bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 16330: Aspirin Dosing by Body Mass Index: A Patient-Centric Trial Assessing Benefits and Long-Term Effectiveness
Authors: Shah Nishant P , Hoke Cara , Rhodes Grace , Stebbins Amanda , Wruck Lisa M , gupta Kamal , Kripalani Sunil , Munoz Daniel , Whittle Jeffrey , Benziger Catherine , Girotra Saket , Knowlton Kirk U , Polonsky Tamar S , Rothman Russell , Harrington Robert A , Hernandez Adrian F , Jones William S
Published: December 2023

Introduction:
Elevated body mass index (BMI) is a risk factor for cardiovascular (CV) events. It remains unclear if the effectiveness and safety of aspirin dose (81mg vs 325mg) is modified by baseline BMI.

Research Question:
To determine differences in CV event rates and major bleeding between aspirin dose and BMI in patients with coronary artery disease (CAD).

Methods:
Participants from the ADAPTABLE trial were stratified by BMI categories defined as normal weight (BMI <25 kg/m
2
), overweight (BMI ≥25 to <30 kg/m
2
), and obese (≥30 kg/m
2
). The primary outcome was a composite of all cause death, hospitalization for myocardial infarction (MI), or hospitalization for stroke, assessed in a time-to-event analysis. The event rate represented events per 100 patient years of follow up. The primary safety outcome was hospitalization for major bleeding with blood product transfusion. Cox proportional hazards models were used to evaluate the primary outcome by aspirin dose and BMI category.

Results:
A total of 12,715 participants (n=1,822 normal weight, n=4,485 overweight, and n=6,408 obese) had data available for BMI and analysis. The event rate for the primary outcome in those at normal weight was similar across aspirin dose (5.38 for 81mg vs 5.43 for 325 mg, adjusted HR 1.06 [95% CI 0.81-1.39]). This relationship was also seen in both overweight (3.53 for 81mg vs. 3.27 for 325mg, 1.10 [0.88-1.36]), and obese (3.50 for 81mg vs 3.45 for 325 mg, 1.04 [0.87-1.25]) BMI (figure). There was no difference in the primary safety outcome by aspirin dose [normal weight 0.92 (0.41-2.08), overweight 1.65 (0.77-3.55), obese 1.17 (0.62-2.20)]. The overall event rate for the primary outcome was lower in overweight (0.68 [0.57-0.81]) and obese (0.65 [0.55-0.78]) groups compared to normal weight.

Conclusion:
In ADAPTABLE, no difference was seen in CV event rates and major bleeding across BMI by aspirin dose. However, the overall event rates were lower in elevated BMI groups suggesting an obesity paradox.
Abstract 16341: A Rare Case of Dual Cardiomyopathy: Acute Decompensated Heart Failure Secondary to Eosinophilic Myocarditis and Ischemic Cardiomyopathy
Authors: Goel Kunal , Chiou Andrew , Robinson Austin
Published: December 2023

Introduction:
Dual cardiomyopathy, characterized by the coexistence of two distinct forms of myocardial dysfunction, is a rare phenomenon with complex diagnostic and therapeutic challenges. We present a unique case of a patient with combined eosinophilic myocarditis and ischemic cardiomyopathy.

Case Presentation:
A 65-year-old female with history of peripheral eosinophilia presented with worsening dyspnea and abdominal pain. CT abdomen was notable for right renal artery thrombosis. Troponin I was elevated at 0.057 ng/ml and 0.056 ng/ml. Notably, her absolute eosinophil count was elevated to 20.34 K/mcL. EKG with LVH and repolarization abnormalities. TTE showed a severely reduced LVEF of 18% and severe global hypokinesis.

Decision Making:
Given her newly diagnosed cardiomyopathy, a cardiac MRI was obtained that demonstrated presence of two moderate-sized cylindrical thrombi in the LV and subendocardial late gadolinium enhancement in the basal to mid antero/inferoseptum and inferolateral wall, characteristic of both myocardial infarction and eosinophilic myocarditis (Figure 1). She underwent a coronary angiogram that revealed severe mid LAD and OM1 artery stenosis that required PCI. She was initiated on appropriate medical therapy including steroids with normalization of her peripheral eosinophilia and improvement in her clinical symptoms.

Discussion:
This case highlights the intricate interplay between eosinophilic myocarditis and underlying ischemic cardiomyopathy. The timely initiation of appropriate therapies, including corticosteroids for eosinophilic myocarditis and revascularization for ischemic cardiomyopathy, can lead to favorable outcomes in these complex cases.
Figure 1:
Cardiac MRI showing inferolateral LGE and Cylindrical LV thrombi.
Abstract 16361: Atypical Presentation of Myocardial Ischemia Provoked by Food Ingestion
Authors: Akkawi Abdul Rahman , Imran Sana , Dodenhoff Sean-Mikael , Challa Abhiram , Mahdi Ahmad , Eid Freidy
Published: December 2023

Introduction:
A type 2 myocardial infarction typically occurs due to demand ischemia from a blood supply mismatch. Significant blockage can trigger coronary steal syndrome and worsen perfusion in areas with severe coronary artery disease (CAD). In this case, we highlight a patient who experienced a dynamic elevation in troponin levels after food consumption, ultimately necessitating coronary artery bypass graft surgery (CABG), shedding light on the diverse presentations of cardiac ischemia.

Case Presentation:
A 49-year-old male with a history of hypertension, type 2 diabetes mellitus, obesity, recent stroke on dual antiplatelets, and non-obstructive CAD presented with chest discomfort over a period of two months. The patient denied associated symptoms and physical examination was unremarkable. Interestingly, the chest pain occurred specifically after meals. Extensive workup, including an EGD and CTA Abdomen, were negative. The symptoms were refractory to proton pump inhibitors (PPI). An EKG revealed dynamic precordial ST segment depressions, and troponin levels were elevated after meals on multiple occasions, gradually decreasing between meals. A left heart catheterization revealed severe five-vessel blockages; thepatient consequently required a quadrupleCABG. Following surgery, the patient reported a resolution of chest pain.

