bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 18865: Cardiac Arrest on Weekends Are More Fatal Than Weekdays - A Study From National Database
Authors: Agrawal Durgesh , Ahmad Mansoor , Truong Vien T , Mondal Avilash , Sawhney Aanchal , Panjwani Pooja , Patel Krunalkumar , Dutta Abhishek , Bhatia Smriti , Siddique Muhammad Saad , Dhar Sunil , Viganego Federico , Metkus Thomas , Skenderi Sonela
Published: December 2023

Introduction:
The overall survival of cardiac arrest patients is very poor. There is a higher incidence of cardiac arrest on weekends especially on Saturdays as per national statistics. Also, hospitals experience reduced staffing on the weekends. We examined the outcomes of cardiac arrests on weekends compared to weekdays.

Hypothesis:
There is no difference in mortality in cardiac arrests which happen over the weekday compared to over the weekend.

Methods:
This retrospective cohort study used a national inpatient sample database to identify patients from 2016 to 2019 presenting with cardiac arrest on weekdays vs on weekends. SAS 9.3 was used for data analysis. The data were weighted to generate national estimates of the entire US hospitalized population.

Results:
Out of 57,300 patients who presented with cardiac arrest during the study period, 41,410 were on weekdays (72.2%; mean age 65.9; 56.2% males) and 15,890 were on weekends (27.8%, mean age 65.2; 56.7% males). Inhospital mortality was less on weekdays than on weekends (72.4% vs 76.2%). The younger age group (18-40 years) had a higher share of of cardiac arrest on weekends when compared to weekdays (8.2% vs 7.1%). Weekday admissions had a higher rate of prior MI (8.9% vs 7.6%) and a higher rate of comorbities including DM (39.4% vs 36%), CHF (32.2% vs 28.9%), Renal Failure (29.5% vs 26.6%), CAD (34.8% vs 31.7%). Weekend admissions had a higher rate of smoking history (16.9% vs 15.1%). All p values <0.001.

Conclusions:
Cardiac arrest on weekends has a higher mortality rate compared to weekdays. We found a higher burden of comorbidities on patients with weekday cardiac arrest.
Abstract 18876: Safety and Efficacy of Coronary CT Angiography in Acute Chest Pain. A Systematic Review and Meta-Analysis of Randomized Clinical Trials
Authors: Mostafa Mostafa , Abuelazm Mohamed , Eid Mohamed , Victor Varun , Abdou Claudine , Barssoum Kirolos , Al-Azizi Karim , Jneid Hani
Published: December 2023

Background:
Coronary computed tomography angiography (CCTA) allows direct visualization of coronary arteries. As a result of the high accuracy, CCTA has been proposed as an initial step in patients presenting to the emergency department (ED) with acute chest pain to rule out obstructive coronary artery disease (CAD). The effect of the initial CCTA strategy on downstream testing with coronary angiogram and coronary revascularization is yet to be delineated.

Objective:
To investigate the safety and efficacy of CCTA in patients presenting to the ED with acute chest pain compared to standard of care (SoC).
Method:
We searched PubMed, Cochrane CENTRAL Register, and ClinicalTrials.gov (inception through July 1st, 2023) for randomized clinical trials evaluating the outcomes of CCTA in acute chest pain. We used a random-effect model to calculate risk ratio (RR) with a 95% confidence interval (CI). The endpoints were all-cause mortality, major adverse cardiac events (MACE), rates of coronary angiography, and length of stay (LOS).

Results:
A total of 17 studies comprising 9237 patients were included in the analysis. Compared to SoC, the CCTA group had a shorter length of hospitalization (RR -0.3; 95%CI -0.64- -0.13;
P
= 0.0005). There was no significant difference in all-cause mortality or MACE (RR 0.8; 95%CI 0.45- 1.5;
P
= 0.52) and (RR -1.00; 95%CI 0.76- 1.3;
P
= 0.98), respectively. Rates of coronary angiography did not differ between the two groups (RR 0.93; 95%CI 0.61- 1.41;
P
= 0.96).

Conclusion:
CCTA is a reliable non-invasive imaging modality that can play a significant role in evaluating acute chest pain in the emergency department and is associated with a decrease in the length of stay without an increase in MACE. There was no increase in downstream coronary angiogram or coronary revascularization in the CCTA group.
Abstract 18924: Structural and Electrical Remodeling Differences in Ischemia-Reperfusion versus Non-Reperfusion Myocardial Infarction
Authors: sekigawa masahiro , Salas Jonathan , Callans David , Marchlinski Francis E , Gorman Robert , Tschabrunn Cory
Published: December 2023

Background:
Structural and electrical remodeling following myocardial infarction (MI) can result in the development of arrhythmogenic substrate and ventricular tachycardia (VT). Various clinical factors such as reperfusion status, and occluded coronary distribution can impact the size of post-infarction scar.

Objective:
To investigate the structural and electrical remodeling characteristics in 2 different porcine models of MI.

Methods:
Fourteen swine underwent anterior infarction via 180min balloon occlusion followed by reperfusion (IR Group, n=7) or chronic total occlusion by embolizing the mid-LAD with a coil (CTO Group, n=7). Cardiac MRI and electroanatomic substrate mapping (Thermocool ST-SF) and high-resolution activation mapping (Pentaray 2-6-2mm) was performed in all subjects 8-9 weeks following infarction. Low bipolar voltage area (<1.5mV), very low bipolar voltage area (<0.5mV), and CMR LGE intensity volume reconstruction (inHeart Medical) were assessed. Programmed stimulation from the Ventricular apex was performed for VT inducibility assessment.

