bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 12101: Impact of COVID-19 Pandemic on the Incidences of Hospitalizations for Acute Myocardial Infarction and Out-of-Hospital Cardiac Death.
A Nation-Level Analysis
Authors: Motovska Zuzana J , Jarkovsky Jiri , HLINOMAZ Ota , Kala Petr , Hromadka Milan , Mrozek Jan , Precek Jan , Tomasov Pavol , Kozel Martin , Muzafarova Tamilla , Sanca Ondrej
Published: June 2023

Introduction:
COVID-19 infection has increased the risk of thrombosis, and the pandemic has impacted the utilization of healthcare services.

Hypothesis:
The study aims to investigate the consequences of the COVID-19 pandemic on the incidence of hospitalization for acute myocardial infarction (IH-AMI) and out-of-hospital cardiovascular deaths rate (OH-CVD).

Methods:
The analysis was done on data collected in the National Database of Death Records, the National Health Information System, and the Information System of Infectious Diseases. Incidence and number of deaths were expressed per 100 000 inhabitants. For comparison of time periods incidence rate ratio was applied. Over-mortality was described as a change in % against the reference period 2016-2019.

Results:
The population for the analysis consisted of 50,745 AMI cases and 204,392 OH-deaths from any cause. In the pandemic year (vs. 2016-2019 period), there was a significant decrease in AMI hospitalizations with an incidence rate ratio of 0.949 (0.911;0.989) for acute STEMI and 0.949 (0.911;0.989) for NSTEMI, respectively. A significant relationship was found between the decrease in acute STEMI hospitalizations and the number of COVID-infected patients. The risk of OH-CVD increased significantly in 2020 compared to the mean death rates in 2016-2019. The analysis of over-mortality against the reference period 2016-2019 shows the increase of OH-CVD associated with the decrease in hospitalization for acute STEMI significantly related to the number of COVID19 cases (Figure).

Conclusions:
The COVID-19 pandemic significantly affected the number of IH-AMI while increasing the incidence of OH-CVD. These changes were directly impacted by the number of infected in the population. It is, therefore, necessary to focus efforts on informing the population about the safety of hospitalization and ensuring full availability of health care services even in pandemic times.
Abstract 12465: Surgical Outcomes of Patients With Endomyocardial Fibrosis Operated at the Heart Institute in Mozambique
Authors: Nhavoto Carol , Magaia Aissa Sheila , Madede Tavares , Augusto Orvalho , Estefane Sozinho , Macave Joao , Menete Alda , Ferreira Beatriz
Published: June 2023

Introduction:
Endomyocardial fibrosis (EMF) is a myocardiopathy that results from restriction of the ventricular filling caused by the presence of fibrous tissue in the endocardium. It is estimated that this disease affects approximately 12 millions of people worldwide and most of these people are in the Sub-Saharan Africa. Until today there is no consensus regarding the best therapeutic approach in these patients, but there are reports of encouraging results in patients treated surgically.

Objective:
To describe the results of surgical treatment of patients with EMF and the factors that influence it.

Methodology:
86 patients with EMF were operated at Instituto do Coração (Heart Institute) in Mozambique, between 2002 and 2017.

Results:
Most of the patients were male (61.6%) with ages between 3 and 39 years (mean, 12 years). Forty-three per cent (43%) of the patients were coming from the province of Inhambane and 81.4% of them had biventricular disease. Sixty-two per cent (62%) of the patients were in functional classes III/IV of
New York Heart Association
(NYHA)
.
After the surgery, most of the operated patients (70.9%) had improvement in the NYHA functional class. The post-operatory mortality was 6.9% and mainly related to heart failure. The cumulative mortality after 12, 24 and 60 months was 5.7%, 7.7% e 23.5% respectively. The survival after 5 years was estimated around 76.5%.

Conclusion:
Apart from an elevated post-operatory and cumulative mortality, EMF surgery can significantly improve the patients’ functional class and survival, so it can be considered a valid alternative to patients with EMF who present in advanced stages of the disease (NYHA functional classes III and IV).
Abstract 12466: Assessment of Extracellular Matrix Remodeling Biomarkers Shortly After Admission for ST-Elevated Myocardial Infarction
Authors: Angeli Elisavet , Reese-Petersen Alexander , Frydland Martin , Genovese Federica , Hassager Christian
Published: June 2023

Introduction:
ST-elevated myocardial infarction (STEMI) is followed by changes in the extracellular matrix (ECM) composition. ECM protein fragments are released into the bloodstream and can be targeted as biomarkers. We aimed at investigating the prognostic ability of ECM biomarkers in STEMI patients.

Methods:
Biomarkers of collagens type I, III, IV degradation (C1M, C3M, C4M, respectively) and collagen type VI formation (PRO-C6) were measured by specific enzyme-linked immunosorbent assays in plasma of 221 patients admitted with STEMI. Plasma was collected at two timepoints, at admission and 6-12 hours post-admission. The prognostic ability of the biomarkers was evaluated via Cox-proportional hazard regression analyses using all-cause mortality at 1 year as outcome.

Results:
The plasma concentration of all biomarkers significantly increased (15.5-28.4%) from admission to 6-12 hours post-admission (p<0.0001). All biomarkers were prognostic for all-cause mortality within the first year after STEMI, after adjustment for potential risk factors (age, BMI, sex, blood pressure and smoking status) (Table 1).

When applying a forward hazard regression analysis including the risk factors and the four ECM biomarkers at admission, PRO-C6 and C1M remained significantly associated with all-cause mortality at 1 year (C1M: HR=1.02, p-value=0.004, PRO-C6: HR=1.08, p-value=0.03). While after 6-12 hours, only C1M remained significantly associated (C1M: HR=1.04, p-value<0.0001).

