bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 18355: Trends In Ambulatory Postpartum Blood Pressure Measurement In Hypertensive Disorders Of Pregnancy
Authors: Sheehan Megan M , Li Tang , Chen Jinbo , Lewey Jennifer
Published: December 2023

Introduction:
Hypertensive disorders of pregnancy (HDP) are associated with a significantly increased risk of hypertension (HTN) in the years following delivery. Despite this, postpartum follow-up rates are low and evaluation for HTN in the first year postpartum is not well described in clinical practice. Our objective is to describe patterns of ambulatory BP measurement in the year following delivery.

Methods:
We identified all patients in a large health system with a delivery from 2018-2020. We describe prevalence of ambulatory blood pressure (BP) measurements according to HTN subtype: preeclampsia, gestational HTN (GHTN), or chronic HTN (CHTN), as assessed by ICD-10 codes. Logistic regression was used to examine relationship between patient factors and BP measurement.

Results:
We identified 25,843 patients of whom 87% had at least 1 BP check after delivery. Patients with preeclampsia and CHTN were more likely to have an outpatient BP measurement compared to normotensive patients in all time periods (Table). Patients with GHTN only had higher rates of BP measurement in the early postpartum period.Among patients with any hypertensive disorder, factors associated with BP measurement within 12 weeks included age >30 years (odds ratio (OR) 1.31, 95% confidence interval (CI) 1.12-1.55) and cesarean delivery (OR 1.3, 95% CI 1.1-1.52). In contrast, patients who were non-Hispanic Black (OR 0.69, 95% CI 0.56-0.84), current smokers (OR 0.55, 95% CI 0.41-0.76), or had public insurance (OR 0.31, 95% CI 0.26-0.37) were less likely to have a BP measurement within 12 weeks.

Conclusions:
Most postpartum individuals have at least one blood pressure measurement within 12 weeks of delivery, though ongoing BP evaluation is less common after 12 weeks. Age and racial disparities in BP measurement are prevalent. Future work will characterize and evaluate blood pressure trends and treatment in this cohort.
Abstract 18359: Association of Depressive Symptoms and Risk of 30- and 90-day Hospital Admissions in Patients With a New or Worsening Diagnosis of Peripheral Artery Disease
Authors: Jacque Francky , Callegari Santiago , Romain Gaelle , Cleman Jacob , Scierka Lindsey , Mena-Hurtado Carlos , Smolderen Kim G
Published: December 2023

Introduction:
Patients diagnosed with Peripheral Artery Disease (PAD) often present with a complex profile of comorbidities, including a high mental health burden. Depressive symptoms are associated with worse long-term PAD outcomes, but it is unknown whether they translate into a higher short term hospital admission.

Methods:
Patients with a new or worsening PAD diagnosis (Rutherford 1-3) enrolled at US in the PORTRAIT registry from 2011-2015 were included. The 8-item Patient Health Questionnaire assessed depressive symptoms (scores 0 to 24, higher scores more depressive symptoms). The Youden Criterion based on time-dependent receiver operator curves was used to describe high vs. low-risk admission groups. Adjusted Cox regression models generated risk estimates associated with continuous PHQ-8 scores and all-cause, cumulative 30- and 90-day admissions based on patients’ medical records.

Results:
We included 669 patients in the analysis (mean age 68.6 ± 9.6 years, 57.6% male, 73.0% white). The mean PHQ-8 Score was 4.8 ± 5.2; 61.9% was classified as low- (PHQ-8 <5) vs. 38.1% high-risk (PHQ-8 ≥ 5) for admissions based on the Youden Criterion. Patients in the low-risk vs. high-risk group had admission rates of 7.7% [95% CI 5.5-10.7] vs. 12.9% [95% CI 9.5-17.5] at 30 days (p-value: 0.023) and 16.2 [95% CI 13.1-20.0] vs. 25.6% [95% CI 21.0-31.0] at 90 days (p=0.002). In the adjusted model, depressive symptoms (per 1-unit increase) were independently and proportionally associated with 30-day (HR=1.06, 95% CI 1.01-1.11; p=0.026) and 90-day (HR=1.04, 95% CI 1.01-1.08; p=0.021) admissions following PAD diagnosis (e.g. those with scores >20 had a >20% or >30% 30- and 90-day admission risk, respectively) (Figure 1).

Conclusion:
Thirty- and 90-day admission risk for patients with a new or worsening PAD diagnosis is high, especially for those with depressive symptoms. Value-based PAD care should include screening and integrated care pathways for depression to mitigate this risk.
Abstract 18374: Effective Atomic Number and Electron Density Number Acquired Using Latest Spectral CT Enable the Differentiation of Infarcted Myocardium and Hypertrophied Myocardium From Normal Myocardium
Authors: Funabashi Nobusada , Akaza Shin , Shukuya Atsushi , Asano Hiroki
Published: December 2023

Introduction:
Spectral CT can acquire effective atomic (EAN) and electron density number (EDN). Hypothesis: EAN and EDN using spectral CT enable the differentiation of infarcted myocardium and hypertrophied myocardium from normal myocardium.

Methods:
We analyzed 146 patients (73 males; mean age 55 ± 14 years old) who had no significant coronary stenosis on CT (7500; Philips) and normal ECG (normal group), 20 patients with previous myocardial infarction (MI) (12 males; mean age 73 ± 7 years old) (MI group), and 10 patients with hypertrophic cardiomyopathy (HCM) (5 males; mean age 66 ± 15 years old) (HCM group). On CT, we measured EAN and EDN in the interventricular septum (IVS), left ventricular (LV) anterior wall (LVAW), and lateral wall (LVLW) within a 1.0 mm2 circle at LV inflow level in the non-contrast and early contrast phase. In MI and HCM groups, EAN and EDN were also measured in the infarcted and hypertrophied myocardium, respectively.