Discussion:
Our patient developed chest pain and demonstrated elevated troponin levels after each meal. With an extensive negative workup, further evaluation was necessary. Theoretically, circulatory flow in the splanchnic circulation during food digestion can mimic physical activity. Additionally, a full stomach may irritate the diaphragm and lead to arrhythmias. This case highlights the potential role of meals as triggers for coronary artery disease in patients with critical coronary blockage. Demand cardiac ischemia can manifest with atypical presentations that may pose diagnostic challenges. It is essential to recognize the atypical presentations of myocardial infarction to aid in the timely diagnosis and treatment of this potentially life-threatening condition.
Abstract 16375: Cardiovascular Risk Factors and Timing of Diagnosis Among Caregivers in the United States
Authors: Makuvire Tracy T , Latif Zara , Warraich Haider
Published: December 2023

Introduction:
The burden of family caregiving has been increasing in the US. However, caregiver burden may be associated with a higher risk of cardiovascular disease (CVD) among adults.

Hypothesis:
A higher caregiver burden is associated with an increased risk of CVD.

Methods:
Using data from the National Health and Nutrition Examination Survey (NHANES) between 2017 and March 2020, we conducted a cross-sectional analysis of US adults. We evaluated the prevalence of CVD, age at diagnosis, and treatment rates of caregivers and non-caregivers. The term "caregivers" refers to adults who reported that they had to stay at home to take care of their families. Outcomes included the average age at first diagnosis, rates of treatment, and average levels of hemoglobin A1c, cholesterol, and triglycerides. Descriptive and analytical statistics were generated using STATA.

Results:
Among the 15,560 US adults, 488 were identified as caregivers. Compared to non-caregivers, caregivers were, on average, older (43 vs. 33 years), more likely to be female (93% vs. 49%), Hispanic (34% vs. 22%), born outside the US (51% vs. 18%), and married (79% vs. 56%) (all p<0.001). While there was no difference in hemoglobin A1c, triglyceride, and LDL-cholesterol levels, caregivers were more likely to self-report CVD risk factors at a younger age: diabetes mellitus (44 vs. 49 years), hypertension (42 vs. 47 years), heart failure (37 vs. 57 years), and stroke (42 vs. 57 years) (all p<0.05). Caregivers were less likely to follow lifestyle modifications such as weight loss or taking cholesterol medications. Caregivers had greater odds of being diagnosed with CAD (3.9 [CI 1.7-8.8]), angina (4.4 [CI 1.4-13]), heart attack (4.8 [CI 2.0-12]), and stroke (2.0 [CI 1.2-3.6]). But this association was not significant after adjusting for age, gender, race, and college education.

Conclusion:
In this nationally representative sample study, 93% of caregivers were female and had CVD risk factors, such as diabetes and hypertension, detected at younger ages than non-caregivers. A high caregiver burden exposes patients to early CVD risk. As caregiver burden increases, early detection and treatment in this largely female patient population is crucial to reduce sex-related CVD disparities.
Abstract 16383: The Burden of Cardio-Metabolic Disorders Among the Hospitalized Population With Renovascular Hypertension and Predictors of Mortality; a Population-Based Retrospective Study
Authors: Evbayekha Endurance O , Bastidas Leonela , Gaibor Carlos , Kuttab Rani , Foster Dawson , Jelwan Yara , Elmasry Yansoun , Desai Purav , Abbas Amer , pohlman thomas
Published: December 2023

Introduction:
Cardio-metabolic disorders (CMBD), including hypertension, diabetes, obesity, stroke, and non-alcoholic fatty liver disease, significantly burden healthcare systems globally. The impact of atherosclerotic renovascular hypertension (rHTN) on the overall cardiovascular health of hospitalized patients is of particular interest, as it may be associated with a higher risk of adverse outcomes. We aimed to study the burden of CMBD in this population.

Hypothesis:
We hypothesize that rHTN cohorts have a considerable burden of CMBD, and studying this will provide valuable insights for improved management.

Methods:
We used the ICD-10 diagnostic code (I150) to identify hospitalizations with rHTN from the National Inpatient Sample Database (NIS) (2016-2020). We excluded individuals with fibromuscular dysplasia. We analyzed the prevalence of CMBD, specifically obesity, dyslipidemia (DysL), type-2 diabetes (T2DM), and coronary artery disease (CAD). We used multivariate regression analysis to estimate the probability of each subgroup as an independent predictor of mortality.

Results:
There were 7899 hospitalizations diagnosed with rHTN, the mean age was 58 years ± 25, and 54% (4363) were females. There was an ethnic prevalence of 56.1% (4423) Caucasians, 23.2% (1816) Blacks, 14.7% (1162) Hispanics, and 3.3% (259) Asians. The median length and cost of hospitalization was 4 days and $41,145, respectively. CMBD burden analysis revealed that 42.8% (3381) had DysL, 37.9% (2994) T2DM, 32.8% (2591) CAD, and 16.1% (1272) had obesity. The CAD subgroup was independently associated with mortality, with an adjusted odds ratio (aOR) of 1.5 (1.05-2.1, p=0.04). The other subgroups did not have a statistically significant independent association with mortality, T2DM 0.9 (0.6-1.3, p=0.7), DysL 0.5 (0.4-1.01, p=0.06), and obesity 0.8 (0.5-1.4, p=0.4).

Conclusion:
rHTN remains prevalent in the middle age group, and a large proportion have cardiometabolic risk factors, including dyslipidemia, type-2 diabetes, and coronary artery disease. Coronary artery disease remains an independent predictor of mortality in this population. Prevention, early detection, and aggressive treatment of CMBD and CAD cannot be overemphasized.
Abstract 16390: Polygenic Risk Scores Predict Future Atrial Fibrillation-Related Stroke/Systemic Embolism
Authors: Park Hanjin , Kim Daehoon , Jang Eunsun , Yu Hee Tae , Kim Tae-Hoon , Sung Jung-Hoon , Pak Hui-Nam , LEE Moon Hyoung , Yang Pil-sung , JOUNG BOYOUNG
Published: December 2023

Introduction:
Targeted screening for atrial fibrillation (AF) should include those at highest risk of future AF-related stroke/systemic embolism, which might be potentially preventable.

