bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 13468: Dietary Intake of Minerals and Risk of Cardiovascular Mortality in the Golestan Cohort Study
Authors: Yazdanpanah Mohammad Hosein , Torres Adriana , Sharafkhah Maryam , Poustchi Hossein , Etemadi Arash , Kamangar Farin , Dawsey Sanford M , Abnet Christian C , Hashemian Maryam , Malekzadeh Reza
Published: June 2023

Introduction:
Several studies have linked cardiovascular disease (CVD) to dietary intake of a few minerals, although the link is still unclear, and the findings may not apply to various populations. In a prospective study in a Middle Eastern population, we aimed to assess the relationship between dietary intakes of calcium, selenium, zinc, iron, magnesium, and copper and the risk of CVD mortality.

Methods:
We used data from the Golestan Cohort Study, which has followed 50,045 participants aged 40-75 years since 2004. We excluded subjects reporting extreme intakes of total energy and a positive history of cancer, CVD, or diabetes at baseline. Mineral intake was estimated from the baseline food frequency questionnaire. Supplement use was not common in this population. Mineral intakes were adjusted by the nutrient density method. We used Cox proportional hazards models to estimate hazards ratio (HR) and 95% confidence intervals (CI) for cardiovascular mortality using the lowest quintile of intake as a reference group for each mineral with adjustment for potential confounders.

Results:
We analyzed 41,863 subjects that had a mean age of 51.5+8.7 years at baseline
.
During 579,339 person-years of follow-up (median: 14.1 Years), 3,065 (7.22%) participants died due to CVD. Calcium was the only mineral with a mean intake below the US Recommended Dietary Allowance. We observed significant associations between calcium intake (HR
Q5 vs Q1
=0.82, 95% CI=0.73-0.93), selenium intake (HR
Q5 vs Q1
=1.14, 95% CI=1.01-1.29), and CVD mortality (P-values <0.05). We observed no statistically significant associations with zinc (HR
Q5 vs Q1
=1.10, 95% CI=0.98-1.24), iron (HR
Q5 vs Q1
=1.08, 95% CI=0.96-1.22), magnesium (HR
Q5 vs Q1
=1.01, 95% CI=0.90-1.14), or copper (HR
Q5 vs Q1
=1.11, 95% CI=0.99-1.26) intake and CVD mortality. When modeled as continuous linear variables, iron and copper intake were associated greater risk of CVD mortality (P-values<0.05).

Conclusion:
Dietary calcium intake was associated with decreased, whereas selenium and possibly copper intake were associated with increased risk of CVD mortality in this Middle Eastern population.
Abstract 13476: Prevalence of Hemochromatosis in Non-Rheumatic Valvular Heart Disease and Its Effect on Prognosis: A National Cohort Analysis
Authors: Hussain Bilal , Mahmood Ahmed M , Garcia Rafael , cuevas christel , Khan Sohail , Waqar Fahad , Alexander Thomas
Published: June 2023

Background

Hemochromatosis can lead to heart failure, starting as restrictive cardiomyopathy and resulting in dilated cardiomyopathy if not treated. There is limited literature regarding whether hemochromatosis has an impact on the prognosis of non-rheumatic valvular heart disease (NRVHD). We aimed to establish the prevalence of hemochromatosis in NRVHD patients and its prognostic implications.

Methods

A retrospective cohort analysis was conducted with National Inpatient Sample 2016-2019. Primary outcome was the effect of hemochromatosis on prognosis of patients with NRVHD. Secondary outcomes were the independent predictors of mortality which were calculated with multivariate logistic regression analysis.

Results

120,425 patients had a diagnosis of hemochromatosis with a prevalence of 0.085%, out of these 3.82% (n=4595) had NRVHD. Mean age was 65.4 years, 59% patients were males, 75% were white, and 18% were black. For individual valvular involvement, we observed that aortic valve was affected in 1.84% patients (n=2210), mitral valve in 1.82% patients (n=2195), tricuspid valve in 0.4% patients (n=485) and pulmonic valve in 0.13% patients (n=155). Hemochromatosis was associated with significantly lower odds of mortality of 53% in patients with non-rheumatic (NR) aortic valve disease (OR 0.47, CI 0.22 - 0.99, p=0.04). This association of hemochromatosis with reduction in mortality was not seen in patients with NR mitral (OR 0.49, p=0.06), tricuspid (OR 0.76, p=0.6), or pulmonary valve disease. The independent predictors of mortality in patients with hemochromatosis and NRVHD were acute liver failure (OR 5.4, p=0.05) and female gender (OR 3.7, p=0.02). Among the patients with hemochromatosis and NR aortic valve disease 8.3% underwent transcatheter while 6.1% underwent surgical aortic valve replacement.

Conclusions

Prevalence of hemochromatosis with co-morbid NRVHD is 3.82%. The independent predictors of mortality in this patient population are acute liver failure and female gender. Hemochromatosis is associated with 53% lower odds of mortality in patients with NR aortic valve disease. Extensive research and further studies are required to explore the possible causes for the observed reduced mortality.
Abstract 13478: Observatory of Hospitalizations and Mortality in 37 Cardiology Departments in 17 Sub-Saharan African Countries: The February Study From African Research Network
Authors: N'GUETTA Roland , Yameogo Valentin , Cavagna Pauline , Menta Ichaka , Ayo Bivigou Elsa , Kouam Kouam Charles , PERIER Marie-Cécile , Traore Abdoulaye K , Nzisabira Jolis , Houenassi Martin Dèdonougbo , Takombe Jean Laurent , Ngaide Aliou Alassane , Allawaye Lucien , Diop Ibrahima Bara , antignac marie , JOUVEN Xavier
Published: June 2023