Results:
In the non-contrast and early contrast phase, the EAN was significantly lower in the infarcted myocardium group than in the normal group (p < 0.01), in the non-infarcted myocardium than in the MI group (p < 0.05) and non-hypertrophied myocardium in the HCM group (p < 0.05), and in the hypertrophic myocardium in the HCM group than in the normal group (p < 0.05) and non-hypertrophic myocardium in the HCM group (p < 0.05). In the non-contrast and early contrast phase, the EDN was also lower in the infarcted myocardium than in the normal group (p < 0.01), non-infarcted myocardium in the MI group (p < 0.05), hypertrophied and non-hypertrophied myocardium in the HCM group (p < 0.05).

Conclusion:
The use of EAN and EDN enables the differentiation of infarcted myocardium (EAN and EDN) and hypertrophied myocardium (EAN) from normal myocardium even on non-contrast CT alone. The use of EAN and EDN enables the detection of abnormal myocardial characteristics (blood flow decrement, fibrotic change, hypertrophy, and inflammation) on non-contrast CT alone.
Abstract 18379: Implementation of a Fully Automated Procedural Reporting System for Cardiology Fellowship
Authors: Julien Howard M , Adusumalli Srinath , Reza Nosheen , Sanghavi Monika , Silvestry Frank , Anyanwu Emeka C
Published: December 2023

Introduction:
Contemporary cardiovascular fellowship training is based in the principles of competency-based medical education (CBME). Inclusive of CBME, core cardiovascular training statements suggest a minimum number of procedures necessary to achieve levels of training. However, current platforms for procedure logging create an onerous burden on trainees and program leadership which can result in incomplete data capture. There is a paucity of experience with automated case logging tools across training programs. Herein, we present the experience of fully automating trainee case logging within the echo lab at a large cardiovascular fellowship program.

Methods:
Structured trainee procedure attribution data (patient age, gender, and procedure type) were captured during routine clinical activity within our EHR structured reporting module (Epic Cupid). Attribution was extracted from the EHR reporting warehouse (Epic Clarity) and summarized for trainees weekly via email. Following a weeklong buffer period to allow for corrections, the data were uploaded to the institutional educational reporting platform (MedHub) via a web application programming interface. All stages of this workflow were fully automated.

Results:
During the post-intervention period (June 2022 to May 2023), 32 cardiovascular fellows participated. Attribution was initially captured for transthoracic and transesophageal echocardiograms and later expanded to include exercise and dobutamine stress echocardiograms. A monthly average of 584 procedures were captured for trainees. There were no attribution errors reported. The intervention was uniformly perceived as helpful by both trainees and leadership with requests for expansion to other cardiovascular procedure types.

Conclusion:
Fully automated educational experience reporting is feasible in a large cardiovascular training program and can be implemented without change to clinical workflows or administrative burden.
Abstract 18385: Platelet Transcriptome in Type 2 Diabetes Provides Insight Into Peripheral Artery Disease and Cardiovascular Events
Authors: Muller Matthew A , Newman Jonathan D , Luttrell-Williams Elliot , Ruggles Kelly , Barrett Tessa A , Berger Jeffrey
Published: December 2023

Background:
Platelets are integral to atherothrombosis and peripheral artery disease (PAD), processes that are accelerated in diabetes. We evaluated the platelet transcriptome, generated a platelet RNA score, and investigated whether it could serve as a novel biomarker of PAD severity and major adverse cardiovascular events (MACE).

Methods:
We performed RNA sequencing on circulating platelet samples obtained from 133 patients enrolled in the platelet activity and cardiovascular events in PAD study. The transcriptome was (1) compared in PAD patients with Type 2 Diabetes (T2D) (n=73) vs without T2D (n=60), and (2) correlated with platelet aggregation responses to submaximal epinephrine (0.4uM). Using the overlap of transcripts identified by these approaches, we scored each sample based on a rank-based phenotypic metric (Singscore) to develop a T2D-specific platelet RNA score. This platelet score was compared in PAD patients with (vs without) critical limb ischemia (CLI), and PAD patients with (vs without) incident MACE (myocardial infarction, stroke, or death) after multivariable adjustment.

Results:
Overall, 384 transcripts were differentially expressed in PAD patients with vs without T2D (P<0.01; 195 upregulated and 189 downregulated). Gene set enrichment analysis noted upregulation of pathways related to cell chemotaxis, acute inflammatory response, and platelet alpha granules in T2D. Among these 384 genes, 102 significantly correlated with platelet aggregation (P<0.01) and were used to create a T2D platelet RNA score. To evaluate its clinical significance, this score was 3- times higher in PAD with (vs without) CLI (P=0.002). Further, after adjusting for age, sex, race, T2D, hypertension and coronary artery disease, the platelet score above (vs below) the median was associated with increased MACE (HR 2.8, 95% CI 1.4 to 5.6, P = 0.003).

Conclusions:
These findings demonstrate a unique platelet transcriptome in T2D that is associated with PAD severity and future risk of cardiovascular events. This work provides an important step toward the use of platelet RNA to unlock novel molecular mechanisms and inform future clinical outcomes.
Abstract 18390: Ibrutinib Increases Ventricular Arrhythmia Burden Independently of Atrial Arrhythmia
Authors: Torelli Stefan , Jiang Yunqiu , Ayala Alyssa , Fazal Muhammad , Witteles Ronald M , Baykaner Tina , Zhu Han , Rhee June W , Cheng Paul
Published: December 2023

Introduction:
Use of Bruton Tyrosine Kinase inhibitors (BTKi) such as ibrutinib is frequently limited by atrial arrhythmia, possibly through off-target inhibition of C-Terminal-Src-Kinase (CSK). Whether BTKi can directly trigger ventricular arrhythmia is less clear. Case reports and retrospective analysis have suggested a link, but causal effect is not established. The association is further put into doubt by absent expression of CSK or BTK in ventricular cardiomyocytes, and absence of ventricular arrhythmia signals in meta-analyses of BTKi RCTs. Further study is critically needed.

