bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 18260: Association of Physical Activity History With Disease Penetrance in a Disease-Based Cohort Does Not Replicate in a Healthcare-Based Genomic Screening Population
Authors: Carruth Eric D , Wang Weijia , Pendleton Catherine , Nevius Christopher D , Keefer Rachel , Tichnell Crystal , Murray Brittney , James Cynthia A , Haggerty Christopher M
Published: December 2023

Background:
Physical activity (PA) restriction is a recommended intervention for patients with arrhythmogenic right ventricular cardiomyopathy (ARVC), due to strong associations of PA history with disease, and the known risk of arrhythmic events in affected patients from tertiary referral centers. However, in patients with secondary findings of genetic risk for ARVC, the association of PA exposure with disease expression is unknown.

Hypothesis:
Among individuals with incidentally identified pathogenic or likely pathogenic (P/LP) variants in desmosome genes (PKP2, DSP, DSG2, DSC2), clinical evidence of disease will be associated with higher pre-diagnostic PA exposure.

Methods:
The MyCode (MC) cohort included individuals with P/LP variants in desmosome genes, discovered via population genomic screening of 175,000 individuals; the Johns Hopkins (JH) disease-based cohort included ARVC probands and family members with single P/LP variants enrolled in the JH ARVC Registry. The ARVC task force criteria (TFC) status of each patient was defined based on most recent clinical evaluation. Recreational PA history from age 10 to time of diagnosis (TFC+) or survey (TFC-) was self-reported through structured phone interview and each activity was assigned a metabolic equivalent score.

Results:
The MC cohort was older, more female-predominant, had a lower proportion of
PKP2
variants, and had less disease than the JH cohort (Figure; all p<0.001). As expected, MET-hrs/year of exercise prior to presentation was significantly higher in affected vs. unaffected patients in the JH cohort. In contrast, no association between PA history and disease expression was observed in MC (p=0.42).

Conclusions:
The MyCode cohort demonstrated both a paucity of clinically evident disease and a lack of obvious association of exercise with disease expression. These findings may be seen as reassuring in the management of patients with secondary ARVC genetic findings, but additional data are needed.
Abstract 18261: Efficacy and Safety of Bempedoic Acid for Prevention of Cardiovascular Events and Diabetes Mellitus: A Systematic Review and Meta-Analysis of Randomized Control Trials
Authors: Yasmin Farah , Najeeb Hala , Moeed Abdul , Ali Eman , Rahman Saad Ur U , Khan Mohammad S , Shah Nishant , Michos Erin D
Published: December 2023

Background:
Bempedoic acid (BA) is considered an alternative therapy for hyperlipidemia (HLD) in statin-intolerant patients. Given the positive results from the CLEAR-OUTCOMES trial, we performed a meta-analysis pooling recently conducted randomized control trials (RCTs) to provide a comprehensive clinical evaluation of the safety and efficacy of BA.

Hypothesis:
Bempedoic acid therapy in HLD patients with statin intolerance may be associated with a significant reduction in LDL-C levels, and CV events.

Methods:
All RCTs reporting CV outcomes and/or % change in LDL-C from baseline till completion of follow-up duration in HLD patients with statin-intolerance were included in MEDLINE, Google Scholar, and Scopus databases (Inception to April 2023). The outcome measures were summary random effects risk ratio (RR) and mean differences (MD) with 95% confidence intervals.

Results:
Twelve RCTs were included with 18 510 patients (10,033 BA vs. 8,477 placebo). BA therapy resulted in greater significant % reduction in LDL-C levels post-treatment (mean difference from baseline: 21.73% [-26.94, -16.51], p<0.00001) with no significant impact of the male sex, age, and follow-up duration on LDL-C upon meta-regression analysis. The risk of MACE (RR, 0.86 [0.79, 0.93], p < 0.0004), coronary artery revascularization (RR, 0.81 [0.72, 0.91], p = 0.0005), and myocardial infarction (RR, 0.71 [0.51, 0.99], p= 0.04) were significantly reduced with BA (
Figure 1)
. However, no significant reduction in cardiac death (RR, 1.05 [0.89, 1.24], p = 0.56) was observed. A total of 1,019 new-onset DM events (521/6027 with BA; 498/4946 with placebo) were reported, and demonstrated a non-significant lower risk of new-onset or worsening DM (RR 0.83; 95% CI [0.62, 1.13]; P = 0.24) with BA vs. placebo.

Conclusion:
BA was observed to be safe, efficacious, associated with improved cardiovascular outcomes, and with no effect on new-onset or worsening DM among HLD patients with statin intolerance.
Abstract 18264: Associations of High-Sensitivity Troponin and Natriuretic Peptide Levels With Cognitive Outcomes in SPRINT
Authors: Haney Devin , de Lemos James A , Berry Jarett D , Dalmacy Djhenne , Ascher Simon
Published: December 2023

Background:
Subclinical elevations in high sensitivity cardiac troponin T (hsc-TnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) identifies a high-risk subgroup with reduction in cardiovascular disease in response to intensive systolic blood pressure (SBP) lowering. However, it remains unknown if these markers also identify subgroups with greater improvement in cognitive outcomes from intensive SBP lowering.

Methods:
We measured hs-cTnT and NT-proBNP at baseline in Systolic Blood Pressure Intervention Trial (SPRINT). Adjudicated cognitive outcomes were classified as probable dementia (PD) and mild cognitive impairment (MCI). Combined cardiac biomarker categories were defined as elevated, intermediate, and non-elevated. The association of combined biomarker categories with risk of cognitive outcomes was assessed using multivariable Cox proportional hazards models. Heterogeneity in the effect of intensive versus standard SBP lowering on the risk of cognitive outcomes across combined biomarker categories was determined.

