bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4139661: Usefulness of High-sensitive Troponin I and N-terminal pro-B-type Natriuretic Peptide in Coronavirus Disease 2019 Risk Stratification on and after Omicron Variant Waves: COVID-MI Registry Cohort-2 Analysis
Authors: Toyota Toshiaki , Ichiyanagi Tomohiro , Sano Madoka , Morimoto Takeshi , Azumi Yuta , Hideyuki Hayashi , Murai Ryosuke , Ooka Junichi , Sasaki Yasuhiro , Taniguchi Tomohiko , Kim Kitae , Kobori Atsushi , Ehara Natsuhiko , Kinoshita Makoto , Furukawa Yutaka
Published: November 2024

Introduction:
Troponin-defined myocardial injury or N-terminal pro-B-type natriuretic peptide (NT-proBNP) elevation frequently coincides with coronavirus disease 2019 (COVID-19). Our prior study (COVID-MI Registry Cohort-1) confirmed that high-sensitive troponin I (HsTnI) and NT-proBNP effectively stratified mortality risk. However, variants of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) change rapidly, and it remains unclear whether these biomarkers are consistently effective in predicting prognosis of COVID-19 patients irrespective of epidemic periods.

Research Questions:
Can HsTnI or NT-proBNP stratify mortality risk in recent COVID-19 cohorts?

Aims:
To assess the potential of HsTnI and NT-proBNP levels for risk stratification in the recent COVID-19 waves.

Methods:
In the COVID-MI Registry Cohort-2, we enrolled 1115 consecutive COVID-19 patients admitted between October 2021 and October 2022, during the Omicron variant endemic. We collected data of HsTnI or NT-proBNP levels from hospital charts or using the samples in our hospital's serum/plasma bank if the data were not available. The primary outcome measure was all-cause mortality.

Results:
On admission, more than one-third of patients were classified as having severe COVID-19. HsTnI and NT-proBNP levels were available for 427 and 414 patients, respectively. The median HsTnI and NT-proBNP levels were 16 (interquartile range [IQR]: 5-57) ng/L and 524 (IQR: 140-2056) pg/mL, respectively. We stratified the patients into three groups by HsTnI level: <5.0 ng/L (95 patients), 5.0 ng/L to 99%ile URL (151 patients), and ≥99%ile URL (181 patients). For NT-proBNP, patients were grouped as follows: <125 pg/mL (95 patients), 125-900 pg/mL (161 patients), and ≥900 pg/mL (158 patients). The median follow-up duration was 25 days. Regarding cumulative 30-day incidence of mortality, higher HsTnI as well as higher NT-proBNP levels were associated with a higher risk. (HsTnI: < 5.0 ng/L group, 1.1%; 5.0 ng/L to 99%ile URL group, 3.0%; and ≥ 99%ile URL group, 21.7%; P <0.001. NT-proBNP: < 125 pg/mL group, 0%; 125-900 pg/mL group, 4.7%; and ≥ 900 pg/mL group, 17.1%; P <0.001).

Conclusions:
HsTnI and NT-proBNP levels on admission can stratify mortality risk in recent COVID-19 cohorts, which is consistent with previous studies on different SARS-CoV-2 variants.
Abstract 4139822: Adipocyte TRPM7 promotes aortic dissection by accelerating SMC phenotype switching
Authors: Wang Mi , Gao Min
Published: November 2024

Background:
Aortic dissection (AD) is a life-threatening condition with high mortality. It initiates from an acute intimal tear, which allows a large amount of blood to penetrate into media, leading to the formation of intramural hematoma or false lumen. Digging into and unravelling the pathogenesis of AD will aid in exploring novel therapeutics for AD.

The major characteristics of AD is degeneration of aortic wall architecture. Particularly, the phenotypic switching of VSMCs and enhanced tissue inflammation are pivotal steps of AD progression. Studies have shown that upregulation of Trpm7 triggers the phenotypic switching of VSMCs.

Perivascular adipose tissue (PVAT) harbors mature adipocytes that regulate vascular function physiologically and pathologically. Inflammatory cytokines secreted from PVAT promotes VSMC phenotypic switching.

This study aims to explore whether the adipocyte TRPM7-mediated Ca2+ could uncouple Bip-IRE1a and perturb the inhibition of Bip on IRE1a, inducing PCG1a mRNA decay and inflammatory cytokines secretion, thus promoting VSMC phenotypic switching and the development of AD.

Methods:
Mouse breeding. Trpm7fl/fl mice were cross-bred with Ap2-Cre mice to generate adipocyte-specific Trpm7 KO mice.

Mouse genotyping. Genomic DNA was extracted from the mouse tail for PCR to validate the genotype of mice.

Establishment of BAPN-induced TAD mouse model. 3-week-old mice was administered with BAPN intragastrically (1g/kg/day) for 4 weeks.

H&E staining. Different segments of mouse aorta were subjected to H&E staining to examine the lesions.

EVG staining. Different segments of mouse aorta were subjected to EVG staining to examine the aortic wall architecture.

Real-time quantitative PCR (qPCR). The expression level of inflammatory genes and VSMC contractile genes, including IL1b, TNF-a, Acta2, Cnn1, Tagln, S100A4, as well as Trpm7 were assessed by qPCR.

Results:
Adipocyte-specific Trpm7 KO mice (Trpm7fl/fl ; Ap2-Cre ) were successfully generated and each genotype was validated by PCR.

BAPN-induced TAD mouse model was successfully established. The mortality rate reached to 50-80%.

Adipocyte-specific deletion of Trpm7 hindered inflammation and the development of TAD effectively.

