bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 17973: Higher N-Terminal Pro-b-Type Natriuretic Peptide in Heart Failure With Rheumatoid Arthritis is Associated With Worse Short-Term Outcomes
Authors: Mirzai Saeid , Abdulhai Farah , Littlejohn Emily , Menon Venu , Tang Wai Hong W , wassif heba
Published: December 2023

Background:
The chronic inflammation of rheumatoid arthritis (RA) is known to cause a higher incidence of heart failure (HF); however, studies on the outcomes of patients with RA and HF are limited.

Research Questions:
We compared outcomes between matched patients with HF with versus without RA with a specific look at NT-proBNP as a prognostic marker.

Methods:
We conducted a retrospective study of adult patients with HF with RA (n=186) one-to-two propensity score matched to patients with HF without RA (n=135,233) from our tertiary care center from January 2001 to December 2022. RA and HF were defined by International Classification of Diseases (ICD) codes; HF was limited to ICD codes reported within the Heart, Vascular, and Thoracic Institute. Patients were matched using demographics (age, sex, and race) and comorbidities (hypertension, hyperlipidemia, diabetes, smoking, CAD, atrial fibrillation, CKD, COPD, cirrhosis, and cancer).

Results:
A total of 558 patients with HF were included, 186 with RA and 372 without RA. The sample’s mean age at HF diagnosis was 69±13 years, 69.2% were female, and 62.9% had HFpEF. Patients in the two groups did not differ by NT-proBNP or LVEF. During a maximum 1-year follow-up after HF diagnosis, the two groups did not differ in combined 1-year mortality/hospitalization. When each group was split by median NT-proBNP, patients in the higher NT-proBNP groups had less HFpEF and worse combined 1-year mortality/hospitalization (Figure 1; HR 2.44, 95%CI 1.39-4.27, p=0.002 in those with RA and HR 1.50, 95%CI 1.06-2.13, p=0.023 in those without RA). The outcomes did not differ when comparing patients with versus without RA with high NT-proBNP.

Conclusions:
Short-term outcomes did not differ amongst patients with HF with versus without RA once matched for demographics and comorbidities. Furthermore, NT-proBNP was a prognostic marker for worse short-term outcomes in patients with RA and HF.
Abstract 17975: Improvement in Exercise Capacity After Surgical Septal Myectomy in Obstructive Hypertrophic Cardiomyopathy Patients is Related to Peak Exercise Strain Rate and Mechanical Reserve
Authors: Vera Sarmiento Hernan L , Liu Hongyun , Carreno Martinez Angie , Pozios Iraklis , Haileselassie Bereketeab , Lu Daiyin , Ventoulis Ioannis , Sorensen Lars , Phillip Susan , Abraham M Roselle , Abraham Theodore
Published: December 2023

Background:
Significant improvements in functional capacity are noted after septal myectomy in symptomatic patients with obstructive hypertrophic cardiomyopathy (oHCM). However, the underlying mechanism behind these improvements is unclear.

Methods:
Conventional and strain echocardiography, at rest and post-exercise, was performed pre-and post-septal myectomy in 59 OHCM patients (42 men; mean age 50±12years). Exercise capacity was expressed as metabolic equivalents (METs) after treadmill exercise testing. Global longitudinal peak systolic strain (S) and stain rate (SR) were measured at rest and peak-exercise.

Results:
After myectomy, outflow gradient decreased significantly (resting gradient: 69±43 to 13±8mmHg; provoked gradient: 141±50 to 40±21mmHg; both p<0.001) with no significant change in ejection fraction (66±5% to 65±4%, p=NS). METs improved significantly (9.5±3.2 to 10.6±2.9, p=0.001). There was no significant change in S and SR at rest (S: -15.17±2.89% to -15.27±2.75%; SR:-0.95±0.18S-1 to -0.92±0.15S-1, both p=NS) or post-exercise (S: -17.06±3.63% to -16.68±2.79%; SR: -1.45±0.30S-1 to -1.52±0.28S-1, both p=NS). Mechanical reserve (MRES, change in systolic SR with exercise) increased significantly (55±30% to 67±32%, p=0.02). METs correlated significantly with exercise SR and MRES determined pre-myectomy (exercise SR: r=-0.41, p=0.003; MRES: r=0.33, p=0.017) and post-myectomy (exercise SR: r=-0.53, p<0.001; MRES: r=0.51, p<0.001). Improvement in METs was significantly correlated with changes in MRES (r=0.36, p=0.019). Multivariable linear regression confirmed an independent correlation between exercise SR and MRES with METs.

Conclusions:
Resting and peak exercise myocardial contractility (longitudinal S and SR) do not change significantly after septal myectomy. Post-myectomy MRES improves significantly and exercise capacity post-myectomy correlates significantly with pre- and post-myectomy functional status.
Abstract 18005: Underrepresentation of Women in Clinical Trials of Heart Failure With Reduced Ejection Fraction
Authors: Ekpo Eson J , Balla Sujana , Ngo Summer , Witting Celeste , Sarraju Ashish , Rodriguez Fatima
Published: December 2023

Background:
There are established sex-specific differences in heart failure with reduced ejection fraction (HFrEF) outcomes. Randomized clinical trials (RCTs) based on cardiovascular outcome benefits, typically either reduced cardiovascular mortality or hospitalization for heart failure (HHF), and influence current guidelines for therapy.
Objectives:
To evaluate the representation of women in HFrEF RCTs that observed reduced all-cause or cardiovascular mortality or HHF.

Methods:
We queried Excerpta Medica dataBASE, Medical Literature Analysis and Retrieval System Online, Cumulative Index to Nursing and Allied Health Literature, and PubMed for HFrEF RCTs that reported a statistically significant benefit of intervention resulting in improved mortality or HHF published from 1980 to 2021. We estimated representation using the participation-to-prevalence ratio (PPR). PPR was calculated based on the proportion of women with HFrEF in the Framingham cohort (40%). A PPR of 0.8 to 1.2 was considered representative.

