bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 14339: Differences in Clinical and Angiographic Characteristics Following Intracoronary Ergnovine and Acetylcholine Provocation Test for Coronary Artery Spasm
Authors: Rha Seung-Woon , Choi Se Yeon , Choi Byoung Geol , Byun Jae Kyeong , Cha Jinah , Battumur Byambasuren , Hyun Sujin , Park Soohyung , Kang Dong Oh , Park Eun Jin , Kim Ji Bak , Na Jin Oh , Choi Cheol Ung , KIM Eung Ju , Park Chang Gyu
Published: June 2023

Background:
Ergnovine (Erg) and Acetylcholine (Ach) are useful agents for assessing significant coronary artery spasm (CAS). However, comparison studies of the two agents are limited.

Methods:
A total of 8,093 consecutive patients (pts) who underwent Erg or Ach provocation test between November 2004 and June 2021 were enrolled. Significant CAS was defined as focal or diffuse severe transient luminal narrowing (>70%) with/without chest pain or ST-T change on ECG. We divided into two groups according to provocation agent; 1) the Erg group (n=639), 2) the Ach group (n = 7,454). We investigated whether there are differences in clinical and angiographic characteristics according to intracoronary Erg or Ach provocation test.

Results:
Baseline clinical characteristics were similar between the two groups except the Erg group were more elderly (58.5 years vs 56.6 years, p < 0.001) and dyslipidemia (36.0% vs 18.6%, p < 0.001) but lower rates of current smokers (16.0% vs 21.1%, p = 0.002) and alcoholics (27.1% vs 32.9%, p = 0.002). During the provocation test, the higher rates of myocardial bridge, ECG change, chest pain, atrioventricular node block, and positive CAS results but lower rates of baseline spastic change were shown in the Ach group. More pts received to lower Ach dose and higher Erg dose during the provocation test. In CAS positive patients, the Ach group had higher rates of spasm in the left anterior descending artery and mid site, but lower proximal site (table).

Conclusion:
Clinical and angiographic parameters were different between Erg and Ach provocation tests. Further study would be needed to validate the different parameters and different positive rates between the two agents.

Table. Angiographic and Procedural Parameters during Ergonovine versus Acetylcholine Provocation Test
Abstract 14364: Protein Kinase C Beta II Inhibitor Provides Cardiovascular Protection When Combined With Conjugated Myristic Acid and Trans-Activator of Transcription in Porcine Ischemia-Reperfusion Injury
Authors: Harrell Kayla P , Nair Arjun , Boakye Tanoh Desmond , Singh Sunit , Andrews Emily , Dean Tameka , CHEN Qian , Barsotti Robert , Young Lindon
Published: June 2023

Prompt reperfusion is vital to resuscitating ischemic myocardium. However, cardiomyocyte death still occurs due to ischemia-reperfusion (I/R) injury, which is mediated in part by oxidative stress. Major sources of reactive oxygen species (ROS) during I/R are NADPH oxidase (NOX-2) and mitochondria, which are principally activated by protein kinase C βII (PKCβII). Previously, myristic acid (Myr) and trans-activator of transcription (Tat) conjugated PKCβII inhibitor (Myr-Tat-PKCβII-; N-Myr-Tat-CC-SLNPEWNET) exhibited cardioprotective effects in ex vivo rat hearts. In this study, we hypothesize that Myr-Tat-PKCβII- will mitigate cardiac injury in an in vivo porcine myocardial I/R model compared to scrambled peptide controls. Male Yorkshire pigs (38-50kg) underwent regional I(1hr)/R(3hrs) through balloon-assisted occlusion of the second diagonal branch of the left anterior descending coronary artery (LAD) supplying ~40% of the anterior portion of the myocardium. During reperfusion (balloon deflation), a bolus of Myr-Tat-PKCβII- or scrambled control was infused into the LAD. Cardiac function was evaluated as the relative change in ejection fraction (EF) at the end of 3hr reperfusion compared to baseline. Serial measurements of serum creatine phosphokinase (CPK), troponin I, and myoglobin were evaluated to assess cardiac injury. Post-reperfused hearts were stained with Evans Blue dye to identify the area at risk (AR) and 1% triphenyltetrazolium chloride to demarcate the area of necrosis (AN). Infarct size (AN/AR), EF, and cardiac injury markers were analyzed via Student’s t-test. Myr-Tat-PKCβII- preserved EF with a relative change of 1.2±2.8% compared to 8.9±2.2% in control hearts (p<0.05) from mean baseline EF (61.4±0.5%). Myr-Tat-PKCβII- significantly decreased myoglobin levels at 1hr reperfusion (135±132ng/mL, n=4) compared to scrambled control (1022±346ng/mL, n=3 p<0.05). Myr-Tat-PKCβII- reduced infarct size to 13.5±3.9% (n=4) compared to scrambled control hearts (27.5±7.9%, n=6). CPK and troponin I levels were comparable in both groups. These results suggest Myr-Tat-PKCβII- mitigates cardiac injury when given at reperfusion onset. Future studies will examine Myr-Tat-PKCβII- in an 8 week in-vivo, porcine MI survival study.
Abstract 14368: Growth Differentiation Factor-15 in Heart Failure Across Body Mass Index Categories: The PREHOSP-CHF Study
Authors: Iguchi Moritake , Wada Hiromichi , Shinozaki Tsuyoshi , suzuki masahiro , Ajiro Yoichi , Matsuda Morihiro , Koike Akihiro , Koizumi Tomomi , shimizu masatoshi , Ono Yujiro , Takenaka Takashi , Sakagami Satoru , Morita Yukiko , Fujimoto Kazuteru , Yonezawa Kazuya , Yoshida Kazuro , Ninomiya Akiyo , Nakamura Toshihiro , FUNADA JUNICHI , Kajikawa Yutaka , Oishi Yoishifumi , Kato Toru , Kotani Kazuhiko , Abe Mitsuru , Akao Masaharu , Hasegawa Koji
Published: June 2023

Introduction:
Growth differentiation factor-15 (GDF-15), a stress-responsive member of the transforming growth factor ꞵ cytokine superfamily is an independent prognostic predictor in patients with heart failure (HF). GDF-15 has been also reported to be associated with cardiac cachexia and malnutrition. However the association of GDF-15 and prognosis in patients with HF according to body mass index (BMI) is unclear.