Results:
Of 8,111 SPRINT participants with measured biomarkers and at least one follow-up cognitive assessment, 830 (10.2%) experienced the composite outcome of PD or MCI. After multivariable adjustment, elevated vs. non-elevated cardiac biomarker levels were independently associated with increased risk of composite outcome [HR 95% CI: 1.56 (1.26 - 1.92)]. The effect of intensive SBP lowering on the composite outcome was strongest among participants with non-elevated cardiac biomarkers (see Table).

Conclusion:
Elevated cardiac biomarkers were associated with higher risk for cognitive impairment. The effect of intensive SBP lowering on preventing cognitive impairment was strongest among patients with non-elevated cardiac biomarkers. This suggests that intensive SBP lowering may be more effective in preventing cognitive impairment in individuals with favorable cardiac biomarker profiles.
Abstract 18286: Histone Acetyltransferase P300/CBP in Pulmonary Arterial Hypertension and Associated Right Ventricular Failure
Authors: Bourgeois Alice , Lemay Sarah-Eve , Grobs Yann , Romanet Charlotte , Theberge Charlie , Sauvaget Melanie , Martineau Sandra , Breuils Bonnet Sandra , Potus Francois , Provencher Steeve , Boucherat Olivier , Bonnet Sebastien
Published: December 2023

INTRODUCTION
Pulmonary arterial hypertension (PAH) is defined by increased pulmonary artery (PA) pressure and vascular remodeling, partly due to excessive proliferation and survival of PA smooth muscle cells (PASMCs). Initially, RV hypertrophy allows adaptation to increased resistance, but as the disease progresses, maladaptive remodeling takes place, leading to RV failure and death. Current therapies aim to promote vasodilatation, but none of them directly targets pathological lungs or RV remodeling. The histone acetyltransferases P300/CBP have been identified as central players driving gene expression in various cellular processes such as proliferation/apoptosis and hypertrophy/fibrosis, all of which are critical features of pathological lung and RV remodeling in PAH. Given their role in controlling gene transcription programs, we hypothesized that P300/CBP contributes to maladaptive remodeling.

METHODS & RESULTS
We show by western blot (WB) and immunofluorescence (IF) increased P300 expression in isolated PASMCs and distal PAs from PAH patients compared to controls (p<0.01) as well as in monocrotaline (MCT) and sugen-hypoxia rat models (p<0.05). Similar results are observed in remodeled RV from PAH patients, MCT- and pulmonary artery banding-subjected rats (WB).
In vitro,
P300/CBP inhibition (CCS-1477 or siRNA) reduces H3K27 acetylation (WB, p<0.05) in PAH-PASMCs and RV fibroblasts (RVFbs). This effect is accompanied by a decrease in PAH-PASMC proliferation and resistance to apoptosis [WB (PCNA, PLK1, Survivin), IF (Ki67, AnexinV), p<0.01]. Similarly, P300/CBP inhibition reduces proliferation (WB, PCNA, Survivin) and activation/extracellular matrix production (WB, pSMAD2/3, aSMA, Fn, Col1, MMP2) in RVFbs. In addition, P300/CBP inhibition prevents phenylephrine-induced hypertrophy in H9C2 cells and adult rat cardiomyocytes (IF, p<0.05).
In vivo,
administration of CCS-1477 reduces pulmonary vascular remodeling (Elastica Van Gieson, p<0.05), improves pulmonary hemodynamics (p<0.01) and attenuates RV fibrosis (Masson’s Trichrome, p<0.05) in MCT rats with established PAH.

Conclusion:
We provide evidence that targeting P300/CBP may represent a promising avenue to tackle both lung and RV maladaptive remodeling in PAH.
Abstract 18320: Vessel-Specific Coronary Inflammation Quantified Using Perivascular Fat Attenuation Index Score on CCTA Detects the Vulnerable Coronary Artery and Predicts Acute Plaque Events
Authors: Chan Kenneth , Wahome Elizabeth , Antonopoulos Alexios S , Nicol Edward , Volpe Lucrezia , West Henry , Patel Parijat , Tomlins Pete , Neubauer Stefan , Channon Keith M , Antoniades Charalambos
Published: December 2023

Background:
Coronary artery inflammation can be detected non-invasively on routinely performed coronary computed tomography angiograms (CCTA) by measuring the 3D changes of perivascular adipose tissue attenuation. Fat attenuation index (FAI) Score is the corrected metric of coronary inflammation measured in any of the 3 coronary arteries, and predicts acute myocardial infarction (AMI). Although FAI score is able to detect the vulnerable patient, it is unclear whether it can be used to detect the vulnerable artery in advance of an acute event.

Aim:
To evaluate the ability of FAI Score to detect the vulnerable coronary artery in patients undergoing CCTA for investigation of chest pain.

Methods:
Consecutive patients (n = 3,393, mean age 61±15, 57% male) from two UK hospitals in the Oxford Risk Factors and Non Invasive Imaging (ORFAN) study underwent CCTA between 2010-2018 for suspected coronary artery disease (CAD), and were followed up prospectively for a median of 7.7 years. AMI events were recorded via nationwide screening and the culprit vessel was identified based on the target lesion in percutaneous coronary intervention (PCI). FAI score was generated with CaRi-Heart® device.

