bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 13759: Impact of Shock Network Protocols on Reducing Cardiogenic Shock Death in STEMI Cases: A Middle Eastern Study
Authors: Clementi Fabrizio , Egaimi Musab T , Corvo Pierfrancesco , seo heeyoung , Almorraweh Alghafek , Choi Wonsuk , Vallabh Kamil , Aidam Lateefa , Haque Sumera , Al Zubaidi Abdulmajeed
Published: December 2023

Introduction:
The optimal use of mechanical circulatory support (MCS) in managing acute myocardial infarction with cardiogenic shock (AMICS) treated with percutaneous coronary intervention (PCI) remains a complex clinical challenge. In response to this, our study seeks to explore the implementation of a systematic Shock Protocol that integrates pre-PCI MCS in patients presenting with STEMI and SCAI class C and above.

Hypothesis:
Utilizing a prospective, multi-centre STEMI database, our study aimed to assess the impact of the Shock Protocol on survival at hospital discharge.

Methods:
From January 2022 to February 2023, five participating sites within our STEMI network committed to the study, adhering to a standardized protocol for AMICS treatment. The selection criteria mirrored those of the "SHOCK" trial. The survival rate at hospital discharge for this cohort was compared to pre-protocol implementation (October 2020-December 2021).

Results:
Of 745 STEMI cases, 418 and 327 were treated before and after protocol implementation. AMICS diagnoses were in 10.5% and 10.7% in the BSP and ASP groups, respectively. The mean ages were 53 (BSP) and 51 (ASP), with 90% males. Approximately 83% and 85% of BSP and ASP patients, respectively, were on vasopressors or inotropes at Cath-Lab arrival. Pre-Cath-Lab cardiac arrests (CA) occurred in 20% (BSP) and 33% (ASP), while post-arrival CA incidence was 30% (BSP) and 12% (ASP). MCS was used in 27% (BSP) and 87% (ASP). In ASP, 85% of devices were implanted pre-PCI. Median FMC-to-balloon times were 104 ±28.2 (BSP) and 77 ±41.6 (ASP) minutes. Discharge survival rates were 77% (BSP) and 82% (ASP). Mortality predictors: TIMI flow <3 post-PCI, post-Cath-Lab CA, and SCAI class D/E. In SCAI class D/E patients, protocol implementation enhanced survival at hospital discharge.

Conclusions:
In our STEMI network, upfront MCS use in AMICS patients improved post-discharge survival.
Abstract 13801: Gender Disparity in Clinical and Management Outcomes in Patients With Pulmonary Embolism: A Systematic Review and Meta-Analysis
Authors: Khan Ubaid , Abuelazm Mohamed T , Halem Ahmed , badawy ahmed , Saeed abdallah , M. AlBarakat Majd , Hatamleh Zaid , Nasir Muhammad Moiz , Ali Shafaqat , Abdelazeem Basel
Published: December 2023

Introduction:
Gender is a unique characteristic that may contribute significant variation in prognostic aspects and outcomes to various clinical conditions. We aim to compile all evidence from original studies relevant to sex-based disparities in pulmonary embolism (PE) associated clinical outcomes.

Methods:
We conducted a systematic review and meta-analysis synthesizing observational comparative studies, which were retrieved by systematically searching: PubMed, Web of Science, SCOPUS, and Cochrane through April 12
th
, 2023. We reported dichotomous outcomes using risk ratio (RR) along with the corresponding 95% confidence interval (CI).

Results:
We included 18 studies with a total of 1,339,937 patients. There was no difference between men and women regarding all-cause mortality (RR: 0.99 with 95% CI [0.89, 1.10], P = 0.81), in-hospital mortality (RR: 0.94 with 95% CI [0.88, 1.02], P = 0.13), PE-related mortality (RR: 0.86 with 95% CI [0.68, 1.09], P = 0.21), and recurrence (RR: 1.00 with 95% CI [0.82, 1.22], P = 0.99). However, the major bleeding rate was significantly higher among women (RR: 0.69 with 95% CI [0.48, 0.98], P= 0.04). Also, there was no difference between men and women regarding catheter thrombolysis (RR: 0.96 with 95% CI [0.81, 1.14], P= 0.66) and heparin infusion (RR: 1.00 with 95% CI [0.95, 1.04], P= 0.90).

Conclusion:
There was no difference between men and women regarding clinical and management of PE outcomes, with a trend towards worse outcomes and decreased interventions among women, with a significant increase in major bleeding. Further policy measures are required to investigate the reasons behind this trend and if it has any clinically significant impact on patients' management and prognosis.
Abstract 139: Targeted Blood Pressure, Oxygenation, and Duration of Device-Based Fever Prevention After Out-of-Hospital Cardiac Arrest - Effects on 1 Year Survival
Authors: Meyer Martin A , Hassager Christian , Schmidt Henrik , Moller Jacob , Kjaergaard Jesper
Published: December 2023

Background:
In the post-resuscitation phase after cardiac arrest various treatment modalities have been proposed for improving outcomes. The “Blood Pressure and Oxygenation Targets in Post Resuscitation Care” (BOX) trial investigated whether, a higher versus lower blood pressure target, a liberal versus restrictive oxygenation target, and a longer versus shorter duration of device-based fever prevention in comatose patients could improve outcomes. No differences in rates of discharge from hospital with severe disability or dying from all causes at 90 days were found for neither of the 3 interventions However, the long-term effects of these interventions are unknown.

Objective:
To investigate the effects of each of the 3 interventions of the BOX-trial on 1-year mortality rates.

Methods:
In the BOX trial (NCT03141099), comatose resuscitated out-of-hospital cardiac arrest patients were randomly assigned to the following interventions at hospital admission: 1. A blood pressure target of either 63 mmHg or 77 mmHg (blinded); 2. An arterial oxygenation target of 68 to 75 mmHg or 98 to 105 mmHg; 3. Device-based fever prevention administered as an initial 24 hours at 36°C and then either 12 or 48 hours at 37°C a total of 36 or 72 hours. Patients were followed for 1 year for the occurrence of death from all causes, and mortality rates are reported separately for each of the 3 interventions.