Methods:
The PREHOSP-CHF study is a multicenter prospective cohort study among patients with HF. A total of 1,024 patients (mean age, 75.5 years, 58.7% male) were included in the analyses. Serum levels of GDF-15, as well as N-terminal pro brain natriuretic peptide (NT-proBNP), high sensitivity troponin I (hs-cTnI), and high sensitivity C-reactive protein (hs-CRP), were measured. We divided the patients into 3 groups based on the tertile of BMI: low (≤19.9), middle (19.9<, ≤23.4), and high (>23.4).

Results:
The low BMI group were older, and had more female, HF with preserved ejection fraction (≥50%), and NYHA 3/4. NT-proBNP levels were higher in the low group, but hs-cTnI and hs-CRP were comparable between the 3 subgroups. Median GDF-15 levels in the low, middle and high groups were 2271, 2264, and 1888 pg/ml, respectively. During 2 years follow-up, all-cause death and major adverse cardiovascular events (MACE: cardiovascular death and HF hospitalization) occurred in 111 and 130 in the low group, 66 and 132 in the middle group, and 34 and 88 in the high group. After adjustment for clinical confounders and cardiac biomarkers, higher GDF-15 was significantly associated with the incidence of all-caused death and MACE in the entire cohort. BMI subgroup analysis revealed that higher GDF-15 was significantly associated with the incidence of all-caused death and MACE in the middle and high groups, but not in the low group (Figure).

Conclusions:
Among HF, higher GDF-15 was significantly associated with all-cause death and MACE especially in the middle and high BMI groups.
Abstract 14377: Alteration in Cardiac Function via Upregulation of Interferon Pathway in Skeletal Muscle
Authors: Kumari Manju , Evangelakos Ioannis , Frey Norbert , Heeren Joerg
Published: June 2023

Introduction:
Cardiac abnormalities are a major cause of death in patients with myositis. Chronic inflammation resulting from increased infiltration of inflammatory cells in skeletal muscle followed by muscle weakness and myofiber atrophy is a characteristic of myositis. Transcriptomics and myopathological studies show IFN-1 pathway play a major role in pathophysiology of myositis. However, we do not understand how does IFN-1 signaling from inflamed skeletal muscle regulates cardiac function. Interferon regulatory factor 3 (IRF3) is a key transcriptional regulator of IFN-1 signaling cascade. Here we generated a skeletal muscle-specific IRF3 transgenic mouse model that recapitulates muscle atrophy and cardiac dysfunction facilitated by tissue cross-talk via elevated IFN-1 levels.

Hypothesis:
Persistent inflamed microenvironment by IRF3 and IFN-1 levels in skeletal muscle impairs muscle fitness, alters metabolome as well as myokine signaling and generates cardiac stress followed by impaired cardiac metabolism.

Methods:
Skeletal muscle-specific transgenic mouse model with constitutive activation of IRF3 was exploited to mimic sustained IFN-1 signaling found in myositis in vivo. Effect on muscle inflammation and weakness was determined by gene expression analysis and forelimb grip strength. Effect on cardiac inflammation, mitochondrial function, and heart function was examined. Histological assessment was done to determine fiber cross-sectional area and fiber type in whole muscle and myocytes.

Results:
Our data show increased mRNA levels of
IRF3
in muscle atrophy model. Characterization of skeletal muscle-specific IRF3 transgenic mice showed activation of genes regulating IFN-1 pathway (
Isg15
,
Ifit1
,
Rsad2
, and
Mx2
, etc.) and macrophage infiltration (
CD14
,
CD68
) in skeletal as well as cardiac muscle. In vitro and in vivo histological analysis showed alteration in fiber type markers. The inflammatory milieu generated by IRF3 altered metabolome and myokine levels affecting transcriptional molecular circuits regulating tissue cross-talk and metabolic pathways in the heart.

Conclusion:
Our studies identified skeletal muscle-specific activation of IRF3 as a model to study IFN-1 induced damage to cardiac function in vivo.
Abstract 14384: A Decade Trend, Sex, Racial and Economic Disparities in Hospitalization for Premature Acute Myocardial Infarction Among Patients With Obesity and Morbid Obesity: A Decade Trend From the National Inpatient Sample
Authors: ASEMOTA IRIAGBONSE R , Shaka Hafeez , Sharma Bharosa , Akuna Emmanuel , Almani Muhammad Usman , Usman Muhammad , Sana Muhammad Khawar , Yilmaz Mahir , DeAngelo Sean , Hammo Hasan
Published: June 2023

Introduction:
Epidemiological evidence suggests that obesity is associated with Acute myocardial infarction (AMI). Studies on the incidence and outcomes of patients with premature AMI who are obese are limited with attention to disparities are scarce.

Hypothesis:
Obesity and Morbid Obesity is associated with increasing premature AMI

Methods:
This was a trend study of the National Inpatient database from 2010 to 2019. We searched for AMI as primary reason for hospitalization with obesity or morbid obesity as a comorbidity using the ICD codes. We estimated trends, inpatient mortality, mean length of hospital stays (LOS) and mean total hospital charges (THC) over the period. We performed a stratified analysis in categories: sex (male and female), race (Caucasians, Blacks, Hispanics), and median household income for patient's zip code (low-income quartile [LIQ] vs high-income quartile [HIQ]) to assess disparities in outcomes. Multivariable regression analysis adjusted for age and sex was used to obtain trend statistics on outcomes.

