bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 18964: Long-Term Prognostication of Atherosclerotic Cardiovascular Disease Risk Based on the Discordance Between Coronary Artery Calcium Area and Density
Authors: Gajbhiye Drumadala , Bukhari Syed Muhammad Hassan , Younus Shifa , Gulraiz Azouba , Wazir Momna , Raza Samina , Munir Maryam , Neelam FNU , Mehmood Saad
Published: December 2023

Introduction and Hypothesis:
Coronary artery calcium scoring is used to quantify the burden of atherosclerotic plaque in coronary arteries in patients with coronary artery disease. It is measured as a product of two variables: plaque area and density. Our study sought to evaluate the long-term prognosis of atherosclerotic cardiovascular disease (CVD) based on the discordance between these two variables.

Methods:
1750 patients with a CAC score greater than 0 were enrolled in this retrospective, multicenter study. Agatston CAC score was used to quantify a lesion as the product of plaque area and a 4-level categorical peak calcium density factor. COX proportional hazards were performed for atherosclerotic CVD mortality over a median period of 5.2 years while adjusting the Agatston CAC score and other classic risk factors.

Results:
The mean age was 61.2 years, and 19% were female. The prevalence of plaque discordance was 23% (12% high calcium area/low calcium density, 11% low calcium area/high calcium density). Compared to those with low calcium area/low calcium density, patients with low calcium area/high calcium density had a 65% lower risk of ASCVD death (HR: 0.27 [95% CI: 0.08-0.95]). Female sex ([95% CI: 1.25-1.76]) and body mass index ([95% CI: 1.16-1.32], per 5 kg/m2 higher) were significantly associated with high calcium density discordance.

Conclusions:
Our study concluded that high calcium density relative to plaque area confers lower long-term ASCVD risk, likely as an imaging marker for lesion severity. Additional studies are needed to define a robust definition of calcium area/density discordance for real-life clinical risk prediction.
Abstract 18968: Safety and Efficacy of Shockwave Intravascular Lithotripsy in the Management of Calcified Coronary Arteries: A Systematic Review and Meta-Analysis
Authors: Ponna Pramod Kumar , Hameed Maha , Yaqoob Sadia , Gor Rajvi , Shama Nishat , Gonuguntla Akhilesh , Benton Stewart , Shahid Farhan , Alahdab Fares
Published: December 2023

Introduction:
Shockwave intravascular lithotripsy (SWL) aims to facilitate optimal stent delivery and expansion for improved blood flow in treating calcified coronary artery disease. We sought to assess the safety and efficacy of SWL in managing de novo calcified lesions, lesions after failed/sub-optimal pre-dilatation with conventional balloon-based devices, under-expanded stents, and in-stent restenosis.

Methods:
A comprehensive literature search (Medline, Embase, Web of Science, Cochrane, and Google Scholar) was performed for studies that evaluated SWL in managing calcified coronary lesions. Efficacy outcomes included residual stenosis <30% and successful stent delivery with a low incidence of device delivery failure. Safety outcomes included procedural complications and major adverse cardiovascular events (MACE). MACE is a composite outcome of all-cause mortality, cardiac mortality, myocardial infarction, target vessel/lesion revascularization, and stent thrombosis. Event rates across the included studies were pooled in a meta-analysis using the random effects model. An overall estimate and 95% confidence interval were reported for each outcome. Heterogeneity was estimated using the I-squared statistic.

Results:
Out of the 1446 identified studies, 40 were included, with a total of 2718 patients. Residual stenosis <30% was achieved in 91.3% of patients (95% confidence interval 89.7% to 92.6%). Device delivery failure occurred in 6.7% of patients (95% CI 5% to 9%). In-hospital MACE occurred in 6.1% of patients (95% CI 5% to 7.4%), 30-day MACE in 7.4% (95% CI 6.2% to 8.8%), 6-month MACE in 8.3% (95% CI 7.1% to 9.6%), and 1-year MACE in 10% (95% CI 8.7% to 11.4%).

Conclusions:
SWL is a safe and efficient calcium modification intervention with high clinical success, minimal angiographic complications, and a low adverse event rate. Direct comparisons with the standard of care are needed in larger studies to establish clinical utility and superiority.
Abstract 18973: Regional Differences in Optimization of Medical Therapy for Heart Failure With Reduced Ejection Fraction: Data From the HF-OPT Trial (Heart Failure Optimization Trial)
Authors: Winter Stefan , Colley Byron , Doering Michael , Duncker David , Gummadi Siva , Perings Christian , Jonsson Orvar , Maier Lars , Robertson Michael , Sanchez Robert , Wittlinger Thomas , Veltmann Christian ,   HFOPT-Investigators
Published: December 2023

Background:
Society guidelines for the optimization of guideline-directed medical therapy (GDMT) in patients with heart failure (HF) are almost identical between the United States (US) and Europe (EU). While GDMT has helped to improve survival and reduce HF hospitalization in this population, the initiation as well as titration to target doses shown to be safe and effective in clinical trials has been suboptimal.

Purpose:
The objective of this analysis was to assess regional differences in GDMT prescription in the United States (US) vs. Europe (EU) between 2017 and 2022.Methods: Medication data from patients (pts) with newly diagnosed heart failure with reduced ejection fraction (HFrEF) during wearable cardioverter-defibrillator use was collected from 487 pts (54% from US, 72% male, age 59±13 years). Target dose of GDMT was defined as the lowest maximum dose from either the ESC or ACC/AHA/HFSA guidelines. ACE-I/ARB/ARNI (AAA), beta blockers (BB), and mineralocorticoid receptor antagonists (MRA), were the main GDMT options for HFrEF patients at the time of HF-OPT. Association between medication with region and gender were assessed using logistic regression.

