bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 13849: Characteristics and Outcomes of COVID-19 in Patients With a Left Ventricular Assist Device
Authors: Fleites Jorge , Natori Yoichiro , Simkins-Cohen Jacques , Butrous Hoda , Bauerlein E Joseph J , Phancao Anita , Loebe Matthias , Anjan Shweta , Munagala Mrudula
Published: November 2023

Introduction:
Patients with left ventricular assist devices (LVAD) are at increased risk for SARS-CoV-2 (COVID-19) complications. There is paucity of literature on factors influencing outcomes of LVAD patients with COVID-19 infection.

Methods:
A single center retrospective chart review of LVAD patients diagnosed with COVID-19 between March 2020 and March 2023, was performed to define the clinical characteristics and outcomes in this cohort. Demographics, clinical, laboratory, and imaging variables were analyzed.

Results:
Of 130 LVAD patients, 34 (26.2%) developed COVID-19. The cohort comprised of 27 males (79.4%) with a median age of 63.5 years and BMI of 27.6 (Table 1). Twenty-one had non-ischemic cardiomyopathy (61.8%) with either Heartmate 2 or Heartmate 3 LVADs (38.2% each). Most patients reported NYHA class III (44.1%). The common comorbidities included hypertension (94.1%), hyperlipidemia (79.4%), atrial fibrillation (67.4%), and chronic kidney disease (61.8%). Twenty-eight (82.4%) patients were hospitalized and 2 (7.1%) required mechanical ventilation (Table 2). The average initial and peak INR were 2.39 and 3.26, respectively. No complications of pump hemolysis or thrombosis, or systemic embolisms were noted. Two deaths were reported: one passed away while in the hospital from COVID-19, and another 16 months later due to sequelae of post-COVID pulmonary fibrosis.

Conclusions:
This is the largest single center study analyzing outcomes of COVID-19 in LVAD patients to date. Our cohort experienced a lower mortality rate from COVID-19 infection compared to prior studies. Larger studies are needed to guide management strategies and analyze long-term outcomes.
Abstract 13856: Echocardiographic Findings in Women With Ischemic Sudden Cardiac Death
Authors: Hookana Ida , Eskuri Anette , Holmstrom Lauri , Vahatalo Juha , Kentta Tuomas , Tikkanen Jani T , Pakanen Lasse , Perkiomaki Juha , Huikuri Heikki , Junttila Juhani
Published: November 2023

Background:
Majority of sudden cardiac deaths (SCD) are caused by coronary artery disease (CAD). Many women who experience SCD do not exhibit the traditional risk factors associated with SCD, which poses challenges in terms of SCD prevention and prediction. The data of SCD in women are limited as women are often underrepresented in SCD studies.

Aim:
The objective of this study was to investigate sex-specific echocardiographic findings in subjects with ischemic SCD.

Methods:
The study group consisted of 4392 subjects with ischemic SCD (20.2 % women) derived from the FinGesture study. The cause of death was determined at medicolegal autopsy. Pre-SCD echocardiography (ECHO) reports were collected from medical records. Ventricular and atrial dimensions as well as left ventricular mass (LVM) were categorized by using widely accepted thresholds. LVM was calculated using the LVM formula (LV Mass = (0.8 * [1.04 * ((LVEDD + IVSd + PWd)
3
- LVEDD
3
)]) + 0.6)). Left ventricular ejection fraction (LVEF) was classified into four categories: normal (>55 %), mildly reduced (45-55 %), moderately reduced (35-45 %) and severely reduced (<35 %). ECHO reports were available for 325 SCD victims (20.3 % women).

Results:
Left ventricular hypertrophy (LVH) was prevalent in 84.6 % of women and 76.4 % of men (p = 0.440). A thickened interventricular septum was observed in the majority of subjects in both sexes (84.8 % in women vs. 85.9 % in men, p = 1.000). Similarly, an enlarged left atrium was commonly found in both women (70.2 %) and men (72.3 %) (p = 0.856). The prevalence of dilated left ventricular end-diastolic diameter was 27.3 % in women and 30.1 % in men (p = 0.651). Overall, no significant differences were observed between the sexes in sex-adjusted ventricular or atrial dimensions. However, women with ischemic SCD were more likely to have a normal LVEF compared to men (63.4 % in women vs. 45.5 % in men, p <0.001). Additionally, the prevalence of severely reduced LVEF was significantly lower in women than in men (5.4 % in women vs. 15.9 % in men, p = 0.005).

Conclusions:
LVH is a common finding in subjects with ischemic SCD. Women with ischemic SCD are less likely than men to have severely reduced LVEF prior to SCD. Additionally, in women, ischemic SCD tends to occur more often without a decrease in LVEF.
Abstract 13873: Deep Learning-Based GWAS of Aortic Valve Function Links 81 Loci to Aortic Stenosis Risk
Authors: Pirruccello James , Kany Shinwan , Ramo Joel , Hou Cody , Jurgens Sean J , Nauffal Victor , Cunningham Jonathan , Lau Emily , Ho Jennifer E , Olgin Jeff , Elmariah Sammy , Lindsay Mark E , Palotie Aarno , Ellinor Patrick T
Published: November 2023

Background & Aims:
The genetic influences on normal aortic valve (AV) function and their impact on aortic stenosis (AS) risk are of significant interest. We sought to identify common genetic determinants of normal variation in AV function, and to understand their relationship with clinical disease.

Methods:
We used deep learning to measure peak velocity, mean gradient, and aortic valve area from MRI in UK Biobank participants. We conducted genome-wide association studies (GWAS) in a subset of 44,780 participants without cardiovascular disease. We performed multi-trait analysis of GWAS (MTAG) to incorporate data from AV measurements and AS diagnoses in UK Biobank and FinnGen, and applied PRScs to construct polygenic scores (PGS).