Results:
There was a total of 173,106 hospitalizations for obesity with early AMI with the proportion of females (63.7%). There was an increase in early MI by 60.9% among obese patients, with mean in-hospital mortality of 1.3%. Female obese patients had a 33% increase in inpatient mortality with premature AMI, with the highest increase among black women compared to white women (78.7% vs. 35.0%). Hospitalization for adult premature AMI in patients with morbid obesity was 64,926 with proportion of female 66.1% from 2010 to 2019. The incidence of hospitalization for premature AMI among morbidly obese patients increased by 120% from 2010 to 2019. The average mortality from 2010 to 2019 among morbidly obese patient with premature AMI was 2.0% in the decade studied. There was a trend toward decreased mortality over the years; however, on subgroup analysis, the decrease in mortality was significant among whites but not among blacks, LIQ, or HIQ in early MI with morbid obesity.

Conclusions:
Our study shows a significant increase in hospitalization for premature AMI in obese and morbidly obese patients. The female obese patient has higher inpatient mortality with highest among blacks compared to whites.
Abstract 14391: The Transcriptional Landscape of Liver Sinusoidal Endothelial Cells
Authors: Toledano Sanz Pablo , Reventun Paula , Viskadourou Maria , Osburn William , Alcharani Nunzio , Lowenstein Charles J , Arvanitis Marios
Published: June 2023

Introduction:
Human liver endothelial cells (HLEC) are a heterogeneous cell population. Single cell transcriptomics and immunostaining assays have categorized HLEC into two major groups according to their location within the liver lobules (zone 1 or periportal HLEC and zones 2/3 or central venous (CV) HLEC).

Hypothesis:
Cellular deconvolution of the bulk transcriptome of HLEC will highlight important properties of HLECs and their transcriptional regulators.

Methods:
We uniformly processed all bulk RNA-seq data from HLECs in Gene Expression Omnibus. We used CIBERSORTx with human liver single cell RNA-seq data to perform cell type deconvolution of bulk HLEC RNA-seq. We compared the transcriptome of HLEC subpopulations to that of HUVEC. We then applied the HOMER motif finding algorithm on the promoters of genes up/downregulated in HLEC compared to HUVEC.

Results:
We analyzed data from 10 HLEC samples and 107 HUVEC samples from 37 independent experiments. Principal component analysis revealed that 6 of the 10 HLEC samples have robust transcriptional differences compared to HUVEC. CIBERSORTx showed that those 6 HLEC samples correspond to CV HLECs and can be identified by FCGR2B expression. Differential gene expression analysis revealed enrichment of inflammatory and coagulation pathways in CV HLEC and enrichment of proliferation and mitosis pathways in HUVEC. CV HLEC showed increased expression of factors VIII, X, XII, Protein S and antithrombin III. We validated gene expression at the protein level by Western blot. A transcription factor (TF) prioritization approach using HOMER motif enrichment revealed a potential role for E2F, and RXR-RAR TF as primary determinants of the differences between HUVEC and CV HLEC.

Conclusions:
We identify and characterize CV HLEC as a distinct endothelial subtype relevant to inflammation and coagulation. We also identify downregulation of E2F and upregulation of RXR-RAR TF as potential key regulators of the CV HLEC transcriptome.
Abstract 14403: Hospital- and Patient-Level Quality Indicators for Acute Coronary Syndrome Using Nationwide Database
Authors: Kanaoka Koshiro , Iwanaga Yoshitaka , nakai michikazu , Nishioka Yuichi , Myojin Tomoya , Okada Katsuki , Noda Tatsuya , Sakata Yasushi , Imamura Tomoaki , Miyamoto Yoshihiro
Published: June 2023

Introduction:
The efficacy of the quality indicators (QIs) using administrative data was unclear.

Hypothesis:
The use of QIs is associated with lower mortality in patients with acute coronary syndrome (ACS) at both hospital and patient levels.

Methods:
Patients with ACS who underwent percutaneous coronary intervention (PCI) between April 2014 and March 2018 in the National Database of Health Insurance Claims and Specific Health Checkups of Japan were included. Twelve quality indicators (QIs) were extracted from the administrative data and the association of the QIs with all-cause mortality was investigated.

Results:
A total of 221,267 patients from 1,220 hospitals were analyzed. The adherence to PCI on admission day, aspirin use on arrival, P2Y12 inhibitor use, and left ventricular function assessment was high (median proportion >90%), and adherence to outpatient cardiac rehabilitation was low (median proportion <10%) among all the QIs. Higher acute phase composite QI score was associated with reduced risk-adjusted 30-day mortality at hospital level (β=-0.92 [95% confidence interval -1.19 to -0.66], P<0.001). Four acute-phase and six subacute-phase QIs were inversely associated with 30-day and long-term mortalities at patient-level, respectively (all P<0.001).

Conclusions:
There were substantial variations in the care of ACS in the current nationwide database. A higher adherence to the QI sets was associated with survival gains at both hospital and patient levels. Multilevel approach using QI may be effective for improvement of survival among these populations.
Abstract 14406: CD36 Facilitate Macrophage Phagocytosis Through Mitochondrial ROS During Initiation of Atherosclerosis
Authors: Zhang Jue , Chang Jackie , Beg Mirza Ahmar , Zhao Yiqiong , Chen Yiliang
Published: June 2023

Introduction:
Macrophage-mediated phagocytosis is essential for tissue homeostasis but abnormal phagocytosis may lead to metabolic defect and chronic inflammation. Macrophage-derived lipid-laden foam cell is a hallmark of the early stages of atherosclerosis. However, phagocytosis efficiency in foam cells is not well explored. We previously showed that oxLDL/CD36 signaling in macrophages promoted mitochondrial reactive oxygen species (mtROS) production, foam cell formation, and facilitated diet-induced atherosclerosis. The aim of this study is to investigate the role of CD36-mediated mtROS production in phagocytosis during the early stages of atherosclerosis.

