glycemic control with CVD events among adult cancer survivors with elevated FBG level.
Abstract 11439: Predictors of Long-Term Heart Failure Readmissions Following PCI in Women
Authors: Morris Michelle , von der Lohe Elisabeth , Kreutz Rolf
Published: June 2023

Introduction:
Heart failure (CHF) is a common cause of readmission following percutaneous coronary intervention (PCI), particularly within the first 30 days. Female sex has been shown to be an independent predictor of 30-day readmission following PCI, with higher rates of readmission secondary to CHF observed in women. Whether the increased risk for CHF readmission persists beyond this early period has not been well studied.

Methods:
In this multicenter, retrospective observational study clinical outcomes were analyzed after PCI among patients included in the Indiana University Health Multicenter Cath Registry Study. Hospital readmission for acute CHF was the primary endpoint and analyzed through use of the Indiana network for patient care.

Results:
Among 13,871 patients included in this study, 14.5% were readmitted for CHF after the index PCI during mean follow up of 2.8 years. Women (n=4,411) were more likely to be readmitted for CHF than men (n=9,460) [HR 1.37,95% CI: 1.26-1.5; p<0.001). Women were older than men (66.1 vs. 63.8 years, p<0.001) and more likely to have diabetes (49% vs. 41%, p<0.001). Female sex persisted as independent predictor of CHF readmission after multivariate adjustment (p=0.004). The higher rate of CHF readmission in women continued to accrue beyond 30 days and event curves continued to diverge over the duration of follow up (Fig.).] Major predictors of CHF readmission included end stage renal disease, cardiogenic shock during index PCI, mechanical ventricular support at time of PCI, diabetes mellitus, and history of COPD, whereas discharge with ACEI or ARB was protective.

Conclusions:
Heart failure readmission remains a major cause of morbidity for women after undergoing PCI. The excess risk of CHF readmission in women extends beyond the early 30-day post PCI period.
Abstract 11446: Impact of Higher Synchronized Left Ventricular Pacing Rate for Prognosis on Cardiac Resynchronization Therapy
Authors: Miyazaki Yuichiro , ishibashi kohei , Ueda Nobuhiko , Wakamiya Akinori , Shimamoto Keiko , Nakajima Kenzaburo , Kamakura Tsukasa , Wada Mitsuru , Inoue Yuko , Miyamoto Koji , Nagase Satoshi , Aiba Takeshi , Kusano Kengo
Published: June 2023

Background:
The adaptive cardiac resynchronization therapy (aCRT) algorithm provides synchronized left ventricular pacing (sLVP) to produce fusion with the intrinsic right ventricular activation in normal atrioventricular (AV) conduction. Although sLVP has benefits over biventricular pacing (BiV), the adequate sLVP rate for better clinical outcome is still unclear.
Purpose:
The aim of this study was to assess the association between sLVP rate and clinical outcome.

Methods:
Among our cohort of 271 consecutive patients who had CRT implantation between April 2016 and August 2021, we evaluated 63 CRT patients without considerably prolonged AV conduction to whom we applied the aCRT algorithm (48 males, mean age: 64±14 years old, and the median follow up period: 316 days [interquartile range: 212-809days]).

Results:
At follow-up 6 months after CRT implantation, the frequency of CRT responder was 71% (n=45). The sLVP rate was significantly higher in responder compared to non-responder (75±30 vs 47±40 %, p=0.003). Receiving operating characteristics (ROC) curve analysis revealed that optimal cut-off value during sLVP rate was 59.4% for prediction of CRT responder (an area under the curve: 0.70, sensitivity: 80%, specificity: 61%, positive predictive value: 84%, and negative predictive value: 55%). Kaplan-Meier analysis demonstrated that higher sLVP group (sLVP≥59.4%, n=43) had better prognosis (cardiac death and heart failure hospitalization) compared to lower sLVP group (sLVP<59.4%, n=20) (log-rank p<0.001) (Figure) and multivariate Cox hazard analysis revealed that higher rate was associated with good prognosis (p<0.001).