Results:
In the unadjusted analysis, 26 loci were associated with at least one AV measurement. Incorporating the AS GWAS using MTAG, we identified 81 distinct loci (62 with AV traits, 54 with AS, 35 overlapping), including PCSK9 (β=0.032, P=5.8E-09) and LDLR (β=0.018, P=2.3E-10). Additional loci were associated with lipid metabolism (LPA, FADS2, SORT1), atherosclerosis (CDKN2B, ARHGEF26, OTUD7B, PRDM16), inflammation (IL6, KLF2, TRAF1), and cardiac development and aortic root function (SMAD3, GATA4, ELN, TBX20, TEX41). The PGS for the unadjusted mean gradient was predictive of AS in FinnGen (HR 1.36 for the top 5% of participants vs all others, P=1.8E-14). All of Us participants in the top 5% of the MTAG-adjusted peak velocity PGS had an HR of 2.5 for incident AS (P=4.4E-08). Mendelian randomization showed association between Lp(a) and LDL—but not ApoA—on greater peak velocity (P=2.7E-13, P=1.6E-16, and P=0.60, respectively).

Conclusion:
We identified 81 genetic loci linked to AV function or AS. AV measurement PGS were strong predictors of AS risk. ApoB and Lp(a) showed causal association with higher peak velocity. These findings have implications for the early pathogenesis of AS and suggest modifiable pathways as targets for prevention.
Abstract 13887: Longitudinal Trends in Donor and Recipient Risk Profile, and Clinical Outcomes, for Donation After Circulatory Death Heart Transplantation
Authors: Lerman Joseph B , Guidot Daniel M , Patel Chetan B , Agarwal Richa , Sweitzer Nancy K , Keenan Jeffrey , Milano Carmelo A , Schroder Jacob , Devore Adam D
Published: November 2023

Background:
The US rate of Donation after Circulatory Death (DCD) Heart Transplant (HT) increased threefold from 2020 to 2022. While early analyses of DCD HT have suggested similar outcomes compared to donation after brain death HT, this may be the result of a restrictive DCD donor and recipient selection process, intended to minimize risk in the first US DCD HT cohorts.

Hypothesis:
We hypothesized that risk profiles for DCD HT donors and recipients have increased over time, as DCD HT has rapidly expanded. We sought to identify longitudinal changes in risk profiles for DCD donors and recipients from 2019-2023, and determine if such changes have impacted post-DCD HT clinical outcomes.

Methods:
We analyzed the UNOS thoracic organ database from December 2019 to March 2023. DCD HT donor and recipient risk characteristics were evaluated over time for significant trend. One-year recipient survival was compared over time.

Results:
During the study period, 716 DCD HT were performed. Recipients were mostly male (79%), Caucasian (68%), and had mean age of 54 years. Over time, several donor and recipient characteristics were significantly different (Table, Figure). Donors were older, and had increased BMI, creatinine, and agonal phase to cross-clamp time, although overall lower ischemic time. Recipients were more likely to be status 1 or 2, and had increased BMI, waitlist time, creatinine, and CPRA. Donor and recipient comorbidities and mechanical support use were unchanged. Post-HT survival over time was unchanged.

Conclusions:
Since the first US DCD HT, several donor and recipient risk-factors have increased. These increased risk profiles have not translated into reduced one-year survival.
Abstract 15604: Dietary Patterns, Blood Pressure and Proteinuria in a West African Chronic Kidney Disease Population
Authors: Kwakyi Edward P , Zhao Runqi , Ulasi Ifeoma , Parekh Rulan , Arogundade Fatiu , Adu Dwomoa , Solarin Adaobi , Raji Yemi , mamven manmak , Mitchell Diane , Waikar Sushrut , Ojo Akinlolu O , GBADEGESIN RASHEED , Eduful Ernestina , Ilori Titilayo
Published: November 2023

Introduction:
There is little known about the impact of dietary patterns on blood pressure (BP) in West Africa. Our study describes associations of dietary patterns with BP and albuminuria and is the first study to do so in a well-phenotyped West African CKD cohort.

Research question:
What are the associations of dietary patterns with BP and proteinuria in West African CKD patients?

Methods:
We performed a cross-sectional analysis of participants from the Diet, Apolipoprotein L1, and CKD study; an ancillary study under the H3 Africa Network. We analyzed 24-hour dietary recalls in 583 participants. Dietary patterns were derived via principal component analysis, and the first 3 principal components with eigenvalues > 1 were selected. We measured proteinuria using 24-hour urine samples. Mixed effect linear regression models were used to estimate the β coefficient and 95% confidence interval for the quartiles of the dietary patterns with BP and proteinuria after adjusting for covariates.

Results:
The mean age was 49±17 years with 51% males and the mean eGFR (2009 CKD-Epidemiology collaboration formula) was 68±39 mL/min/1.73m
2
. The median 24-hour urine protein was 0.31g (IQR=0.13-1.07). We identified the
Dried fish, Oils and vegetables; Poultry and Cereal;
and the
Fruit and Cereal dietary patterns
. Compared to Q1 (lowest consumption), higher quartiles of intake of the Poultry and Cereal dietary pattern were associated with lower systolic BP (SBP) and diastolic (DBP). Higher consumption of the Poultry and Cereal dietary pattern was associated with lower 24hr urine protein, with a significant p for trend (p=0.05). Compared to Q1, Q4 of this pattern was associated with reduced odds of proteinuria (
Table 1
).