Non-communicable diseases represent the second common cause of death in Sub-Saharan Africa (SSA) accounting for 50% of deaths in several countries. Furthermore, 80% of cardiovascular diseases (CVD) deaths occurs in low and middle-income countries. Data regarding the characteristic of patients with CVDs are scarce in SSA. To describe hospital admission for CVD and care components in 17 in SSA countries. We conducted a transversal and longitudinal study in CV departments of 37 hospitals (public and private) in 17 SSA countries. The February study is an ongoing observatory included all inpatients in February from each year since 2016. Data including socio-demographic and clinical characteristics, CV risk factors, causes of admission, medication and length of stay were collected during hospitalization by the investigating physicians. Patient wealth index was assessed by physicians as low, middle and high according to patient capacity to afford hospitalization. All analyses were performed with random effect on countries and through scripts developed in the R software 4.0.3. Overall, 4360 in-hospital patients were included in the February study, the mean age was 56.7 ± 16.8 years, and 56.4 % were men. Individual wealth index was low, middle and high in 1158 (27.7%), 1812 (43.4%) and 1203 (28.8%) patients, respectively. The main cause of hospital admission was heart failure (41.5%)(figure) followed by acute coronary syndrome (11.9%) and stroke (11%). Causes of admission varied significantly across countries and over years. Overall, 73.8% of patients had at least one CV risk factors and hypertension (≥ 140±90mmHg) was noticed in 55.2% of patients. Average length of stay was 10 days. Mortality rate was 11% and did not vary over time but was significantly different according to patient wealth index (p<0.05) consistent by sex, age, and type of hospital.The February observatory provides reliable data in SAA. High rate of hospitalization mortality remain open to investigation.
Abstract 13480: The Association Between Exercise Intolerance and Diagnostic Scores for Suspected Heart Failure With Preserved Ejection Fraction Patients
Authors: Lee Chan Joo , YOON MINJAE , Oh Jaewon , Kang Seok-min
Published: June 2023

Introduction:
The newly proposed HFA-PEFF and H
2
FPEF scores have been used in diagnosing heart failure with preserved ejection fraction (HFpEF).

Hypothesis:
We investigated the association between these scores and exercise intolerance in suspected HFpEF patients.

Methods:
We analyzed 2,031 patients with one more symptom of HF who underwent echocardiography, cardiopulmonary exercise test, and measurement of NT-proBNP between 2012 and 2021 at a single tertiary center. After excluding the patients with LVEF <50% or apparent cause of HF symptoms other than HFpEF, 1,032 patients with suspected HFpEF were enrolled in calculating the HFA-PEFF and H
2
FPEF scores to estimate the probability of HFpEF.

Results:
Patients (mean age 61 years old, 63.9% female, 6.7% atrial fibrillation) were stratified according to HFA-PEFF scores [0-1 (low, n=219), 2-4 (intermediate, n=590), or 5-6 (high, n=223)] and H
2
FPEF scores [0-1 (low, n=378), 2-5 (intermediate, n=605), or 6-9 (high, n=49)]. Cohen’s weighted kappa coefficient for agreement of both scores risk category was 0.47. The mean peak VO
2
was 29.4, 24.6, 20.6 (p<0.001), and 28.1, 23.1, 19.6 (p<0.001) ml/kg/min in the low, intermediate, and high-risk category according to HFA-PEFF and H
2
FPEF scores, respectively. Also, peak VO
2
was correlated with the HFA-PEFF and H
2
FPEF scores (r=-0.454, p<0.001; r=-0.463, p<0.001). The HFA-PEFF and H
2
FPEF had the predictive value of low peak VO2 (<20 ml/kg/min) with AUC 0.708 and 0.731, respectively.

Conclusions:
HFA-PEFF and H
2
FPEF scores were associated with exercise capacity. This association supports the clinical usefulness of HFA-PEFF and H
2
FPEF scores as an indicator of exercise intolerance in HFpEF patients.
Abstract 13499: Unravelling the Pathophysiology of Right Ventricular Maladaptive Hypertrophy in Chronic Pulmonary Hypertension Through Imaging and Omics
Authors: Garcia-Lunar Ines , Pereda Daniel , Jorge Inmaculada , Saiz Galindo Jorge , Solanes Nuria , Ascaso Maria , Galan Carlos , Rodr?guez Arias Juan J , Jiménez Francisco Rafael , Nuche Berenguer Jorge , Dantas Ana Paula V , Morán María , Camafeita Emilio , Rigol Montserrat , Barbas Coral , Vazquez Jesus , Fuster Valentin , Ibanez Borja , Garcia-Alvarez Ana
Published: June 2023

Introduction:
Right ventricular (RV) failure is the strongest determinant of survival in chronic pulmonary hypertension (PH), but its pathophysiological mechanisms remain unclear.

Hypothesis:
In addition to RV pressure overload, compounds liberated from the pulmonary vascular damage (identifiable by omics) may exert a detrimental effect on RV function in PH.

Methods:
Four different experimental models of RV pressure overload in 48 Yucatan pigs were developed: chronic postcapillary PH by pulmonary veins banding (M1); chronic PH by aorto-pulmonary shunting (M2); RV pressure overload by PA banding (thus without PH) (M3); and sham procedure (M0). Animals were evaluated at 1, 5 and 8 months after surgery by right heart catheterization, cardiac magnetic resonance (CMR), and blood/histological sampling. Unsupervised proteomic and metabolomic analyses were performed and compared among experimental groups and to the severity of RV dysfunction.

Results:
A total of 33 pigs completed follow-up (M1,n=8; M2,n=6; M3,n=10; and M0,n=9). As expected, M1&M2-animals developed chronic PH, whereas M3-animals had severely increased RV systolic pressure without PH (Table). M3-pigs developed more severe RV hypertrophy (significantly higher mass on CMR and cardiomyocyte area on histology), but maintained normal function. In contrast, M1&M2 animals developed RV systolic disfunction and increased myocardial apoptosis in M1. Plasma metabolomic and proteomic patterns differed among groups, highlighting greater inflammation and taurine/arginine deficiency in PH models (M1&M2), coagulation disturbances in M1, and predominant lipidomic changes in M3. Key proteins/metabolites from coagulation, complement system and apolipoproteins pathways significantly associated with RV performance.