Results:
Compared to patients in the US, EU (Germany, Austria, France) pts were significantly more likely to receive ACE-I/ARB/ARNI and MRA and to achieve target doses by 90 and 180 days (p<0.01). Interestingly, ARNI prescription rates did not differ between US and EU (39% and 47%, p=0.09) by 180 days, although target doses were more likely to be reached in the EU by 180 days (23% vs. 12%, p<0.01). In contrast, rates of BB use and achieving target doses did not differ between regions (Figure). Finally, pts in the EU were more likely to receive all three medication classes by 180 days (80% vs 42%, p<0.001), and more likely to be prescribed target doses of all three medications (12% vs. 7%, p<0.05). After adjusting for region, there was no difference in gender for day 90 and 180 prescriptions and target doses for BB, AAA, and MRA.Conclusions: Adherence to GDMT was superior in the EU compared to the US with regards to ACE-I/ARB/ARNI and MRA. There was no difference in BB use between regions. Target dosage rates, however, were overall low in both regions.
Abstract 18991: Effect of Sex Steroids on Lipid Profile in Female to Male Transgender Patients: A Systematic Review and Meta-Analysis
Authors: Rahman Saad Ur U , Hamza Mohammad , Sharma Aakanksha , Kumar Nomesh , Patel Bansari , Patel Neel N , Naseem Masooma , Naveed Hamza , Sattar Yasar , Alraies Chadi
Published: December 2023

Background
The medical transition of transgender individuals involves the administration of exogenous sex steroids to induce desired changes in secondary sexual characteristics. In the case of female-to-male (FtM) transgender individuals, the use of testosterone therapy is common. The impact of testosterone on lipid metabolism and dyslipidemia in this specific population is not well understood. Our study combines all the previous studies to study the impact of sex steroids in FtM transgender population.

Aim
To assess the effects of sex steroids on lipid profile in FtM transgender patients.

Methods:
PubMed, Cochrane, and Embase were searched from inception till May 2023 for all randomized control trials (RCTs) and observational studies. Primary outcomes were changes in basal metabolic profile (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), triglyceride levels (TG), HDL, and LDL. All the baseline values before and after utilization of sex steroids were studied. A meta-cont module was used along with Inverse-variance method to calculate the pooled standard mean difference (SMD) for continuous outcomes with a probability value of p < 0.05 considered to be statistically significant.

Results:
A total of 21 studies with 1208 FtM transgender patients were included. Sex steroids resulted in statistically significant elevation in LDL-C (SMD 0.2850 [0.1169; 0.4531] p < 0.0009), TG (SMD 0.4312 [0.2522; 0.6101] p < 0.0001), TC (SMD 0.1754 [0.0536; 0.2972] p < 0.0048), and BMI (SMD: 0.2429 [0.0983; 0.3875] p < 0.0010) while HDL levels were significantly reduced from the baseline. However, no significant relationship between SBP and DBP was studied
(Figure 1).

Conclusion:
In conclusion, sex steroids increase lipid levels in transgender patients, potentially contributing to dyslipidemia and cardiovascular risk.
Abstract 18997: Management of Immune Checkpoint Inhibitor Mediated Myocarditis
Authors: Mudra Sarah , Culver Austin , Kumar Ashwin , Yesilyaprak Abdullah , Agrawal Ankit , Dey Amit K , Rizk Alexander , Li Jason , Johnson Adam , McGowan Kevin , Majid Muhammad , Njus Meredith , Lawrence Luke , Klein Allan L
Published: December 2023

Clinical Presentation:
A 52-year-old female with metastatic Stage IVB (T4N3M1c) lung adenocarcinoma presented with worsening dyspnea. She had just completed her 3
rd
round of carboplatin/pemetrexed/pembrolizumab/MK-5890 chemotherapy. Upon examination she was noted to be hypertensive and tachycardic with an elevated high-sensitivity troponin T. ECG showed sinus tachycardia, left axis deviation, and flattened T waves in lead V5 and V6. In the ED, she subsequently developed supraventricular tachycardia and was admitted to the ICU. TTE demonstrated moderately reduced EF of 30-35%. TTE also identified hypokinesis in the basal to mid anterior and lateral walls and apical akinesis. Initial CMR showed an EF of 31% with akinesis of the mid and apical anterior, septal and inferior wall. Given the clinical and imaging findings, she was diagnosed with myopericarditis secondary to pembrolizumab and started on 1 mg/kg methylprednisolone taper for 60 days. Repeat CMR after completion of steroid taper showed evidence of weighted T2 edema in myocardium and pericardium. Late gadolinium enhancement (LGE) in inferior and lateral epicardium and adjacent pericardium as well as patchy LGE throughout the myocardium with significant EF improvement (57%) (Figure 1A-B). In our patient, multi-modality imaging was used to confirm the diagnosis and monitor treatment response.

Discussion:
Immune checkpoint inhibitors (ICI) are a novel class of immunotherapies used in certain malignancies. Initial treatment of myocarditis consists of cessation of further ICI and administration of corticosteroids. Additionally, symptomatic myocarditis treatment should be started. Reinitiating ICI therapy should ultimately be done with shared decision making.
Abstract 18999: Long-Term Risk of Stroke After Coronary Artery Bypass Surgery With Carotid Revascularization: A Randomized Controlled Trial
Authors: Knipp Stephan C , Holst Hans Torulv T , Bilbilis Konstantinos , Kamler Markus , Weimar Christian
Published: December 2023

Introduction:
In patients with carotid artery stenosis, combined coronary and carotid surgery has been widely used despite lack of evidence from randomized trials. Moreover, there are no data on long-term outcome following carotid revascularization versus best medical treatment.