Conclusion:
sLVP was associated with CRT response and higher sLVP rate (≥59.4%) may be important for good prognosis in patient with aCRT.
Abstract 11465: Impact of a QTc Risk Score Advisory on Mortality in Intensive Care Units
Authors: Malone Daniel , Heise C. , Tan Malinda S , Gallo Tyler , Tisdale James E , Woosley Raymond , Antonescu Corneliu , Gephart Sheila
Published: June 2023

Introduction:
Prolongation of the heart rate-corrected QT interval (QTc) is associated with increased mortality. We hypothesized that incorporation of a QTc prolongation risk score (QTc-RS) into a clinical decision support (CDS) advisory may reduce mortality in patients in intensive care units (ICUs).

Objective:
To evaluate the effectiveness of a QTc-RS risk score CDS on inpatient mortality in ICUs within hospitals in a wide geographical area.

Methods:
A QTc-RS CDS advisory incorporating a validated risk score using patient information available in the electronic health record was implemented throughout urban and rural facilities in the Banner Health system. Risk factors were assigned points as follows: female (1 point), age > 67 years (1), administration of a loop diuretic (1), diagnosis of acute myocardial infarction (2), serum K
+
≤ 3.5 mEq/L (2), sepsis (3), diagnosis of heart failure (3), one medication with a known risk of torsades de pointes (TdP) (3), two or more medications with known risk of TdP (3), and a Fridericia-corrected QTc > 500 ms (4). The QTc-RS was automatically calculated in the background each time an order for medication with a known risk of TdP was initiated. The pre-implementation period consisted of hospitalized patients from January 1, 2020 to March 31, 2020, with QTc-RS ≥12. However, clinicians did not receive a QTc-RS CDS advisory when placing an order for a medication with a known risk of TdP for these patients. The post-implementation period was from April 1, 2020 to December 13, 2020 and included patients where clinicians received an advisory when placing an order for a medication with a known risk of TdP and the QTc-RS ≥12. Logistic regression was conducted to assess the impact of implementing the QTc-RS advisory on inpatient mortality.

Results:
We evaluated 620 unique hospitalized patients during the pre-implementation period and 3,112 hospitalized patients post-implementation of the CDS. Mortality was lower in the post-implementation cohort compared to that in the pre-implementation cohort (odds ratio =0.61, 95% confidence interval 0.49-0.76). Increasing QTc-RS was associated with increasing mortality [(OR=1.08 (1.02-1.14)].

Conclusion:
Implementation of a QTc-RS CDS advisory was associated with lower mortality.
Abstract 11486: Hormone-Independent Sex Dimorphisms in Cardiac Reparative Functions of Bone Marrow Stem Cells: Underlying Epigenetic Insights
Authors: Gurrala Charan T , Cheng Zhongjian A , Mallaredy Vandana , Cimini Maria , Joladarashi Darukeshwara , Truongcao May , Wang Chunlin , Lucchese Anna Maria , Huang Grace , Gonzalez Carolina , Magadum Ajit , Roy Rajika , Ghosh Jayashri , Benedict Cindy , Koch Walter J , Kishore Raj
Published: June 2023

Introduction:
This work was designed to identify the hormone-independent mechanisms that govern the superiority of female endothelial progenitor cells (F-EPC) for cardiac repair post myocardial infarction (MI). A direct comparison of therapeutic efficacy of gender-specific stem cells or estrogen-independent mechanisms of gender-specific dimorphism in the reparative properties of EPCs has not been established.

Hypothesis:
We hypothesized that epigenetic mechanisms contribute to the sex-specific functional dimorphisms of Sca-1+/CD31+ EPCs in regulating cardiac reparative functions post-MI.

Methods:
Male (M), female (F), and ovariectomized (OVX) mice derived Sca-1+/CD31+ EPCs were subjected through a series of cytokine quantifications and epigenetic CUT&Tag screening, followed by assessment of their therapeutic function
in vitro
and
in vivo
.