Results:
The final analysis included 33 RCTs. All trials except two were mentioned in the 2022 American College of Cardiology/American Heart Association/Heart Failure Society of America Guidelines for the Management of Heart Failure. Women represented 23.2% of enrolled participants (n = 24,363/ 104,972), ranging from 11.4% to 40.1% per-trial. Overall PPR was 0.58, with per-trial estimates ranging from 0.29 - 1.00. Five trials (15.2%) had a PPR of women representative of the disease population. Representation didn’t change significantly by the decade examined. The proportion of women in North American and Multiregional trials was significantly greater than in trials conducted in Europe (p = 0.04). The proportion of women was greater in industry trials compared to government-funded trials (p = 0.05).

Conclusions:
Women are underrepresented in HFrEF RCTs that have demonstrated mortality or HHF benefits, which may affect the sex-specific generalizability of major trial results. Sustained efforts are warranted to ensure equitable and appropriate inclusion of women in HFrEF trials.
Abstract 18010: Trends in CardioMEMS Use Among Patients With Heart Failure in the US
Authors: Sinnenberg Lauren , Yang Lin , Kobayashi Taisei , Tanna Monique , Nathan Ashwin S , Khatana Sameed A , Groeneveld Peter W , Eberly Lauren A
Published: December 2023

Introduction:
The implantable pulmonary artery pressure (PAP) monitor, CardioMEMS, has been shown to reduce heart failure (HF) hospitalizations and improve quality of life among patients with symptomatic heart failure. However, uptake of the CardioMEMS device has been limited, and its utilization across sociodemographic groups has not been studied.

Methods:
This was a retrospective study of commercially insured patients in the US from October 1, 2015 to October 1, 2020, using the Optum Clinformatics Data Mart. Adult patients (age > 18) with heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF) were included in the analysis. Multivariable logistic regression models were used to assess the factors associated with CardioMEMS placement.

Results:
There were 501,755 HFpEF and HFrEF patients who met inclusion criteria. Of these, 1,042 (0.002%) had CardioMEMs devices implanted. Rate of CardioMEMS implantation has increased over the last 6 years (0.04% in 2015 vs. 0.35% in 2021) but remains low, particularly among Asian and Hispanic patients (Figure 1). In a multivariable analysis, compared to patients who did not have a CardioMEMS device, those who did were more likely to have a higher income (>$100,000) (Adjusted odds ratio (AOR) 1.39, 1.16-1.67, p<0.001). Patients in the Southern United States (AOR 0.52, CI 0.43-0.62, p<0.0001) and older patients (AOR: 0.96, CI 0.95-0.96, p <0.001) were less likely to have a CardioMEMS device implanted. Patients with CardioMEMS were more likely to have chronic kidney disease, obesity, and valvular pathology (p <0.0001). No gender differences were seen in CardioMEMS utilization.

Conclusions:
Overall utilization of the CardioMEMS device is low, but rising. CardioMEMS utilization is not distributed equally across demographic groups—younger patients and those with higher incomes were more likely to have the device implanted.
Abstract 18022: Multiplexed Generation and Functional Annotation of Hypertrophic Cardiomyopathy-Associated
MYH7
Missense Variants in Isogenic Gene-Edited Stem Cell-Derived Cardiomyocytes
Authors: Friedman Clayton E , Fayer Shawn , Pendyala Sriram , Chien Wei-Ming , Loiben Alexander , Tran Linda , Chao Leslie S , Mckinstry Ashley , Ahmed Dania , Karbassi Elaheh , Fenix Aidan M , Murry Charles E , Starita Lea M , Fowler Douglas M , Yang Kai-chun
Published: December 2023

Hypertrophic cardiomyopathy (HCM) is an inheritable cardiac condition affecting 1:200-500 people and is characterized by left ventricular hypertrophy that can cause heart failure. Autosomal-dominant, missense mutations in
MYH7
(encoding MHC-β) cause 33% of genotype
+
HCM cases. Despite this, 75% of
MYH7
missense variants are of unknown clinical significance (VUS). Human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) can elucidate the effect(s) of VUS, however, new variant identification by genetic testing outpaces methods to gene edit hiPSCs. Thus, we developed a method called
CR
ISPR
a
On-
T
arget
E
diting
R
etrieval (CRaTER) which increased successful gene-editing 25-fold over current methods. We leveraged CRaTER to enrich for edited hiPSCs, generating a library of 113
MYH7
missense variants. As mutations can reduce protein stability and abundance, we flow sorted
MYH7
variant hiPSC-CMs into bins based on differing MHC-β protein abundance followed by next generation sequencing to calculate variant abundance scores. This multiplexed assay identified 31 residue substitutions as functionally abnormal, including all tested pathogenic variants and VUS. MHC-β depletion was validated in clonal hiPSC-CMs and by Western blotting of patient myocardium with a
MYH7
mutation. Additionally, we found that severe MHC-β depletion is associated with increased cell size, a hallmark pathological phenotype of HCM. Finally, single-cell contractility analyses of hiPSC-CMs with a pathogenic
MYH7
variant revealed hyperdynamic physiology relative to isogenic controls, suggesting an association between MHC-β loss and systolic dysfunction. Together, CRaTER enables the generation of isogenic hiPSC variant libraries at unprecedented scale for differentiation to disease-relevant cell types. Functional analyses of
MYH7
variant hiPSC-CMs have revealed a novel correlation between MHC-β protein depletion and pathogenicity that accurately predicts
MYH7
variant effect and has implications for future
MYH7
variant effect interpretations.
Abstract 18027: Contribution of Sex and Age Differences to Life's Simple 7 Metrics in Cardiac Rehabilitation
Authors: Chacin-Suarez Audry , Abraham Helayna , Olson Thomas P , Brewer LaPrincess C
Published: December 2023

Background:
Life's Simple 7 (LS7) have been identified as key health factors aimed at achieving ideal cardiovascular health (CVH) and improving healthy life expectancy; however, it is unclear if different patient populations respond similarly to optimization of health behaviors. We sought to quantify the contribution of sex and age differences to changes in LS7 components in patients participating in cardiac rehabilitation.

