bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 14095: Factors Influencing Timely Recognition and Treatment of Severe Hypertension in Pregnancy
Authors: Parekh Jay , Morrison Jane , Kyriakides Tassos , Magee Laura A , Tornatore Jean , Firoz Tabassum
Published: June 2023

Background:
Severe hypertension is an obstetric emergency. Timely identification and management can reduce risk of serious events. Aims of our study were to 1)assess whether severe hypertension is being recognized and managed within the recommended time frame and 2)evaluate the factors that are associated with timely identification and treatment of severe maternal hypertension.

Methods:
A retrospective study of pregnant and postpartum women presenting with severe hypertension to tertiary care hospital between 1/1/19 to 12/1/19. Main outcome measures were ‘time to repeat blood pressure check(TTC)’ and ‘time interval between confirmation of severe hypertension and initiation of pharmacotherapy(TTT)’. We examined the association of the type of hospital unit, time of day of presentation and race/ethnicity with the outcome measures.

Results:
A total of 656 women were included in the study. Median time for repeat blood pressure check was 16 minutes. Only 46.2% of women had a repeat blood pressure check within 15 minutes. Median interval between confirmation of severe hypertension and initiation of therapy was 38.5 minutes. 63.3% of women were treated within the recommended time frame of 60 minutes. Both timely blood pressure re-check(15.6% vs 51.4%, p < 0.001) and initiation of treatment(38.5% vs 70.8%, p < 0.001) were significantly lower in the emergency department (ED). TTC(57.9% vs 31.4%, p < 0.001) and TTT(86.4% vs 42%, p < 0.001) were significantly better in the labor and delivery unit. Time of day(day 51.6% vs night 57.3%, p = 0.15) and race/ethnicity(black 57.1% vs non-black 51.6%, p = 0.16) were not associated with delay in repeat blood pressure check. However, black race(46.2% vs 28.6%, p = 0.018) was associated with delayed initiation of therapy compared to non-black patients.

Conclusions:
We found both the rates of timely identification and treatment of severe maternal hypertension in the ED were lower compared to other units. This points to need for continuous education of ED healthcare providers about timely recognition and management of severe maternal hypertension. We also found racial disparities in timely initiation of therapy, thus demonstrating the need for standardization of protocols.
Abstract 14096: Examination of the Serum Metabolome After Dietary Carbohydrate, Milk Protein, and Soy Protein Interventions Identified Novel Metabolites for Blood Pressure: The ProBP Trial
Authors: Li Changwei , Bundy Joshua D , Tian Ling , Zhang Ruiyuan , Chen Jing , Kelly Tanika N , He Jiang
Published: June 2023

Introduction:
In the Protein and Blood Pressure (ProBP) trial, milk and soy protein supplements reduced blood pressure (BP) compared to carbohydrate intervention. We investigated the underlying mechanisms influencing the effects.

Methods:
Serum metabolites were profiled at pre-trial baseline and after supplementation with carbohydrate, soy protein, and milk protein, respectively, among 80 ProBP participants. We tested the mediating and modifying effects of metabolites on BP-lowering effects of soy and milk protein interventions.

Results:
Dietary interventions significantly (
P
<6.49х10
-4
) changed 40 metabolites, of which 29 had reduced levels. Two clusters of metabolites mediated 45.5% and 100% of the effects of soy and milk protein interventions, respectively. Within the clusters, lipid
4-cholesten-3-one
had the largest effect and mediated 12.7% (
P
=0.03) and 16.3% (
P
=0.045) of the effects of soy and milk protein interventions, respectively. At baseline, amino acids
5-oxoproline
and
taurine,
lysophospholipid
1-arachidonoyl-GPA(20:4)
, and acylcholines
oleoylcholine
,
dihomo-linolenoyl-choline
, and
arachidonoylcholine
predicted BP increase during carbohydrate intervention; while lipids
N-stearoyl-sphinganine(d18:0/18:0)
and
isoursodeoxycholate
and peptide
gamma-glutamylserine
predicted less reduction of BP during soy protein and milk protein supplements (
P
<6.49х10
-4
). Finally, effects of soy and milk protein interventions on systolic and diastolic BP were influenced by changes of
isobutyrylglycine
(
P
for interaction=0.02 and 9.12х10
-5
, respectively). In the bottom tertile of
isobutyrylglycine
changes, soy and milk protein reduced 5.10 (
P
=0.03) and 4.43 (
P
=0.01) mmHg systolic BP and 3.22 (
P
=0.03) and 3.12 (
P
=0.04) mmHg diastolic BP, respectively; while in the top tertile, the two interventions had no or increasing effects on systolic (β
soy protein
=-0.04,
P
=0.98; β
milk protein
=-2.34,
P
=0.25) and diastolic BP (β
soy protein
=3.19,
P
=0.02; β
milk protein
=1.08,
P
=0.43).

Conclusions:
We documented serum metabolites altered by dietary carbohydrate, milk protein, and soy protein interventions, and identified important metabolites mediating or modifying the BP-lowering effect of milk and soy protein interventions.
Abstract 14113: Atrial Fibrillation Associated With Differences in Proteomic Composition of Retrieved Acute Ischemic Stroke Emboli
Authors: Akkipeddi Sajal Medha K , Rahmani Redi , Schartz Derrek , Chittaranjan Siddharth , Gunturi Aditya , Ellens Nathaniel , Kohli Gurkirat , Bhalla Tarun , Mattingly Thomas , Morrell Craig , Bender Matthew T
Published: June 2023

Introduction:
Study of the composition of acute ischemic stroke emboli is still in infancy, though recent literature has begun to demonstrate remarkable heterogeneity in the composition of ischemic stroke emboli from different etiologies. Atrial fibrillation (AF) is a significant risk factor for stroke, and so in this study we investigate differences in proteomic composition between retrieved stroke emboli from patients with and without AF.