Conclusion:
Maladaptive RV hypertrophy in PH is associated with significant changes in plasma proteins and metabolites. Their identification may help to identify potential targets.
Abstract 13512: Patiromer to Manage Hyperkalemia in Patients Receiving Optimized Renin-Angiotensin-Aldosterone System Inhibitors for Heart Failure (DIAMOND): Prespecified Analysis of Patients With Hyperkalemia or Previous Hyperkalemia
Authors: Coats Andrew J
Published: June 2023

Introduction:
Renin-angiotensin-aldosterone system inhibitors (RAASis) are central to the treatment of heart failure with reduced ejection fraction (HFrEF); hyperkalemia (HK) or fear of HK often leads to suboptimal RAASi use. In the DIAMOND trial, 85% of patients with HFrEF and HK (serum potassium [sK
+
] ≥5.0 mEq/L) or previous HK, which had led to RAASi discontinuation, achieved optimal RAASi and mineralocorticoid receptor antagonist (MRA) doses with open label run-in patiromer treatment. The benefit of using patiromer in patients with current HK vs a history of HK is unknown.

Methods:
Patients with HFrEF and either present HK or previous HK entered a single-blinded run-in phase ≤12 weeks to optimize RAASi while receiving patiromer; then were randomized (1:1) double-blind to continue with patiromer, or patiromer withdrawal (placebo). The primary endpoint was the mean change in sK
+
from baseline (BL) to the end of study. Secondary endpoints were: sK
+
>5.5 mEq/L, durable enablement of MRA at target dose, adverse events (AEs) of HK, HK-related hard outcomes, and a win ratio of novel RAASi use score. This prespecified analysis was conducted in patients with HK or with previous HK.

Results:
Of 1195 patients entering the run-in phase, 878 were randomized, of whom 354 (40%) had HK on study entry and 524 (60%) had normokalemia at BL. Of patients with HK (83.9%) and patients with previous HK (85.3%) achieved patiromer-facilitated RAASi optimization during the run-in. Patiromer consistently controlled sK
+
in patients both groups. A greater effect of patiromer on maintaining MRA at target dose, was seen in patients with HK versus those with previous HK.

Conclusion:
In patients with HFrEF, patiromer can effectively control sK
+
and facilitate the optimization of MRA use, this may be of most benefit to patients with HK.
Abstract 13542: Associations of Pulmonary Artery Stiffness With Mortality in Pulmonary Arterial Hypertension
Authors: Nelson Kyle , Elbaum Lindsay , Gonzalez Lengua Carlos A , Garcia-Alvarez Ana , Sanz Javier
Published: June 2023

Introduction:
Pulsatility, the relative area change of the pulmonary artery (PA) during the cardiac cycle has been associated with impaired prognosis in pulmonary arterial hypertension (PAH), but other measurements of stiffness are not well explored.

Hypothesis:
Multiple indices of PA stiffness derived from cardiac magnetic resonance (CMR) and right heart catheterization (RHC) predict outcome in PAH

Methods:
Retrospective chart review on 108 patients with PAH who had a clinically indicated CMR and RHC within 90 days, and for the primary endpoint of all-cause mortality. From CMR and RHC data, PA areas and indexes of stiffness (pulsatility, compliance, capacitance, distensibility, elastic modulus, and the pressure-independent stiffness index beta) were measured. Data was analyzed using Cox-proportional hazards models.

Results:
We included 108 patients with average age of 51 (+/- 13) years, 79% female with a mean PA pressure of 46 +/-12 mmHg, and a mean right ventricular ejection fraction (RVEF) of 38 +/-14%. After a median follow-up of 6 years, 58 (54%) patients had died. Most indices of increased stiffness were associated with higher mortality after adjusting for age, sex, diuretic use, mean PA pressure and RVEF (
Table
).

Conclusions:
Among patients with PAH, most measurements of PA stiffness strongly correlated with mortality.
Abstract 13589: Strong African Immigrant Social Network Influences Self-Care of African Immigrants With Chronic Illness
Authors: Osokpo Onome H , Iroegbu Christin , Lewis Lisa M , Huang Liming , Hirschman Karen , Naylor Mary D , Riegel Barbara J
Published: June 2023

Background:
Self-care is a fundamental component of chronic illness management. Although, there is increasing recognition that social networks can substantially impact the self-care of individuals with chronic illness, little is known about how social networks are associated with self-care among African immigrants living with hypertension, diabetes, or other chronic illness in the US.

Methods:
In this descriptive, cross-sectional study, we enrolled a convenience sample (n=128) of self-identified sub-Saharan African immigrants in the Northeastern U.S. age ≥ 35 years, with symptomatic chronic illness, who spoke and understood English. Self-care was measured with the Self Care of Chronic Illness Inventory measuring self-care maintenance, monitoring, and management (scores standardized 0-100, ≥70 adequate self-care). Social network was measured using four items that assess social network either with Americans or other African immigrants (e.g., “I spend my free time with African people”) using a 5-point response scale (1-Never to 5-Always); higher score=better social network. Multivariable linear regression was used to assess associations between social network and self-care adjusting for age, gender, marital status, education, employment status, and duration of US residency.

Results:
The sample on average was 56 years old (±11 years), male (68%), married (70%), college educated (82%), employed (66%), lived with family or others (89%), and had a long duration of residency (16±11 years). Most participants had hypertension (48%) and/or diabetes (20%). Self-care scores were adequate (
x
78.7, 79.3, 73.9 for self-care maintenance, monitoring and management). Social network as a composite score was positively associated with self-care maintenance (p=0.06). Social network with other African immigrants had a positive association with self-care maintenance (p=0.03) while social network with American people was not associated with self-care.