Hypothesis:
Ibrutinib induces ventricular arrhythmia through a unique mechanism.

Methods:
We performed a retrospective crossover study of ibrutinib-treated patients with serial cardiac monitoring both on and off ibrutinib (pacemakers, loop recorders, or multiple holters) across a 10-year span in a large academic center to compare burden of atrial/ventricular ectopy on and off ibrutinib. A separate group of Chronic Lymphocytic Leukemia (CLL) patients with serial cardiac monitoring not on BTKi was used as additional controls. To determine biological correlation, we tested the ability of ibrutinib to induce arrhythmia in cultured human Induced Pluripotent Stem Cell derived ventricular cardiomyocytes (iPSC-vCMs).

Results:
88% (15/17) of patients on ibrutinib with serial cardiac monitoring had increased burden of Premature Ventricular Contractions (PVCs), with an average increase of 155 PVCs/hour (p<0.0001). An increase was not observed in the control cohort. Ventricular arrhythmia burden was not associated with atrial arrhythmia burden. Removing patient-related confounders,
in vitro
analysis of iPSC-vCMs demonstrated that ibrutinib induced arrhythmia following three days of treatment in a dose-dependent manner.

Conclusions:
In patients with continuous/serial cardiac monitoring, ibrutinib is associated with a significant increase in ventricular ectopy (average of 155 PVCs/hr). Lack of ventricular and atrial arrhythmia concordance suggests an alternative mechanism of arrhythmia induction. Increased arrhythmogenicity of human ventricular cardiomyocytes treated with ibrutinib indicates a direct myocardial mechanism.
Abstract 18399: Loss of Myeloid Epigenetic-Metabolic Crosstalk by BAF60a Deficiency Aggravates Atherosclerosis
Authors: Zhao Yang , Liu Yuhao , zhao Guizhen , Chen Eugene , Zhang Jifeng
Published: December 2023

Introduction:
Atherosclerosis is a primary medical concern, characterized by the involvement of immune cells within atherosclerotic plaques. Notably, the modulation of gene expression through chromatin remodeling and transcription machinery, known to be disrupted in disease conditions, is less studied in macrophages within atherosclerotic plaques.

Hypothesis:
We propose that
BAF60a
, a component of the SWItch/Sucrose Non-Fermentable (SWI/SNF) chromatin remodeling complex, might be instrumental in atherosclerosis by modulating disease-specific epigenetic-metabolic crosstalk, offering a potential therapeutic avenue.

Methods:
To evaluate our hypothesis, we assessed
BAF60a
expression in macrophages derived from advanced plaques. To decipher its role, myeloid
Baf60a
was deleted in mice with hypercholesterolemic ApoE deficient backgrounds. Subsequent changes in atherosclerotic lesion size, mitochondrial integrity, cellular adhesion, and apoptosis were characterized. ChIP-seq and ATAC-seq were employed to analyze the function of
BAF60
a in maintaining key transcription factor activities.

Results:
Our results revealed a marked downregulation of
BAF60a
in macrophages from advanced plaques. Upon myeloid
Baf60a
deletion, we observed compromised mitochondrial integrity, increased cellular adhesion, enhanced apoptosis, and amplified plaque formation. Importantly,
BAF60a
was crucial in preserving mitochondrial energy homeostasis in the face of pro-atherogenic stimuli, as it sustained Nuclear Respiratory Factor 1 (
NRF1
) access to critical genes. BAF60a overexpression rescued these defects in an NRF1-dependent manner.

Conclusions:
We conclude that the
BAF60a-NRF1
axis is a key regulator of mitochondrial function in atherosclerosis. Our study underscores the potential of restoring the disrupted epigenetic-metabolic crosstalk as a promising therapeutic strategy in treating atherosclerosis.
Abstract 18434: Amanita Muscaria and Pantherina Withdrawal as a Cause of Lone Atrial Fibrillation
Authors: Cruz Ponce Alejandro , Akhlaq Hira , Ilagan Justin , Tavakolian Kameron , Mararenko Anton , Udongwo Ndausung , Alshami Abbas , Alrefaee Anas , Heaton Joseph , Contino Chase
Published: December 2023

Introduction:
The Amanita mushroom family is known for use as a means of suicide or for psychedelic effects. The manifestations of Amanita mushroom poisoning include gastrointestinal poison, cholinergic effects and organ failure. In this paper, we will discuss the first observed study of a patient who developed new onset atrial fibrillation (AF) with rapid ventricular response (RVR) after withdrawal from accidental chronic poisoning of
Amanita muscaria
and
pantherina
over the course of three weeks.

Case:
A 29 year-old male with no prior past medical history presented with three days of palpitations. He began taking
A. pantherina
and
muscaria
three weeks prior to help treat sexual addiction. He started with 0.35 mcg twice a day, then doubled the dose after one week, then three days prior to presentation he started taking three grams twice per day. He noticed palpitations as he increased his dose, but then acutely worsened after he stopped taking mushrooms. In the emergency department, he was found to have new onset atrial fibrillation with rapid ventricular rate as well as frequent episodes of nonsustained ventricular tachycardia. An alcohol level and urine drug screen were unremarkable. Thyroid stimulating hormone was within range. His heart rate did not respond to intravenous diltiazem. He was transitioned to an esmolol infusion that responded with rapid improvement in heart rate as well as ventricular ectopy suppression. He eventually underwent a transesophageal echocardiogram and was transitioned to oral beta blocker therapy. He was discharged with no complications and near full recovery.