Conclusions:
Biomarkers reflecting degradation of collagens type I, III and IV, and formation of collagen type VI, were significantly altered shortly after admission for STEMI. PRO-C6 and C1M demonstrated an independent prognostic ability of risk of all-cause mortality within the first year after a STEMI event.
Abstract 12480: Changes in Tmao Levels Following Bariatric Surgery Vary by Procedure Type
Authors: Sherry Beth H , Zhang Ruina , Garabedian Michela , Berger Jeffrey S , Heffron Sean P
Published: June 2023

Introduction:
Trimethylamine-N-oxide (TMAO), a metabolite generated by the gut microbiota from dietary phosphatidylcholine and carnitine, is linked to atherosclerosis and thrombosis. Although bariatric surgery improves CV outcomes, several studies in both animals and humans have shown increased TMAO levels after bariatric surgery. We tested the impact of the two most common bariatric procedures on plasma TMAO.

Methods:
This study included 93 severely obese non-diabetic individuals who did not take diabetes or lipid-lowering medications and underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). Plasma TMAO was measured before and ≥ six months after bariatric surgery.

Results:
Mean age of the subjects was 31.4 ± 7.2 years and 90% were female. At baseline, average weight and BMI were 117.1 ± 24.4 kg and 43.4 ± 8.0 kg/m
2
respectively. Average baseline plasma TMAO level was 2.2 ± 1.4 μM. 29 patients underwent RYGB and 64 patients underwent SG. There were no significant differences in baseline weight, BMI, or TMAO between procedures. RYGB patients lost significantly more weight than SG patients (37.5 ± 8.6 kg for RYGB vs 32.8 ± 9.0 kg for SG, p = 0.03). TMAO levels did not change following SG, whereas they increased after RYGB (
Figure
). Changes in TMAO were not associated with changes in other clinical measures, for example, body weight and BMI (
Figure
) for either RYGB or SG patients.

Conclusions:
We found contrasting responses in circulating TMAO following bariatric surgical procedures employing dissimilar anatomical alterations. Given TMAO-associated CVD risk, these differences may lead to contrasting CV outcomes in the future. Additional research to understand changes in TMAO and the microbiota after bariatric surgery, and their clinical relevance, are warranted.
Abstract 12575: Subgroup Comparison of Deep-Learning Electrocardiogram Model Performance for Predicting New-Onset 1-Year Atrial Fibrillation Incidence
Authors: Yoo Hakje , Yum Yunjin , Kim Jong-ho , Joo Hyung Joon J
Published: June 2023

Background:
Surveillance of high-risk individuals as determined by an atrial fibrillation (AF) prediction model would be a good strategy to prevent stroke and other complications from AF. Recently, several deep learning (DL) models to predict new onset AF using 12-lead electrocardiography (ECG) have been introduced. However, their performance has not been compared among different patient groups.

Methods :
Data of 99,281 patients who underwent 12-lead ECG at Korea University Anam Hospital from January 2017 to December 2019, excluding patients already diagnosed with AF, were studied. The data was split into a 60% training set, 20% validation set and 20% test set. Using age, sex, and raw ECG waveforms as inputs, DL models of ResNet and a multi-layered perceptron module were developed to predict 1-year new onset AF incidence.

Results:
The DL model using both ECG waves and simple demographic information (age and sex) as input (ECG-AS model) showed better performance compared to the DL model using only ECG waves (ECG model) for AF prediction in the test dataset (area under the receiver operating characteristics curves [AUROCs] 0.79 for ECG model and 0.89 for ECG-AS model, respectively). In subgroup analysis divided by clinical features such as CHA2DS2-VASC score, there was little difference in the performance of the DL model. Interestingly, The DL model performed worse in patients with normal sinus rhythm (NSR) compared to patients with non-NSR (AUROC 0.70 vs 0.81 for ECG model, 0.82 vs 0.90 for ECG-AS model, Table 1).

Conclusions:
ECG of NSR may not have sufficient information to predict AF. In applying the AF prediction DL model using 12-lead ECG to real-world clinical practice, it may be helpful to add clinical information to the input along with appropriate patient selection.
Abstract 12592: Nuclear Sirtuin Sirt6, Protects Mice From Endotoxin-Induced Septic Cardiomyopathy
Authors: Samant Sadhana A , Bhaskara Pillai Vinod Kumar , Hund Samantha , Gupta Madhu , Gupta Mahesh P
Published: June 2023

Introduction:
Dysregulated systemic inflammatory response from host to infection can result in sepsis and multi-organ failure. Heart is one of the most affected organ. Even with recent medical advances, mortality rate with sepsis is 30-70%. Imbalance of inflammatory and metabolic pathways are crucial in the pathogenesis of sepsis and a multi-target approach is needed. SIRT6 is a key enzyme shown to restore energy homeostasis and to promote cardiac health in various adverse conditions.

Hypothesis:
We examined whether SIRT6 could alleviate pathogenic effects of sepsis in a murine lipopolysaccharide (LPS)-induced cardiomyopathy model.

Methods:
By injecting 10mg/kg LPS in wild-type (WT) and SIRT6 whole body overexpressing (T6-Tg) mice, endotoxemia was induced (n=5-6 each). Cardiac functions were assessed by echocardiography. Using heart tissues (n=3 each), TaqMan gene expression arrays were analyzed. Heart protein and serum cytokine levels were also estimated. Rat H9C2 cell line was used for
in vitro
studies.

Results:
SIRT6 overexpression in mice prevented LPS-induced hypothermia (p<0.001) and limited mortality to 30% compared to WT. LPS-injected T6-Tg mice showed preserved cardiac functions compared to WT (fractional shortening and ejection fraction, p<0.001). LPS-injected WT mice hearts showed 2- to 6-fold mRNA upregulation in pro-inflammatory transcription factors HIF1α, TLR4 and activating transcription factor 4 (ATF4). These factors were significantly (p<0.05) downregulated in LPS-injected T6-Tg hearts. With four-fold increase in ATF4 mRNA, a known inducer of amino acid transporters, expression of solute carriers (SLC3a2/7a1/7a5/7a8) was significantly upregulated in LPS-treated WT hearts, while reduced with SIRT6 overexpression. Pyruvate dehydrogenase kinase 4, which controls metabolic switch in sepsis, showed 4-fold increase in mRNA expression in LPS-treated H9C2 cells that was downregulated by SIRT6 overexpression. Similarly, upregulated inflammatory cytokines IL6, TNFα and lipocalin-2 were significantly (p<0.05) downregulated with SIRT6 overexpression.