Trpm7 inhibitors FTY720 hindered the progress of TAD significantly.

Conclusion:
Adipocyte-specific deletion of Trpm7, as well as Trpm7 blockers FTY720 markedly ameliorates TAD, suggesting that Trpm7 enhances TAD progression.
Abstract 4139838: The Role of Tele-Training And Tele-Support During Transitional Care From Hospital To Home In The Caregivers of Stroke Survivors : A Longitudinal Moderation Analysis
Authors: Bartoli Davide , Petrosino Francesco , Lombardi Eleonora , Vellone Ercole , DAMICO VINCENZO , Pucciarelli Gianluca
Published: November 2024

INTRODUCTION:
Stroke is the most common cause of adult disability and has a significant impact on the quality of life(QOL) of survivors and caregivers.It is important to implement a tailored intervention that could improve caregiver preparedness for the transition home after a stroke.A patient-and caregiver-centred educational approach,which directly involves caregivers,may have better long-term results.In the light of a recent review,it was identified that it improves dyadic QOL if teletraining and telesupport interventions are developed simultaneously and early in the transition of care from hospital to home.

AIM:
Is to investigate whether, from 0 to 3 months after hospital discharge, preparation by video-training and telesupport moderates the QOL over time of caregivers of stroke survivors.

METHODS:
A multicentre longitudinal study was carried out in 6 Italian centres, with video-training before discharge and supported by care transition nurses.Data were collected through interviews starting in January 2024.The WHOQOL-BRIEF was used for QOL and the Caregiver Preparedness Scale and Preparedness Assessment For The Transition Home for preparedness, the care problems of the family nucleus were investigated Caregiver Strain Index,the Multidimensional Scale of Perceived Social Support was used for perceived social support,burden was investigated with the Caregiver Burden Inventory and finally mutuality between caregiver and stroke survivor was investigated with the Mutuality Scale.The structural equation modeling was estimated using the Maximum Likelihood with robust standard method with NLMINB optimization used by Mplus.

RESULT A total of 27 dyads were enroled,88% of the caregivers were female.The model showed a good fit to the data(X
2
(84)=90.5,p=.295,SRMR = .096,RMSEA=.031,CFI=.996,TLI= .995).Support had a significant positive effect on QOL(β= .4304,p < .001), while evolution showed a significant negative effect on QOL(β = -.3258,p = .001).The perceived burden did not have a significant effect on QOL(β = .0258, p = .707).Support had a significant negative effect on evolution(β =-.2407,p = .036),whereas perceived burden showed a nonsignificant effect on evolution(β = .1483,p= .111).

DISCUSSION:
The model describes how teletrainig and telesupport improves caregivers' QOL as early as 3 months after hospital discharge,compared with previous studies where QOL with traditional supportive interventions or training improves but not significantly or with longer time frames.
Abstract 4139890: High Visceral-to-Subcutaneous Fat Ratio is Correlated with Increased Coronary Artery Disease Severity Based on Computed Tomography-derived SYNTAX Score Regardless of Physique Stratified by Waist Circumference
Authors: Okawa Keishiro , Otagiri Kyuhachi , Miyagi Takuya , Oyama Yushi , Sakai Takahiro , Kitabayashi Hiroshi
Published: November 2024

Background:
Waist circumference (WC) has been recognized as a significant factor of metabolic syndrome and is closely associated with the amounts of abdominal visceral and subcutaneous fats. Although abdominal fat distribution (AFD) is indicated using the ratio of the visceral fat area (VFA) to the subcutaneous fat area (SFA), i.e., V/S ratio, which is possibly related to an increased risk of coronary artery disease (CAD), few studies have shown the impact of the AFD and physique on CAD. A computed tomography (CT)-derived SYNTAX score (CT-SX score) has been suggested as a feasible method of assessing CAD severity based on coronary CT angiography (CCTA). We aimed to evaluate the effect of AFD based on the V/S ratio and physique classified by WC on CAD complexity using the CT-SX score.

Methods:
CCTA was conducted on 931 consecutive patients suspected of CAD. Furthermore, a plain abdominal CT was also performed to measure VFA and SFA. To evaluate the AFD, V/S ratios were also determined. CAD severity was assessed using CCTA. Significant stenosis was defined as ≥50% diameter stenosis. The CT-SX score was calculated in patients with ≥1 significant stenosis. Finally, patients were classified into low and high WC groups based on their median value (84.79 cm).

Results:
Of the 931 patients enrolled, 308 (33.1%) had ≥1 significant stenosis. There was a positive correlation between the V/S ratio and CT-SX score regardless of the WC. Although VFA positively correlated with the CT-SX score in the low WC group, SFA negatively correlated with the CT-SX score in the high WC group. In a multivariate analysis adjusted for traditional coronary risks, same results were observed (Figure).

Conclusions:
The AFD indicated by the V/S ratio appears to be an effective index to determine CAD severity regardless of the physique based on WC. However, factors that increase the V/S ratio vary depending on the physique; therefore, interventional treatment tailored to each physique may help mitigate CAD progression.
Abstract 4139933: Hypercholesterolemia and proprotein convertase subtilisin/kexin type 9 potentiate inflammatory response against aortic valve bioprosthetic tissue post-implantation.
Authors: Salle Marine , Guimbretière Guillaume , Aumond Pascal , Le Vely Benjamin , Le May Cedric , Cariou Bertrand , Le Tourneau Thierry , toquet claire , Merot Jean , Roussel Jean Christian , Capoulade Romain
Published: November 2024

Introduction:
Calcific aortic valve stenosis is the more frequent valvular disease, affecting more than 10% of patients >75 years old. Surgical or transcatheter aortic valve replacement is the only treatment available. There is an increase use of bioprosthetic valves, even if they present a limited durability with the progressive development of structural bioprosthetic deterioration (SVD). Recent clinical studies highlighted an association between circulating lipid factors, such as proprotein convertase subtilisin/kexin type 9 (PCSK9), Lipoprotein (a) and LDL-cholesterol, and SVD. However, the underlying mechanisms remain unknown.