Conclusions:
Consuming a Poultry and Cereal dietary pattern may be beneficial for BP and proteinuria in West African CKD patients.
Abstract 15627: Accumulation of Chronic Conditions in Patients <65 Years of Age Diagnosed With Atrial Fibrillation
Authors: Chamberlain Alanna M , Alonso Alvaro , Noseworthy Peter A , Gersh Bernard J , Manemann Sheila M , Weston Susan , Killian Jill , Ryu Euijung , Roger Veronique L , Siontis Konstantinos
Published: November 2023

Background:
Multimorbidity is common in atrial fibrillation (AF), particularly among older patients who generally have multiple cardiovascular and non-cardiovascular chronic conditions. However, less is known about the accumulation of chronic conditions in younger patients with AF.

Methods:
Patients aged <65 with incident AF from 2013-2019 from a 27-county region in the Midwest (N=4907) were matched 1:1 on age (±5 years) and sex to referents from the same community. The index date for the matched pair was the date of first diagnosis of AF. Diagnosis of 20 other chronic conditions was ascertained from 3 years prior to index through 12/31/2022. Mean cumulative function curves were used to visualize the accumulation of conditions; Andersen-Gill models estimated associations between AF/referent status and accumulation of conditions.

Results:
The mean age was 55 years for both patients with AF and matched referents; 71% were male. In the 3 years leading up to AF diagnosis, only 4% of patients with AF had no additional chronic conditions and 69% had ≥3 chronic conditions. In contrast, 35% of referents had 0 and 32% had ≥3 chronic conditions. The accumulation of chronic conditions was accelerated in patients with AF compared to referents prior to AF diagnosis/index (Figure). After index, patients with AF had increased accumulation of chronic conditions (HR (95% CI): 1.93 (1.71-2.20), 1.82 (1.62-2.05), 1.68 (1.55-1.83), and 1.53 (1.44-1.64) for ages <50, 50-54, 55-59, and 60-64 years, respectively). After 1 year, the differences were attenuated in all age groups with no difference observed between patients with AF and referents in the oldest age group (1.26 (1.08-1.46), 1.28 (1.11-1.47), 1.13 (1.02-1.24), and 1.05 (0.97-1.13) for ages <50, 50-54, 55-59, and 60-64 years).

Conclusion:
Patients <65 years with AF have an increased accumulation of chronic conditions compared to those without AF, in particular prior to their AF diagnosis and within the first year after AF diagnosis.
Abstract 15629: Innovative Approach to Mitral Regurgitation in a Patient With Partially Dehisced Annuloplasty Band After Mitral Valve Repair
Authors: Borges Alexandrino Francisco , Kopecky Kathleen , Arghami Arman , Pislaru Sorin , Sinak Lawrence J , Alkhouli Mohamad , Bird Jared G
Published: November 2023

Case:
A 65-year-old patient presented 4 months after mitral valve repair (annuloplasty band, commissuroplasty, neo-chordae to the anterior mitral leaflet (AL)). At follow up, he developed significant hemolytic anemia (Hemoglobin 10.1g/dL, LDH 650U/L, Bilirubin 1.4mg/dL and haptoglobin<14 mg/dL). TEE revealed the substrate for hemolysis: moderate-severe mitral regurgitation (MR) starting at the coaptation of A2 and P2 scallops due to AL overriding the posterior (PL). The jet was then directed posteriorly to a small (3 x 6 mm confirmed by cardiac CT) area of annuloplasty band dehiscence at the base of the P2 scallop, with the band in direct path of the flow. The unique feature was that AL retained coaptation with the annuloplasty band, thus forming a small tunnel from the A2-P2 coaptation defect to the dehisced area. Given that redo surgery early after initial intervention would be challenging, the Heart Team decided to pursue percutaneous closure at the level of the dehisced annuloplasty to reduce regurgitation and mitigate hemolysis. Under 3D TEE guidance closure with a 12mm AVP plug was attempted but resulted in interference with PL motion with a new jet of regurgitation laterally. Using two 8mm AVP plugs was successful in closing the dehiscence with minimal impact on PL. Overall regurgitation was reduced to mild. Within a week hemolysis labs improved: LDH337 U/L, Bilirubin0.7 mg/dL.

Discussion:
Annuloplasty band dehiscence is a known cause of recurrent MR after repair. As regurgitation occurs at the leaflet coaptation zone, percutaneous closure of these defects is usually futile. In this patient we took advantage of the maintained coaptation between the AL and annuloplasty band.
Abstract 16080: Complementary Roles of Near-Infrared Spectroscopy and Intravascular Ultrasound in the Prediction of Periprocedural Myocardial Injury
Authors: Irie Daisuke , Matsumoto Hidenari , Isodono Koji , Higuchi Satoshi , Tanisawa Hiroki , Ohya HIdefumi , Kitamura Ryoji , Shinke Toshiro
Published: November 2023

[Introduction]
Lipid-rich plaque detected by near-infrared spectroscopy (NIRS) and attenuated plaque detected by intravascular ultrasound (IVUS) predict periprocedural myocardial injury (PMI) following percutaneous coronary intervention (PCI). The relationship between echolucent plaque detected by IVUS (considered to represent intraplaque hemorrhage) and PMI remains uncertain.

[Research Questions]
Can the combination of NIRS and IVUS enhance the prediction of PMI? [Aims] We aimed to elucidate whether echolucent plaque is independently associated with PMI following elective PCI and whether the combination of NIRS and IVUS signatures improves the predictive ability for PMI. [Methods] This multicenter retrospective study included 121 lesions from 121 patients who underwent elective NIRS-IVUS-guided stent implantation. PMI was defined as post-PCI cardiac troponin-T >5х the upper reference limit. A maximum 4-mm lipid core burden index >457 was regarded as lipid-rich plaque. Echolucent plaque and attenuated plaque were defined as the presence of an echolucent zone and an attenuation arc >90° on IVUS, respectively.