Methods:
The full proteomic composition of retrieved thromboembolic material from 24 patients with AIS was evaluated by mass spectrometry. The abundance of individual proteins in patients with AF was compared to that of patients without AF using Mann-Whitney U-tests, with significant differences described by the fold change (FC) in abundance. Cut-offs for significance were set at p = 0.05 and an FC difference of 2x. Descriptive heatmaps with sorted dendrograms were generated using the proteins with significant FC differences between patients with and without AF.

Results:
Proteins with the greatest FC enrichment in emboli from patients with AF included ferritin light chain (p = 0.006), ferritin heavy chain (p = 0.003), eosinophil peroxidase (p = 0.01), eosinophil lysophospholipase (p = 0.02), eosinophil-derived neurotoxin (p = 0.02), the neprilysin modulator nicastrin (p = 0.0007), HLA class I B α chain (p = 0.02), among others. Notably, neutrophil and histone proteins were also significantly enriched in emboli from patients with AF (p < 0.05 for all). Proteins with the greatest FC enrichment in emboli from patients without AF included interferon-induced GTP-binding protein Mx1 (p78) (p = 0.04) and mitsugumin-53 (p = 0.03).

Conclusions:
This data demonstrates that clot composition may directly reflect underlying stroke etiology. More specifically, the enrichment of eosinophil, neutrophil, and histone proteins in emboli from patients with AF points to significant immunothrombosis in emboli from this patient population. These findings may underlie distinct mechanisms in clot formation or maintenance in AF, and inform not only future studies on stroke pathophysiology, but also future work on novel pharmacotherapies for acute ischemic stroke in this patient population.
Abstract 14127: The Role of Sodium Glucose Co-Transporter 1 in Hyperglycemia Ischemia Reperfusion Injury
Authors: Almalki Alhanoof , Arjun Sapna , Jasem Hussain , Yellon Derek M , Bell Robert
Published: June 2023

Introduction:
Hyperglycemia is a common finding in ACS patients in both diabetic and non-diabetic, it is considered a powerful predictor of prognosis and mortality. The role of hyperglycemia in ischemia-reperfusion injury is not fully understood, whether the Sodium Glucose Co-Transporter 1(SGLT1) plays a role in increase injury, before and/or after reperfusion, remains to be elucidated. SGLT2 inhibitors clinical trials have shown significant improvements in cardiovascular outcomes in diabetic and non-diabetic, yet the mechanism is not fully understood and whether SGLT1 plays a role in infarct augmentation remains to be elucidated.

Hypothesis:
High glucose at reperfusion leads to excess myocardial injury and the increased injury is mediated through the activity of SGLT1.

Methods:
RT-PCR and in-situ hybridization (RNAScope) combined with Immunofluorescence integrated co detection with different cell marker techniques were used to detect SGLT1 mRNA expression in Sprague-Dawley whole myocardium and Zucker diabetic rats. An Ex-vivo Langendorff ischemia-reperfusion perfusion model was used to study the effect of high glucose on myocardium at reperfusion. Canagliflozin a non-selective SGLT inhibitor (1μmoL/L to block the SGLT1 and SGLT2 transporter and 5nmol/L to block only the SGLT2 transposer) and Mizagliflozin a selective SGLT1 inhibitor (100nmol/L) was introduced following ischemia at two different glucose concentration concentrations at reperfusion and its effect on infarct size measured using triphenyltetrazolium chloride (TTC) staining.

Results:
Our data reveal that SGLT1 is homogenously expressed throughout the myocardium and is particularly evident within the vasculature. We have also demonstrated that high-glucose mediated injury in the isolated, perfused heart model and it is abrogated through the administration of both mixed SGLT2/SGLT1 inhibitor, canagliflozin, at a dose that inhibits both SGLT2 and SGLT1, and through the administration of novel specific SGLT1 inhibitor, Mizagliflozin.

Conclusions:
We have shown that SGLT1 is present in the myocardium. Hyperglycemia appears to augment myocardial infarction and inhibition of SGLT1 attenuates this increase.
Abstract 14142: Trends in Cardiovascular Services and Procedure Volumes Across Different Phases of the COVID-19 Pandemic: An Analysis of 2019- 2022
Authors: Cader Aaysha , Chowdhury Ishmum Z
Published: June 2023

Introduction:
The COVID-19 pandemic's impact on cardiovascular (CV) services globally was variable, with little data on trends from South Asia.

Hypothesis:
We hypothesized changes in trends of CV services delivery and procedure volumes from 2019-2022. We aimed to assess the pandemic's impact at a Bangladesh tertiary cardiac centre.

Methods:
Data on patient visits, admissions, procedures and catheterization volumes were collected from January 2019 to February 2022. Differences for each month of the preceding year were expressed as a percentage (%Δ). Trends (2019 to 2022) were graphically depicted via line diagrams.

Results:
Significant reductions of cardiology services occurred in 2020, especially ER visits (Δ-59.5%; p<0.001). Patient and procedure volumes reached almost pre-pandemic levels by Q1 of 2021. A decline of admissions and procedures was seen in March-April 2021 as compared with 2020, coinciding with the
Delta
variant. By Q4 of 2021, patient visits, outpatient procedures and catheterization volumes had reached near pre-pandemic levels again. During the
Omicron
surge (Q1 of 2022), a small decline in outpatient visits (Δ-10.9%) and procedures (Δ-6.83%) was seen. However, in-patient admissions (Δ4.39%) and catheterization procedures (Δ5.7%) showed a rise in February 2022, compared to January, with ER visits showing the steepest rise (Δ 41.9%). Although ER visits remained relatively blunted post-pandemic (2020-2021), this trend was not reflected in outpatient visits/procedures, admissions and catheterization procedures, which all increased to pre-pandemic levels by end 2021.

