bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 16187: COVID-19 and Outcomes of Acute Ischemic Stroke - A Nationwide Cross-Sectional Study
Authors: Patel Urvish K , Singer Emad , Tammineedi Sai Niharika , Tar Deen , Diallo Mamadou , Kapil Leslie , Intsiful Tarsha , Duc Huy Le , Mukesh Sindu , Patel Neel , Abusharkh Fathi , Fernando ortiz Juan , Singla Ramit , Patel Smit , Arumaithurai Kogulavadanan
Published: December 2023

Introduction:
Acute ischemic stroke (AIS) is thesecond leading cause of death globally, accounting for approximately 11% of alldeaths, long-term disability, and functional impairments in survivors. TheCOVID-19 pandemic has raised concerns about its impact on AIS patients.
Aim:
This study aimed to assess the outcomes,including mortality and severity of disability in AIS hospitalizations withCOVID-19.

Methods:
We performed a retrospective cross-sectionalanalysis of the Nationwide Inpatient Sample (NIS-2020) in adulthospitalizations for AIS to compare the outcomes [death & APRDRGseverity/disability] in COVID-19 patients using ICD-10 codes. We performedweighted analyses using chi-square, unpaired t-test, and multivariate logisticregression models to evaluate COVID-19-associated poor outcomes amongst AISpatients.

Results:
Out of 504,460 AIS patients, 7,590 had AIStriggered by COVID-19. Amongst AIS hospitalizations, COVID-19 was more frequentin age group >65 year old 63.2%, male 52.6%, White race (51.4%), patientwith Medicare (58.7%), median household income 0-25 percentile (33.6%), Southzone (43.4%), and hypertensives (83.7%). AIS patients with COVID-19 had ahigher mortality (10.93% vs 3.8%) and severe/extreme disability (93.21% vs37.43%) rates in comparison to patients without COVID-19. (p<0.0001) Inregression analysis COVID-19 was associated with 213% higher odds of mortality(aOR: 3.13, 95% CI: 2.90-3.38, p<0.0001, c:0.671) and higher odds of severe/extreme disability(26.85, 24.53-29.39, p<0.0001, c:0.686) compared to AIS patients withoutCOVID-19.

Conclusion:
These findings emphasize the substantialimpact of COVID-19 on AIS patients by elevating mortality and risk of severedisability compared to their counterparts. Efforts should be directed towards earlyidentification of stroke population that is at higher risk ofCOVID-19-associated poor outcome and prompt management tomitigate the burden of the both diseases.
Abstract 16198: Targeting Lipid Nanoparticles to the Blood Brain Barrier to Ameliorate Acute Ischemic Stroke
Authors: Nong Jia , Glassman Patrick M , Muzykantov Vladimir , Brenner Jacob , Marcos-Contreras Oscar A
Published: December 2023

There are more than 7.6 million new cases of ischemic strokes annually. Despite numerous unsuccessful drug trials for acute ischemic stroke (AIS), one common reason for their failure is the limited concentration of drugs reaching the at-risk penumbra. To address this issue, we have utilized nanotechnology to significantly enhance drug concentrations in the blood-brain barrier (BBB) of the penumbra. The increased BBB permeability during AIS is believed to be detrimental to neurons due to exposure to toxic plasma proteins. To develop drug-loaded nanocarriers targeted to the BBB, we have conjugated them with antibodies that bind to various cell adhesion molecules (CAMs) on the BBB endothelium. In a mouse model of AIS induced by transient middle cerebral artery occlusion, we compared the accessibility of nanocarriers targeting platelet endothelial CAM (PECAM), intercellular CAM (ICAM), and vascular CAM (VCAM), including liposomes and lipid nanoparticles (LNP). VCAM-targeted liposomes exhibited significantly higher uptake in the ipsilateral hemisphere compared to the contralateral counterpart, and superior targeting with a 2.5-fold higher uptake than ICAM, 1.9-fold higher than PECAM, and 20-fold higher than the untargeted control IgG counterpart (A). Similarly, VCAM-targeted LNP displayed a 3.4-fold, 2.4-fold, and 12.2-fold higher uptake than ICAM, PECAM, and IgG, respectively (B). Flow cytometry analysis revealed that VCAM-targeted liposomes were primarily associated with endothelial cells and leukocytes (C). In a therapeutic study, VCAM-targeted dexamethasone-loaded liposomes or IL-10 mRNA-loaded LNP reduced the infarct volume by 35% and 73%, respectively (D). VCAM/IL-10 mRNA LNP also achieved a 100% survival rate (E) and elevated plasma levels of IL-10. In conclusion, VCAM-targeted lipid nanoparticles provide a novel platform for effectively concentrating drugs within the compromised BBB of the penumbra, thereby improving the outcomes of AIS.
Abstract 16199: Postsurgical Takotsubos Complicated by Clot Burden in the Setting of Heterozygous Prothrombin Gene Mutation
Authors: Umrani Rohan , Choudhry Mansoor
Published: December 2023

Introduction:
Postsurgical Takotsubo cardiomyopathy (TCM) is associated with acute stress secondary to catecholamine release causing reversible left ventricular (LV) failure. We present a diagnostically challenging presentation of postsurgical TCM with underlying prothrombin gene mutation.

Case Presentation:
A 53 year old female underwent laparoscopic hysterectomy 2 days prior to presentation with chest pain and shortness of breath. Vitals were unremarkable, labs showed elevated troponin and EKG consistent with NSTEMI. CTA chest demonstrated significant clot burden to the ascending and descending aorta. Echocardiogram revealed a reduced ejection fraction (EF) of 25-30% with apical ballooning and thrombus. She was admitted on heparin drip and completed an infusion of eptifibatide for 24 hours. Repeat CTA chest demonstrated mildly reduced clot burden. Left heart catheterization (LHC) was precluded due to aortic arch clot. Coronary CTA revealed no CAD with a calcium score of 0. Coagulopathy workup showed heterozygous prothrombin G20210A variant. She was discharged on warfarin. Repeat echocardiography 1 month later showed improved EF to 40-45%.