Results:
The CTO group had more extensive low bipolar voltage area (CTO: 36±6cm
2
vs. IR: 23±12cm
2
, p=0.04) and dense low bipolar voltage areas (CTO: 20±7cm
2
vs. IR: 7±6cm
2
, p=0.01). LV EDV was similar (CTO: 122±14ml vs. IR: 136±38ml, np) and there was no significant difference in LVEF (CTO: 28±4% vs. IR: 26±4%, np) and CMR LGE scar volume (CTO: 12±3ml vs. IR: 12±4ml, np). Voltage mapping demonstrated clear significant differences in substrate size and LV Endocardial CMR LGE intensity was more homogeneous in the CTO group than the IR group (Figure). Monomorphic VT was inducible in all 14 subjects. A total of 19 VTs were induced in CTO group (range 1-4, TCL 241±33ms) and 12 in IR group (range 1-2, TCL 208±17ms).

Conclusions:
Creation of a chronic infarct results in a significantly larger area of abnormal arrhythmogenic substrate than 180 minutes of ischemia-reperfusion.
Abstract 18929: Sex Differences in Outcomes and Morphologic Features in Patients With Non-Ischemic Cardiomyopathy With Implantable Cardioverter-Defibrillators Implanted for Primary Prevention
Authors: Al-Deiri Danah , Kiang Alan , Salam Donna , Wang Tom Kai Ming , Chen David , Santangeli Pasquale , Tang Wilson , Nguyen Christopher , Nezafat Reza , Sroubek Jakub , Kwon Deborah H
Published: December 2023

Background
Prior studies have demonstrated significantly lower rate of mortality and appropriate primary prevention implantable cardioverter defibrillator (ICD) therapy in female non-ischemic cardiomyopathy (NICM) compared to men. However, the sex specific mechanisms of protective risk in women are unclear. Therefore, we sought to compare morphologic and tissue characteristic features of NICM patients who underwent cardiac magnetic resonance (CMR) prior to ICD implantation and risk of ventricular arrhythmia and mortality based on sex.

Methods:
NICM patients who underwent prior CMR within 1 year of ICD implantation between 2002 and 2018 were evaluated. Cox and Fine-Gray models were used to compare event-free survival as appropriate. Clinical characteristics; left atrial volume; ventricular volume, function and remodeling; and late gadolinium enhancement derived from CMR were evaluated with simple t test and chi square analysis to determine their predictive value.

Results:
We identified a total of 311 patients (118 (37.9% female), median age 65) who met our inclusion criteria. Despite similar scar percentage and LVEF between both genders (p = 0.26, p= 0.62, respectively), females demonstrated significantly lower risk of all-cause mortality/LVAD/transplant in comparison to males (HR 0.48, CT 0.27-0.87; P = 0.016). There was a trend towards lower risk of appropriate ICD therapy in females, (HR 0.54, CI 0.28-1.01; P = 0.055). Comparison of morphologic and functional measures based on sex are listed in Table.

Conclusions:
Female NICM patients who underwent primary prevention ICD implantation experienced significantly lower mortality/LVAD/transplant rates compared to men, despite similar LVEF and scar burden. Sex differences in ventricular/atrial volumes and function, as well as relative wall thickness, may provide insights into underlying mechanisms of protective effects.
Abstract 18937: High Prevalence of Pediatric Hypertension is Associated With Social Determinants of Health Including Childhood Opportunity Index
Authors: Zaidi Abbas H , Brewer Benjamin , Zadokar Varsha , Lopes Joanne , Witherell Colleen , Miller Jonathan , De Ferranti Sarah D
Published: December 2023

Background:
Pediatric Hypertension(HTN) is a significant public health concern. The risk for adult HTN and end-organ damage begins in childhood. Patient factors such as social determinants of health (SDOH), including the Childhood Opportunity Index (COI) and how they impact the prevalence of pediatric HTN are poorly understood.

Hypothesis:
Elevated blood pressure (BP) and BP in the hypertensive range are prevalent in pediatric patients. SDOH factors are associated with high BP(elevated BP or BP in the hypertensive range).

Methods:
Patients seen in primary care at Nemours Children’s Health (NCH) between 6-17 years formed the cohort and various SDOH factors including COI were analyzed.

Results:
95,627 patients aged 6-17 years seen at NCH from DE and PA formed the cohort between August 2017 and September 2022. Children with developmental delay, anxiety, ADHD were excluded. The overall prevalence of elevated BP was 9.5% and BP in hypertensive range was 2.8% based on the definition from the American Academy of Pediatrics 2017 HTN guidelines. A multivariable analysis showed factors associated with having a high BP were living in DE(P<0.001), non-English speaking(P<0.001), non-white race(P=0.03), being on public insurance(P<0.001), Male gender(P<0.001), older age(P<0.001), and low COI(P<0.001) with a C statistic of 0.77.

Conclusions:
Elevated BP and BP in the hypertensive range are prevalent across pediatric patients. Various SDOH factors are associated with having a high BP including COI, which indicates the vulnerability of certain populations to having high BP and development of adult HTN and future cardiovascular risk. Understanding these SDOH factors could help recognize and treat pediatric patients with HTN.
Abstract 18940: Can the Religious Observation of Fasting Cause Prinzmetal’s Angina?
Authors: Qureshi Natasha , Vashistha Kirtivardhan , Ali Syed , Kanei Yumiko
Published: December 2023

CASE DESCRIPTION:
A 73-year-old male with HTN, HLD, CAD/MI status post PCI to the RCA and LAD (2021), and former tobacco use presented with acute, severe, left-sided chest pain with nausea, diaphoresis and dizziness. He started fasting and adjusted his sleep schedule 3 days prior for Ramadan, but did not miss any of his medications including isosorbide and ranolazine. He was chest pain free on arrival, but subsequently developed severe chest pain becoming bradycardic, hypotensive and hypoxic. At that time the EKG (Figure 1) showed ST elevation (STEMI) in leads II, III and aVF with high degree atrioventricular block. He was started on intravenous fluids and a vasopressor but had spontaneous resolution of symptoms within 10 minutes. Emergent coronary angiography revealed stable 70% stenosis of an ostial left circumflex (LCx) artery and non-obstructive CAD of the RCA. Labs revealed normal blood glucose, negative urine toxicology and mild elevation of troponin (trended serially). Echocardiogram was normal with no regional wall motion abnormalities. He was treated as vasospastic angina with addition of a calcium channel blocker without recurrence of his symptoms.