Hypothesis:
To investigate whether AF polygenic risk score (AF-PRS) can predict future AF-related stroke/systemic embolism.

Methods:
A total of 41,337 individuals (≥65 years) free of AF and additional risk factor for stroke at baseline were included from the UK Biobank. A stroke/systemic embolism event was considered AF-related and potentially preventable when a previously undiagnosed AF was identified at the time of stroke/systemic embolism or up to 3-years after the event.

Results:
For a median of 11.4 (10.5-12.3) years, 334 AF-related stroke/systemic embolism developed. After adjusting for CHARGE-AF, AF-PRS identified significant gradient for AF-related stroke/systemic embolism with 3.78-fold higher risk in the top quintile of the AF-PRS (HR 3.78, 95% CI 2.57-5.58, p<0.001) whereas not for AF-unrelated stroke/systemic embolism (HR 0.97, 95% CI 0.78-1.23, p=0.860). The number needed for 5-years of AF screening to find 1 AF-related stroke/systemic embolism was 79 for high CHARGE-AF and high AF-PRS whereas 831 for low CHARGE-AF and low AF-PRS. AF-PRS added to CHARGE-AF resulted in a significant improvement in C-indices for AF-related stroke/systemic embolism [C index (standard error) 0.606 (0.011) to 0.676 (0.010), ΔC-index <0.001] whereas not for AF-unrelated stroke/systemic embolism.

Conclusions:
AF-PRS predicted future AF-related stroke/systemic embolism beyond traditional clinical risk factors. Targeted AF screening on high genetic risk patients might identify more screening preventable stroke/systemic embolism events.
Abstract 16402: Pitx2c-Conditional Knockout Mice May Become a Useful Model to Elucidate the Pathogenesis of Post-Capillary Pulmonary Hypertension
Authors: Seya Daiki , Inoue Takahiro , Baba Sunsuke , Akaike Toru , Minamisawa Susumu
Published: December 2023

Introduction:
Pulmonary hypertension (PH) is an intractable disease that causes cardiopulmonary dysfunction due to elevated pulmonary arterial pressure. The pathogenesis of PH varies greatly depending on whether the primary lesion is upstream or downstream of the pulmonary capillaries, and the latter, post-capillary PH (pc-PH) caused by pulmonary vein stenosis/obstruction or left heart disease, currently has not an appropriate animal models to study its pathophysiology and pharmacological effects.

Hypothesis:
We hypothesized that a tissue-specific deletion of a gene involved in the formation of pulmonary veins could create a pathological mouse model of pc-PH.

Methods:
Focusing on the homeobox transcription factor Pitx2c, which has been reported to be indispensable for the formation of pulmonary veins, we generated Pitx2c-conditional knockout (cKO) mice specific for pulmonary vein and atrial myocardium by crossing Pitx2c-floxed mouse lines with Cre mouse lines for sarcolipin, a sarcoplasmic reticulum membrane protein. Then, we examined the cardiac morphology and hemodynamics of the Pitx2c-cKO mice.

Results:
Tissue weights of 8-week-old Pitx2c-cKO mice showed that the relative weights of both atria (especially the right atrium), right ventricle and lungs were significantly increased in Pitx2c-cKO mice, while the relative weight of the left ventricle was decreased. Furthermore, echocardiography performed on 3-month-old Pitx2c-cKO mice revealed that the right ventricle was markedly enlarged in Pitx2c-cKO mice, with enlarged pulmonary artery annulus diameter and increased velocity time integral (VTI) of blood flow through the right ventricular outflow tract. Pitx2c-cKO mice also had significantly decreased left ventricular end-diastolic diameter (LVDd), end-systolic diameter (LVDs), and mass (LVM). On the other hand, there was no difference in left ventricular fractional shortening (%FS) or tricuspid annular plane systolic excursion (TAPSE), indicating no cardiac dysfunction in Pitx2c-cKO mice. Cardiac catheterization also revealed elevated right ventricular pressure in some Pitx2c-cKO mice.

Conclusion:
These primary findings suggest that the Pitx2c-cKO mice may be a model for understanding the pathogenesis of pc-PH.
Abstract 16411: Patent Foramen Ovale Combined With Solitary Pulmonary Arteriovenous Malformation
Authors: Dondapati Manasa , Gier Chad , Nessa Sayedatun , Koroneos Nicholas , Stefanowski Kamil , Ohngemach Daniel , Parikh Puja
Published: December 2023

Introduction:
A transthoracic echocardiogram (TTE) with bubble study is standard during evaluation of patients presenting with cryptogenic stroke to evaluate for the presence of a patent foramen ovale (PFO). However, other uncommon conditions, such as solitary pulmonary arteriovenous malformations (sPAVM), can also present with stroke and abnormal bubble study. We examine a case of a woman who presented with an acute ischemic stroke and was found to have both a PFO and sPAVM.

Case:
A 64-year-old woman with hypertension presented with acute onset facial droop, left arm paresis, and aphasia. A computed tomography (CT) scan of her head did not show an intracerebral hemorrhage or large vessel occlusion. However, magnetic resonance imaging showed acute infarction of the right thalamus. During initial work up, a chest x-ray was also obtained and there was concern for possible pulmonary malignancy. A subsequent contrast-enhanced CT of her chest revealed a right lower lobe PAVM. A TTE with bubble study showed bubbles in the left atrium, which was attributed to PAVM. Interventional radiology was consulted, and the patient underwent PAVM embolization. TTE was repeated and continued to show bubbles in the left atrium. Transesophageal echocardiogram (TEE) revealed an atrial septal aneurysm with PFO. After interdisciplinary discussion and shared decision making, she eventually underwent successful transcatheter PFO closure with an Amplatzer PFO occluder. Genetic testing for hereditary hemorrhagic telangiectasia was negative.