Discussion:
TCM accounts for 1-3% of cases of acute coronary syndromes (ACS) and affects women at a rate of 90%. Studies have shown that TCM with apical ballooning is minimally associated with LV thrombus . The presence of heterozygous prothrombin gene mutation increases risk of clot formation by 2 to 3 times. Surgery can cause this risk to dramatically increase. Coronary CTA was the best noninvasive approach to make the diagnosis as the risk of LHC was too great given the anatomic challenge of the aortic arch clot. We advocate for hypercoagulable workups to inform management of anticoagulation in patients with clotting events without known risk factors for thrombus formation.
Abstract 16201: Use of Cardiac Computed Tomography (CT) Imaging Biomarker Variables for the Prediction of Incident Heart Failure: Multi-Ethnic Study of Atherosclerosis
Authors: Mehta Aditya , De La Rosa Angelo , Hansen Spencer , McClelland Robyn , Bertoni Alain G , Budoff Matthew J
Published: December 2023

Introduction:
Several predictive heart failure (HF) models exist to determine incident HF. We aimed to create a model that uses cardiac CT imaging biomarkers to improve discrimination scores of incident HF.

Hypothesis:
Cardiac CT variables increase predictive abilities of the Pooled Cohort Equations to Prevent HF (PCP-HF) score (a validated 10-year risk of new-onset HF prediction model) in all HF, HFrEF, and HFpEF.

Methods:
MESA participants aged 45-84 years old and free of clinical CVD who completed a cardiac CT were included for study analysis. The outcome of interest was new-onset HF. Clinical risk factors were obtained. Cardiac CT variables analyzed included left ventricular size index (LVSi) and calcifications of coronary arteries (CAC), aortic valve (AVC), mitral valve (MVC), and thoracic aorta (TAC).

Results:
Among 6,667 MESA study participants who underwent cardiac CT, 426 events of new-onset HF occurred during the follow-up period. Among the 426 events, 173 (40.6%) were categorized as HFrEF, 193 (45.3%) were categorized as HFpEF, and 60 (14.1%) had missing ejection fraction data. The reported data is based on the Cox model adjusted for all CT variables in one model with log(PCP-HF). For all incident HF (preserved and reduced), CAC (HR 1.10 95% CI 1.05-1.15, p<0.001) and LVSI (HR 1.14 95% CI 1.10-1.18, p<0.001) were statistically significant with an improvement in c-stat from .773 to .805. For HFpEF, CAC (HR 1.07 95% CI 1.01-1.14, p<0.025), AVC (HR 1.08 95% CI 1.00-1.16, p<0.037) and MVC (HR 1.12 95% CI 1.05-1.19, p<0.001) were statistically significant with an improvement in c-stat from .782 to .800. For HFrEF, CAC (HR 1.15 95% CI 1.08-1.23, p<0.001) and LVSI (HR 1.28 95% CI 1.23-1.34, p<0.001) were statistically significant with an improvement in c-stat from .751 to .815.

Conclusions:
Current HF prediction models, including PCP-HF model, are based on clinical risk factors. As evidenced by this model CAC, AVC, MVC and LVSi have statistical significance with improvement in c-statistics of the PCP-HF model when adjusted for CT variables. HFpEF and HFrEF have different CT variables with enhanced predictive ability.This study emphasizes the need to study the utility of cardiac CT imaging biomarkers in the development of an incident HF predictive model.
Abstract 16203: A Case for Cardiomems Use in Cardiac Amyloidosis to Prevent Hospitalization
Authors: Pascoe Michael , Kolodziej Andrew , Thompson Mindy , Yackzan Andrew , Crabtree Megan , Birks Emma , Vaidya Gaurang
Published: December 2023

Background:
Patients with cardiac amyloidosis (CA) have recurrent hospital admissions for heart failure (CHF). However, CardioMEMS placement is still considered ‘investigational’ by various insurance payers, requiring peer-to-peer review for approval. Landmark CardioMEMS trials did not identify CA patients in their cohort, so the benefit is unclear. Results and Discussion: Three patients with symptomatic CA (2 with light-chain, one with transthyretin CA) are presented. All the patients had chronic kidney disease stage 3, worsening orthostatic symptoms with heart failure medical therapy and a history of ≥ 2 hospitalizations/year for CHF with acute kidney injury. To prevent further hospitalizations, CardioMEMS was planned but denied by their respective insurance companies as ‘investigational use’, which required a rigorous appeal process to overturn. One year prior to CardioMEMS, there were 8 hospitalizations due to CHF between all three candidates. After implantation, there was only 1 CHF-related hospitalization. This represents a 88% decrease in hospital admissions for CHF, saving a potential 7 CHF hospitalizations in the succeeding year and potentially adding one quality-adjusted life-year (QALY)/patient. Decompensated CHF adversely affects the quality of life of CA patients. CardioMEMs costs $20,000/device on average and $100/month of monitoring cost. The average cost of heart failure hospitalization is $14,000. Amongst the 3 patients, there was a total expenditure of $112,000 in hospitalizations prior to CardioMEMS placement. With an 88% reduction in hospitalization and correcting for the cost of device placement and monitoring, there was a $11,653/patient/year decrease in spending with CardioMEMS placement. Additionally, the cost of adding 1 QALY/patient was only $21,200 with CardioMEMS. The Institute for Clinical and Economic Review values one QALY at $50,000 to $150,000 as an acceptable cost and the expenditure with CardioMEMS comes significantly lower.

