bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 15569: The Effect of Cardiac Pulmonary Nerve Stimulation on Cardiac Inotropy and Quality of Life in Patients With Acute Decompensated Heart Failure
Authors: Emani Sitaramesh , Civitello Andrew , Tahirkheli Naeem K , Edes Istvan F , Libbus Imad , Spinelli Julio C
Published: December 2023

Background:
Acute decompensated heart failure (ADHF) results in over 1 million hospitalizations annually and involves neurohormonal disruption as well as autonomic dysfunction. Neuromodulation of the cardiac plexus using cardiopulmonary nerve stimulation (CPNS), currently being evaluated in clinical trials, is a novel strategy to treat ADHF.

Methods:
An interim analysis of 12 patients from ongoing trials was conducted. Patients were admitted with a principal diagnosis of ADHF (elevated NT-proBNP and LVEF≤50%) and underwent implant of a 16-electrode catheter (Figure 1A) in the right pulmonary artery, allowing cardiac plexus stimulation for 48 hrs. Stimulation was performed at 20 Hz frequency, 2.0 ms pulse width, and stimulation amplitude/vector (2.5-10 mA) to optimize cardiac function. LV pressure, arterial pressure, and ECG were concurrently recorded. An additional 12 patients not implanted were followed as a parallel standard of care (SOC) cohort.

Results:
There were no device-related serious adverse events (SAEs) during the index hospitalization or at 30 days post-discharge. Two SAEs unrelated to device occurred in 2 patients (clonic seizure and post-discharge pneumonia resulting in death). In response to stimulation, there was a statistical increase in maximum LV dP/dt (from 799 to 824 mmHg/sec, p<0.01) and a statistical decrease in pressure time index (from 27.9 to 27.5 mmHg*sec, p<0.05). Patients that received CPNS reported a significantly greater improvement in symptoms, function, and quality of life at 30 days (KCCQ-12; from 14.1 to 74.7, p<0.0001) compared to patients in the SOC cohort (Figure 1B; 60.6 vs. 8.4, p<0.05).

Conclusion:
In-hospital CPNS therapy is feasible and well-tolerated in ADHF patients. Stimulation increased cardiac inotropy, decreased energy consumption, and improved symptoms, function, and quality of life. Further investigation is required to determine if CPNS therapy leads to sustained improvement in clinical outcomes.
Abstract 15585: Robotic versus Manual Percutaneous Coronary Intervention: An Updated Systematic Review and Meta-Analysis
Authors: Elfaituri Muhammed K , Khaled Ala , BenGhatnsh Ahmed , Elfaituri Ahmed , Faraj Hazem Abdelkarem A , Msherghi Ahmed
Published: December 2023

Introduction:
Robotic percutaneous coronary intervention (PCI), a recent development in managing coronary artery disease, offers potential advantages such as enhanced precision, stability, and radiation protection over traditional manual PCI. Despite these promises, a comprehensive and current comparison of safety and effectiveness between these methods remains to be established.

Hypothesis:
This study aims to evaluate and compare the outcomes of robotic and manual PCI.

Methods:
A comprehensive search of electronic databases, including PubMed, EMBASE, and the Cochrane Library, was carried out up to May 2023, aiming to identify studies comparing robotic and manual PCI. The primary outcomes were major cardiovascular events and myocardial infarction rates, and secondary outcomes included contrast volume used (in mL), procedural time (in minutes), and fluoroscopy time (in minutes). Relative risk (RR) for categorical outcomes and mean difference for continuous outcomes were calculated using a random-effects model. All statistical analyses were performed using R software (version 4.0.3) with the metafor and meta packages.

Results:
Our search strategy identified eight studies, including 2339 patients (703 in the robotic group and 1636 in the manual group). The pooled RR of major cardiovascular events was 0.91 (95% CI: 0.48-1.70, P=0.76, I2=0%), and myocardial infarction rate was 0.88 (95% CI: 0.43-1.83, P=0.73, I2=0%), indicating no significant difference between robotic and manual PCI. Notably, robotic PCI was associated with a statistically significant mean reduction in the contrast volume of -14.28 mL (95% CI: -23.65 to -4.93, P<0.01, I2=0%). However, the differences in procedural time and fluoroscopy time did not reach statistical significance, with 2.73 minutes (95% CI: -4.71 to 10.17, P=0.47, I2=62%) and -2.15 minutes (95% CI: -4.35 to 0.05, P=0.06, I2=51%) respectively.

Conclusions:
Compared to its manual counterpart, this study highlights that robotic PCI significantly decreases contrast volume use while maintaining similar outcomes in other procedural parameters. This underscores robotic PCI's potential in interventional cardiology, also indicating the need for more high-quality trials for long-term outcome confirmation.
Abstract 15592: Artificial Intelligence-Derived Left Ventricular Global Longitudinal Strain is Associated More Strongly With All-Cause Mortality Than is Speckle Tracking Echocardiography-Derived Strain in a Cohort of Cardio-Oncology Patients
Authors: Wass Sojin Youn , Carneiro Herman , Lobo Tabitha , Amutuhaire Willington , Tashtish Nour , Okyere Robert , Al-Kindi Sadeer , Hoit Brian
Published: December 2023

Introduction:
Myocardial strain, a marker of heart muscle deformation, is crucial for assessing cardiac function and prognosis in cardiovascular diseases. Speckle Tracking Echocardiography (STE) is the preferred non-invasive method for strain. However, STE's accuracy can vary due to image quality, vendor-dependence, and operator inconsistency. STE-derived Global Longitudinal Strain (manual GLS) changes are key in early detection of cancer treatment-related cardiotoxicity.

Hypothesis:
We hypothesized that AI-derived GLS would have a stronger correlation with all-cause mortality (ACM) than STE-derived GLS.