Conclusion:
Two years on from the pandemic, cardiology services and cath lab volumes have reached almost pre-pandemic levels in 2022, except for ER visits which remained low, albeit gradually rising. Procedure volumes reduced during the
Delta
variant, but not during the
Omicron
surge, a positive indication of the learning and adaptability of healthcare system to surges.
Abstract 14281: Direct-Current Cardioversion During Ablation Predicts Recurrence of Atrial Arrhythmia During Long-Term Follow-Up
Authors: Vasilottos Nektarios , Kumar Awaneesh , King Chase , Tanawuttiwat Tanyanan , Miller John M , Das Mithilesh
Published: June 2023

Background:
The predictive value of termination of atrial fibrillation (AF) with direct-current (DC) cardioversion (CV) during catheter ablation (CA) during a long-term follow-up is not known.

Methods:
We studied the long-term success of CV during ablation in patients who underwent catheter ablation of AF and followed them for recurrence of AF/atrial flutter (AFL).

Results:
Of 187 patients (male: 75%, mean age: 60.3 ± 10.7 years), 96 (51.3%) patients required DC cardioversion during the initial CA. A mean number of 1.4 ± 0.6 ablations (p=NS) were performed during follow-up in both groups. There were no significant differences in baseline characteristics including age, gender, race, body mass index, left ventricular ejection fraction, and presence of hypertension, diabetes, and valvular disease. During a median (±1SE) follow-up of 5.23 ± 0.17 years, a significantly higher percentage of patients who needed CV during CA had recurrence of AF/AFL as compared to patients who did not need CV to terminate AF during CA (39.6 vs 16.5%, p < 0.001). Cox regression analysis confirmed DC cardioversion during ablation as a predictor of recurrence of AF/AFL at time of last follow-up (OR: 2.78, 95% CI 1.52 to 5.10, p < 0.001). Kaplan-Meier survival analysis shows significantly decreased time to recurrence in patients who had CV during initial ablation than those who did not require DC cardioversion (log-rank p <0.001).

Conclusion:
DC cardioversion during catheter ablation is a predictor for recurrence of AF/AFL during long-term follow-up.
Abstract 14294: Patients With Chronic Kidney Disease Have a Lower Odds of Ventricular Tachycardia Than General Population
Authors: Mararenko Anton , Alshami Abbas , Udongwo Ndausung , Douedi Steven , Pannu Viraaj , Odak Mihir , Zacks Eran
Published: June 2023

Introduction:
Monomorphic ventricular tachycardia (VT) often results from scar formation secondary to chronic ischemia or myocardial infarction. Microvascular disease is a known risk factor for myocardial dysfunction as it can lead to focal scar formation and thus increase the risk for VT. Chronic kidney disease (CKD) is characterized by microvascular dysfunction on the basis of animal studies through metabolic, endocrine, and immune pathways and therefore was suspected to be a risk factor for developing VT.

Methods:
We conducted a retrospective cohort study utilizing the Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS) 2019 database to investigate hospitalizations for patients aged 18 years old or older with VT based on stage of CKD. Comorbidities were identified through their international classification of diseases, 10th revision (ICD-10 codes) recorded in the discharge record for each hospitalization. Records having cocaine or other stimulants were excluded. An alpha (p) value less than 0.05 was considered statistically significant.

Results:
A total of 456,925 patients were identified based on the inclusion and exclusion criteria above. The number of patients that had VT with and without CKD was 163,760 (3%) and 293,165 (1%), respectively. However, after an adjusted analysis was performed we discovered that the odds ratio of VT in patients with CKD was 0.735 (95% CI 0.720-0.751).

Conclusions:
In our retrospective cohort study, patients with CKD were found to have a lower risk of developing VT. This is suspected to be due to electrolyte derangements, such as hyperkalemia and hypermagnesemia, commonly seen in these patients and thus creating a cardioprotective electrolyte balance.
Abstract 14329: Impact of Low Body Mass Index on Cardiac Tamponade During Catheter Ablation for Atrial Fibrillation
Authors: Tonegawa-Kuji Reina , Nakai Michikazu , Kanaoka Koshiro , Kusano Kengo , Iwanaga Yoshitaka , Yamane Teiichi
Published: June 2023

Background:
Cardiac tamponade is a potentially fatal complication of catheter ablation for atrial fibrillation (AF). The risk of cardiac tamponade during AF ablation in underweight patients has never been investigated. This study aimed to evaluate the impact of body mass index (BMI) on the prediction of cardiac tamponade during AF ablation.

Methods:
Patients who underwent catheter ablation for AF between April 2016 and March 2018 were analyzed using a Japanese nationwide claims database, the Japanese Registry of All Cardiac and Vascular Diseases and the Diagnosis Procedure Combination (JROAD-DPC). Mixed-effects multivariable logistic regression analysis was performed to investigate the association between BMI and cardiac tamponade.

Results:
A total of 59,807 hospitalizations (median age: 67 [60-73], 29% women) with catheter ablation for AF were analyzed. Cardiac tamponade occurred in 657 patients (1.1%). Multivariable analysis revealed that being underweight (BMI <18.5) was associated with an increased risk of cardiac tamponade (odds ratio [OR] 1.46, 95% confidence interval [CI] 1.05-2.02) when compared with having a normal weight (BMI 18.5-<25) (Figure). Other predictors of an increased risk of cardiac tamponade were age >75 years, female sex, history of heart failure, hypertension, diabetes, and dialysis treatment. In a stratified analysis by ablation technique, being underweight was associated with an increased risk of cardiac tamponade in the radiofrequency ablation group, but it was not a significant predictor in the cryoballoon ablation group.