Conclusion:
CardioMEMs has been shown to decrease the number of hospitalizations in patients with HF and has a similar benefit in patients with CA. The CardioMEMs device has the capability to improve patient quality of life and decrease the cost of medical care of CA patients.
Abstract 16215: Reduced Left Atrial Strain and Risk of Ischemic Stroke in Patients With Normal Sinus Rhythm: A Systematic Review and Meta-Analysis
Authors: Benitez Gonzalez Maria , Barriga Guzman Rocio , Carvalho Ferreira Andre L , Lima Ana , Guida Camila
Published: December 2023

Introduction:
Abnormalities in the left atrium have been linked to a higher risk of ischemic cerebrovascular events. Left atrial (LA) strain analysis can identify LA dysfunction, even in patients with normal LA volumes. However, the precise association between LA strain and the occurrence of ischemic stroke in individuals who are in normal sinus rhythm (NSR) is not well established.

Hypothesis:
This systematic review and meta-analysis aimed to assess the relationship between reduced LA strain and the risk of ischemic stroke in patients with NSR.

Methods:
We searched PubMed, Embase, and Cochrane Central for studies that examined our clinical question. Two reviewers independently performed study selection, data extraction, and assessment of bias. Statistical analysis was performed using Review Manager 5.4.1. Heterogeneity was assessed with I2 statistics. We calculated pooled multivariable-adjusted hazard ratios (HR) with 95% confidence intervals (CI) under a random effects model.

Results:
We included 8,632 patients from 4 cohort studies, of which 3 were prospective. The mean follow-up ranged from 2.5 years to 10.9 years. The mean age ranged from 68.8 to 75.2 years. All results were obtained through multivariable-adjusted analysis, which includes adjusting for LA size and occurrence of new-onset atrial fibrillation during follow-up. The incidence of ischemic stroke was significantly increased in patients with reduced reservoir strain (HR 1.53; 95% CI 1.09-2.15; p=0.01; Figure 1) and conduit strain (HR 1.39; 95% CI 1.16-1.59; p < 0.001). Reduced contractile strain was not predictive of stroke incidence (HR 1.94; 95% CI 0.96-3.93; p=0.07).

Conclusions:
Our findings indicate an independent association of reduced LA strain with an increased incidence of ischemic stroke in patients without a previous history of atrial fibrillation. Future studies are warranted to evaluate the role of LA strain as part of a comprehensive risk stratification for stroke.
Abstract 16216: Sociodemographic Disparities in Severity of Multisystem Inflammatory Syndrome in Children: The National MUSIC Study
Authors: Lopez Keila N , Truong Dongngan , Anderson Brett R , Baker-Smith Carissa M , Bradford Tamara T , Dionne Audrey , Dummer Kirsten , Forsha Daniel E , Franklin Wayne J , Handler Stephanie , Harahsheh Ashraf S , Hasbani Keren , hu Chenwei , Jone Pei-Ni , Lang Sean , McHugh Kimberly E , Oster Matthew , Pearson Gail D , Portman Michael A , Preminger Tamar , Russell Mark , Sanil Yamuna , Sexson Tejtel S , Shakti Divya , Shea Ryan , Trachtenberg Felicia , Wang Shuo , Wong Jonathan P. P , Newburger Jane W
Published: December 2023

Introduction:
The long-term outcomes after the Multisystem Inflammatory Syndrome in Children (MUSIC) study investigates sequelae in multisystem inflammatory syndrome (MIS-C) post-COVID across 33 US and Canadian sites. Among children with COVID-19, the adjusted MIS-C incidence rate ratios are higher in children who are Hispanic or Black. Our objective was to assess sociodemographic disparities associated with MIS-C severity and adverse outcomes.

Methods:
This multicenter cross-sectional study included US persons <21 years-old with MIS-C from 6/2020-1/2022. The primary composite outcome of greater illness severity included
>
1 findings: vasoactive medications, cardiac dysfunction or elevated troponin, intubation, or mechanical support. Secondary outcomes were days from symptom onset to hospital admission and hospital length of stay (LOS). Predictor variables were patient distance to the hospital, neighborhood social deprivation index (SDI-higher score is worse), race/ethnicity, and non-primary English language. Covariates were age, insurance, asthma, and obesity. Multivariable models used backwards selection at significance p<0.05.

Results:
There were 1115 MIS-C patients, with a median age of 9 years old (IQR 5.6, 12.7), 39.2% female, 28.1% non-Hispanic Black, 27.8% Hispanic, 47.3% with public insurance, and a median SDI of 54 (IQR 25.0, 82.5). On multivariable analysis, increased odds of more severe illness included Hispanic ethnicity, odds ratio (OR) 1.5 (95% CI 1.1, 2.2); non-Hispanic Black race, OR 1.7 (95% CI 1.1, 2.4) compared to non-Hispanic whites; and ages 13-17 years, OR 3.7 (95% CI 2.4, 5.6) compared to those ages 0-5 years. Longer time to hospital admission was associated with lower SDI (i.e., less deprivation; p=0.009) and further distance from hospital (p=0.006). Risk factors for longer LOS were adolescent age (p=0.002) and non-Hispanic Black race (p=0.018). Asthma and obesity had no association with MIS-C severity.

Conclusion:
MIS-C severity and adverse outcomes are associated with sociodemographic factors, including being Black and/or Hispanic. Future studies should explore risk mechanisms , including systemic racism, environmental and genetic causes, quality of medical care, or multifactorial interactions.
Abstract 16235: Older Patients Presenting With Cardiogenic Shock Have Worse Outcomes: Insights From a Quaternary Referral Center Registry
Authors: Brahmbhatt Darshan H , Scolari Fernando , Vishram-Nielsen Julie K , Wang Vicki N , Keon Kristine A , Shin Emily , De Pellegrin Overgaard Ava Isabella , Nisar Mahrukh , Billia Filio , Overgaard Chris , Luk Adriana
Published: December 2023

Background
Cardiogenic shock (CS) is a life-threatening clinical syndrome of reduced cardiac output that leads to multi-organ failure. Despite improvements in the possible therapies available, it remains a significant cause of morbidity and mortality among patients admitted to the Cardiac Intensive Care Unit (CICU). It remains unclear how age of the admitted patient may affect outcomes.
Aim
We investigated survival of CS patients admitted to a single quaternary North American center stratified by age.