Methods:
We retrospectively analyzed 1,224 echocardiograms, from 762 patients, with STE GLS values from Harrington Heart and Vascular Institute Cardio-Oncology studies performed between Jan 2021 - Jun 2022. Images were analyzed using EchoGo Core (Ultromics Ltd), a cloud-based, AI-powered software employing convolutional neural networks. Pearson's correlation coefficients and Bland-Altman analysis compared STE and AI-derived GLS (R-Studio). Both methods were evaluated using Receiver Operating Characteristic (ROC) curves. Patients were divided into tertiles based on their GLS values to assess ACM hazard ratios (HR).

Results:
Out of 762 patients, a moderate correlation (r=0.63, p<0.001) existed between STE and AI-derived GLS. The mean difference between the two was 2.37 and the limits of agreement were -3.65 to 8.39. The Area Under the Curve (AUC) was higher for AI (0.66) than STE GLS (0.59). Over an average follow-up of 215 days (± 169 days), 26 deaths occurred. When Tertile 3 was compared to Tertile 1, AI-derived GLS showed an HR of 4.46 (p=0.023), whereas the STE GLS HR was not statistically significant (HR=2.4).

Conclusions:
The study showed moderate agreement between AI and manual GLS measurements. The HR for ACM was statistically significant only in AI-derived GLS in patients undergoing cardiotoxic chemotherapy.
Abstract 15625: Left Atrial Appendage Volumetric and Functional Assessment Using Cardiac CT-Derived Three-Dimensional Models
Authors: Abdelradi Amr , Atia Andrew , Kalot Mohamad , Shyam Sunder Sunitha , Sharma Umesh C
Published: December 2023

Introduction:
The left atrial appendage (LAA) is the most common site of thrombus formation in atrial fibrillation (AF) patients who develop strokes, yet its dynamic volumetric parameters remain uncharacterized. We present a quantitative analysis of cardiac phase-specific LAA volumes and function using cardiac CT-derived three-dimensional (3D) models of 920 LAA segmentations.

Methods:
We measured LAA volumes at 10% increments of the cardiac cycle (R-R interval) in patients with AF and controls with sinus rhythm (SR). After identifying the LAA orifice using anatomical landmarks on multiplanar CT images, we performed computational LAA segmentation using specialized software. For precise mapping, we used iterative active region-growing and cutting tools to separate the LAA from surrounding structures. We used the resulting 3D model for volumetric assessment of the LAA during the cardiac cycle.

Results:
We analysed 580 LAA segmentations in patients with AF and 340 segmentations in patients with SR. Both groups displayed LAA volume increase from 0 to 40% of the cardiac cycle followed by a gradual decrease during diastole. LAA volumes were significantly higher in AF at 0%, 10%, 70%, 80%, and 90% of the cardiac cycle (p =0.01, 0.021, 0.047, 0.025 and 0.011, respectively). LAA volumetric variance within the AF group was significantly greater (p<0.001). LAA ejection fraction was significantly lower in AF compared to SR (40.8±16.1% vs 49.7±12.6%, p=0.003). Polynomial plots of incremental volume changes showed an accelerated rate of LAA filling in early systole in the SR, which was significantly dampened in AF.

Conclusions:
We present the first comparative analysis of LAA volumetric and functional assessment in patients with AF and SR. We conclude that impaired LAA filling and emptying in AF can contribute to blood stasis and thrombogenicity. Further investigations into the utility of LAA metrics as prognostic and risk-stratification tools in patients with AF are warranted.
Abstract 15643: Social Determinants of Health, Epigenetic Aging, and Subclinical Cardiovascular Disease: The Coronary Artery Risk Development in Young Adults (CARDIA) Study
Authors: Pedamallu Havisha , Ning Hongyan , Kim Kyeezu , Joyce Brian , Kershaw Kiarri N , Lloyd-Jones Donald M
Published: December 2023

Introduction:
Associations of social determinants of health (SDOH) with subclinical cardiovascular disease (CVD), such as left ventricular mass index (LVMI) and coronary artery calcification (CAC), are poorly described. Mechanisms of such associations may involve epigenetic changes like DNA methylation. We sought to examine associations between selected SDOH measures and subclinical CVD, and potential mediation by GrimAge acceleration (GrimAA), a measure of epigenetic aging.

Methods:
We included 2932 Black and White adults from the CARDIA year 20 (Y20) exam (mean age 45y, 48% Black, 57% female). Associations between SDOH measures at Y20 (or cumulative up to Y20) and Y25 ln(CAC score +1) or LVMI (in g/m
2.7
) were examined using linear regression. Statistical mediation analysis was used to estimate the proportion of associations attributable to GrimAA among 880 participants in whom it was measured.

Results:
All selected SDOH measures at Y20 - residential racial segregation (G* Score); census tract poverty; food insecurity; difficulty paying for basics, medications, or healthcare; and maximum years of participant or parental education - were associated with LVMI at Y25 (Table). For example, each 1% higher census tract poverty was associated with an average 0.95 g/m
2.7
higher LVMI. Several SDOH measures were also associated with CAC score at Y25. Similar associations were observed between cumulative SDOH exposures from Y0-Y20 and Y25 subclinical CVD. GrimAA mediated >30% of the statistical association between participant education and LVMI or CAC (Table), and >20% of the associations of residential segregation and census tract poverty with LVMI.

Conclusions:
SDOH metrics were significantly and longitudinally associated with subclinical CVD in midlife. DNA methylation, as represented by GrimAge acceleration, appears to statistically mediate these associations, suggesting possible molecular mechanisms by which SDOH may accelerate CVD risk.
Abstract 15650: Recovery of Cardiomyopathy Following Accessory Pathway Ablation
Authors: Goulding Avedisian Taylor , Qureshi Abul Moiz , Manan Haris , Riad Mariam , Omar Bassam
Published: December 2023

Background:
Wolf-Parkinson-White (WPW) can cause significant arrhythmia in addition to left ventricular (LV) dessynchrony and cardiomyopathy, which may be reversible by accessory pathway ablation.