Discussion:
This case highlights the importance of evaluating for less common causes of stroke such as sPAVMs and multidisciplinary approach to complex cases. The American Heart/Stroke Associations recommend PFO closure for patients presenting with ischemic stroke and no other identifiable cause. However, there is not clear guidance on the management of patients who present with stroke and have both PFO and PAVMs. Although PFOs are commonly ruled out with TTE/TEE and bubble study, there may be utility in also ruling out PAVMs as they are an important and reversible cause of paradoxical emboli. Further studies should the evaluate the management of patients with both PAVM and PFO with a focus on the optimal strategy for sequence of closure.
Abstract 16440: Gender Differences of In-Hospital Outcomes in Acute Myocardial Infarction and Cardiogenic Shock Patients Using Impella: From the Nation Inpatient Sample 2016-2019
Authors: FU Shizhe , Kairu Wang , CONG Guangzhi , Ma Xueping , HUANG Hui , JIA Shaobin
Published: December 2023

Background:
There is a lack of independent studies on gender differences in hospital outcomes with Impella in patients with acute myocardial infarction (AMI) combined with cardiogenic shock (CS). Our study aims to provide evidence on the impact of gender differences on AMI-CS patients receiving Impella with a nationally representative sample.

Methods:
Data were obtained from the National Inpatient Sample (NIS) from 2016 to 2019. Patients with AMI and CS were searched in the NIS using ICD-10 CM codes, and those with Impella were screened using ICD-10PCS codes. Patients treated with Impella were then stratified by gender. We used multivariate regression analysis with inverse probability weighting(IPTW) based on propensity scores to compare the risk of in-hospital death after Impella among patients of different genders.

Results:
From 2016-2019, a total of 2,953 inpatients with AMI combined with CS using Impella were identified. Of these, 28.5% were women. Women treated with Impella were older (mean age 68.42 versus 64.68 years, P<0.0001). Male inpatients on Impella had a higher proportion of NSTEMI, and were more likely to have smoking, congestive heart failure, cardiac arrhythmias, and acute renal failure. Female inpatients were more likely to have STEMI and were more likely to have Chronic pulmonary disease, uncomplicated hypertension, hypothyroidism, and valvular disease. After IPTW-adjusted baseline clinical covariates, women using Impella had a higher risk of in-hospital death than men, while length of stay and total hospital cost did not differ significantly between genders (OR, 1.33 [95%CI, 1.10-1.60]; Beta, -0.05 [95%CI, -0.80-0.71]; and Beta, 8105.24 [95%CI, -25376.84-9166.35]; respectively).

Conclusions:
Impella use was lower in women. However, in-hospital mortality was significantly higher in women among AMI-CS patients using Impella. Further studies are needed to explore the reasons for higher mortality in female patients using Impella.
Abstract 16444: Gut Microbiota Derived Metabolite, Ursodeoxycholic Acid, and the Risk of Cardiovascular Disease
Authors: Mirzaei Sahereh , Devon Holli A , Cantor Rita M , Laakso Markku , Lusis Aldons J
Published: December 2023

Introduction:
Gut microbial metabolites have been recognized as risk factors for cardiometabolic diseases. The associations between plasma levels of the gut microbiota derived metabolites with cardiovascular disease (CVD) have not been comprehensively examined. Our objective was to investigate the association between 6 secondary bile acids including ursodeoxycholic acid and CVD. Ursodeoxycholic acid is used to dissolve cholesterol gall stones to treat cholestatic liver diseases.

Hypothesis:
Gut microbiota derived metabolites are associated with CVD.

Methods:
We performed a secondary analysis of data from the cross-sectional Metabolic Syndrome in Men (METSIM) cohort. Our study included 915 men aged 45-73 years (age = 54.94 ± 5.04 years, BMI = 27.31 ± 3.44), randomly selected from the population register of Kuopio, Eastern Finland, from 2005 to 2010. The associations between 6 secondary bile acids (ursodeoxycholic acid, glycoursodeoxycholate, glycolithocholate sulfate, taurocholenate sulfate, taurochenodeoxycholate, and glycocholenate sulfate) and the risk of CVD were investigated. Kaplan-Meier analysis with Cox proportional-hazards regressions were conducted for the time-to-event analysis to determine hazard ratios (HR) and 95% confidence intervals (CI) for CVD. Adjustments were made for traditional cardiovascular risk factors (age, systolic blood pressure, low-density and high-density lipoprotein cholesterol levels, triglyceride levels, smoking status, high-sensitivity C-reactive protein, estimated glomerular filtration rate, and alcohol consumption).

Results:
Participants were stratified into groups according to quartile metabolites levels and CVD. During a median follow-up of 16 years, n = 62 (7%) of patients experienced CVD. Only ursodeoxycholic acid was significantly associated with CVD risk. Cox regression analyses showed that the adjusted HR for CVD was higher in patients in quartile 4 (HR: 2.8, 95% [CI]: 1.35-4.6; p =0.008) than in quartile 1. The Kaplan-Meier analysis indicated that patients in quartile 4 had a significantly lower event-free survival (p = 0.037) compare to quartile 1.

Conclusions:
Ursodeoxycholic acid, a secondary bile acid, was positively associated with an increased risk of CVD.
Abstract 16450: Increased Monocyte Count and Neutrophil-to-Lymphocyte Ratio With ICI Myocarditis
Authors: Chan Antonia , Huang Yuhsin , Ivanovic Maja , Ivanovic Maja , Waliany Sarah , Batchelder Ryan , Neal Joel , Wakelee Heather , Fan Alice , Reddy Sunil , Katsumoto Tamiko , Cheng Paul , Wu Sean M , Witteles Ronald M , Zhu Han
Published: December 2023

Introduction:
Diagnosing immune checkpoint inhibitor (ICI) myocarditis remains complex in practice, often requiring advanced imaging or invasive endomyocardial biopsy. We constructed an institutional cohort of patients who received at least 1 dose of ICI and developed probable or definite ICI myocarditis.

Hypothesis:
We hypothesized that routine serum biomarkers, including troponin I, neutrophil-to-lymphocyte ratio (NLR), monocytes, and AST/ALT, would be elevated and peak at diagnosis.