Methods:
All CS patients aged 18 years and older admitted between January 2014 and December 2021 were identified from a prospective CICU admissions registry. Patients with durable left ventricular assist device (LVAD) and heart transplant (HT) were excluded, as were CICU readmissions during the index hospitalization. Patient characteristics, co-morbidities and outcome data were collected. Survival between age groups (<30, 30-40, 40-50, 50-60, 60-70 and >70 years old) was compared using Kaplan-Meier methods. A Cox proportional hazards model evaluating survival differences by age as a continuous variable was created and quantified the association between age and mortality with other covariates: sex, etiology, admission creatinine, sodium, lactate, white blood count (WBC) and mean arterial pressure (MAP). All analyses were right-censored for LVAD or HT.

Results:
1284 CS patients were identified, with mean age 60 years, 71% male, 21% due to acute MI. In-hospital survival stratified by age was significantly different (figure), p(Log Rank<0.001). In the unadjusted model, increasing age led to an increased mortality, hazard ratio (HR) 1.029, p<0.001. In the adjusted model for mortality, age remained significant, HR 1.023, 95% confidence interval 1.015-1.030, p<0.001.

Conclusion
In a contemporary CICU registry, patients admitted with CS had higher mortality with advancing age. This should be a consideration in planning the use of potentially limited CICU resources.
Abstract 16246: Hypothermic and Hyperkalemic Perfusion Prolonged the Ischemic Time in Porcine Model of Donor After Circulatory Death
Authors: Inoguchi Keita , Kawamura Takuji , Yoshioka Daisuke , Kawamura Masashi , Kawamura Ai , Yamashita Kizuku , Misumi Yusuke , Taira Masaki , Shimamura Kazuo , Miyagawa Shigeru
Published: December 2023

Introduction:
There is a worldwide shortage of donors in heart transplantation(HTx), and one way to expand donor sources is HTx from donors after circulatory death (DCD). Several nations have successfully incorporated DCD HTx into clinical practices. However, the limitation of ischemic time from cardiac arrest is one of the significant barriers to the expansion of DCD.

Hypothesis:
Hypothermic and hyperkalemic (HT-HK) perfusion can prolong the time from cardiac arrest to heart procurement.

Methods:
A model of brain death was created by balloon occlusion of the intracranial cavity of pigs, and the ventilator was stopped to create a controlled DCD model. To mimic HTx, we adopted a model in which the ascending aorta was cross clamped (AXC) under open chest in pigs, systemic circulation was maintained using ECMO, and then the AXC was released to resume heartbeat and evaluate cardiac function. 1. To examine the limitation of the warm ischemic time (WIT), we performed systemic perfusion including the heart after a certain period from cardiac arrest, and evaluate whether the heartbeat resumed or not. 2. Following cardiac arrest, we performed HT-HK perfusion, accompanied by chest opening, AXC for cardioplegia infusion, and simultaneous systemic warming and potassium correction. Then, we evaluate whether the heartbeat resumed and cardiac function. 3. the preserved heart by HT-HK perfusion was transplanted orthotopically into the other pig and evaluated its cardiac function.

Results:
1. ECMO reperfusion within 30 minutes after WIT led to heartbeat resumption, while reperfusion after 60 minutes did not. 2. Among the six pigs subjected to HT-HK perfusion, one had cardiac arrest during brain death preparation, and another went into ventricular fibrillation after the release of AXC. However, four pigs resumed heartbeat and normal contraction with an average time of 94.0±9.2 minutes from the cardiac arrest. Cardiac function after HTx from DCD with HT-HK perfusion was favorable, with a left ventricular ejection fraction of 63% after weaning from cardiopulmonary bypass.

Conclusions:
DCD with hypothermic and hyperkalemic perfusion prolonged the time from cardiac arrest to procurement, and exhibited favorable post-transplant cardiac function, suggesting its usefulness.
Abstract 16276: Complex Corynebacterium Case: Management of Recurrent Corynebacterium Bacteremia in a Patient With Cardiac Implanted Electronic Device and Left Ventricular Assist Device
Authors: Narowska Gabriela , Horton Edward R , Saporito Richard , Hamad Eman A , gangireddy chethan , Whitman Isaac R
Published: December 2023

Background
Cardiac implantable electronic device (CIED) infections are morbid and costly. Atypical organisms are increasingly recognized as a cause of CIED infections. We present a case of recurrent Corynebacterium striatum bacteremia requiring CIED and left ventricular assist device (LVAD) extraction.

Case Presentation
A 54-year-old female dialysis patient with diabetes, ischemic cardiomyopathy, primary prevention single chamber transvenous defibrillator (ICD) 8 years prior, and destination LVAD presented with chronic C. striatum driveline site infection and relapsing and remitting bacteremia. Over the prior two years, she suffered from chronic driveline infections requiring wound care, driveline washouts, and antibiotics, although not seen by the electrophysiology (EP) team. After a fourth episode of bacteremia, she underwent ICD extraction and LVAD pump exchange, followed by 6 weeks of vancomycin and 3 months of rifampin. She then remained free of bacteremia for 19 months, though continued to demonstrate evidence of driveline infection despite pump exchange. Ultimately, C. striatum bacteremia recurred. Given unrelenting soft tissue infection and recurrent bacteremia, redo LVAD exchange was deferred and she was treated with lifelong suppressive antibiotics.