Case:
A 21-year-old female athletics major college student presents with dyspnea, fatigue and occasional palpitations associated with dizziness. Electrocardiogram (EKG) revealed WPW with left bundle branch block pattern suggestive of right-sided bypass tract (panel A). Transthoracic echocardiogram (TTE) revealed LV ejection fraction (LVEF) 35 - 40% and significant interventricular dessynchrony on M-mode (panel B).

Decision-making:
It was felt that her symptoms and LV dysfunction are due to QRS widening and possibly arrhythmia caused by the bypass tract, and that ablation is warranted. Electrophysiology study 3-D map revealed 2 insertion points of the bypass tract along the tricuspid annulus (panel C). Ablation was performed initially along the inferior tricuspid annulus, leading to QRS complex narrowing with a change in the delta wave axis. Another activation site was mapped separately to the anterolateral tricuspid annulus; ablation at this site eliminated pre-excitation altogether. Post procedure EKG revealed normalization of the PR interval and diffuse T wave abnormalities likely due to cardiac memory (panel D). Follow-up in 6 weeks revealed an LVEF of 60 - 65% and normal wall motion on TTE with improvement of her symptoms; she was cleared to resume sports.

Conclusion:
WPW can be associated with significant cardiomyopathy and heart failure due both to arrhythmia and marked LV dessynchrony, which may be reversed by radiofrequency ablation.
Abstract 15662: Age-Adjusted Premature Cardiac Mortality Rate Among United States Counties by Social Vulnerability Index From 2018 to 2021
Authors: Abouzid Mohamed R , Ghanim Mohammed , Almohamad Maha , Alhasanat Odai , Khraisat Own , Ebeidat Ahmad , Ebeidat Shaden , Mofleh Dania
Published: December 2023

Background:
Considerable differences in premature cardiovascular disease (CVD) mortality rates exist across counties in the United States. Ecological examination and the association with county-level social vulnerability Indices (SVI) are limited.

Aims: This study provides an updated analysis of age-adjusted premature CVD mortality rates and association with county-level SVI from 2018 to 2021.

Methods:
In this ecological cross-sectional study, we used United States county-level CVD mortality data from the Centers for Disease Control and Prevention (CDC) WONDER database (2018-2021) for non-elderly adults (<65 years) and CDC SVI classified into quartiles (1st least vulnerable and 4th most vulnerable). We calculated age-adjusted CVD mortality rates per 100,000 persons including Ischemic heart disease (IHD), stroke, heart failure, and hypertension ICD-10 codes: I20-I25, I60-I69, I50 and I10-I13, I15 respectively. A multivariable mixed negative binomial regression model with county intercept examined the association between SVI and CVD mortality rate adjusted for gender, and ethnicity.

Results:
Overall, the age-adjusted CVD mortality rate per 100,000 persons was 111.0 (IHD 68.1 (95% CI:67.8-68.4), stroke 8 (95% CI: 7.9-8.0), heart failure 3.7 (95% CI:3.6-3.8), and hypertension 26.3 (95% CI 26.1-26.5)), increasing in a stepwise manner from the 1st to 4th SVI quartile. Counties in the 4th quartile had significantly higher mortality compared to the 1st quartile for CVD IRR=2.5 (IHD IRR=2.27 (95% CI:1.65-3.11), stroke IRR=2.72 (95% CI: 1.84-4.02), heart failure IRR=2.84 (95% CI:1.74-4.62), and hypertension IRR=2.83 (95% CI 1.79-4.45)).

Conclusions:
We observed a higher premature CVD mortality rate in the most vulnerable compared to the least vulnerable counties, adjusting for demographic characteristics. Targeted public health interventions are needed to effectively mitigate the growing burden of premature CVD in vulnerable populations.
Abstract 15670: Intramural Coronary Artery is Predictive of Short and Long-Term Coronary Complications Following Arterial Switch Operation
Authors: Thompson Zachery , Bishop Ryan , Thompson Anna , Stephens Sara , Kalustian Alyssa , HEINLE Jeffrey S , Adachi Iki , Binsalamah Ziyad , Doan Tam
Published: December 2023

Background:
Intramural coronary arteries (IMCA) are associated with worse outcomes following arterial switch operations (ASO), though data on the effect of IMCA on longer term coronary complications following ASO remains sparse.

Hypothesis:
IMCA increases the risk of coronary complications both short and long-term following ASO.

Methods:
A retrospective cohort study included 393 patients with available data following ASO at a tertiary center (1995-2020). IMCA and Yacoub types were recorded from operative reports. Coronary outcomes included mortality (n=7), coronary reintervention (n=6), abnormal perfusion on stress imaging (n=4) or left ventricular (LV) dysfunction (n=7). Demographic and surgical data was collected. Wilcoxon rank-sum test assessed differences in continuous variables. We performed univariable Cox proportional hazard (PH) regression to examine time-to-event during 4 periods: the entire study period, 1-year, 5-year, and 10-year post-op. Multivariable Cox PH using Schoenfeld residuals with backward elimination was performed for the entire cohort and 1-year post-op.

Results:
A total of 28/393 (7%) patients had IMCA. During a median follow-up of 10 years (4 - 17), 6% (n=24) had coronary complications. On univariable analyses, IMCA and Yacoub-B were associated with overall coronary complications. At 1-year, IMCA and Yacoub-C were predictive while higher operative weight and male sex were protective of outcomes. At 5- and 10-year post-op, IMCA remained predictive. On multivariate analysis, IMCA was an independent risk factor of coronary complications, hazard ratio of 11.09 (2.98-41.30), p<0.0001 at 1 year postop and 4.37 (1.73-11.04), p=0.002 for the entire study period.