Methods:
This retrospective cohort study used EHR data from patients on ICI at a single academic institution who developed probable or definite myocarditis from 7/2015 - 1/2023. Inclusion criteria and diagnosis date were defined using Bonaca criteria and/or documented clinical consensus, e.g. initiation of steroids for presumed myocarditis. Primary outcomes were levels of troponin I/high sensitivity troponin I, monocytes, NLR, and AST/ALT. LOESS regression with default smoothing parameter α = 0.75 was used to evaluate biomarker patterns 7 days pre- and post- diagnosis.

Results:
We included 16 cases of myocarditis. At diagnosis, most patients had at least 1 significant elevation in troponin I (100%), AST (81%), ALT (63%), or monocytes (69%) while on ICI (Figure 1). After diagnosis, absolute monocyte and lymphocyte count initially decreased before rebounding. Serum NLR rose prior to and briefly after diagnosis (Figure 2).

Conclusions:
Peripheral cardiac and non-cardiac biomarkers change with ICI myocarditis. Further research on routine non-cardiac biomarkers associated with myocarditis and other ICI toxicities may help prevent high-grade adverse events.
Abstract 16467: The Prevalence, Racial Distribution, and In Hospital Outcome of Percutaneous Coronary Intervention in Non ST Elevation Myocardial Infarction With Patients With Wild Type Transthyretin Cardiac Amyloidosis
Authors: Ouedraogo Faizal , Bolaji Olayiwola , Adabale Olanrewaju , Shoar Saeed , V Nair Ambica , Evbayekha Endurance O , Antia Akanimo , Nriagu Bede N , Yanogo Arnaud , Idowu Abiodun , Oghoghorie Stanley O , Graham Saeed
Published: December 2023

Introduction:
Epicardial coronary arteries are also a target for intramural amyloid deposits in cardiac amyloidosis beyond the myocardium. For patients with restrictive cardiomyopathy and some degree of stable chronic angina, the role of coronary revascularization has not been clearly shown to have additional benefits over medical management. In unstable angina and Non-ST-elevation acute coronary syndrome (NSTE-ACS) population, isolated observations have painted a grimmer prognosis.

Hypothesis:
We hypothesized that wild-type ATTR-CA patients with NSTEMI undergoing Percutaneous coronary interventions (PCI) had poor outcomes. We sought to establish their prevalence and uncover the determinants of these outcomes.

Methods:
A five-year retrospective inquiry of the National Inpatient Sample (NIS) database from 2016 to 2020 on all the patients admitted with a matching diagnosis to the ICD-10 code of interest.

Results:
Over the five-year span of our observation, about 1,116,170 patients were admitted to the hospital in the US with an NSTE-ACS diagnosis, of which 99% underwent PCI during the same hospitalization (1,116,065). Among the latter 1,505 patients (1%) had ATTR-CA. The most represented demographics in that subpopulation were men (69%), elderly about 74 years old on average (80%), and Whites (60%). The cumulative mortality rate among the ATTR-CA PCI group was higher (18%) than the general NSTE-ACS PCI (14%). Factors associated with survival at hospital discharge were female sex (p-value 0.008), and black race (p-value 0.019). Meanwhile, Asian race (p-value 0.0001), being in a teaching hospital (p-value 0.0001), medium to large size hospital (p-value 0.0001) were harbingers of poor outcomes including death (18%), prolonged hospitalization (about 9.5 days), and higher healthcare costs (about $127,319).

Conclusions:
PCI has mortality benefits in STEMI and unstable CAD. However, in the ATTR-CA with unstable CAD, this might not be the case as seen with the staggering 28% risk increase in mortality rates in our study. Percutaneous revascularization in wild-type ATTR-CA deserves its own category when clinicians are weighing the benefits and a multidisciplinary approach should be preferred.
Abstract 16476: Association Between Atrial Fibrillation and Deep Learning Derived Retinal Features Trained on Electrocardiogram versus Coronary Artery Calcium
Authors: Rim Tyler H , Kang Hyun Goo , Lee Chan Joo J , Kim Sung Soo , Kim Hyeonmin , Lee Geunyoung , Yu Marco , Tham Yih-Chung , Cheng Ching-Yu , Park Sung Ha , Lip Gregory
Published: December 2023

Introduction:
This study aimed to assess the ability of a deep learning algorithm, Reti-AF, developed from retinal photos, to predict atrial fibrillation (AF) incidence. Its predictive performance was evaluated using the UK Biobank and compared to Reti-CAC, a similar algorithm trained on coronary artery calcium (CAC) scores.

Hypothesis:
We hypothesised that Reti-AF and Reti-CAC could potentially predict the incidence of AF.

Methods:
Due to the lack of atrial fibrillation (AF) patients in the UK Biobank, a Masked AutoEncoder method was used with a Vision Transformer (ViT) model. The model was first trained on 636,992 fundus images from a health screening dataset, then fine-tuned with an additional 6,068 retinal images from the UK Biobank. The survival analysis of the UK Biobank's longitudinal data was performed to assess the model's predictive performance for AF, with hazard ratios calculated.

Results:
In longitudinal validation among participants without baseline AF, Reti-AF was significantly associated with AF incidence (HR=5.50, 95% CI, 1.98-2.57, highest tertile of Reti-AF versus the first tertile) in a univariable model. However, this significance was not maintained in a multivariable model (HR=1.23, 95% CI, 0.93-1.30). When Reti-CAC was applied to predict AF, it showed a significant association with AF incidence in both univariable (HR=9.30, 95% CI, 6.68-12.96, highest tertile of Reti-CAC versus the first tertile) and multivariable (HR=1.84, 95% CI, 1.26-2.70) models after adjustment for age, gender, smoking, diabetes, hyperlipidemia, hypertension, and baseline chronic kidney disease.