Methods and Results:
We conducted flow cytometry-based phagocytosis assays using E. coli bioparticles conjugated with pH-sensitive pHrodo® dyes. Utilizing peritoneal murine macrophages, we showed that pre-treatment of oxLDL, but not native LDL or HDL, stimulated phagocytosis efficiency in a dose- and time-dependent manner. However, CD36 deficiency in macrophages attenuated oxLDL-stimulated phagocytosis by ~50%. Reducing mtROS levels either by MitoTempo, a mtROS scavenger, or using MCAT macrophages, which overexpress human catalase in the mitochondria, also significantly decreased oxLDL-stimulated phagocytosis in vitro. To explore the physiological relevance, we conducted in vivo phagocytosis assay by IV injection of pHrodo bioparticles into ApoE
-/-
and ApoE
-/-
/CD36
-/-
mice after chow or high fat diet (HFD) for 6 weeks. We found that aortic F4/80
+
/TREM
+
foamy macrophages from ApoE
-/-
mice on HFD showed 1.5-fold increase in phagocytosis compared with those from ApoE
-/-
mice on chow diet. CD36 deficiency in ApoE
-/-
mice blocked the HFD-induced phagocytosis in aortic foamy macrophages. Moreover, we investigated the phagocytosis of apoptotic cells (efferocytosis) by macrophages and showed that mtROS-induction is critical for efficient efferocytosis in vivo.

Conclusions:
OxLDL stimulates macrophage phagocytosis, which is dependent on CD36. CD36-mediated mtROS production is essential for aortic macrophage phagocytosis and may play a role in foam cell formation during the initiation of atherosclerosis.
Abstract 14434: Prognostic Implications of Exercise Induced Hypertension in Adults With Repaired Coarctation of Aorta
Authors: Ramachandran Dhanya , Andi Kartik , Goda Ahmed , ABOZIED OMAR , Egbe Alexander C
Published: June 2023

Background:
The prognostic implications of exercise induced hypertension (EIH) in adults with repaired coarctation of aorta (COA) and treated hypertension are unknown. The purpose of this study was to assess the relationship between EIH and cardiovascular events, and to determine whether exercise blood pressure (BP) improved risk stratification in this population.

Methods:
Retrospective study of patients with COA on antihypertensive therapy that underwent exercise testing (2003-2019). BP was measured at rest in 3 different clinical settings and averaged to determine the resting BP. EIH was defined as systolic BP (SBP) >210 (males) or >190 (females) at peak exercise. Cardiovascular event was defined as atrial fibrillation, ventricular tachycardia, heart failure hospitalization, heart transplant, and cardiovascular death.

Results:
Of 327 patients (age 35±13 years), 116 (35%) had EIH. Although the resting BP was similar between patients with versus without EIH, the EIH group had higher pulsatile arterial load, more advanced left ventricular remodeling, and were less likely to be on angiotensin converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB). EIH was associated with cardiovascular events (HR 1.06 [95%CI 1.02-1.08]) independent of resting SBP, and improved prognostic accuracy above resting SBP (C-statistic 0.671 [95%CI 0.645-0.694] to 0.727 [95%CI 0.709-0.750], p=0.01). ACEI/ARB was associated with a lower risk of cardiovascular events.

Conclusions:
EIH was associated with cardiovascular events independent of resting BP, and patients receiving ACEI/ARB had lower risk of EIH and cardiovascular events. These data suggest that exercise BP could be used to assess adequacy of antihypertensive therapy, and to guide titration of antihypertensive therapy.
Abstract 14442: Longitudinal Cardio-Oncology Trends in Sex and Racial Disparities in PCI and Inpatient Mortality: Machine Learning Augmented Propensity Score Analysis of Over 101 Million Hospitalizations
Authors: Monlezun Dominique , Koutroumpakis Efstratios , Iliescu Gloria , patel rishi , Karla Aamuktha , Kim Jin wan , Honan Kevin , Park Jong Kun , Alexandrescu Sofia , Woods Myrshia , Cilingiroglu Mehmet , Marmagkiolis Konstantinos , Iliescu Cezar
Published: June 2023

Introduction:
The longitudinal trends of cardio-oncology healthcare disparities is unknown.

Methods:
We performed the first nationally representative longitudinal analysis using Machine Learning-augmented Propensity Score adjusted multivariable regression (ML-PSr) and the 2016-2018 National Inpatient Sample (NIS), the United States’ largest all-payer inpatient dataset.

Results:
Among 101,521,656 hospitalizations from 2016-2018, 3,233,249 (3.18%) were female with active cancer, 18,310 (0.57%) had STEMI, 4,670 (0.14%) received LHC, 3,360 (0.10%) received PCI, and 160 (0.005%) received percutaneous heart pump (Impella). The most common active primary malignancies significantly differed for females (lung [15.19%], breast [14.10%], uterus [10.60%], leukemia [8.88%], and non-Hodgkin lymphoma [NHL] [6.92%]) versus males (prostate [15.56%], lung [15.21%], leukemia [10.05%], NHL [8.50%], and colon [6.57%]) (p<0.001). Among those with active cancer and STEMI, white females versus white males had similar likelihood of PCI, but nonwhite females versus nonwhite males were significantly less likely to receive PCI in 2016 (43.86% versus 52.20%, p=0.009), 2017 (25.64% versus 30.52%, p=0.039) and 2018 (11.10% versus 14.73%, p=0.001). In ML-PS multivariable regression fully adjusted for age, sex, race, income, region, STEMI, metastasis, NIS-calculated mortality risk by DRG, and the likelihood of receiving PCI, in 2016 PCI had less mortality reduction for females (OR 0.68, 95%CI 0.55-0.85; p<0.001) than males (OR 0.58, 95%CI 0.49-0.68; p<0.001) with nearly equal in 2017 for females (OR 0.50, 95%CI 0.34-0.74; p<0.001) and males (OR 0.50, 95%CI 0.38-0.66; p<0.001), but in 2018 there was a comparable non-significant mortality reduction for both females or males.