Hypothesis:
May simultaneous coronary artery bypass grafting (CABG) and carotid endarterectomy (CEA) prevent the long-term risk of stroke?

Methods:
In the Coronary Artery Bypass graft surgery in patients with Asymptomatic Carotid Stenosis (CABACS) trial, patients with coronary disease and high-grade carotid stenosis (NASCET >=70%) were randomized to receive combined simultaneous CABG+CEA or CABG alone. Primary endpoint was the composite rate of non-fatal stroke or death within 30 days after surgery, with both treatments assumed to be equally safe and efficacious. Secondary endpoints included any stroke, stroke or vascular death and death of any cause, and follow-up was five years. While our previous report focused on primary outcome, here we evaluate the long-term results of the trial.

Results:
The trial was terminated prematurely after recruitment of 129 patients in 17 centers in Germany and the Czech Republic. The rate of stroke or death at 30 days was not significantly different following combined CABG+CEA and CABG alone (18.5% (95% confidence interval [95% CI]: 0.099-0.300) versus 9.7% (95% CI: 0.036-0.199), p=0.203). By 5 years, stroke or death rate was 40.6% (95% CI: 0.285-0.536) following CABG+CEA and 35.0% (95% CI: 0.231-0.484) following CABG alone (p=0.581). Strokes of any kind tended to occur more frequently after CABG+CEA (5 years: 29.4% vs. 18.8%, p=0.245), while death rate was similar in both treatment arms (25.4% vs 23.3% (p=0.837). Subgroup analysis revealed no significant effect of center on outcomes.

Conclusions:
Long-term risk of stroke or death was higher after combined CABG+CEA, mainly due to increased perioperative event rates. Because of minor power, further trials are warranted to confirm our results.
Abstract 19008: ATP-Dependent Citrate Lyase Drives Cardiac Left Ventricular Dysfunction by Metabolic Remodeling
Authors: Liu Shijie , Kim Kyoungmin , Gao Yaqi , Gammon Seth , Tan Lin , Taegtmeyer Heinrich , Lorenzi Philip , Piwnica-Worms David , Martin James F , Karlstaedt Anja
Published: December 2023

Introduction:
Cardiovascular diseases and cancer are the leading causes of death worldwide. Recurrent mutations of metabolic enzymes in cancer cells benefit tumor growth, creating a systemic metabolic phenotype and increasing the risk for adverse cardiac events. Computational analysis revealed an oncometabolic phenotype in the heart, characterized by a switch from oxidative towards reductive carboxylation of α-ketoglutarate and citrate. Our studies identified the ATP citrate lyase (ACL) as a critical regulatory enzyme driving metabolic adaptation during cancer by increasing acetyl-CoA synthesis and histone 3 acetylation in the heart.

Hypothesis:
We hypothesized that ACL is crucial for cardiac adaptation during oncometabolic stress.

Methods:
To answer these questions, we developed a cardiac-specific mouse model lacking ATP citrate lyase using clustered regularly interspaced short palindromic repeats (CRISPR)-associated (Cas)9 genomic editing. Cas9-Myh6-dtTomato mice (n=14-17 male and female mice/group) were subcutaneously injected 6 days after birth with single gRNA targeting the Acly locus. Cardiac function was monitored using echocardiographic examinations weekly between 12 and 20 weeks. We used in vivo [
18
F]-FDG-positron emission tomography (PET) and stable isotope tracer labeling to identify and quantify metabolic alterations in vivo in response to the loss of ACL.

Results:
Knockdown of ACL causes left ventricular systolic dysfunction as evidenced by significantly reduced ejection fraction and an increased left ventricular diameter.
In vivo
[
18
F]-FDG-PET revealed that loss of ACL increased plasma glucose uptake which is consistent with maladaptive metabolic remodeling and impaired oxidative metabolism during heart failure. RNA-sequencing followed by pathway enrichment analysis revealed differential expression of genes involved in mitochondrial function and lipid metabolic processes. Mass spectrometry-based metabolic flux analysis showed an increased malate m+2 to citrate m+2 ratio, consistent with reduced citrate efflux from the mitochondria towards the cytosol.

Conclusions:
ACL activity regulates reductive citrate flux and drives metabolic adaptation associated with cardiac dysfunction
Abstract 19022: Is Peritoneal Dialysis Superior to Hemodialysis Regarding Outcomes in End-Stage Renal Disease Patients With ST-Segment Elevation Myocardial Infarction? Insights From the National Inpatient Sample Database (2016-2020)
Authors: Gajjar Rohan , Bobba Aniesh , Shoura Sami J. , Vardar Ufuk , Teaima Taha , Gangu Karthik , Vummaneni Siri , Aviral Vij , Yadav Neha
Published: December 2023

Introduction:
ST-segment elevation myocardial infarction (STEMI) in end-stage renal disease (ESRD) is associated with worse outcomes. Peritoneal dialysis (PD) has shown better hemodynamic tolerability and quality of life. We analyzed outcomes comparing PD to HD in ESRD patients with STEMI using the National Inpatient Sample (NIS) database.

Methods:
NIS (2016-2020) was queried to identify adult STEMI admissions with co-morbid dialysis-dependent ESRD using ICD-10-CM codes, then stratified to HD-ESRD and PD-ESRD using ICD-10-PCS codes. Propensity score matched HD-ESRD controls were derived based on demographics and baseline co-morbidities. Multivariate logistic/linear regression were used to analyze the outcomes, such as inpatient mortality and complications, length of stay (LOS) and total hospital charge (THC).

Results:
Of the ESRD patients with STEMI, 1225 underwent PD, and 10675 underwent HD. Trend analysis showed declining in-patient mortality despite increasing STEMI burden in HD group, with up-trending mean LOS and THC. In contrast, PD group showed unchanging trends. Upon propensity score matching, PD patients showed similar adjusted odds of inpatient mortality and mean LOS but significantly lower mean THC. Further, PD patients had lower adjusted odds of inpatient complications, mainly ischemic strokes, pulmonary embolism, and hemopericardium.