Discussion:
A report published in 1869 described the first description of the pharmacological effect of
A. muscaria
showing it is 143 times more toxic than acetylcholine due to the inability of cholinesterase to hydrolyse or inhibit its effect. The acute cardiovascular toxicities are well described, however, this case is the first description of chronic cardiac toxicity manifesting as new onset AF with RVR, caused by
A. muscaria
and
pantherina
withdrawal. We suggest that cardiovascular monitoring, including event monitors, are essential for complications of
A. muscaria
and
pantherina
. More detailed studies need to be done.
Abstract 18437: Efficacy and Safety of Dapagliflozin in Patients With Heart Failure and Previous Myocardial Infarction
Authors: Peikert Alexander , Vaduganathan Muthiah , Claggett Brian L , Kulac Ian J , Foà Alberto , Desai Akshay S , Jhund Pardeep S , Lam Carolyn S , Kosiborod Mikhail N , Inzucchi Silvio E , Martinez Felipe A , de Boer Rudolf A , Hernandez Adrian F , Shah Sanjiv J , DeMets David L , Kober Lars , Ponikowski Piotr , Sabatine Marc S , Petersson Magnus , Langkilde Anna Maria , McMurray John J , Solomon Scott D
Published: December 2023

Introduction:
Patients with HF and history of myocardial infarction (MI) may represent a distinct subpopulation with unique pathways of disease progression and elevated risk of clinical events. Whether SGLT2 inhibitors may modify disease trajectory in such individuals is uncertain.

Methods:
The DAPA-HF and DELIVER trials compared dapagliflozin with placebo in patients with symptomatic HF with LVEF ≤40% and >40%, respectively. In this pooled participant-level analysis, we assessed efficacy and safety outcomes by history of MI. The primary outcome in both trials was the composite of cardiovascular (CV) death or worsening HF.

Results:
Of the total of 11,007 patients, 3,731 (34%) had a prior MI and were at higher risk of the primary outcome across the spectrum of LVEF in covariate-adjusted models (HR 1.12 [95% CI 1.02-1.24];
Left Panel
). Dapagliflozin reduced the risk of the primary outcome to a similar extent in patients with (HR 0.83 [95% CI 0.72-0.96]) and without prior MI (HR 0.76 [95% CI 0.68-0.85];
P
i
nteraction
=0.36), with consistent benefits on key secondary outcomes as well (
Right Panel
). Serious adverse events did not occur more frequently with dapagliflozin, irrespective of prior MI.

Conclusions:
History of MI confers increased risks of adverse cardiovascular outcomes in patients with HF across the spectrum of ejection fraction. Dapagliflozin consistently and safely reduces the risk of adverse cardiovascular outcomes, regardless of previous MI. Ongoing trials are actively examining SGLT2 inhibitors when introduced early after acute MI.
Abstract 18447: Comparative Seasonal Variation in Outcomes Among Patients Hospitalized for Heart Failure in Cold- and Warm-Climate States
Authors: Brinza Ellen K , Kao David P
Published: December 2023

Background:
Despite emerging evidence that extreme heat and air pollution exposure are linked to adverse cardiovascular disease outcomes, paradoxical seasonal trends in heart failure hospitalizations and deaths have been observed, with peaks occurring in winter months. This study aimed to explore how seasonal variations in heart failure admissions differ among individuals hospitalized in cold-climate and warm-climate states.

Methods:
Population-level, state-wide data were used to explore outcomes among all individuals hospitalized for heart failure in Texas (1999-2016) and New York (1994-2007). Seasonal variation was assessed using time of discharge (January-March, April-June, July-September, October-December). Multivariable logistic and linear regression were used to explore the relationship between time of discharge and the primary outcomes of interest: mortality and length of stay (LOS). Analyses were adjusted for age, sex, race, ethnicity, and comorbidities (hypertension, hyperlipidemia, diabetes, CAD, arrhythmias, anemia, COPD, tobacco use).

Results:
Among individuals hospitalized for heart failure in both Texas and New York, mortality and LOS were significantly increased during winter months compared to spring, summer, and early fall (Table). While similar seasonal trends were observed across states, the observed effect sizes were smaller in the Texas population.

Conclusions:
Among patients hospitalized for heart failure in Texas and New York, there is an increase in mortality and LOS during winter months. However, the differences in effect sizes after controlling for traditional risk factors suggests that other variables (i.e., temperature fluctuations) may affect these seasonal trends and warrants further exploration.
Abstract 18463: Direct Oral Anticoagulants versus Vitamin K Antagonists in Morbidly Obese Patients (BMI ≥ 40): An Updated Systematic Review and Meta-Analysis
Authors: Akbar Usman , Malik Saad U , Qadeer Abdul , Shafique Nouman , Mustafa Bisher
Published: December 2023

Introduction:
The safety and efficacy of direct oral anticoagulants (DOACs) compared to vitamin K antagonists (VKAs) remain unknown in patients with BMI ≥ 40 kg/m
2
. We aim to evaluate the risk of recurrent VTE and major bleeding in patients with a BMI ≥ 40 when started on DOACs versus VKAs.

Methods:
We conducted a systematic literature search according to PRISMA guidelines to identify studies using the terms: “venous thromboembolism”, “Vitamin K antagonists” and “direct oral anticoagulants”. After the screening, We extracted the data till May 2023 in a data extraction sheet. Our inclusion criteria were: adult patients, morbidly obese (BMI ≥ 40 kg/m
2
), who were on DOACs or VKAs for VTE or atrial fibrillation. We used a variance-weighted random-effects model to analyze data on DOACs vs. VKAs, estimating event rates and odds ratios while assessing heterogeneity. Data were analyzed using the ‘meta’ package in R.