Conclusions:
Coronary related complications occurred in 6% of patients following ASO. Increased risk of immediate and long-term coronary complications after ASO in patients with IMCA supports a more intense follow-up and stress testing.
Abstract 15672: Cerebral and Renal Saturation Trendings in Neonates With Congenital Heart Disease in the Pre-Intervention Period: A Prospective Study
Authors: Michel Carolina , Mir Marina , Moore Shrian Sara , Wutthigate Punnanee , Simoneau Jessica , Villegas Martinez Daniela , Shemie Sam , Brossard-Racine Marie , Dancea Adrian , Bertolizio Gianluca , Altit Gabriel
Published: December 2023

Introduction:
Limited data exists on the trends of cerebral (CSat) and renal (RSat) saturations measured by near infrared spectroscopy (NIRS) of neonates with a congenital heart defect (CHD) during the first days of life in the pre-interventional setting.

Hypothesis:
We hypothesized that retrograde aortic flow in aorta as an indicator of diastolic steal would be associated with adverse CSat/Rsat profiles.

Methods:
We conducted a single-center prospective study recruiting newborns with CHD. CSat/ RSat were monitored until day 7 and averaged every hour. Daily echocardiograms were performed. Presence/ absence of holodiastolic retrograde flow in post-ductal aorta was assessed by an expert blinded to NIRS measurements and clinical status. Random mixed effect models were constructed to evaluate the association between NIRS trends and retrograde flow.

Results:
We included 49 newborns, of which 27 (55%) had retrograde flow. CSat remained stable throughout the monitoring period in the non-retrograde group, while it progressively declined in those with retrograde flow. An association was found between retrograde flow and negative trends CSat (β= -9.1%, 95%CI [-14.3 — -3.8]) and RSat (β= -8.4%, 95%CI [-14.5— -2.3]).

Conclusions:
In infants with CHD, retrograde flow in the descending aorta was associated with a CSat/RSat decline within the first week of life. Future studies should evaluate whether normalization of these parameters decreases the burden of neurological injury.
Abstract 15677: Heart Transplant in Older Adults: Before and After the 2018 United Network for Organ Sharing Allocation Change
Authors: Golob Stephanie , Leiva Orly , Goldberg Randal , Kadosh Bernard , Cruz Jennifer , Nazeer Haider , reyentovich alex , Dodson John A
Published: December 2023

Introduction:
There is an increasing trend towards transplanting older adults, and the proportion of those over 70 who have been transplanted has increased in recent years. In 2018, the United Network for Organ Sharing (UNOS) implemented a 6-tier allocation policy to replace the prior 3-tier system. There have been significant shifts in cardiac transplantation practices and patient outcomes following the implementation of the new policy.

Hypothesis:
This study aims to evaluate the impact of the new allocation policy on older adults.

Methods:
Adult patients who received heart transplant between January 1, 2010 and December 31, 2021 were identified in the UNOS registry and stratified by whether they were transplanted pre-2018 or post-2018. Outcome of interest was mortality at 1 after heart transplant. Multivariable Cox proportional hazard modeling was used to estimate hazard ratios associated with outcomes of interest.

Results:
661 patients over the age of 70 were transplanted pre-2018 and 413 patients over 70 were transplanted post-2018. Those who were transplanted after the 2018 UNOS allocation change were less likely to have had an ischemic cardiomyopathy, more likely to have had an IABP or be on ECMO prior to transplant, and more likely to have had cancer prior to transplant. There was no difference in rates of diabetes, prior CVA, and dialysis for those transplanted pre- vs post-2018. 1 Year mortality for those pre- and post-2018 were similar (10.4% pre-2018, 11.4% post-2018, HR 1.11, CI 0.77-1.61, p=0.6).

Conclusions:
There has not been a change in mortality in older adults with the 2018 UNOS allocation change. The increase in usage of IABP and ECMO prior to transplant post-2018 mirror changes in the overall population. Notably, post-2018, more older adults with prior malignancies are being transplanted.
Abstract 15748: Association of Clonal Hematopoiesis in the Setting of Human Immunodeficiency Virus Infection With Subclinical Atherosclerosis and Vascular Inflammation
Authors: Durstenfeld Matthew S , Kentoffio Katherine J , Teng Alexandra J , Abohashem Shady M , Li Danny , Ma Yifei , Hoh Rebecca , Deeks Steven , Bick Alexander G , Tawakol Ahmed A , Hsue Priscilla Y
Published: December 2023

Background:
Clonal hematopoiesis of indeterminate potential (CHIP) is associated with cardiovascular disease (CVD) and common in HIV, but whether CHIP contributes to atherosclerosis in HIV is unknown. We hypothesized CHIP is associated with atherosclerosis and arterial inflammation among people with HIV (PWH).

Methods:
We studied treated, suppressed PWH ages 35-70 years old with ≥1 CVD risk factor. CHIP mutations were detected with a validated targeted sequencing assay. We measured carotid intima-media thickness (IMT) longitudinally with ultrasound and aortic inflammation and lymph node activity using cross-sectional
18
F-FDG-PET. Inflammatory biomarkers were measured with a multiplex electrochemiluminescence assay. We used linear regression with adjustment for age, sex, nadir CD4 count, smoking, hypertension, diabetes, and hyperlipidemia.

Results:
We included 231 PWH (52±9 years, 7% female). 32 (14%) had CHIP with median variant allele fraction of 3.1%. Common mutations were in DNM3TA (n=21) and TET2 (n=6). Only age was associated with CHIP (OR 2.3 per decade older, 95%CI 1.2-3.9; p=0.003). Among N=165 (CHIP=22), mean IMT was 1.0 mm with and without CHIP (p=0.63), unchanged after adjustment (Figure). CHIP was not associated with prevalent or incident plaque. Over 3.2 years, IMT progression was faster among those with CHIP (0.033 mm/year; p=0.10), attenuated after adjustment (0.022 mm/year; p=0.27). Among 80 with FDG-PET, CHIP (n=12) was associated with higher lymph node activity (SUV p=0.04) that was attenuated in reference to background activity and adjusted for risk factors. CHIP was not associated with arterial inflammation (p=0.83), inflammatory markers, or viral persistence markers.