Results:
A total of 296 AMI events occurred during the follow up period and 176 patients underwent PCI (59 attributed to the right coronary artery (RCA), and 93 to left anterior descending artery (LAD)). Patients with high FAI score in the LAD had 2 times higher risk for AMI in the LAD (Fig. A), but not in the RCA (HR 1.73 95% CI 0.96-3.08, p=0.07). Similarly, patients with high FAI score in the RCA had 1.9 times higher risk for AMI in the RCA (Fig. B), and modestly elevated risk for an AMI from the LAD. (HR 1.62, 95% CI 1.02-2.59, p=0.04)

Conclusion:
Vessel-specific FAI score predicts AMI caused by a culprit lesion in the corresponding coronary artery. The ability of FAI score to identify the vulnerable artery before it gives a plaque rupture event may be useful in planning targeted therapeutic interventions.
Abstract 18337: Myocardial Work - A Novel Approach to Investigate the Effects of Right Ventricular Apical Pacing on Left Ventricular Regional Work and Function
Authors: Abdul Samad Nurul H , Straw Sam , Lowry Judith E , Gierula John , Witte Klaus K , Paton Maria F ,   Leeds Institute of Cardiovascular and Metabolic Medicine
Published: December 2023

Background:
Right ventricular pacing (RVp) is the most common method of delivering bradycardia pacing, but it is associated with left ventricular (LV) systolic dysfunction (LVSD) in 40% of patients. Animal models have shown that RVp-induced electrical conduction delay leads to dyssynchronous LV activation, resulting in uneven myocardial work (MW) distribution. This work redistribution is believed to trigger adaptive structural remodelling, aiming to achieve a more uniform LV load distribution. Cardiac resynchronisation therapy (CRT) responders demonstrate normalised MW distribution and baseline constructive MW measurements may predict CRT response. However, there is limited evidence on MW in patients with pacemakers.

Hypothesis:
Long-term RVp in atrioventricular block (AVB) patients with pacemakers may influence MW.

Method and Results:
One hundred and eighteen patients (mean age 75±10 years; 69% male) with AVB receiving pacemaker therapy were included. Echocardiographic assessment and MW calculations were performed pre- and post-implant. LVSD was defined as LVEF <50%. Among patients, 33 (28%) had LVSD at follow-up (mean time 26±19 months). RVp significantly influenced LVEF (F (1, 18) = 1193, p <0.001), while MW changes were evaluated using repeated measures ANOVA. Constructive work showed a significant interaction effect at the septal wall (F (1, 21) = 8.57, p = 0.008), with no changes observed at the lateral wall (F (1, 51) = 0.93, p = 0.35). However, wasted work exhibited significant interaction effects at both the septal and lateral walls (F (1, 21) = 16.30, p <0.001 vs. F (1, 51) = 7.10, p = 0.014, respectively) (Figure 1).

Conclusion:
Constructive and wasted work measures at septal and lateral walls are associated with LVSD in patients receiving a pacemaker for AVB. MW may add additional predictive value in identifying people at risk of developing RVp-associated LVSD who may benefit from more complex device therapy such as conduction system pacing, or CRT.
Abstract 18357: Racial Disparities in Direct Oral Anticoagulant Orders in Patients With Nonvalvular Atrial Fibrillation Within A Large Integrated Health System
Authors: Escobedo Victor S , Wong Pacheco Daniela , Zhou Mengnan , Lee Mingsum , Lang Daniel T , An Jaejin
Published: December 2023

Introduction:
Anticoagulant (OAC) use for stroke prevention in non-valvular atrial fibrillation (NVAF), specifically direct oral anticoagulants (DOAC) use, is suboptimal in racial/ethnic (RE) minorities.

Hypothesis:
We hypothesized differences in OAC and DOAC orders among RE groups over time in patients newly diagnosed with NVAF from 2012-2022 within a large US integrated healthcare system.

Methods:
We conducted a retrospective cohort study using Kaiser Permanente Southern California electronic medical record data on adults with NVAF between 2012-2022. We compared the proportion of OAC and DOAC orders within 60 days from the first NVAF diagnosis among those with a CHA
2
DS
2
-VASc score ≥2 across self-reported RE groups over time using chi-squared tests. Multivariable logistic regression was used to compare OAC and DOAC orders in RE groups compared with non-Hispanic White (NHW) adjusting for age, sex, and CHA
2
DS
2
-VASc score.

Results:
Of 59,340 OAC eligible patients from 2012-2022, 52% of patients received an OAC order and 33% received a DOAC order. DOAC orders across all RE groups increased over time, with DOAC orders comprising 95% of all OAC orders for new NVAF patients in 2022. The percentages of OAC and DOAC orders were highest among NHW patients in most years. In 2022, OACs were ordered at higher rates for NHW (67.1%) than Asian (67.0%) (OR=0.84, 95% CI=0.67-1.05), Hispanic (65.6%) (OR=0.63, 95% CI=0.54-0.74), or non-Hispanic Black (62.0%) (OR=0.54, 95% CI=0.43-0.68) patients. In 2022, DOACs were ordered at higher rates for NHW (65.3%) than Asian (64.2%) (OR=0.78, 95% CI=0.63-0.98), Hispanic (64.1%) (OR=0.64, 95% CI=0.55-0.75), or non-Hispanic Black (60.7%) (OR=0.55, 95% CI=0.44-0.69) patients (
Figures 1a/1b
).

Conclusions:
Although DOAC orders have been increasing over time across all RE groups, minority groups were still less likely to receive OAC or DOAC orders than NHW patients.
Abstract 18375: Improving Rate of Prenatal Diagnosis of Critical Congenital Heart Disease Despite the Covid19 Pandemic: A Canadian Multiprovincial Study
Authors: Eckersley Luke G , Lougheed Jane , Fruitman Deborah S , B.Szabo Adrienn , Lad Mrinal M , Poolsaar Heili , He Rose , Nield Lynne E , Thakur Varsha , Hornberger Lisa K , Arya Bhawna , Freud Lindsay R
Published: December 2023

Background
Restriction to travel, reallocation of health resources and physical distancing during the COVID19 pandemic caused extraordinary health system strain, requiring limited tertiary referral acceptance. The overall impact of public health measures during COVID19 on diagnosis of congenital heart disease (CHD) has not been explored. We sought to determine the rate, timing of diagnosis and pregnancy outcomes of critical CHD prior to and during the COVID era.