Results:
Our analysis included a total of 16 studies (n= 62704 patients). Obese patients on DOACs had a significant reduction in the risk of recurrent VTEs compared to VKAs OR 0.72 (95% CI: 0.59 - 0.88, I2 :19%). Also, DOACs were associated with a lower risk of major bleeding compared to VKAs in morbidly obese patients (OR = 0.65, 95% CI: 0.58 - 0.74, I2 :0%). For non-major bleeding, although the statistical significance was not reached, a consistent trend favoring DOACs was observed (OR = 0.76, 95% CI: 0.47-1.21). (Figure1)

Conclusions:
Among morbidly obese patients (BMI ≥ 40), DOACs are associated with a significantly lower risk of recurrent VTEs, and major bleeding compared to VKA. For non-major bleeding, there was a trend favoring DOACs over VKA. Increased recruitment of obese patients in clinical trials is needed to provide us with robust data for informed clinical decision-making.
Abstract 18478: Association of Family History and Cardiomyopathy-Associated Gene Variants of Unknown Significance in Ethnic Minority Patients With Early Onset Atrial Fibrillation
Authors: Deshpande Ashwini , Hill Michael , Dabbas Jood , Sandu Shashank , Boxley Peter , Arnold Joshua , Qiao Victor , Chalazan Brandon , Tofovic David , Darbar Dawood
Published: December 2023

Introduction:
Underrepresentation of ethnic minorities in genetic studies can complicate interpretation of variants of unknown significance (VUS) in these groups. Likely pathogenic or pathogenic (LP/P) cardiomyopathy (CM) gene variants are associated with early onset-atrial fibrillation (EOAF) in a cohort of predominantly European ancestry, but prevalence in minorities, and the role of VUS, is unclear. Three-generation family history (FH) may provide insight into the potential pathogenicity of VUS in ethnic minorities.

Hypothesis:
In patients with EOAF and low comorbidity burden carrying CM VUS, does positive FH suggest variant pathogenicity?

Aims:
To determine whether CM gene VUS in ethnic minority probands with EOAF are associated with a FH of arrhythmia, stroke, or heart failure.

Methods:
Of 301 individuals from the University of Illinois Health Multi-Ethnic AF Registry who underwent whole exome sequencing, we identified 89 with either LP/P variant, positive FH from medical records, or AF diagnosis age ≤55 years and ≤2 comorbidities. We examined 22 genes strongly associated with CM and graded pathogenicity according to American College of Medical Genetics criteria. A three-generation FH was obtained by contacting probands or family members.

Results:
A FH was obtained in 36 patients (Figure 1a; median age 52 years, 56% female, 83% African-American, 17% Hispanic/Latinx). LP/P variants were present in 3 (8%) probands, VUS in 10 (28%), and likely benign/benign (LB/B) or no variant in 23 (64%). A FH of arrhythmia, heart failure, or stroke was present in 27 subjects (75%) with a FH of heart failure more likely in VUS carriers compared to those with LB/B or no variant (70% vs 26%, p=0.02), with no difference in FH of arrhythmia or stroke.

Conclusion:
Probands with EOAF who carry CM VUS have greater rates of FH of heart failure than those without disease-associated variants. This suggests pathogenicity of CM VUS in ethnic minorities with EOAF.
Abstract 18479: Lack of Catalytic and Non-Catalytic Function of PI3 Kinase Gamma in Mice Increases Hypoxia-Induced Pulmonary Hypertension
Authors: Gnatzy-Feik Leoni , Berghausen Eva , Vantler Marius , Rebekka Müller , Zierden Mario , Ghigo Alessandra , Hirsch Emilio , Baldus Stephan , Rosenkranz Stephan
Published: December 2023

Rationale:
Pulmonary hypertension (PH) is characterised by vasoconstriction and remodelling of pulmonary vessels, leading to elevated pulmonary arterial pressure and right ventricular (RV) hypertrophy. PI 3-kinase γ (PI3Kγ) is expressed in leukocytes, cardiomyocytes, and endothelial cells (EC) which are all involved in the pathogenesis of PH. The catalytic function of PI3Kγ is involved in leukocyte recruitment and EC proliferation which are important for vascular remodelling and maladaptive cardiac hypertrophy whereas its non-catalytic function affects cardiac contractility via cAMP signaling. Furthermore, inactivation of PI3Kγ impairs nitric oxide production by eNOS, which may lead to increased vascular resistance. Therefore, we investigated the role of both catalytic and non-catalytic functions of PI3Kγ in the pathogenesis of PH.

Methods:
PI3Kγ knockout mice (PI3Kγ
-/-
), as well as mice with a catalytically inactive form of PI3Kγ (PI3Kγ
KD/KD
) were exposed to hypoxia-induced PH (21 days at 10% O
2
hypoxia (HOX)). Systolic right ventricular pressure (RVSP) was measured using a Millar pressure catheter inserted via the jugular vein. RV hypertrophy was determined by Fulton's index.

Results:
PI3Kγ
-/-
mice showed significantly increased RVSP after hypoxia compared to WT controls (HOX WT 34.16±3.21 mmHg vs HOX PI3Kγ
-/-
37.04±2.31 mmHg; p=0.0049). Already under normoxia (NOX), an increased RVSP was measured in PI3Kγ
-/-
mice (NOX WT 26.13±1.2mmHg vs. NOX PI3Kγ
-/-
28.07±0.88 mmHg, p=0.0157). A significant increase in RVSP was also detected in PI3Kγ
KD/KD
(HOX WT 34.67±2.02 mmHg vs. HOX PI3Kγ
KD/KD
37.95±1.39 mmHg; p=0.0228). Here, a significant increase in RV hypertrophy was evident for PI3Kγ
KD/KD
mice (HOX WT 0.38±0.06 vs. HOX PI3Kγ
KD/KD
0.46±0.09; p=0.0037) which was not detected in PI3Kγ
-/-
compared to WT controls after hypoxia.