Methods:
We included 937 adult patients who participated in CR from January 2018 to September 2020. LS7 metrics at baseline (pre-CR) and completion of CR (post-CR) were collected and changes in LS7 components (body mass index (BMI), diet, smoking, physical activity (PA), blood pressure (PB), cholesterol, glucose) were assessed by sex and age groups (<65 vs ≥65 years old). Each LS7 component was assigned 0 (poor), 1 (intermediate), or 2 (ideal) points and a final score was computed to estimate an individual’s level of CVH (0-14 pts): 0-6 = poor, 7-8= intermediate, 9 -14= ideal.

Results:
The mean age was 64±13 years, and 34% were female. Patients attended a mean of 11.1±12.5 CR sessions. LS7 components with the highest proportion within the poor category were HbA1c (41%) and BMI (50%) at the time of CR enrollment; neither women nor men showed improvement on either component. The trend towards improvement from poor to intermediate range on cholesterol and BP metrics was seen only in older patients (Table 1). Mean LS7 score improvement was greater in the older group, P=.01 (Fig 1). Both women and men equally improved LS7 scores (Table 2, Fig 2).

Conclusions:
Patients participating in CR demonstrated improvement in overall LS7 scores regardless of sex and age. However, age disparities exist in LS7 metrics, with exacerbated differences noted by a lack of improvement in LS7 components such as BP and cholesterol in younger patients. Our insights provide opportunities to explore equitable CVH.
Abstract 18062: Association of Leisure Time Physical Activity With Incidence of Heart Failure With Preserved and Reduced Ejection Fraction in the Million Veteran Program
Authors: Sheikh Shamlan , Farah Michel , Dey Andrew , Joseph Jacob , Gaziano John M , Djousse Luc
Published: December 2023

Introduction:
Heart failure (HF) continues to be the leading cause of hospitalization in older men in the United States. While previous studies have reported beneficial effects of leisure time physical activity (LTPA) on cardiovascular disease, it is unclear whether LTPA is associated with incidence of HF with reduced or preserved ejection fraction (EF). The current study examined the association of LTPA with incidence of HF in US Veterans in the Million Veteran program.

Methods:
The MVP is a nationally representative, prospective cohort study of Veterans which started in 2011 and has currently enrolled over 900,000 participants. Self-reported vigorous, moderate, and light activity was collected at baseline and converted into hours of metabolic equivalent of task per week (MET-h/week). HF was ascertained using ICD-9 code of 428.x or ICD-10 code of I50.x. We defined incident HFpEF using ejection fraction ≥ 50% and HFrEF using ejection fraction ≤ 40%. Cox proportional hazard model was used to compute multivariable adjusted hazard ratio (HR) and 95% confidence intervals (95%).

Results:
Among 461,267 Veterans analyzed, the mean age was 63.9 years (SD 12.7) and 95% were men. Participants were followed for 5 years, with 25,192 new cases of HF (12,226 HFrEF and 10,422 HFpEF) occurred. In a multivariable adjusted model, LPTA was inversely associated with incident HF with HR (95% CI) of 1.00 (ref), 0.82 (0.79-0.86); 0.67 (0.63-0.71); 0.65 (0.62-0.69); and 0.50 (0.48-0.53), from the lowest to the highest quintile of LTPA, respectively, p for linear trend <0.00001. Similar inverse associations were observed for HFpEF as well as HFrEF (p<0.0001 each).

Conclusion:
Our data are consistent with inverse association of LTPA with incidence of HF including HFpEF and HFrEF.
Abstract 18080: Pediatric Sex Detection Through AI-Enabled ECG Analysis: Evaluating Accuracy and the Influence of Pubertal Development
Authors: O'Sullivan Donnchadh , Anjewierden Scott , Greason Grace , Attia Zachi , Lopez-Jimenez Francisco , Friedman Paul , Noseworthy Peter A , Anderson Jason , Kashou Anthony H , Eidem Benjamin W , Johnson Jonathan N , Niaz Talha , Madhavan Malini
Published: December 2023

Introduction:
Biologic sex and hormonal concentrations shape ECG parameters due to sex hormone effects on cardiac function. AI-enabled ECGs have previously been shown to accurately predict patient sex in adults and correlate with sex hormone levels.

Aims:
We aimed to test the ability of AI-enabled ECGs to predict pediatric patient sex and explore the influence of pubertal development.

Methods:
Two AI-enabled ECG models were created using a convolutional neural network trained on pediatric 10-second, 12-lead surface ECGs. The first model was trained de novo using pediatric data. The second model used transfer learning from a previously validated adult data-derived algorithm. We analyzed the first ECG from 89,063 pediatric patients (aged <19 years) recorded from 1988-2022, and divided the cohort into training, validation, and testing datasets. Subgroup analysis was performed on prepubertal (0-7 years), pubertal (8-14 years), and post-pubertal (15-18 years) patients.