Discussion
Corynebacterium species have historically been considered skin flora, but more recently have been identified as pathogens, both as a cause of endocarditis, and a common organism in LVAD associated soft tissue infections. There are few reports of CIED infection. Source control is difficult in bacteremia patients with both CIED and LVAD. In this case, recurrent bacteremia could be attributed to recurrent driveline-soft tissue infection. However, the prolonged freedom from bacteremia off antibiotics after CIED extraction, despite ongoing soft tissue and driveline infection, argues that her transvenous ICD may have been seeded. This case highlights the growing spectrum of bacteria implicated in CIED-related infection, that early extraction may be a critical intervention regardless of infectious source, and importance of multidisciplinary discussions including heart failure, surgery, infectious disease, and EP to improve outcomes in this complex population.
Abstract 16295: Glucose Homeostasis and Frequency of Pre-Heart Failure in Hispanics/Latinos: Insights From the Echocardiographic Study of Latinos (ECHO SOL)
Authors: Duran Luciano Priscilla , chavez Patricia , Swett Katrina , Cai Jianwen , Ponce Sonia , Talavera Gregory A , Kansal Mayank M , Daviglus Martha L , Schneiderman Neil , Sotres-Alvarez Daniela , Allison Matthew A , Ostfeld Robert , Corsino Leonor , Rodriguez Carlos J
Published: December 2023

BACKGROUND:
Diabetes Mellitus (DM) is an independent risk factor for heart failure (HF), yet research on the association of glucose homeostasis with pre-HF is limited. We assessed glucose homeostasis longitudinally in relation to prevalent and incident pre-HF in the Echocardiographic Study of Latinos, Echo-SOL.

Methods:
Serial echocardiograms from 1595 adults (mean age 56.4 years), 61% female, from Echo SOL were analyzed on average 4.3 years apart. Prevalent pre-HF was defined as the presence of one of the following parameters: LVEF <50%, global longitudinal strain > -15%, diastolic dysfunction ≥ grade 1, left ventricular mass index >115 in men/>95 in women, relative wall thickness >0.42. Glucose homeostasis was assessed at baseline (2008-2011) by fasting plasma glucose (FGP), oral glucose tolerance test (OGTT), and hemoglobin A1C (A1C) and categorized as normal glucose tolerance [NGT]: FPG<100 mg/dL, OGTT <140 mg/dL, and A1C <5.7%; prediabetes [PDM]: FPG 100-125 mg/dL, OGTT 140-199 mg/dL, or A1C 5.7-6.4%. Among those with prevalent DM, controlled DM [CDM] was defined as A1C <7%, and uncontrolled DM [UDM] as A1C >7%. Incident pre-HF was assessed at visit 2 (2014-2017) among those free of pre-HF at visit 1. Complex survey design is accounted for in all analyses.

Results:
Over time there was increased frequency of UDM with decreased frequency of NGT
(Figure)
. Prevalent pre-HF (72.5% overall) gradually increased as glucose homeostasis worsened: 50.5% NGT, 69.2% PDM, 78.3% CDM, 86% UDM, p value <0.05. Incident pre-HF (56.2% overall) occurred more frequently among baseline dysregulated glucose categories: 65.5% PDM, 71.3% UDM, p value <0.05.

CONCLUSION:
Pre-HF rates, in both the non-DM and DM groups, increase with worsening and uncontrolled glucose homeostasis. Early detection of antecedent PDM stages and uncontrolled diabetes may offer opportunities to prevent clinical HF.
Abstract 16311: Differential Outcomes of Primary Percutaneous Coronary Intervention Compared to Medical Management Alone for Very Elderly Patients With ST-Elevation and Non-ST-Elevation Myocardial Infarctions - A Systematic Review and Meta-Analysis
Authors: Fazeel Hafiz Muhammad , Malik Saad U , Ranjha Shaheryar , Yousaf Amman , Yousaf Hamza , Salah Ud Din Essa
Published: December 2023

Introduction:
ST-segment elevation myocardial infarction (STEMI) and NSTEMI in elderly are therapeutic challenges as percutaneous coronary intervention (PCI) is often withheld owing to concern for side effects. It is also unsure if outcomes vary for these two syndromes.

Hypothesis:
PCI is better than conservative medical therapy (CMT) in very elderly patients (age > 80 years) and if such results vary with presence of transmural infarction.

Methods:
PubMed, Embase, Cochrane database and clinicaltrials.gov were searched for relevant studies. The primary end point was mortality outcomes for both syndromes and secondary outcomes included short and long term major adverse cardiovascular events (MACE) and bleeding events for NSTEMI patients.

Results:
Nine STEMI studies with N= 1528 (PCI= 1119, CMT= 409) and eleven NSTEMI studies with N= 36089 (PCI= 9770 , CMT= 26319) were included. For STEMI patients, PCI showed significantly better 30-day [RR= 0.35 (0.22-0.56), p= 0.01, I
2
=60.08], one-year [RR= 0.28 (0.17-0.47), p= 0.001, I
2
= 68.36] and long-term mortality [RR= 0.40 (0.12- 1.36), p= 0.001, I
2
=86.07]. These outcomes did not replicate in NSTEMI patients for whom no difference was found for in-hospital mortality [RR= 0.44 (0.17- 1.16), p= 0.08, I
2
= 59.9] and 30-days all-cause mortality [RR= 0.32 (0.29- 0.36), p=0.53, I
2
= 0.0]. However, 12-month outcomes were better with PCI for all-cause mortality [RR= 0.29 (0.23- 0.37), p< 0.001, I
2
= 81.32] and MACE [RR= 0.44 (0.21-0.87), p=0.001, I
2
= 84]. The short-term bleeding risk seemed lower with CMT [RR=1.29 (0.56-3.09), p< 0.001, I
2
=90.4] without any long-term bleeding difference [RR= 1.85 (0.21-16.24), p < 0.001, I
2
= 99.2] though large heterogeneity and wide confidence intervals limit definite conclusions.