DISCUSSION:
Vasospastic angina is an important cause of acute coronary syndrome. Our patient had severe vasospastic angina while being treated for CAD for over 10 years. No prior studies have linked fasting to vasospasm. We hypothesize that fasting and a diurnal sleep schedule may contribute to worsened episodes in susceptible individuals due to hormonal changes including glucose shifts and an increase in catecholamines and cortisol. Increased catecholamine levels may induce spasm by stimulation of alpha receptors in the coronary arteries, and cortisol can induce vascular inflammation, potentiating negative effects. We highlight the importance of keeping high clinical suspicion for a diagnosis of vasospasm, as well as the need to further understand the complex pathophysiology to counsel patients in the future.
Abstract 18958: Management of Patients With Suspected Left-Sided Prosthetic Valve Endocarditis According to Myocardial FDG-PET CT Results
Authors: Caceres Juan , Edwards Mark , Harris Andrew
Published: December 2023

Introduction:
Accurate diagnosis of prosthetic valve endocarditis (PVE) is challenging because echocardiography (Echo) can be limited by artifact from prosthetic material. Myocardial FDG-PET (PET) can improve diagnostic accuracy; however, little is known about its effect on patient management.

Research Question:
Does PET affect management of patients with suspected left-sided PVE?

Methods:
A retrospective, single-center study was conducted on all admitted patients with a history of aortic valve replacement (AVR) or mitral valve replacement (MVR) or repair who underwent a myocardial PET for suspected endocarditis between April 2016 to December 2022. PET was defined as positive, negative, or indeterminate based on signal intensity/pattern at valve prosthesis. For this analysis, patients with indeterminate results were included with negative results, resulting in four groups PET+, PET-, Echo+ and Echo-. Patients were followed up to twelve months. Data were obtained from chart review and supplemented with national death index data.

Results:
Of a total of 146 included patients, 68% had a surgical AVR, 14% had a transcatheter AVR and 21% had an MVR. Median age was 63 years and 30% of patients were female. Most patients had positive blood cultures on admission (66%). The Echo+/PET+ group had a high rate of definite PVE (95%). PVE was rejected in 58% of those in the Echo-/PET- group. PET+ patients were more likely to undergo surgery in both the Echo- (24% for PET+ vs. 12% for PET-) and Echo+ (62% for PET+ vs. 20% for PET-) groups. High rates of prolonged antibiotic courses (73%) were seen across all groups; PET- groups had lower rates of prolonged antibiotics.

Conclusions:
Although most patients with suspected PVE underwent initial conservative management, PET+ patients had higher rates of surgical management. Negative PET results may help to identify patients with suspected PVE that may not require prolonged antibiotics.
Abstract 18959: Glycosphingolipid-Mediated Cardiomyocyte and Immune Cell Dysfunction in Hypoplastic Left Heart Syndrome
Authors: Turner Mary E , Pietra Ashley E , Sanchez Erin E , Garcia Anastacia M
Published: December 2023

Introduction:
Hypoplastic Left Heart Syndrome (HLHS) is the leading indication for heart transplant and the most common cause of cardiovascular death in infants. However, the mechanisms associated with heart failure progression in HLHS are poorly understood. Glycosphingolipids (GSLs) have been implicated in a variety of biological and disease processes, however, the role of GSLs in the context of HLHS pathophysiology have not been explored. Here we test the hypothesis that aberrant GSLs drive maladaptive cardiac and immune cell responses and predispose HLHS patients to pathologic remodeling and eventual cardiac dysfunction.

Methods:
GSL content was measured by mass-spectrometry. To test the direct effect of the specific GSL species, lactosylceramide (LacCer), cardiac and peripheral immune cells (PBMCs) were treated with liposomes containing 3uM LacCer (C18:0 and C24:0). Mitochondrial respiration was assessed using the Seahorse Bioanalyzer (Agilent). Expression of metabolic proteins were assessed by western blot. Statistical analysis between 2 groups was performed using an unpaired T-test.

Results:
LacCer is significantly increased in heart tissue and in isolated PBMCs from patients with HLHS (A), and isolated mitochondria are highly enriched with LacCer. Moreover, exogenous LacCer is sufficient to impair cardiomyocyte mitochondrial fatty acid beta-oxidation (B), induce ROS generation, and decrease the expression of metabolic proteins Additionally, exogenous LacCer is sufficient to promote inflammation and decrease mitochondrial bioenergetics in PBMCs (C).

Conclusions:
These data highlight a novel role for LacCer in modulating cardiomyocyte and immune cell phenotypes and suggest aberrant GSLs contribute to the HLHS pathophysiology. Elucidation of the molecular mechanisms involved in impaired immune cell and cardiomyocyte responses in HLHS is crucial and these data suggest a unique avenue for therapeutic intervention in this population.
Abstract 18993: Regional Disparities in Authorships of Cardiovascular Research Presented at the American Heart Association’s Scientific Sessions Reporting Healthcare Disparities 2020-2023
Authors: Damarlapally Nanush , Mohammed Adil S , Gurram Priyatham , Manne Suvidha , Mahadevan Arankesh , Abrishami Shabnam , Lekkala Sai Prasanna P , Tera Chenna reddy , Mahadevaiah Ashwini , Mellacheruvu Sai Priyanka P , Guddeti Ananth V , Chauhan Shaylika , Desai Rupak
Published: December 2023

Background:
Geographic and temporal distribution of disparity authorships is unclear. Our aim was to examine authorship trends in 2020-2023 American Heart Association (AHA) abstracts reporting social and demographic disparities.