Results:
The cohort consisted of 46.6% males, with 21,434 prepubertal, 26,300 pubertal, and 41,329 post-pubertal children. No significant performance difference was observed between the two models. Both models demonstrated 81% accuracy and an overall AUC of 0.91 in the testing cohorts, with high discriminatory ability in post-pubertal teenagers (AUC = 0.98).
(Figure 1)

Conclusions:
AI-ECG predicts pediatric patient sex with varying performance across pubertal stages. The highest discriminatory ability is observed post-puberty, decreasing in pubertal and prepubertal children. The results suggest hormonal and physiological changes during puberty may influence cardiac electrophysiology measurably. More research is required to interpret CNN-predicted sex discordance with actual sex and its implications for future cardiovascular risk.
Abstract 18112: LVAD Recipient and Caregiver Perspective on Prognosis and End of Life Care: A Qualitative Study
Authors: Mignery Matthew , Malik Aroosa , Shore Supriya
Published: December 2023

Background:
For left ventricular assist device (LVAD) recipients and caregivers, accurate understanding of prognosis is central to shared decision making. Our study evaluates (i) patient and caregiver estimated survival after a LVAD and (ii) describes how patients and caregivers rationalize estimated survival.

Methods:
We conducted a qualitative study with 18 LVAD recipients and 9 caregivers using semi-structured interviews. Interviews were transcribed and coded, with themes identified using rapid qualitative analysis.

Results:
Included patients had a median (range) age of 60.5 (28-83) years, 12 (67%) were men and 10 (56%) received their LVAD as destination therapy (DT). Participating caregivers included 8 (89%) women supporting 5 (56%) DT LVAD recipients. Depression was reported by 7 (39%) patients and 2 (22%) caregivers. Reported quality of life was low for most participants [median EQ-VAS score 60 (range 25-70) for patients and 50 (range 20-80) for caregivers]. Only 6 patients reported willingness to trade survival in favor of better quality of life. In the event of cardiac arrest, 15 (83%) patients and 7 (78%) caregivers reported wanting CPR for themselves or loved one. Although most participants reported health concerns primarily relating to their cardiac health and LVAD complications, both patients and caregivers provided high estimates of life expectancy [median 16 (range 3-45) and 14 (range 3-32) years respectively]. We identified three themes explaining how LVAD recipients and caregivers rationalize their estimated survival (i) survivor’s bias (ii) optimism (iii) minimization. Exemplary quotes are provided in the Table below.

Conclusions:
Several patients and caregivers reported low quality of life with concerns around poor cardiovascular health and LVAD complications. However, their estimated survival frequently exceeded clinically observed survival. This suggests an opportunity for improving patient-physician prognosis communication.
Abstract 18115: A Multidisciplinary Approach to Critical Cardiac Illness Survivorship: Cardiac Intensive Care Unit Recovery Clinic
Authors: Hoffman Alexander , Smith Gustav J , Thornton Brianne , Hillerson Dustin
Published: December 2023

Introduction:
Cardiac intensive care unit (CICU) survivors have a high burden of morbidity and debility. Patients discharged from the CICU with a diagnosis of cardiogenic or septic shock, coma after cardiac arrest, or receive mechanical ventilation or mechanical circulatory support are referred by the CICU team to the Cardiac Intensive Care Unit Recovery Clinic (CICURC), a multidisciplinary clinic aimed at identifying barriers to return to function and optimizing medical and rehabilitation therapies.

Aims:
To define the cardiac profile and symptom burden of CICURC patients and compare outcomes to those referred but never attended.

Methods:
The medical records of sequential patients referred to the CICURC at our institution were retrospectively reviewed for clinical and outcome variables. Surveys were used to assess for cognitive, physical, or mental health impairment, findings of post-intensive care syndrome (PICS). Chi-squared test was performed to compare outcomes between groups.

Results:
From CICURC opening July 1, 2022, through May 27, 2023, 27 patients were referred, of whom 15 (56%) were seen in CICURC. The median age of patients seen in clinic was 61 years (IQR 47-74), 14 (93%) were male, 11 (73%) had an out-of-hospital cardiac arrest, 9 (60%) recovered from cardiogenic shock, of whom 5 (33%) were on mechanical circulatory support, and 12 received mechanical ventilation (80%). The median EF was 40% (IQR 25-50). From surveys, 5 patients screened positive for PICS (33%) and 6 were at risk for malnutrition (43%). Compared to those who did not attend clinic, only 1 (7%) CICURC attendee was readmitted within 30 days (vs. 3 [25%], p=0.18) and later died (vs. 4 [40%], p=0.04).

Conclusions:
CICU survivors have a high burden of disability after discharge. Multidisciplinary clinics focused on CICU recovery may reduce 30-day readmissions and mortality. Further research is needed on diagnosing PICS and therapies for recovery from critical cardiac illness.
Abstract 18133: Inducible, Endothelial Cell-Specific Knockout of
Heg1
Exacerbates Atherosclerosis Development in Mice
Authors: Tamargo Ian , Baek Kyung In , Kang Dong-Won , Kim Yerin , Tsuji Shoutaro , Jo Hanjoong
Published: December 2023

Introduction:
Stable blood flow patterns in straight, non-branching regions of the vasculature protect against atherosclerosis by inducing expression of atheroprotective proteins in endothelial cells. Heart of glass homolog 1 (HEG1), a recently-identified, stable flow-induced endothelial protein, is a single-pass transmembrane glycoprotein that has been shown to be essential for vascular development and integrity.

Hypothesis:
Due to its demonstrated importance in vascular biology, and its induction by stable flow, HEG1 was hypothesized to mediate atheroprotective endothelial responses to stable flow and protect against atherosclerotic plaque formation.

Methods:
To test the effect of HEG1 expression on atherosclerosis development, inducible endothelial cell-specific HEG1 knockout mice (HEG1
iECKO
) were generated, and exposed to hypercholesterolemia- and flow-induced models of atherosclerosis. Atherosclerotic plaque development, as well as vascular functional and mechanistic responses were compared between HEG1
iECKO
and littermate control mice.

Results:
HEG1 expression was found to be necessary for endothelial Krüppel-like factor 2 and 4 (KLF2/4) expression, two critical transcription factors that control the majority of flow-sensitive endothelial gene transcription. HEG1
iECKO
mice were found to have more extensive and advanced atherosclerotic plaques as compared to littermate controls.