Results:
For all three interventions 789 patients were included in the analyses. For the interventions of higher compared to lower blood pressure targets, the 1-year mortality rates were 36% (143 of 393) and 35% (138 of 396), respectively (log-rank p=0.47). For the interventions of liberal compared to restrictive oxygenation targets the 1-year mortality rates were 37% (146 of 395) and 34% (135 of 394), respectively (p=0.46). For the interventions of device-based fever prevention for a total of 72 hours compared to 36 hours the 1-year mortality rates were 36% (142 of 396) and 35% (139 of 393) respectively (p=0.89).

Conclusions:
There were no indications of differentiated rates of mortality at 1 year for neither a higher compared to lower targeted blood pressure, a liberal compared to restrictive oxygenation target, nor a longer compared to shorter duration of device-based fever prevention.
Abstract 13902: Using a Proteomics-Based Cardiovascular Risk Test to Identify Systemic Changes in a Clinical Trial of Nonalcoholic Fatty Liver Disease
Authors: Sanyal Arun , Simpson Missy , Hinterberg Michael , Hales Erin , Paterson Clare , Neuschwander-Tetri Brent , Diehl Anna Mae , Dasarathy Srinivasan , Loomba Rohit , Chalasani Naga , Kowdley Kris , Hameed Bilal , Kleiner David , Behling Cynthia , Tonascia James , Yates Katherine , Williams Stephen A
Published: December 2023

Background:
Nonalcoholic steatohepatitis (NASH) is associated with increased cardiovascular outcomes. Assessment of the impact of NASH therapy on cardiovascular risk is an important element of NASH drug development but is challenging particularly in early phase trials. Aptamer-based proteomic profiles (Somalogic®) in serum have been used to develop and validate a risk score as a surrogate for cardiovascular (CV) risk.

Hypothesis:
Improvement in NASH histology will result in improved proteomic cardiovascular risk scores.

Methods:
A post-hoc analysis of proteomic profiles of serum samples, using the Somalogic® platform, from the Pioglitazone vs. Vitamin E vs. Placebo for Treatment of Nonalcoholic Fatty Liver Disease (PIVENS) trial was conducted. PIVENS was a 96-week trial of nondiabetic participants with (NASH). We applied the proteomic CV risk scores to samples from baseline, on therapy and end of treatment visits (n=7) visits and received liver histology results at baseline and 96 weeks on N = 209 (84.6%) study participants. Generalized linear and mixed models were used to assess the association between CV risk score, treatment arm and change in liver biopsy results.

Results:
Baseline scores were similar across groups (mean 0.19, SD 0.14). There was no association between treatment arms and changes in scores during therapy and end of treatment. However, improvement in histological markers of activity (lobular inflammation and NAFLD activity score) and fibrosis were associated with improved cv risk scores (Figure) (p< 0.05 for all).

Conclusions:
Improvement in hepatic inflammation, NAFLD activity score and fibrosis were associated with improved proteomic CV risk scores regardless of treatment provided. Additional prospective validation of these findings is warranted. Proteomic profiling can potentially be used to track changes in cardiovascular risk profile changes in response to therapy in the short term NASH treatment trials.
Abstract 13937: Socioeconomic Status in Pediatric Patients With Anomalous Aortic Origins of Coronary Arteries: An Individual- and Zip Code-Level Analysis
Authors: Sidiq Sameer A , Przybycien Thomas , Gray Kimberly , Mihail Sandra , Doan Tam , Sachdeva Shagun , Reaves-O'Neal Dana , Binsalamah Ziyad , Molossi Silvana M
Published: December 2023

Introduction:
Anomalous aortic origin of a coronary artery (AAOCA) is the second leading cause of sudden cardiac death in the young. Limited data is available on potential disparities on access to care and whether socioeconomic status is associated with AAOCA.

Hypothesis:
AAOCA occurrence, severity, and treatment relate to socioeconomic status and may unfold inequities to care.

Methods:
Single-center retrospective study of 553 pediatric patients with AAOCA residing in Texas. Zip code socioeconomic characteristics were extracted from American Community Survey 2021 5-year estimates. All Texas zip codes were ordered into quartiles by characteristic. Age at diagnosis, signs of ischemia, and surgery status were compared by race and zip code parameters. Mann-Whitney U test was for non-parametric variables and χ
2
test, Fisher’s test, or one-way ANOVA for categorical variables.

Results:
Table 1 depicts patients’ demographics. AAOCA patients tended to reside in zip codes at the 4
th
quartile of income (39%, p=<0.001), education (29%, p=0.003), and employment (42%, p=<0.001) (Table 2). There was no difference in age at diagnosis, signs of ischemia, or occurrence of coronary surgery by individual race or zip code socioeconomic parameters.

Conclusions:
AAOCA pediatric patients tend to live in zip codes with higher socioeconomic status (SES). These differences may reflect disparities in access to diagnosis and care. Further studies are needed to determine the burden of AAOCA in low SES populations.
Abstract 13938: Trends in In-Hospital Implantation of Implantable Cardiac Monitors in the Unites States: 2016-2019
Authors: Nahlawi Acile , Sanadgol Ghazal , Ptaszek Leon , Ruskin Jeremy N
Published: December 2023

Introduction:
Implantable cardiac monitors (ICM) are widely employed for long-term cardiac rhythm monitoring. While a majority of ICMs are implanted on an outpatient basis, national estimates on their use in the inpatient setting are lacking.

Methods:
The National Inpatient Sample and the National Readmission Database were queried to identify inpatient ICM implantations between 2016 and 2019. Baseline characteristics, in-hospital outcomes, readmission rates, and trends over time were assessed for the study population and compared between the largest diagnostic cohorts: neurologic and cardiac.