Methods:
We reviewed 801 AHA conference abstracts, analyzing 723 reports. Regional information of authors and their reported disparities related to gender, race, region, healthcare access (HCA), comorbidities (CO), socioeconomic status (SES) were collected. Descriptive and trend analyses were performed using Chi-square tests, and Pearson's and Kendall's Tau b correlation tests. P <0.05 was considered significant.

Results:
We analyzed 1440 primary and senior authorships from 723 abstracts. The majority of authors (92%) were from North America, predominantly USA (90%), with a significant representation from the South (33.6%) vs. other regions (Image 1). Disparities on outcomes such as race, gender, SES, CO, geographical locations, and HCA were reported as 53.9%, 33.9%, 26.6%, 24.9%, 17.8%, and 13.6% respectively. From 2020 to 2023, there was a declining trend in authors reporting on gender (ptrend<0.001) and HCA (ptrend-0.03) disparities, whereas disparities on SES had an increasing trend (ptrend<0.001). An increase in reporting of gender disparities was associated with increased reporting of racial disparities (r = .081, τb = .081). We also found positive correlations between SES and HCA (r = .155, τb = .155). Conversely, there was a negative correlation between gender and SES (r = -0.133, τb = -0.133), and between CO and healthcare access HCA (r = -0.078, τb = -0.078). All correlations were statistically significant (p < 0.05).

Conclusion:
The trends show that authors have reported more SES disparities in recent times compared to HCA, race, and gender. With expected financially challenging times ahead, to address these findings, it remains important to focus research on income based equalities in HCA and outcomes.
Abstract 18995: Association Between Prediabetes and Higher Risk of Mortality Following Acute Ischemic Stroke: A Meta-Analysis
Authors: Patel Bhavin A , Mahajan Kshitij , Dhaliwal Kanwar Bir Singh , Kaushik Vishrut , Dixit sakshi , Brar Samrath Singh , Atwal Siddharth A , Singh Jugraj , Nader Bakhtawar , Trivedi Rishika , Dhingra Avleen , ARORA ARPIT , Vyas Ankit , Desai Rupak , Jain Akhil
Published: December 2023

Introduction:
Prediabetes is known to increase the risk of cardiovascular and cerebrovascular mortality. This study aims to examine the relationship between prediabetes and mortality in patients who have experienced a stroke.

Methods:
A systematic search was conducted in PubMed/Medline, SCOPUS, and Google Scholar databases until May 2023 to identify relevant articles reporting on the association of prediabetes with ischemic stroke mortality. A random-effects model was used to calculate odds ratios (OR), heterogeneity was assessed using I 2 statistics, and sensitivity analysis was performed using the leave-one-out method.

Results:
Our final analysis contained 11 studies which included 84,833 prediabetic patients with a mean follow-up time of 20.9 months. The prediabetes cohort comprised patients of an average age of 67 years from various countries, including Korea, Italy, Japan, China, Spain, and the Netherlands. Initially, the unadjusted analysis showed no significant association between prediabetes and post-stroke mortality (OR 1.06, 95% CI 0.51-2.19) with high heterogeneity (I2=94.7%, P<0.01). However, after adjusting for baseline characteristics and comorbidities, the prediabetes cohort exhibited a significantly higher risk of post-stroke mortality (adjusted OR 1.68, 95% CI 1.29-2.19) with moderate heterogeneity (I2=49.45%, P=0.03). Subgroup analysis by country revealed higher odds of mortality in Korea, Italy, Spain, Japan, and the Netherlands. However, statistical significance was not reached for each subgroup, indicating the need for larger studies.

Conclusions:
Our findings suggest that prediabetes is associated with a nearly 68% higher risk of mortality following a stroke. This warrants more prospective studies with prediabetes to validate these findings.
Abstract 19002: Impact of Pulmonary Hypertension on Covid-19 Pneumonia Hospitalizations: Analysis of The National Inpatient Sample 2020
Authors: Kodali Mouna , Atluri Ramtej
Published: December 2023

Background:
SARS-CoV-2 swept across the globe, overwhelming healthcare systems across the world regardless of borders and socioeconomic factors. COVID pneumonia (CP) can result in ARDS and increased pulmonary artery pressures. Pulmonary hypertension (PHT) is generally a chronic cardiopulmonary disease that is associated with progressive vascular remodeling. We aimed to assess the impact of underlying PHT on CP patients with a large sample size.

Methods:
We utilized the National Inpatient Sample from 2020 to identify 1,058,815 hospitalized adults with CP. These hospitalizations were further stratified based on the presence of PHT. A multivariate regression model was used to adjust for confounders and analyze the variables.

Results:
Of those who were admitted for CP, 24,284 (2.3%) had PHT. In-hospital mortality was higher in those with PHT (19.6% vs 10.9%; p<0.001). Figure 1 shows the Forrest plot for multivariate analysis of in-hospital outcomes when adjusted for patient demographics, comorbidities, and hospital characteristics. When adjusted similarly, CP patients with PHT had longer length of stay (LOS) by 1.3 days (p<0.001) and had additional hospital costs (HC) of $23,232 (p<0.001).

Conclusions:
CP patients who had PHT had significantly worse outcomes in terms of in-hospital mortality, LOS, HC, cardiac arrest, arrhythmias, sepsis, cardiogenic shock, and being intubated. These patients are unable to tolerate the ventilation-perfusion mismatch and the rise in pulmonary arterial pressures seen in ARDS.
Abstract 19004: Clinical Outcomes Following Treatment for Tricuspid Regurgitation: Repair vs. Replacement
Authors: Chodisetty Shreya , Kalra Kanika , Guyton Robert A
Published: December 2023

Background:
Tricuspid regurgitation (TR). previously regarded as the ‘forgotten valvular disease’, has gained a lot interest lately due to its deleterious effects on the right ventricle and long-term outcomes. Surgical literature on outcomes after isolated tricuspid surgery is limited. Although, the guidelines recommend repair of the tricuspid valve, few studies compare outcomes of replacement with repair.