Conclusion:
Our results indicate that SIRT6 could protect heart from LPS-induced sepsis by restoring metabolic homeostasis via regulation of multiple pathways.
Abstract 12624: Smooth Muscle Cell Alpha-Actin Pathogenic Variant That Predisposes to Moyamoya-Like Cerebrovascular Disease Alters Smooth Muscle Cell Phenotype and Metabolism
Authors: Kaw Anita , WU TING , Pedroza Albert J , Chattopadhyay Abhijnan , Guo Dongchuan , Kaw Kaveeta , Zhou Zhen , Fischbein Michael P , Ghaghada Ketan , Marrelli Sean P , Kwartler Callie , Milewicz Dianna M
Published: June 2023

Pathogenic variants in
ACTA2
, which encodes smooth muscle α-actin (
α-SMA
), predispose to thoracic aortic disease.
ACTA2
variants disrupting arginine 179 (
R179
) also predispose to moyamoya-like (
MMD
) cerebrovascular disease, characterized by occlusion of the distal internal carotid arteries by neointimal cells that stain positive for smooth muscle cell (
SMC
) markers. Mice with conditional knockin of the
Acta2
R179C mutation specifically in SMCs were generated (

Acta2
SMC-R179C/+

). RNA sequencing and 2D gel electrophoresis confirmed presence of the mutation.
Acta2
SMC-R179C/+
SMCs are not fully differentiated, maintain stem cell marker expression, and proliferate and migrate faster than wildtype (
WT
) SMCs. Seahorse analyses show increased glycolysis and decreased oxidative respiration (
OXPHOS
) in
Acta2
SMC-R179C/+
SMCs, which have reduced mitochondrial mass and complex I activity, suggestive of deficient electron transport chain activity. Nicotinamide riboside (
NR
) augments complex I activity to boost OXPHOS without altering mitochondrial mass in
Acta2
SMC-R179C/+
SMCs. NR also increases differentiation and reduces migration in
Acta2
SMC-R179C/+
SMCs. With left carotid artery ligation (
LCAL
), 33% of
Acta2
SMC-R179C/+
mice die within 4 days due to strokes, and 100% of surviving
Acta2
SMC-R179C/+
mice at postop day 21 have occlusive lesions in the injured artery (8% in WT mice) containing α-SMA+ cells and fibrin deposits.
Acta2
SMC-R179C/+
mice also exhibit markedly increased left carotid artery diameter and increased number, diameter, and tortuosity of left-sided collateral vessels compared to WT mice at postop day 21. NR treatment reduces deaths of LCAL-injured
Acta2
SMC-R179C/+
mice to 8%, completely resolves occlusive lesion formation in 50% of mutant mice, and attenuates collateral formation and remodeling. These data suggest that immature SMCs with the
ACTA2
R179C variant proliferate and migrate into the neointima causing MMD-like occlusive disease. Shifting metabolism to OXPHOS with NR drives differentiation and reduces migration, which diminishes arterial lesions in

Acta2
SMC-R179C/+
mice. These data support the use of NR as a therapeutic to prevent MMD-like lesions and ischemic strokes in children with
ACTA2
p.R179 variants.
Abstract 12723: The Tendyne Valve: A Novel Approach to Mitral Valve Replacement
Authors: Shah Neal , Haeffele Christiane , Sharma Rahul , Tuzovic Mirela
Published: June 2023

Clinical Presentation:
64-year-old female with history of CAD with STEMI s/p PCI of RCA, HFrEF (45%), afib, HTN, DM2, severe MR and moderate calcific MS presented with shortness of breath found to have recurrent CHF. She was not amenable to surgical valve replacement and standard transcatheter percutaneous options are limited given the significant MAC. Tendyne (Abbot) transcatheter mitral valve implantation (TMVI) is an experimental minimally invasive option to treat significant MR with challenging mitral anatomy. Patient underwent a minimal apical thoracotomy via TEE guidance, placement of delivery catheter and valve deployment followed by an apical tether to maintain adequate tension. Post-deployment, there was no significant MR, MS or LVOT obstruction.

Imaging Findings:
See Image.

Discussion:
TEE is critical from pre-procedure planning to device implant and post-procedural monitoring. Pre-procedural planning requires accurate understanding of the mitral valve anatomy. During the trans-apical thoracotomy, TEE is essential in confirming correct puncture site to ensure appropriate delivery catheter position. Once appropriately positioned, evaluation via color doppler nad 3D are necessary to evaluate device seating, residual regurgitation and LVOT obstruction. Once apical cap is tethered into apex, the valve is re-visualized on TEE to ensure appropriate valve tension prior to closure of thoracotomy.

Conclusion:
TENDYNE TMVI is a reasonable option to consider for patients with significant MR and challenging mitral anatomy and not an open surgical candidate. TEE imaging is critical to optimize valve implantation both pre-procedural and post-procedural.
Abstract 12774: Detecting Change in Cardiopulmonary Bypass Blood Flow Rate With a Novel, Wireless, Wearable Doppler Ultrasound Patch: A Pilot Study
Authors: Munding Chelsea E , Kenny Jon-Emile S. S , Yang Zhen , Clarke Geoffrey , Elfarnawany Mai , Eibl Andrew M , Eibl Joe K , Nalla Bhanu , Atoui Rony
Published: June 2023

Introduction:
Assessing preload reserve (PR) is important when managing cardiac surgery patients. Typically, a 10% change in cardiac output is used as a reference standard to gauge PR; how this change in cardiac output translates to common carotid artery (CCA) velocity is unknown. In this pilot study, we compared known changes in cardiopulmonary bypass (CPB) flow rate to those measured by a novel wireless, wearable Doppler ultrasound placed over the CCA.