Results:
F-EPC and OVX EPC secrete high levels of proangiogenic factors and low amounts of pro-inflammatory cytokines compared to M-EPC. Further evaluation of the inflammasome showed that the M-EPC secreted the most elevated amounts of CCL3, and other inflammatory chemokines compared to F-EPC and OVX EPC. The secretome of F-EPC and OVX EPC was found to be substantially proangiogenic
in vitro
than the male EPCs. Post-MI injection of F-EPC and OVX EPC resulted in remarkable preservation of cardiac structure and functions. In contrast, post-MI injection of M-EPC resulted in an inflamed myocardium. Epigenetic sequencing of the sex differential EPCs for the H3K9me3 mark showed high methylation in M-EPC compared to F-EPC and OVX EPC. The inhibition of histone methyltransferase, G9a using BIX-01294 upregulated the secretion of inflammatory factors in all EPCs. The conditioned medium from all EPCs with high levels of CCL3 inhibited angiogenesis
in vitro
. Neutralizing CCL3 in the same medium restored
in vitro
angiogenesis.

Conclusion:
EPCs from both fertile and OVX female mice retain better cardiac reparative activity than their male counterparts irrespective of sex hormone influence. Mechanistically, we show that this gender-based functional dimorphism of EPCs is mediated, in part, by differential epigenetic regulation of chemokine CCL3.
Abstract 11507: Role of Cardiovascular Magnetic Resonance Imaging in Covid-19 Recovered Patients
Authors: Kunal Shekhar , Bagarhatta Prachi , Palleda Girish , BANSAL ANKIT , Batra Vishal , Daga Mradul , Sharma Ashok , Bansal Kalpana , Gupta Mohit
Published: June 2023

Introduction:
Myocardial injury has been reported in up to one-third of patients with COVID-19. Cardiac magnetic resonance imaging (CMR) can detect myocardial injury and sub-clinical LV dysfunction in recovered patients with COVID-19.

Hypothesis:
To evaluate for cardiac involvement in recovered COVID-19 patients using CMR.

Methods:
A total of 30 subjects recently recovered from COVID-19 and abnormal left ventricular global longitudinal strain were enrolled. Routine investigations, inflammatory markers and CMR were done at baseline with follow-up scan at 6 months in individuals with abnormal baseline scan. Additionally, 20 age-and sex-matched individuals were enrolled as healthy controls (HCs).

Results:
All 30 enrolled subjects were symptomatic during active COVID-19 disease and were categorized as mild: 11 (36.7%), moderate: 6 (20%) and severe: 13 (43.3%). Of the 30 patients, 16 (53.3%) had abnormal CMR findings. Myocardial edema was reported in 12 (40%) patients while 10 (33.3%) had LGE. No difference was observed in terms of conventional LV parameters however, COVID-19 recovered patients had significantly lower right ventricular (RV) ejection fraction, RV stroke volume and RV cardiac index compared to HCs. Follow-up scan was abnormal in 4/16 (25%) with LGE persisting in 3 patients. Myocardial T1 (1284 + 43.8 ms vs 1147.6 + 68.4 ms; P<0.0001) and T2 values (50.8+16.7 ms vs 42.6+3.6 ms; P=0.04) were significantly higher in post COVID-19 subjects compared to HCs. Similarly, T1 and T2 values of severe COVID-19 patients were significantly higher compared to mild and moderate cases.

Conclusions:
An abnormal CMR was seen in half of recovered patients with persistent abnormality in one-fourth at six months. Our study suggests a need for closer follow-up among recovered subjects in order to evaluate for long term cardiovascular sequelae.
Abstract 11545: The Role and Impact of a Women in Cardiology Mentorship Program on Female Residents
Authors: Spears Jenna , Romanelli Jeanine E
Published: June 2023

Introduction:
Women are underrepresented in Cardiology, especially in interventional specialties. This study sought to evaluate the impact that a formal Women in Cardiology (WIC) mentorship program would have on female internal medicine residents.

Hypothesis:
We hypothesized that a formal mentorship program would positively impact female residents’ decision to pursue a career in Cardiology, and hoped to highlight this through this study.

Methods:
A formal WIC Mentorship Program was established at our institution, which featured educational content, open discussions and networking opportunities. Members of the program included female cardiologists from various sub-specialties, cardiology fellows and medical residents. An anonymous survey was then conducted to evaluate the impact of this program on female residents. This survey was completed by 100% of the participants.