Objective:
We aim at deciphering the role of hypercholesterolemia and/or PCSK9 on the early processes leading to SVD.

Methods:
Subcutaneous implantation of bioprosthetic tissue was performed on 10-week old wild type (WT), PCSK9 knock-out (KO) and PCSK9 overexpressing C57BL/6J mice for 28 days. A qualitative anatomopathological score evaluating cell density, infiltration, and tissue degradation was developed. Infiltrated immune cells were characterized by IHC, with a focus on anti- (CD163+) and pro-inflammatory (F4/80+) macrophages, lymphocytes (CD3+) and polynuclear eosinophils (CCR3+).

Results:
An important infiltration of mononuclear cells into the explanted punches was observed among the 3 groups (n=10 mice/group). Cell recruitment was more pronounced in mice overexpressing PCSK9 compared to WT and KO. The anatomopathological score of PCSK9 overexpressing mice was significantly higher as compared to WT and KO (7.0 [4.1-8.4] vs 4.0 [3.0-4.5] and 2.8 [2.0-3.9], respectively; p=0.008). The infiltrate was mainly composed of macrophages (CD163+ F4/80+) and polynuclear eosinophils, even if few lymphocytes were observed. Polynuclear eosinophils were more abundant in mice overexpressing PCSK9 compared to WT and KO (p=0.01 and p=0.002).

Conclusion:
Hypercholesterolemia and/or high PCSK9 level promote the cellular response against the bioprosthetic tissue. It potentiates the infiltration of polynuclear eosinophils and macrophages, pointing out for an exacerbated inflammatory response, post implantation. Deeper cellular/molecular analyses are ongoing to provide mechanistic clues to better understand the link between hypercholesterolemia/PCSK9 and the early inflammatory processes leading to SVD.
Abstract 4140037: The association of housing unaffordability with medication adherence and health outcomes among non-elderly adult Medicaid beneficiaries with atherosclerotic cardiovascular disease
Authors: Khatana Sameed Ahmed , Yang Lin , Eberly Lauren , Nathan Ashwin , Qaisrani Fatima , Roberts Eric , Reina Vincent , Groeneveld Peter
Published: November 2024

Background:
The burden of housing costs is at an all-time high in the United States. Individuals with lower socioeconomic status experience worse health outcomes and are also disproportionately impacted by housing costs. Whether housing unaffordability is independently associated with medication adherence or health outcomes in individuals with cardiovascular (CV) disease is not well studied.

Methods:
All 19- to 64-year-old Medicaid beneficiaries in the United States with atherosclerotic CV disease (ASCVD) – coronary artery disease, peripheral arterial disease, and cerebrovascular disease/stroke – in 2018 were identified using Medicaid administrative claims data. The study population was limited to people continuously enrolled in 2019 and excluded Medicare-Medicaid dual enrolled beneficiaries. Medication adherence to Statin therapy and the number of all-cause and CV emergency department (ED) visits and hospitalizations were assessed in 2019. ZIP code level housing cost burden was measured as the proportion of all residents who spent more than 30% of their income on housing costs and was obtained from the 2015-2019 American Community Survey. Negative binomial generalized estimating equation (GEE) models were fit to account for the hierarchical nature of the data and were adjusted for individual demographic and clinical variables and area-level measures of socioeconomic status and social vulnerability.

Results:
A total of 443,984 beneficiaries with ASCVD living in 24,349 ZIP codes were identified. The mean ZIP-code level proportion of residents with unaffordable housing was 33.5% (SD=6.3%). In the multivariable GEE models, a 1 percentage point increase in the proportion of residents with unaffordable housing was associated with 0.05% (95% CI 0.01% to 0.1%) lower adherence to Statin therapy. It was also associated with a 0.6% (95% CI 0.3% to 0.8%) increase in the number of CV ED visits and a 0.3% (95% CI 0.04% to 0.5%) increase in CV hospitalizations. Housing unaffordability was also associated with a significant increase in all-cause ED visits [0.4% (95% CI 0.2% to 0.5%)].

Conclusion:
Among non-elderly adult Medicaid beneficiaries with ASCVD, residence in a ZIP code with higher levels of housing unaffordability was independently associated with lower medication adherence to Statin therapy and a higher number of CV ED visits and hospitalizations. Whether improving housing affordability among this population can improve CV health outcomes needs to be studied further.
Abstract 4140044: Female Patients with Occlusive Myocardial Infarction without ST Elevation Experience Longer Delays in Receiving Emergent Reperfusion
Authors: Kisova Timea , Herman Robert , Demolder Anthony , Bahyl Jakub , Hybasek Dzurikova Hana , Smith Stephen , Meyers Harvey , Hellerman Mark , Lauwers Rinaldo , Pletnickx David , Schelfaut Dan , El Ters Fadi , Tanios Alain , Ricci Fabrizio , Rossi Davide , Bartunek Jozef , Barbato Emanuele
Published: November 2024

Background:
Sex disparities in symptom presentation are well-documented in female patients with Acute Coronary Syndrome (ACS). Moreover, nearly half of the patients with acutely occlusive myocardial infarction (OMI) do not meet the STEMI criteria at admission, leading to delays in receiving emergent reperfusion. This delay may be more pronounced in female OMI patients without ST-elevation (NSTEMI-OMI), potentially due to differences in symptom presentation and recognition.