Methods:
Cases of CHD with due date/birth date from 1 Jan 2016 to 1 Mar 2022 that required or were anticipated to require neonatal intervention were identified from surgical and referring centres in Ontario and Alberta. Pregnancies were categorized as reaching 18 weeks GA before (pre-COVID) or after 1 March 2020 (COVID). Outcomes included timing of diagnosis (pre/postnatal), GA at prenatal diagnosis, and pregnancy outcome. Data are presented as mean, 95% CI or median (IQR); rank-sum comparison of continuous variables or Chi
2
comparison of proportions were used.

Results:
Prenatal diagnosis occurred in 1240/1823 (68% (65.8, 70.1)) of cases of critical CHD overall, with a pre-COVID rate of 867/1305 - 66% (64, 69) and COVID rate of 373/518 - 72% (68, 76), p=0.02. During COVID, earlier median GA at obstetric ultrasound (median GA: pre-COVID 20.1 (19.1, 22), COVID 19.9 (19.1,21.3), p=0.025) and diagnosis of CHD (median GA: pre-COVID 21.7 (20.3, 24.3), COVID 21.3 (20,23.3), p=0.006) occurred. Prenatal diagnosis before 22 weeks GA (pre-COVID 449/851, 52.3% vs COVID 219/371, 59%; p=0.043) and termination were more common during COVID (pre-COVID 28% (25,31), COVID 35% (30,40) p=0.015).

Conclusion
The rate of prenatal diagnosis of critical CHD continued to improve during the COVID pandemic in two of Canada’s largest provinces. Unexpectedly, obstetric ultrasounds occurred earlier, leading to earlier prenatal diagnosis of CHD. These findings may have implications for referral practices in the post-COVID era.
Abstract 18376: Social Vulnerability Indices as a Measure for the Impact of Social Determinants of Health on SGLT2-i Prescriptions in Patients With HFrEF
Authors: Puttur Anushree , Kapcin Kyle , Ta'ani Omar A , Naser Abdallah , Shah Aaisha , Venkat Divya
Published: December 2023

Introduction:
Sodium-glucose cotransporter-2 inhibitors (SGLT2-i) are an important member of the 5 pillars of goal directed medical therapy (GDMT) in patients with heart failure with reduced ejection fraction (HFrEF) that was introduced in the 2022 AHA/ACC/HFSA heart failure guidelines. Despite the role of GDMT in reducing cardiovascular mortality and heart failure outcomes, medication accessibility remains limited among more socially vulnerable populations. Social Determinants of Health (SDoH) play a vital role in how patients receive and engage with health care.
Goals/Aims:
Our study aims to utilize the social vulnerability indices (SVI), an underutilized tool used to quantify social vulnerability, to determine associations between SDoH with SGLT2-i prescriptions.

Methods/Approach:
A retrospective review of SVI in 864 patients with a diagnosis of HFrEF in two urban Internal Medicine outpatient clinics between April 2022 and June 2023 was performed. Composite social vulnerability, as well as subgroups of individual data points utilized in the Centers for Disease Control and Prevention SVI were compared between those prescribed and not prescribed a SGLT2-i. Patients with a diagnosis of HFrEF were assigned SVI scores based on geocoded census tract level data. Chi-square analysis was performed to compare groups. A p-value less than <0.05 was considered significant.

Results:
A total of 864 patients were evaluated. 78 of these patients were prescribed a SGLT2-i, while 786 were not prescribed a SGLT2-i. Those with a SVI overall percentile of 74-100% (less social vulnerability) were significantly more likely to be on a SGLT2-i (19.23% vs 10.02%, p = 0.022). Descriptively, patients with SVI Est <24% below poverty were less often prescribed SGLT2-i (92.05% vs 7.95%). Similarly, those without a vehicle as defined by SVI Est <24% households with no vehicle available were on less frequently prescribed SGLT2-i (93.24% vs 6.76%).

Conclusion:
Use of SVI data may help identify barriers to SGLT-2 prescribing in patients with HFrEF when analyzed on a population level. Further studies and investigations to target these barriers may be beneficial in increasing the amount of patients on indicated GDMT.

Keywords:
social determinants of health, SGLT-2i, GDMT, HFrEF
Abstract 18451: Point-of-Care Aid-to-Diagnosis for Heart Failure Using Artificial Intelligence Based on Seismocardiography Acquired With a Smartphone in the Emergency Department
Authors: Long Tran T , El Ahmadie Diaa , Mainil Geoffrey , Hossein Amin , Meurant Virginie , Almorad Alexandre
Published: December 2023

BACKGROUND
The number of new heart failure (HF) diagnoses in hospitals constantly increases. The associated clinical signs lead to a delay in treatment. Reliable and rapid diagnostic assistance is needed at earlier stages. Kinocardiography (KCG), based on Seismocardiography (SCG), allows the computation of non-invasive cardiac kinetic energy that is used to characterize the cardiac function and could detect HF among patients at risk.

PURPOSE
In a multi-centric study, test the performance of smartphone-based KCG recording in diagnosing HF in the emergency department (ED).

METHODS
Adult patients presenting with dyspnea in the ED were recruited. Relevant clinical characteristics were recorded. A blood sample was collected for NT-proBNP measurement, and a 180-sec KCG was acquired with a smartphone. The patient is supine on the back; the smartphone is placed on his chest to acquire the precordial vibrations due to the heartbeats. Cardiac kinetic energy (CKE) metrics are derived from these vibrations, including diastolic gradient kinetic energy (
ΔiK
diastolic
). The final HF diagnosis was assessed from the medical record at discharge from the ED. The primary outcome is the performance of an AI-based on CKE metrics at classifying HF, measured using metrics including the area under the receiver operating characteristic curve (AUROC), negative predictive value (NPV), and specificity, with two-sided 95% CIs.
RESULTS
375 patients were recruited; among these, 137 patients were diagnosed with HF (78 [70.2;85.7] years, 26.8 [23.4;29.6] kg/m
2
, 45.7% male, 4843.0 [3199;7845] pg/ml, 88 HFpEF, 17 HFmrEF, 37 HFrEF) and 243 without HF (65 [54;74] years, 27.9 [25.3;31.3] kg/m
2
, 50.2% male, 291.0 [71;803] pg/ml).
ΔiK
diastolic
was significantly lower in patients with HF (0.37 [0.11;0.72] vs. 0.06 [-0.05;0.29] %, p<0.005). The AI approach resulted in an AUROC of 0.85 (0.80-0.89), sensitivity of 85.0% (74.2-90.3), and NPV of 79.0% (77·7-82·9).