Conclusions:
In this analysis of a large nationwide database of patients with AF who underwent ablation, being underweight was independently associated with an increased risk of cardiac tamponade during AF ablation. Clinicians should consider the higher risk of cardiac tamponade in the underweight population and take appropriate measures to reduce this risk.
Abstract 14359: Impact of Marital Stress on 12-month Health Outcomes Among Young Adults With Acute Myocardial Infarction
Authors: Zhu Cenjing , Dreyer Rachel P , Li Fan , Spatz Erica S , Caraballo Cesar , Mahajan Shiwani , Raparelli Valeria , Leifheit Erica C , Lu Yuan , Krumholz Harlan M , Spertus John , DONOFRIO Gail , Pilote Louise , Lichtman Judith H
Published: June 2023

Background:
Psychosocial stress is associated with worse cardiac outcomes, but little is known about the prognostic impact of marital stress in young adults (≤55 years) with acute myocardial infarction (AMI). We investigated the association between marital stress and 1-year health outcomes in young AMI survivors.

Methods:
We used data from the VIRGO study (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients), which enrolled people aged 18-55 years with AMI (2008-2012). Marital stress was assessed among married/partnered participants at 1 month post-AMI using the Stockholm Marital Stress Scale, categorized as absent/mild, moderate, and severe. Main outcomes were physical/mental health status, generic/disease-specific quality of life, angina, depressive symptoms, and all-cause readmission at 1 year post-AMI. Linear and logistic regression models were sequentially adjusted for baseline health status, demographics, and socioeconomic factors (including education level, income level, employment status, and insurance status).

Results:
Among the 1593 married/partnered participants in our study, more women reported severe marital stress than men (39.4% vs 30.4%, p=0.001). Having severe marital stress was associated with worse physical and mental health, lower generic and cardiovascular-specific quality of life, more angina and depressive symptoms, and 1.48 times higher all-cause readmission at 1 year post-AMI. These associations remained significant after adjusting for baseline health score and patient demographics (
Table Model 1
), but they attenuated and became non-significant when further adjusting for socioeconomic factors (
Model 2
).

Conclusion:
Marital stress was associated with worse health outcomes in young AMI patients, which can be partially mediated by socioeconomic factors. Further research is needed to understand this complex relationship and potential causal pathway associated with these findings.
Abstract 14396: Periprocedural Myocardial Injury After Elective Percutaneous Coronary Intervention is Associated With Excess Long-Term Mortality
Authors: Talmor Nina , kozloff sam , Major Vincent J , Shah Binita , Babaev Anvar , Razzouk Louai , Attubato Michael , Feit Frederick , Slater James , Smilowitz Nathaniel
Published: June 2023

Introduction:
Periprocedural myocardial injury (pMI), characterized by elevations in circulating cardiac biomarkers, is common following percutaneous coronary intervention (PCI) for stable ischemic heart disease. We sought to characterize incidence, risk factors, and long-term outcomes of pMI early after PCI.
Methods:
Patients who underwent elective PCI at a large academic medical center between 2011 and 2020 were included in this retrospective, observational study. We characterized patient and procedural characteristics from local submissions to the NCDR CathPCI registry. All patients underwent routine measurements of CK-MB at 1 and 3 hours post-PCI. Patients with abnormal CK-MB or troponin pre-PCI were excluded. For patients with multiple PCI, only the first PCI was included in the analysis. pMI was defined as any post-PCI CK-MB >99th percentile upper reference limit of the assay. The primary outcome was all-cause mortality derived from the Social Security Administration Death Master File. Cox proportional hazards models were generated to estimate the hazard of mortality associated with pMI.
Results:
We identified 10,923 patients undergoing elective PCI with routine post-PCI CK-MB measurement, with 47,959 patient-years of follow-up (mean: 4.4 years, range: 0 - 9.7). pMI occurred in 1843 cases (16.9%). Patients with pMI were older, more likely to be men, and had a higher burden of cardiovascular risk factors compared to those without pMI (
Table
). Over long-term follow-up, 483 patients (4.4%) died. Long-term, all-cause mortality was higher among patients with versus without pMI (8.0% vs. 3.7%, p<0.001). After adjustment for age and sex, pMI was associated with an excess hazard for long-term mortality (hazard ratio 1.48, 95% CI 1.22-1.80).
Conclusion:
Myocardial injury detected early after PCI is common and is associated with increased long-term all-cause mortality. Efforts to reduce pMI incidence are needed.
Abstract 14417: Implications of Atrial Fibrillation on Clinical Outcomes of Patients With Hypertrophic Obstructive Cardiomyopathy
Authors: Shafi Irfan , Awadelkarim Abdalaziz , Alhusain Rashid , Minhas Hersimren , Lakkis Nasser
Published: June 2023

Introduction:
Atrial fibrillation is a comorbidity often seen in patients with hypertrophic cardiomyopathy (HCM); however, contemporary data on its prevalence and clinical implications in the obstructive variant of HCM is scarce.

Hypothesis:
We sought to study the outcomes and implications of atrial fibrillation among patients hospitalized with hypertrophic obstructive cardiomyopathy (HOCM).

Methods:
Patients with a principal discharge diagnosis of HOCM between 2016 and 2019 were identified in the National Readmissions Database. Among those, patients with and without a diagnosis of atrial fibrillation were categorized. HOCM hospitalizations with atrial fibrillation were matched 1:1 fashion to HOCM without atrial fibrillation.