Conclusions:
Our analysis showed a declining trend in inpatient mortality with STEMI in HD group. Although propensity-matching showed similar inpatient mortality, our research deemed PD superior to HD in STEMI patients, given lower financial burden and better outcomes with lower odds of inpatient complications.
Abstract 19029: Cardio-Oncology Incidence, Cardiac Arrest, and Mortality for Adolescent versus Pediatric Patients: Machine Learning Propensity Score National Analysis
Authors: Park Jong Kun , Monlezun Dominique , Alexandrescu Sofia , Ali Abdelrahman , Pushparaji Bala , Koutroumpakis Efstratios , Cilingiroglu Mehmet , Iliescu Gloria , Marmagkiolis Konstantinos , Iliescu Cezar
Published: December 2023

Introduction:
The incidence of cardio-oncology disease, arrest, and inpatient mortality among adolescent and pediatric versus adult patients is largely unknown, which undermines optimal care of these high-risk patients.

Methods:
BAyesian Machine learning-augmented Propensity Score (BAM-PS) translational statistics with multivariable regression was performed on the National Inpatient Sample.

Results:
Of the 142,651,868 hospitalizations from 2017-2020, 13.69% were pediatric (0-13 years old), 1.13% were adolescent (14-17 years old), and 85.18% were adult patients (over 17 years old). Adults were significantly more likely than adolescent and pediatric patients to have cancer and cardiac disease (99.37% versus 0.15% versus 0.47%, p<0.001). The most common primary malignancies among adolescent or pediatric patients with cardio-oncology disease were leukemia (39.66% versus 52.60%), bone/connective (27.00% versus 12.43%), brain/nervous (8.02% versus 13.80%), Hodgkin lymphoma (7.17% versus 1.09%), and renal (6.01% versus 1.27%). In active cardio-oncology disease by BAM-PS multivariable regression controlling for clinical confounders and severity, adolescent and pediatric patients had comparable mortality odds to adults. Outside of active cardio-oncology disease, pediatric patients (OR 4.95, 95%CI 4.70-5.20, p<0.001) had significantly greater mortality odds than adults, as did adolescent patients but with less magnitude of increased odds (OR 2.03, 95%CI 1.78-2.31, p<0.001). In active cardio-oncology disease, pediatric patients (OR 0.17, 95%CI 0.04-0.68, p=0.013) had significantly lower odds of arrest compared to adults, with adolescents having comparable arrest odds versus adults. Among adolescent and pediatric patients with active cardio-oncology disease, African American versus Caucasians (OR 4.67, 95%CI 1.18-18.42, p=0.028) had significantly greater mortality odds.

Conclusions:
This machine learning multi-year national study suggests the existence of increased mortality in African American adolescent and pediatric patients with concomitant cancer and cardiovascular disease. Overall, adolescent and pediatric patients with cardio-oncology have better outcomes with more effective long-term management.
Abstract 19041: The Role of Social Support in Functional Status and Physical Activity in Patients With Coronary Heart Disease: A 20-Year Analysis From the Heart and Soul Study
Authors: Elnaggar Abdelaziz , Hoffmann Thomas J , Whooley Mary A , Szuba Rochelle , Dancu Caroline A , Park Linda G
Published: December 2023

Introduction:
Living with coronary heart disease (CHD) significantly impacts patients’ daily activities and physical exercise. Social support influences functional status and physical activity in patients with CHD. Multiple dimensions of social support may be associated with activities of daily living (ADL) and physical activity (PA) outcomes in patients with CHD.

Hypothesis:
Is higher perceived social support positively associated with ADLs and PA in patients who have lived with CHD for over 20 years?

Methods:
We analyzed data from the Heart and Soul prospective cohort study from 3-time points: 2000-2002, 2005-2007, and new data that were collected in 2022 among survivors of the original cohort. We measured social support using the Interpersonal Support Evaluation List (ISEL) with appraisal, belonging, and tangibility dimensions. Functional status was assessed using the Lawton (instrumental ADLs [IADLs]) and Katz scales (ADLs) and self-reported PA. Logistic mixed-effects models were employed, adjusting for ISEL dimensions, age, gender, socioeconomic status, ethnicity, marital status, and time.

Results:
Among 680 patients [(mean age at baseline 65.9 (SD10.2); 121 females (17.8%)], higher levels of appraisal (OR: 1.08; CI: 1.01-1.16) and belonging support (OR: 1.12; CI: 1.05-1.20) were significantly associated with higher IADL scores in the Lawton scale. Only belonging was significant in the Katz ADL scale (OR: 1.11; CI: 1.00-1.29). The tangible dimension was not significant in both scales. All dimensions exhibited significant positive associations with PA, with belonging support showing the strongest association (OR: 1.11; CI: 1.05-1.18) (P <.05 & 95% CI). A positive trend was observed between ADL and PA with ISEL dimensions, warranting further investigation of potential time-dependent effects.

Conclusions:
In this study examining 3-time points over 20 years, social support dimensions emerged as predictors of improved ADL and increased PA in patients with CHD. Results emphasize the need to foster social support as part of long-term care strategies.
Abstract 19042: Statewide Burden of Ischemic Heart Disease Attributable to Dietary Risk Factors From 1990-2019 in United States: A Systematic and Comparative Benchmarking Study
Authors: AMIN VISHRANT P , chenna venkata sai harshabhargav , Lakkimsetti Mohit , Kamani Yashkumar G , Dahiya Roopali , Dhawan Arushi , Mahesh Gangannapalle , Kyada Sumit , DESAI HARDIK D
Published: December 2023

Introduction:
Ischemic Heart Disease (IHD) is the 1
st
leading cause of deaths among all causalities in United states (US). However, there is a large statewide variation within the US due to IHD attributable to dietary risk factors. Comparable and consistent state-level burden of total IHD attributable to dietary risk factors have not been produced previously.