Conclusions:
The study found that combining deep learning with retinal photos and coronary artery calcium (CAC) as a reference, led to more accurate prediction of atrial fibrillation (AF) incidence compared to using AF. Furthermore, Reti-CAC was shown to be capable of predicting both cardiovascular disease onset and AF incidence.
Abstract 16488: Sestrin2 Protects Against Long-Term Cardiac Injury and Remodeling by Modulating mTORC1 Activation in Myocardial Ischemia/Reperfusion
Authors: Li Xuan , Wang Zhen , Docarmo Jussara M , Da Alexandre A , Mouton Alan J , Omoto Ana C , Hall John E
Published: December 2023

Introduction:
Myocardial ischemia/reperfusion (I/R) injury can lead to long-term cardiac dysfunction and heart failure with reduced ejection fraction (HFrEF) in aged hearts. However, young hearts may exhibit some resistance to this process and retain better cardiac function. Our previous studies have identified a novel protein called Sestrin2 (Sesn2), which is downregulated in aged hearts.

Hypothesis:
Sesn2 may protect hearts from progressing to HFrEF following myocardial I/R.

Methods:
We induced myocardial I/R injury by ligation/release of the left anterior descending coronary arteries (LAD) in both C57BL/6J mice and mice with cardiac-specific Sesn2 knockout (Sesn2

cKO

). Cardiac function was assessed, and samples were collected at baseline, one day post I/R, seven days post I/R, and 28 days post I/R.

Results:
In wild-type (WT) hearts (12-18 weeks), cardiac function showed a slight decrease 28 days post I/R (IR28D), but the ejection fraction (EF) remained above 50%. However, Sesn2

cKO

mice exhibited a significant reduction in cardiac function at IR28D, with an about 27.5% decrease in EF compared to WT hearts. We also observed a significant increase in volume at diastole in Sesn2

cKO

mice at IR28D compared to their baseline and corresponding WT. Furthermore, when comparing mitochondrial respiration in the area at risk (AAR) of the left ventricles between the two groups, we found a significant decrease in oxygen consumption rate (OCR) and a significant increase in H
2
O
2
production in Sesn2

cKO

hearts. Additionally, the mammalian target of rapamycin complex 1 (mTORC1) was significantly upregulated in Sesn2

cKO

mice compared to WT hearts.

Conclusions:
Sesn2 exerts a cardiac protective effect by downregulating mTORC1 activation, thereby reducing long-term cardiac injury following I/R, attenuating cardiac remodeling, and improving mitochondrial respiration in the AAR of the heart.
Abstract 16506: Effect of COVID-19 on Outcomes of Patients Hospitalized With Takotsubo Cardiomyopathy
Authors: Singh Sukhvir , El Sharu Husam , Teaima Taha , Subramanian Lakshmi , Orjonikidze Nini , Muhyieddeen Amer , Khdeir Omar
Published: December 2023

Introduction:
Takotsubo Cardiomyopathy (TCM), commonly known as stress cardiomyopathy, is a condition characterized by the abrupt occurrence of acute left ventricular dysfunction, triggered by a variety of physical and psychosocial factors. The influence of COVID-19 on the outcomes of TCM hospitalizations remains relatively understudied. Thus, our objective was to investigate the impact of COVID-19 (COVID) on the outcomes of individuals hospitalized with TCM.

Methods:
The 2019-2020 National Inpatient Sample (NIS) was analyzed to identify adult hospitalizations admitted for TCM with a concurrent diagnosis of COVID-19 using International Classification of Disease 10 Clinical Modification (ICD-10-CM) codes. We compared baseline characteristics using T-test and Chi-square for continuous and categorical variables, respectively and multivariate regression analysis was used to adjust for potential confounders.

Results:
Out of the 41,324 TCM hospitalizations, 1,665 had a concurrent COVID infection. Hospitalizations with TCM and COVID had statistically significant difference in mortality (adjusted Odds Ratio (aOR) 2.30; Confidence Interval [CI] 1.2-4.5, p = 0.01), longer length of stay (LOS) 4.1 days (CI 2.8-5.5, p < 0.001), and higher mean total hospital charges (THC) of $46,452 (CI 17,711-75203). Figure 1 shows the Forrest plot for multivariate analysis of in-hospital morbidities when adjusted for patient demographics, comorbidities and hospital characteristics.

Conclusions:
Patients hospitalized for TCM with concurrent COVID 19 infection had increased in-hospital mortality, longer LOS, higher THC and increased odds of cardiogenic shock, cardiac arrest, acute kidney injury (AKI), use of mechanical ventilation and use of vasopressor support.
Abstract 16539: Endometriosis Does Not Have a Causal Role in Determining Cardiovascular Disease and Cardiac Structure and Function: Evidence From Mendelian Randomization
Authors: Ardissino Maddalena , Chen Jun Yu , Millar Ophelia , Xu Gillian , Girling Joanna , Ng Fu Siong
Published: December 2023

Introduction:
Previous observational studies have suggested an association between endometriosis and higher risk of cardiovascular disease. However, in the observational setting residual confounding could drive the association.

Hypothesis:
In this study, we hypothesize that endometriosis might be causally related to cardiac disease, structure and function, and investigate this using Mendelian randomization (MR), a method that is not liable to influence by observational confounding.

Methods:
Genome-wide significant (p<5x10-8) uncorrelated (r2<0.001) variants associated with endometriosis in a recent genome-wide association study of 60,674 cases and 701,926 controls were extracted as instrumental variants. Gene-outcome association data was extracted from GWAS of atrial fibrillation, coronary artery disease, heart failure, ischaemic stroke, and 15 different indexed cardiac magnetic resonance markers of structure and function. Inverse-variance weighted MR was used for primary analysis. A further exploratory analysis was performed for the outcome of atrial fibrillation, extracting data from a different GWAS study, to further explore to a borderline result on primary analysis.

Results:
A higher genetically-predicted risk of endometriosis was not associated with risk of atrial fibrillation (OR 1.06, 95%CI 1.00 to 1.12, p=0.059), coronary artery disease (OR 1.00, 95%CI 0.93 to 1.07, p=0.933), heart failure (OR 1.00, 95%CI 0.94 to 1.05, p=0.920), or ischaemic stroke (OR 0.97, 95%CI 0.91 to 1.03, p=0.342). Replication analysis using a different data source for atrial fibrillation corroborated a lack of association (OR 1.02, 95%CI 0.96 to 1.09, p=0.488). There were no associations with any of measures of cardiac structure and function, as displayed in Figure 1.