Conclusions:
Our study provides novel evidence that female racial minorities receive post-STEMI PCI at lower rates than male racial minorities, white females, and white males, though mortality disparities appear to have a favorable trend over time.
Abstract 14447: Multi-Center Evaluation of Stress Myocardial Blood Flow by Cardiac Magnetic Resonance in Known and Suspected Ischemic Heart Disease: Preliminary Findings From the AQUA-MBF Initiative
Authors: Wang Shuo , Wang Haonan , Benovoy Mitchel , Ng Ming-Yen , Kim Paul , Singh Amita , Patel Hena , Saeed Ibrahim , Pontone Gianluca , Mushtaq Saima , Urmeneta Javier , Hillier Elizabeth , Gormsen Lars C , Laustsen Christoffer , Janich Martin A , Salerno Michael , Hirsch Alexander , Lubberink Mark , Maceira Alicia , Monmeneu Jose , Pazhenkottil Aju P , Nagpal Prashant , Friedrich Silke , Gutbrod Joseph , Flournoy Caroline , Tada Yuko , Tsun Hei Sin , Fong Ambrose Ho Tung , Cheng Ka Man Carmen , Goh Victor K , Madsen Simon , Arai Andrew E , Friedrich Matthias G , Patel Amit R
Published: June 2023

Introduction:
Quantitative myocardial blood flow (MBF) analysis using stress cardiac magnetic resonance (CMR) has been shown to detect obstructive coronary artery disease (CAD) and coronary microvascular dysfunction (CMD) in several mostly small, single-center studies. The AQUA-MBF (
A
ssessment of
QUA
ntitative
MBF
) study is a multicenter initiative involving 16 centers.

Hypothesis:
The goal of this sub-study is to determine if MBF can differentiate CAD, CMD, and normal volunteers in this multicenter setting.

Methods:
We present data from 53 subjects (15 with CAD, 20 at risk for CMD and 18 controls) who underwent vasodilator stress CMR (Figure) using 1.5T and 3.0T MR scanners (General Electric). At risk for CMD was defined as having diabetes and 2 other risk factors in absence of ≥50% stenosis based on coronary CT. CAD was defined as the presence of stenosis ≥70% based on invasive coronary angiography. Stress perfusion images were acquired using the dual sequence technique. Stress MBF was measured in each of the 16 AHA segments using Fermi deconvolution (Circle Cvi42). In the CAD group, each segment was further classified as having late gadolinium enhancement (LGE), supplied by CAD, or a normal remote territory. The means of the 5 groups were compared using one-way analysis of variance.

Results:
The segmental stress MBF (ml/g/min) for the 5 groups are shown in figure. Compared to the normal group, segmental stress MBF in 4 disease groups were significantly lower (p<0.001). Segmental MBF in those at risk for CMD was lower than normal segments and greater than CAD segments (p<0.001). LGE and CAD segments had the lowest stress MBF but similar to each other (p=0.9).

Conclusions:
In this multicenter study, we show that quantification of MBF using the dual sequence stress perfusion CMR technique can differentiate diseased from healthy myocardium and also between obstructive CAD and those at risk for CMD.
Abstract 14448: On-Table Extubation Associated With Lower Resource Utilization and Non-Inferior Outcomes After Coronary Bypass
Authors: Telenson Stacey , Soliman Fady K , Vertsman Ronald , Basseri Benjamin , Chiricolo Antonio , Pantin Enrique , Lemaire Anthony , Ikegami Hirohisa , Russo Mark J , Lee Leonard Y
Published: June 2023

Introduction:
Minimizing the duration of postoperative ventilation facilitates early discharge from the intensive care unit (ICU) thus promoting enhanced recovery after cardiac surgery (ERAS). Hence, we sought to investigate the impact of on-table extubation on outcomes and resource utilization after coronary artery bypass graft (CABG) surgery.

Methods:
We performed a retrospective review of a prospectively collected local database, including all patients undergoing CABG surgery at a large academic center from January 2020 to December 2021. Patients were stratified into two groups, on-table (before leaving the operating room) extubation versus early (< 6 hours after procedure) extubation. In-hospital mortality and postoperative complications were compared using univariate analyses. Length of stay (LOS), 30-day readmission and high resource utilization (HRU), a binary outcome defined as direct procedure cost of the highest quartile, were investigated.

Results:
A total of 691 patients were included in our analysis, 267 (38.6%) of which were extubated on-table. The two groups had similar median age and preoperative ejection fractions. However, on-table extubation patients were more likely to be males (86.9% vs 76.6%, p<0.001) with smaller BMIs (27.7% vs 28.5%, p=0.002), lower STS risk scores (0.75% vs 0.95%, p=0.022) and lower cerebrovascular disease prevalence (8.2% vs 14.2%, p=0.017). Compared to early extubation, on-table extubation patients had similar rates of in-hospital mortality (0 % vs 1.4 %, p=0.051), postoperative blood transfusion (7.5% vs 9.0%, p=0.494), reintubation (2.6% vs 3.5%, p=0.499) and pneumonia (1.9% vs 3.3%, p=0.263). As hypothesized, on-table extubation patients had shorter ICU LOS (32hrs vs 39hrs, p=0.02), shorter postoperative LOS (4.9 days vs 5.9 days, p=0.003), and lower incidence of high resource utilization (18.0% vs 29.5%, p<0.001). ICU readmission (3.8% vs 3.5%, p=0.887) and 30-day readmission (5.2% vs 7.3%, p=0.277) were similar in the two groups.