Conclusions:
Among PWH, CHIP mutations were not associated with subclinical atherosclerosis or arterial inflammation, proposed mechanisms of how CHIP could cause CVD. Clinical outcomes studies are needed to ascertain the impact of CHIP on CVD in HIV.
Abstract 15756: To Close or Not to Close: A Case of Multisystem Immune Checkpoint Inhibitor Toxicity and PFO
Authors: Ropri Ayesha , Yoo Jeanwoo , El-Hajjar Mohammad , Sah Anuraag , Shkolnik Boris , Belov Dmitri
Published: December 2023

Introduction:
Recent emergence of immune checkpoint inhibitors (ICIs) in oncologic treatments has led to increasing research on their side effect profile. Myocarditis occurs in roughly 0.04-1.14% of patients treated with ICIs and is associated with up to 50% mortality. We present a case of multisystem ICI toxicity requiring comprehensive evaluation to ultimately reveal a PFO shunt as the cause of persistent hypoxemia.

Case:
A 67-year-old male with Stage IIIC cutaneous melanoma presented with non-radiating pleuritic chest pain, diplopia, dyspnea and syncope. ECG showed high grade AV block and right bundle branch block. Labs showed elevated troponin, creatinine kinase and inflammatory markers. An echocardiogram showed edematous myocardium, a small pericardial effusion, and akinetic apical/inferior septal segments. Despite diuresis, 5g of methylprednisolone, IV immunoglobulin plus mycophenolate and resolution of AV block, the patient had hypoxemia on 100% FiO2. He underwent a CTA (which ruled out PE and ICI-induced pneumonitis) and fluoroscopic sniff test (revealing bilateral moderate diaphragm paresis). A recent cardiac catheterization on prior admission showed no obstructive coronary disease. Arterial blood gas showed pO2 120 mmHg without hypercapnia on 100% FiO2. We suspected a shunt as the underlying cause and obtained a bubble study disclosing a large (> 25 bubble) PFO with right-to-left shunt.

Results:
Given the timing of symptoms, it was determined that pembrolizumab administration caused myocarditis and myositis with diaphragmatic paresis. In patients with pulmonary disease or diaphragmatic paresis, elevated intrathoracic and pulmonary artery pressures have been a proposed mechanism of acute worsening of right-to-left shunt resulting in hypoxemia. The patient underwent right heart catheterization and PFO closure using Gore Cardioform septal occluder with resolution of hypoxemia. A repeat echocardiogram obtained 1 month later was normal.

Conclusion:
All concerning clinical symptoms in the setting of ICI use require a thorough evaluation. In this case, persistent hypoxemia despite treatment for ICI toxicity unmasked a large PFO requiring closure. A multisystem approach should be used to assess suspected ICI myocarditis.
Abstract 15764: Early versus Late Initiation of Non-Vitamin K Antagonist Anticoagulation After Ischemic Stroke in Patients With Atrial Fibrillation: A Systematic Review and Meta-Analysis
Authors: Adelkhanova Alla , Oli Prakash , Shrestha Dhan B , Khoury Mtanis , Shtembari Jurgen , Shaikh Rafae , Bodziock George , Patel Nimesh , Kalahasty Gautham , Whalen S. Patrick , Shantha Ghanshyam
Published: December 2023

Introduction:
Atrial fibrillation (AF) is a common cause of acute ischemic stroke (AIS). Non-vitamin K antagonist oral anticoagulants (NOACs) are recommended for stroke prevention. However, presumed higher risk of hemorrhagic transformation in early (≤ 5 days) start of NOACs delays timing of anticoagulation initiation after AIS. This meta-analysis was conducted to evaluate granularity of data on the timing of initiation of NOACs after AIS in patients with AF.

Methods:
This meta-analysis followed the PRISMA guidelines and is registered in PROSPERO (CRD42023391198). PubMed, PubMed Central, Embase, and Scopus databases were searched for relevant articles from inception through May 2023. Title and abstract were screened by two independent authors, followed by full text review in Covidence platform. Pertinent data was extracted in Microsoft Excel. Data were analyzed using RevMan v5.4 with odds ratio as effect measure.

Results:
A total of 6326 studies were identified from database search. Five studies with 7442 patients were included. There was no significant difference between the groups in terms of recurrent stroke (OR 0.86, CI 0.62-1.20;), intracranial hemorrhage (OR 0.71, CI 0.26-1.93), major bleeding (OR 1.22, CI 0.66-2.26) or mortality (OR 0.75, CI 0.44-1.27). However, pooled results from two studies showed a statistically significant lower occurrence of hemorrhagic transformation in early NOAC group as compared to late NOAC group (OR 0.43, CI 0.32-0.60).

Conclusions:
Based on this meta-analysis, early NOAC initiation after AIS in patients with AF is a safe strategy in terms of efficacy (recurrent stroke) and safety (major bleeding, intracranial hemorrhage, mortality, and hemorrhagic transformation).
Abstract 15766: Patient Profile, Treatment and Outcomes in Patients With Acute Coronary Syndrome: Preliminary Results From the Get With the Guidelines Mexico Project Initiative at the National Institute of Cardiology
Authors: Araiza Diego , Najera-Rojas Nitzha Andrea , Robles-Ledesma Mariana , Ezquerra Osorio Alejandro , De los ríos Arce Luis Fernando , De Los Rios Manuel O , Lugo Gavidia Leslie Marisol , Leiva Jose Luis , Gopar-Nieto Rodrigo , Sierra Lara Martinez Jorge Daniel , Gonzalez-Pacheco Hector , Arias-Mendoza Alexandra
Published: December 2023

Introduction:
Acute coronary syndromes represent the first cause of cardiovascular mortality. However, important heterogeneity exists in patient profile, access to treatment and outcomes, especially in developing countries.

Hypothesis:
Barriers to improve outcomes in patients with ACS may differ in developing countries. Individualized strategies may be needed to improve adoption of guideline recommendations.

Aims:
To describe baseline characteristics, treatments and outcomes in patients with ACS in Mexico.