Results:
A total of 101,430 adults underwent in-hospital ICM implantation between 2016 and 2019 (52.9% neurologic, 39.2% cardiac). Patient characteristics and outcomes are shown in Table 1. There was a 170% increase in inpatient ICM procedures from 2016 to 2019. Significant changes in patient profiles and readmission rates were observed over the study period. The trends are shown in Table 2a. After adjusting for confounders, patients with cardiac indications were more likely to have complications and be readmitted, but had lower mortality, length of stay, and hospitalization cost compared with the neurology cohort. The ORs are shown in Table 2b.

Conclusions:
The number of inpatient ICM implantations has increased significantly, likely reflecting expanding indications. The profiles of patients receiving ICM also changed to include more primary neurologic indications, comorbidities, and non-white races. Small and medium sized hospitals performed the procedure more frequently. Complication rates were extremely low and remained constant during the study period.
Abstract 13955: Real-World Patients With Obstructive Hypertrophic Cardiomyopathy Treated With Mavacamten: A US Single Center Experience
Authors: Reza Nosheen , Dubey Anand , Carattini Thomas , Maya Juan , Ferri Mauricio , Botros Afraim , Marzolf Amy , Hornsby Nicole , de Feria Alejandro , Owens Anjali T
Published: December 2023

Background:
Mavacamten, a first-in-class allosteric reversible inhibitor of cardiac myosin ATPase, was approved by the US Food and Drug Administration for the treatment of symptomatic obstructive hypertrophic cardiomyopathy (HCM) in April 2022.

Purpose:
To describe the characteristics of real-world patients initiated on mavacamten at a US HCM center of excellence.

Methods:
All patients started on mavacamten from May 2022 to February 2023 were included. Baseline demographics, clinical characteristics, and echocardiographic data, including left ventricular ejection fraction (LVEF) and left ventricular outflow tract (LVOT) gradients at rest and with Valsalva, were collected. Descriptive statistics were presented as means (standard deviations) and medians (interquartile ranges [IQRs]) or as counts and percentages as appropriate.

Results:
Of 45 patients initiated on mavacamten in the study period, 47% were female, 13% were non-White, and median age was 63 years (IQR 48, 70). Two-thirds were privately insured. Hypertension was common (56%), and 27% had an implantable cardioverter defibrillator. Median duration of HCM diagnosis was 6 years (IQR 4, 13), and two patients (4%) had undergone septal reduction therapy. At the time of the baseline echocardiogram prior to drug initiation, 42% had NYHA III symptoms, 56% were on background monotherapy with a beta-blocker, 24% with a nondihydropyridine calcium-channel blocker, and 20% were on both. All patients were in either sinus or an atrial-paced rhythm. Median LVEF was 69% (IQR 65, 75), and median septal wall thickness was 19 mm (IQR 18, 22). Median resting LVOT gradient was 57 mmHg (IQR 35, 80), and median Valsalva LVOT gradient was 78 mmHg (IQR 63, 91) (
Table
).

Conclusions:
In this single center experience of patients with obstructive HCM initiated on mavacamten, clinical characteristics were largely similar to those of patients enrolled in the phase 3 randomized trials of mavacamten, EXPLORER-HCM and VALOR-HCM.
Abstract 13956: Trends in Cardiology Specialty Applicants and Match Rates: A Comparative Analysis From 2017 to 2021
Authors: Obeidat Omar , Abughazaleh Saeed , Tarawneh Mohammad
Published: December 2023

Introduction:
The demand for well-trained cardiologists is increasing, particularly in the US. Understanding trends in cardiology specialty applicants and match rates is crucial to address the demand-supply gap.

Aim:
Analyze the trends in cardiology specialty applicants and match rates between 2017 and 2021.

Methods:
Data from the NRMP and the ABIM websites were examined using chi-square tests to examine changes in match rates among different applicant types. Furthermore, we assessed the proportion of applicants matching at their first, second, third, or subsequent choices. Statistical analysis was conducted using IBM SPSS version 23.

Results:
There is a significant increase in the number of matched US MD applicants from 482 in 2017 to 549 in 2021 (p=0.0001). However, the match rate for US MD applicants experienced a decline from 89.8% in 2017 to 83.1% in 2021. The number of matched US DO applicants also significantly increased from 60 in 2017 to 103 in 2021 (p=0.0001), with the statistically significant change starting in 2020. We observed a decrease in an applicant's probability of matching at their first choice from 52.7% to 45.3% after the virtual interviews season (p=0.001). In contrast, the probability of matching at a program beyond the third choice increased over time, rising from 152 in 2017 to 288 in 2021.

Conclusions:
This study highlights the increasing competitiveness of the cardiology match process. The observed trends in match rates underscore the challenges faced by different applicant groups, particularly after the implementation of a virtual interview format. Further investigation into these factors is warranted to better understand and address the disparities.
Abstract 13962: Exploring the Therapeutic Potential of SGLT2 Inhibitors and Oral Ketone Ester in HFpEF: A Comprehensive Exploration of Cardiac Function, Structure, and Metabolism in a Rat Model
Authors: Yurista Salva , Guarin Bedoya David , Eder Robert , Chen Shi , Jiang William , Welsh Aidan , Liu Feiyang , Weigand-Whittier Jonah , Yen Yi-Fen , Nguyen Christopher
Published: December 2023

Introduction:
This study aimed to assess the potential efficacy of the SGLT2 inhibitor empagliflozin and oral ketone ester supplementation as treatments for heart failure with preserved ejection fraction (HFpEF), which is commonly associated with obesity and type 2 diabetes mellitus.

Methods:
Twenty-week-old obese ZSF-1 rats were initially fed a high-fat diet (HFD) to establish and maintain the phenotype. Subsequently, the rats were randomly assigned to different treatment groups. These groups consisted of a control group receiving only the high-fat diet (HFD), as well as groups receiving empagliflozin, ketone ester (DeltaG®, KE), or a combination of both in addition to the HFD. Cardiac magnetic resonance imaging (CMR) and hyperpolarized carbon-13 (13C) labeled pyruvate magnetic resonance spectroscopy imaging were used to evaluate cardiac function and metabolism. Histological and molecular markers of cardiac remodeling were assessed in the left ventricle.