Conclusions:
In this sample of African immigrants, self-care was adequate. Having a strong social network with other African immigrants promoted self-care maintenance. Social networks of African immigrants can be used and harnessed in developing culturally concordant self-care interventions.
Abstract 13613: Prevalence of Atrial Fibrillation and Procedure-Outcome in Patients Undergoing Catheter Ablation for Premature Ventricular Contractions
Authors: Mohanty Sanghamitra , Shetty Sai Shishir , Baho Karim , Della Rocca Domenico G , QUINTERO MAYEDO ANGEL , MacDonald Bryan , Gianni Carola , Morris Trevor , Helmy Rami , Asfour Issa , Kessler Danielle , Bassiouny Mohamed , Gallinghouse G , Burkhardt John , Horton Rodney , Al-Ahmad Amin , Natale Andrea
Published: June 2023

Introduction:
Atrial fibrillation (AF) and premature ventricular contractions (PVC) are common arrhythmias encountered in clinical practice. Theoretically, retrograde atrial conduction can occur in the presence of PVC, causing atrial ectopy. However, the clinical significance of this association is not defined yet.

Hypothesis:
We investigated the prevalence of AF in patients with PVC and its impact on PVC ablation.

Methods::
Consecutive patients undergoing PVC ablation at our institution between 2016 and 2019 were included in this analysis. Patients with structural heart disease, hyperthyroidism, malignancy, alcoholism and advanced renal or hepatic disease were excluded. For all patients, 12-lead ECG was used to diagnose AF and assess PVC morphology. During the index procedure, all PVC morphologies were targeted for ablation. Patients were followed up with remote monitoring as well as ICD interrogations and office visits every 6 months for 2 years. Detection of any PVC in the electrogram was considered as recurrence.

Results:
A total of 394 patients undergoing PVC ablation were included of which 96 (24%) had the documented evidence of AF. Baseline characteristics of the study population
without
(group 1, n=298) versus
with AF
(group 2, n=96) is provided in table 1. Clinical parameters were comparable between the groups except age, which was higher in group 2. PVCs with multiple (≥2) morphology were detected at the index procedure in 41 (13.7%) and 58 (60.4%) patients in group 1 and 2 respectively (p <0.001). At 2 years of follow-up, recurrence rate following PVC-ablation was significantly higher in group 2 compared to group 1 (17 (18%) vs 27 (9%), p=0.026).

Conclusions:
In this consecutive series, AF was documented in 1/4
th
of the population undergoing PVC ablation and presence of AF was associated with lower procedural success at long term, which could be attributed to older age and significantly higher prevalence of multiple morphology’ PVCs in the group 2 population.
Abstract 13640: Sex Differences in Heart Failure With Reduced Ejection Fraction in the GALACTIC-HF Trial
Authors: Pabon porras Maria A , Cunningham Jonathan , Claggett Brian , Diaz Rafael , Felker Gary Michael , McMurray John J , Metra Marco , Heitner Stephen , Kupfer Stuart , Malik Fady , Solomon Scott , Teerlink John R
Published: June 2023

Introduction:

Women with heart failure with reduced ejection fraction (HFrEF) are undertreated with guideline recommended therapy and experience worse quality of life compared with men. Low enrollment of women in HFrEF outcomes trials has limited inferences about drug efficacy in women. We investigated sex-differences in baseline characteristics, clinical outcomes, and response to omecamtiv mecarbil in the GALACTIC-HF trial.

Methods:

The GALACTIC-HF trial randomized patients with symptomatic HFrEF with EF of 35% or less to omecamtiv mecarbil or placebo. Baseline characteristics for male and female participants were compared using parametric or non-parametric tests. Risk of the primary endpoint, heart failure event or cardiovascular death, was compared between sexes using Kaplan-Meier curves and Cox regression adjusted for 13 relevant clinical covariates. Treatment effect heterogeneity was evaluated by the sex*treatment interaction term.

Results:

Of the 8,232 patients enrolled, 1749 (21.2%) were women. Women had lower total Kansas City Cardiomyopathy score (59.1 vs 65.8, P<0.001) and were less likely to be treated with ARNI (17.5% vs 20.0%, P=0.02), SGLT2 inhibitor (1.5% vs 2.9% P=0.001), ICD (24.5% vs 33.7%, P<0.001) or CRT (11.5% vs 14.7%, P<0.001). Compared to men, women had lower rates of the primary end point (hazard ratio [HR] 0.89 95% CI 0.81-0.97, p=0.01), which persisted after covariate adjustment (HR 0.85 [95% CI 0.77-0.92], p=0.001). Sex did not significantly modify treatment effect of omecamtiv mecarbil on the primary endpoint (p-interaction = 0.37). Women had higher rates of any reported adverse event but lower risk of serious adverse event leading to treatment discontinuation.

Conclusions:

Women with HFrEF had worse quality of life, were less likely to be treated with guideline-based therapies and had 15% lower risk of HF event or cardiovascular death compared with men. The effect of omecamtiv mecarbil did not significantly differ by sex.
Abstract 13643: Examining the Association Between Social Determinants of Health and Health-Related Quality of Life Among Children With Cardiac Conditions
Authors: Crilly Colin J , Sharma Priya , Tam Vicky , Smith Christopher , Tang Jie , Dori Yoav , Gillespie Matthew J , Glatz Andrew C , Obyrne Michael L
Published: June 2023

Introduction:
Patient-reported outcomes like health-related quality of life (HRQOL) measure the health and well-being of patients, providing insights not communicated by traditional outcomes. The degree to which social determinants of health (SDOH) influence HRQOL is under-studied.

Methods:
A cross-sectional analysis of subjects aged 8-18 years referred for cardiac catheterization from 1/1/18-12/31/21 was performed, evaluating the association between HRQOL (measured through child and caregiver-proxy reports of cardiac-specific HRQOL (Pediatric Cardiac Quality of Life Inventory (PCQLI)) and general HRQOL (Pediatric Quality of Life Inventory (PedsQL))) and a panel of potential SDOH. Potential SDOH measures were calculated at subject’s neighborhood level by linking their addresses to block group/census tract data. SDOH measures included Childhood Opportunity Index, which measures neighborhood resources supporting child development, and Social Deprivation Index, which measures neighborhoods’ levels of disadvantage. Linear regression was used to evaluate the association between SDOH and HRQOL (PCQLI and PedsQL total scores), adjusting for presence of cardiac symptoms (New York Heart Association Class).