Research Question and Aims:
Whether, tricuspid repair or replacement is the optimal therapy for TR is not fully understood. Therefore, we sought to compare outcomes and survival after the two techniques.

Methods:
Our institutional STS database was queried to identify patients who underwent surgery for TR from 2017-2022. Of the 200 patients identified, 84 were excluded due to major concomitant procedures. After exclusion, 70 patients underwent tricuspid replacement and 46 underwent repair. Pre-, intra- and post-operative characteristics were tabulated and compared using t-tests and fisher’s exact test. 5-year survival was analyzed using Kaplan-Meier curves.

Results:
Tricuspid repair was notably done in a significantly older patient population compared to replacement (p=0.005) likely due to presence of more endocarditis in the younger population who underwent replacement (Figure 1). Tricuspid repair was associated with a significantly longer cross-clamp time. Post-operative complications including pacemaker implantation rates were not significantly different between the groups. 30-day and 5-year mortality rate was also not found to be significantly different between the two interventions. From the limited mid-term echo follow up, TAPSE reduced to 1.5 from 2.1 in the repair group (p=0.01).

Conclusions:
Younger patients with endocarditis underwent more replacements than repairs. 30-day outcomes and 5-year survival were not significantly different in the two groups however, RV function seemed to worsen in patients who underwent TV repair.
Abstract 19018: Unraveling the Regulatory Landscape of NKX2-5 in Human Left Atrial Tissue: Implications for Atrial Fibrillation
Authors: YANG YUEQIN , Torres Natalia S , Cho Scott , Guo Hongchao , Tristani-Firouzi Martin
Published: December 2023

Cardiac transcription factors are emerging as crucial modulators of atrial fibrillation (AF), with rare and common variation implicated in AF. Mutations in NKX2-5 and more recently, NFATC1 were reported in families with autosomal dominant young-onset AF. Here, we explore the landscape of NKX2-5 and NFATC1 in human left atrium, using Chromatin Immunoprecipitation Sequencing (ChIP-seq), DAVID functional annotation and HOMER motif analyses. Post-mortem human left atrial tissue samples (n=5) were obtained from the National Disease Research Interchange (NDRI) within a recovery interval of < 4 hours. Preserved microstructural integrity and normal staining patters for TNNT2 and vimentin were verified using confocal microscopy. ChIP-seq analysis revealed an average of 2.62k NKX2-5 binding peaks, with 118 genes bound in all samples. Functional analysis identified significant enrichment in gene ontology categories and pathways (Table 1), including adrenergic and PPAR signaling pathways known to participate in AF susceptibility. Using HOMER, we mapped 55 NFATC1 consensus binding sites to the NKX2-5 ChIP peaks. Two NFATC1 consensus sites localized to an NKX2-5 binding peak located upstream from MEF2A (Figure 1). Published HI-C data from human right atrium indicates the NFATC1 binding sites are adjacent to the promoter of MEF2A in 3D space, suggesting that NKX2-5 and NFATC1 co-regulate MEF2A. In murine atria, mef2A regulates genes involved in fibrosis and adhesion, processes that are crucial in the pathogenesis of atrial fibrillation. Our data, together with published literature, provide a framework for understanding transcriptional networks that may predispose to human AF.
Abstract 19055: Effectiveness of Mobile Health Applications for Exercise Promotion on Cardiorespiratory Fitness After a Cancer Diagnosis: A Systematic Review and Meta-Analysis
Authors: Ghazi Sanam M , Stock James C , Cao Weidan , Rahurkar Saurabh , Gregory Megan E , Addison Daniel
Published: December 2023

Introduction:
Cancer survivors are at higher risk for cardiovascular (CV) related mortality. Smartphone application based (app-based) interventions that promote exercise and physical activity are an increasingly prevalent strategy for health promotion. Yet, whether these mobile health (mHealth) interventions improve CV risk after a cancer diagnosis is unknown.

Methods:
Leveraging MEDLINE/PubMed, Scopus, and Clinical Trials.gov, we identified studies through May 1, 2023. Literature searches were conducted on articles meeting study inclusion criteria and with reported cancer diagnoses. Search terms included
smartphone
,
mobile health
,
mHealth
,
app
,
mobile application
,
exercise
,
cancer
and
cardio-oncology
. The main outcomes and measures included change in cardiovascular fitness, reflected by 6-minute walk test (6MWT), VO2max, 3-minute step test and systolic blood pressure or any mention of cardiac measures. Effect sizes were calculated as Cohen’s d. Aggregate effect sizes and moderator variables were tested using random effects models.

Results:
Overall, from 656 articles, 7 randomized controlled trials (RCTs) with 341 participants were identified. Interventions included mobile apps (n = 6), smartwatches (n = 2), or smartwatch plus an option to also use a web, mobile, or tablet app (n = 1); median age 49.71± 5.9 years; median duration of mHealth use 12 weeks. Across the 7 RCTs, mHealth was associated with improved cardiorespiratory outcomes (Cohen’s d=0.33; 95% CI, 0.07-0.60). Results maintained significance when cholesterol outcomes were added to the other cardiorespiratory outcomes (
d
= 0.30; 95% CI = 0.03-0.56). There was no heterogeneity (
Q
= 5.86,
P
>0.05) or publication bias (
P
> .05). Among the 4 studies examining the 6MWT, the between groups Δ Cohen’s d was 0.27 (95% CI, -0.21, 0.75).