Results:
Of the 40,516 HOCM hospitalizations, 14,637 (36.12%) had a secondary diagnosis of atrial fibrillation. Propensity score-matched comparison between HOCM with and without atrial fibrillation (Figure 1) showed higher cardiogenic shock (2.69% vs. 1.98%, p-value <0.01), and acute stroke (3.85% vs 2.91%, p-value <0.01) as compared with HFpEF without atrial fibrillation (Table 1). Total charges were higher in HOCM with atrial fibrillation compared to patients without atrial fibrillation ($ ($86,392.6 vs. $83,762.21). The 30 days all-cause readmission rate among patients admitted with HOCM with AF was higher than those without AF (15.91% vs 14.80, p-value <0.01).

Conclusions:
In patients with HOCM presence of atrial fibrillation was associated with higher cardiogenic shock and acute stroke.
Abstract 14509: A Rare Case of Cardiac Tamponade as an Initial Presentation of Native Aortic Valve Infective Endocarditis
Authors: Dasari Mahati , Arun Kumar Pramukh , Ray Ayita , Bojar Robert , Thabet Nasif Ramses
Published: June 2023

Background:
Pericardial involvement is a rare presentation of infectious endocarditis (IE). We present a case of septic cardiac tamponade, paravalvular abscess and fibrinous pericarditis secondary to native aortic valve (AV) IE.

Presentation: A 50-year-old gentleman with a history of IV drug use presented with fever, dyspnea and pleuritic chest pain for one week. He was febrile, tachycardic and hypotensive on presentation. Examination revealed a new onset early diastolic murmur.

Workup: EKG showed mild diffuse ST segment elevations and PR segment depressions suggestive of pericarditis. Blood cultures grew
Serratia marcescens
in 6 out of 6 bottles and IV cefepime was initiated. TTE revealed large effusion with right atrium and right ventricle diastolic collapse consistent with tamponade physiology (fig. A, B). A vegetation was seen on the right coronary cusp of AV along with aortic insufficiency and aortic root abscess. TEE confirmed the above findings (fig. C-F)

Management: An emergency cardiac surgery was performed for acute aortic regurgitation and cardiac tamponade. Intraoperative findings revealed 600mL of purulent effusion. A large vegetative mass near left-to-right commissure covering an abscess cavity that extended into the aortic wall that destroyed the annulus and extended into the ventricular muscle. AV replacement with 21mm Inspiris pericardial AV and pericardial patching was done. Epicardial tissue as well as AV leaflet cultures revealed moderate to heavy growth of
S. marcescens
. He was discharged on cefepime for a total duration of 6 weeks. Follow up TTE revealed normal peak and mean transaortic gradients.

Conclusion:
Cardiac tamponade is a rare but life-threatening complication of IE. Pericardial involvement should prompt us further work up to exclude intra-cardiac abscess which carries poor prognosis due to high complication rates. Hence, early multidisciplinary team response is of paramount importance to reduce in-hospital mortality.
Abstract 14515: Initial Experience With Artificial Intelligence-Guided Echocardiography Acquisition in Rural America: Implementation and Quality Assessment
Authors: Kelsey Michelle , Dunn Gary , Duckworth muchelle , Provencher Alicia , Pattison Brenda , Adams David , Blaha Michael J , Budoff Matthew J , Cheng Susan , Fox Ervin R , Judd Suzanne E , Martin Randolph , Ramachandran Vasan S , Rhodes James D , Kloster Thomas Yngvil , Thomas James , Daubert Melissa A , Douglas Pamela S , Bloomfield Gerald S
Published: June 2023

Background:
Use of artificial intelligence-guided echocardiography (AI echo) may increase access to imaging, but there is little experience of its application in rural and low resource settings. The Risk Underlying Rural Areas Longitudinal (RURAL) cohort is the first NHLBI population-based cohort study to employ AI echo.

Hypothesis:
AI echo is feasible and produces adequate quality images to assess cardiac structure and function among rural populations.

Methods:
The RURAL study, in partnership with Caption Health (Brisbane, CA), is using AI echo in a multiethnic cohort of 4600 participants, performed in a mobile exam unit (MEU) in 10 rural U.S. communities. Non-sonographer MEU technicians underwent 10 hrs in-person competency-based training before scanning. Cardiac structure and function were analyzed in an independent core laboratory. Ejection fraction (EF) was visually estimated and calculated using Caption Health’s Auto EF technology.

Results:
Overall, 138 participants had AI echoes analyzed from Sept 2021 to May 2022 of whom 62% were women, with 70% obese (body mass index (BMI) ≥ 30kg/m
2
), median BMI 33.8kg/m
2
(Table 1). Median time per scan was 20.0mins (15.5, 29.7). Image quality was adequate for visual EF in 97%, with left ventricular dimensions measurable in 88% and left atrial diameter in 91%. Adequate images of the right heart and ascending aorta were less common: base of the right ventricle measurable in 62%, right atrium 61% and ascending aorta 60%. Most participants (96%) had LVEF ≥ 50% by visual estimation, and there was 96% agreement between visual and Auto EF for this group. Image quality, but not measurability, varied with BMI.

Conclusion:
AI echo imaging technology can be used by non-sonographers to acquire adequate quality images characterizing cardiac structure and function in a rural and predominantly obese population, suggesting utility across the spectrum of BMI and applicability in low resource environments with limited access to healthcare.
Abstract 14702: The Burden of Cardiac Adverse Events Associated With Anaplastic Lymphoma Kinase Tyrosine Kinase Inhibitors: A Large Pharmacovigilance Database Analysis
Authors: Thakre Anuj , Babbili Akhilesh , Thotamgari Sahith Reddy , Grewal Udhayvir , Beedupalli Kavitha , Dominic Paari
Published: June 2023

Introduction:
Anaplastic Lymphoma Kinase tyrosine kinase inhibitors (ALK TKIs) have played a pivotal role in the management of Metastatic Non-Small-Cell Lung Cancer (NSCLC). ALK rearrangements are associated with improved survival compared to the standard first-line therapy. However, the cardiovascular safety profile of these agents remains understudied.