Methods:
Using Global Burden of Disease methodology, deaths, and disability adjusted life years (DALYs) due to IHD attributable to dietary risk factors were analyzed by age group, sex, year, and location across the US from 1990-2019. Results were presented in all age counts and age standardized rate per 100,000 person years.

Results:
The annual percentage of change (APC) in total DALYs increased by 32% for IHD attributable to a high sodium diet, followed by a 10% increase for a diet high in sugar-sweetened beverages and a 2% increase for a diet low in vegetables. In terms of total deaths, the highest APC increase was observed in Nevada (142%), followed by Alaska (98%) and Arizona (65%). Conversely, the District of Columbia and Nebraska had the lowest APC increases in total DALYs and deaths. Regarding age groups, the highest APC increase in the total number of deaths was seen in the 95+ year group (97%), followed by the 90-94 age (44%), 55-59 age (10%), and 50-54 age (3%).

Conclusions:
Statewide disparities of IHD attributable to dietary risk factors in the US is significant and calls for comprehensive public health strategies. By addressing the root causes and promoting healthier dietary habits, it is possible to reduce the burden of IHD, improve population health outcomes, and alleviate the strain on healthcare systems and the economy.
Abstract 19044: Upfront Right Ventricular Assist Device at the Time of Lvad Implantation Reduces Mortality, Stroke, and Major Bleeding Risk
Authors: GAMERO HUAMAN MARIA , Liotta Mark , Kaki Praneet , Brailovsky Yevgeniy , Rajapreyar Indranee
Published: December 2023

Introduction:
Right ventricular failure (RVF) is a major cause for increased morbidity and mortality after continuous-flow left ventricular assist device (cf-LVAD) implantation. Patients who are high-risk for developing RVF would benefit from early support via right ventricular assist devices (RVADs) to improve hemodynamics and reduce RVF associated complications. However, current RVF prediction models have limited predictive value. To reduce RVF complications, select institutions have implemented upfront RVAD use in those deemed high-risk with mixed results. In this study, we examined our institutional cohort of high-risk RVF patients who received either emergent or upfront RVADs during LVAD implantation and associated one-year outcomes.

Hypothesis:
Does providing temporary RVAD support upfront to high-risk patients during LVAD implantation impact associated complications and outcomes.

Goals/Aims:
To assess one-year clinical outcomes for high-risk patients receiving RVADs during LVAD implantation.

Methods:
We retrospectively reviewed patients who underwent placement of both LVAD and upfront RVAD at our institution between January 2015 and August 2022. Patients were stratified by the type of RVAD placed (percutaneous vs central) and timing of support (upfront vs emergent). Outcomes were assessed up to one-year post-LVAD implantation.

Results/Data:
Of the 50 patients reviewed, 36 (72%) underwent upfront RVAD implantations and 14 (28%) underwent emergent RVAD implantations. The upfront cohort consisted of 16 of the total 19 INTERMACS 1 patients, 15 of total 21 INTERMACS 2 patients, 4 of total 9 INTERMACS 3 patients, and 1 of 1 INTERMACS 4 patients. Compared to emergent RVADs, patients who received upfront RVAD had significantly decreased one-year mortality (17.1% vs 50.0%, p=0.031), decreased cerebrovascular accidents (2.8% vs 28.6%, p=0.018), and decreased major bleeding (0% vs 40%, p=0.005). There was no significant difference in the length of stay, arrhythmias, gastrointestinal bleed, hemodialysis requirement, driveline infections or vasoplegia.

Conclusion:
Patients receiving upfront RVAD at the time of cf-LVAD implantation have improved survival and decreased incidence of cerebrovascular accidents.
Abstract 19063: An Updated Meta-Analysis Comparing Left Bundle Branch Area Pacing and Biventricular Pacing for Cardiac Resynchronization Therapy
Authors: Siddamsetti Sisir , Shereef Hammam , Galuk Jesse , Bhatia Atul , Sra Jasbir
Published: December 2023

Introduction:
Left bundle branch area pacing (LBBAP) is a type of conduction system pacing that has been considered as an alternative to biventricular pacing (BVP) in patients requiring cardiac resynchronization therapy (CRT).

Hypothesis:
We performed a meta-analysis comparing the clinical and echocardiographic outcomes between LBBAP and BVP in patients requiring CRT.

Methods:
We performed a systematic literature review in Embase, PubMed, and SCOPUS for all the related articles until November 2022. The literature search yielded 44 publications, of which 6 studies fulfilled the inclusion criteria. The Inverse Variance random effects model was used for continuous variables to calculate Mean Difference (MD) and 95% confidence intervals (CI) and Mantel- Haenszel random effects model was used for dichotomous variables to calculate odds ratio (OR) and 95% confidence intervals (CI). Outcomes analyzed were changed in left ventricle ejection fraction (LVEF), left ventricle end-diastolic dimension (LVEDD), NYHA class, and QRS duration and patients with the echocardiographic response (as defined as LVEF improvement >5%) and heart failure hospitalizations.

Results:
Over a mean follow up of 8+/-2 months, LBBAP when compared to BVP resulted in significant difference in LVEF improvement (MD = 5.78 % (95% CI [4.75%, 6.80%], P<0.00001), QRS duration reduction (MD = -24.77 ms) (95% CI [-32.78, -16.77], P<0.00001), NYHA class reduction (MD = -0.43, 95% CI [-0.78, -0.08], P=0.02) and number of patients with echocardiographic response (OR = 2.94, 95% CI [1.40-6.14], P=0.004) at follow up. There was no significant difference in LVEDD reduction (MD = -0.5 mm, 95% CI [-3.36, 2.37], P=0.73) and HF hospitalization rates (OR = 0.42, 95% CI [0.11-1.61], P=0.21) between the 2 groups.