Conclusions:
Smartphone app-based exercise promotion interventions appear to be a viable strategy for improving cardiorespiratory fitness after a cancer diagnosis.
Abstract 19060: Single-Nuclei RNA-Seq Provides Novel Insights Into Cellular Composition and Transcriptional Changes in Human Right Ventricular Failure
Authors: Thandavarayan Rajarajan A , Mahalingam Rajasekaran , Neupane Rahul , Mysore Krupa R , Youker Keith , Suarez Erik , Karakikes Ioannis , Ashrith Guha
Published: December 2023

Introduction:
Right ventricular failure (RVF) is a common consequence of pulmonary hypertension, but effective treatment options are currently lacking. To develop precise molecular and cellular targets for therapeutic development, a comprehensive investigation of cell type-specific responses and cellular heterogeneity in RVF is needed.

Hypothesis:
Cellular heterogeneity exists within the myocardium of RVF patients with pulmonary hypertension, and identifying specific genes contributing to failure can be aided by studying these distinct subpopulations.

Methods:
To test this hypothesis, we performed single-nucleus transcriptome analysis of 120,000 nuclei from ventricle samples of RVF patients with advanced or end-stage pulmonary hypertension with severe right heart failure undergoing heart double lung transplantation and normal control (NC) subjects. Single nuclei RNA sequencing was performed using 10x genomics, and bioinformatics tools were used for analysis.

Results:
Unsupervised clustering of 120,000 nuclei led to the identification of transcriptionally distinct subpopulations within 6 major cell types. We identified a unique fibroblast subpopulation expressing SERPINE1 in RVF and observed extensive crosstalk between the fibroblast cells and the other cardiac cell types through Visfatin signaling. In addition, other major cardiac cell types, such as cardiomyocytes, endothelial cells, and macrophages within the failing hearts also exhibited significant alterations in the signaling pathways compared with the control hearts.

Conclusions:
Our study provides novel insights into the single-cell landscape within the myocardium of RVF patients, revealing remarkable changes in the expression patterns of fibroblast genes. The identified sub-cluster of the fibroblast cell population could serve as a specific and potential therapeutic target in the clinic.
Abstract 19065: Resource Utilization After Cardiac Surgery in Adults With Congenital Heart Diseases: A Nationwide Analysis
Authors: Diaz Castrillon Carlos E , Sultan Ibrahim , Viegas Melita , Hoskoppal Arvind , Nelson Jennifer , Castro Medina Mario , da Silva Luciana , Iyanna Nidhi , Yousef Sarah , Wang Yisi , Morell Victor
Published: December 2023

Objective:
This study examined resource utilization following cardiac surgery among ACHD patients.Methods: We used the NIS (2012-2018) to identify >18yo admissions with TOF, Pulmonary valve anomalies/Congenital Pulmonary Stenosis, cTGA, DORV, TGA, HLHS, and Ebstein's anomaly and Open-heart valve or Great Vessels\Conduit replacement procedures. Hospitalization costs were adjusted for inflation to 2022 US dollars using the medical care component of the US Consumer Price Index. A mixed-effect linear regression model was used to identify factors associated with increased costs.Results: Out of 91,565 admissions, 4,578 involved one of the procedures of interest. The median age was 32 (IQR 34 - 46), and 46.6% were females. The median hospitalization cost was $54,400 (IQR 40,990 - 74,520). Valve procedures were the most common (79%). Overall, 19% of admissions had multiple HRU codes, with Blood transfusions (12.5% ) and ICD/pacemakers (7.2% being the most common. The high and low tercile group had a median hospitalization cost of $92,370 (IQR 74,850 - 120,900) and $36,300, IQR 31,180 - 40,930). Hospital-level factors, complications, and the need for HRU services significantly increased hospitalization costs. Notably, in-hospital mortality was associated with a 58% cost increase.

Conclusion:
Although the proportion of ACHD admissions requiring cardiac surgery is relatively low, the economic burden is significantly high, particularly those with in-hospital mortality. On average, higher hospitalization costs are associated with complications, the utilization of HRU procedures, the type of hospital providing care, and the US region.
Abstract 19078: Coronary Artery Disease in Very Young Adults: Characteristics, Associated Factors and In-Hospital Mortality
Authors: Ndunda Paul M , pachariyanon pavida , Golden Joseph , Nwagbara Kenechukwu , Pierotti Tyler , Dacdac Kyle Felipe , Modi Morni , Hawkins Alison , Lobello Alyssa , Modi Kalgi
Published: December 2023

Introduction:
Premature CAD carries a poor long-term prognosis. However, there is little data on CAD in very young adults. Understanding the characteristics and associated factors in this population is paramount to the prevention and improvement of outcomes of CAD.

Aims
To assess characteristics, associated factors, and in-hospital mortality in adults aged 18-35 years with significant CAD (S-CAD) undergoing invasive coronary angiography.

Methods:
This is a retrospective cohort study of patients who underwent coronary angiography in a single academic center from 2003-2023. S-CAD was defined as major epicardial CAD with at least 50% stenosis. Chi-square, Fischer exact, and Mann Whitney U tests were used to analyze categorical and continuous variables respectively. Logistic regression was used for multivariable analysis.

Results:
A total of 330 patients were included in the study. Patient characteristics are presented in table 1. Factors associated with the incidence of S-CAD include ST elevation, elevated troponin, total cholesterol, LDL, triglyceride, glucose, high WBC & platelet count, low Platelet: WBC ratio, and no cocaine use (p <0.05). On multivariable analysis, ST elevation (OR 5.67 (2.15 - 14.94), high troponin (OR 1.11 (1.03, 1.19), total cholesterol (OR 1.01 (1.01, 1.03), and glucose levels (OR 1.01 (1.01, 1.01) were statistically significant (p<0.05). There was no significant difference in in-hospital all-cause mortality between the group with and without S-CAD (2.2% and 0.8%

respectively; OR 2.75 [0.38, 19.80] p=0.56). Cardiovascular (CV) mortality was 2.2% and 0% respectively (p=0.07). The CV deaths were from STEMI with cardiogenic shock.