Results:
Untreated HFpEF rats exhibited obesity, diabetes, cardiac hypertrophy, atrial enlargement, lung congestion, increased cardiomyocyte size and fibrosis, as well as elevated expression of atrial natriuretic peptide (ANP), col1a1 (fibrosis marker), and TIMP1. The treatment groups displayed decreased body weight, increased circulating ketone levels, and reduced blood glucose levels. All treatment regimens significantly mitigated ventricular hypertrophy, atrial enlargement, and lung congestion. Furthermore, they reduced cardiomyocyte size, ANP expression, fibrosis marker expression, and increased cardiac ATP levels. CMR revealed that the combination of empagliflozin and KE resulted in improvement in diastolic function. Hyperpolarized [1-13C] pyruvate imaging revealed a decrease in lactate/pyruvate ratio in empagliflozin-treated hearts, indicating improved oxidative metabolism.

Conclusions:
The findings of this study suggest that targeting cardiometabolic dysregulation holds promise as an effective approach for the treatment of HFpEF. While both empagliflozin or KE alone demonstrated improvements in cardiac energetics and remodeling, the combination of empagliflozin and KE yielded the most notable benefits in enhancing cardiac diastolic function.
Abstract 13973: Amyloidosis and Heart Failure is a Deadly Combination: A Retrospective Study From 2015-2019 Using the National Inpatient Sample
Authors: Singireddy Shreyas , Chawla Raghav , Gonzalez Cardona Jaime , Patel Dipal , Andanamala Haripriya
Published: December 2023

Introduction:
Heart failure (HF) is a common cause of hospitalization in the United States. Amyloidosis has become a more accepted cause of HF in the US however contemporary data on amyloidosis affecting the heart is relatively lacking even in the setting of increased mortality and morbidity rates. This study is aimed to define the prevalence of HF in amyloidosis along with looking at inpatient mortality, length of stay and other relevant factors.

Methods:
For the current study, the National Inpatient Sample (NIS) was queried for the years 2015 Q4-2019. Our cohort of interest included patients with amyloidosis. We further identified patients with heart failure using the ICD-10 diagnosis codes algorithm for Elixshauser comorbidity scoring.

Results:
A total of 23,586 patients were identified with amyloidosis between 2015 Q4 and 2019. Interestingly, 49% of those patients (11,560 people) were identified with a diagnosis of HF, reflecting its increased prevalence in patients with amyloidosis. The mean age of the cohort was 71.9 years (SD=12.3), Patients with heart failure were overall more likely to be males (63.7% vs 50.2%, p<0.001), and were more likely to be African American (30.4% vs 16.2%, overall p<0.001), compared to patients without heart failure. When compared to amyloidosis subjects without HF, those with HF experienced an increased rate of mortality (7.2% vs 5.5%, p<0.001), a longer length of stay (LOS) with a mean difference of 0.7 days (7.9 days vs 7.2 days, p<0.001), and a more costly overall hospitalization with a mean difference of $10,906.1 ($90159.3 vs $79253.2, p<0.001). Upon multivariable logistic regression analysis, the presence of HF (OR 1.24, 95%CI 1.11-1.401, p<0.001) was associated with higher odds of in-hospital mortality.

Conclusions:
Our study shows that HF is a dominant comorbidity in patients with amyloidosis with almost every other patient being affected. Additionally, when compared to those without HF, patients with HF were more likely to be African American, have a longer length of stay, have more costly admissions, and overall had a higher rate of in-patient mortality.
Abstract 13988: Post Stress Test High-Sensitivity Cardiac Troponin I in the Evaluation of Patients With Acute Chest Pain for Enhanced Ischemic Risk Assessment: A Pilot Study
Authors: Zlochiver Viviana , Walczak Sara , Adefisoye James , Runningen Phyllis , Klein Sara , Kresa Jodi , Lobacz Don , Peterson Michael , Salfer Joell , Stenzel Nataly , Allaqaband Suhail Q , Jan M F
Published: December 2023

Introduction:
High-sensitivity cardiac troponin I (hs-cTnI) assays provide comparable diagnostic information that allow for better detection of myocardial injury. However, hs-cTnI release after cardiac stress testing and its potential utility for identifying inducible myocardial ischemia and risk-stratification are unclear.

Aim:
This pilot study examined integrating hs-cTnI biomarker testing into cardiac imaging stress testing to improve detection of inducible ischemia and aid in risk-stratification in patients with chest pain being evaluated for acute coronary syndrome (ACS).

Methods:
We prospectively enrolled 200 consecutive adult patients referred by the Emergency Room for cardiac stress testing for evaluation of possible ACS. A venous blood sample was collected between 0.5 and 2 hours post stress testing; cTnI concentrations were measured in-house by high sensitivity methods. Changes from pre-stress test hs-cTnI concentrations were calculated and association with outcome was explored using a logistic regression model.

Results:
Patient median age was 62 years, IQR 54-70; 49% were women. ACS known risk factors included hypertension 81.5%, cigarette smoking 49.5% and diabetes 33.5%. Median BMI was 31.63 kg/m
2
, IQR 27.24-35.84. Pre-stress test hs-cTnI median levels were 6 ng/L, IQR 5-9, for women (URL <52 ng/L) and 8 ng/L, IQR 6-12, for men (URL <77 ng/L). A total of 121 patients (60.5%) underwent nuclear stress tests, and 79 (39.5%) received echocardiographic stress tests. Of the 191 samples analyzed, 36% revealed increased hs-cTnI levels from pre-stress test values: 33% in nuclear stress tests (median increase 2 ng/L, IQR 1-5), 41% in echocardiographic stress tests (median increase 2 ng/L, IQR 1-5). In the 155 patients with 6 months of follow-up, changes in post-stress test hs-cTnI levels were not significantly correlated to stress test results, percutaneous coronary interventions or death (p=.85).