Conclusion:
The results show that both catalytic and non-catalytic inactivation of PI3Kγ in vivo do not counteract the pathogenesis of PH, but conversely enhance it. In this context, reduced phosphorylation of eNOS may play a crucial role, leading to increased vasoconstriction, whereas increased cAMP levels in PI3Kγ
-/-
may help the RV to adapt to the increased pressure. The exact mechanisms will be analysed in the future.
Abstract 18517: Meta-Analysis of Radiation Exposure With Transradial versus Transfemoral Access for Diagnostic Coronary Angiography and Percutaneous Coronary Intervention
Authors: Yasmin Farah , Moeed Abdul , Rahman Saad Ur , Khabir Yumna , Hassan Omer , Khan Safi U , Goel Sachin S , shah alpesh
Published: December 2023

Background:
Transradial (TR) access for cardiac catheterization offers advantages over conventional transfemoral (TF) access by reducing bleeding and vascular complications. However, concerns exist regarding potential increased radiation exposure with TR access. The benefit-risk profile due to increased radiation exposure by this technique remains uncertain. We compared radiation exposure for diagnostic coronary angiograms (DCA) and percutaneous coronary interventions (PCI) between TR and TF access.

Methods:
We searched PubMed, Google Scholar, and Scopus through May 2023 for randomized control trials and observational studies comparing radiation parameters for TR and TF access sites. We compared fluoroscopy time (FT, min) and kerma-area product. The summary estimate was random-effects weighted mean differences (WMDs) with 95% confidence intervals.

Results:
A total of 33 studies (n = 89,366) were included in the analysis. TR was associated with increased FT (WMD 0.94 [0.61, 1.27] p<0.01) vs. TF access, which was consistent for both DCA (WMD 0.71 [0.20, 23]) and PCI subgroups (WMD 1.09 [0.61, 1.58]) (p for interaction = 0.29). There were no significant differences for the kerma-area product (WMD -0.20 [-0.59, 0.19], p=0.32) between the two access sites, consistent for both DCA (WMD -0.04 [-0.40, 0.32]) and PCI (WMD -0.32 [-0.59, 0.19]) (p for interaction = 0.51) as shown in
Figure 1
.

Conclusion:
TR was associated with increased FT; however, the two access sites had no significant differences concerning kerma-area products.
Abstract 18538: Results of a Self-Management Intervention to Improve Hypertension in Black Patients Using the Electronic Health Record Patient Portal
Authors: Duckie Charmaine , Boston Karen , Champagne Brittney , Halpern David , Granger Bradi B
Published: December 2023

Introduction:
Nearly half of American adults (47%) have hypertension (HTN), and non-Hispanic Black patients are disproportionately represented among those diagnosed (56% versus 48% for White, 46% for Asian, and 39% Hispanic adults). Models of care to reduce blood pressure for the Black patient population are not consistently implemented, in large part due to systemic and structural barriers to care.

Hypothesis:
The purpose of this study was to improve access to and use of digital education, skills for self-measured blood pressure (SMBP) monitoring, use of the electronic health record (EHR) patient portal, and blood pressure from baseline to 3 months in a cohort of Black Americans.

Methods:
A pre-post intervention design was used to evaluate the team-based, nurse-led intervention. Patients received coaching on HTN goals, screening for social determinants of health (SDOH), medication review, self-paced portal-based videos, and teach-back for BP cuff use. Post-implementation blood pressure (BP) and self-management (knowledge, cuff-use, patient portal use, and attendance at follow-up) were measured using the HELM tool, Chronic Care Model (CCM) and American Heart Association (AHA) HTN toolkit. 12-month follow-up is ongoing.

Results:
Black participants (n=80) averaged 59 (SD 10) years of age; most were female (n=58, 73%), employed (n=59, 75%), non-smokers (n=66, 84%), with average BMI 34.5 (SD8). From 0-3-months, views of portal-pushed videos increased to 69%, knowledge scores improved pre- (M = 67.9, SD = 16.7 to post (M = 75.2, SD = 17.4), and mean systolic BP was significantly reduced by 20.3mmHg (95%CI 16.11, 24.44). Average systolic BP pre was 152.13 (SD = 16.87) and post was 131.85 (SD = 13.13), t (79) = 9.71, p< .001. Sustainability at 12-months is ongoing.

Conclusions:
A team-based, nurse-led model improves patient engagement, adoption of portal-prescribed education, skills for SMBP, EHR-reported BP, and visit follow-up for Black patients with uncontrolled BP.
Abstract 18543: Association of Nonalcoholic Steatohepatitis With Predicted 10-Year Cardiovascular Risk, Independent of Diabetes Status (NHANES 2017-2020)
Authors: Woolley Jonathan J , Fishman Jesse , Parrinello Christina , O'Connell Thomas
Published: December 2023

Introduction:
Evidence suggests patients with nonalcoholic steatohepatitis (NASH), particularly those with significant fibrosis (stages ≥F2), have elevated CV-event risk.

Hypothesis:
The association of NASH with diabetes may confound the relationship between NASH and CV-event risk.

Goals/Aims:
To estimate primary CV-event risk associated with presumed NASH, adjusting for diabetes.

Methods:
A cross-sectional analysis of the 2017-March 2020 NHANES cycle was conducted. Presumed NASH was defined as evidence of steatosis (controlled attenuation parameter [CAP] ≥302 dB/m), exclusion of excessive alcohol consumption or hepatitis B/C, and FibroScan-AST (FAST) score ≥0.48. Non-NASH controls were matched 3:1 based on age, sex, and race. The 10-year probability of a primary CV event was estimated using the Framingham Heart Study risk equations. Linear models were used to estimate the association of presumed NASH with CV risk, with and without adjustment for diabetes, and distinguishing fibrosis stages F0-F1 vs F2-F4 within presumed NASH.