Conclusions:
Together, these data indicate that HEG1 is an atheroprotective protein that mediates beneficial effects of stable flow on vascular endothelial cells, likely via control of KLF2/4 expression, and that HEG1 may be a promising new drug target for the treatment of atherosclerosis.
Abstract 18147: Diagnosing Brugada Syndrome in Absence of Electrocardiographic Pattern: Predictive Modeling of Activation Delay in the Right Ventricular Outflow Tract
Authors: Monaco Cinzia , Della Rocca Domenico , Pannone Luigi , Del Monte Alvise , de Asmundis Carlo
Published: December 2023

Introduction:
Diagnosing Brugada Syndrome(BrS)involves detecting the type1 ECG pattern, spontaneously or drug-induced, which can be challenging(concomitant diseases, ECG phenocopies, unavailability of pharmacological agents, hypersensitivity). Intrinsic cellular changes that cause ECG abnormalities are mainly located in the right ventricular outflow tract(RVOT).

Hypothesis:
Comparing the activation time(AT)delay between the RVOT and the anterior right ventricle(RVa)in subjects with BrS(with concealed or manifested pattern 1) vs normal controls may provide a cut-off value for a new diagnostic method.

Methods:
Seventy-five participants(mean age 46±24 y; 45 men), 57 BrS, 10 healthy controls, and 8 RBBB patients, underwent ECGI and ECG recordings. Concealed BrS patients underwent an ajmaline infusion to be studied both in the absence and presence of pattern1. Ventricular epicardium has been divided into 8regions and the mean activation time(ATM)has been calculated for each region. The ATMs were normalized to QRS length (ATM%) and compared across populations.

Results:
Analysis of ATMs% in RVa did not show differences between groups. Instead, analysis of ATM and ATM% in RVOT, showed significant differences between controls and BrS both with concealed or manifested ECG pattern1 (37.2±6.23vs68.33±14.73 ms, p<0.001; 37.2±6.23vs107.6±21.16 ms, p<0.001). By setting the true negative (controls) and true positive (BrS) populations, the diagnostic performance tests were done: a 45% increase in RVa ATM was the best predictor of delayed RVOT activation in BrS (AUC=0.97,Accuracy=0.92,F-score=0.95). In patients with RBBB the increase between RVa and RVOT remained below the cut-off of 45%

Conclusions:
In BrS, patients exhibit a pathological delay in the AT of the RVOT, considered significant if it exceeds 45% of the ATM in the RVa. It could be used as alternative diagnostic method when the conventional approach is inconclusive or the ECG pattern is not manifested.
Abstract 18175: LncRNA in Monocytes of Patients With Type 2 Diabetes and Established Cardiovascular Disease Modulate the Expression of Protein-Coding Genes
Authors: Halabi Najeeb , Thomas Binitha , Al Suwaidi Jassim , Amin Jayyousi , Bradic Martina , Abi Khalil Charbel
Published: December 2023

Introduction:
Monocytes contribute to cardiovascular complications of type 2 diabetes (T2D) through various mechanisms.

Objectives:
We investigated diabetes-induced changes in long non-coding RNAs (lncRNA) from monocytes of patients with T2D and established cardiovascular disease.

Methods:
We performed polyA capture and paired-end RNA sequencing of monocytes from 120 patients with T2D and 37 non-diabetes controls. Monocytes were sorted using FACSAria2 flow cytometer. Alignments and gene counts were done with STAR to reference GRCh38 using Gencode (v41) gene annotations. The batch correction was done with CombatSeq and differential expression analysis with EdgeR. The false discovery was controlled with the Benjamini-Hochberg procedure. Pathway analysis was done with the IPA software using differentially expressed genes (DEGs) with a p-value < 0.05. Co-expression analysis was done with cdsR and Cytoscape.

Results:
We found two significantly upregulated lncRNAs in monocytes from diabetes patients (ENSG00000287255 and ENSG00000289424, FDR = 0.035). Pathway analysis on DEGs revealed a network affecting cellular movement, growth, and development that includes directly interacting plasma membrane genes ITGB4 and CDH1, nuclear genes HIF1a, ZEB1, ETS1, TWIST1, SNAI2, NFKB complex, and lncRNA genes SNHG29 and FBXL19-AS1 (p < 1*10^
-25
). Analysis within T2D patients revealed one lncRNA upregulated only in monocytes from patients with microvascular disease (ENSG00000261654 on chr1, FDR =0.022). Interestingly, co-expression analysis uncovered correlated expression clusters between lncRNAs and protein-coding genes, with one interesting interaction identified between the highly connected MCR1 and SNHG7, a lncRNA shown to respond to IGF-1 (insulin-like growth factor 1)
.

Conclusion:
Monocytes from patients with diabetes have differentially expressed lncRNA genes that potentially impact diabetes-related pathways.
Abstract 18187: Scoring System to Predict Reduced Left Atrial Appendage Emptying Velocity
Authors: Enders Robert , Uhlich Cody , Baghdadi Sarah , Smith Ross , Tabak Carine , Bajaj Matthew , Parikh Riya , Morgan Ethan , Baer Jacob , Jiwani Sania , Harvey Christopher , Noheria Amit
Published: December 2023

Introduction:
Left atrial appendage emptying velocity (LAAev) as assessed on transesophageal echocardiography (TEE) is a surrogate for propensity for LAA thrombus and cardioembolic stroke. Identifying patients with decreased LAAev is important for risk stratification. CHA
2
DS
2
-VASc score is used to stratify stroke risk in atrial fibrillation (AF) but does not incorporate rhythm, type of atrial fibrillation or transthoracic echocardiography (TTE).

Objective:
To create a composite scoring system using clinical and TTE variables to predict reduced LAAev.