Conclusion:
This study provides insight into the potential of hs-cTnI to aid in identifying inducible myocardial ischemia in a real-world, high-throughput setting. Although a subset of patients exhibited modest increases in hs-cTnI post stress testing, overall, these did not appear to be correlated with inducible myocardial ischemia.
Abstract 13992: A Dacron Limited Transannular Patch Prevents Progressive Pulmonary Valve Annulus Dilation: Results of Serial Early, Intermediate, and Long-Term Follow-Up
Authors: Swartz Michael F , Orie Gabrielle , Yoshitake Shuichi , Atallah-Yunes Nader A , Cholette Jill , Alfieris George
Published: December 2023

Objective:
The repair of tetralogy of Fallot (ToF) using a transannular patch can result in progressive pulmonary valve annulus (PVA) dilation, preventing the option of a future catheter-based pulmonary valve replacement and requiring early reoperation. A rigid Dacron limited transannular patch (LTAP) that nominally expands the PVA may prevent long-term annular dilation and reoperation.

Hypothesis:
Infants following a LTAP would have similar rates of PVA growth compared to infants requiring only a subvalvar (SV) repair.

Methods:
Infants < 1 year between 1998-2018 requiring a SV or LTAP ToF repair were divided into two groups based on the surgical approach. Pre-operative and serial follow-up echocardiograms quantified the PVA diameter and corresponding Z-Score at 5, 10, and 15 years. Multivariate analysis examined the risk factors for reoperation.

Results:
From 232 ToF repairs (LTAP-94; SV-138), the LTAP group was significantly younger (103±53 vs. 138±67 days; p<0.001) and had a smaller pulmonary valve annulus Z-Score (-2.9±1.4 vs. -0.8±1.4; p<0.001) at the time of repair. Over a follow-up of 10.4±5.9 years, PVA growth was linear in both groups (Figure 1). The PVA diameter was similar in both groups at 5 and 10 years but was significantly smaller within the LTAP group at 15 years. The PVA diameter Z-scores remained similar at 5, 10, and 15 years in both groups, and only one patient in the LTAP group had a PVA Z-score > 1.0 during follow-up. The 15-year freedom from reoperation between the LTAP and SV groups was (89 % vs. 91 % p=0.6). Greater age at the time of ToF repair was protective (Hazard Ratio: 0.989, 95% CI: 0.979, 0.998; p=0.01); however, PVA Z-Score or LTAP repair was not associated with reoperation.

Conclusions:
Infants following a Dacron LTAP have linear PVA growth, allowing future percutaneous pulmonary valve replacement and similar reoperation rates to those requiring only a SV repair.
Abstract 13995: Remote, Smart Device Based Cardiac Rehabilitation After Myocardial Infarction - Smart Rehab Study
Authors: Wohlfahrt Peter , Jenca Dominik , Mrazkova Jolana , Suchánek Pavel , Kotrc Martin , Sramko Marek , Melenovsky Vojtech , Zelizko Michael , Pitha Jan , Adamkova Vera , Kautzner Josef
Published: December 2023

Introduction:
After myocardial infarction (MI), increasing functional capacity is an important goal of cardiac rehabilitation, that improves prognosis. However, standard cardiac rehabilitation is not accessible to many patients. Telemedicine programs are emerging as promising alternatives to in-person programs, but evidence confirming its benefits is lacking.

Hypothesis:
Smart device based remote cardiac rehabilitation can improve functional capacity assessed by VO2peak after MI.

Methods:
Patients were offered participation at the time of hospitalization for MI. One month after MI, patients underwent a cardiopulmonary exercise test, 6-minute walking test (6MWT) and were randomized 1:1. In the intervention group, patients received a smart watch to track the recommended number of steps, that was derived from the 6MWT. Adherence to the recommendations was telemonitored by a study nurse, with an over the phone motivation talk if compliance was unsatisfactory. In the control group, patients were recommended 150 minutes/week of moderate intensity exercise. Exercise stress tests were repeated after 3 months.

Results:
In total, 59 patients (mean age 51.5±10.4 years, 10.2% women, 67.8% STEMI, 96.6% PCI, mean discharge EF 48±10%) were included in the study. At baseline, there was no difference in clinical characteristics and functional capacity between the intervention (n=29) and control (n=30) groups. After 3 months of the intervention, VO2peak improved in the intervention arm with between group difference of 1.56 ml/kg/min (95%CI 0.06-3.05, p=0.041), with no difference in 6-minute walking distance (p=0.11). The effect of intervention differed by baseline functional capacity (p for interaction <0.01). Among patients with VO2peak at baseline ≤95% predicted, the between-group VO2peak difference after 3 months was 2.46 ml/kg/min (95% CI 0.78-4.13, p=0.005), and also oxygen uptake efficiency slope (between group difference 235, 95% CI 43-428, p=0.02) and 6-minute walking distance improved (between group difference 60m, 95% CI 1.5-119, p=0.045).

Conclusions:
Smart device based remote cardiac rehabilitation improves functional capacity after myocardial infarction, particularly in those with decreased functional capacity. NCT03926312
Abstract 14011: Micra AV Leadless vs. Dual-Chamber Transvenous Pacing Outcomes Among Patients With End-Stage Renal Disease in the Medicare Population
Authors: Longacre Colleen , Higuera Lucas , Crossley George H , El-Chami Mikhael F
Published: December 2023

Introduction:
Leadless pacing is often considered a useful alternative for patients with end-stage renal disease (ESRD) due to their limited vascular access and high infection risk. However, there is limited evidence on the comparative outcomes of leadless pacing vs. transvenous pacing in this population.

Hypothesis:
The reduction in complications and reinterventions associated with leadless pacing in the broader population extends to patients with ESRD.

Aims:
To compare complications and reinterventions between ESRD patients implanted with a Micra AV leadless pacemaker vs. a dual-chamber transvenous pacemaker.

Methods:
Data from the Micra Coverage with Evidence Development (CED) Study were used to identify ESRD patients implanted with a Micra AV leadless pacemaker (N=1,116), or a dual-chamber transvenous pacemaker (N=2,163) between February 5, 2020 and December 1, 2021 in the Medicare population. Logistic regression was used to compare unadjusted and propensity score overlap weight-adjusted 30-day acute complication rates. Cox models were used to compare 6-month chronic complications and reinterventions between groups.