Conclusions:
LBBAP is an effective alternative to BVP in patients with an indication for CRT.
Abstract 19064: Sex Specific Gene Profile in Canine Sinoatrial Node
Authors: Li Ning , Fioritto James , Webb Amy , Kalyanasundaram Anuradha , Zakharkin Stas , Joseph Matthew , Mohler Peter J , Hummel John , Fedorov Vadim
Published: December 2023

Introduction:
Biological sex plays an important role in cardiac function and occurrence of cardiac arrhythmias. Clinical reports show that adult females have faster resting and intrinsic heart rate (HR) while males have faster HR peak and larger HR reserve. Furthermore, inappropriate sinus tachycardia primarily occurs in females, suggesting sex-specific function and/or structure of the sinoatrial node (SAN). The aim of the study is to define sex-specific molecular features of the SAN complex.

Methods:
mRNA was isolated from SAN pacemaker tissue of healthy adult canines (male=4, female=4). Differential RNA expression patterns of >400 genes, including fibrosis, inflammation, and metabolism markers were quantified with nCounter Nanostring fibrosis panel. Quantitative PCR was used to compare mRNAs of key ion channels related to SAN pacemaker function.

Results:
Nanostring panel revealed sex-specific and SAN-specific gene profiles of inflammation and fibrotic markers with multiple mRNAs higher in male (e.g. NLRP3, CD86, COL3A1, TGFB1) and several higher in females (e.g. MARCOL, IL20RB). mRNAs responsible for SAN pacemaking e.g. HCN1, HCN4, Cav1.3, and GIRK4 are higher expressed in female SAN. Sex-specific retrospective analysis of published gene profiles from non-failing human hearts showed a similar pattern to canine with HCN1, HCN4, Cav1.3 expression higher in female SAN.

Conclusions:
The study revealed significantly different gene expressions of fibrosis, inflammation, and pacemaking in male vs female SAN. The higher expression of HCN1/4 and Cav1.3 may explain the faster intrinsic sinus rhythm and susceptibility to SAN arrhythmias in females. The elevated fibrosis and inflammation genes in male SAN may suggest higher vulnerability to fibrotic remodeling during cardiac disease.
Abstract 19083: AI-Enabled ECG Detection of Atrial and Ventricular Septal Defects in Pediatric Patients
Authors: Greason Grace , O'Sullivan Donnchadh , Anjewierden Scott , Attia Zachi , Lopez-Jimenez Francisco , Friedman Paul , Noseworthy Peter A , Anderson Jason , Kashou Anthony H , Eidem Benjamin W , Johnson Jonathan N , Niaz Talha , Madhavan Malini
Published: December 2023

Background:
Atrial septal defects (ASD) and ventricular septal defects (VSD) are among the most common forms of congenital heart disease (CHD). Early detection and intervention for these defects are crucial to prevent complications. Given advancements in AI technology, the development of AI-enabled ECG models for detecting these defects is of significant interest.

Aims:
This study aimed to create AI models using pediatric ECG data for the detection of ASD, VSD, and a combined model detecting either ASD or VSD.

Methods:
We analyzed a dataset of 7,795 pediatric patients from Mayo Clinic who had undergone echocardiography between 2002 and 2022, with corresponding 10-second, 12-lead surface ECGs taken within 14 days of echocardiography. This dataset included 259 patients with ASDs and 139 patients with VSDs (single or multiple). The control group was comprised of 7,397 patients without significant or complex CHD. For cases and controls, we included patients with all forms of electrocardiographic abnormalities and those with valvular lesions who had less than moderate stenosis or regurgitation. The dataset was divided into training, validation, and testing subsets to develop convolutional neural network (CNN) models for ASD, VSD, and either ASD or VSD detection.

Results:
Our ASD and VSD detection models achieved test AUCs of 0.82 (95% CI 0.76, 0.88) and 0.80 (95% CI 0.70, 0.90), respectively. Meanwhile, a combined model that detected either ASD or VSD demonstrated a test AUC of 0.81 (95% CI, 0.76, 0.86), sensitivity of 0.73, specificity of 0.76, PPV of 0.14, and NPV of 0.98 (Figure 1).

Conclusions:
AI-enabled ECG models demonstrate promising performance in detecting ASD and VSD in pediatric patients. A combined model that detects either ASD or VSD also shows robust results. Future research should focus on multi-center validation of these models, refining their diagnostic capacities, and investigating their potential for early intervention in CHDs.
Abstract 19103: Prognostic Factor for Cardiac Dysfunction in Severe Patients With Heat Stroke
Authors: SOH Moon Seung , Park Jin-Sun , Shin Joon-han
Published: December 2023

Introduction:
Heat stroke is defined by failure of thermoregulation and central nervous abnormalities as a result of high core body temperature from exposure to high temperatures or hard exercise. The cardiovascular system is one of the most vital targets with heat stroke, and the early prediction for cardiovascular dysfunction is very important.

Hypothesis:
We aimed to investigate the prognostic value of numerous factors and scoring system for predicting cardiac function in emergency patients with heat stroke.

Methods:
We analyzed the data and clinical outcomes of the patients with heat stroke who were admitted from 2017 to 2021. Glasgow Coma Scale (GCS) was measured based on the patient's level of consciousness and responsiveness, and the APACHE (Acute Physiology and Chronic Health Evaluation) score was calculated by vital signs, GCS, and laboratory data on admission. Clinical variables including echocardiogram were compared according to the median, and receiver operating characteristic (ROC) curve for predicting critical outcomes such as death, ventilator, and dialysis were analyzed.