Results:
After involvement in the WIC mentorship program female residents indicated that they: 1) were more interested in pursuing a procedural subspecialty (interventional cardiology or electrophysiology) (5/7, 71.43%); 2) were more comfortable approaching female fellows and attendings (7/7, 100%); 3) were more aware of the diversity of possible careers in Cardiology (6/7, 85.71%) 4) felt female mentorship was important for their future career (7/7, 100%) 5) found the program helpful and would attend future meetings (7/7 100%).

Potential factors that discouraged women from pursuing cardiology were explored. The majority of residents indicated that concerns over work-life balance had discouraged them (4/7; 57.14%). A smaller portion of residents indicated concerns over radiation exposure (2/7; 28.57%) and discrimination (3/7; 42.86%) had discouraged them. All residents subsequently indicated that their concerns were addressed and lessened by the mentorship program.

Conclusions:
The importance and positive impact of mentorship were highlighted in this study. The adoption of similar mentorship programs across other institutions may be utilized to encourage interested female residents to pursue a career in cardiology, especially in procedural subspecialties.
Abstract 11603: Comparing Analytical Methods for Composite Endpoints in Heart Failure With Reduced Ejection Fraction: Insights From the VICTORIA Trial
Authors: Westerhout Cynthia M , Rathwell Sarah , Anstrom Kevin J , Hernandez Adrian F , Ponikowski Piotr , Ezekowitz Justin A , Voors Adriaan A , Felker Michael , Bakal Jeffrey , Blaustein Robert O , Nkulikiyinka Richard , OConnor Christopher M , Armstrong Paul W
Published: June 2023

Background:
In the VICTORIA trial in patients with heart failure with reduced ejection fraction, vericiguat (V) versus placebo (P) reduced the primary composite outcome (heart failure hospitalization [HFH] or cardiovascular death [CVD]) from 38.5 to 35.5% (1869 events: V=897, P=972) (
Fig A
). In this prespecified analysis, we assessed vericiguat’s treatment effect using weighted composite endpoint (WCEP) and win-ratio (WR) methods.

Methods:
Clinical events were centrally adjudicated. A survey of 37 international trial leaders conducted before database lock led to the derivation of relative weights of subtypes of HFH (mild [change in therapy] 0.39; moderate [requiring IV diuresis] 0.50; severe [urgent deterioration requiring inotropic support] 0.67) and CVD (1.0). A WCEP model estimated the effect of vericiguat on mean survival after severity-weighting recurrent HFH events and CVD. The unmatched WR approach, which accounted for recurrent HFH events, was applied with the hierarchy of HFH<CVD.

Results:
All 3412 primary clinical events in 5050 patients were analyzed in the WCEP model (855 CVD [V=414, P=441]; 875 severe HFH [V=416, P=459]; 1614 moderate HFH [V=767, P=847]; 68 mild HFH [V=38, P=30]). WCEP yielded a higher hospitalization-adjusted survival in the vericiguat arm (mean 78.2 vs 75.6%; difference [95% CI]: 2.4% (1.7-3.2%]; p<.0001) (
Fig B
). 2608 events were used in the WR model (V=1232, P=1376) which also found an improvement in clinical outcomes in the vericiguat arm (WR [95% CI]: 1.13 [1.03-1.24]; p=0.01) (
Fig C
).

Conclusions:
These 2 alternative methods complement the primary VICTORIA analysis with more refined characterization of vericiguat’s treatment effect. While both WCEP and WR included recurrent events, the prespecified WCEP approach allowed for inclusion of all recurrent events and further insight into the severity of HFH. These findings may help inform health providers, consumers, and those planning future HFrEF trials.
Abstract 11672: A Case of Postpartum Seizure, Cardiac Arrest, and Shock
Authors: Hoeger Christopher W , Levy Alex , Feinberg Loryn , Shainker Scott , Sabe Marwa
Published: June 2023