Results:
ESRD patients implanted with Micra AV had a higher overall comorbidity burden (mean Charlson Comorbidity Index 7.9 vs. 7.6, P=0.001) and higher rates of emergency admission (18.6% vs. 14.0%, P=0.001). Despite these differences, there was no difference in the rate of complications at 30 days (unadj. 13.9% vs. 13.8%, P=0.92; adj. 12.9% vs. 14.6%, P=0.20). At 6 months, Micra AV patients had significantly lower rates of chronic complications (unadj. HR 0.72, 95% CI: 0.54-0.96, P=0.02; adj. HR 0.64, 95% CI: 0.48-0.87, P=0.004) and reinterventions (unadj. HR 0.50, 95% CI: 0.29-0.86, P=0.01; adj. HR 0.53, 95% CI: 0.30-0.91, P=0.02)
(figure)
.

Conclusion:
In patients with ESRD, AV synchronous leadless pacing is associated with lower rates of complications and need for reintervention compared to dual-chamber transvenous pacing.
Abstract 14024: Proteomic Predictors of Transitioning From Metabolically Healthy to Unhealthy Status in Middle-Aged Adults: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Ozkan Bige , Echouffo Justin B , North Kari E , Nambi Vijay , Hoogeveen Ron C , Ballantyne Christie M , Selvin Elizabeth , Coresh Josef , Ndumele Chiadi E
Published: December 2023

Background:
Metabolic health status predicts adverse cardiovascular outcomes. Among persons with similar weight, some metabolically healthy individuals stay metabolically healthy, whereas others develop metabolic syndrome (MetS) over time.

Hypothesis:
Plasma proteins can identify biological correlates of transitioning from metabolically healthy to unhealthy status.

Methods:
We quantified 4,955 plasma proteins using SomaLogic v4.0 in stored samples of ARIC Visit 2 participants. We assessed metabolic health at Visits 2 (1990-92) and 4 (1996-98). We split the sample into 2/3 discovery and 1/3 validation subsamples and used Bonferroni-corrected p-values. Among metabolically healthy individuals (no MetS) at Visit 2, we evaluated the associations of baseline plasma protein concentrations with the odds of developing metabolic unhealthy status by Visit 4 using logistic regression. We performed gene product enrichment analysis to assess biological pathways associated with transitioning to metabolically unhealthy status.

Results:
We included 4,539 participants (mean age: 56±6 years, 58% women, 17% Black adults, mean BMI 25 kg/m
2
). Adjusting for confounders, 306 proteins were significantly associated with transitioning from metabolically healthy to unhealthy status. After further adjustment for BMI, 121 proteins had significant associations (p<10
-5
). Of these, 49 proteins were validated (p<0.05/121). We identified proteins with known associations (growth hormone receptor, adiponectin, plasminogen activator inhibitor) with metabolically unhealthy status and ~20 novel proteins (MXRA8, VOPP1, CRYZL1). Biological pathways overrepresented by these proteins included tyrosine kinase signaling, complement and coagulation cascades, and calcium signaling pathways.

Conclusions:
Plasma proteins are linked to developing metabolic unhealthy status over 6 years. These proteins could be useful in identifying and preventing poor metabolic health.
Abstract 14039: Therapeutic Potential of Beta Hydroxybutyrate in Nonalcoholic Fatty Liver Disease (NAFLD)-Induced Cardiovascular Disease
Authors: Badmus Olufunto O , Taylor Lucy C , Greer Jennifer R , McGowan Karis E , Hinds Terry , Stec David E
Published: December 2023

Background:
Cardiovascular disease (CVD) is the leading cause of mortality in non-alcoholic fatty liver disease (NAFLD). Beta hydroxybutyrate (BHOB), a liver metabolite, is the major ketone that serves as an alternative fuel source in the body. Our previous studies show that hepatocyte peroxisome proliferator activator receptor-α knockout (Ppara
HEPKO
) mice, model of NAFLD-induced CVD, exhibit reduced circulating levels of BHOB.

Hypothesis:
We hypothesized that restoring plasma BHOB levels will improve cardiovascular function in Ppara
HEPKO
mice.

Aims:
To determine the therapeutic role of BHOB in NAFLD-induced CVD.

Methods:
30 weeks old male Ppara
HEPKO
mice were given 1,3 butanediol (20% in drinking water) (Ppara
HEPKO
+ BHOB) or vehicle (Ppara
HEPKO
) (n=6) for 6 weeks. Plasma BHOB was measured at baseline and after treatment. Cardiac structure and function were measured by high resolution ultrasound echocardiography (VEVO 3100), using the B-mode, M-mode, pulse wave and tissue doppler at baseline and after treatment. Mean arterial blood pressure was measured by radiotelemetry. Liver fat was determined by EchoMRI, Oil Red O staining and hepatic triglyceride levels.

Results:
After 6 weeks of BHOB treatment, Ppara
HEPKO
exhibit increased plasma BHOB compared to baseline (0.5 ± 0.01 vs. 0.2 ± 0.02mmol/L), attenuated arterial blood pressure compared to control (109 ± 3 vs. 121 ± 4mmHg), improved systolic function: cardiac output (13.8 ± 0.8 vs. 11.1 ± 0.7ml/min), stroke volume (31.1 ± 2.1 vs. 23.4 ± 1.3ml/min), improved diastolic function: isovolumic relaxation time (18.7 ± 0.8 vs. 20.6 ± 0.9m/sec), E/e’ (-29.6 ± 0.9 vs. -32.4 ± 1.4), and attenuated vascular stiffness. Interestingly, BHOB did not alleviate hepatic fat compared to control as demonstrated by EchoMRI (0.8 ± 0.3 vs. 0.7 ± 0.3), hepatic triglyceride (1.4 ± 0.3 vs. 1.3 ± 0.2mM) and Oil Red O staining.