CONCLUSION
This study shows that an AI system applied to SCG acquired during a 3-mins examination with a smartphone can detect HF among patients presenting dyspnea. These findings highlight the potential for a non-invasive, workflow-adapted, point-of-care, aid-to-diagnosis for earlier diagnosis.
Abstract 18453: Giant Right Atrial Lipoma Inducing Atrial Flutter and Tachycardia-Mediated Cardiomyopathy: The Value of Multimodality Cardiac Imaging
Authors: Khayyat Kholghi Maedeh , Almaraz Karla B , Garcia Mark E , Ratliff Michelle , Yassin Said , Roldan Carlos A
Published: December 2023

Case Presentation:
A 60-year-old male who presented with progressive dyspnea on exertion and atrial flutter with rapid ventricular response. His TTE showed a large (5.1 x 3.9 cm) right atrial (RA) mass occupying 80% of a severely dilated RA attached to the lateral wall (Fig A) and severe global LV hypokinesis with an ejection fraction of 20 - 25%. A TEE was then performed to further characterize this mass and showed a large (6.3 x 5.5 x 3.7 cm), heterogeneously echoreflectant, bi-lobed, and partially mobile RA mass attached to the lateral wall (Fig B,C) just below the superior vena cava and extending near the tricuspid valve annulus with sparing of the leaflets and only mild tricuspid regurgitation. At last, a chest CT scan showed a large (5.5 x 4.5 x 3.3 cm) mass which was tissue characterized as RA lipoma (Fig D). Therefore, patient underwent an uncomplicated surgical resection of the mass with partial removal of RA free wall (Fig D,E) repaired with a pericardial patch. Pathology confirmed a RA lipoma. Patient’s atrial flutter was then ablated, and patient was discharged home in stable condition.

Discussion:
This case illustrates an unreported cavitary giant RA lipoma inducing atrial flutter and tachycardia-mediated cardiomyopathy and emphasizes the importance of multimodality cardiac imaging in its diagnosis and management. Cardiac lipomas are rare benign tumors usually of small size and therefore mostly incidentally detected. They can rarely lead to embolization, conduction abnormalities, and flow obstruction requiring surgical resection. In this patient, pre-operative echocardiography and CT imaging were critical in the assessment of the tumor size, tissue characterization, location, motion, relation or extension to other cardiac structures, and obstruction or dysfunction of heart valves. Pre-and-intraoperative echocardiography were also essential in planning and performing the successful surgical resection of the RA lipoma.
Abstract 18454: Temporal Trends in Assessment and Management of Iron Status in Patients With Heart Failure: A Multi-Institutional Study
Authors: Minasian Alexandra , Griskowitz Catharine , Prasad Cheshta , Campain Joseph , Chen Kailin , Walker Lauren , Cocca Spofford Diane , Malhotra Rajeev , Lewis Gregory D
Published: December 2023

Background:
Over the last decade there has been extensive investigation of iron deficiency in heart failure (HF). HFrEF patients are often refractory to oral iron supplementation whereas intravenous (IV) iron repletion has been shown to improve functional capacity, prompting a Class II guideline recommendation to assess iron stores and replete iron intravenously. The purpose of this study is to understand temporal patterns in assessment of iron status as well as utilization of oral and IV iron preparations in patients with HF.

Methods:
The Mass General Brigham (MGB) Research Patient Data Registry (RPDR) was used to conduct a retrospective analysis of patients with both HFrEF and HFpEF across 3 1-year intervals in 2012, 2017, and 2022. Circulating levels of iron, ferritin, and transferrin saturation (TSAT) were assessed. Patients were further classified according to the HF guideline-based definition of iron deficiency (ferritin <100 ng/mL or 100-299 ng/mL with a TSAT < 20%). Iron deficient (ID) HF patients were assessed for use and frequency of IV iron or oral iron for repletion.

Results:
Electronic health records within the MGB Healthcare System identified 23,687 total HF patients in 2012, 25,271 in 2017, and 36,059 in 2022. Among these patients, the percentage with iron studies measured within the calendar year were 48%, 62%, and 90% respectively. Of those with HF 5,557 (23%), 8,460 (33%), and 19,955 (55%) met guideline-based diagnostic criteria for iron deficiency. Oral iron supplements were used in 68%, 44%, and 19% of all ID HF patients. IV iron was given to only 4%, 11%, and 14% of ID patients (
Figure
).

Conclusion:
The temporal trends of iron assessment and repletion demonstrate a significant increase in assessment of iron stores by health care providers but persistent utilization of oral formulations in excess of IV formulations to treat ID. These data suggest a significant gap in implementation of a therapy associated with functional improvement in HF.
Abstract 18471: Cardiovascular Risks Among the Transgender Population in Rural United States: Spotlight on the Appalachian Region
Authors: Ezeh Ebubechukwu , Perdoncin Maddie , Al-Hiari Mohammed , Ogbu Chukwuemeka , MARCUM MELISSA , Saunders Elizabeth , Mader Jason
Published: December 2023

Introduction:
Previous findings suggest that transgender (TGD) populations have disproportionately higher cardiovascular (CV) risks. We aimed to evaluate the prevalence and odds of CV risk factors in the TGD population in rural Appalachia.