Cardiogenic shock (CS) in the peripartum period is associated with significant morbidity and mortality. Treatment of CS by specialists in high-volume centers is associated with improved outcomes. A healthy 34-year-old pregnant woman underwent planned cesarian section delivery for placenta previa at a community hospital, which was complicated by postpartum hemorrhage treated with methylergonovine, tranexamic acid, and carboprost. One hour later, she was hypertensive, tachycardic, and had a generalized seizure followed by hypoxemia and pulseless electrical activity. She was persistently hypotensive after resuscitation. An echocardiogram (TTE) demonstrated a left ventricular ejection fraction of 25%. She was transferred to our cardiac intensive care unit (CCU) for consideration of mechanical circulatory support (MCS). The patient arrived at the CCU on multiple vasopressors and inotropes. The advanced HF, CCU, and maternal fetal medicine teams assessed the patient on arrival. Bedside right heart catheterization demonstrated right atrial pressure of 6 mmHg, pulmonary arterial pressure of 22/17 mmHg, pulmonary capillary wedge pressure of 10 mmHg, and Fick cardiac index of 2.5 L/min. BP was improving and vasoactive agents were weaned. The bleeding risk of anticoagulation for MCS after postpartum hemorrhage was thought to outweigh the potential benefit of MCS with normal filling pressures and weaning of vasoactive agents, thus MCS was not deployed. An electroencephalogram revealed status epilepticus, and magnetic resonance imaging of the brain was suggestive of posterior reversible encephalopathy syndrome with hemorrhage secondary to cerebral vasospasm. TTE on hospital day 4 showed normalization of biventricular function, and she made a full neurologic recovery and was discharged home on hospital day 15. Given the normalization of cardiac and neurologic function with supportive care only, her shock was attributed to methylergonovine-induced cerebral vasospasm leading to seizures with subsequent respiratory and cardiac arrest and myocardial stunning. This case demonstrates the importance of rapid team-based diagnostic assessment of peripartum patients presenting in suspected CS to appropriately triage the use of MCS.
Abstract 11675: Heart Failure Patients Express Preferences Toward Benefits of Feeling Well and Living Longer With Added Therapy
Authors: Alder Madeleine R , Bachmann Justin , Lindenfeld Joann , Rothman Russell , Rollins Allman , Xu Meng , McCoy Allison , Stevenson Lynne W
Published: June 2023

Introduction:
Therapies for heart failure (HF) in the United States have been approved to decrease hospitalizations and mortality rather than to make patients feel better. Patients considering possible benefits of a new therapy may express different preferences for feeling well versus living longer.

Methods:
During collection of patient-reported outcomes at HF clinic visits, patients described along a five-point scale the benefits they would want from an additional HF therapy in relation to feeling well or living longer. They were also asked if their quality of life (QOL) was limited mostly by HF, equally by HF and other medical problems, or mostly by other medical or non-medical problems. Pairwise comparisons were made between patients in 3 groups defined by those who valued living longer in preference to feeling well, those who regarded those benefits equally, and those who valued feeling well over living longer.

Results:
Between 7/2019-3/2021, responses during HF clinic visit at an academic center were provided by 1,876 patients. When asked what benefit they would want from a new treatment, 12% valued longevity over feeling well, 69% equally valued feeling well and living long, and 19% valued feeling well over living longer (Figure). Patients placing higher value on living longer were more likely to be younger and more likely to be African-American (both p< 0.001). A majority of patients perceived that their QOL was limited as much or more by other medical or non-medical factors as by their HF.

Conclusions:
For an additional therapy, contemporary outpatients with HF express preference at least as often for benefit to feel well as to live longer, with the majority of patients ranking them as equal. As new treatments for HF are developed and approved, increasing emphasis is warranted on investigating their impacts on how patients feel.
Abstract 11714: High-Output Heart Failure in Multiple Myeloma: Novel Approach to a Challenging Diagnosis
Authors: Hirsch Eric , Slipczuk Bustamante Leandro , Travin Mark , Moadel Renee , Jorde Ulrich P , VUKELIC Sasha
Published: June 2023

High-output heart failure (HOHF) is a rare complication of multiple myeloma and is believed to be related to arteriovenous shunting in osseous myeloma lesions. Timely diagnosis is crucial, as these patients respond best to aggressive treatment of the underlying malignancy.