Results:
In total, 111 subjects (age 12.8±2.9 years, of which 89% identified as White, 5% Black, and 8% Hispanic, and 27% Medicaid-insured) were studied. Primary cardiac diagnoses included single ventricle heart disease (19%), complex biventricular repairs (20%), and orthotopic heart transplantation (12%). The majority (69%) denied having symptoms. Out of a potential 100, subject-reported scores were 67±18 on the PCQLI and 74±19 on the PedsQL. Caregiver-proxy reported scores were 70±17 on the PCQLI and 71±19 on the PedsQL. Worse SDOH was consistently associated with lower HRQOL adjusted for presence of symptoms (Table 1).

Conclusions:
Worse SDOH was associated with worse HRQOL in pediatric cardiac patients independent of symptoms severity
Abstract 13649: Differential Effect of Variable Autonomic Modulation Stimulation Parameters on Autonomic Function
Authors: Whyte Seabrook , Barber Rylee , Sample Karlie , Amil Faris , Farhat Kassem , Stavrakis Stavros
Published: June 2023

Introduction:
Reduced heart rate variability (HRV) is associated with increased risk of cardiovascular morbidity and mortality. Previous studies have shown that transcutaneous vagus nerve stimulation (tVNS) increases HRV and improves autonomic function, but the effect of variable stimulation parameters on autonomic function remains unclear.

Hypothesis:
We examined the effect of variable stimulation parameters of tVNS on autonomic function.

Methods:
Healthy volunteers were recruited for this study. Each participant underwent autonomic function testing consisting of HRV during deep breathing and mental arithmetic stress test (MAST), with and without tVNS. Participants were randomized to 4 groups of different stimulation parameters in a 2x2 fashion (frequency 5Hz and 20Hz; amplitude 1mA below discomfort threshold or 50% below discomfort threshold). tVNS was applied for 5 minutes for each session. HRV was analyzed in a blinded fashion using Kubios software. Results were compared with 2-way ANOVA, adjusted for multiple comparisons.

Results:
Thirty participants were included (mean age 39±14 years, 70% female). Stimulation amplitude was 26±13 mA and 14±7 mA in the 1mA below and 50% below discomfort threshold groups (p=0.001). There was a greater change in HRV parameters with 20Hz vs. 5Hz stimulation versus baseline during MAST (low frequency: -8.1±2.8%, vs. 1.4±1.8%, p=0.01; high frequency 8.2±3.7% vs. -1.3±1.8%, p=0.03; SD2 of Poincare plot -7.9±2.9 ms vs. 4.2±3.1 ms, p=0.005, respectively; Figure). No differences were observed between the 2 different amplitude groups.

Conclusions:
Stimulation frequency may influence the acute effect of autonomic modulation on autonomic function parameters. These findings have implications for autonomic modulation study design. Further studies in disease states are warranted.
Abstract 13659: Automated Detection of Aortic Stenosis From Single-View 2-Dimensional Echocardiography Using a Semi-Supervised, Contrastive Learning Approach
Authors: Oikonomou Evangelos K , Holste Gregory , Mortazavi Bobak , Wang Zhangyang , Khera Rohan
Published: June 2023

Introduction:
Early diagnosis of aortic stenosis (AS) is critical for its timely management. However, despite emergence of hand-held echocardiography, the detection and grading of AS requires Doppler imaging, which is limited by both access and expertise. We developed a semi-supervised, contrastive learning approach to identify severe AS using limited labelled data of parasternal long axis (PLAX) videos from transthoracic echocardiography (TTE).

Methods:
We sampled TTE studies performed between 2015-2021 in a large health system. TTEs from 2015-2020 were used for training, with oversampling of AS for diagnostic enrichment (5311 studies, age 70±16 years, n=2601 [49%] women, 5029 unique patients). The testing set represented studies in 2021 without oversampling for AS (2040 studies, mean age 66±16 years, n=997 [49%] women, n=2034 unique patients). We performed self-supervised pretraining by selecting different PLAX videos from the same patient as positive samples for contrastive learning (multi-instance self-supervised learning) (
A
). The learned weights were used to initialize a 3D convolutional neural network to predict severe AS (
B
).

Results:
An ensemble model of three different weight initialization methods achieved an AUC of 0.97 (95% CI: 0.96-0.99) for severe AS detection, with 0.96 (95% CI: 0.83-0.97) specificity at 90% sensitivity. Among patients without severe AS, positive predictions were characterized by significantly higher peak aortic velocities compared to negative predictions, with no differences in LV function - a negative control (
C
). Saliency maps highlighted the aortic valve as most relevant to the final predictions (
D, i-v:
positive;
vi:
negative predictions).

Conclusions:
We have developed a novel method to detect severe AS using single-view TTE videos without requiring Doppler data. Our findings have significant implications for point-of-care ultrasound screening as part of routine clinic visits and in low-resource settings.
Abstract 13679: Arterial Stiffness and Carotid Intima-Media Thickness Progression Preceding Worsening Left Ventricular Hypertrophy and Diastolic Dysfunction in Youth: A Temporal Causal Longitudinal Study
Authors: Agbaje Andrew O , Zachariah Justin P , Tuomainen Tomi-Pekka
Published: June 2023

Introduction:
Left ventricular hypertrophy (LVH) is a marker of cardiovascular events and is driven by ventriculo-vascular interactions with stiffening arteries. But longitudinal relations of left ventricle with aorta is uncharacterized in youth.

Hypothesis:
Aortic stiffening, measured as change in carotid-femoral pulse wave velocity (cfPWV), and arterial thickening measured as change in carotid intima-media thickness (cIMT) each independently predicts and precedes changes in LVH indices even after adjustment for BP.