[Results]
PMI occurred in 39 lesions. Multivariable analysis revealed that echolucent plaque, attenuated plaque, and lipid-rich plaque were independent predictors of PMI. Adding echolucent plaque and attenuated plaque to lipid-rich plaque improved the predictive performance (C-statistics: 0.825 vs. 0.688; p=0.001). The incidence of PMI increased with the number of predictors: 3% (1/39), 29% (10/34), 47% (14/30), and 78% (14/18) for 0, 1, 2, and 3 predictors, respectively.

[Conclusions]
Echolucent plaque emerged as a significant predictor of PMI, independent of lipid-rich plaque and attenuated plaque. Compared with NIRS alone, the combination of NIRS with IVUS signatures improved the predictive ability of imaging.
Abstract 16099: Life’s Essential 8 and Genetic Predisposition Predict Brain Volume Change, Mild Cognitive Impairment and Dementia Risk
Authors: Wang Qi , Zhu Dongshan
Published: November 2023

Introduction:
Life’s Essential 8 (LE8) are the key measures for improving and maintaining cardiovascular health, as defined by the American Heart Association in 2022. The associations of LE8 with future brain volume change, mild cognitive decline (MCI), and dementia have been unclear.

Hypothesis:
We hypothesized that LE8 status might be related to future brain volume change, and predict risk of MCI and all-cause dementia. Apolipoprotein E (APOE) gene and polygenic risk score (PRS) may modify the association between them.

Methods:
We used cohort data from UK Biobank. LE8 was categorized into low (<50 score), moderate (50-79 score), and high (≥80 score) levels. Genetic predisposition was measured by APOE e4 carrier status and a polygenic risk score (PRS) calculated based on 39 non-APOE genetic variants. Linear regression models were used to analyze LE8 every 10-score increase and change of brain volume (total and hippocampus etc.). Cox regression models were used to estimate the hazard ratio (HR) and 95%CI on the association between LE8 and MCI and dementia.

Results:
We included 126,785 participants with a mean (SD) age of 56.0 (8.0) years and 53.5% were female. After a median of 13.0 years follow-up, we recorded 1797 (1.4%) people with MCI, and 1055 (0.8%) with dementia. Every 10-score increase of LE8 was related to 2826.11mm
3
increase in total brain volume, 8.41 and 12.04 mm
3
increase in left and right hippocampus volume respectively, while 393.41mm
3
decrease in ventricular cerebrospinal fluid volume (p values all <0.001). Compared to people with a low LE8, those with a high LE8 were associated with decreased risk of MCI (HR 0.54, 95% CI 0.44-0.68) and dementia (0.63, 0.47-0.85). Compared to people with high LE8 and no APOE e4 allele, those with low LE8 and one or two APOE e4 alleles were associated with increased risk of MCI (2.36, 1.69-3.29) and dementia (4.37, 2.86-6.68). The joint effects of LE8 and PRS showed that people with high LE8 and low PRS had lower risk of dementia.

Conclusions:
High LE8 was associated with increased total brain volume, hippocampus volume and decreased ventricular cerebrospinal fluid volume. Higher LE8 was also linked to reduced risk of MCI and dementia. There were joint effects between LE8 and APOE, PRS on MCI and dementia risk.
Abstract 16911: Timing of Initiation of Extracorporeal Membrane Oxygenation Support and Outcomes Among Patients With Cardiogenic Shock
Authors: Jentzer Jacob C , Drakos Stavros G , Selzman Craig , Owyang Clark G , Teran Felipe , Tonna Joseph
Published: November 2023

Introduction:
Venoarterial extracorporeal membrane oxygenation (VA ECMO) provides full hemodynamic support for cardiogenic shock (CS), but optimal timing of ECMO initiation remains uncertain.

Hypothesis:
We hypothesized that earlier initiation of ECMO would be associated with improved survival in CS patients.

Methods:
We analyzed adult patients with CS who received VA ECMO from the Extracorporeal Life Support Organization (ELSO) Registry from 2009 - 2019, excluding those cannulated following an operation. Multivariable logistic regression evaluated the association between time from admission to ECMO initiation and in-hospital mortality.

Results:
Among 8619 patients (median 56.7 years; 33.5% females), the duration from admission to ECMO initiation was 14 (5, 32) hours. Patients who had ECMO initiated within 24 hours (n = 5882 [68.2%]) differed from those who had ECMO initiated after 24 hours, with younger age, more preceding cardiac arrest, and worse acidosis. After adjustment, patients with ECMO initiated more than 24 hours after admission had higher risk of adjusted in-hospital mortality (adjusted OR 1.20, 95% CI 1.06-1.36, p = 0.004) (Figure 1). Each 12-hour increase in the time from admission to ECMO initiation was incrementally associated with higher adjusted in-hospital mortality (adjusted OR 1.06, 95% CI 1.03-1.10, p < 0.001). The association between longer time to ECMO and worse outcomes appeared stronger in patients with lower shock severity. Among patients who were cannulated within 24 hours, those cannulated during the same day shift had lower mortality than those who were admitted at night and cannulated the following day (adjusted OR adjusted OR 0.81, 95% CI 0.66-0.99, p = 0.04).

Conclusions:
Longer delays from admission to ECMO initiation were associated with higher mortality in a large-scale, international registry. Our analysis supports optimization of door-to-support time and the avoidance of inappropriately delayed ECMO initiation.
Abstract 16921: The Capture of the Left Conduction System Appears to Be Essential for Left Bundle Branch Area Pacing to Provide a Greater Acute Hemodynamic Response Than Biventricular Pacing
Authors: Poviser Lukas , Waldauf Petr , Stros Petr , Vesela Jana , Vondra Vlastimil , Whinnett Zachary , Kautzner Josef , Curila Karol
Published: November 2023

Introduction:
Left bundle branch area pacing (LBBAP), which includes left bundle branch pacing (LBBP) and left septal myocardial capture (LVSP), is a novel alternative of cardiac resynchronization therapy (CRT). However, it is unknown whether the left conduction system capture is required or whether LV septal capture only is sufficient in patients with a CRT indication.