Conclusion:
Our findings indicate that BHOB treatment improves arterial blood pressure, systolic, diastolic, and vascular function in, Ppara
HEPKO
knockout mice. However, BHOB did not alleviate hepatic steatosis suggesting that BHOB improves cardiovascular function in Ppara
HEPKO
mice independent of changes in hepatic fat content.
Abstract 14051: The Associations Between Loneliness and Circulating Lipoproteins as Well as Diabetes Risk in African-American Women Residing in Resource-Limited Neighborhoods: Data From the Step It Up Physical Activity Intervention
Authors: Reynolds Sandy , Baumer Yvonne , Dave Ayushi , Cintron Manuel , Tarfa Hannatu , Pita Mario , Ortiz-Whittingham Lola , Potharaju Kameswari , Baez Andrew , Thompson Keitra , Osei Baah Foster , Ayers Colby , Neally Sam , Curlin Kaveri , Vijayakumar Nithya , Mitchell Valerie , Marah Marie , Collins Billy , Saurabh Abhinav , Sampson Maureen , Remaley Alan , Powell-Wiley Tiffany M
Published: December 2023

Background:
Loneliness is a public health crisis and recent reports suggest that people suffering from loneliness have increased cardiovascular disease (CVD) risk. A potential link between loneliness and CVD is an atherogenic shift in the lipoprotein profile. We investigated associations between loneliness and lipoproteins in African American (AA) women residing in resource-limited neighborhoods of Washington, DC.

Methods:
Participants were enrolled in Step It Up, a technology-based, community-engaged PA intervention. Fasting blood samples were drawn at baseline to measure lipoproteins using nuclear magnetic resonance (NMR) technology. The Lipoprotein Insulin Resistance Index (LP-IR), a diabetes risk marker, was calculated. Loneliness was measured using the UCLA Loneliness scale. Associations between loneliness, lipoprotein particles and LP-IR were analyzed using multivariable regression adjusted for BMI, ASCVD 10-year risk score, and lipid-lowering therapy.

Results:
106 AA women with CVD risk (Age 55.9±13, BMI 36.3±6.7) were enrolled into Step It Up. We found that higher loneliness at baseline was associated with higher Apo-B, LDL concentration (LDL-c), and LDL particle number (LDL-p) but not with LDL particle size (LDL-z, Table). We observed that higher loneliness associated with increased triglyceride rich lipoprotein size (TRL-z). This relationship seems to be due to very large and large TRL particles (TRL-p, Table). No significant associations were found with the HDL-related measures. Lastly, loneliness significantly associated with LP-IR, a new diabetes risk marker (Table).

Conclusions:
Thus, our data show that higher loneliness in AA women from under resourced neighborhoods is associated with increased hyperlipidemia and diabetes risk. This highlights a potential mechanism by which loneliness may accelerate CVD risk and support the urgent need for multilevel interventions to reduce loneliness and CVD risk in at-risk populations.
Abstract 14054: Pre-Hospital Predictors of Cardiogenic Shock Among ST-Segment Elevation Myocardial Infarction Patients With and Without Cardiac Arrest: Implications for Shock Teams
Authors: Yang Cathevine , Lee Terry , Kochan Andrew , Barker Madeleine , Roston Thomas , Singer Joel , Grunau Brian , Helmer Jennifer , Wong Graham C , Fordyce Christopher
Published: December 2023

Introduction:
Cardiogenic shock (CS) develops in up to 8.6% of patients with STEMI and is associated with poor outcomes. Early identification of patients at risk of CS is paramount to enable timely mobilization of shock teams to improve outcomes.

Hypothesis:
We hypothesized that pre-hospital clinical parameters can predict development of CS in STEMI patients undergoing primary PCI. Using these predictors, we developed a risk score to rapidly identify patients at risk of developing CS.

Methods:
We performed a retrospective cohort study using prospective data from a centralized STEMI registry of a healthcare system serving 1.25 million people. Patients presenting with STEMI with intent to receive primary PCI between 2012 to 2020 were included. Logistic regression was used to assess the relationship between predictors and the occurrence of CS at any point from first medical contact to hospital discharge. The prediction model was converted to a risk score by scaling of the regression coefficients. The accuracy of the risk score was determined using C-statistic.

Results:
Among 2736 consecutive STEMI patients, 15.2% (n=415) developed CS. Overall, 10.9% of patients had prehospital cardiac arrest, which was more likely in those with CS (46.5% vs. 4.5%, p<0.001). Patients with CS were more likely to have prolonged first medical contact-to-device time per national guidelines (74.7% vs. 53.3%, p<0.001). Regression analysis identified 8 parameters that predict CS as shown in Table 1. Two models, with and without cardiac arrest, were developed. Both models show C-statistics of 0.80 and above.

Conclusions:
Among STEMI patients with intent to undergo primary PCI, we identified 8 clinical parameters that strongly predict CS. This has been developed into a scoring system which can be easily used by emergency service providers to rapidly identify patients with CS and enable timely shock team activation.
Abstract 14056: The Role of Immune Activation in Trametinib-Induced Cardiomyopathy
Authors: Morrissey Samantha M , Beak Ju Youn , Schroder Melissa , Sandroni Peyton B , Jensen Brian C
Published: December 2023

Introduction:
Trametinib (Trm) is a highly selective inhibitor of MEK1/2, downstream targets of the RAS signaling pathway that has been used widely for the treatment of BRAF V600E/K-mutant melanoma. Multiple clinical trials are also underway investigating its use in colorectal, prostate cancer, leukemia, and triple negative breast cancer. Trm is generally well tolerated but can be associated with potentially serious cardiotoxicity in 5-20% of treated patients. The specific mechanisms driving Trm-induced cardiomyopathy (TIC) are largely unexplored. The goal of this project is to investigate the role that resident and infiltrating inflammatory cells play in TIC.

Hypothesis:
Our data suggest that Trm provokes cardiomyocyte immune responses including increased production of inflammatory cytokines, NF-KB signaling, and macrophage infiltration. We hypothesize that this activation occurs through DAMP-driven activation of the TLR and cGAS-STING pathway.