Conclusions:
Total cholesterol and glucose levels were associated with the incidence of S-CAD. STEMI was the presenting syndrome in a high proportion of patients with S-CAD. Despite young age, in-hospital mortality was similar to published rates in the general adult population.
Abstract 19090: Top Patient Initiated Uses of the Chronic Care Management Phone Line in a Rural Setting Reported Through Patient Survey
Authors: Miller Samuel , Jimmerson Garrett , Al Tibi Ghaith , Miller Jered , Chronos Nicolas
Published: December 2023

Introduction:
Patients can utilize Medicare’s Chronic Care Management [CCM] in different ways depending on their specific needs and conditions. It is important to have an understanding of patient utilization of this service in order to better tailor the program to their needs. Patient access to a CCM program has previously been found to reduce health expenditures, and improve engagement between the patient and the medical facility.

Research Question:
How do patients utilize the CCM phone line when it comes to their medical needs?

Goal:
The goal was to determine the top patient-initiated uses of the CCM phone line.

Methods:
An anonymized survey was sent out via email to patients enrolled in the CCM program of our rural clinic. Patients were asked to indicate how they have used the CCM phone line in the last 6 months. Patients also responded to their experiences with CCM as it relates to callback time and perception of access to providers. Finally, patients were asked if they would benefit from receiving a quarterly newsletter on current innovation in healthcare as part of CCM. Percentages were calculated based on patient responses.

Results:
Patients responded to some or all questions of the survey (N = 477). When asked, 94.78% of patients reported receiving a response within 24 hours after calling in regards to their specific request. In addition, 95.35% of patients affirmed that CCM provides an easier and more efficient access for patients to clinical providers when a need or concern arises than traditional clinical care. When asked about receiving a healthcare innovations newsletter as part of CCM, 63.48% of patients thought it would be beneficial.

Conclusion:
Patients utilized the Chronic Care Management Phone Line to accomplish various tasks. In conclusion, the majority of patients used the service to schedule appointments, request medication refills, and seek medical advice while agreeing that medical education (newsletter) could be a potentially beneficial aspect of CCM.
Abstract 19095: Enhancing Lesion Depth and Pulmonary Vein Isolation in Pulsed Field Ablation: Investigating the Effect of Voltage and Repeated Therapy Application
Authors: Mittal Lakshya , Moon Loell B , Pipenhagen Catherine , Geurkink Christopher G , Miller Matthew , Fish Jeffrey M
Published: December 2023

Introduction:
PFA has emerged as a promising approach for achieving effective PVI in the treatment of AF. This study investigates the impact of repeated therapy application and voltage on lesion depth during PFA and resulting PVI outcomes. By investigating this relationship, we seek to enhance lesion depth and optimize PFA protocols, ultimately leading to improved PVI outcomes and better management of AF patients.

Methods:
The VOLT
TM
PFA system was used to create lesions in potato sections with 37°C saline (N=3). Multiple PFA therapy repetitions were performed (1х, 2х, 4х, 6х, or 8х) at various voltages (1200V, 1400V, 1600V, or 1800V), with catheter rotation to achieve circumferential vein coverage. A chronic (30-day) canine study was performed at 1800V with 2х (Group 1, N=6) or 8х (Group 2, N=6) repetitions to understand
in vitro
to
in vivo
translation in terms of PVI success.

Results:
Two-way ANOVA results indicated that the effect of both voltage and therapy repetition was significant (P≤0.001) on minimum and maximum potato lesion depths. With increase in both voltage and repetition independently, lesion depths generally increased and 1800V as well as 8х produced significantly deeper lesions compared to 1200V and 1х, respectively.

Functional block was achieved acutely in all veins at 30 min post treatment. Chronic functional block results were 87.5% for Group 1 (5/6 LSPV, 4/6 RSPV, 6/6 LIPV, 6/6 RIPV) and 100% for Group 2 (6/6 LSPV, 6/6 RSPV, 6/6 LIPV, 5/5 RIPV), showing increased success with repeated PFA ablation. All Group 1 PVs without chronic block were shown to be misaligned with the target vein, while 8 applications in Group 2 overcame less ideal PV alignment.

Conclusions:
Results suggest that through optimized voltage and therapy repetition, PFA can significantly enhance lesion depth, leading to improved PVI in AF treatment. Chronic PVI rates were improved from Group 1 to 2 at 1800V with additional PFA applications, compensating for less ideal PV alignment in Group 1.
Abstract 201: 3D-Printed Automated Pressure-Cycled Resuscitator Maintains Respiratory Homeostasis in Swine With Normal to Moderately Low Lung Compliance
Authors: Walsh Brian K , Mullen Evan , Martins Eliauria R , de Andrade Dantas Álvaro J , da Costa Caio , Barbosa Roberto João , de Oliveira Filho Luiz Alberto G
Published: December 2023

Background:
During resuscitation, manual ventilation is commonly used. However, the effectiveness of this approach heavily relies on the skills of the individuals performing, often leading to inconsistent tidal volumes and respiratory rates. Such variations in ventilation can disrupt the removal of CO
2
resulting in altered pH. To address this problem, we leveraged advancements in fluidics and 3D printing to develop a miniature, automated, pressure-cycled resuscitator (inVent) that operates without any moving parts or settings.

Hypothesis:
The inVent will be able to maintain a pH of 7.2 or higher in swine with a dynamic compliance (Cdyn) of 25-50 ml/cmH
2
O.

Goals/Aims:
To assess the inVent’s performance in an animal model with normal to severe lung injury.