Methods:
We searched TEE reports of unique patients from 2016-2022 at the University of Kansas Medical Center. Additional information was extracted from review of TEE imaging, TTE reports and detailed medical chart review. Significant univariate predictors of reduced LAAev (<30 cm/s) were added to a stepwise selection multivariable logistic regression model with significance level for entry and stay 0.15. Based on their respective odds ratios, selected variables were assigned different point values to create a risk score.

Results:
We included 995 patients (women 38.1% men, age 71.3±12.7 yrs, white 89.3%, LAAev 41.6±21.0 cm/s). The derived score includes different points assigned for long-standing persistent/permanent AF, persistent AF, paroxysmal AF, current rhythm AF, coronary artery disease, congestive heart failure, female sex, age ≥70 yrs and negative points for >moderate mitral regurgitation; categorized into high, intermediate and low risk (see Figure). The rate of reduced LAAev <30 cm/s was respectively 55.7%, 35.2% and 9.0%.

Conclusions:
Our scoring system was able to stratify risk of reduced LAAev and needs to be validated in independent datasets.
Abstract 18204: Application of Machine Learning in Predicting All-Cause Mortality in Patients With Left Ventricular Assist Device
Authors: Truong Vien T , Nguyen Binh , Wang Alex Xing X , Dai Phan , Patel Vivek , Ahmad Mansoor , Siddique Muhammad Saad , Usama Syed Muhammad , Mondal Avilash , Quach Kevin , Agrawal Durgesh , Shah Syed Fahad , Skenderi Sonela , Metkus Thomas , Dhar Sunil , Chung Eugene
Published: December 2023

Introduction:
Machine learning has been demonstrated to significantly enhance the accuracy of cardiovascular risk prediction across various cardiac diseases.

Hypothesis:
This study sought to develop a machine learning (ML) framework to predict all-cause mortality in patients with left ventricular assist device (LVAD).

Methods:
All patients in INTERMACS registry who received an LVAD from June 2006 to December 2017 were screened. The Light Gradient Boosting Machine (LightGBM) algorithm was used to train an ML model for predicting all-cause mortality. Nested ten-fold cross-validation was performed to optimize the model and estimate its performance on unseen data. Model performance was assessed using the receiver operating characteristics (ROC) curves.

Results:
The final study group consisted of 22,137 patients, with a mean age of 56±13 years, and 21.3% being female. After a median follow-up of 12.4 months (IQR, 4.7 - 27.1 months). The overall all-cause mortality was reported in 7228 patients (32.7%). The proposed LightGBM-based framework had good performance with an area under the receiver operating characteristic curve (AUC-ROC) of 0.74 ± 0.05 on average over the 10 trials. Furthermore, when stratified by gender, the LightGBM-based framework had good performance (AUC-ROC of 0.73 for males and AUC-ROC of 0.70 for females).

Conclusions:
A ML model using LightGBM can predict all-cause mortality in LVAD patients with good performance.
Abstract 18205: Ethnicity and Aortic Stenosis: Presentation, Management and Outcomes
Authors: Biswas Dhruva , Wu Jack , Bharucha Apurva , Fairhurst Natalie , Kaye George , Baghai Max , Dworakowski Rafal , Byrne Jonathan , MacCarthy Philip , Shah Ajay M , Eskandari Mehdi , O'Gallagher Kevin
Published: December 2023

Background:
Ethnic disparities exist in the diagnosis and management of aortic stenosis (AS), including decreased rates of transcatheter aortic valve implantation (TAVI) in Black patients. We sought to identify if disparities persist in the setting of universal healthcare and whether they are affected by social deprivation.

Methods:
A validated natural language processing pipeline was applied to the electronic health records of >1M patients at King’s College Hospital (UK) to identify 6214 patients with AS (4.5% Asian, 7.6% Black, 87.9% White self-reported ethnicity). All analyses are adjusted for age and social deprivation.

Results:
Black and Asian patients had more comorbidities (P<0.05), while Black patients had more cardiac symptoms compared to White patients (P<0.05). Mean time from first report of breathlessness to AS diagnosis was 2.61 years for Asian patients, 2.93 years for Black patients, and 2.09 years for White patients (P<0.05). For those with severe AS, TAVI was performed in 14.3% of Asian patients, 14.3% of Black patients, and 20.2% of White patients. The mean time from severe AS diagnosis to TAVI was 0.41 years for Asian patients, 0.88 years for Black patients, and 0.52 years for White patients (P= NS). Surgical aortic valve replacement (AVR) was performed in 12.5% of Asian patients, 15.5% of Black patients, and 15.4% of White patients. The mean time to AVR was longer for Black patients (1.07 years) compared to Asian (0.19 years) and White patients (0.35 years, P<0.05). The mortality benefit of TAVI or AVR interventions was similar between race and ethnicity groups in a Cox multivariate analysis.

Conclusions:
Ethnicity-based differences exist in the presentation, diagnosis and management of AS, despite correction for social deprivation. Further, Black patients with severe AS are less likely to receive TAVI intervention, and wait significantly longer for AVR, despite similar efficacy. These data should stimulate strategies to address inequity.
Abstract 18215: The Silent Intruder Unveiled: A Case of Renal Malignancy Presenting as Cardiac Mass
Authors: Khalil Muhammad Hasib H , Haider Mobeen , Khalid Yousra , Rahman Saad Ur U , Bodine Christopher
Published: December 2023

Background:
Cardiac mass is a space-occupying lesion within the cardiac cavity. Its differential diagnosis includes thrombus, vegetation or tumor. Diagnosis is on imaging. Primary cardiac tumors are benign, solitary masses attached by a stalk in the atria. Carcinomas are metastatic from direct invasion or hematogenous spread. Right-sided cardiac masses present with shortness of breath, fatigue, syncope, and night sweats. We discuss a patient with a right atrial (RA) mass as the presenting sign of renal malignancy. Case: A middle-aged female with no prior cardiac history presented to the hospital with complaints of shortness of breath. On presentation, the patient was hemodynamically stable. Echocardiogram showed a 4.9 x 2.9cm mobile RA mass heterogeneous in texture and attached to the interatrial septum with a narrow stalk. Further views showed that the RA mass continued into the inferior vena cava (IVC) and filled it entirely. A CT scan abdomen demonstrated a heterogeneous mass involving the left kidney extending from the left renal vein into the IVC and ultimately extending up to the RA. Given the high suspicion of renal cell carcinoma (RCC), a biopsy was offered however the patient declined further workup.