Methods:
From the Avon Longitudinal Study of Parents and Children, UK birth cohort, 1856 adolescents (1011 females) were assessed at mean age 17.7 years and followed for 7 years. Vicorder measured cfPWV and ultrasound measured cIMT were grouped in tertiles as low (reference), moderate, and high. Echocardiography measured cardiac abnormalities are left ventricular mass indexed for height
2.7
(LVMI
2.7
) ≥51g/m
2.7
as LVH; relative wall thickness ≥44 as hiRWT; LV diastolic function E/A as ≥1.5 (LVDD); and LV filling pressure E/e’ ≥8 as hiLVFP. Data were analysed with generalized logit mixed-effect model and cross-lagged structural equation path model adjusting for cardiometabolic and lifestyle factors.

Results:
Over follow-up, LVH prevalence increased from 3.6% to 7.2% and LVDD from 11.1 to 16.3%. High cfPWV progression was associated with worsening LVH [Odds ratio 1.23 (1.13 - 1.35); p<0.001] and worsening hiLVFP [1.14 (1.13 - 1.14); p<0.0001]. Likewise, high cIMT progression was associated with worsening LVH [1.27 (1.26 - 1.27); p<0.0001] and worsening hiLVFP [1.17 (1.07 - 1.28); p<0.001]. Neither cfPWV nor cIMT progression was associated with worsening hiRWT nor LVDD. In cross-lagged models, higher baseline cfPWV was associated with future LVMI
2.7
(β=0.06, SE, 5.14, p=0.035), RWT, LVDF, and LVFP. However, baseline LVMI
2.7
, RWT, LVDF, and LVFP were not associated with follow-up cfPWV. Baseline cIMT was not associated with follow-up cardiac indices and
vice versa
.

Conclusions:
Youth aortic stiffness progression temporally preceded and may causally associate with worsening LVH and hiLVFP but not hiRWT. Mechanistic delineation of coupling in ventriculo-vascular remodeling and consequent physiologic dysfunction is warranted.
Abstract 13692: Gender, Process of Care and Mortality in Heart Failure Patients in India: Findings From the National Heart Failure Registry India
Authors: Malviya Amit , Mishra Animesh , Ganapathi Sanjay , Bahl Ajay , roy ambuj , Prajapati Jayesh , Manjunath C.N. , sethi rishi , Guha Santanu , Satheesh Santhosh , Jeemon Panniyamakal , Dhaliwal R.S. , Sharma Meenakshi , Sivadasanpillai HARIKRISHNAN
Published: June 2023

Introduction:
HF mortality rate vary by gender in high income countries. Process of care is often associated with differences in HF mortality.

Hypothesis:
We hypothesized that, HF process of care is associated with differential mortality in men and women.

Methods:
National Heart Failure Registry is a nationwide registry . Data from 10851 consecutive acute decompensated heart failure patients (ESC2016) criteria was analysed. At baseline we examined sociodemographic characteristics, clinical features , disease etiology and co-morbid conditions of patients. We assessed both in-hospital and 90-day mortality.

Results:
The mean age of study population was 59.9 (SD=13.5). More than two third (69%) participants were men. Sixty-five percent (Women = 58.6%, Men =68.2%, p value = p<0.001) and 13%( Women = 19.5%, Men =9.6%, p value = p<0.001) of patients had HF with reduced ejection fraction and HF with preserved ejection fraction, respectively. In this study, 71.2%(Women =74.2 %, Men = 69.8%, p value = p<0.001) of patients had New York Heart Association (NYHA) Class III or Class IV. In-hospital and 90-day mortality rate were 6.7%(Women = 7.6%, Men = 6.3%, p value = 0.010) and 14.2%(Women = 14.9%, Men = 13.9%, p value =0.160), respectively(Fig:1). Beta blockers (BB), angiotensin converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB), and mineralocorticoid receptor antagonists (MRA) were prescribed in 75.7% (Women=74.2%, Men=76.4%, p value = 0.015), 61.2% (Women=60.6%, Men=61.4%, p value = 0.405) and 64.7% (Women=66.4%, Men=64.0%, p value = 0.016), respectively. The study population had very low usage of devices like the automatic implantable cardioverter-defibrillator 0.9% (Women=0.4%, Men=1.1%, p value =p<0.001), cardiac resynchronization therapy defibrillator 1.0% (Women=1.1%, Men=1.0%, p value =0.75).

Conclusion:
The HF process of care differences may partially explains the differences in mortality in men and women.
Abstract 13769: AT1R Autoantibody Levels Are Elevated in Patients Who Required Immunosuppression Escalation in Immune Checkpoint Inhibitor Mediated Myocarditis
Authors: Akhlaghi Narjes , Shen Miles , Bow Laurine , Miller Maureen , Hwa John , Halene Stephanie , Baldassarre Lauren A , Kwan Jennifer M
Published: June 2023

Intro:
Angiotensin-II (Ang-II) plays an important role in the pathophysiology of various cardiovascular disorders, including cardiomyopathy and hypertension. Angiotensin II type 1 receptor (AT1R) mediates the deleterious effects of Ang-II and can cause vasoconstriction, vascular and cardiac remodeling, and cell death. Animal models have shown that the AT1R signal is obligatory for the development of virus-induced myocardial injury through the proinflammatory action of Ang-II. Data from animal studies and human case studies showed AT1R autoantibodies (AT1R A) were a novel mediator of vasomotor changes and LV dysfunction related to acute myocarditis and that blocking AT1R can be effective.

Hypothesis:
Little is known whether patients on immune checkpoint inhibitors (ICI) develop AT1R A and whether this can worsen the severity of ICI myocarditis. We measured AT1R A in 9 hospitalized patients who were diagnosed with ICI induced myocarditis. We describe this cohort, the course of their illness and their response to steroids.

Methods:
This was a prospective study. Quantitative antibodies to AT1R at the time of hospitalization were measured by an Enzyme Linked Immunosorbent Assay (ELISA) (One Lambda) and classified as positive (>17U/mL); at risk (10-17 U/mL) and negative (<10 U/mL).