Methods:
C57BL/6 mice were gavaged with Trm 3mg/kg/day for 3 days prior to sacrifice. Heart tissue was analyzed via RNAseq, confocal microscopy, and flow cytometry. In vitro assays were completed using neonatal rat ventricular myocytes (NRVM).

Results:
RNAseq data of whole heart tissue from Trm treated mice surprisingly demonstrated increased expression of transcripts in inflammatory pathways. In vitro stimulation of NRVMs with Trm demonstrated increased production of inflammatory cytokines including IFNy and increased NF-KB signaling. Confocal microscopy of Trm treated heart tissue demonstrated increased CD68+ macrophage recruitment compared to control. None of these findings would have been predicted by our previous knowledge of cardiomyocyte MEK biology.

Conclusions:
Trm treatment is associated with cardiomyopathy in up to 20% of patients. Understanding the mechanisms driving this disease pathogenesis may help reduce likelihood of adverse cardiac events associated with future MEK inhibitor therapy used alone or in combination with other agents. Our novel findings suggest that Trm causes immune dysregulation and inflammation in the heart. Future studies will focus on further characterization of immune cell subsets involved and mechanisms of innate immune activation in TIC.
Abstract 14068: The Lipid Droplet-Associated lncRNA
LIPTER
Preserves Cardiac Lipid Metabolism of Human Cardiomyocytes
Authors: Han Lei , Huang Dayang , Wu Shiyong , Liu Sheng , Wang Cheng , Wan Jun , Yang Lei
Published: December 2023

Background:
Lipid droplets (LDs) are cellular organelles critical for maintaining lipid homeostasis. LD accumulation is associated with cardiomyopathies and heart failure in hyperlipidemia-related metabolic disorders. Currently, the cardiomyocyte (CM) intrinsic mechanism governing LD transport remains poorly understood.

Hypothesis:
We hypothesize that long non-coding RNA (lncRNA) can directly participate in LD transport in human CMs.

Goals:
To reveal a lncRNA
LIPTER
-mediated lipid droplet transport system in human CMs and define its role in preserving cardiac lipid metabolism.

Methods:
LIPTER and MYH10 were knocked out in human iPS cells using CRISPR/Cas-9. Myh10 was conditionally knocked out in mouse CMs. A LIPTER transgenic mouse line was established to test the effects of LIPTER transgene on high fat diet-induced cardiac dysfunction. LIPTER was delivered into CMs of Lepr
db/db
mice using AAV-9.

Results:
We identified a human lncRNA, Lipid-Droplet Transporter (LIPTER), essential for LD transport in human CMs. LIPTER binds phosphatidic acid and phosphatidylinositol 4-phosphate on LD surface membranes and the MYH10 protein, connecting LDs to the MYH10-ACTIN cytoskeleton and facilitating LD transport. LIPTER and MYH10 deficiencies impair LD trafficking, mitochondrial function, and survival of human iPS cell-derived CMs. Conditional Myh10 deletion in mouse CMs leads to LD accumulation, reduced fatty acid oxidation, and compromised cardiac function. We identify NKX2.5 as the primary regulator of CM-specific LIPTER transcription. Notably, LIPTER transgenic expression mitigates cardiac lipotoxicity, preserves cardiac function, and alleviates cardiomyopathies in high fat diet-fed and Lepr
db/db
mice.

Conclusions:
We unveil a molecular connector role of
LIPTER
in intramyocyte LD transport, crucial for lipid metabolism of the human heart, and hold significant clinical implications for treating metabolic syndrome-associated heart diseases.
Abstract 14079: Inhibition of NOX2 Prevents Obesity-Mediated Atrial Fibrillation
Authors: Sridhar Arvind , DeSantiago Jaime , Arif Mahmud , Ly Olivia T , Chen Hanna , Barney Miles , Owais Asia , Jousma Jordan , Nukala Sarath Babu B , Wang Xinge , Abdelhady khaled , Massad Malek G , Rizkallah Lona Ernst , Ong Sang-Ging , Rehman Jalees , Darbar Dawood
Published: December 2023

Introduction:
Obesity is an independent risk factor for atrial fibrillation (AF). While oxidative stress plays an important role in obesity-mediated AF, the specific pathways that cause atrial remodeling remain unclear. NADPH oxidase 2 (NOX2), a major source of cytosolic reactive oxygen species (ROS) production in the heart, is increased in diet-induced obese (DIO) mice and can independently predispose to post-operative AF via atrial remodeling.

Hypothesis:
We used a
Nox2
-knock-out (KO) mouse model and mature human iPSC-derived atrial cardiomyocytes (hiPSC-aCMs) to test the hypothesis that NOX2 increase modulates ion channel remodeling in obesity-mediated AF.

Methods:
DIO mice and palmitic acid (PA)-treated hiPSC-aCMs were given a NOX blocker (apocynin), and GSK2793059, a NOX2-specific small molecule inhibitor respectively. Trans-esophageal rapid (TE) pacing was used to examine changes to the AF phenotype. Whole-cell patch clamping, qPCR, Western blotting, and electrical mapping were performed to study ion channel remodeling in both models.

Results:
DIO, DIO-Apocynin, and DIO
Nox2
-KO mice displayed increased weight compared to control and
Nox2
-KO mice (Figure A). After TE pacing, DIO-Apocynin mice displayed 28.2 ± 25.4 s and DIO
Nox2
-KO mice displayed 17.4 ± 31.8 s compared to 167.3 ± 168.9 s in DIO mice (Figure B). Electrophysiological studies show that Nox2 inhibition reverses ion channel remodeling in
I
Na
,
I
Ks
, and
I
Ca,L
(Figure D-F), and atrial fibrosis (Figure H) and prolongs the atrial action potential (AP; Figure C) and increases conduction velocity (CV; Figure G-I) in both DIO mice (Figure C-I) and PA-hiPSC-aCMs (Figure J-L).

Conclusions:
Collectively, genetic and pharmacological inhibition of NOX2 in DIO mice and PA-treated hiPSC-aCMs abrogate ion channel and structural remodeling and prevents the development of obesity-mediated AF. These findings have important implications for targeted antioxidant therapy for obese patients with AF.