Discussion:
RCC can invade through the renal vein into the IVC and involve the right heart. Cavoatrial tumor thrombus extension is seen in 1% of RCC. In this case, the RA mass was the first step in the diagnosis of renal malignancy. It is imperative to assess for the extension of a RA mass into the IVC as it has diagnostic implications. Treatment is resection performed on cardiopulmonary bypass for intracardiac exploration and preventing embolization.
Abstract 18223: The Afro-DPP Program: A Pilot Cluster-Randomized Virtual Cardiometabolic Health Program to Improve Hypertension and Glycemic Control Among African Immigrants
Authors: Ogungbe Oluwabunmi V , Turkson-Ocran Ruth-Alma , Hinneh Thomas , Owusu Loretta , Spaulding Erin , Mensah Jasmine , Gbaba Serina , Sinyan Aminata , Assani-Uva Adeline , Commodore-Mensah Yvonne
Published: December 2023

Background:
Black persons and immigrants in the US are disparately impacted by poor cardiometabolic health (CMH). We hypothesized that combining lifestyle intervention with culturally specific curriculum and remote monitoring will improve CMH.

Aim:
To test the effectiveness of a culturally tailored intervention on blood pressure (BP) and hemoglobin (Hb) A1ccontrol among African Immigrants.

Methods:
Afro-DPP is a pilot cluster-randomized trial (NCT05144737) that compared effectiveness of a multicomponent CMH intervention in 60 adults with ≥2 CMH risk factors attending two churches (first intervention or delayed intervention arms). First intervention arm began the lifestyle intervention with a Lifestyle Coach; delayed intervention arm began 6 months later. The outcomes were 6-month change in BP, body weight, and HbA1c.

Results:
There were 30 adults in each arm, mean age was 50.6(±11.9) years. At 6 months, in the first intervention arm, systolic BP and diastolic (BP decreased by 11.32 mmHg and 9.73 mmHg, respectively; in the delayed intervention arm SBP and DBP decreased by 9.31 mmHg and 5.34 mmHg, respectively (
Figure
). In the first and delayed intervention arms, we observed a 2.6kg and 2.4kg weight reduction, respectively. HbA1c reduction was greater in the first compared to delayed intervention arm (-0.29, 95% CI, -0.58 to 0.01%). Likelihood of BP (<130/80mmHg) and HbA1c (<7%) control were 2.00 (95% CI 1.73 to 2.29) and 1.57 (95% CI 1.02 to 2.42) times higher in the first compared to delayed intervention arm.

Conclusions:
The improvement in BP and body weight supports effectiveness of a culturally specific multicomponent intervention in improving CMH among African immigrants.
Abstract 18239: Diabetes Status Does Not Modify the Association Between Prolonged Exposure to Elevated Fasting Blood Glucose and Midlife Cognitive Function
Authors: Kang Soo Jung , De Anda-Duran Ileana , JIN XUANYI , Fernandez Camilo A , Carmichael Owen T , Bazzano Lydia A
Published: December 2023

Introduction:
The association between type 2 diabetes mellitus (T2DM) and cognitive function(CF) has been well established. However, whether the impact of elevated fasting blood glucose(FBG) levels on CF according to T2DM status remains unclear.

Hypothesis:
We hypothesized that the impact of elevated FBG on midlife CF would be greater in people with T2DM than in those without T2DM.

Methods:
We studied 673 midlife participants of the Bogalusa Heart Study (age at baseline 36.7 ± 4.4 years, follow-up period 12.6 ± 1.0 years, age at midlife 49.2 ± 4.5 years, 63% women, 30.2% Black) with ≥3 measurements of FBG across the follow up period. Midlife T2DM status was defined as having FBG≥ 126 mg/dL or taking anti-diabetic medications at the time of midlife neuropsychological (NP) examination. Elevated FBG was defined as FBG≥ 100 mg/dL. Exposure duration of elevated FBG (ED_FBG) was defined as the time interval from initial detection of elevated FBG to midlife NP examination. Participants were classified into 3 distinct NP profiles (optimal, average, and mixed-low) using cluster analysis based on their NP performance, with mixed-low signifying worse CF. Associations between ED_FBG and NP profiles were analyzed using multinomial logistic regression models, adjusting for education status. Stratified analysis of the multinomial regression models according to midlife T2DM status, race and sex were performed.

Results:
Prevalence of midlife prediabetes and T2DM were 34.0% (n=229) and 11.1 % (n=75), respectively. A total of 120 participants (17.8%) were exposed to ED_FBG during the follow-up period. Mean ED_FBG was 9.1 ± 3.2 years. Mean ED_FBG was significantly longer in Black participants and men. The OR for having a mixed-low CF compared to optimal CF was 1.09 for a 1-year increase in ED_FBG (95% CI 1.02, 1.16), adjusted for education status. Stratified analysis according to midlife T2DM status, race, and sex did not yield significant results.