Conclusions:
PCI has significant mortality benefits especially for STEMI patients. For NSTEMI patients undergoing PCI, the extended mortality risk improves without concurrent increment in major bleeding risk.
Abstract 16318: Using Arterial Recoil for Large Bore Access Closure After Impella Assist Device Removal
Authors: Talha Khawaja M , Winscott John G , Patel Vishal , Ashley Kellan E , McMullan Michael , Lemor Alejandro , Campbell William , Hernandez Gabriel A
Published: December 2023

Background:
The use of Impella assist device for high-risk percutaneous coronary interventions (HR-PCI) and cardiogenic shock (CS) has increased in the last decade and requires a large bore arterial access (LBA). However, LBA closure following Impella removal is associated with significant complications.

Objective:
To describe the safety and efficacy of a novel method of LBA closure using arterial recoil following Impella removal.

Methods:
A descriptive, retrospective review of electronic medical records in all patients that underwent LBA closure using this novel method from July 1, 2018, to June 30, 2022, was performed at the University of Mississippi Medical Center. The procedure involves controlled downsizing of the arterial sheath from 12 French (Fr) to 6 Fr with intermittent compression to allow patent hemostasis facilitated by arterial recoil. Baseline characteristics and outcomes including closure success, immediate or delayed (>6 hours) bleeding, and access site hematoma/pseudoaneurysm were included.

Results:
Of 103 patients with Impella placement, 20 (19%) underwent LBA closure with the arterial recoil method. Patients were predominantly male (80%) and White (55%) with a mean age of 65
+
16 years. The most common indication for Impella placement was HR-PCI (40%), followed by non-acute myocardial infarction (AMI) CS (35%), and AMI-CS (25%). After downsizing of the femoral sheath to 6 Fr, 14 patients (70%) underwent manual compression, 3 patients had a 6 Fr sheath left in place to maintain access, 2 patients underwent placement of a Perclose device, and 1 patient underwent placement of a Vascade device. Successful LBA closure was performed in all patients with no immediate or delayed bleeding complications. A total of 5 patients (25%) died inpatient, including one patient who had palliative removal of the Impella device; the deaths were unrelated to complications of Impella removal.

Conclusions:
LBA closure post-Impella removal with this novel method is safe and effective. Further prospective studies are needed to ascertain its comparative efficacy.
Abstract 16322: Role of Spleen Tyrosine Kinase in Pathomechanism of Aortic Dissection
Authors: SHIBATA RYO
Published: December 2023

Background:
Aortic dissection (AD) is a fatal aortic disease of which molecular pathogenesis has not been elucidated. In our previous studies, we found that systemic inhibition of Syk, spleen tyrosine kinase, exacerbates AD leading and sudden death in model mice. However, cell type-specific role of the AD pathogenesis is unknown. Subject: How does Syk contribute to the pathogenesis of AD. And what cells in the aorta contribute to the pathogenesis of AD. Methods and results: Mouse AD model was created by continuous infusion of β-aminopropionitrile and angiotensin II (BAPN+AngII) for 14 days as previously reported. Iba1 and αSMA, markers of activated macrophage (Mϕ) and smooth muscle cell (Sm), respectively, were double-stained with p-Syk in the mouse AD model. As a results, we found that both Mϕ and Sm are activated in the same region as Syk. This suggests that Syk contributes in some way to Mϕ and Sm in the pathogenesis of AD. Mϕ-specific Syk knockout mice were generated using the Cre-LoxP system. Phenotype effects were compared in the controls and Mϕ-specific Syk knockout groups, but there were no significant differences in AD lesion length and mortality. Sm-specific Syk knockout mice were generated using the tamoxifen-induced CreERT2 system to avoid alteration of aortic phenotypic at the baseline. Ten-week-old mice with loxP sequences at both ends of the Syk gene in Sm were injected with 1 mg/day of tamoxifen for 5 days, and In Situ Hybridization showed that p-Syk was reduced in the aortic tunica media after 2 weeks. Phenotypic comparisons with controls what did not receive tamoxifen showed no significant differences in AD lesion length and mortality. These results differ from previous findings that systemic Syk inhibition increases AD.

Conclusions:
We found that systemic inhibition of Syk exacerbates the pathogenesis and mortality of AD, and that Syk has some activation in Mϕ and Sm. However, deletion of Syk in Mϕ or Sm alone had no apparent effect on the pathogenesis of AD. These results suggest that the action of Syk in AD pathogenesis is not solely due to Mϕ and Sm, but is due to a more complex mechanism involving multiple cells interactions.
Abstract 16389: Inflammatory Chronic Kidney Disease is Associated With Incident Heart Failure: A Pooled Cohort Analysis
Authors: Hamid Arsalan , Minhas Abdul Mannan Khan M , Tio Maria Clarissa , Khan Mohammad S , Usman Muhammad Shariq S , Kamimura Daisuke , Siddiqi Tariq J , Pandey Ambarish , Butler Javed , Hall Michael E
Published: December 2023

Introduction:
High sensitivity C-reactive protein (hsCRP), a biomarker of inflammation, can risk stratify patients for cardiovascular disease including heart failure (HF). It is not well established if inflammation increases the risk of HF in patients with chronic kidney disease (CKD) and if hsCRP can be utilized to risk stratify patients with CKD for their risk of incident HF.

Aims:
We assessed the role of hsCRP in risk stratifying patients with CKD for incident HF.

Methods:
We studied participants of 3 major epidemiologic cohorts: Atherosclerosis Risk in Communities Study, Multi-Ethnic Study of Atherosclerosis, and Jackson Heart Study. High inflammation was classified as hsCRP >3 mg/L and CKD was classified as estimated glomerular filtration rate <60 mL/min/1.73m2. Participants were stratified into 3 groups: neither CKD nor high inflammation, CKD without high inflammation, or CKD with high inflammation. Cox hazards models adjusted for age, sex, race, body mass index, smoking, alcohol use, diabetes, hypertension, and coronary disease were utilized for analysis.