Methods:
A sample of 14 adult patients undergoing elective CABG was studied. While on CPB, at least two changes in blood flow (one negative, one positive) were made. The corresponding change in CCA velocity was measured by a wearable continuous wave (CW) Doppler ultrasound patch. For each subject, CPB flow changes were determined from the displayed spectrogram by the peristaltic pulsation frequency and CCA velocity changes were calculated from the automated maximum velocity trace. 5-10s windows pre- and post-CPB speed changes were selected, with sufficient signal quality to determine both relative CPB flow and CCA velocity. A “dose-response” curve was fitted to the relative changes in flow and velocity for each subject, as shown in Fig. 1, and the CCA velocity change corresponding to a 10% change in CPB flow was calculated.

Results:
CPB flows ranged from 0.5-6.3L/min. Mean relative flow changes were -58 and 179%, corresponding to mean CCA velocity changes of -43 and 107%. A mean CCA velocity change of 14% was found to correspond to 10% CPB flow change, ranging from 1.5-27.8%.

Conclusions:
CCA velocity measured with the Doppler patch successfully tracked changes in CPB flow. A CCA velocity change of >14% suggests a >10% change in cardiac output. Although preliminary, these results provide another important parameter for predicting the response to preload using a novel, easy-to-use, wireless Doppler device.
Abstract 12787: Microrna Administration Attenuates the Contraction Deterioration of Microrna-1 Deficient Heart But Not the Susceptibility of Arrhythmia
Authors: Yang Dandan , Wan Xiaoping , Schwieterman Neill , Kacira Ege , Xu Xianyao , Cavus Omer , Shah Tithi , Tang Feng , Laurita Kenneth R , Wold Loren E , Hund Thomas J , Mohler Peter J , Deschenes Isabelle , Fu Jidong
Published: June 2023

Introduction:
Aged people are much more likely to suffer arrhythmias or develop heart failure. MicroRNA-1 (miR1), encode by two distinct genes in the mammalian genome, is an evolutionarily conserved, striated muscle-enriched microRNA with a critical role in regulating cardiac physiology. Full knockout of miR1 in mice causes postnatal lethal. Interestingly, miR1 expression was significantly decreased to the level of 12.5±4.0% in the heart of 18-month aged animals, in comparison with that in young mice (age 3-4 months).
Aims:
We hypothesize that miR1 deficiency is one of the major etiologies in diseased and/or aged hearts and study the therapeutic effect of miR1 administration.

Methods and Results:
We generated miR1-75% knockdown (75%KD) mice and confirmed that miR1 expression was 4-5 fold lower in 75%KD hearts than in WT hearts. Echocardiogram showed that 75%KD mice demonstrated impaired cardiac contractile function, evidenced by decreased ejection fraction, and fraction shortening. Surface ECG recording showed that 75%KD mice had significantly lower heart rates, shorter PR interval, prolonged QRS interval as well as premature ventricular contractions. Consistently, optical mapping of
ex vivo
hearts revealed that 75%KD hearts had slower ventricular conduction velocity. Whole transcriptome RNA-sequencing and Proteomic assays demonstrated cardiac electrical and metabolic remodeling in miR1-deficient hearts. Compared to WT cells, 75%KD ventricular cardiomyocytes showed more hyperpolarized RMPs with prolonged APD; the sarcomere shortening was significantly decreased at a 5Hz fast pacing rate. Structurally, 75%KD myocytes had disrupted mitochondria with a shorter length of sarcomeres. We delivered miR into the animals through intravenous tail vein injection and found that 12-week miR1 administration could significantly attenuate the decrease of ejection fraction of 75%KD hearts, however, miR1-treated hearts had significantly higher inducibility of arrhythmia than control-RNA treated hearts.

Conclusions:
MicroRNA-1 deficiency causes cardiac electrical and metabolic remodeling. Restoring miR1 prevents the contraction deterioration of miR1-deficient hearts but increases the risk of arrhythmia.
Abstract 12790: The Role of Social Determinants of Health in Rural Hf Outcomes
Authors: Gilstrap Lauren , Leggett Christopher , O'Malley James , Carlos Heather , Wong Sandra , kraft sally , Mackwood Matthew , Skinner Jonathan
Published: June 2023

Background:
Over 6.5 million Americans suffer from heart failure (HF) and 20% of these, 1.5 million Americans, live in rural areas. Compared to urban patients with HF, rural patients have higher rates of hospitalization and higher mortality. The reasons for these disparities are not well understood. In this study, we aimed to determine how much of the variation in urban/rural 30-day mortality could be explained by: 1) comorbidities; 2) guideline directed medical therapy (GDMT) use and 3) social determinants of health (SDOH).

Methods:
Using 100% Medicare Parts A and B and a random 40% sample of Part D, a cohort of 356,194 fee-for-service beneficiaries with ≥1 hospitalization for HFrEF between 2008 and 2016 was created. Rurality was determined using the beneficiaries’ ZIP code of residence and the Rural/Urban Commuting Areas (RUCA) classification. Hierarchical, logistic regression modeling, we then examined the association between 1) comorbidities; 2) GDMT use; and 3) the area deprivation index (ADI), a summary variable capturing multiple SDOH, and 30-day death after hospital discharge among HF patients in urban vs. rural areas.

Results:
When adjusting only for age, sex and race, rural patients have 15% higher odds of death (95% CI 12%, 19%, p<0.001) in the 30 days after discharge for HFrEF. When comorbidities are added, the odd increase to 18% - an unexpected finding since comorbidity burdens are higher in rural areas. When GDMT use is added, the odds increase to 20%, also unexpected since prior work has shown GDMT is higher in rural areas. When ADI is added, the odds decrease to 14% (95% CI 10%, 18%, p<0.001), suggesting that unlike comorbidities and GDMT use, ADI explains much of variation in urban/rural 30-day death rates.