Methods:
Our case-control study enrolled 92 self-identified TGD people and 73 randomly selected cisgender people. The average age for the TGD and cisgender groups were 29.2 and 29.9, respectively. CV risks of interest examined in both groups were tobacco use, hypertension (HTN), prediabetes/diabetes mellitus (DM), obesity, and hyperlipidemia (HLD). Univariate analysis was used to generate the prevalence of risk factors. Multivariable logistic regressions, adjusted for age and family history of ASCVD, were used to estimate the odds ratio and 95% confidence Interval of having risks of interest.

Results:
This analysis included 89 and 69 TGD and cisgender individuals, respectively. There was a >6-fold increase in tobacco use (adjusted OR 6.64 [2.59-17.01]) and 4-fold increase in prediabetes/DM (adjusted OR 3.98 [1.05-15.15]) among the TGD population. Among the TGD population, there were increased odds of obesity (OR 13.39 [3.30-54.30] and HLD (OR 3.46 [1.03-11.59]) in the trans-male group compared to the trans-female group. Also, surgical and/or hormonal treatments were significantly associated with higher odds of tobacco use (OR 6.67 [2.80-15.98]), and statin need (OR 3.97 [1.14-13.81] in the TGD group.

Conclusion

The TGD population have disproportionately higher odds of CV risks in rural Appalachia, worse among trans-male and individuals who received hormonal and/or surgical treatment. This study is limited by sample size.
Abstract 18522: Pyridoxamine (vitamin B6) Mitigation Of Structural Valve Degeneration Of Bioprosthetic Heart Valves
Authors: Zakharchenko Andrey , Thomas Tina , Hall Emily , Chorny Michael , Ferrari Giovanni , Levy Robert
Published: December 2023

Introduction:
Bioprosthetic heart valves (BHV) fabricated from glutaraldehyde treated bovine pericardium (BP) have limited durability due to structural valve degeneration (SVD) resulting from both calcification and advanced glycation end product (AGE) deposition.

Hypothesis:
We investigated the hypothesis that PYR modification of BHV leaflets mitigates AGE-serum protein uptake, oxidation, and calcification mechanisms in model studies, both in vitro and in vivo.

Methods:
To model AGE accumulation in BHV, we used well-established in vitro and in vivo models. AGE and serum albumin (SA) uptake in BP were quantitated per immunohistochemistry (IHC) staining intensity. PYR uptake was quantified using a novel fluorescent assay. BP collagen was examined by second-harmonic generation (SHG) microscopy. Calcification studies investigated the activity of BP alkaline phosphatase (ALP), and BP calcium levels were quantitated using a colorimetric assay. In vivo studies used a juvenile rat subdermal BP implantation model with PYR oral administration or BP-PYR modification. Endpoints were calcification, SA, and AGE accumulation per IHC and ALP activity per enzyme histochemistry.

Results:
PYR modification of BP resulted in high-affinity binding of PYR with 2.0±0.2 μg/mg of PYR binding to BP that was stable for 28 days in physiological conditions. Modification had an inhibitory effect on SA uptake in vitro with 60±5% (p<0.001) reduction in IHC staining intensity; PYR modification of BP resulted in increased protection from oxidative damage in vitro with collagen structure preservation (by SHG) after ten days, while control tissues were degraded. After 28-day of in vivo subdermal BP implantation in rats, a significant 70±5% (p<0.001) decrease and 80±5% (p<0.001) decrease in SA IHC staining and AGE staining, respectively, as well as ALP activity was documented in BP-PYR. Quantitative analysis of calcium content demonstrated a reduction from 108±5 μg/mg in control to 77±5 μg/mg in BP-PYR explants (p<0.001).

Conclusions:
Our study demonstrated that PYR mitigates SVD mechanisms
in vitro
and
in vivo,
limiting both AGE-serum protein accumulation and calcification with associated inhibition of ALP.
Abstract 18525: Sex Differences in Reporting of Statin-Associated Diabetes Mellitus - A Pharmacovigilance Analysis of Us Drug Safety Data
Authors: Kao David P , Reusch Jane E , Regensteiner Judith G
Published: December 2023

Introduction:
Limited observational and clinical trial data have suggested a higher likelihood of statin-associated diabetes mellitus (DM) in women compared with men. However, real-world evidence of sex differences in statin-associated DM generally and with specific statins are lacking. Spontaneous adverse reporting pharmacovigilance systems provide an opportunity to assess these potential sex differences.

Hypothesis:
Statin-associated DM is reported to the FDA disproportionately more in women than in men.

Methods:
: Adverse event reports from the FDA Adverse Event Reporting System between 1960 and 2021 were obtained. Cases that included lovastatin, fluvastatin, pravastatin, simvastatin, atorvastatin, and rosuvastatin were analyzed together and individually with respect to reporting of DM vs. all other reactions starting at FDA approval of each. Signals of disproportionate reporting (SDR) were identified using the proportional reporting ratio (PRR) with a threshold of 2, and X2 of 4 with > 3 cases of reaction if interest. Differences between SDR in men vs. women were identified using a lower bound of the 95% confidence interval of the Reporting Odds Ratio (ROR) > 1 in > 3 events.

Results:
In both men and women, DM was associated with a significantly elevated PRR for all statins combined and individually for atorvastatin, lovastatin, rosuvastatin, fluvastatin, simvastatin, and nominally for pitavastatin. Pravastatin was disproportionately reported in women only (M=1.80, W=2.32). Using ROR, statin-induced DM was reported significantly more frequently for atorvastatin, simvastatin, pravastatin, and rosuvastatin but not for pitavastatin, fluvastatin, or lovastatin.