Hypothesis:
To study the effect of biventricular (Biv) CRT, LBBAP, and, more specifically, LBBP and LVSP on the effectivity of LV performance using a dedicated protocol of blood pressure measurements.

Methods:
Patients with QRSd ≥ 130 ms of nonRBBB morphologies and an indication for CRT were included. During implantation, the leads were placed in the RV apico-septum, lateral/posterolateral branch of the coronary sinus, and the left septal area to obtain LBBAP. LBBAP was further classified as LBBP or LVSP during decremental output pacing. The acute hemodynamic response was calculated from the changes in the systolic blood pressure measured invasively from the peripheral artery using a high-precision protocol with multiple transitions between the tested pacing configurations.

Results:
CRT was attempted in 25 consecutive patients with an average age of 68 years. Biv CRT and LBBAP were successful in 23 and 24 patients, respectively. LBBP was achieved 17 and LVSP 13 times (in 6 patients, both capture types were observed). Eight patients had ischemic cardiomyopathy, mean LVEF was 30 ± 6 %, and QRSd during spontaneous rhythm was 174 ± 18 ms. Both Biv CRT and LBBAP significantly reduced QRSd (51 ± 24 ms and 47 ± 22 ms) and resulted in an increase of systolic blood pressure (8 ± 0 mmHg for Biv CRT, and 11 ± 0 mmHg, for LBBAP;
p
< 0.001 for both) compared to right ventricular pacing. LBBAP increased systolic blood pressure more than Biv CRT (3 ± 0 mmHg;
p
< 0.001). This was mainly due to a significant increase in blood pressure during LBBP compared to Biv CRT (5 ± 1 mmHg;
p
< 0.001), while no difference was observed between LVSP and Biv CRT (1 ± 0 mmHg;
p
= 0.174).

Conclusions:
In consecutive patients with CRT indication, LBBAP improved acute hemodynamic response more than Biv CRT. Capturing the left conduction system appears to be essential for LBBAP to outperform Biv CRT.
Abstract 19115: In-situ Resuscitation Training in Cardiology Procedural Suites
Authors: Bahru Rahel , OConnor Brenna , Daugherty JoAnn , Minokadeh Anushirvan , Suresh Preetham
Published: November 2023

Background:
Critical Care Advanced Resuscitation Training (CC-ART) prepares critical care teams for emergency situations through training that occurs in a simulated clinical space. Simulated environments do not always accurately mirror the actual clinical environments. Simulations conducted in the actual clinical environment, also known as in-situ simulation, may overcome some of these challenges.

Goal:
To explored the impact of in situ, ART simulation in a Cardiac Catheterization Lab (CCL) and an Electrophysiology Lab (EPL) on the staff’s experience, confidence, and communication skills.

Method:
Key leadership and educator team members collaborated on the in-situ simulation set up. Coordination with Simulation Center and Central Supply Department was completed to arrange for delivery of high-fidelity manikins and training crash cart to the site. A team of physicians and nurse educators created CCL and EPL scenarios for the simulations and wrote a simulation evaluation survey for CCL and EPL nurses and technologists who attended.

Results:
. Simulations were run by both critical care anesthesiologist and clinical nurse educator. Pre-simulation and post-simulation surveys were collected immediately prior to and after the in-situ simulation. 38 staff completed pre and post surveys. Pre-simulation, 50.00% of staff strongly agreed that they were confident in their ability to care for a decompensated patient based on the prior CC-ART training versus, post-simulation, 84.21% strongly agreed. Pre-simulation, 26.32% strongly agreed that the simulation center training was similar to their actual work experience versus post-simulation, 78.95% agreed the in-situ simulation matched their actual work experience. Pre-simulation, 52.63% strongly agreed that they were confident in their ability to communicate their needs during emergencies or code blue situations versus post-simulation 86.84% agreed.

Conclusion:
This quality improvement project highlights the effectiveness of in situ resuscitation simulation in improving healthcare professionals' confidence, training realism, and communication skills
.
Analysis of patient outcomes is needed to determine the effectiveness and duration of impact of in situ training for clinical practice.
Abstract 19119: Predictors and Outcomes of Myocardial Infarction in Patients With and Without Takotsubo Cardiomyopathy
Authors: Jamshed Aneeza , Abbasi Ayesha , Vardar Ufuk , Karki Sadichhya
Published: November 2023

Introduction:
Takotsubo Cardiomyopathy often presents as acute myocardial infarction (MI) due to reversible cardiac dysfunction caused by catecholaminergic surge.

Hypothesis:
Is there any difference in the short-term outcomes of the patients who present with MI accompanied with Takotsubo cardiomyopathy when compared to MI alone.

Methods::
National Inpatient Sample Database of 2016-2019 was queried for the Primary ICD code of MI and secondary as Takotsubo Cardiomyopathy. The in-patient mortality was the primary outcome whereas CVA, CHF and Arrythmias were considered as secondary outcomes.

Results:
Around 3million patients were discharged with MI per year, out of which 4% had Takotsubo Cardiomyopathy (TC). 65% of the patients in both groups were older than 65 years. The mean age of patients for TC with MI was 68 years as compared to 70 years in the MI group without TC. The inpatient mortality for the patients with MI and TC was 28% whereas for those with MI alone was 18% (p=0.000) with the aOR 2.4 (95% CI1.97- 2.93 p=0.00). Female gender is not significantly associated with odds of TC in MI (aOR:1.077 p= 0.401 95% CI: .90-1.28). The percentage of TC with MI was more in Black population (18%) as compared to MI alone (13%) with p=0.007. No difference in the mean Charlson index was found between the two groups (4.5 vs 4.2). Patients with MI and TC had higher odds of atrial arrythmias (36% vs 31% p=0.001) with a OR: 1.35 p=0.001 (95% CI: 1.13-1.63). TC was associated with lesser odds of CVA, CAD, HTN, CHF and DM in MI where there was no difference in smoking, dyslipidemias and other baseline factors. Patients with TC had a higher mean LOS 0.5 days.