Conclusions:
On-table extubation is a safe and effective ERAS practice, that is associated with lower ICU LOS, postoperative LOS, and resource utilization, without affecting rates of reintubation, ICU readmission, 30-day readmission or operative mortality.
Abstract 14451: Mechanistic Classification and Outcomes of Isolated Aortic Regurgitation in a Contemporary Cohort of Patients
Authors: Unni Rudy R , Liang Jiaming (Calvin) , Jelaidan Ibrahim , Harnett David , Boodhwani Munir , Glineur David , Burwash Ian G , Chan Kwan L , Coutinho Thais , Prosperi-Porta Graeme , Fu Angel Yi Nam , Willner Nadav , Messika-Zeitoun David , Beauchesne Luc M
Published: June 2023

Introduction:
Aortic valve regurgitation (AR) is due to leaflet disease and/or dilatation of the functional aortic annulus complex. Understanding the mechanism(s) of AR informs surgical planning of valve and aorta repair. In this study we aimed to examine the etiologies, mechanisms, and outcomes of isolated pure native severe AR in a contemporary consecutive cohort of patients.

Methods:
From our institutional echocardiography database, we identified all patients with native moderate-to-severe (3+) or severe (4+) AR between 2014-2019. Patients with infective endocarditis, aortic dissection, or other concomitant valve disease were excluded. AR was classified using the El-Khoury classification: Type I-normal leaflet motion (Ia = ascending aorta and sinotubular junction dilatation, Ib = aortic root dilation, Ic = aortic annular dilation), Type II-leaflet prolapse, and Type III-leaflet restriction. Valve anatomy and clinical outcomes were also extracted.

Results:
A total of 560 patients with at least moderate-to-severe (3+) AR were identified, 270 were excluded (92 patients for endocarditis, 152 patients for concomitant valvulopathy, 23 patients for acute aortic dissection, and 11 patients for other reasons), and 282 patients (77.3% male) were included. The most common mechanism was Type II (leaflet prolapse), idenfied in 98 (35%) patients. Multiple mechanisms of AR were identified in 164 (58%) patients. The most common combination was Type Ib (aortic root dilation) and Type II (leaflet prolapse) seen in 45 (27%) patients. Ninety-nine (35%) patients had a bicuspid aortic valve (BAV). Follow-up was available for 275 patients (98%) with a median duration of 4.7±2.4 years. Of the 158 (57%) patients who underwent surgical intervention, valve repair was performed in 77 patients (49%) and valve replacement in 80 (51%) patients. Valve intervention was more common in women (70%) than in men (54%).

Conclusion:
In a large contemporary cohort of patients with at least moderate to severe (3+) isolated pure native AR, Type II (leaflet prolapse) was the most common mechanism, however multiple mechanisms are present in most AR patients. Aortic valve repair now accounts for almost half of the surgical interventions for isolated AR in our center.
Abstract 14490: Relationship Between Right Heart Catheterization Hemodynamics and Glycosylated Hemoglobin Levels in Adults With Heart Failure With Reduced Ejection Fraction
Authors: Del Rio-Pertuz Gaspar , Morataya Cristina , Parmar Kanak , Elharabi Zeyad , Davis Daniel , Abohelwa Mostafa , Ochoa Ozman , Tran Alison , Nugent Kenneth , Argueta-Sosa Erwin E
Published: June 2023

Introduction:
Elevated glycosylated hemoglobin (HbA1c) levels have been associated with adverse outcomes in heart failure (HF). However, the relationship between hemodynamics and glycemia has not been established.

Hypothesis:
Elevated HbA1c levels are associated with abnormal right heart catheterization (RHC) hemodynamic parameters in patients with HF with reduced ejection fraction and no prior diagnosis of diabetes mellitus (DM).

Methods:
We performed a retrospective study of adults patients (>21 years) with a left ventricular ejection fraction <40% who underwent a RHC between June 1, 2015 and June 1, 2021 and had HbA1c levels measured 30 days before or after the RHC. We excluded patients who had received blood transfusions within 90 days prior to HbA1c measurement and patients with known DM. We conducted univariate and multivariate regression analysis adjusted for age, gender, and body mass index (BMI) to test for an association between RHC hemodynamic parameters and HbA1c.

Results:
A total of 136 patients were included with a mean age of 55 ± 15 years; 75% were males. The mean BMI was 29.88 ± 8.08 kg/m2, and meanHbA1c was 5.99 ± 0.64%. Unadjusted univariate models showed that HbA1c is significantly associated with cardiac index (CI) by Fick and thermodilution, right atrial pressure (RAP), and mean pulmonary arterial pressure (mPAP). After multivariateanalysis, for every one unit increase in HbA1c, there was a 0.19 and 0.26 L/min/m2decrease in expected CI by thermodilution and by Fick, respectively (
P
= 0.03 and
P
<0.01). For every one unit increase in HbA1c, there was a 2.39 mmHg increase in expected RAP (
P
= 0.01). There was no association between MPAP and HbA1c after adjustment (Table 1).

Conclusions:
Changes in HbA1c levels measured within 30 days before or after the index RHC in patients with a left ventricular ejection fraction <40% were associated withchanges in hemodynamic parameters that correlate with congestive hemodynamics(reduced CI and elevated RAP).
Abstract 14495: Impact of Complete Revascularization in Chronic Total Occlusion Patients With Multi-Vessel Disease on Long-Term Clinical Outcomes
Authors: Rha Seung-Woon , Choi Byoung Geol , Choi Se Yeon , Byun Jae Kyeong , Cha Jinah , Battumur Byambasuren , Hyun Sujin , Park Soohyung , Kang Dong Oh , Park Eun Jin , Kim Ji Bak , Na Jin Oh , Choi Cheol Ung , KIM Eung Ju , Park Chang Gyu
Published: June 2023

Background:
This study compares the long-term clinical outcomes between two different treatment strategies: percutaneous coronary intervention (PCI) versus medical therapy (MT) for chronic total occlusion (CTO) in multi-vessel disease (MVD) patients.

Methods:
The study data obtained from the CTO registry of Korea University Guro Hospital (KUGH), Seoul, South Korea. This trial is a single-center, prospective, all-comer registry designed to reflect “real world” practice since 2004. the study population has been divided into two groups: the CTO-PCI group having 233 patients and the CTO-MT group having 230 patients. A propensity score matching (PSM) analysis had performed to adjust for confounding factors.