Results:
8,692 participants with 460 incident HF events followed over a median 8.32 years were included in our analysis. Participants with CKD without high inflammation (HR = 1.45; 95% CI 1.14 to 1.85) and CKD with high inflammation (2.05; 1.61 to 2.61) were associated with an increased risk of incident HF compared with participants without CKD or high inflammation (referent, Figure). Furthermore, participants with CKD and a hsCRP >3 mg/L had an increased risk of incident HF (1.41; 1.06 to 1.88) compared with participants with CKD but hsCRP ≤3 mg/L (referent).

Conclusions:
Patients with CKD and high levels of inflammation carry a 2-fold increased risk of incident HF. In patients with CKD, hsCRP levels >3mg/L may be useful to risk stratify patients with increased risk of developing HF.
Abstract 16394: Increasing Prevalence of Cardiovascular Comorbidities Among Patients With Primary Biliary Cirrhosis: 2012-2020
Authors: Iskander Mina , Patel Ankoor , Mintz Joel , Uribe Juan , Vasquez Moises , Quintero Martinez Juan , Luna Alvarez Amezquita Jose , mustafa mohammed , Rustgi Vinod K
Published: December 2023

Background:
Primary Biliary Cirrhosis (PBC) is an autoimmune cholestatic liver disease characterized by progressive damage to the small bile ducts within the liver. PBC is a chronic inflammatory condition frequently associated with cardiac complications in practice, including hyperlipidemia, cardiac arrythmias, and cardiomyopathy. However, data regarding the cardiovascular disease trends and complications in patients with PBC is limited.

Aims:
To demonstrate the trends of cardiac complications including atrial fibrillation (AF), congestive heart failure (CHF), cardiac arrythmias, myocardial infarction (MI), coronary artery disease (CAD), and valvular disorders in patients with PBC.

Methods:
A retrospective cohort study using The National Inpatient Database was used to identify patients with PBC from 2012 to 2020.

Results:
A total of 22,136 patients inpatients with PBC were identified. Prevalence increased from 2,374 in 2012 (mean [SD] age 63.9 [14.2] years; 85.3% female) to 2,470 in 2020 (mean [SD] age 65.3 [13.9] years; 84.0% female). There was a statistically significant marked increase in MI (4.6% to 8.1%; P<0.001), CHF (14.2% to 21.6%; P<0.001), CAD (14.9% to 17.3%; P<0.001), and AF (12.3% to 16.2%; P<0.001) from 2012 to 2020. There was no significant increase in valvular disorders (8.2% to 9.3%; P=.286) and a significant decrease in cardiac arrythmias (24.2% to 23.4%; P=0.011) found from 2012 to 2020.

Conclusion:
In an inpatient population with PBC, with there was a significant uptrend in MI, AF, CAD, and CHF between 2012 to 2020. There was no change found in valvular disorders and a downtrend in cardiac arrythmias over the same time frame. Further data assessing the cardiovascular outcomes in PBC and its etiology are needed to optimize strategies for long term management of these patients from a cardiovascular standpoint.
Abstract 16397: Inflammatory Biomarkers as Predictors of Systemic vs. Isolated Pocket Infection in Patients Undergoing Transvenous Lead Extraction
Authors: Lacharite Roberge Anne Sophie , Toomu Sandeep , Aldaas Omar , Ho Gordon , Pollema Travis L , Birgersdotter-Green Ulrika
Published: December 2023

Intro:
Cardiovascular implantable electronic device (CIED) infections are a common indication for device extraction. Early diagnosis and complete device and lead removal are crucial to reduce morbidity and mortality. The lack of clear infectious symptoms and signs make the diagnosis of CIED infections challenging and may delay referral for extraction.

Methods:
We performed a retrospective analysis of patients undergoing transvenous lead extraction for CIED infection at UCSD from 2012 to 2022 (n= 164). Our control group underwent extraction for non-infectious etiologies such as device malfunction, lead fracture or system upgrade (n=281). Patients were classified as systemic infection (n=88) or isolated pocket infection (n=68) based on the presence or absence of sepsis. Prospectively collected pre-operative procalcitonin (PCT), C-reactive protein (CRP), and white blood cell count (WBC) were compared between groups using Kruskal-Wallis and Dunn-Bonferroni tests.

Results:
PCT and WBC medians differed significantly between the systemic infection, the pocket infection, and the control groups (p<0.001 and p=0.021 respectively). Pairwise comparisons revealed the systemic infection group had a higher PCT than the control group (p<0.001), as well as the pocket infection group (p=0.009). There was no significant difference in PCT between the control group and the isolated pocket infection group (p=0.685). Regarding pairwise differences in WBCs, a higher value was only associated with systemic infection when compared with our control group (p=0.018). CRP levels were not significantly different between groups (p=0.117) and the difference was again limited to systemic infection vs control groups (p=0.017).

Conclusion:
In patients with CIED infections requiring extraction, systemic infection was associated with elevated pre-operative PCT when compared to isolated pocket infection and controls. Elevated WBCs and CRP levels were also associated with systemic infection. However, inflammatory biomarkers including PCT were not elevated in isolated pocket infections. The results suggest that inflammatory markers are not predictive to help with the diagnosis of pocket infections, which ultimately requires a high level of clinical suspicion.
Abstract 16419: Assessing the Evidence Base of Cardiology-Specific Oncology Guideline Recommendations: Implications for Health Policy
Authors: Jhawar Nikita , Schneider Artur , Kusumoto Fred
Published: December 2023

Introduction:
Oncology societies have been contributing guidelines/recommendations to the limited yet growing body of literature in cardio-oncology.
Research Questions:
What are the levels of evidence (LOE) and classes of recommendation (COR) for cardiology-specific recommendations produced by major oncology societies?