Conclusions:
Takotsubo cardiomyopathy is associated with higher odds of in-patient mortality, mean LOS and Atrial Arrythmias in MI without any difference in age, comorbidity index and gender.
Abstract 19121: Averaged Impedance Drop Workflow for Pulmonary Vein Isolation
Authors: Friedman Daniel , Piorkowski Christopher , Tranter John H , Overmann Jed , Husain Ilaaf , Speltz Molly , Thao Riki , Fish Jeffrey
Published: November 2023

Background:
Previous studies demonstrate that averaged impedance drop (AID) is the most accurate predictor of focal atrial RF ablation lesion transmurality when using the TactiFlex™ SE Ablation Catheter in combination with AutoMark in EnSite™ X EP System version 3.0, however data demonstrating successful incorporation of AID into a pulmonary vein isolation workflow is lacking.

Objective:
We explored use of AID in conjunction with the AutoMark Distance (AMD) tool to create sets of contiguous, transmural atrial lesions in a chronic swine model and to compare results with inter-lesion gap rates from a historical study of a previous generation catheter (TactiCath) using LSI™ guidance.

Methods:
RSPV isolation and SVC-IVC and RSPV-CIPV lines were performed in swine (n=9) via point-by-point ablation (target contact force 10g). AID targets of 11, 13, and 15% were selected and minimum-maximum duration bounds were employed (30W/15-50s, 40W/8-20s and 50W/5-10s). Inter-lesion distances of 4mm and 5mm were chosen (balanced across RF powers and anatomical targets). After 12±3 days survival, lesion sets were examined using gross pathology and histology.

Results:
Histological analysis showed gap incidence rates of 4/223 (1.8%) and 9/215 (4.2%) in the right and left atria, respectively. Per-condition results are shown in Figure 1. The target AID was achieved in 339/487 (69.6%) of ablations, with the target AID reached prior to the minimum duration in 89/487 (18.3%) of trials. Collateral effects were observed, including pulmonary artery thrombosis and inflammation/necrosis extending to trachea/bronchus (N=1). Further characterization of these adverse events could potentially guide upper bounds for AID targets.

Conclusions:
AID guided ablation resulted in a low rate of inter-lesion gaps, overall comparable to historical data. However, safety and efficacy varied by delivery condition and these results may be useful for guiding clinical use.
Abstract 19123: Associations Between Multiple Dimensions of Poor Sleep and Life’s Essential 8 Cardiovascular Health Score During the Menopausal Transition: Findings From the AHA Research Goes Red Weight Study
Authors: Aggarwal Brooke A , Scaccia Samantha , Charliyan Gary , Wang Pengchen , Allison Matthew A , Catov Janet M , Reynolds Harmony , Vaidya Dhananjay
Published: November 2023

Introduction:
The sleep health metric in AHA Life’s Essential 8 (LE8), a measurement of cardiovascular health (CVH), consists only of sleep duration. Associations of other dimensions of sleep health including sleep quality with the LE8 CVH and its individual components have not yet been evaluated.

Methods:
Participants were 291 women (n=98 pre-, n=94 peri-, n=99 post-menopausal, mean age=50 ± 3.2yr) between 45-55y from the AHA Research Goes Red Weight Study, which utilized Verily’s online platform. Standardized questionnaires included the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), and Berlin questionnaire for risk of obstructive sleep apnea (OSA), and a 1-wk NIH ASA 24-Hour Dietary Assessment. The LE8 CVH and component scores were computed. Cross-sectional associations between sleep and overall CVH scores and individual metrics were tested using multivariable logistic regression models adjusted for age, race/ethnicity, education, employment, insurance, and menopausal status.

Results:
Half of women slept <7 hours/night, 79% reported poor sleep quality (PSQI≥5), one-third had high-risk OSA phenotype, 51% reported insomnia symptoms (ISI≥8), and 12% had evening chronotype. Compared to pre-menopausal women (67%), significantly more post-(83%) and peri-menopausal (86%) women reported poor sleep quality (p<0.01). Women with poor sleep quality had 3-fold higher odds of poor overall CVH score (p=.04). Women with high-risk OSA phenotype and evening chronotype also had ~3-fold higher risk of poor overall CVH scores (OR=3.58, CI=1.79-7.18, and OR=3.33, CI=1.45-7.69, respectively). Poor sleep quality was associated with greater odds of low score on the diet component (OR=2.97, CI=1.55-5.69). Insomnia symptoms were associated with poor score on the BMI component (OR=1.92, CI=1.15-3.21). High-risk OSA phenotype was associated with greater odds of poor scores on the blood pressure, blood glucose, and BMI components (OR=2.3, CI=1.2-4.3; OR=3.2, CI=1.5-7.1, and OR=11.6, CI=6.2-21.6).

Conclusions:
Multiple aspects of sleep other than duration were associated with overall LE8 CVH score, and individual metrics, among women across menopause. Findings support potential incorporation of sleep quality into CVH constructs.
Abstract 19189: A Rare Case of
Neisseria Gonorrhoeae
Native Aortic Valve Infective Endocarditis With Development of Gerbode Defect
Authors: Sidwell Chris J , Ha Albert , Hua Alexandra , Pietrini Nicholas , Wanamaker Brett , Yang Bo
Published: November 2023

Introduction:
Infective endocarditis (IE) is a devastating condition most commonly caused by gram-positive cocci (
S. aureus
,
S.
viridans
,
S.
gallolyticus
,
Enterococcus spp.) and gram-negative organisms (e.g. HACEK organisms). We present a case of Native Aortic Valve IE due to disseminated
N. Gonorrhea
in an immunocompetent patient.