Results:
We enrolled 67 patients (60 ± 21year-old, 52 males). The median of APACHE score and GCS were 16.3 and 11, and the patients were classified into two groups (high and low) by median respectively. In the low GCS group, left ventricle ejection fraction (LVEF) was lower and the proportion with wall motion abnormalities was higher (
p
=0.008; 0.020). Also, LVEF was lower in the high-APACHE score group (
p=
0.046). ROC curve analysis for predicting critical outcomes showed that GCS and APACHE score had the highest area under the curve value of 0.744 and 0.734 (
p
=0.001; 0.001).

Conclusions:
Echocardiography should be recommended earlier for evaluating LV function in severe patients of heat stroke with lower GCS and higher APACHE score.
Abstract 19109: AI-Enabled Automated Cardiac Chambers Volumetry in ECG-Gated Coronary Calcium Scans vs. Non-Gated Lung Cancer Screening Scans
Authors: Naghavi Morteza , Yankelevitz David , Reeves Anthony , Budoff Matthew J , Zhang Chenyu , Atlas Kyle , Atlas Thomas , Henschke Claudia
Published: December 2023

Introduction:
We have developed an AI-enabled automated volume measurement of cardiac chambers (AutoChamber) that works on ECG-gated non-contrast coronary artery calcium scans and correlates well with contrast enhanced coronary CT angiography scans. Automated LA and LV volumes have shown to predict atrial fibrillation (Afib) and congestive heart failure.

Hypothesis:
In this study, we hypothesize that AutoChamber volumetry results in ECG-gated CAC scans correlated well with those of non-gated full-chest lung cancer screening scans in the same individuals.

Methods:
We have studied 169 cases of paired ECG-gated cardiac CT scans and non-gated lung scans. Mean±SD for age was 62±10 with 52% female. All caseswere asymptomatic and were scanned for preventive health assessment. AutoChamber was run on all cases by an independent operator who was not involvedin data analysis. P value was calculated using a two-tailed test of significance with α=0.05.

Results:
AutoChamber in cardiac scans vs lung scans reported volume (Mean±SD) for left atrium (LA) as 67.2 and 70.1, left ventricle (LV) 102.8 and 105.5 right atrium (RA) 81.9 and 85.7 right ventricle (RV) 140.7 and 134.2 left ventricle wall (LVW) 113.0 and 109.7 respectively (P < 0.0001). Correlations between cardiac and lung scans for each cardiac chamber: LA (R2= 0.85), LV (R 2= 0.93), RA (R2= 0.91), RV (R2= 0.92), and left ventricular wall (LVW) R2= 0.95. (P <0.0001 for all).

Conclusions:
AutoChamber volumetry results are similar in ECG-gated cardiac scans vs non-gated full-chest lung scans. This AI-enabled automated tool is promising as it can provide added value to patients undergoing coronary calcium and lung cancer screening scans flagging enlarged cardiac chambers at risk of future Afib and heart failure.
Abstract 19206: Race, Ethnicity, Gender, and Age Differences in Covid-19-Related Mortality From Diseases of the Heart
Authors: Oladele Carol R , Dark Tyra , Pathak Elizabeth B
Published: December 2023

Introduction:
Early evidence showed SARS-CoV-2 infection was associated with increased risk of acute cardiovascular complications. COVID-19 has since been implicated in intermediate and long-term cardiovascular disease. However, the impact of COVID-19 on heart disease mortality for specific demographic groups has not been investigated. Goals: This study aimed to determine whether excess heart disease mortality was COVID-19 related and whether differences existed by race/ethnicity, gender, and age.Research Question: What was the excess heart disease mortality associated with COVID-19 in 2020 and 2021?

Methods:
Death certificate and population data (2010-2021) for Black, White, and Hispanic adults were analyzed. Deaths with diseases of the heart (DOH) as either underlying or contributing cause were included (ICD-10 I00-I09, I11, I13, I20-I51). We fit a log-linear regression model to annual death rates for 2010-2019. Model coefficients were used to estimate expected DOH death rates for 2020-2021. We then compared observed to expected DOH mortality rate ratios and rate differences by age, sex, and gender for those pandemic years. The proportion of excess DOH deaths which had COVID-19 reported on the death certificate was calculated.

Results:
From 2010-2019, mortality from DOH was highest among Black men. Ratios of observed to expected DOH mortality rates for 2020-2021 were highest among younger ages (25-44 years), men, and Hispanics and Blacks compared to Whites. The proportion of excess DOH deaths with reported COVID-19 was highest among Hispanics compared to other demographic groups across all ages except those 85+. Seventy-five and 78 percent of excess deaths among Hispanic adults 55-64 years were COVID-19 related.

Conclusion:
Excess deaths during the COVID-19 pandemic were highest among young Black men and COVID-19 was more often reported with excess DOH deaths among Hispanic adults. Findings are consistent with other evidence of disproportionate negative social and structural impacts of COVID-19 among Black and Hispanic communities.
Abstract 19218: Prognosis of Apical Hypertrophic Cardiomyopathy in Patients With Implantable Cardioverter Defibrillators
Authors: Kondo Yusuke , Nakano Miyo , Nakano Masahiro , Kajiyama Takatsugu , Kobayashi Yoshio
Published: December 2023

Aims:
This Short Communication aims to identify the difference between the prognoses of apical and other types of hypertrophic cardiomyopathy (HCM) in patients with implantable cardioverter defibrillators (ICDs).