Purpose:
To investigate disparities in delays from admission ECG to percutaneous coronary intervention (PCI) between male and female patients with acute OMI stratified according to the presence of STEMI criteria.

Methods:
Electrocardiograms (ECGs), laboratory and coronary angiography (CAG) data were sourced from a total of 623 consecutive OMI patients from five international cohorts from 2012 to 2023. The final diagnosis of OMI was adjudicated by two expert physicians based on all available data. Patients were stratified into STEMI-OMI and NSTEMI-OMI based on their initial admission ECG and time-to-PCI: <2hrs vs. >2hrs, respectively. Each cohort was further subdivided based on sex (male vs. female).

Results:
A total of 314 STEMI-OMI patients (24% female) and 309 NSTEMI-OMI (30% female) were included in the analysis. Median ECG-to-balloon (E2B) time between STEMI-OMI and NSTEMI-OMI patients was 48 minutes and 17.1 hours, respectively (p<0.001). Female STEMI-OMI patients had an E2B of 47.0 minutes (95% CI: 30-78), compared to 50.6 minutes (95% CI: 30-72) for male patients, respectively, and did not differ significantly (p=0.85) (Fig 1A). In NSTEMI-OMI, female patients had a significantly longer median E2B time of 20.1 hours (95% CI: 10.2-48.2) as compared to 15.7 hours (95% CI: 5.6-28.0) (p=0.002) in male patients (Fig 1B).

Conclusion:
The present international multi-centric validation of consecutive patients with acute coronary occlusion reveals a significant sex disparity in NSTEMI-OMI patients, with female patients experiencing a 4.4-hour delay to reperfusion compared to males. These findings highlight the need for unbiased diagnostic strategies to address sex differences in ACS presentation.
Abstract 4140048: The Critical Role of Visceral Adipose Tissue in the Temporal Progression of Cardiac Remodeling Due to Pressure Overload
Authors: TARRAF Alissa , Nabuco Leva Ferreira Freitas Jose-Americo , Delmont Thais , Altintas Dogus , Radu Costin , Pini Maria , Czibik Gabor , folliguet thierry , ZHANG yanyan , Bischof Oliver , Derumeaux Genevieve
Published: November 2024

Background:
Myocardial fibrosis is a key indicator of cardiac remodeling caused by pressure overload, involving a complex interplay of mechanical, inflammatory, and neurohormonal factors. Our recent studies reveal a harmful interaction between visceral adipose tissue (VAT) and the heart during aging, where profibrotic proteins from VAT and plasma contribute to heart fibrosis. We hypothesize that transverse aortic constriction (TAC)-induced pressure overload induces VAT remodeling and VAT profibrotic secretome that aggravates cardiac fibrosis and compromises heart function.

Purpose:
- To determine the interaction between VAT and heart

-To assess the time course of TAC-induced transcriptomic changes in presence or absence of VAT

Methods:
We divided wild-type male mice (5-month-old, n=10/group) into four groups: a visceral Lipectomy group and a Sham group two weeks before either a moderate TAC (26G; i.e. gradient between left ventricle and aorta of 30mmHg) or a sham surgery. We sacrificed the mice at 1- and 8-week after TAC. We performed
in vivo
metabolic tests, echocardiography, and invasive hemodynamics, followed by
ex vivo
tissue analysis. We subsequently examined cardiac transcriptomic changes in TAC versus control groups, as well as the effect of visceral lipectomy through RNA-seq followed by Partial Least Squares Regression and Over-Representation Pathway Analysis.

Results:
TAC-induced cardiac pressure overload initiates a pathological heart-VAT crosstalk stimulating a senescence-like profibrotic (TGFb, Spp1) and proinflammatory secretory phenotype (TNFa, IL6, PAI1) in VAT as early as 1 week after TAC. Importantly, we demonstrate that VAT lipectomy reverses TAC-induced cardiac remodeling and restores normal heart function. Transcriptomic analyses show the powerful effect of TAC on gene expression, notably profibrotic (MMP9, TGFb1, Col1a1) and prohypertrophic genes (Nppa, Nppb) increase. After 1 week, TAC had a stronger effect than lipectomy, while 8 weeks post-TAC, lipectomy could reverse all the transcriptomic changes induced by TAC with a transcriptomic profile of TAC+lipectomy similar to sham group.

Conclusion:
This study highlighted the exacerbation by VAT of the detrimental impact of TAC on the heart. Our findings show a dynamic crosstalk between the heart and VAT orchestrated by the secretome of the adipose tissue resulting in transcriptomic and physiological heart changes.
Abstract 4140244: In a Murine Model of Experimental Sepsis, Cardiac-Specific Jarid2 Knockdown is Associated With Improved Myocardial Function and Survival
Authors: Tsoporis James , Wang Yambo , Desjardins Jean-Francois , Ektesabi Amin , Izhar Shehla , Lee Youngsook , Parker Thomas , dos Santos Claudia , Leong-Poi Howard
Published: November 2024

Introduction:
Sepsis is a life-threatening condition characterized by a dysregulated host response to infection, leading to acute heart failure, decreased contractile function, and biventricular dilation. Emerging evidence suggests that the transcriptional repressor Jarid2 may play a regulatory role in sepsis.

Hypothesis:
We hypothesize that cardiac-specific knockdown (KD) of Jarid2 could enhance cardiac function and improve survival in response to sepsis.