Hospital Course:
The patient is a 30-year-old female who presented with a chief complaint of subacute chest pain and constitutional symptoms. Echocardiography revealed aortic valve abscess and severe aortic insufficiency with concerns of aorto-atrial fistula. The patient was treated with antibiotics and transferred to our hospital.

Upon transfer, the patient was initially stable. Physical exam was notable for a pandiastolic murmur. The patient rapidly deteriorated into cardiogenic and septic shock. TTE revealed aortic root abscess, LVOT-RA fistula (Gerbode defect), and right atrial vegetation. Emergent surgical exploration revealed IE of the aortic valve with destruction of right and non-coronary cusps and vegetation eroding from the base of the aortic root through the membranous septum to the right atrium without tricuspid valve involvement. She underwent successful treatment with debridement and reconstruction.

Initial blood cultures were positive for
N. gonorrhoeae.
The patient was negative for HIV and no gynecologic source was identified. After an extended hospital course, the patient was discharged with IV antibiotics.

Discussion & Conclusion:
We present a rare case of
N. Gonorrhoeae
aortic valve endocarditis leading to aortic valve destruction with subsequent abscess and fistulae formation. This case demonstrates a rare and severe consequence of disseminated gonococcal infections (DGI), though the patient was without other manifestations of DGI.
Patient Awareness of Heart Failure Diagnosis: A Community Study
Authors: Shropshire Stacie J. , Fabbri Matteo , Manemann Sheila M. , Roger Véronique L. , Killian Jill M. , Weston Susan A. , Chamberlain Alanna M.
Published: November 2023

Background

Heart failure (HF) is a complex disease that contributes to a high number of hospitalizations, deaths, and economic health care costs each year. However, among patients with HF, there is a lack of awareness of their HF diagnosis that has not been fully examined.

Methods and Results

Residents from 3 counties of southeast Minnesota with a first‐ever
International Classification of Diseases, Ninth Revision
(
ICD‐9
) code 428 or
Tenth Revision
(
ICD‐10
) code I50 between January 1, 2013 and March 31, 2016 (N=2461) were prospectively surveyed to measure HF self‐awareness. A total of 1114 patients returned the survey (response rate, 45%), and 787 had validated HF upon medical record review. Among these 787 patients with HF (mean age, 76 years; 53% men), 37% (n=293) were aware of their HF diagnosis. After adjustment, being a woman (odds ratio [OR], 1.56 [95% CI, 1.10–2.22]), having HF with reduced ejection fraction (OR, 1.58 [95% CI, 1.13–2.22]), attending the HF clinic (OR, 4.07 [95% CI, 2.25–7.36]), and having coronary artery disease (OR, 1.65 [95% CI, 1.16–2.37]) were all associated with increased awareness of an HF diagnosis. Conversely, having diabetes was associated with decreased awareness of an HF diagnosis (adjusted OR, 0.69 [95% CI, 0.50–0.95]).

Conclusions

Awareness of an HF diagnosis is low in a community population of patients with HF. Strategies to improve patient awareness of their diagnosis should be implemented to improve self‐care behaviors and outcomes in patients with HF.
Coronary Artery Calcium and Cognitive Decline in the Diabetes Prevention Program Outcomes Study
Authors: Gadde Kishore M. , Yin Xiaoyan , Goldberg Ronald B. , Orchard Trevor J. , Schlögl Mathias , Dabelea Dana , Ibebuogu Uzoma N. , Watson Karol E. , Pi‐Sunyer F. Xavier , Crandall Jill P. , Temprosa Marinella , Luchsinger José A. ,   the Diabetes Prevention Program Research Group
Published: November 2023

Background

Our aim was to investigate the association of coronary artery calcium (CAC) with cognitive function in adults with impaired glucose tolerance or type 2 diabetes.

Methods and Results

The Diabetes Prevention Program was a randomized controlled trial comparing an intensive lifestyle intervention, metformin, or placebo for prevention of type 2 diabetes among patients with prediabetes. After 3 years, intensive lifestyle intervention and placebo were stopped, the metformin arm was unmasked, and participants continued in the DPPOS (Diabetes Prevention Program Outcomes Study). Approximately 14 years after randomization (Y14), CAC (Agatston score) was assessed with computed tomography, and cognitive performance was assessed with the Spanish English Verbal Learning Test (SEVLT) and Digit Symbol Substitution Test. SEVLT and Digit Symbol Substitution Test were reassessed 5 years later (Y19) along with the Modified Mini‐Mental State Exam. We examined cross‐sectional and longitudinal associations between CAC and cognition among 1931 participants using linear and logistic regression. In unadjusted analyses, compared with no calcification, CAC score >300 was associated with decreased performance on all cognitive tests at Y14 in both sexes. Additionally, CAC >300 was associated with a greater 5‐year decline in SEVLT Immediate Recall in both sexes and SEVLT Delayed Recall in women. After adjustment for demographic, genetic, metabolic, vascular, and behavioral covariates, CAC score >300 remained associated with greater decline in only SEVLT Delayed Recall in women.

Conclusions

In women with prediabetes or diabetes, CAC >300, compared with no calcification, was independently associated with greater decline in verbal memory.