Conclusions:
Statin-associated DM is disproportionately reported to the FDA in both men and women for most agents compared with other adverse events. Importantly, statin-associated DM is reported significantly more in women than men for the statins most commonly used in current practice.
Abstract 18530: Associations Among Self-Reported and Physiologic Sleep Measurements and Fatigue in Adults Following Major Cardiac Events
Authors: Forster Anna , Alwine Jennifer , Wierenga Kelly L
Published: December 2023

Background:
Insufficient sleep contributes to fatigue and cardiometabolic disorders. Current sleep measures vary in accuracy, with weak correlations between self-report and physiologic measures. Developing reliably associated self-report and physiologic sleep measures can optimize data collection methods.

Purpose:
Investigate correlations between self-reported and physiologic sleep measures in cardiac rehabilitation patients and determine associations with fatigue.

Methods:
Participants (N = 25, 58% male, 89% non-Hispanic white, mean age = 61 years) recruited from cardiac rehabilitation centers participated in a three-arm RCT. Inclusion criteria were experiencing a myocardial infarction or revascularization procedure, enrollment in cardiac rehabilitation, and experiencing depression or anxiety. Participants without complete sleep measures were excluded. Data was collected at baseline, 3-, and 6-months. Sleep was measured over 8 days with an investigator-developed self-report diary and an ActiGraph GT9X Link accelerometer. ActiGraphs collected data with a 30Hz sampling rate and were scored using the autodetected sleep periods to determine total sleep time. Mean daily minutes of sleep were calculated from self-report and ActiGraph data. Participants also completed a demographics survey and Fatigue Severity Scale. Statistical methods included Pearson correlation coefficients with 95% confidence intervals (CI) estimated with Fisher's r-to-z transformation.

Results:
Results showed self-reported and ActiGraph measured sleep were highly correlated (r = 0.889, [95% CI 0.812, 0.935], p < 0.001). Fatigue was not correlated with self-reported (r = 0.074, [95% CI -0.206, 0.342] p = 0.607) or ActiGraph measured sleep (r = 0.150, [95% CI -0.131, 0.408] p = 0.295). Even though the finding was non-significant, the correlation between fatigue and ActiGraph measured sleep was larger than self-reported sleep.

Conclusion:
Accurate sleep measures are essential to inform future research and interventions. Unlike past work, this investigator-developed, self-report measure was strongly correlated with the physiologic measure. Researchers should consider reliability when selecting sleep measures.
Abstract 18534: Catheter-Directed Mechanical Thrombectomy: A PERTinent Paradigm Shift
Authors: Honnekeri Bianca , patel dhriti , Cameron Scott J , Chaudhury Pulkit , Tefera Leben
Published: December 2023

Introduction:
The emergence of catheter-directed mechanical thrombectomy (MT) heralded a paradigm shift in the management of pulmonary embolism (PE). There is a paucity of data on the degree to which the availability of this modality has impacted clinical-decision making by the multidisciplinary Pulmonary Embolism Response Team (PERT). We examine data from a single center experience at a large tertiary hospital to shed light.

Research Question:
How does the recent emergence of MT as a therapeutic strategy impact the approach of a PERT team?

Aim:
To examine the degree to which the integration of MT into the clinical decision-making algorithm for PE management has impacted the treatment course recommended by a PERT team.

Methods:
A retrospective analysis was performed to compare PERT recommendations in a contemporary cohort (10/2020-3/2023) to a historical cohort (1/2015-6/2016) prior to the availability of newer generation mechanical thrombectomy catheters in the same institution.

Results:
The contemporary cohort consisted of 306 patients, of which 50% were treated with advanced therapies including MT, catheter-directed lysis, systemic tPA, or ECMO. In the historical cohort, 28% of patients received advanced therapies. Of those treated with advanced therapies, 84% were MT and 1% were catheter-directed lysis in the contemporary cohort compared to 6% MT and 31% catheter-directed lysis in the historical PERT cohort.

Conclusion:
The integration of MT into the PERT decision-making process portends a new era in the management of PE. At our center, it significantly expanded the ambit of advanced therapies, such that a majority of patients now receive some form of advanced therapy, rather than anticoagulation alone. This is in stark contrast with the pre-MT era. These findings underscore the importance of a PERT team’s ability to adapt to evolving treatment modalities and highlights the need for continued multidisciplinary expertise in optimizing care for PE patients.
Abstract 18549: Focal Pericoronary Adipose Tissue Evaluated by Atomic Numbers on Contrast Spectral Computed Tomography Was Associated With Coronary Arterial Plaques: A Site-by-Site Analysis
Authors: Funabashi Nobusada , Shukuya Atsushi , Asano Hiroki , Kawamura Akio , Mizuno Naoko
Published: December 2023

Introduction:
Inflammation in pericoronary adipose tissue (PCAT) around the coronary arterial wall causes coronary arterial sclerosis. Many studies evaluated the relationship between total PCAT volume and coronary arterial sclerosis on a patient-by-patient basis. Hypothesis: Inflammation in PCAT may occur focally in coronary arterial system to which coronary arterial plaques localize. Using novel spectral CT, based on atomic number as a new parameter, the focal characteristics of PCAT were evaluated.

Methods:
17 patients (10 males, mean age 70 years) underwent cardiac spectral CT (7500, Philips, Tokyo, Japan). From contrast data, atomic numbers of PCAT were determined at a 1) right side site and 2) left anterior side site of a proximal portion of the right coronary arteries (RCA), 3) anterior side site of the left main coronary arteries, 4) left side site of a proximal portion of the left circumflex artery, and left side site of a distal portion of the RCA (five sites each patient). We also evaluated coronary arterial plaques on enhanced CT images at five corresponding sites for which atomic numbers were determined.