Methods:
We generated mice with cardiac-specific Jarid2KD using an alpha myosin heavy chain-specific Cre-LoxP system. Using an in vivo model of cecal ligation and puncture (CLP) with 12-week-old wild-type (WT) and cardiac-specific Jarid2KD mice we investigated whether Jarid2 is a potential novel target for sepsis treatment.

Results:
In response to 48 hours of CLP, WT mice exhibited over 60% mortality vs. WT-Sham. Survivors developed bacterial peritonitis, an increased inflammatory response (left ventricle (LV): 15-fold increase in IL-6, 3-fold increase in IL-1β and TNF-α, vs. WT-Sham), and apoptosis (LV: 2.5-fold increase in apoptotic Bax/Bcl2 ratio vs. WT-Sham). Jarid2KD showed myocardial dysfunction with a 20-35% decrease in dp/dt, echo-derived ejection fraction (EF), fractional shortening (FS)), a switch from adult α-myosin heavy chain (MHC) to fetal β-MHC, and a 40-50% reduction in LV Jarid2 mRNA and protein compared to WT-Sham. In contrast, Jarid2KD mice despite a similar decrease in LV Jarid2 expression to WT-CLP mice, demonstrated resistance to CLP-induced bacterial peritonitis with cardiac function (dp/dt, EF, FS) similar to the WT-Sham. Histological staining revealed better organization of cardiomyocytes and preservation of functional ultrastructure. Furthermore, Jairid2KD displayed a survival rate of over 90%, a reduced LV inflammatory response (LV: 2-fold increase in IL-6, no change in IL-1β and TNF-α), maintenance of α-MHC, and absence of apoptosis vs. WT-CLP. Metabolic genes such as NDUFA9, Cox4il, ND1, ND4 and PGC1b were downregulated approximately 60-75 per cent in Jarid2KD vs WT-CLP suggesting an improved ability to regulate energy usage. Improved survival was observed even 7 days post-CLP (65% in WT-CLP compared to 100% in Jarid2KD).

Conclusion:
Cardiac-specific JARID2KD improves survival and reduces sepsis-induced myocardial dysfunction. Thus, Jarid2 may serve as a novel therapeutic target for treating sepsis-induced myocardial dysfunction.
Abstract 4140247: Place and Race in Cardiovascular Outcomes among Prostate Cancer Patients in Georgia: a 20-year Geospatial Analysis
Authors: Nain Priyanshu , Kulkarni Neel , Rupji Manali , Hyma Kunhiraman Harikrishnan , Datta Biplab , Patel Vraj , Jiang Stephanie , Stabellini Nickolas , Weintraub Neal , Mandawat Anant , Cantu Stephanie , ward kevin , Switchenko Jeffrey , Patel Sagar , Guha Avirup
Published: November 2024

Background:
Men with prostate cancer (PC) frequently die of cardiovascular disease (CVD). Rurality has shown to increase adverse outcomes in PC men. 26% of Georgians live outside Urban centers and 120/159 counties of Georgia (GA) are considered rural.

Aim:
To identify CVD mortality (CVDm) risk factors in GA public health districts (PHD) and map the racial differences in CVDm across PHDs.

Methods:
Men ≥ 18 years with PC (2004–2018) were identified using GA Cancer Registry, with mortality data from state vital statistics and National Death Index. CVDm was identified by ICD-10 codes. A multivariable Fine and Gray model identified CVDm risk factors. Adjusted competing risk analysis included factors like PHD, race, age, T-stage, hormone therapy, and Gleason Score. Race specific 5-year CVDm rates per 100000 were calculated by multiplying county-specific standardized mortality ratios (SMRs) by the crude race-specific mortality rates of CVD and then aggregating these into PHDs. The ratio of Black vs White CVDm was calculated for each of GA's 18 PHD and mapped using R.

Results:
Of 51,262 men with PC (median age 63), 36.2% were Black, predominantly from greater Atlanta area (36%) and ~17% received hormone therapy. CVDm was noted in 4.1% of cohort. The PC cohort risk factors for CVDm are presented in Table 1.

Men with stage T2-3 PC had a lower risk of CVDm vs stage T1 PC (aHR 0.52, CI 0.36-0.75; aHR 0.47, CI 0.31 – 0.71). CVDm was significantly higher in northwest (aHR 1.72), west central (aHR 1.85), coastal (aHR 1.92), and southeast (aHR 1.90) GA vs. greater Atlanta area. CVDm was significantly higher in Black men (aHR 1.47). High Gleason scores significantly correlated with CVDm (aHR 1.48), though hormone therapy use showed no statistical difference (P=0.124)

Figure 1 shows the mapped relative racial disparity. Overall, the highest Black vs. White CVDm differences were noted in Northeast, LaGrange, and Southwest GA as well as Dekalb County in Atlanta (1.81 - 3.63).

Conclusion:
In GA, there are significant geographic and racial differences in CVDm in men with PC. Determining the reasons (i.e., insufficient access to care, inadequate CVD risk prevention) is needed to establish healthcare equity for all men with PC in GA.
Abstract 4140280: The Association of the Muscle Mass with Exercise Capacity and Childhood Opportunity Index in Patients with Fontan Circulation
Authors: Tercek Abigail , Smith Kevin , Karolcik Brock , Arora Gaurav , Kreutzer Jacqueline , Olivieri Laura , Christopher Adam , Alsaied Tarek
Published: November 2024

Background:
The Child Opportunity Index (COI) is a validated, comprehensive measure of social context, comprised of 29 indicators of child neighborhood opportunity, split into three domains (education, health and environment, and socioeconomic). Our previous work showed that low COI is associated with a 10% lower percent of predicted peak VO
2
post-Fontan. Exercise intolerance is a known prognostic factor for this patient population. Previous studies have shown that health inequities in education, environment, and socioeconomics factor into worse exercise outcomes. Cardiac MRI (CMR) measured muscle mass is a novel practical technique to evaluate muscle mass. We hypothesized that lower muscle mass by CMR is associated with lower exercise capacity and lower COI z-scores.