Conclusion:
Living in a rural area is associated with a higher risk of 30-day death following a HFrEF hospitalization. Unlike comorbidities and GDMT use, SDOH appear to explain much of this difference in 30-day death rates.
Abstract 12842: Adipose Tissue Derived Ceramides Regulate the Myocardial Redox State and Predict Cardiovascular Outcomes
Authors: Polkinghorne Murray D , Akawi Nadia , Badi Ileana , Checa Antonio , Kotanidis Christos , Akoumianakis Ioannis , Antonopoulos Alexios S , Krasopoulos George , Sayeed Rana , Walcot Nicholas , Channon Keith M , Wheelock Craig , Antoniades Charalambos
Published: June 2023

Introduction:
Ceramides biosynthesis is dysregulated in obesity, yet their role as mediators of obesity-induced myocardial dysfunction is unclear.

Objective:
We investigate the causal role of AT-derived ceramides in regulating the myocardial redox state and explore their prognostic value in patients with CVD.

Methods:
In 880 cardiac surgery patients, 20 sphingolipids were measured in plasma, subcutaneous-, thoracic- and epicardial-AT biopsies and their secretomes. Myocardial redox state was measured and the contribution of NOXs, uncoupled eNOS and mitochondrial oxidases to O
2
.-
production quantified. Median follow-up was 8.3 years. Genetic variants were identified to predict CVD outcomes using cis-Mendelian Randomisation. The underlying mechanisms were explored using differentiated H9c2 cardiomyocytes
in vitro
and human myocardial tissue
ex vivo
.

Results:
C16:0-ceramide (CerC16) was the most abundant ceramide secreted from AT (p<0.0001). Patients with high plasma CerC16 and C16:0-glucosylceramide (GlcC16) had significantly increased myocardial O
2
.-
production (vs low/int.)
(A)
. Patients with rs112572487
(B)
, an intronic SNP in
UGCG
, had significantly increased plasma GlcC16
(C)
and myocardial NOX-derived O
2
.-
(D)
vs those without. Exogenous CerC16 (20nM) induced O
2
.-
production in H9c2 cardiomyocytes and human myocardial tissue
(E)
, an effect prevented by the
UGCG
inhibitor D-PDMP. Importantly, high plasma GlcC16 led to a higher risk of cardiac death and/or heart failure (HR=2.128 [1.101, 4.115], p=0.025) vs low/int. levels, a relationship also seen with rs112572487
(F)
. rs112572487 also led to an increased risk of new, post-operative atrial fibrillation in hospital (HR=1.805 [1.188, 2.742], p=0.006).

Conclusions:
We demonstrate for the first time, that AT-derived ceramides are causally related with dysregulated myocardial redox signalling and adverse cardiovascular disease outcomes in patients with advanced atherosclerosis.
Abstract 12861: Demographics and Clinical Characteristics of Patients Presenting With Sinus Bradycardia After Bariatric Surgery
Authors: Somoza-Cano Francisco , Mogollon Ivan , Al Armashi Abdul Rahman , Patell Kanchi , Herrera-Ramos Alejandro , Toledo-Martinez Juan F , Hammad Faris , Ravakhah Keyvan
Published: June 2023

Introduction:
Sinus bradycardia following bariatric surgery has been described in current literature. Whether certain demographics and clinical characteristics affect this occurrence remains a topic of discussion.

Hypothesis:
We assessed the hypothesis that certain patient characteristics may affect the prevalence of sinus bradycardia after bariatric surgery.

Methods:
This cross-sectional analysis nested in a community cohort assessed 321 bariatric surgeries from 2012 to 2020. Due to incomplete data, 179 patients were excluded. A descriptive analysis was made using means and standard deviation (SD) for continuous variables and count and percentages for categorical variables. Odds ratios (OR) were calculated for associations with 95% confidence intervals (CI), and Student’s t-test was used to compare means.

Results:
For the categorical variables evaluated, only beta blocker usage was significantly different (
p
= 0.014) with nearly a tripling of the estimated odds for bradycardia [OR: 2.702 (95%, CI: 1.291 - 5.658)]. For the quantitative measures, only the heart rates showed significant differences between the groups (with and without bradycardia) and they were significant at all follow-up times.

Conclusions:
Our study showed that sinus bradycardia is a common occurrence among patients undergoing bariatric surgery. The use of beta blockers was significantly predictive of bradycardia. Further studies are needed to evaluate the need for dose reduction or discontinuation of beta blockers in the perioperative period in select cases. Additionally, medical centers should be aware of this development to avoid over-treatment.
Abstract 12863: Similar Rates of Embolic and Bleeding Events for Direct Oral Anticoagulants and Warfarin in the Treatment of Left Ventricular Thrombus
Authors: Conant Alexander , Deng Yuting , Sims Daniel B
Published: June 2023

Introduction:
Left ventricular thrombus (LVT) is common post-STEMI, with an incidence of as high as 26% in patients with anterior MI. AHA guidelines recommend systemic anticoagulation with warfarin for patients with LVT. However, the efficacy of direct oral anticoagulants (DOACs) compared to warfarin in the treatment of LVT is unknown.

Hypothesis:
Rates of embolic events and bleeding will be similar in LVT patients treated with DOACs compared to warfarin.

Methods:
Retrospective single institution study of all patients with LVT diagnosed between 2010 and 2021 and treated with an anticoagulant. The primary outcome was embolic events (stroke, TIA, and other systemic embolism). Secondary outcomes were all bleeding events, major and minor bleeding per International Society on Thrombosis and Haemostasis criteria, and all adverse outcomes. p<0.05 by Chi-square test was considered significant.

Results:
Included were 164 patients with LVT who received anticoagulation. Of those, 29 were prescribed DOACs and 135 warfarin. A similar percentage of patients on DOACs and warfarin had embolic events (6.9% and 6.7%, respectively, p=0.97). DOACs had a trend towards lower rates of bleeding events, major and minor bleeding, all adverse outcomes, and percentage of patients experiencing an adverse outcome (10.3% vs 25.2%, p=0.13).