Registration information

clinicaltrials.gov
. Identifier: NCT00038727.
Cooling the Coldest Continent: The 4 December 2021 Total Solar Eclipse over Antarctica
Authors: Garreaud René , Bozkurt Deniz , Spangrude Carl , Carrasco-Escaff Tomás , Rondanelli Roberto , Muñoz Ricardo , Jubier Xavier M. , Lazzara Matthew , Keller Linda , Rojo Patricio
Published: November 2023

Total solar eclipses (TSEs) are impressive astronomical events that have attracted people’s curiosity since ancient times. Their abrupt alterations to the radiation balance have stimulated studies on “eclipse meteorology,” most of them documenting events in the Northern Hemisphere while only one TSE (23 November 2003) has been described over Antarctica. On 4 December 2021—just a few days before the austral summer solstice—the moon blocked the sun over the austral high latitudes, with the path of totality arching from the Weddell Sea to the Amundsen Sea, thus producing a ∼2-min central TSE. In this work we present high-resolution meteorological observations from Union Glacier Camp (80°S, 83°W), the only location with a working station under totality, and South Pole station. These observations were complemented with meteorological records from 37 surface stations across Antarctica. Notably, the largest cooling (∼5°C) was observed over the East Antarctic dome, where obscurity was ∼85% while many sectors experienced insignificant temperature changes. This heterogenous cooling distribution, at odds with the seemingly homogeneous land surface of Antarctica, is partially captured by a simple radiative model. To further diagnose the effect of the eclipse on the surface meteorology, we ran multiple pairs of simulations (eclipse enabled and disabled) using the Weather Research and Forecasting (WRF) Model. The overall pattern and magnitude of the simulated cooling agree well with the observations and reveal that, in addition to the solar radiation deficit and cloud cover, low-level winds and the height of the planetary boundary layer are key determinants of the temperature changes and their spatial variability.
Psychosocial Readiness for College: A Multidimensional Model and Measure for Students Entering College in Their Twenties
Authors: Phillips-Berenstein Michal , Willner Tirza , Gati Itamar
Published: November 2023

Dropping out of college is often linked to insufficient academic or psychosocial readiness. Therefore, assessing students’ readiness, preferably before they begin their first year of college, may help identify those at risk of dropping out. The present study aimed to develop and test a multidimensional measure that assesses psychosocial factors promoting student persistence. The Psychosocial Readiness for College questionnaire (PRCq) aims to assess the readiness of students who have deferred entering college to their twenties and comprises six dimensions: Academic Self-Efficacy, Educational Commitment, Social Comfort, Campus Engagement, Self-Discipline, and Resilience. The PRCq was administered to five cohorts of first-year college students in Israel ( N = 7,382). The PRCq demonstrated good psychometric properties, and exploratory and confirmatory factor analyses supported its six dimensions. The PRCq demonstrated measurement invariance across age, gender, SES, first vs. non-first-generation students, and institution type. The PRCq’s construct validity was supported by the negligible associations between the scale scores and high-school GPA and pre-college scholastic aptitude test, and the pattern of associations with the Big-5 personality factors. The PRCq’s predictive validity was supported by the student dropout rate after one year. Implications for students at risk of dropping out and interventions to decrease this risk are discussed.
Frontline professionals’ use of and attitudes towards technology to support interventions for adolescents with depression symptoms: A mixed methods survey
Authors: Loades Maria E , Cliffe Bethany , Perry Grace
Published: November 2023

Depression is common in adolescence, and subthreshold symptoms even more so. Untreated, it is disabling. Yet, upscaling traditional clinic-based provision would be prohibitively expensive. We aimed to investigate frontline, non-specialist professionals’ use of and attitudes towards technology to increase the availability of early help.

Method

Cross-sectional survey of a convenience sample of professionals in the UK ( N = 115, including low intensity practitioners, GPs, education staff, school nurses). The survey included rating scales and free text boxes. Quantitative data were analysed descriptively, and we used reflexive thematic analysis for the qualitative data.

Results

Frontline professionals rate their technological competence as good and have favourable attitudes towards using technology to support adolescents with depression symptoms. They rated online resources as most useful with mild-moderate symptoms, compared to severe symptoms ( t(110) = 14.54, p < .001, Cohen’s d = 1.49). Technology was viewed as important to bridge the needs-access gap and professionals were interested in learning about online SSIs due to usefulness ( r = .32, p < .001).

Conclusion

Technology, such as SSIs, are of interest to mental health professionals and may be useful for supporting adolescents with depression. Future research should explore the use of SSIs for treating adolescent depression.
Genome-wide identification and expression analysis of the GASA gene family in Chinese cabbage (Brassica rapa L. ssp. pekinensis)
Authors: Sun Bingxin , Zhao Xianlei , Gao Jiahui , Li Jie , Xin Yue , Zhao Yonghui , Liu Zhiyong , Feng Hui , Tan Chong
Published: November 2023

Background

The Gibberellic Acid-Stimulated Arabidopsis (GASA) gene family is widely involved in the regulation of plant growth, development, and stress response. However, information on the GASA gene family has not been reported in Chinese cabbage (Brassica rapa L. ssp. pekinensis).

Results

Here, we conducted genome-wide identification and analysis of the GASA genes in Chinese cabbage. In total, 15 GASA genes were identified in the Chinese cabbage genome, and the physicochemical property, subcellular location, and tertiary structure of the corresponding GASA proteins were elucidated. Phylogenetic analysis, conserved motif, and gene structure showed that the GASA proteins were divided into three well-conserved subfamilies. Synteny analysis proposed that the expansion of the GASA genes was influenced mainly by whole-genome duplication (WGD) and transposed duplication (TRD) and that duplication gene pairs were under negative selection. Cis-acting elements of the GASA promoters were involved in plant development, hormonal and stress responses. Expression profile analysis showed that the GASA genes were widely expressed in different tissues of Chinese cabbage, but their expression patterns appeared to diverse. The qRT-PCR analysis of nine GASA genes confirmed that they responded to salt stress, heat stress, and hormonal triggers.

Conclusions

Overall, this study provides a theoretical basis for further exploring the important role of the GASA gene family in the functional genome of Chinese cabbage.