Results:
The analysis included 123/369 matched participants with/without presumed NASH. Mean (SE,
P
value) incremental probability of a primary CV event associated with presumed NASH was 1.4% (1.2%,
P
=0.26) before adjustment for diabetes, and 1.8% (1.0%,
P
=0.10) after adjustment. In participants ages <65, the association with presumed NASH was statistically significant at 2.3% (1.1%,
P
=0.05) before adjustment for diabetes, and 2.1% (1.0%,
P
=0.04) after adjustment, and elevated in fibrosis stages F2-F4 (see Table). Limited sample size challenged reliability of estimates for ages ≥65.

Conclusions:
Among individuals ages <65, a significant association of presumed NASH and primary CV-event risk was observed, before and after adjusting for diabetes. The incremental risk was greater for fibrosis stages F2-F4, suggesting the importance of accounting for fibrosis stage in predicting CV risk.
Abstract 18567: Acute Inhibition of Phosphodiesterase 1 (PDE1) Decreases Tension Generation in Pediatric Heart Failure
Authors: Chaudhry-Waterman Nadia , Jonas Eric , Stone Matthew , Sucharov Carmen , Stauffer Brian L , Miyamoto Shelley D , Nakano Stephanie J
Published: December 2023

Introduction:
Children with heart failure (HF) due to dilated cardiomyopathy (DCM) or single ventricle congenital heart disease (SV) ultimately require heart transplantation due to the lack of effective medical therapies. Inhibition of PDE1 (PDE1i) is currently being investigated in adult HF, however it is unclear if PDE1i use should be extrapolated to pediatric HF.

Objective:
To evaluate the acute effect of PDE1i on loaded myocardial contractility in pediatric DCM and SV trabeculae.

Methods:
Hearts were obtained from DCM (N=25) and SV (N=27) children who underwent transplant between 2010-2020. Right ventricular trabeculae are freshly isolated and mounted in a multi-chamber muscle bath.
Ex vivo
contractile response of isolated trabeculae was measured in response to 10uM PDE1i, the non-selective β-agonist isoproterenol (Iso), and untreated. To assess contractile response with increased cyclic adenosine monophosphate (cAMP) from β-adrenergic stimulation, a subset of baths received Iso and PDE1i. Percent change in max tension was determined by the difference between max tension and baseline tension, divided by baseline tension.

Results:
In pediatric DCM and SV trabeculae, acute PDE1i resulted in lower max tension generation when compared to untreated trabeculae (DCM p=0.003 and SV p=0.01). In DCM trabeculae, % change in tension was also lower with PDE1i when compared to Iso (p=0.0053) however there was only a trend toward significance in SV (p=0.06). There was no difference between % change in tension between Iso and PDE1i+Iso in either DCM or SV.

Conclusions:
Although PDE1 has high expression and activity in human cardiomyocytes, acute PDE1i treatment of explanted trabeculae results in decreased max tension generation. Even in the setting of elevated cAMP, PDE1i does not alter max tension generation. Thus, while there may be beneficial effects of PDE1i in pediatric HF, the consequences are unlikely related to a direct increase in cardiomyocyte contractility.
Abstract 18571: Fetal Sirolimus Therapy for Giant Cardiac Rhabdomyoma
Authors: Brar Razleen , Kalan Amanda , Komarlu Rukmini R
Published: December 2023

Background:
Cardiac rhabdomyomas in tuberous sclerosis regress spontaneously, large masses can cause hemodynamic compromise. Fetal sirolimus therapy cause regression. We report a case of successful fetal therapy in mother with fetally diagnosed tuberous sclerosis (TS).

Case:
A 22 year old female with uncomplicated pregnancy and negative cardiac history presented for fetal echocardiogram at 21 weeks due to cardiac masses. Fetal echocardiogram: levocardia, normal segmental cardiac anatomy, d-looped ventricles, normally related great arteries. Multiple masses seen in both ventricles, largest in LV free wall from base to apex and another involving mitral papillary muscle, no initial obstruction, patent ductal and aortic arches. Amniocentesis confirmed diagnosis of TS. Fetus was followed with serial monitoring of cardiac outputs and size of masses. At 30 weeks, LV mass had doubled from 1.7 to 4 cm with LV diastolic dysfunction and reduced cavity size, large pericardial effusion, left ventricular outflow tract obstruction (LVOTO). IVC was mildly dilated with liver enlargement. Fetal MRI confirmed diagnosis of rhabdomyoma with small subependymal nodules. Given LVOTO and large effusion, mother was started on sirolimus therapy with loading dose of 5 mg and subsequent dose adjustments for target trough sirolimus of 10 to 15 ng/ml. Serial mother monitored with labs, weekly ultrasounds and echocardiograms. Mass decreased in size with resolution of effusion and LVOTO. At 37 weeks, due to oligohydramnios, baby was delivered without hemodynamic compromise. Postnatally no LVOTO and normal systolic function with mass measuring ~ 2.0 cm. Baby has been followed off sirolimus therapy.

Role of Imaging:
Serial echocardiograms enabled optimal decision making to treat mother with sirolimus therapy.

Conclusions:
Maternal sirolimus therapy can help regress cardiac rhabdomyomas with hemodynamic implications with serial close outpatient monitoring.
Abstract 18572: Mimickers of Chiari Network in the Left Atrium
Authors: Manley Casco Dario , Mangla Ashvarya , mungee sudhir , Kalvakuri Kavitha
Published: December 2023

Case:
84-year-old female with ischemic cardiomyopathy and severe secondary mitral regurgitation with restricted leaflet mobility due to chordae tethering and a large central regurgitant jet. She underwent trans-catheter edge to edge repair with Mitra Clip NTW. The clip was aligned in the 12 to 6 o'clock position in the middle of A2/P2 scallop and appropriate graft was obtained with good tissue bridging. The trans mitral gradient at the end of the procedure was 3 mmHg and final V-waves at 10 mmHg. After the guiding catheter was moved back to the right atrium, the transesophageal echocardiogram (TEE) showed the presence of an echo dense flickering, bubble-like mobile structure around the right upper pulmonary vein. The heart team agreed that it looked like an endothelial disruption induced by the guiding catheter. After careful consideration and using shared decision making, the patient was maintained on Eliquis for 6 months without evidence of thromboembolic phenomena. Repeat TEE showed a healed dissection flap and no echo dense structure seen previously.