Results:
Following PSM, the two groups comprised the matched individuals from 336 pairs (total N=272 patients). The baseline clinical and angiographic characteristics were well-balanced between the two groups. Up to a 5-year clinical follow-up by Kaplan-Meier survival analysis, the primary endpoint, as defined as the composite of all-cause death or myocardial infarction (MI), occurred more in the CTO-MT group (32.6%) than in the PCI group (2.3%), as did all-cause death (2.3% vs. 8.4%, P=0.042) and MI (4.3% vs. 0.0%, P= 0.023). Target vessel revascularization (TVR) at CTO lesions still occurred more in the CTO-PCI group than in the CTO-MT group (38.3% vs. 6.8%, P=0.009).

Conclusions:
PCI is shown as a reasonable treatment option compared to MT for CTO lesions in MVD patients; TVR risk is still higher, although.
Abstract 14516: Systolic Slope of the Outflow Cannula Predicts Heart Failure Readmission Risk in Patients With Heartmate 3 Left Ventricular Assist Device
Authors: Gupta Nikhil , Siddiki Mikail , Hackett Ian , Kanelidis Anthony J , Plana Alejandro , Belkin Mark N , Poonawalla Maria , Lang Roberto M , Pinney Sean P , Jeevanandam Valluvan , Salerno Christopher , Grinstein Jonathan
Published: June 2023

Introduction:
Left ventricular assist devices (LVAD) may lead to left ventricular (LV) recovery in patients with heart failure with reduced ejection fraction (HFrEF) via LV offloading and subsequent positive remodeling. Current echocardiographic markers of LV recovery in LVAD patients are not well defined. The peak systolic slope, also known as systolic acceleration, of the outflow cannula has recently been shown to be a marker of underlying LV contractility and a tool to assess for LV recovery. We hypothesized that variations in the systolic slope would predict heart failure (HF) admissions.

Methods:
A total of 63 unique patients with LVAD at The University of Chicago Medical Center had HeartMate 3 (HM3) outflow tract Doppler signals obtained during routine transthoracic echocardiography (TTE) of suitable quality between 2015 and 2022. Systolic acceleration, systolic deceleration, diastolic acceleration, and the presence of flow reversal were measured. Mortality and HF admissions were recorded up to one year from the date of the TTE.

Results:
Increased systolic acceleration through the HM3 outflow cannula was associated with a decreased 1-year HF admission risk (352.8 [241.9, 515.8] cm/sec
2
vs 249.2 [164.0, 316.5] cm/sec
2
among readmitted patients, p = 0.03; Figure 1A). Systolic deceleration also predicted 1-year HF admission (-318.6 [-477.9, -244.0] cm/sec
2
vs -217.8 [-304.5, -188.8] cm/sec
2
among readmitted patients, p = 0.04; Figure 1B). Other variables, including the presence of flow reversal and diastolic acceleration, were not significantly associated with HF admission risk.

Conclusions:
Systolic acceleration, which reflects LV contractility, and systolic deceleration, which represents LV relaxation, are predictive of HF admission in patients with the HM3 LVAD.
Abstract 14547: A Rare Case of Pericardial Effusion Causing Cardiac Tamponade in Preeclampsia
Authors: Rehman Saif ur , Anjum Zauraiz , Javed Ayesha , Salama Amr , Liu Hongli , Iqbal Uzma
Published: June 2023

Background:
Cardiovascular manifestations of preeclampsia are caused by increased peripheral vascular resistance and systemic endothelial damage causing third spacing of fluids. Usually this presents as lower extremity edema or non-cardiogenic pulmonary edema. Here we report a rare case of third spacing into pericardial space causing cardiac tamponade in a patient with severe pre-eclampsia. To our knowledge, only 2 similar cases have been reported so far.

Case presentation:
35-year-old female G1P0A0 presented to the hospital at 36 weeks and 6 days of gestation with complaints of elevated blood pressure, headache, blurring of vision, and shortness of breath. On physical exam, she had blood pressure of 170/85, 3+ bilateral lower extremity edema and labs showed urine protein to creatinine ratio of 13,962. She was diagnosed with severe pre-eclampsia and underwent emergent C-section without any complications. On postoperative day 1, patient continued to complain of shortness of breath and became hypoxic requiring 2 to 3 L of supplemental oxygen. Chest x-ray showed slight pulmonary edema but BNP was 49. She had persistent lower extremity swelling and was empirically diuresed with IV Lasix with some improvement in her symptoms. An echocardiogram showed large circumferential pericardial effusion with early right ventricular diastolic collapse consistent with cardiac tamponade. Her LV function was normal with an EF of 70% without any wall motion abnormalities. She was taken to the Cath Lab for pericardiocentesis and underwent drainage of almost 650 cc of yellowish clear-colored fluid. Analysis of the fluid showed 1186 nucleated cells, pH 7.5, and protein of 2.9 mg/dl. Her ANA and Rheumatoid factor were negative. The pericardial drain was removed after 5 days with no evidence of recurrence of tamponade on repeat echo.

Conclusion:
Peripartum shortness of breath with leg swelling is a common complain among pregnant women with pre-eclampsia. Although peripartum cardiomyopathy is more common, pericardial effusion with cardiac tamponade is also a potential diagnosis and should be kept in the differential. Echocardiography can differentiate these entities.
Abstract 14554: Novel Upstream Targets for Atrial Fibrillation
Authors: Sirish Padmini , Yang Jun , Datta Esha , Ballal Aditya , Srivatsa Uma N , Kiaii Bob , Izu Leighton , Hammock Bruce D , Chiamvimonvat Nipavan
Published: June 2023

Introduction:
Atrial fibrillation (AF) represents one of the most common arrhythmias seen clinically and is associated with a significant increase in morbidity and mortality, yet, current treatment paradigms have proven largely inadequate. One of the main contributors to the pathophysiology of AF is inflammation. Hence, reduction of inflammation associated atrial remodeling represents a novel therapeutic strategy for the treatment of AF. One of the most biologically important groups of oxylipins (oxygenated lipids) is the eicosanoids that are potent modulators of immune responses and are derived from arachidonic acid, linoleic acid among others, which are metabolized through three pathways including the cytochrome P450 (CYP) pathway. The CYP products are major anti-inflammatory metabolites with several cardioprotective effects.