Methods:
We interrogated the Food and Drug Administration’s Adverse Event Reporting System (FAERS) database for the reported cardiac adverse events (AE) of: crizotinib, ceritinib, alectinib, brigatinib, and lorlatinib. The number of cardiac AEs reported for ALK TKIs were compared with all the other drugs between 2011-2022. Disproportionality analysis was performed using Reporting Odds Ratio (ROR).

Results:
We identified a total of 20,337 AEs for ALK TKIs, of which 1191 were cardiac AEs. The most frequently reported cardiac AEs associated with ALK TKIs were pericardial diseases (271), followed by bradyarrhythmia (253) and heart failure (HF) (245). HF reporting was significantly higher with lorlatinib (ROR 2.9; CI 95% 2.0-4.1). Ceretinib was associated with significantly higher reporting of pericardial diseases (ROR 28.3; CI 95% 22.6-35.3), and other tachyarrhythmias (ROR 8.9; CI 95% 5.7-13.8). Alectinib was associated with significantly higher reporting of bradyarrhythmias (ROR 9.7, CI 95% 7.8-12.1).

Conclusion:
Cardiovascular AEs were disproportionately higher with ALK TKIs for pericardial diseases and bradyarrhythmias with ceretinib and alectinib respectively. Larger prospective studies are needed to identify high-risk groups that would benefit from robust cardiovascular surveillance.
Abstract 14762: Prospective Study Evaluating Management of Hypertension Induced by Anti-VEGF Therapy in Patient With Active Cancer: Preliminary Report From the VEGFHTN Trial
Authors: Potter Adam S , Pierce Elizabeth , Caldwell Rebecca , Pina Gaspar , Oderinde Praise , Koutroumpakis Efstratios , Iliescu Cezar , Deswal Anita M , Palaskas Nicolas L
Published: June 2023

Introduction: A
nti-neoplastic agents that target vascular endothelial growth factor (VEGF) are known to have cardiovascular toxicities, principally hypertension, with a reported incidence of 21-40% in first-time users. Anti-VEGF induced hypertension can be challenging to control, and significant enough to lead to a dose reduction or discontinuation of the VEGF-targeted therapy, preventing patients from completing their cancer therapy.

Methods:
A single center prospective cohort of patients with cancer starting anti-VEGF therapy was compared to a retrospective control cohort that was 1:1 matched on gender, race, ethnicity, cancer type, and anti-VEGF therapy. For the prospective cohort, antihypertensive medications were started per an anti-VEGF hypertension algorithm. Elevated blood pressure was defined as consecutive blood pressure readings above 140/90 mmHg and control of blood pressure defined as consecutive readings <140/90 mmHg. Time to development of elevated blood pressure and blood pressure control, number of anti-hypertensive medications needed to control blood pressure were recorded.

Results:
The prospective cohort consisted of 31 patients which were 1:1 matched to 31 controls who received antihypertensives per standard of care. There were 50% female patients with mean age 61.0 ± 11.9 years. The most common anti-VEGF therapies received included lenvatinib (39%) and bevacizumab (33%) and the most common cancers being treated were kidney (43%) and liver (39%). In the prospective cohort
,
24 (77%) developed hypertension greater than 140/90 mmHg compared to 18 (42%) in the control cohort (p=0.174). Of those who developed hypertension the time to control of blood pressure (<140/90mmHg) was improved in the prospective algorithmic approach to anti-VEGF hypertension compared to control (30.5 ± 35.6 days vs 104.9 ± 121.2 days respectively, p=0.007). More anti-hypertensive medications were used in the prospective cohort compared to the matched control (2.6 ± 1.1 vs 1.3 ± 1.0 respectively, p<0.001).

Conclusion:
A significant proportion of patients receiving VEGF-targeted therapy will develop hypertension. An algorithmic approach to anti-VEGF hypertension leads to earlier blood pressure control.
Abstract 14765: Cardiovascular Safety Reporting Among Cancer Pharmacotherapy Agents in Breast Cancer Clinical Trials
Authors: Hamid Arsalan , Thigpen Samuel C , Butler Javed , Hall Michael E
Published: June 2023

Introduction:
Cancer pharmacotherapy has been associated with cardiovascular (CV) harm in early phase trials. Later phase (2 & 3) trials offer potential to uncover the frequency of CV harm not identified in smaller early phase trials. We assessed whether the cancer pharmacotherapy agent administered impacts how later phase breast cancer clinical trials exclude patients and report CV safety assessments.

Methods:
We searched Embase and Medline records for phase 2 & 3 breast cancer pharmacotherapy trials (2018-2019). We examined exclusion criteria due to CV conditions and CV safety assessment through CV imaging, electrocardiograms, or biomarkers. Fischer’s exact test was utilized to compare reporting.

Results:
After our search, 50 clinical trials were included. Trials administering microtubule inhibitors were most likely to exclude participants with CV conditions (e.g. myocardial infarctions and arrhythmias) compared to other agents (kinase inhibitors etc.) (93.5 vs 68.4%, p=0.04). Trials administering HER-2 receptor antibody agents more often excluded patients with heart failure (HF) or low ejection fraction (EF) compared to other agents (100.0 vs 62.9%, p<0.01). Trials administering anthracyclines frequently exclude patients with HF or low EF, albeit not statistically more than other agents (92.9 vs 66.7%, p=0.07). Only 46% trials performed electrocardiograms, 40% performed CV imaging, and none reported biomarker collection. Trials administering HER-2 receptor antibody agents conducted the greatest CV imaging (p<0.01). While trials utilizing other agents did not selectively perform relevant safety assessments to identify toxicity the agent would be at risk of inducing compared to all agents.