Methods:
A retrospective, single-center study was performed, analyzing 75 post-Fontan patients who had CMR completed between 2010 and 2022. The anterior and paraspinal muscles were measured (Figure). COI z-scores were split into low and high levels, and univariate analyses were subsequently performed to determine associations between COI levels, exercise capacity and muscle mass.

Results:
The mean age of the population was 19.09 years ± 8.58 with the majority being male (65.3%). Most patients underwent an extracardiac conduit repair (65.3%) (Table). There was a positive correlation between anterior (r=0.36, p=0.007) and paraspinal (r=0.34, p=0.01) muscle mass to peak VO
2
. There was no significant difference in paraspinal (p=0.15) or anterior (p=0.72) muscle mass between COI groups. Similarly, there were no significant associations between muscle mass and specific COI domains.

Conclusion:
Muscle mass correlated with exercise capacity in our population and is easy to measure by CMR. There was no correlation between COI level and muscle mass in this study, suggesting that the COI impact on exercise capacity is not directly mediated by lower muscle mass and that other factors should continue to be explored.
Abstract 4140295: An Implementation Strategy Package to Improve Familial Hypercholesterolemia Recognition in Primary Care: The CAREFH Study
Authors: Gidding Samuel , Jones Laney , Cawley Dylan , Carr Lauren , Colonie Ryan , Romagnoli Katrina , Kirchner H Lester , Hu Yirui , Williams Marc
Published: November 2024

Background:
Familial hypercholesterolemia (FH) is under-diagnosed and under-treated.

Goals/Aims/Hypothesis: We developed an implementation strategy package to increase primary care awareness regarding familial hypercholesterolemia. We hypothesized that providers would be more likely to order a screening lipid profile in those without one in the prior 5 years and would be more likely to diagnose FH and/or order genetic testing in eligible patients after intervention compared to the prior 6 months.

Methods:
The intervention included face to face education regarding FH at 20 primary care locations in the Geisinger Health System, development of electronic health record tools (Smart Set, Dutch Lipid Clinic Score calculator, Clinic Note Template), simplification of genetic test ordering procedures, and notification of primary care providers on the day that patients without a lipid profile in the last 5 years or eligible for an FH workup (presence of premature myocardial infarction or LDL-C
>
190 mg/dl) were on their schedule. Data was collected for 6 months prior to intervention and 6-12 months post intervention.

Results:
In patients without a recent test, lipid profiles were more likely to be ordered in patients post intervention (10,251/40,463 (25.3%) pre vs. 14,574/45,089 (32.3%) post; p < 0.0001). An FH diagnosis was added to the chart more commonly post intervention in patients with phenotypic criteria (6/8129 (0.1%) pre vs 32/7879 (0.4%) post; p < 00001). No patients had genetic testing ordered prior to intervention whereas 37 did afterwards. Electronic health record tools were used at < 1% of encounters.

Conclusions:
An intervention that includes face to face education regarding FH, simplification of genetic test ordering, and reminders to primary care providers regarding patients eligible for an FH evaluation improves rates of lipid testing, FH diagnosis and genetic test ordering. FH specific electronic health record tools were not frequently used.
Abstract 4140309: Developing a Community-Informed Service Delivery Model to Increase Uptake of Rheumatic Heart Disease Primary Prevention
Authors: Miller McCall , Vaughn Lisa , nakitto miriam , Pulle Jafesi , Sarnacki Rachel , de Loizaga Sarah , Beaton Andrea , Rwebembera Joselyn
Published: November 2024

Introduction:
Primary prevention of rheumatic heart disease (RHD) is aimed at timely diagnosis and treatment of superficial group A
Streptococcal
infections, most commonly Strep sore throat. However, uptake and delivery of primary prevention in RHD-endemic regions is suboptimal. Development of scalable and sustainable models is urgently needed. Community co-design is an important aspect of development, aimed at ensuring approaches are culturally and contextually appropriate and reach the highest number of community members.

Aim:
Utilize a community-based participatory research (CBPR) approach to co-develop a model for RHD primary prevention in Uganda.

Methods:
Group Level Assessment (GLA) was used to evaluate the community’s priorities and provide insights around sore throat in the community to identify potential interventions. Personas, or potential user archetypes, were then developed to capture the behaviors and characteristics of diverse future users of primary prevention in the district. Finally, these personas were used in community co-design workshops to identify barriers and facilitators to potential interventions, generate creative solutions to overcome identified barriers, and prioritize implementation models for testing. The final list of implementation strategies was taken by workshop participants to the broader community for additional validation and feedback.

Results:
The GLA sessions identified six key priorities: 1) Desire for formal treatment; 2) Lack of access to resources and long distances; 3) Competing traditional methods of treatment; 4) Strong influence of community leaders; 5) Importance of mothers as caregivers; and 6) Need for sore throat awareness and education. Five personas were created including: Hands-on Caregiver, Restricted Caregiver, Removed Family Decision Maker, Helpful Neighbor, and Influential Leader. Design workshops identified the highest rated interventions as train village health teams to diagnose, conduct outreach screening events, and designate a sore throat focal person at health facilities. Participants then proposed potential practical applications of these interventions.