Methods:
We retrospectively analysed the database of our ICD clinic. All patients were implanted with ICDs from October 2006 to August 2017. We classified patients with HCM based on left ventricular (LV) outflow tract obstruction (LVOTO) and midventricular obstruction (MVO), in addition to apical HCM and other non-obstructive HCM types. Patient backgrounds, incidences of appropriate ICD therapies, hospitalizations for heart failure, electrical storms, and total deaths were examined.

Results:
A total of 64 consecutive Japanese patients with HCM and ICDs were enrolled in this study. The mean follow-up period was 86 ± 24 months, the mean age was 65 ± 14 years, and 83% of the patients were male. The LV ejection fraction was 56 ± 14%, the LV max wall-thickness was 19 ± 7 mm, 9.0% had LV apical aneurysms, and the HCM Risk-SCD was 4.4 ± 2.1. We classified the patients into two groups: 14 patients with apical HCM and 50 patients with other types of HCM. During the follow-up periods, there was no significant difference in the incidence of electrical storm, hospitalization for heart failure, and death between the 2 groups (p=0.11, p=0.60, p=0.39, respectively). Appropriate therapies occurred in 6 of 14 (43%) patients with apical HCM patients and 5 of 50 (10%) patients with other types of HCM (p=0.010).

Conclusions:
Compared with patients with other types of HCM, patients with apical HCM have a comparative prognosis, and treatment of ventricular arrhythmias should be strongly considered.
Abstract 196: Splenic Red Blood Cell Mobilization During Cardiac Arrest in Swine
Authors: Rolland Tyler J , Cucinotta Daniel , Zahra Sumbule , Weil Brian R
Published: December 2023

Objective:
The spleen can rapidly mobilize red blood cells (RBCs) to increase blood O
2
carrying capacity in response to a variety of stressors. However, the contribution of splenic RBC mobilization to blood oxygenation during cardiac arrest (CA) and its impact on resuscitation efforts have not been directly studied. Accordingly, we subjected splenectomized swine to CA to test the hypothesis that splenic RBC mobilization meaningfully affects blood O
2
content during CPR.

Methods:
Swine (n=18) were randomized to splenectomy (SPLX; n=9) or sham surgery (SHAM; n=9) 1-week before undergoing 8-minutes of electrically-induced VF CA followed by CPR with defibrillation and epinephrine (EPI; 0.015 mg/kg iv). Serial blood sampling was performed to assess hemoglobin, hematocrit, and blood O
2
content before CA, during CPR, and following return of spontaneous circulation (ROSC).

Results:
Compared to baseline, SHAM animals exhibited a significant 41±5% increase in hemoglobin and hematocrit and 30±4% rise in O
2
carrying capacity during CA that was absent after SPLX (
Figure
). Although this did not significantly affect the rate of ROSC between SPLX (44%) and SHAM (56%) groups, time to ROSC (779±196 vs. 455±37 sec; p=0.02) and EPI needed to achieve ROSC (3.3±1.3 vs. 1.4±0.2 boluses, p=0.04) were significantly higher after SPLX. Among animals that achieved ROSC (n=4/group), between-group differences in hemoglobin, hematocrit, and O
2
carrying capacity persisted for up to 90 min post-ROSC alongside a significant reduction in RBC count in SPLX (6.4±0.1 x 10
6
/μL) vs. SHAM (7.3±0.2 x 10
6
/μL) animals (p=0.01).

Conclusion:
Splenic RBC mobilization during CA contributes to a significant rise in blood O
2
carrying capacity that is evident during CPR and throughout the early post-ROSC period. The absence of this response is associated with a prolonged time to ROSC and additional hemodynamic support, suggesting that impaired splenic RBC mobilization may adversely affect outcomes after CA.
Abstract 200: A Newly Drug Delivery System Combined With the Resuscitative Endovascular Balloon Occlusion of the Aorta in a Pig With Hemorrhagic Shock Model
Authors: Yamanaka Takahiro , Homma Koichiro , Matsuoka Tadashi , Tamura Tomoyoshi , Suzuki Sayuri , Kaito Daiki , Ono Soichiro , Maeshima Katsuya , Sasaki Junichi
Published: December 2023

Background:
The use of resuscitative endovascular balloon occlusion of the aorta (REBOA) for hemorrhagic shock (HS) has grown in popularity. However, REBOA has a risk of complications related to blocking the blood flow downstream to the visceral organs. Several drugs have been reported so far to mitigate ischemia, including hydrogen gas (H
2
); however, they could not reach the downstream of REBOA as they are distributed through the bloodstream. This study aimed to develop a system to deliver drugs to the ischemic organs where REBOA blocks the bloodstream.

Methods:
Herein, a female 40-kg swine volume-regulated HS model was used. In addition to the REBOA in zone 1, a catheter was inserted for drug delivery retrograde into the right femoral artery. The top tip of the catheter was positioned distal to the REBOA balloon. After HS induction (20% of the total blood volume), drug delivery capability was evaluated in three REBOA use patterns, such as controlled HS in normal time of full inflation , uncontrolled HS with liver injury in extended time of full inflation, and partial inflation. Simultaneously with the REBOA inflation, the intra-aortic irrigation of a drug-containing solution, H
2
-dissolved saline, was initiated.

Results:
The occlusion by the REBOA was achieved in all cases after shock induction (approximately 40 mmHg). In all patterns, the concentration of H
2
in the portal vein, which represents the concentration of outflow from the intestine and inflow to the liver, increased immediately after the irrigation. A full inflation setting required 30 mL/min of irrigation speed to obtain the minimum effective concentration of H
2
(1%), whereas a partial inflation setting required 2 mL/min.

Conclusion:
A drug delivery system combined with the REBOA was developed, which enabled the drugs to be administered downstream of REBOA. The newly developed system can potentially overcome the major limitations of REBOA.