Results:
For a total of 85 sites among 17 patients using enhanced CT, 31 sites had no plaques (group 1), 14 sites had only non-calcified plaques (group 2), 20 sites had only calcified plaques (group 3), 16 sites had mixed plaques (group 4), and four sites had stent implantations (group 5). The mean of atomic numbers for 81 sites, excluding four sites with a stent implantation, were 6.4, 6.8, 6.4, and 6.1 in groups 1-4, respectively (P=NS). For a total of 81 sites, excluding four implantation sites, we evaluated relationship between age and atomic numbers in groups 1-4. Positive correlations were observed in group 1 (R= 0.25) and 3 (R= 0.39), however negative correlation was observed in group 2 (R= -0.37) and 4 (R= -0.40) between age and atomic numbers. No significant differences in atomic numbers were noted between males and females.

Conclusions:
This is the first study in which focal PCAT was evaluated by atomic numbers and the relationship to coronary arterial plaques determined by site-by-site analysis. This new CT parameter may evaluate the status of PCAT and be a predictor of future occurrence of coronary arterial plaques, which are related to PCAT inflammation.
Abstract 18569: Patient and Provider Factors Associated With the Initiation of Sodium-Glucose Cotransporter-2 Inhibitors (SGLT2i) in the Year Post FDA Approval for HFpEF and HFmrEF
Authors: Martyn Trejeeve M , Saef Joshua , Bansal Agam , Martinez Kathryn , Block-Beach Hunter , Hohman Jessica , Albert Nancy M , Starling Randall , Tang Wai Hong W
Published: December 2023

Introduction:
Despite robust evidence for, and Food and Drug Administration (FDA) approval of sodium-glucose cotransporter-2 inhibitors (SGLT2i) for heart failure with preserved and mildly reduced ejection fraction (HFpEF/HFmrEF), use of this therapy is suboptimal.

Hypothesis:
We aimed to determine 1) prescribing context (inpatient/outpatient) and prescriber type of SGLT2i; 2) patient and provider level predictors of SGLT2i prescription in the year following FDA approval.

Methods:
All patients in a diverse, multi-state (Ohio and Florida), multi practice/hospital integrated system who had least 1 ambulatory encounter for HF and documented EF
>
40% were included. Data come from the electronic health record. We compared patients who were prescribed SGLT2i in the year post FDA approval 2/24/22-2/24/23 against those who were not using multivariable logistic regression to assess independent predictors of SGLT2i prescription.

Results:
20,255 patients with HFpEF/HFmrEF were included in the study. Mean age 73±9 yrs, female (49.8%), Black (17.4%), DM2 (34%), AFib (43%), CKD (35%), baseline medications: BB (52.4%), ACEi/ARB (41%), MRA (19.7%), ARNI (6.5%), SGLT2i (3.2%). There were 1118 (5.6%) patients were newly prescribed SGLT2i in the study period. SGLT2i were most commonly initiated by cardiology 54.2%, general medicine 25.3% and endocrinology 8.5%. Of prescriptions, 82.9% were outpatient, 17.1% inpatient. Independent patient level predictors of SGLT2i prescription were DM2 2.82 (2.09-3.82), p<0.001; AFib 1.42 (1.07-1.92), p=0.018; higher eGFR 1.16 (1.09-1.25), p<0.001 and increasing EF 0.88 (0.81-0.97), p<0.001. Insurance type/median income were not significant. Provider level predictors were total HF visits with each specialty: HF cardiology, 1.21 (1.13-1.29), p<0.001; general cardiology, 1.1 (1.04-1.15), p<0.001; and primary care, 1.1 (1.08-1.17), p<0.001. After excluding patients with DM2, predictors were total visits with HF specialists, and general cardiologists.

Conclusions:
In the year post FDA approval, there has been significant underutilization of SGLT2i. Diabetes status and provider factors were associated with SGLT2i use, the majority of which were initiated in the outpatient setting by cardiology providers.
Abstract 18593: High Prevalence of Venous Thrombosis in Cardiac Amyloidosis and the Proposed Clinical and Echocardiographic Integrated Risk Stratification Tool
Authors: de Carvalho Singulane Cristiane , Bilchick Kenneth C , Neyestanak Maryam E , Wang Yu , Slivnick Jeremy A , Addetia Karima , Sun Deyu , Lang Roberto M , Epstein Frederick H , Patel Amit R
Published: December 2023

Introduction:
The prevalence of thromboembolism (VTE) in cardiac amyloidosis (CA) is not well defined. Additionally, there is no risk stratification tool to identify CA subjects at risk for VTE to guide prophylactic treatment. We sought to identify the prevalence of VTE in CA and to develop a model to predict VTE in this population.

Methods:
A total of 150 subjects from two academic centers with confirmed CA (69±11years, 56% male, 58% AL-CA), and no history of VTE, atrial arrhythmia or anticoagulation use were included. The primary endpoint was DVT, pulmonary embolism or right atrial thrombi (RA). The LASSO technique was used to evaluate nearly 50 potential clinical and echocardiographic covariates in order to develop a multivariable model for predicting VTE. The subjects were randomly divided in a proportion of 70:30 into training and testing dataset. The diagnostic performance of the model was assessed by calculating the AUC of a ROC curve.

Results:
Thirty-two subjects (21%) developed VTE after CA diagnosis (18 DVT, 3 RA thrombus, 11 in multiple concurrent locations). The majority occurred within one year of the echocardiogram (78%). Multivariable analysis revealed four variables independently predictive of VTE (p<0.05), based on the regularization parameter (lambda=0.08). VTE was more likely in the presence of liver disease or alcohol abuse, end-stage renal disease, increased LA volume and lower TAPSE. The model had excellent discrimination (AUC=0.823) (Panels A-B) and when applied to the test set an accuracy of 84.4%. The nomogram that can be used to predict the probability of VTE in CA using the covariates identified is illustrated on Panel C.

Conclusions:
High prevalence of VTE was identified in CA. The developed clinical and echocardiographic risk scheme is user-friendly and has the potential to identify patients with CA at high risk for VTE. It remains to be determined if pre-emptive anticoagulation in this higher risk group might be beneficial.