Methods:
Prospective study including patients with ACS who were either transferred from eight referring hospitals or arrived directly at a referral center in Mexico City between October 2022-April 2023. The data was collected as part of the GWTG-Coronary Artery Disease Mexico Project, powered by the American Heart Association. Continuous variables are reported as mean±standard deviation (SD), or median and interquartile range (IQR), according to their distribution.

Results:
A total of 206 patients were included, 73.5% with STEMI and 26.5% with NSTEMI & UA. The mean age of the study population was 60 (54-69) years and 79.9% were male. The prevalence of diabetes was (56.8%), hypertension (41.6%) and smoking (62.5%). Median time from symptom onset to first medical contact was 8.4 (3.2-15.8) hours and 99.5% of patients arrived as walk-ins (mostly private vehicles). Among those transferred from a non-PCI center, 70% were transported by ambulance, 20% used private vehicles and 10% were transported by air. Amid STEMI patients, 86.6% received reperfusion during the first 12 hours since symptom onset: 36.4% primary PCI & 52.0% pharmacoinvasive strategy; in patients with NSTEMI/UA, 62% underwent PCI. Prescription of guideline recommended medications at discharge was high: high intensity statins (97.3%), beta-blockers (84.2%), ASA (96.3%), ACEI/ARB (93.1%). The overall hospital survival was 95.1%.

Conclusions:
In these preliminary results from the GWTG Mexico Project Initiative, we observed high reperfusion rates and a high prescription of guideline recommended therapies at discharge; however, important deficiencies exist in the pre-hospital setting. These results may influence future healthcare policies to reinforce prehospital care.
Abstract 15775: Prehospital Scene Delays in the Prehospital Care of ST-Segment Myocardial Infarction (STEMI)
Authors: Shekhar Aditya C , Kimbrell Joshua , McCartin Michael , Blumen Ira J
Published: December 2023

Introduction:
Emergency medical services (EMS) are an important link in the chain of care for patients experiencing time-sensitive cardiovascular emergencies, including ST-segment elevation myocardial infarction (STEMI). Recent quality initiatives have focused on reducing delays in STEMI care in both the prehospital and in-hospital environments. For instance, “door-to-balloon times” are tracked to ensure minimal delays from the time a STEMI patient enters a hospital to revascularization. In the prehospital realm, comparably less research has investigated factors contributing to delays in care for STEMI patients. Prolonged “scene times” - the time spent with a patient prior to transport - represents one area where focus is needed.

Methods:
As part of an ongoing initiative, EMS providers are encouraged to limit scene times to under 20 minutes for STEMI patients. We queried data from the Minnesota State Emergency Medical Services Regulatory Bureau (EMSRB) to ascertain what percentage of EMS encounters involving STEMI patients within the state’s MNSTAR EMS database between 2018 and 2021 had a scene time of greater than 20 minutes. Encounters involving helicopter emergency medical services (HEMS) were excluded.

Results:
Between 2018 and 2021, there were a total of 5178 STEMI patient encounters meeting eligibility criteria. Approximately 67.6% (n~3501) of patient encounters involved a scene time less than or equal to 20 minutes. Rural communities were associated with prolonged scene times when compared with metropolitan communities.

Conclusions:
Our preliminary analysis of EMS data from Minnesota shows one-third of STEMI encounters had scene times greater than 20 minutes. Thus, reducing prehospital scene times by EMS may be one method to streamline the care for STEMI patients. Further research should investigate what factors influence EMS crews to spend more than 20 minutes on scene with STEMI patients.
Abstract 15784: Clonal Hematopoiesis of Indeterminate Potential is Associated With Increased Risk of Incident Hypertension
Authors: Naderian Mohammadreza , Saadatagah Seyedmohammad , Dikilitas Ozan , Kullo Iftikhar J
Published: December 2023

Introduction:
Clonal hematopoiesis of indeterminate potential (CHIP) is associated with an increased risk of heart failure (HF) and stroke, particularly HF with preserved ejection fraction and hemorrhagic stroke (HS).

Hypothesis:
We hypothesized that CHIP is associated with incident hypertension and this association mediates the effect of CHIP on HF and HS.

Methods:
In 200K UK-Biobank participants with exome sequencing, we ascertained CHIP as variant allele fraction (VAF) ≥2% and large CHIP as VAF ≥10%. Hypertension, HF, and HS diagnosis were determined based on the ICD-9 and ICD-10 codes. Cox proportional hazards models were used to test the association of both CHIP and the CHIP subtypes based on the most implicated driver genes (i.e.,
DNMT3A
,
TET2
, and
ASXL1
) with incident hypertension. Logistic regression models were used for mediation analyses, quantifying the extent to which hypertension mediates the effects of CHIP.

Results:
After excluding those with hematological malignancy (n=1,025) and pre-existing hypertension (n=14,754), 184,760 participants (56.14±8.12 years, 44.25% male, and 95.33% white ethnicity) were included. During a median follow-up of 12.2 years, 42,049 (22.76%) participants developed hypertension. CHIP mutations were significantly associated with incident hypertension (Table). Mutations in
DNMT3A
and
TET2
but not
ASXL1
drove this association. Mediation analysis revealed 17.9% (9.4% - 38.2%, P<0.001) of the effect of CHIP on HF and 5.7% (2.4% - 22.4%, P<0.001) of the effect on HS were mediated through the increased risk of hypertension.

Conclusion:
CHIP is associated with an increased risk of hypertension. The association of CHIP with HF and HS is partially mediated by hypertension. These findings suggest a new mechanistic pathway for the association of CHIP with cardiovascular diseases.
Abstract 15785: Effects of Empagliflozin on Fatty Acid Binding Protein 4 and Body Composition in Patients Without Diabetes but With Risk Factors for Adverse Cardiac Remodeling From the Empa-Heart 2 Cardiolink-7 Randomized Clinical Trial
Authors: Yang Ning-i , Wang Chao-Hung , Mazer David , Verma Subodh
Published: December 2023

Background:
Prevention of the progression from stage B to C heart failure is an unmet need. Increased fat composition in skeletal muscle is one of the mechanisms associated with heart failure with preserved ejection fraction. Fatty acid binding protein 4 (FABP4) is known to facilitate the transport of fatty acid to tissue mitochondria for lipid oxidation. Knockdown of FABP4 gene is associated with increased body weight and fat mass in animal models. We sought to determine if Sodium-glucose co-transporter 2 (SGLT2) inhibition with empagliflozin leads to change in blood FABP4 levels and improvement in body composition in patients without diabetes and significant heart failure but with risk factors for adverse cardiac remodeling.