Hypothesis:
We hypothesize that lipid metabolites may represent a new therapeutic target for AF

Methods:
In the cross-sectional study, human atrial appendage specimens and blood from informed and consented patients were obtained in accordance with the approved UC Davis IRB protocol. Metabolomic profiling for over 100 metabolites was assessed from the plasma of patients using LC-MS/MS. We used Functional Connectome, an extension of the singular value decomposition for matrices, to determine how the metabolites were functionally related to each other. The underlying mechanisms of AF were determined using an integrated approach with molecular biology, flow cytometry, and electrophysiology.

Results:
Metabolomic profiling shows a significant difference in several metabolites from the arachidonic and linoleic acid pathways in the cohort with AF compared to patients in NSR. There was a significant increase in oxidative stress, endoplasmic reticulum stress, inflammatory cytokines, nuclear translocation of NF-κB, and the activation of MAPK and TGF-b pathways from patients with AF compared to NSR cohort.

Conclusions:
The study provides important insights into the functional relatedness of the metabolites from the CYP pathway in patients with AF and reveals the prospect of arachidonic and linoleic acid metabolites being novel therapeutic targets in the treatment of AF.
Abstract 14569: Impact of Psoriasis on Inpatient Outcomes of Patients Admitted for Coronary Artery Bypass Graft: Analysis of the National Inpatient Sample
Authors: Saleem Sania , Abbasi Ayesha , Shoura Sami , Akuna Emmanuel , Bhatti Mahak K , Kannayiram Sandhya-Shri
Published: June 2023

Introduction:
Psoriasis is a systemic chronic inflammatory disorder with a global prevalence of 2-3%. Characterized by its skin manifestations and multiple comorbidities, it is notably associated with 50% increased likelihood of coronary artery, cerebrovascular and peripheral artery diseases. This study aims to assess the impact of psoriasis on inpatient outcomes of patients admitted for coronary artery bypass graft (CABG).

Hypothesis:
Co-existing psoriasis worsens hospital outcomes in patients admitted for CABG.

Methods:
We searched the National Inpatient Sample (NIS) 2016-17 database to identify adult hospitalizations with CABG as the principal diagnosis with and without psoriasis as a secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality. Secondary outcomes were length of hospital stay (LOS) and total hospital charge (THC). Using Stata 17 software, multivariable logistic and linear regression analysis were applied to adjust for confounders.

Results:
There were over 71 million discharges included in the combined 2016-17 NIS database. Out of 477,389 CABG hospitalizations, 3,765 (0.8%) had psoriasis. The adjusted odds ratio (AOR) for inpatient mortality for CABG with co-existing psoriasis compared to those without psoriasis was 0.67 (95% CI 0.39-1.15, p=0.146). Hospitalizations for CABG with co-existing psoriasis had a decreased adjusted mean LOS by -0.44 days (95% CI {-0.85} - {-0.25}, p=0.037) and incurred a lower THC by -16,178.83 USD (95% CI {-27,541.02} - {4,816.63}, P=0.005) compared to those without psoriasis.

Conclusions:
In summary our study showed that CABG patients with psoriasis had a lower THC and LOS with no significant difference in mortality compared to CABG patients without psoriasis. It may be attributed to younger age group or immunosuppressive therapy and might warrant investigation into a more lenient CABG criteria for psoriasis patients.
Abstract 14573: High Performance of Artificial Intelligence-Based Model for Scoring Breast Arterial Calcification on Mammograms
Authors: Nerlekar Nitesh , Goel Vinay , Yeong Chee , Spear Ella , Cameron William , Mantey Richard , Belrose Nora , Nicholls Stephen
Published: June 2023

Purpose:
Mammographically detected breast arterial calcification (BAC) has been reported as a surrogate marker for coronary vascular disease (CVD). BAC is often not reported, reducing the power of this risk marker. Here we assess a deep-learning algorithm for BAC quantification, and in cases where the software identified BAC but the readers did not, assess correlation with clinical CVD.

Methods:
Screening digital mammograms (n=285, 1232 images) were selected from a tertiary Australian hospital from a sample of patients who underwent CVD screening (137 confirmed CVD). Two readers identified binary presence/absence of BAC. A deep learning software (cmAngio™ , CureMetrix, USA) quantified BAC score (scale 0-100). Reader-software discordance was adjudicated by a third observer. Area under the curve (AUC) was used to assess performance with 95% confidence intervals (CI) presented. Interobserver agreement was assessed by Cohen’s kappa (k).

Results:
Interobserver agreement for visual BAC was good (k=0.78, CI:0.71-0.85, p<0.01). BAC scores ranged from 0-100, with 12% scoring 0. The algorithm had high performance, AUC 0.92 (CI:0.88-0.96, p<0.001) vs initial reader assessment, increasing to AUC 0.98 (CI:0.97-0.99, p<0.001) after adjudicated assessment. At an empirical threshold of BAC score ≥5 to denote BAC presence, BAC prevalence was 38% (109/285) by software, and 31% (87/285) visually. In cases where only the software identified BAC (n=35), BAC scores were all <25, with 37% (n=13) having confirmed CVD and 9% (n=3) myocardial infarction.

Conclusion:
cmAngio demonstrates excellent performance for detecting BAC on screening mammograms. Faint BAC may be missed by human readers, is better identified by the software, and in these cases there is a high rate of CVD suggesting use in a screening population may improve risk prediction for CVD.