Discussion:
Unlikely to be thrombus or air bubbles, this structure looked like what we would see in a Chiari network. Complications after Mitra Clip procedure have been well described and can be broadly divided into procedure related and device related. Endothelial disruption with the imaging characteristics shown in this case has not been described. There are no evidence-based guidelines on how to proceed with this type of complication. It is well known that endothelial damage increases the risk for thrombosis and embolic phenomena. Due to concerns of a stroke, the decision was made to start anticoagulation with the plan of redo TEE. This case demonstrates the importance of performing TEE after Mitra Clip procedure to look for lesions that would increase the risk of stroke. It also demonstrates that patients with endothelial disruption after Mitra clip may benefit from short term anticoagulation for stroke prevention.
Abstract 18575: Impact of Mechanical Circulatory Support on In-Hospital Mortality in Ventricular Tachycardia Ablation: A United States Nationwide Analysis
Authors: Akkawi Abdul Rahman , Chehab Omar , Briasoulis Alexandros
Published: December 2023

Background:
Mechanical circulatory support (MCS) devices have emerged as a valuable tool in ventricular tachycardia (VT) ablation procedures, offering potential benefits such as improved hemodynamic stability, preserved organ perfusion, and optimized coronary perfusion during prolonged VT induction and mapping. However, the impact of different MCS modalities on in-hospital mortality following VT ablation remains unclear.

Objective:
This study aimed to investigate the impact of various MCS modalities on in-hospital mortality in those undergoing VT ablation during hospitalization.

Method:
We analyzed data from the National Inpatient Sample to identify patients who underwent VT ablation and received transient mechanical cardiac support between 2019 and 2020. The primary endpoint was in-hospital mortality, stratified by different MCS modalities. Additionally, we explored independent predictors of in-hospital mortality.

Result:
A total of 850 patients underwent VT ablation and required MCS from January 2019 to December 2020. Among these patients, extracorporeal membrane oxygenation (ECMO), percutaneous left ventricular assist device (PLVAD), intra-aortic balloon pump (IABP), and a combination of more than one MCS modality were utilized in 5.8%, 64.7%, 18.8%, and 10.5% of cases, respectively. The in-hospital mortality rates for these groups were 40%, 16%, 22%, and 61%, respectively (p<0.01). Notably, the use of multiple MCS modalities, female sex, other races, and self-payment were independent predictors of mortality, with adjusted odds ratios (aOR) of 21.9 (p=0.008; 95% confidence interval [CI]: 2.2-217.1), 9.27 (p=0.045; 95% CI: 1.1-82.1), 27 (p=0.038; 95% CI: 1.1-29.4), and 27.6 (p=0.041; 95% CI: 1.2-660.8), respectively.

Conclusion:
Our study highlights that the use of multiple MCS modalities, female sex, other races, and self-payment are independent predictors of in-hospital mortality, highlighting the need for careful consideration and selection of MCS for VT ablation patients.
Abstract 18579: Endocytic Adaptor Protein DAB2 is a Novel Atheroprotective Regulator in Atherosclerosis
Authors: Cui Kui , Dong Yunzhou , Wang Beibei , Li Kathryn , Shyy John , Chen Hong
Published: December 2023

Introduction:
Endothelial dysfunction and arterial inflammation are critically important for cardiovascular diseases such as atherosclerosis. Of major importance, they are among the predominant culprits that promote the transition from stable to vulnerable atheromas. Our pilot studies revealed Disabled Homolog 2 (Dab2) deficiency in endothelial cells (EC) results in endothelial dysfunction. However, the molecular mechanisms that direct Dab2 to combat endothelial dysfunction during atherosclerosis are completely unknown.

Hypothesis:
Dab2 prevents the progress of atherosclerosis by maintaining EC function and reducing inflammatory factors.

Methods and Results:
We examined the expression of endothelial Dab2 in human atherosclerosis patients and ApoE
-/-
mice fed a western diet (WD) for 12 weeks by immunoflurecent co-staining of VE-cadherin and Dab2 and observed drastically reduced Dab2 expression in the endothelium and intima of human fatty streaks and mouse atherosclerotic aortae. Genetic deletion of Dab2 in the endothelium of ApoE
-/-
mice on a WD for 12 weeks significantly increased atherosclerosis as revealed by Oil Red O staining of aortic roots and arches, suggesting that Dab2 could be a atheroprotective flow-responsive gene. Similar results were found in WT and EC-iDab2KO mice injected with AAv8-PCSK9 virus. RNA-seq of primary mouse aortic ECs (MAECs) isolated from WT and EC-Dab2iKO mice revealed Dab2 deficiency upregulated many inflammatory genes. qRT-PCR confirmed TNF-α and IL-6 were significantly upregulated in Dab2KO MAECs. Additionally, we observed an increase in Dab2 binding to NEMO in the absence of endocytic adapter proteins epsins via co-IP with anti-Dab2 in WT and epsin-deficient DKO MAECs. We also found three Klf4 binding sites present in the Dab2 gene promoter/enhancer and that overexpression of Klf4 upregulated Dab2 expression in a dosage-dependent manner.

Conclusions:
Our findings indicated the essential role of Dab2 in protecting the atherogenic endothelium by reducing macrophage accumulation and increasing plaque stability in the aortic roots, which may provide new anti-atherosclerotic therapeutics.