Conclusion:
HER-2 receptor antibody trials selectively exclude patients with at risk conditions and conduct imaging to monitor cardiotoxicity. However, breast cancer trials using other pharmacotherapies do not have a uniform approach to CV exclusion criteria or safety assessments. Breast cancer pharmacotherapy trials should establish a standardized approach to conduct safety assessments that can identify early CV toxicity specific to the agent administered. This may allow inclusion of high risk patients and generate more generalizable data.
Abstract 14768: Contemporary Hospitalization and Thirty-Day Readmission Rates of Unstable Angina in the United States: Insights From Nationwide Readmissions Database 2016-2019
Authors: Yeo Ilhwan , Zhong Ming , Jang Sun-Joo , Minutello Robert M , Shah Tara
Published: June 2023

Introduction:

There are limited data on the contemporary hospitalization rate and 30-day readmission characteristics of unstable angina (UA).

Methods:
Using Nationwide Readmissions Database from 2016 to 2019, we identified UA hospitalizations based on ICD-10-CM codes and analyzed the rate, trend, timing, causes, and costs of 30-day readmissions after UA in the United States. Multivariable regression analysis was conducted to determine the predictors of 30-day readmission.

Results:
A total of 498,008 patients were hospitalized with UA, resulting in the in-hospital mortality of 0.4%. During the study period, a significant decrease in the temporal trend of UA hospitalization rate was observed (
Figure 1
). Among 458,823 patients who were discharged alive, 11.4% were readmitted within 30 days with a median time to readmission of 9 days. There was a significant reduction in the temporal trend of 30-day readmission rate (
Figure 2
). The most common cause of readmission and procedure during the readmission were recurrent UA and left heart catheterization, respectively. While cardiovascular comorbidities, including congestive heart failure and atrial fibrillation, were associated with an increased likelihood of 30-day readmission, the ischemic evaluation performed during index hospitalization was associated with decreased odds of readmission (
Table
). The mortality during the readmission was 2%. The cumulative costs of hospitalization were $30,729 vs. $14,998 for UA patients with and without readmission, respectively.

Conclusions:
The index hospitalization and early readmission rates of UA have decreased over time. About 1/10 of UA patients were readmitted within 30 days of discharge, primarily due to recurrent UA. The early readmission may be reduced by a timely ischemic evaluation following UA.
Abstract 14777: Poor Utilization of Sodium Glucose Cotransporter-2 Inhibitors in Diabetic Patients With Coronary Artery Disease
Authors: Tsai Stacy , Choi Ruth , Heywood James T
Published: June 2023

Introduction:
Sodium glucose cotransporter-2 inhibitors (SGLT2is) are antihyperglycemic agents found to significantly reduce cardiovascular mortality and heart failure hospitalizations for type 2 diabetics with cardiovascular disease. Despite guidelines from international and national societies recommending the initiation of SGLT2is in this patient population, there are many at-risk patients who have not received this life-saving therapy. We examined this at-risk population at Scripps Health and aimed to address potential barriers to the prescribing of SGLT2is.

Methods:
SlicerDicer, a data analysis tool in Epic the electronic health record, was utilized to assess population data. With the support of the hospital pharmacy and therapeutics committee, SGLT2is, Empagliflozin and Dapagliflozin, were put on formulary and available for inpatient initiation in April 2022.

Results:
From January to December 2021 across all Scripps Health campuses, there were 1050 type 2 diabetics with hemoglobin A1c > 5.7%, the majority of whom were treated with antihyperglycemic agents, with GFR > 30 mL/min/1.73m
2
, who underwent PCI for coronary artery disease. Of those patients, more than 75% were not on an SGLT2i. After SGLT2is were available for initiation in the inpatient setting, informational and educational sessions were provided to health care providers, including physicians, nurses, and other allied health professionals. These sessions reviewed current guidelines, how to prescribe the medication, and the side effects to monitor. New workflow was created such that inpatient prescription of SGLT2is would trigger pharmacy support with the submission of prior authorizations and patient counseling.

Conclusions:
Despite strong guideline recommendations for the use of SGLT2is from cardiology and diabetes societies, a minority of diabetic patients with coronary artery disease, free of contraindications, receive this therapy. This represents an important opportunity to improve patient outcomes. We used a multi-pronged approach to address foreseeable barriers to the prescription of SGLT2is in this at-risk population.
Abstract 14980: Enhanced External Counterpulsation Improves Cognitive Function in Long Covid Patients
Authors: Sathyamoorthy Mohanakrishnan , Sevak Rajkumar , Verduzco-Gutierrez Monica , Cabrera Juan , Lopez Marielisa , Shah Sachin A
Published: June 2023

INTRODUCTION:
Enhanced External Counterpulsation (EECP) has been described to help Long Covid related cardiovascular (e.g. chest pain, fatigue) and neurocognitive (e.g. brain fog) symptoms. We sought to determine whether EECP improves cognitive function.

Methods:
A retrospective evaluation of a contemporary consecutive patient cohort referred to Flow Therapy for management of Long Covid. All patients subjectively reporting brain fog were assessed using the BrainCheck tool to determine degree of cognitive impairment pre- and post EECP therapy. BrainCheck is an FDA-approved, web-based battery of standardized neuropsychological tests that includes the Trail Making Test (Trails A, Trails B) for assessing executive function (cognitive flexibility), the Digit Symbol Substitution Test (DSST) for assessing attention and processing speed, the Stroop Test for assessing executive function (response inhibition), and the List Learning Test for immediate/delayed verbal memory evaluation. BrainCheck scores have a normative mean of 100±15 with a clinically meaningful change ranging from 12-21 depending on age. Change from baseline to post-EECP were assessed using the paired student’s t-test.