Hypothesis:
Empagliflozin increases blood FABP4 concentration and lowers body fat composition without changes in skeletal muscle mass.

Methods:
A total of 42 individuals between 40 and 80 years of age without diabetes but with risk factors for adverse cardiac remodeling were randomized to empagliflozin (10 mg/day; n=21) and placebo (n=21) groups for 6 months. Body composition parameters measured by bio-impedance analysis (InBody-720) included body weight (BW), skeletal muscle mass (SMM) and body fat mass (BFM) at baseline and 6 months follow up. Blood FABP4 concentrations were measured at the same time points.

Results:
There were no significant differences between two groups in baseline characteristics, BW, SMM, BFM, or FABP4. From baseline to 6 months, empagliflozin compared to placebo significantly increased blood FABP4 concentrations (6067.3 ± 7591.4 pg/ml vs 2714.9 ± 11232.6 pg/ml, p = 0.002), but decreased BW (-1.19 ± 1.01 kg vs 0.34 ± 2.59 kg, p = 0.018) and BFM (-0.68 ± 1.27 kg vs 0.53 ± 2.01 kg, p = 0.024). However, empagliflozin did not significantly affect changes in SMM from baseline to 6 months (-4.01 ± 0.70 kg vs -0.17 ± 0.96 kg, p = 0.387).

Conclusions:
SGLT2 inhibition with empagliflozin, in patients with neither diabetes nor significant heart failure but with risk factors for adverse cardiac remodeling, increased blood FABP4 concentrations and ameliorated BW and body fat composition with no effect on skeletal muscle mass following 6 months of treatment.
Abstract 15791: Higher Diet Quality Associates With Lower Inflammation in Black Adults With Heart Failure
Authors: Davis Erica , Dunbar Sandra B , Higgins Melinda , Ferranti Erin , Butts Brittany
Published: December 2023

Introduction:
Heart failure (HF) is associated with a chronic inflammatory state. Diet-derived metabolites, such as trimethylamine-N-oxide (TMAO), may be associated with chronic inflammation. Most Americans consume a pro-inflammatory diet with high intakes of sugar and processed foods, but adherence to high quality diet patterns may be beneficial in HF-associated inflammation. The Healthy Eating Index (HEI) and the Alternative Healthy Eating Index (AHEI) measure adherence to the Dietary Guidelines for Americans with greater adherence associated with lower inflammation and better HF outcomes but is understudied in Black adults.

Hypothesis:
Higher adherences to the HEI or the AHEI is inversely associated with TMAO and inflammation measured by TNF-α.

Methods:
Participants included Black adults living with HF (N=36, mean age 57 years, 64% women); HEI and AHEI diet scores were derived from a food frequency questionnaire (FFQ). TMAO and TNF-α were analyzed with dried blood spots and immunoassays. A lifestyle factor (LIS) score consisting of alcohol intake, body mass index, physical activity, and smoking was measured. Analyses included correlational and regression analyses.

Results:
Regression models explained the variance of TMAO and TNF-α levels. HEI and related covariates (AHEI, LIS) explained 15.9% change in TMAO levels: F(3,30)=3.09, p<.042. Standardized beta coefficients were at least 0.3 and higher. HEI scores and related covariates explained 17.2% change in TNF-α levels: F(4,29)=2.71, p<.050. There was an inverse correlation between AHEI scores and TNF-α: r=-.36, p=.031.

Conclusions:
Higher diet quality, as measured by the HEI/AHEI, was associated with lower levels of TNF-α. The anti-inflammatory benefits of adherence to healthy eating patterns are important in the self-management of HF, yet these foods may include precursors for TMAO levels. Thus, healthy eating should be balanced with an overall dietary plan that attends to the quantity and nature of foods consumed by those with HF. Interventions which promote adherence to high quality diet patterns are needed in adults with HF, particularly in Black adults who bear an excess burden of disease. More research to understand which specific diet components decrease inflammation in HF are warranted.
Abstract 15801: Nighttime Hypertension is a Risk Factor for Cardiovascular Events in Stage B Heart Failure Patients
Authors: Komori Takahiro , Hoshide Satoshi , Kario Kazuomi
Published: December 2023

Background:
Nighttime blood pressure (BP) was reported to have a stronger association with cardiovascular outcome and hypertensive organ damage than clinic BP, 24-hour BP, and daytime BP in hypertensives. However, the significance of nighttime BP was not established in stage B heart failure (HF) patients. We hypothesized that nighttime BP measured by home BP monitoring device was associated with cardiovascular outcome in stage B HF patients.

Method:
We used the dataset of Japan Morning Surge-Home Blood Pressure study (J-HOP study), and selected 417 of stage B HF patients. The definition of stage B HF was based on Universal definition of HF. The patients with history of HF hospitalization were excluded. BP was measured on waking, before bedtime and during the night. The cardiovascular event was followed.

Result:
Mean follow-up period was 6.6±3.8 years, and 59 cardiovascular events were occurred. When nighttime hypertension was defined as nighttime BP >120mmHg, nighttime HT group showed higher BMI, serum creatinine, HbA1c, and higher prevalence of diabetes, atrial fibrillation, and chronic kidney disease, and lower HDL-cholesterol than nighttime normotension (NT) group. With regard to BP, nighttime HT group, clinic BP, home morning BP, home evening BP, and home nighttime BP were higher in nighttime HT group than in nighttime NT group. In Kaplan-Meier analysis, nighttime HT group had a higher incident of cardiovascular event than nighttime NT group (P<0.01). In Cox multivariate analysis, nighttime HT was significant predictor for cardiovascular event adjusting by significant variables (Hazard ratio 1.84, 95% Confidence interval: 1.01-3.36, P=0.046).