Conclusions:
LVT patients treated with DOACs had a similar risk of embolic and bleeding events and a trend towards less bleeding compared to those treated with warfarin.
Abstract 12901: Cardiac Reverse Remodeling and Functional Changes Assessed by Speckle Tracking Echocardiography After Septal Myectomy in Patients With Symptomatic Hypertrophic Obstructive Cardiomyopathy
Authors: Ha Kyungeun , Lee Hee Jeong , Gwak Seo-Yeon , Kim Kyu , Ko Kyu-Yong , Hong Geu-Ru , Ha Jong-Won , Shim Chi Y
Published: June 2023

Introduction & Hypothesis:
Surgical septal myectomy is an effective treatment in patients with symptomatic hypertrophic obstructive cardiomyopathy (HOCM). Reducing the hemodynamic burden through septal myectomy in HOCM patients is expected to result in cardiac reverse remodeling, but it is unknown whether it improves myocardium functional parameters, which are proven prognosticators for clinical outcome. Therefore, this study aimed to investigate the left atrial (LA) and left ventricular (LV) size and function using conventional and speckle tracking echocardiography (STE) before and after septal myectomy in patients with HOCM.

Methods:
A total of 65 patients with symptomatic HOCM who underwent surgical septal myectomy from 2006 to 2021 were retrospectively analyzed. Patients were excluded if they underwent a valve repair or replacement at the same time. Finally, clinical, echocardiographic, and electrocardiographic variables before and after the surgery were comprehensively analyzed.

Results:
After septal myectomy, there were significant decreases in LA volume index (72±22 vs. 57±18 ml/m
2
, p <0.001) suggestive of improvement of diastolic function. In the analysis of STE, there was no significant difference in LA strain (19.3±8.5 vs. 19.1±8.2%, p=0.883) and LV global longitudinal strain (LS) (-10.3±3.6 vs. -9.6±3.4%, p=0.150) before and after septal myectomy. When we analyzed LV regional LS by dividing into septum and non-septum, septal LS showed a little aggravation (-8.7±4.5 vs. -7.6±3.7 %, p=0.077) with marginal statistical significance. In addition, non-septal LS was not significantly different after septal myectomy (-10.9±4.5 vs. -10.5 ±4.2 %, p= 0.458). The change of LA volume index was significantly correlated with change of QRS duration. Interestingly, the septal LS was deteriorated and non-septal LS tended to be improved as widening of QRS duration.

Conclusions:
After septal myectomy, as hemodynamic load due to LVOT obstruction relieves, there is a significant reduction in LA volume. However, there is no improvement in the global LA and LV mechanical function. Widening of QRS duration, a marker of effective septal myectomy, is associated with LA volume reduction and improvement of longitudinal strain in non-septal LV.
Abstract 12905: Prevalence of Cardiovascular Disease in Mid-Life Among Women Who Have Had a Child With Congenital Heart Disease
Authors: Colello Stephanie , Ittenbach Richard , Klepczynski Brenna , Burnham Nancy , Messersmith Andrew , Gaynor J W , Lewey Jennifer
Published: June 2023

Background:
Women whose offspring have congenital heart disease (CHD) have higher risk of cardiovascular (CV) disease and mortality later in life. The mechanism is not well-understood and may be related to angiogenic imbalance, genetic predisposition, or stress-related pathways. We aimed to describe the prevalence of CV disease and traditional and sex-specific risk factors among women with a child with CHD at 18-23 years after delivery.

Methods:
We conducted an online survey among mothers whose infants had undergone cardiac surgery before six months of age and enrolled in a prospective observational study at the Children’s Hospital of Philadelphia. Maternal surveys investigated sociodemographic characteristics and self-reported health behaviors and medical history. We described the prevalence of baseline characteristics.

Results:
531 women were contacted and 220 (41%) completed the survey and are included in this analysis. Child and maternal characteristics are presented in Table. Mean maternal age was 52 years, 86% were White, and 68% completed college. Regarding sex-specific risk factors, 10% had preeclampsia and 32% had history of preterm delivery. The most common traditional CV risk factors were high cholesterol (32%) and hypertension (27%). Overall, 4.6% of women reported a history of atherosclerotic cardiovascular disease (ASCVD) and 15% reported any cardiac disease, as defined by arrhythmia, structural heart disease, or ASCVD. Of the 6 women with prior myocardial infarction (2.7%), mean age at onset was 44 years. Complexity of the child’s CHD was significantly associated with prevalence of ASCVD but not other types of CV disease (p=0.008)

Conclusion:
Having a child with CHD is a potentially important sex-specific CV risk factor that is not well-studied. Understanding how this maternal characteristic interacts with other traditional and sex-specific risk factors is critical to understanding mechanistic pathways leading to CV disease in these women.
Abstract 12922: Detection of the Effect of Nicotine Delivered by E-Cigarettes or Standard Cigarettes on Cardiovascular System From a Carotid Waveform Using a Physics-Based Machine Learning Approach
Authors: Alavi Rashid , Dai Wangde , Arechavala Rebecca J , Kleinman Michael T , Kloner Robert A , Pahlevan Niema M
Published: June 2023

Introduction:
We have recently shown (Alavi et al. Circulation, (2021)144: A13745-A13745) that adverse effects of nicotine delivered chronically by electronic cigarette (EC) vapor or standard cigarettes on left ventricular systolic function can be captured using intrinsic frequency (IF) method applied on carotid waveforms. Here, we propose a hybrid IF-machine learning (ML) method to detect nicotine effect on cardiovascular system using a carotid waveform.