In this case, a 51-year-old man with multiple myeloma complicated by extensive osseous disease was admitted from oncology clinic for several weeks of worsening dyspnea, early satiety, and bilateral leg swelling. His exam was notable for signs of volume overload, and the BNP was elevated to 1444 pg/ml. An echocardiogram showed new right ventricular dysfunction. After the patient failed to respond to escalating doses of intravenous diuretics, right heart catheterization was performed and revealed elevated biventricular filling pressures with evidence of high cardiac output (Fick CO 17.1 LPM, Fick CI 7.9 LPM/m
2
). In a novel diagnostic approach, 5.1 mCi of technetium-99m-labeled macroaggregated albumin was injected into the aorta at the time of left heart catheterization and then whole body planar images were obtained in anterior and posterior projections. The scan revealed evidence of lower extremity arteriovenous shunting with a proportion of 6% (Fig. 1). He was started on lenalidomide and pulse-dose dexamethasone with improvement in diuretic response and resolution of heart failure symptoms. A follow-up echocardiogram showed normalization of right ventricular size and function. He eventually underwent successful allogeneic stem cell transplant during the admission.

Although Tc-99m MAA is routinely used in the diagnosis of hepatopulmonary syndrome, this is, to our knowledge, the first report of its use to investigate myeloma-related HOHF in the clinical setting. This technique was previously utilized successfully to experimentally correlate between shunting values and cardiac indices. It may be of use in a wider population of patients with HOHF in whom occult shunting is suspected.
Abstract 11748: Prophylactic Aortic Arch Replacement in Patients With Loeys-Dietz Syndrome: Surgical Outcomes and Molecular Rationale
Authors: Pedroza Albert J , Dalal Alex R , Cheng Paul , Tognozzi Emily , Mitchel Olivia , Yokoyama Nobu , Nakamura Ken , Quertermous Thomas , Fischbein Michael P
Published: June 2023

Introduction:
Loeys-Dietz syndrome (LDS) patients typically develop focal aortic root aneurysm but have substantial risk of distal aortic events (arch aneurysm and type B dissection) after root replacement. We offer prophylactic arch replacement to LDS patients of all genotypes undergoing elective valve-sparing aortic root replacement (VSARR) to prevent late aortic events. We hypothesized that non-dilated LDS aortic arch tissue demonstrates ongoing deterioration at the time of VSARR.

Methods:
Aortic tissue was anatomically segmented (root, ascending, arch) then examined via histology and single-cell RNA sequencing (‘scRNAseq’, n=4 patients) to comprehensively profile cellular phenotypes.

Results:
LDS patients (n=8, mean age 37.9 years, 87.5% male) had root aneurysm (mean 45.1 ± 8.9mm) without ascending (35.1± 7.8mm) or arch dilation (28.7 ± 2.8mm) and underwent concurrent VSARR and branched graft total arch replacement. There were no perioperative deaths or strokes and no distal aortic events or reoperations after median 1.26 years follow-up. Histologically, elastin fragmentation and collagen deposition were detectable in each aortic segment (n=4). scRNAseq identified a continuum of smooth muscle cell (SMC) phenotype modulation associated with progressively reduced contractile gene expression. Pathway analysis of 260 genes enriched during SMC modulation identified heightened integrin signaling, transforming growth factor-beta-responsiveness, cell adhesion, and extracellular matrix remodeling. Histologic confirmation using RNA probes specific for modulated SMCs (TGF-beta responsive gene
SERPINE1
and glycoprotein
TNFRSF11B
) identified these cells in the tunica media layer of each aortic segment, with greatest density in the root aneurysm but extending to the arch. In age-matched donor aortas,
TNFRSF11B
+ cells were restricted to the atherosclerotic tunica intima, confirming specificity of medial SMC modulation in aneurysm.

Conclusions:
Total arch replacement during elective VSARR is feasible without substantial morbidity. In LDS patients with root aneurysm, matrix deterioration and SMC phenotype modulation are present in the non-dilated aortic arch, providing molecular rationale for aggressive arch replacement.