Results:
Demographic and co-morbidity details are shown (Table 1). 5/9 patients (55%) were either positive or at risk for AT1R A elevation. 4/9 patients (45%) were AT1R A negative. 4/5 (80%) of the AT1R A positive/at risk required increased immunosuppression whereas 1/4 (25%) of the AT1R A negative required increased immunosuppression for myocarditis.

Conclusions:
AT1R autoantibodies may worsen the severity of ICI myocarditis. A larger cohort study and comparisons of AT1R A levels in non-ICI patients are underway. If trends hold true, testing for AT1R A and treating with an angiotensin receptor blocker may be a potential strategy to reduce ICI myocarditis severity.
Abstract 13779: Metabolic Profiles Identify Distinct Cardiorenal Risk Factors in People With Diabetes Mellitus: Insights From the EXSCEL Trial
Authors: Edmonston Daniel , Nguyen Maggie , Green Jennifer , Buse John , Sourij Harald , Sattar Naveed , Hernandez Adrian F , Holman Rury , Shah Svati H , Mentz Robert J
Published: June 2023

Introduction:
Impaired fatty acid oxidation is common to both kidney and CV complications of diabetes mellitus (DM). We compared metabolic profiles of different cardiorenal trajectories to identify common pathways and unique signatures which may inform disease mechanisms.

Methods
The EXSCEL trial randomized patients with type 2 DM to exenatide vs placebo. For this study, we performed targeted metabolomics of 60 metabolites (45 acylcarnitines [ACs], 15 amino acids, ketone bodies, and nonesterified fatty acids) in 978 EXSCEL participants. Principal components analysis (PCA) was used for dimensionality reduction and multivariable logistic regression to examine the association of each PCA factor with four cardiorenal outcomes: CV (CV death, MI, or stroke), renal (≥30% eGFR decline, ESKD, or renal death), cardiorenal (both outcomes), or neither. We also evaluated the factors associations with hospitalization for heart failure (HHF) and new-onset albuminuria, adjusting for baseline CKD, medication, and treatment allocation.

Results
PCA metabolite factors and cardiorenal outcome associations are listed in Table 1. Considering the directionality of factor loadings, baseline levels of small-chain dicarboxylated ACs and medium-chain ACs were associated with worse cardiorenal outcomes. Long-chain ACs were associated with worse renal outcomes. In contrast, 12-month change in medium-chain saturated ACs and long-chain unsaturated ACs were associated with better CV and renal outcomes, respectively. No factors associated with albuminuria. Baseline nonesterified fatty acids (OR 0.64, 95% CI 0.42-0.99) and 12-month change in medium-chain ACs (OR 1.57, 95% CI 1.04-2.37) associated with HHF.

Conclusions
Baseline associations between ACs and adverse cardiorenal outcomes further link mitochondrial dysfunction with both disorders. However, the association between changes in some ACs with improved outcomes may suggest an adaptive role for these metabolites.
Abstract 13784: Recurrence of Major Adverse Cardiovascular Events Following Acute Coronary Syndrome: Outcomes From a Large Integrated Healthcare System
Authors: Shuey Timothy C , Voyce Stephen J , Johns Alicia , Lagerman Braxton , Gallagher Alexis , Agarwal Shikhar
Published: June 2023

Introduction:
We investigated recurrent events following acute coronary syndrome (ACS) at our large integrated healthcare system

Methods:
We performed a retrospective study of 4,898 patients treated for ACS within the Geisinger Health System between 2015-2021. Data was obtained via programmatic extraction from the electronic health record. The primary outcome was a composite of patients experiencing at least one major adverse cardiovascular event (MACE) in the follow-up period: ACS, coronary revascularization, or cerebrovascular. Descriptive statistics for MACE and prescription medications were performed.

Results:
Median length of time in the study was 2.6 years. Guideline directed medical therapies (GDMT) were >95% for aspirin, beta-blockers and high intensity statin and 88% for P2Y12 inhibitors. Despite this high level of care, 970 (19.8%) patients met the composite primary outcome with an incidence of 11.8 events/100 patient-years. During the study period, 6.6% of patients experienced a subsequent ACS event, 13.7% underwent revascularization and 5.9% had a cerebrovascular event; 4.7% of patients experienced 2 or more MACE events during the follow-up period.

Conclusions:
This data shows that the incidence of recurrent MACE after an initial ACS remains high despite GDMT. Identification of patient characteristics portending elevated residual risk and institution of therapies directed at these patients requires further study.
Abstract 13800: Five-Year All-Cause Mortality in the Contemporary Coronary Artery Disease Patients Who Would Be Eligible for ISCHEMIA Trial
Authors: Ostojic Miodrag C , Arnautovic Natalija , Nezic Dusko , Ragus Tatjana , Otasevic Petar , Tasic Nebojsa , Nikolic Aleksandra , Stanetic Bojan , micovic slobodan , Preradovic Tamara , Unic Stojanovic Dragana , Veljkovic Stefan , Mihajlovic Vladimir , Cucic Luka , Milojevic Milan , Djokic Dragoljub , Boric Snezana , Bojic Milovan
Published: June 2023

Introduction:
Landmark ISCHEMIA (ISCH) trial provided unique information, but the generalizability of its results into myocardial revascularization guidelines and practice has been met by unprecedented debate.

Hypothesis:
We aimed to compare the 5 year all-cause mortality (5y Mt) in our ISCH trial like patients (pts) with results in ISCH.

Methods:
After applying ISCH study inclusion/exclusion criteria we identified 854 pts from our prospective database of 2455 consecutive pts who had the first isolated CABG in 2012-2015 with complex CAD with 100% follow up (F-up) of 5y Mt.

Results:
Comparative characteristics of ISCH like and actual ISCH pts are presented in Table 1. Аll our pts underwent CABG, contrary to ISCH where CABG and PCI were used in 538 and 1532 pts, consecutively. Although in ISCH pts had high diversity of ethnicity, were older, had more DM2 (but less insulin dependent), and had previous PCI or CABG in 25%, our pts were strikingly sicker (lower LVEF, higher proportion of 3VD and proximal LAD, higher NYHA as well as more comorbidities) 5-year mortality was 8.9% compared to 9% in the Invasive arm of ISCH. Of note 48 h mortality from MI type 5 (post CABG) was 1.67% in ISCH, and 30-day Mt in our study was 1.30%, with complete revascularization in 95%. As expected by the disease severity treated by CABG early Mt was higher in our than ISCH pts (Figure 1).