Methods:
Total number of n=117 young healthy adult male and female Sprague Dawley rats (49% (n=57) female, weight ~200-250 g) were randomized and exposed to: 1) purified air, n=32; 2) EC vapor without nicotine (EC NIC-), n=26; 3) EC vapor plus nicotine (EC NIC+), n=27; and 4) standard cigarette smoke from reference combustion cigarettes (3R4F), n=32. All the exposures (nose-only) took place for duration of 5 hours/day, 4 days/week for total of 8 weeks. Third-generation type EC from VaporFi, tank model: Volt 2 was used. E-liquid was tobacco flavored with a 50/50 propylene glycol/glycerin ratio. Similar nicotine amount as the standard cigarette was delivered to the rats of EC NIC+ group. After 8 weeks of exposure, IFs were computed from invasively measured carotid waveforms. A support vector machine (SVM) classifier with radial basis function kernel was trained using IF data from 83 rats to detect (non)-nicotine groups. The
k
-fold cross-validation (
k
=10) was used to avoid overfitting. The remaining rats were used for generalization test (n=14) and stratified blind test (n=20).

Results:
Our SVM model showed positive and negative predictive values of 66.7% and 76.9%, respectively. Sensitivity and specificity were 82.4% and 58.8% for test data (Fig1).

Conclusions:
Our results suggest that nicotine delivered by ECs or cigarettes can be detected by a physics-based ML model from a single carotid waveform. This method can potentially be used for detecting adverse effect of nicotine on cardiovascular system noninvasively.
Abstract 12967: Early Gastrointestinal Bleeding is Most Common Hemorrhagic Complication After Watchman Implantation
Authors: Howard Ato , Germinaro Jill , Squire Joseph , Sanon Saurabh , Jabbour George , Singh Madhurmeet , Voigt Andrew , Mulukutla Suresh , Saba Samir , Jain Sandeep
Published: June 2023

Introduction:
Left atrial appendage occlusion (LAAO) with the Watchman device is increasingly used for patients with an indication for anticoagulation for atrial fibrillation (AF) and a contraindication to long term anticoagulation. Real world early outcomes in this high-risk patient population are scarce.

Methods:
We retrospectively evaluated a healthcare system registry of 1200 patients who underwent LAAO with Watchman 2.5 or FLX between 10/2018 and 8/2021 and included 849 patients with 6-month follow-up. We classified complications in 3 distinct categories (immediate procedural, 6-week post-procedural and 6-month post-procedural) and tracked all thromboembolism, hemorrhage and mortality that occurred after the immediate procedural complications.

Results:
Mean age was 77.6 ± 8.3 years old, 49% were female, 68% had paroxysmal AF, mean CHA
2
DS
2
-VASc was 5.0 ± 1.4, and mean HAS-BLED was 2.9 ± 1.0. Immediate procedural complication rate was 2.4% (access site n=16; tamponade n=2; esophageal injury n=2). 6-week post-procedural complication rate was 4.2% whereas 6-month post-procedural complication rate was 2.0% (% per 100 patient-months). Overall post-procedural complication rate after 6.2 ± 1.1 months was 2.6% of which 0.3% were thromboembolic, 1.2% were hemorrhagic and 1.1% were mortality events (% per 100 patient-months). Gastrointestinal bleeding (GIB) made up 39% and 83% of post-procedural and hemorrhagic complications respectively. Time-indexed post-procedural GIB rate was higher during 6-week period compared to 6-month period (1.9% vs. 0.7%, p=0.00003). Patients with most common indication for LAAO (high risk for bleeding or history of major bleeding, 82.0%) had higher odds of post-procedural GIB than those without bleeding indication (7.0% vs. 2.6%, OR=2.8, p=0.02). GIB was not significantly associated with mortality.

Conclusions:
Post-LAAO complication rate was low and decreased over time when comparing 6-week and 6-month periods in a high-risk patient population. Early GIB was the most common hemorrhagic complication and patients with bleeding indication for LAAO had a higher risk of GIB within the first 6 months after procedure. Further studies targeting ideal antithrombotic regimen after Watchman implantation are needed.
Abstract 12977: Combined Coronary Stenting and Cutting Balloon Angioplasty in the Management of a Postpartum Spontaneous Coronary Artery Dissection
Authors: Somerville Alexander , Weinberg Andrew
Published: June 2023

Introduction:
Spontaneous coronary artery dissection (SCAD), whilst documented in the peripartum period, has limited data in regard to management with cardiac intervention. SCAD is typically managed conservatively; however, in cases of hemodynamic instability and persistent ischemia, cardiac intervention with percutaneous coronary intervention (PCI) or coronary artery bypass grafting can be considered.

Case:
We present the case of a 34-year-old G2P2 female, without significant past medical history, who initially presented with severe substernal chest pain, five days following a spontaneous vaginal delivery. Initial electrocardiogram revealed sinus bradycardia without ischemic changes. Troponin I was elevated to 0.22 and 0.24. Heparin infusion, Aspirin loading, and Metoprolol were initiated. Coronary catheterization was performed and revealed dissection of a large left circumflex artery dissecting distally into the first obtuse marginal (OM1). A drug eluting stent (DES) was placed to the OM1. However, this worsened the dissection hematoma, propagating distally to the second obtuse marginal (OM2), also treated with a DES. Cutting balloon angioplasty was performed on the proximal circumflex to fenestrate the dissection flap and prevent proximal propagation of the dissection. A third DES was placed to the proximal circumflex artery. The patient continued dual anti-platelet therapy (DAPT) for one year, without complication.

Conclusions:
SCAD, in a young postpartum female, is a rare and potentially catastrophic condition. We present a case of SCAD, managed with PCI. This case demonstrates both the risk of dissection propagation with coronary stenting, as well as potential risk mitigation with cutting balloon angioplasty.