Results:
A total of 51 Long Covid patients were included (49.3±11.0 years, 60.8% female, 22% had CAD) with the average duration since Covid diagnosis being 9.9±6.1months. No patients were excluded. All patients completed 25-35 sessions of EECP. Baseline BrainCheck composite score was 88.0±22.1 which significantly improved to 100.1±16.4 post-EECP (+11.9±18.7, p<0.001). When limiting to baseline score under 85 (n=20; baseline average 66.7±17.6) the improvement was +26.0±20.9 (p<0.001). EECP therapy improved the patients’ performance across cognitive domains, as indicated by significant enhancements in scores from baseline in Trails A (+6.1±19.7), Trails B (+5.0±11.8), DSST (+12.9±24.1) and Stroop Test (+11.2±19.1) (all p-values<0.05).

Conclusion:
This is the first evaluation showing significant improvement in Long Covid related cognitive impairment post-EECP therapy. Further study is needed to determine if the mechanistic basis may include EECP induced improved cerebral perfusion, change in endothelial function, or a yet unelucidated pathway.
Abstract 150: Left-digit Bias In Out-hospital Cardiac Arrest - JCS ReSS
Authors: SUZUKI TAKAHIRO , Mizuno Atsushi , Yoneoka Daisuke , Nakashima Takahiro , Matoba Tetsuya , Node Koichi , Yonemoto Naohiro , Tahara Yoshio , Kobayashi Yoshio , Ikeda Takanori ,   and the JCS-ReSS Investigators
Published: June 2023

Introduction:
Left-digit bias, a cognitive bias, has been linked to medical errors in clinical decision-making. Although the impact of left-digit bias on outcome and behavior has previously been examined in the setting of in-hospital cardiac arrest, that in the setting of our-of-hospital cardiac arrest has not been fully evaluated. In the current study, we investigated the impact of left-digit bias on resuscitators’ behavior during out-of-hospital cardiac arrest (OHCA).

Methods:
The All-Japan Utstein Registry of the Fire and Disaster Management Agency is a nationwide, prospective, population-based OHCA registration system in the Utstein format. We retrospectively included all consecutive OHCA patients within three years below and above the age of 80 witnessed by family members from January 1, 2005, to December 31, 2020. The primary endpoints were the percentage of bystander-initiated cardiopulmonary resuscitation (BCPR) performed by family members or EMS and the percentage of prehospital physician-staffed advanced cardiac life support (ACLS). We compared the percentages of resuscitation performed by family members, emergency medical services (EMS), and physicians, by using a regression discontinuity methodology to evaluate if there was a dramatic change in the percentage of BCPR and ACLS performed rate at the age threshold of 80 years, which would imply left-digit bias.

Results:
Of total 1,930,273 cases of OHCA in the All-Japan Utstein registry, we enrolled total of 92,674 (4.8%) patients. The mean age of the population was 80.1 years; 61284 (66.1%) patients were men. There were 37,903 (40.9%) patients between the ages of 77 and 80, and 54,771 (59.1%) patients between the ages of 80 and 83. In this model, we identified no discontinuities in the level (risk difference, -0.50%; 95%CI -1.35% to 0.36%, 0.27%; 95%CI -0.29% to 0.84%, 0.68%; 95%CI -0.29% to 1.66%) for the percentage of BCPR by family members and EMS, and physicians’ ACLS, respectively.

Conclusions:
In conclusion, our findings did not imply that age-related cognitive bias affected the resuscitators’ behavior during out-of-hospital cardiac arrest.
Abstract 15197: Trends in Prevalence and Treatment of Metabolic Syndrome and Individual Components by Race/Ethnicity, 1999-2020
Authors: Lu Yuan , Li Xumin , Liu Yuntian , Caraballo Cesar , Mahajan Shiwani , Massey Daisy , Spatz Erica S , Herrin Jeph , Krumholz Harlan M
Published: June 2023

Introduction:
Nationally representative data evaluating recent trends in racial and ethnic differences in prevalence and treatment of metabolic syndrome (MetS) are sparse.

Methods:
We evaluated 21-year trends in the prevalence and treatment of MetS and individual components in 21,602 adults, using data from the National Health and Nutrition Examination Surveys (NHANES) from 1999 to 2020. We used weighted linear regression to estimate time trends and compared these trends by race and ethnicity.

Results:
Among participants, the mean age was 47.7 (SD, 2.2) years; 51 % were female; 78 %, 12.7%, and 9.3% were White, Black, and Hispanic. From 1999 to 2020, the prevalence of MetS as well as the prevalences of elevated waist circumference and elevated fasting glucose increased significantly for Black, Hispanic, and White individuals (P<0.01 for all). The prevalences of elevated blood pressure and elevated triglyceride increased among Black individuals but did not change among Hispanic and White individuals. The use of antihypertensive, antihyperglycemic, and lipid-modifying medications also increased for all racial/ethnic subgroups. Racial/ethnic disparities in prevalence and treatment of MetS and individual components persisted throughout the study period. Compared with White individuals, Black individuals had higher use of antihypertensive medications but lower use of lipid-modifying medications (P<0.01 for all). Hispanic individuals had lower use of antihypertensive medications and lipid-modifying medications (P<0.01 for all). Across all racial/ethnic subgroups, less than 60% and 30% of people with medication indications received lipid-modifying and antihyperglycemic medications, respectively.

Conclusions:
Temporal trends suggest an increase in prevalence of MetS. There were persistent racial/ethnic disparities in use of antihypertensive, antihyperglycemic, and lipid-modifying medications among people with medication indications.