Conclusions:
Nighttime HT was a prognostic factor in stage B HT patients. Nighttime BP was a therapeutic target to improve the outcome in stage B HT patients.
Abstract 15822: Cardiac Effects of EDG-7500, a Novel Cardiac Sarcomere Regulator: In vitro and in vivo Evidence for Slowing Isovolumic Contraction and Improved Ventricular Compliance
Authors: Del Rio Carlos L , Ma Weikang , Irving Thomas , Roof Steve , Tolley Jessica , Duvall Mike , Hawryluk Natalie , RUSSELL ALAN , Semigran marc , Evanchik Marc
Published: December 2023

Background:
Hypertrophic Cardiomyopathy (HCM) is a disease where excess acto-myosin crossbridge formation results in hyperdynamic contraction, LV hypertrophy, and diastolic dysfunction due to increased myocardial stiffness. Conventional negative inotropes alleviate, to some degree, the systolic alteration in HCM, but do not improve LV filling. EDG-7500 is a small molecule that preferentially decreases diastolic tension and slows the velocity of myocardial force generation by regulating, but not inhibiting, cardiac myosin. This study assessed pharmacodynamic responses to EDG-7500.

Methods:
Myofilament biomechanics and sarcomere structure were evaluated on LV permeabilized pig fibers. In vivo, dogs were instrumented for arterial pressure and LV pressure-volume recordings. Data were obtained with vehicle, EDG-7500 (n = 5; 0.3 mg/kg IV), or metoprolol (2-4 mg/kg IV, n = 3); systemic and LV hemodynamics and load-independent function were examined. *:P<0.05 for EDG-7500 vs. vehicle

Results:
X-ray diffraction studies showed EDG-7500 preserved the myosin head population competent to form crossbridges as well as the recruitment of reserve myosin-heads during calcium activation. EDG-7500 (1μM) slowed crossbridge formation, with a limited reduction in maximal force (-6±2%) and decreased diastolic tension. At 0.3 mg/kg, EDG-7500 slowed early contraction (PEP: +10±1%*) and reduced the peak rate of LV pressure development (+dP/dtmax: -8 ± 1%*) with minimal reductions in peak end systolic elastance (Emax: -4±1%*). Systemic mean arterial pressure and cardiac output were unchanged. EDG-7500 increased LV end-diastolic volume (+5 ± 1%*) and preserved LV end-diastolic pressure (EDP: -8 ± 3%, 9 ± 1 to 8 ± 1 mmHg). A downward and rightward shift of the pressure-volume relationship indicated improved LV compliance. β-AR blockade did not elicit this pro-compliant effect (EDP: +26 ± 12%).

Conclusions:
Cardiac sarcomere regulation with EDG-7500 has a unique cardiovascular profile characterized by the overall preservation of the myosin motor-head population and a slowing of early cardiac contraction and improved LV distensibility. This cardiovascular profile could have salutary effects in patients with HCM or patients with impaired diastolic function.
Abstract 15850: Low Rates of Achievement of Low-Density Lipoprotein Cholesterol Levels <55 mg/dL Among Patients With Atherosclerotic Cardiovascular Disease in the United States: Findings From the Cardiovascular Multicenter Observational Investigation of Lipid Care in the United States-2 Registry
Authors: Navar Ann Marie , Shah Nishant , Shrader Peter , Thomas Laine E , Ahmad Zahid , Allred Clint , Chamberlain Alanna M , Chrischilles Elizabeth A , Dhalwani Nafeesa , Effron Mark B , Hayek Salim , Jones Laney K , Kalich Bethany , Shapiro Michael D , Wojcik Cezary , Peterson Eric D
Published: December 2023

Introduction:
Guidelines are increasingly recommending a goal LDL-C <55 mg/dL in persons with atherosclerotic cardiovascular disease (ASCVD). The proportion and characteristics of US adults with ASCVD with an LDL-C <55 mg/dL remains unclear.

Aims:
To evaluate lipid management in ASCVD patients and factors associated with achieving an LDL-C <55mg/dL.

Methods:
Using electronic health record data from 8 US health systems, we evaluated LDL-C levels and treatment patterns in persons with prevalent ASCVD seen as outpatients between 1/1/2021-12/31/2021 with an LDL-C level within the prior year. Multivariable logistic regression modeling with generalized estimating equations was used to evaluate factors associated with an LDL-C <55 mg/dL.

Results:
Among 178,240 eligible ASCVD patients, 43.5% (77,472) had an LDL- C <70 mg/dL and 22.0% (39,270) had an LDL-C <55 mg/dL. Older age was associated with higher odds of LDL-C <55 mg/dL (OR 1.10 per 10 years, 95% CI 1.07-1.13), while female sex (OR 0.71, 95% CI 0.68-0.64) Black race (OR 0.77, 95% CI 0.70-0.86), and non-coronary artery disease forms of ASCVD including peripheral artery disease (PAD, OR 0.61, 95% CI 0.58-0.64) and cerebrovascular disease (CeVD, OR 0.72, 95% CI 0.66-0.79) were associated with lower odds of LDL-C <55 mg/dL in multivariable modeling. Overall, while 75.0% were on a statin, only 36.9% were on a high-intensity statin, 5.7% were on ezetimibe, and 1.7% were on a PCSK9i. Combination therapy was rare: only 4.2% were on a statin+ezetimibe, 0.5% on statin+PCSK9i, and 0.3% on all three.

Conclusions:
Less than a quarter of US patients with ASCVD achieve an LDL <55 mg/dL. Achieving this goal is even less common among younger adults, women, Black persons, and those with PAD and CeVD. Current therapeutic regimens often fail to use high-intensity statins, and markedly underutilize combinations of statins with ezetimibe and/or PCSK9 inhibitors.