Figure 1. Coronary Catheterization with PCI. A
, SCAD of Lateral Circumflex to OM1.
B
, Post-DES to OM1 with dissection propagation to OM2
. C
, Post-DES to OM2.
D
, Post-Balloon angioplasty and DES to proximal lateral circumflex
Abstract 13029: Acute Myocardial Infarction - Mortality Trends in the United States
Authors: Tayyeb Muhammad , Mughal Mohsin S , Mirza Hasan , Asif Muhammad , Fatima Seemab , Ghani Ali , Waqar Fahad , Mughal Waqar A , wasty najam
Published: June 2023

Introduction:
Acute Myocardial Infarction (AMI) contributes to a significant cardiovascular related deaths in the general population. AMI is a life-threatening condition that occurs when the blood supply to the myocardium is abruptly cut-off due to blockage in coronary arteries resulting in tissue infarction. AMI is associated with high morbidity and mortality (up to 34-42%). We hypothesized that with recent advancements in reperfusion therapy and techniques for treating arrhythmias and pump failure, the mortality rates might show downward trends.

Methods:
In this retrospective observational study, death certificate data was retrieved from the Center for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiological Research (WONDER) database from 2001 to 2020. WONDER database identifies the underlying cause of death. Mortality for AMI including anterior, posterior, inferior wall, or unspecified (ICD-10 121.0; 121.1; 121.2; 121.3; 121.4; 121.9) as an underlying cause of death was queried from 2001 to 2020. This study duration was further divided into five-year periods. Crude mortality rate and age-adjusted mortality rate per 100,000 deaths (with a 95% confidence interval) were calculated for four U.S. census regions to explore regional variations (CR-1 Northeast; CR-2 Midwest; CR-3 South; CR-4 West).

Results:
The overall age-adjusted mortality rate (AAMR) decreased from 58.0 to 27.1 per 100,000 deaths (53.5%) in the years 2001-2005 to 2016-2020 as illustrated in the figure 1. AAMR showed a comparable downward trend in all 4 U.S. census regions (Figure 1).

Conclusions:
From 2001 to 2020 AAMR showed a downward trend which may indicate an improvement in AMI patient care with evolving guidelines based therapeutic interventions. Limitations of this study include intrinsic weakness of the WONDER dataset (Changes with ICD-9 to ICD 10 codes, and potential miscoding) which may need further discovery.
Abstract 13066: Mortality Differences Between Urban and Rural Hospital Admissions for Left Atrial Appendage Occlusion
Authors: Thotamgari Sahith Reddy , Babbili Akhilesh , Seslar Stephen P , Desimone Christopher V , Deshmukh Abhishek
Published: June 2023

Introduction:
There is a variation in cardiovascular outcomes between rural and urban hospitals such as higher mortality for AF. Whether such a relationship exists for safety and outcomes of left atrial appendage occlusion (LAAO) device implantation is unknown.

Hypothesis:
We hypothesized that LAAO procedure in rural hospitals is associated with worse in-hospital outcomes.

Methods:
A cross-sectional examination of patients who were hospitalized for LAAO procedure was performed in the National Inpatient Sample between 2016 and 2019 to compare in-hospital outcomes in patients admitted to urban vs rural hospitals. ICD 10 PCS code 02L73DK was used to identify hospitalizations with LAAO procedure. The cohort was further stratified into rural and urban hospitals. Chi-square test and multivariate logistic regression were used to analyze the association and statistical analyses were performed using weighted values.

Results:
A total of 61,390 hospitalizations for LAAO procedures were identified during the study period. From these, 1185 (1.93%) hospitalizations occurred in rural hospitals. Baseline characteristics and inpatient outcomes are shown in Table 1. LAAO in rural hospitalizations was associated with significantly higher in-hospital mortality [OR 2.94 (1.17-7.14), p<0.001*]. This associated persisted even after adjusting for significant baseline characteristics [aOR 3.55 (1.42-8.84), p=0.006*).

Conclusions:
In-hospital mortality was significantly higher in patients undergoing LAAO in rural hospital. Further studies are needed to validate these findings in a prospective manner.
Abstract 13069: Left Atrial Mechanics in Patients With Hypertrophic Cardiomyopathy
Authors: Dalos Daniel , Mann Christopher , Dachs Theresa - Marie M , Srdits Marc , Binder Christina , Kronberger Christina , Duca Franz , Huelsmann Martin , Hengstenberg Christian , Kastner Johannes , Lang Irene M , Zelniker Thomas A
Published: June 2023

Background:
Patients with hypertrophic cardiomyopathy (HCM) frequently have diastolic dysfunction (DD) characterized by elevated filling pressures. Speckle-tracking analysis of the left atrium (LA) is an imaging tool for quantifying DD, however, its value in HCM is not well established.

Methods.
Transthoracic echocardiographic images of consecutive HCM patients with a septal thickness ≥15 mm and no aberrant loading conditions at an academic tertiary care center were evaluated. Peak atrial longitudinal strain (PALS) was determined by averaging the atrial strain over all segments in the 4- and 2-chamber views (
Figure
).

Results.
Among 205 HCM patients, 108 patients (52 years, 40% female) had sinus rhythm and sufficient image quality to be included. The median interventricular wall thickness was 20 mm (IQR 17-23), the relative wall thickness ratio was 0.65 mm (IQR 0.46-0.87), and the LV mass index was 164.0 g/m
2
(IQR 131.5-188.5). The mean PALS was 18.5% (± 8.8%) and did not differ between men and women. PALS significantly (all p <0.05) correlated with septal thickness (r=-0.31), LA volume index (r=-0.60), E/A ratio (r=-0.25), E/E’ (r=-0.63), systolic pulmonary pressure (r=-0.31), and high sensitivity troponin-T levels (r=-0.43). Moreover, PALS correlated with resting gradients in patients with relevant LV outflow tract obstruction (n=53 [49%]; r=-0.29). Among patients who underwent cardiac magnetic resonance imaging (81%), PALS was significantly correlated with LA ejection fraction (r=0.59) and late gadolinium enhancement of the total LV mass (r=-0.42). In addition, PALS was the only echocardiographic parameter reflecting DD that was significantly associated with the presence of LGE (Odds Ratio 0.93, 95%CI 0.88-0.99).

Conclusion.
PALS is a useful tool for quantifying DD in HCM patients and is associated with the presence of LGE. Future research will need to evaluate its significance in early identification of HCM patients at risk of sudden cardiac death.