Methods:
Hybrid Landrace swine were studied under a protocol approved by the Institutional Animal Care and Use Committee. All swine were anesthetized, and underwent oral intubation. Breath by breath measurements were obtained using the NM3 Monitor (Phillips). All 3 inVent (fluidIQ) resuscitators pressure modules were used pre and post lung injury to fully characterize how each of the modules would react in different lung conditions. Lung injury was induced through a repeated bronchoalveolar lavage. ABG analysis was performed using the epoc system (Siemens). pH values 7.2 or less were considered acidotic while those over 7.2 were considered acceptable.

Results:
8 swine with an average weight of 36 (5.8) Kg were studied. 7 swine contributed to 39,770 breaths of pulmonary mechanics and 33 ABGs recorded. Mean Cdyn was lower than anticipated at 25.8 (14.7) mL/cmH
2
O and a pH 7.32 (0.16). Figure 1 demonstrates a linear relationship with compliance and pH.

Conclusions:
The inVent resuscitator was able to maintain a pH of at least 7.2 in moderate compliance ranges, however struggled to maintain pH of 7.2 or higher in the severely injured. Higher lung compliance ranges are needed to explore possible hyperventilation events.
Abstract 208: Evaluating the Predictive Power of Serum Biomarkers Neuron-Specific Enolase, S-100B Protein, and Neurofilament Light Chain for Neurological Outcomes Following Cardiac Arrest: A Diagnostic Accuracy Meta-Analysis
Authors: Elfaituri Muhammed K , Khaled Ala , BenGhatnsh Ahmed , Faraj Hazem Abdelkarem A , Msherghi Ahmed
Published: December 2023

Introduction:
The assessment of serum biomarkers, specifically Neuron-Specific Enolase, S-100B protein, and Neurofilament Light Chain, at 24 hours post-cardiac arrest is under investigation for its ability to predict brain injury.

Aim:
This study aims to evaluate the accuracy of serum biomarkers NSE, S-100B protein, and NFL predicting post-cardiac arrest neurological outcomes.

Methods:
A systematic search up to December 2022 across PubMed, Embase, and Scopus identified studies examining the association between 24-hour serum levels of NSE, S-100B protein, or NFL and neurological outcomes post-cardiac arrest. Statistical analyses were conducted using R software with mada package to pool sensitivity, specificity, false-positive rates, diagnostic odds ratios, and positive and negative likelihood ratios; each expressed with a 95% Confidence Interval.

Results:
We incorporated 3 studies, with 759 patients in S-100B protein group, 753 in NSE group, and 799 in NFL group. At 24 hours post-cardiac arrest, NSE showed a pooled sensitivity of 37.7% (95% CI: 24.4-53.2%, I2=85.7%) and specificity of 85.5% (95% CI: 81.6-88.7%, I2=0%). S-100B protein demonstrated a pooled sensitivity of 54.7% (95% CI: 32.1-75.5%, I2=94.8%) and specificity of 81% (95% CI: 66.9-90.1%, I2=82.3%). NFL exhibited a pooled sensitivity of 88.1% (95% CI: 47.7-98.4%, I2=93.8%) and specificity of 93.6% (95% CI: 85.4-97.3%, I2=77.7%). The diagnostic odds ratios were 3.57 (95% CI: 1.79-7.15) for NSE, 5.15 (95% CI: 1.55-17.14) for S-100B protein, and 108.65 (95% CI: 11.02-1071.24) for NFL. The positive Likelihood Ratios were 2.61 (95% CI: 1.64-4.14) for NSE, 2.88 (95% CI: 1.37-6.06) for S-100B protein, and 13.87 (95% CI: 5.64-33.69) for NFL, while the negative Likelihood Ratios were 0.73 (95% CI: 0.57-0.93) for NSE, 0.19 (95% CI: 0.9-0.33) for S-100B protein, and 0.06 (95% CI: 0.03-0.15) for NFL.

Conclusion:
Brain biomarkers NSE, S-100B protein, and NFL, especially NFL, with its superior sensitivity and specificity, are promising in predicting neurological outcomes post-cardiac arrest, aiding clinicians in patient management and family communication. The limited number of studies and heterogeneity in results necessitate further validation and research of their predictability.
Abstract 210: The Relationship Between Serum Free Fatty Acid Levels After the Return of Spontaneous Circulation and Neurological Outcomes in Out-of-Hospital Cardiac Arrest Patients
Authors: Ryu Seok Jin , Lee Dong H
Published: December 2023

Background:
Free fatty acids (FFA) are a known risk factor in the development of sudden cardiac death. However, the relationship between FFA and the outcome of out-of-hospital cardiac arrest (OHCA) patients remains unclear. We aimed to examine the association between FFA and neurological outcomes in OHCA patients.

Methods:
This prospective observational study included adult (≥ 18 years) OHCA patients between February 2016 and December 2022. We measured serial FFA levels within 1 h after ROSC and at 6 h, 12 h, 24 h, 48 h, and 72 h after the return of spontaneous circulation (ROSC). The primary outcome was neurological outcome at 6 months. A poor neurological outcome was defined by cerebral performance categories 3, 4, and 5.

Results:
A total of 147 patients were included. Of them, 104 (70.7%) had poor neurological outcomes, whereby the median FFA levels within 1 h after ROSC (0.72 vs. 1.01 mol/L), at 6 h (1.19 vs. 1.90 mol/L), 12 h (1.20 vs. 1.66 mol/L), and 24 h (1.20 vs. 1.95 mol/L) after ROSC were significantly lower than in good outcome group. The FFA levels at 6 h (odds ratio [OR], 0.583; 95% confidence interval [CI], 0.370-0.919; P = 0.020), and 12 h (OR, 0.509; 95% CI, 0.303-0.854; P = 0.011) after ROSC were independently associated with poor neurological outcomes.

Conclusions:
The lower FFA levels at 6 h and 12 h after ROSC were associated with poor neurological outcomes in patients with OHCA. FFA may reflect oxidative metabolism as well as oxidative stress.