Conclusions:
The results do not support a causal role of endometriosis in determining the risk of cardiovascular diseases, and in promoting an adverse cardiac structure and function.
Abstract 16541: Early Aortic Valve Replacement in Symptomatic Normal-Flow, Low-Gradient Severe Aortic Stenosis: A Propensity Score-Matched Retrospective Cohort Study
Authors: Kim Kyu , Cho Iksung , Ko Kyu-Yong , Lee Seung-Hyun , Lee Sak , Hong Geu-Ru , Ha Jong-Won , Shim Chi Young Y
Published: December 2023

Introduction:
Aortic valve replacement (AVR) is a class I indication for symptomatic severe aortic stenosis (AS). However, there is little evidence of the benefit of early AVR in symptomatic patients with normal-flow, low-gradient (NFLG) severe AS.

Hypothesis:
Early AVR has benefit in patients with NFLG severe AS

Methods:
Two-hundred eighty-one patients diagnosed with symptomatic NFLG severe AS (stroke volume index ≥ 35 mL/m
2
, mean transaortic pressure gradient < 40 mmHg, peak transaortic velocity < 4 m/s, and aortic valve area < 1.0 cm
2
) between January 2010 and December 2020 were retrospectively reviewed. After 1:1 propensity score matching, 121 patients aged 75.1 ± 9.8 years (including 63 women) who underwent early AVR within three months after index echocardiography were compared with 121 patients who received conservative care. The primary outcome was a composite of all-cause death and heart failure hospitalization.

Results:
During a median follow-up of 21.9 months, 48 primary outcomes (18 in the early AVR group and 30 in the conservative care group) occurred. The early AVR group presented a significantly lower incidence of primary outcomes (hazard ratio [HR], 0.52; 95% confidence interval [CI], 0.29-0.93; P = 0.028); specifically, there was no significant difference in all-cause death (HR, 0.51; 95% CI, 0.23-1.16; P = 0.110), although the early AVR group showed a significantly lower incidence of hospitalization for heart failure (HR, 0.43; 95% CI, 0.19-0.95, P = 0.037). Subgroup analyses supported the main findings.

Conclusions:
An early AVR strategy may benefit guard against a composite outcome of death or hospitalization for heart failure in symptomatic patients with NFLG severe AS. Future randomized studies must confirm our findings.
Abstract 16560: Home Blood Pressure Monitoring Among Hypertensive Patients and Their Caregivers in a North Indian Population
Authors: Singhania Anusha , Singla Ankur , Kalsi Harsimran , Mahendru Diksha , Singh Samneet , Goyal Ishaan , Ghosh Hiyanoor , Uppal Aditya , Dhand Nishma , Bansal Namita , Batta Akash , Dhanda Aaina , Mittal Ankush , SHARMA SARIT , Sharma Meenakshi , Shivashankar Roopa , singh kavita , Wander Gurpreet S , Mohan Bishav
Published: December 2023

Introduction:
Hypertension (HTN) management guidelines recommend home blood pressure monitoring (HBPM) as an important tool for BP control. Limited data exists on HBPM epidemiology among people with HTN and their caregivers in the Indian context.
Aim:
Assess the prevalence, training and technique of HBPM among people with HTN and their caregivers.

Methods:
People with HTN diagnosed >3 months ago, and their caregivers, were screened from outpatient departments of 3 hospitals (1 tertiary care, 2 community level) in North India and their HBPM use was evaluated. HBPM practices were assessed by observing participants measuring BP using a pre-validated, structured 16-point observational checklist. HBPM knowledge was assessed using a 19-point self-administered questionnaire based on 2017 AHA guidelines. Responses were graded and classified based on quartiles.

Results:
A total of 2750 participants were screened, of which 2588 (48.8% female) were included. The proportion of respondents using HBPM was 20.5% (424/2070) in urban, and 8.5% (44/518) in rural areas. Only 24.7% (n=116) of the 468 participants (232 caregivers) measuring BP at home recalled ever receiving training from any healthcare workers. The majority (75.2%, 352/468) of participants reported learning BPM themselves through observation, videos, and reading. Age, gender, residence, education and occupation had no impact on the length of time participants had used HBPM. In HPBM practice assessment, 15.9% of people with HTN (37/232) vs 5.9% caregivers (14/236) scored excellent (score >75%). In HPBM knowledge assessment, 0.4% of people with HTN (1/232) vs 0 caregivers scored excellent. HPBM practices were better than knowledge, with mean scores of 62.3 ± 13.1% and 40.1 ± 16.2% respectively. Higher education level was associated with improved patient knowledge (p=0.041), but not practices (p=0.225).The most common reason for non-use of HBPM was lack of knowledge of BPM (36.1%, 171/474) in rural areas, and most people in urban areas feeling it was not necessary (41.1%, 677/1646).

Conclusion:
There is need for more robust training on HBPM to enable affording people from all backgrounds to better manage their BP, especially in rural areas. Education level is not a barrier to learning good BPM technique.
Abstract 16562: Subclinical Flow Inefficiencies in Non-Obstructive Hypertrophic Cardiomyopathy Subgroups Revealed by 4D Flow Cardiovascular Magnetic Resonance
Authors: Pola Karin , Ashkir Zakariye , Myerson Saul G , Arheden Håkan , Watkins Hugh , Neubauer Stefan , Arvidsson Per M , Raman Betty
Published: December 2023

Background
Patients with non-obstructive hypertrophic cardiomyopathy (nHCM) may exhibit flow inefficiencies despite normal flow profiles on transthoracic echocardiogram. We investigated whether left ventricular (LV) kinetic energy (KE) and hemodynamic forces (HDF) on 4D flow CMR are abnormal in nHCM, and examined the impact of genotype and hypertrophy phenotype on flow profiles.