Conclusion:
CBPR identified novel implementation strategies for an RHD primary prevention program in Uganda. Next steps include evaluation of the acceptability, feasibility, and uptake of these strategies via a planned implementation trial, and improved primary prevention in an RHD-endemic country.
Abstract 4140363: Developing and testing a new theoretical model of pain among patients with heart failure
Authors: Smith Asa , Jung Miyeon , Pressler Susan
Published: November 2024

Introduction:
An estimated 23-85% of adults with chronic heart failure (HF) experience comorbid chronic pain, yet no comprehensive theoretical models have been developed or tested that completely capture the salient variables which affect pain. The aim of this study was to construct a preliminary theoretical model of pain in HF and evaluate the associations between identified variables in the model with pain presence.

Methods:
In this cross-sectional study, baseline data were obtained from the Cognitive Intervention to Improve Memory in Heart Failure Patients study (MEMOIR-HF) (n = 235). The Biopsychosocial Model of Chronic Pain was adapted for an HF-specific population. The dependent variable was pain presence (yes/no), which was measured using the Health Utilities Index Mark-3 (HUI-3). Independent variables were identified for the model using previous literature and univariate analyses comparing patients with vs. without pain in MEMOIR-HF. Logistic regression was used to test for differences between patients with pain present and not present.

Results:
Demographics were 45.5% men, 54.5% women, 86.4% White, 13.6% Black, mean age 66.39 (SD 12.04) years. Of 235 patients, 159 (67.66%) reported pain on the HUI-3 items.

The variables that were included following univariate analysis and literature review were age, self-reported race and gender, comorbid conditions, sleep disturbances, HF severity, B-type natriuretic peptide, brain-derived neurotrophic factor, body mass index, and depression. Patients with pain were more likely to have worse HF severity (NYHA Class II or III compared with Class I) (Class II: OR 5.09 [1.71 – 15.08], p = .003, Class III: 5.05 [1.73 – 14.71], p = .003), more severe depression (OR 1.14 [1.06 – 1.23], p = .001), and worsened daytime sleepiness (OR 0.90 [0.83 – 0.98], p = .017), see Table 1.

Conclusions:
We believe this study is one of the first to construct and test a preliminary comprehensive model of pain in HF. Complete characterization of pain in HF is needed before treatments can be improved. Future research is needed to explore variables that were not available in the MEMOIR-HF dataset. More robust pain measures are needed to adequately test all variables.
Abstract 4140405: Hospital outcomes of patients with type 1 diabetes mellitus and moderate and severe congenital heart disease
Authors: Bose Cameron , Chin Cindy , Caryl Natalie , Meziab Omar , barber brent , Andrews Jennifer , Seckeler Michael
Published: November 2024

Background:
Advancements in life-saving treatment for patients with moderate and severe congenital heart disease (CHD) has led to the exponential growth of a novel population of individuals with CHD who previously did not survive beyond infancy. Little is known about the impact of other medical comorbidities on the overall health of these individuals. We sought to assess the effect of comorbid Type 1 diabetes (T1DM) on hospitalized individuals with CHD.

Hypothesis:
We hypothesized that individuals with CHD who had comorbid T1DM would have worse hospital outcomes than those without diabetes of any type.

Methods:
We conducted a retrospective review of the Vizient® Clinical Data Base (national, administrative database) for admissions from 10/2019-12/2023 with ICD-10 codes for moderate and severe CHD, aged 1 to 50 years. Data included: demographics, hospital outcomes and costs. Comparisons were made between those with ICD-10 codes for T1DM (E10 – E10.9) and those without any diabetes ICD-10 codes (E10 – E10.9, E11 – E11.9) using t-tests for normally distributed data, Mann-Whitney U test for non-normally distributed data and χ
2
for categorical data.

Results:
There were 64,189 CHD admissions, 846 (13.2%) with T1DM. Details are shown in Table 1. The T1DM group were younger, had a higher prevalence of Whites (consistent with known T1DM epidemiology), higher in-hospital mortality and lower hospital costs.

Conclusions:
This review of a national administrative database has found that hospitalized individuals with CHD and comorbid T1DM are hospitalized at younger ages and are at increased risk for in-hospital mortality. Despite this, hospital costs are lower. This suggests an additional negative effect of T1DM compared to CHD alone. Further studies are needed to examine potential interventions to reduce mortality in this population.
Abstract 4140494: Postpartum linkage to primary care: Does screening for social needs identify those at risk for loss to follow-up?
Authors: Murray Mara , Dugas Julianne , McCloskey Lois , So-Armah Kaku , Yarrington Christina , Buitron de la Vega Pablo , Benjamin Emelia , Battaglia Tracy
Published: November 2024

Background:
Primary care after pregnancy is recommended, especially for individuals with recent adverse pregnancy outcomes (APOs, such as preeclampsia or gestational diabetes), who are at increased risk for future heart disease. Health-related social needs (HRSNs) are recognized barriers to care, yet their pregnancy-related prevalence and associations with care are unknown. We sought to (1) describe the pregnancy-related prevalence of HRSNs, and (2) assess associations between pregnancy-related HRSNs and subsequent linkage to primary care.

Methods:
We analyzed electronic health record data for individuals with prenatal care and delivery (2018-2021) at our urban safety-net hospital. HRSNs were assessed via a routine screener, and we summarized individual responses during pregnancy through 6 weeks post partum as: any positive, all negative, or never screened. Postpartum linkage to primary care was defined as a completed primary care visit after 6 weeks through 1 year post partum. We analyzed the prevalence of HRSNs and their associations with linkage to primary care, using adjusted log-linked binomial regression models. In stratified models we assessed for effect modification by APO history and other variables.