Conclusion:
The present study findings outline that translation of results from the ISCHEMIA trial with practice-changing implications into recommendations for a local Heart Team discussion to advise the best treatment decision for patients with more complex forms of CAD is uncertain and requires further research activities.
Abstract 13809: Multiparametric CMR Tissue Characterization Distinguishes Pathological From Physiological Cardiac Hypertrophy and Correlates With CPET Findings
Authors: Coy-Cangucu Andrea , Paim Layde , Da Silva Luís M , Aparecida Bau Adriana , Martins Camila N , Antunes-Correa Lígia , Sposito Andrei , Nadruz Wilson , Neilan Tomas G , Jerosh-Herold Michael , Coelho-filho Otavio R
Published: June 2023

Introduction:
Physiological and pathological cardiac hypertrophy differ in terms of mechanisms, phenotypes, and outcomes. We aimed to characterize the cardiac tissue phenotype of athletes and HF patients.

Methods:
Prospectively enrolled participants underwent CMR and CPET. HF patients (NYHA class II-III) were classified as HFpEF (LVEF>=45%) or HFrEF (LVEF<45%).

Results:
One-hundred and eighty participants were categorized in four groups: athletes (n=44, 32±12 years), HFpEF (n=47, 61±11 years, H2FPEF score 5±2), HFrEF (n=47, 54±10 years), and healthy controls (n=42, 41±13 years). LVEF was markedly reduced in HFrEF (athletes 65±6%, HFpEF 59±11, HFrEF 29±9, controls 66±4, p<.001). LV mass index (athletes 65±6%, HFpEF 59±11, HFrEF 29±9, controls 66±4, p<.001) and cardiomyocyte mass index (athletes 64±15g/m
2
, HFpEF 66±24, HFrEF 82±36, controls 42±8, p<.001) were greater in athletes and in HF patients (Fig 1A). Athletes and HFpEF patients had concentric LV remodeling, while HFrEF patients showed eccentric remodeling (Fig 1B). Intracellular lifetime of water was longer in athletes and shorter in HFrEF (athletes .17±.07s, HFpEF .15±.05, HFrEF .13±.05, controls .14±.05, p<.001) (Fig 2A). ECV was similarly increased in both HF groups (athletes .28±.04%, HFpEF .31±.05, HFrEF .31±.05, controls .28±.04, p<.001) (Fig 2B). Native T1 (athletes 1175±55ms, HFpEF 1261±61, HFrEF 1274±61, controls 1229±75, p=.01) correlated with CPET maximal oxygen consumption (VO
2
max) in HF patients (r=-.023, p=.048) (athletes 52±10, HFpEF 18±6, HFrEF 17±4, controls 29±9, p<.001).

Conclusion:
Physiological hypertrophy was characterized by increased cardiomyocyte diameter, normal ECV, and shorter native T1 due to its greater cardiomyocyte volume. Contrastingly, pathological hypertrophy’s longer native T1 was a result of its higher ECV and correlated with VO
2
max in HF. Cardiomyocyte diameter was smaller in HFrEF than in HFpEF.
Abstract 13832: Association of Intraoperative Red Blood Cell Transfusions With Venous Thromboembolism After Cardiac Surgery
Authors: Raphael Jacob , Feng Xiaoke , Shotwell Matthew , Mazzeffi Michael , Bollen Bruce , Shah Ashish , Kertai Miklos D
Published: June 2023

Introduction:
Cardiac surgeries have among the highest overall rate of packed red blood cell (PRBC) transfusion among all other surgeries. Recently published data suggests that intraoperative PRBC transfusion is associated with increased risk for postoperative venous thromboembolism (VTE) after non-cardiac surgery. However it is unknown whether similar association also exists after cardiac surgery.

Hypothesis:
Intraoperative PRBC transfusion would be associated with increased risk of postoperative VTE after coronary artery bypass (CABG) surgery.

Methods:
We analyzed all the patients undergoing CABG surgery between January 1, 2015 and December 31, 2019 in the Society of Thoracic Surgeons (STS) adult cardiac surgery database. Using propensity-score-weighted regression analysis, we analyzed the effect of intraoperative PRBC transfusion on hospital-acquired venous thromboembolic complications as well as on pulmonary venous thromboembolism, deep venous thrombosis, operative mortality, readmission within 30 days, and postoperative length of stay.

Results:
The overall rate of intraoperative PRBC transfusion was 17.8% (n=133,484). PRBC transfusion was associated with increased odds for venous thromboembolic complications (odds ratios, OR [95% CI]: 1.27 [1.22-1.32], 1.21 [1.16-1.26], 1.93 [1.85-2.00], and 1.82 [1.75-1.89]) in patients receiving 1, 2, 3 or 4 or more units, respectively. Intraoperative transfusion was also associated with increased odds for deep venous thrombosis (OR [95% CI]: 1.39 [1.33-1.46], 1.38 [1.32-1.44], 2.18 [2.09-2.28], and 1.82 [1.74-1.91]), operative mortality (OR [95% CI]: 1.11 [1.08-1.14], 1.16 [1.13-1.19], 1.29 [1.26-1.32], and 1.47 [1.43-1.50]), readmission within 30 days (OR [95% CI]: 1.05 [1.04-1.06], 1.16 [1.13-1.19], 1.29 [1.26-1.32], and 1.47 [1.43-1.50]), and a prolonged postoperative length of stay (mean difference in days, 0.23 [0.19-0.27], 0.34 [0.30-0.39], 0.69 [0.64-0.74], and 0.77 [0.72-0.82].

Conclusions:
Intraoperative PRBC transfusion was associated with venous thromboembolic complications and adverse outcomes after coronary artery bypass grafting surgery.