Methods
90 participants (70 HCM without echocardiographic outflow tract obstruction and 20 healthy controls) underwent 4D flow CMR. Patients were categorized as phenotype positive (P+) if they had LV hypertrophy (≥15mm or ≥13mm with an HCM family history), or phenotype negative (P-) referring to pre-hypertrophic pathogenic sarcomeric variant carriers. LV KE, HDF and transversal/longitudinal HDF ratio were computed from 4D flow CMR.

Results
P+ patients and controls were of similar age, but P- were younger. P+, P- and controls had comparable LV ejection fraction on CMR, and LV outflow tract pressure gradients and diastolic velocities on echocardiography (Table 1).

Systolic KE was higher in P+ compared to controls (Table 1, Figure 1). Early diastolic KE was higher in P- than P+, reflecting younger P-, but did not differ between P+ and controls. Late diastolic KE was higher in P+ versus P- and controls.

Systolic HDF ratio was higher in P+ than controls (Table 1, Figure 1). Diastolic HDF and HDF ratio were similar between P+ and controls.

Conclusion
Despite comparable flow velocities on echocardiography, nHCM exhibited higher systolic KE and HDF ratio, and late diastolic KE on 4D flow CMR relative to controls. Both the extent and pattern of hypertrophy are important determinants of abnormalities in KE and HDF.
Abstract 16580: Cardiovascular Disease in Cushing Syndrome, Conns Syndrome and Malignant Pheochromocytoma: Which Adrenal Disorder is Associated With Thromboembolism and Cardiac Tumors?
Authors: Hussain Bilal , Mahmood Ahmed M , Alalawi Luay , cuevas christel , Khan Sohail , Waqar Fahad , Ansari Mohammad M , Alexander Thomas
Published: December 2023

Background:
Adrenal disorders result in worse cardiovascular outcomes. Literature suggests that Cushing (CUSH) and Conn’s syndrome (CONS) are associated with coronary artery disease, congestive heart failure (CHF), arrhythmia and stroke. But the date comparing the association of various adrenal disorders with cardiovascular disease (CVD) is limited. We reviewed the prevalence of CVD in CUSH, CONS, and malignant pheochromocytoma (MPH) and explored their prognosis.

Methods:
A retrospective cohort analysis was conducted using National Inpatient Sample 2016-2020. Cohorts of patients hospitalized for CUSH, CONS, MPH and CVD were identified using respective ICD-10 codes. Primary endpoint was outcomes of CUSH, CONS, and MPH in terms of CVD. Multivariate logistic regression model was used to assess prognostic outcomes.

Results:
58060 patients were admitted with CUSH, 3420 with CONS, and 1445 with MPH. CONS has the highest odds of association with CVD (OR 4.87, CI 3.74-6.3, p<0.001), followed by CUSH (OR 3.45, CI 3.3-3.6, <0.001), and MPH (OR 3, CI 2.1-4.3, p<0.001). Upon subgroup analysis of CVD, we observed that CUSH has strongest association with venous thromboembolism (VTE, OR 2.56, CI 2.3-2.8, p<0.001), pulmonary embolism (PE 2.3, OR 2.03-2.6, p<0.001), and CHF (OR 2.2, CI 2.1-2.3, p<0.001). CONS has highest odds of association with primary cardiac tumors (9.2, CI 1.29-65.3, p=0.027), hypertension (HTN, OR 2.8, CI 2.34-3.3, p<0.001), and atrial fibrillation (AF, OR 1.66, CI 1.32-2.06, p<0.001). While MPH is strongly associated with higher odds of pulmonary edema (OR 3.89, CI 1.71-8.8, p<0.01), and HTN (OR 2.8, CI 2.1-3.6, p<0.001).

Conclusion:
Most prevalent CVD in adrenal disorders are HTN, IHD, CHF, and AF. CONS has highest prevalence and strongest association with CVD followed by CUSH and MPH. CUSH is strongly associated with thromboembolism while CONS with primary cardiac tumors, and MPH with pulmonary edema.
Abstract 16591: Surgical vs Non-surgical Repair of Aortic Arch in Type A Aortic Dissection: An Inverse Probability Treatment Weighting Propensity Score
Authors: Nappi Francesco , Salsano Antonio , Avtaar Singh Sanjeet Singh , Gambardella Ivancarmine , Fiore Antonio , Biancari Fausto , Santini Francesco , Mesnildrey Patrick , Schoell Thibaut , Bonnet Nicolas , Spadaccio Cristiano
Published: December 2023

Introduction:
Several surgical techniques are used in acute type A aortic dissection (TAAAD). Most are treated with hemiarch or limited replacement of the ascending aorta with interposition graft while total aortic arch replacement is less frequently performed.

The research question/hypothesis:
Is total arch replacement justified by the favourable late outcomes despite early complications?

Aims:
To evaluate if conservative approaches (root-sparing and hemiarch) can improve the early and late outcomes compared to total arch replacement.

Methods:
From 2005 and 2021, 633 patients underwent TAAAD repair of which 192(30.0%) were women. The ascending aorta replacement with/without root-sparing (group 1) were compared to the partial or total arch replacement cohort (group 2) using propensity score matching. A regression model with inverse probability treatment weighting by propensity score (IPTW) was built to generate a weighted cohort.

Results:
Patients undergoing aortic arch surgery were significantly younger (mean age 61.0 vs 66.5years; p<0.001), frequently male (70%) or with a family history of aortic dissection or aneurysm (P=0.005). Antegrade cerebral perfusion was preferred when arch surgery was performed (83.5% vs33.8%, P<0.001). Post-IPTW by propensity score analysis revealed that aortic arch surgery was associated with thirty-day mortality (odds ratio 1.60; 95% CI, 1.00-2.55, p=0.05), postoperative stroke (odds ratio 2.19; 95% CI, 1.29-3.73, P=0.004), postoperative sepsis (odds ratio 1.76; 95% CI,1.08-2.87, P=0.02) and mid-term mortality (hazard ratio 1.44, 95% CI, 1.05-1.99, p=0.03).

Conclusions:
A tailored approach deploying ascending aorta replacement with or without root-sparing in TAAAD prompted to useful outcomes without compromising durability.