Results:
Of 4941 individuals in our sample, 53% identified as Black non-Hispanic and 21% as Hispanic, 68% were publicly insured, and 93% completed ≥1 HRSN screening. Nearly 1 in 4 screened positive for any HRSN, most often food insecurity (14%) or housing instability (12%), and 53% linked to primary care. Compared with those who screened negative for all HRSNs (n=3491), linkage to primary care was similar among those who screened positive for any HRSNs (n=1079; adjusted risk ratio, aRR 1.04, 95% confidence interval, CI: 0.98-1.10) and lower among those never screened (n=371; aRR 0.77, 95% CI: 0.68-0.86). We found no evidence of effect modification by APO history, race/ethnicity, insurance, language, or Covid-19 pandemic exposure.

Conclusions:
In this diverse postpartum sample, we identified a 24% prevalence of pregnancy-related HRSNs and 53% subsequent linkage to primary care. Linkage to primary care was not associated with HRSN screening result (positive versus negative) but was significantly negatively associated with being missed by HRSN screening. Further research is needed to better understand HRSN screening practices and who is missed by screening, and to identify modifiable barriers to postpartum primary care especially after APOs.
Abstract 4140502: Preventive Effects of Nitric Oxide Donors in Contrast-induced Nephropathy in Patients Undergoing Coronary Artery Angiography: An updated systematic review and meta-analysis of 13 randomized controlled trials.
Authors: A. Ibrahim Ahmed , Rakab Mohamed , Tabassum Shehroze , Amin Ahmed Mazen , Rifai Mohamed K , Manasrah AlMothana , Mahmoud Abdelrahman , Abuelazm Mohamed , Abdelazeem Basel , elsayed emara Ahmed gaber elsayed
Published: November 2024

Background:
Contrast-induced nephropathy (CIN) is associated with increased mortality and morbidity in patients undergoing coronary angiography (CAG) and percutaneous coronary intervention (PCI). We aimed to assess the latest evidence on the preventive effects of nitric oxide (NO) donors in CIN in patients undergoing CAG/PCI.

Methods:
We conducted a systematic review and meta-analysis of RCTs from PubMed, Web of Science, Scopus, Embase, and Cochrane searches until May 5th, 2024. Dichotomous data were pooled using risk ratio (RR), and continuous data were pooled using mean difference (MD), both with a 95% confidence interval (CI), using (R version 4.3).

Results:
Our analysis included 13 RCTs encompassing 3,550 patients. NO donors were significantly associated with a decreased incidence of CIN compared to placebo either as an oral administration (RR: 0.33 with 95% CI [0.26, 0.42], P< 0.01) or IV infusions (RR: 0.56 with 95% CI [0.40, 0.78], P< 0.01). Moreover, NO donors were significantly associated with decreased serum creatinine levels compared to placebo either as an oral administration (MD: -0.07 with 95% CI [-0.10, -0.04], P< 0.01) or IV infusions (MD: -0.07 with 95% CI [-0.09, -0.04], P< 0.01). In terms of safety, NO donors were significantly associated with a decreased incidence of MACE compared to placebo as an oral administration (RR: 0.64 with 95% CI [0.45, 0.89], P< 0.01). However, there was no significant difference between NO donors as IV infusions and placebo in MACE (RR: 0.68 with 95% CI [0.38, 1.21], P= 0.18). Finally, NO donors were significantly associated with a decreased incidence of all-cause mortality compared to placebo as an oral administration (RR: 0.58 with 95% CI [0.36, 0.94], P= 0.03). However, there was no significant difference between NO donors as IV infusions and placebo in all-cause mortality (RR: 1.84 with 95% CI [0.40, 8.52], P= 0.44).

Conclusion:
NO donors as an adjunct therapy are associated with reduced incidence of CIN, and decreased serum creatinine levels either as an oral or IV administration. Also, it was associated with decreased incidence of MACE and all-cause mortality as an oral administration which make this simple low-cost intervention an important therapeutic option in patients undergoing CAG/PCI.
Abstract 4140518: LVAD Recipients and Caregivers Expectations for Communication
Authors: Malik Aroosa , Mignery Matthew , Shore Supriya
Published: November 2024

Introduction:
Effective communication strategies regarding illness trajectory with left ventricular assist device (LVAD) recipients and their caregivers are lacking. This study evaluated LVAD recipients and caregivers’ preferences for effective communication surrounding end of life care and risk of complications.

Methods:
We conducted a qualitative study using semi-structured interviews with 9 LVAD recipients and 9 caregivers between 4/1/2024 – 5/6/2024. Interviews were transcribed and coded, with themes identified using rapid qualitative analysis.

Results:
Included patients had a median age (range) of 65 (24-81) years, 6 (67%) were men, 5 (56%) were White and 5 (56%) received their LVAD as destination therapy (DT). Participating caregivers included 8 (89%) women supporting 5 (56%) DT LVAD recipients. When asked about ways to improve communication regarding illness trajectory with a LVAD, majority of patients and caregivers desired to have communication prior to LVAD placement and favored learning about survival, risk of complications, quality of life with an LVAD. They favored precise estimates of associated risks and survival rather than general outcomes. Additionally, majority of patients and caregivers preferred healthcare providers initiate end of life discussions, with caregivers present in a clinic visit. We identified three themes explaining patients and caregivers’ preference for improved communication for LVAD (i) direct and honest communication (ii) caregiver or care partner as an advocate and (iii) type of information desired. Exemplary quotes highlighting these themes are provided in the Table below.

Conclusion:
Our qualitative study highlights patients and caregivers’ preference for communication surrounding LVAD prognosis, risk, and end of life discussions. This highlights areas of improvement regarding LVAD communication.