Conclusions:
Prolonged exposure to elevated FBG from early adulthood was associated with worse midlife cognitive function regardless of midlife T2DM status. Therefore, even among those without T2DM, prolonged exposure to elevated FBG may affect cognition.
Abstract 18240: Co-Creating Atrial Fibrillation Patient Education Videos by Combining Diverse Patient Feedback, Clinician Peer Review, and ChatGPT Content Analysis to Enhance Guideline-Directed Care Implementation
Authors: Isakadze Nino , Horstman Natalie , Kim Chang , Marvel Francoise A , Blair Stephney , Eddy Courtney , Randhawa Sukhbir , Ng-Thow-Hing Anthony Sky , Cheng Xavier , Spaulding Erin , Nimbalkar Mansi , Calkins Hugh G , Spragg David D , Martin Seth S
Published: December 2023

Introduction:
Strong evidence supports that (1) risk factor modification (RFM), (2) stroke prevention, (3) rhythm and (4) rate control are the four pillars of atrial fibrillation (Afib) management. Critical gaps exist in the clinical implementation of these four pillars. Patients and clinicians have identified lack of patient education as a major contributor to the failure of implementing guidelines in patient care.

Methods/Results:
We previously identified topics of patient education spanning the four pillars of Afib management via human centered design sessions with diverse patients (n=8, median age 69 (IQR 58-78), 50% women, 25% Black, 13% Asian), and clinicians (n=8). Qualitative analysis of the discussions with patients and clinicians was performed to identify desired topics of patient education. After identification of the key topics, we constructed scripts for patient education in an inclusive and iterative manner including physicians, nurses, and technologists (n=10). We then leveraged OpenAI’s ChatGPT - 3.5 artificial intelligence tool to adjust the reading level of the scripts to a 6
th
grade reading level to ensure equitable delivery of education. The scripts were again revised for content accuracy. We then used an animated video creation platform (Vyond, San Mateo, CA) to create twenty videos covering the topics of stroke prevention, lifestyle modification, rhythm, and rate control. The videos will be part of a virtual Afib management intervention to be evaluated in a RCT.

Conclusions:
We have successfully co-created Afib educational videos using input from diverse patients and clinicians with assistance from the artificial intelligence tool ChatGPT. Patient education materials co-created with diverse patients and clinicians have the potential to promote equity in guideline-directed care delivery. We will evaluate the efficacy of the educational videos as part of a virtual Afib management program in Afib guideline implementation in a RCT.
Abstract 18246: Determining the Most Important Factors for 1-year Health Status Using a Machine-Learning Algorithm in Patients With Peripheral Artery Disease Undergoing Revascularization for Claudication
Authors: Romain Gaelle , Cleman Jacob , Smolderen Kim G , Mena-Hurtado Carlos
Published: December 2023

Introduction:
Over time, patients with peripheral artery disease (PAD) are at high risk of poor cardiovascular outcomes, but most immediately, their health status is impacted due to lifestyle-limiting symptoms. To improve functioning, peripheral vascular intervention (PVI) may be offered. We aimed to understand which factors predict subsequent health status outcomes following PVI.

Methods:
We used data from the international ILLUMENATE examining the safety of peripheral angioplasty with vs. without Stellarex drug-coated balloon for femoropopliteal artery disease in randomized trial between 2013 and 2019. Treatment arms were combined for this analysis. EQ-5D 3L Index and Visual Analog Scale (VAS) were assessed at baseline and 1 year. Random forest regression, a base-trees machine-learning algorithm, was built in the training sample (80% of the cohort) and evaluated in the validation sample (20% of the cohort). The importance of 58 included pre-procedural variables was ranked. The most important variables were defined based on visual inspection of the relative importance plots to evaluate the information gained value of each included variable.

Results:
In the 473 included patients, the mean age was 68.2 ± 9.2 years, 32.1% were female and 4.2% were Black. For the 1-year 3L Index, the most important pre-procedural variables were liver disease and the 3L Index (54.1%). For the 1-year VAS, the most important variables were angioplasty/drug eluting stent following by chronic lung disease (94.9%), mechanical thrombectomy (81.0%), anticoagulant (80.1%) and congestive heart failure (76.5%). (Figure)

Conclusions:
As part of an effort to develop an individualized health status profile with machine learning, a predictable ranking of pre-procedural variables can inform 1-year health status outcomes in patients with PAD undergoing PVI for claudication. These approaches can inform clinical decision-making and pre-habilitation efforts to maximize treatment success.
Abstract 18257: Arrhythmias in Tumor Lysis Syndrome
Authors: Osama Muhammad , Khalouf Amani , Ammad Ud Din Mohammad , Hashem Anas , Naeem Nauman , Iqbal Uzma
Published: December 2023

Background:
Tumor lysis syndrome (TLS) is a common complication seen among hospitalized patients with acute promyelocytic leukemia (APL) undergoing induction therapy.
Question:
What is the incidence and type of arrhythmias in patients with TLS?
Methods:
This study utilized the National Inpatient Sample Database between 2015-2019 to identify patients hospitalized with APL and further subclassify them into those with and without TLS. ICD-10 codes were used to identify different types of arrhythmias in both groups. A multivariate logistic regression model was constructed to assess adjusted odds ratio for all-cause mortality and cardiac/renal complications.
Results:
A total of 9938 hospitalizations with APL were identified. Of those, 415 patients had TLS (4.2%). APL patients with TLS were older and more likely to be males. CVA, CHF, CAD, HTN and higher comorbidity scores were more frequent among patients with TLS (Table 1). On adjusted analysis, Patients with TLS had ~2.7-fold increase in all-cause mortality (aOR 2.74, 95% CI [2.12 - 3.55], p< 0.01). In addition, TLS patients had higher rates of cardiac arrhythmias (33.7% vs 21.4%, p<0.01). Atrial fibrillation was the most common arrhythmia (45%), followed by ventricular arrhythmias (11.3%), and lastly, torsade de pointes (8.2%). Finally, TLS patients were more likely to have AKI (aOR 4.13, 95% [3.31 - 5.16], and need hemodialysis (aOR 3.44, 95% CI [2.34 - 5.05], p<0.01).
Conclusion:
Patients with TLS are at high risk for arrhythmias, all-cause mortality and cardiac morbidity. Preventive strategies like continuous telemetry monitoring may allow for early identification of arrhythmias and may help improve outcomes.