Methods:
We reviewed cardiology-specific recommendations published by the American Society of Clinical Oncology (ASCO), American Society of Hematology (ASoH), NCCN (National Comprehensive Cancer Network), and European Society of Cardiology (ESC). LOE and COR were noted for each recommendation.

Results:
The US oncologic societies have made 81 cardiac-specific recommendations (ASCO: 54 (67%); ASoH: 14 (17%); NCCN; 13 (16%) (Tables 1-3). For ASCO, 26 (48%) were COR 1, 23 (43%) COR 2, and 5 (9%) COR 3 supported by LOE A (9%), LOE B (39%), and LOE C (52%). For ASoH, 1(8%) was COR 1, 11(85%) COR 2, and 1(8%) COR 3 supported by LOE B (7%), and LOE C (93%). NCCN made 13 COR 2 recommendations and did not provide LOE classification. The most common recommendations addressed baseline (20%) and serial (24%) assessment, specific imaging modalities (9%), chemotherapy dosing (19%), and radiation therapy (20%). Most recommendations were unique without discrepant statements, but there were some redundancies. ESC produced 271 cardio-oncology recommendations (155 COR 1; 111 COR 2; 5 COR-3) with 3% LOE A, 21% LOE B, and 76% LOE C. The major areas for ESC recommendations included baseline (18%) and serial (33%) assessment, and medications (29%).

Conclusions:
Oncology and cardiology professional society guidelines have provided 352 cardiac related recommendations in the setting of cancer treatment and 73% have the lowest LOE. In this developing field with a limited evidence base, close collaboration between cardiologists and oncologists will be required to provide a cohesive set of recommendations for the cardiac issues associated with cancer treatment.
Abstract 16465: Cardiovascular Disease Burden in the Middle East and North Africa Region
Authors: Alhuneafat Laith , Al Taani Omar , Altarawneh Tala , Elhamdani Adee , Naser Abdallah , Al-Adayleh Rand , Al Ahmad Majd , Ghanem Fares , Alnaimat Saed , jabri ahmad
Published: December 2023

Introduction:
Cardiovascular disease (CVD) remains the leading cause of death globally, including the Middle East and North Africa (MENA) region. However, limited research has been conducted on the burden of CVD in this region.

Hypothesis:
Our study aims to investigate the burden of CVD and related risk factors (RFs) in the MENA.

Methods:
We used data from the Global Burden of Disease (GBD) 2019 to examine CVD prevalence in 21 MENA countries. Prevalence, mortality, and incidence were analyzed using Bayesian regression tools, demographic methods, and mortality-to-incidence ratios. Disability-adjusted life years (DALYs) were calculated, and RFs were evaluated under the GBD's comparative risk assessment framework.

Results:
Between 1990 and 2019, CVD prevalence in the MENA increased by 140.9%, while age-standardized (AS) prevalence slightly decreased (-1.3%). CVD mortality rose by 78.3%, but AS death rates fell by 28.01%. Ischemic heart disease remained the most prevalent condition, with higher rates in men, while women had higher rates of CVA. All-age DALYs increased by 53.3%, but AS DALYs decreased by 32.54%. DALY rates varied across countries and were consistently higher in males. Leading RFs included HTN, high LDL, dietary risks, and elevated BMI.

Conclusions:
The ongoing impact of CVD in the MENA region necessitates targeted interventions that address country-specific variations, including socio-economic factors, healthcare infrastructure, and political stability. To effectively reduce the burden of CVD in MENA, it is crucial to focus on targeting risk factors and implementing effective strategies.
Abstract 16468: A Microtubule-Connexin 43 Regulatory Link Suppresses Cardiac Fibrosis and Arrhythmias in Duchenne Muscular Dystrophy Mice
Authors: Zhou Delong , Nouet Julie , Himelman Eric , Lillo Gallardo Mauricio A , Chong Alexander , Wehrens Xander H , Rodney George , Fishman Glenn I , Lampe Paul , Xie Lai-Hua , Shirokova Natalia , Contreras Jorge , Fraidenraich Diego
Published: December 2023

Duchenne muscular dystrophy (DMD) is a severe X-linked neuromuscular degenerative disorder that leads to premature death in the teens because of multiple dysfunctions in the heart and skeletal muscle. DMD is caused by the absence of dystrophin, a sarcolemma protein encoded by the
dmd
gene, located on the X chromosome. 1:5,000 boys are diagnosed with DMD annually, and there is no cure. Clinically, steroid-based treatments reduce inflammation and thus, palliate skeletal muscle pathology. With improvements in the skeletal muscle, DMD-associated cardiomyopathy has become the leading cause of mortality because nearly all patients develop cardiac disease by age 20. Connexin 43 (Cx43) is a gap junction protein and is responsible for the electrical propagation of signals in the heart; it is upregulated and undergoes pathological remodeling, away from the intercalated disc in the heart of DMD mice (mdx) and patients. Hypo-phosphorylation of a specific triplet of serines in Cx43 had been found in mdx and DMD hearts. To study a potential rescue role for Cx43 phosphorylation in DMD, the triplet of serine residues was replaced by glutamic acid or alanine residues to create a phospho-mimic (Cx43-S3E) or a phospho-dead (Cx43-S3A) version of Cx43 respectively. We found that Cx43-S3E but not Cx43-S3A prevents Cx43 remodeling and development of fibrotic cardiomyopathy, arrhythmias, and heart failure in mdx mice. Remarkably, inhibition of hyperdensified, dystrophic microtubule (MT) polymerization by treatment with colchicine (Colch) enhances Cx43 phosphorylation and reduces Cx43 remodeling in dystrophic hearts, suggesting the presence of a MT-Cx43 regulatory connection. This connection could play an important role in the development of dystrophic cardiomyopathy. Our studies explore the electrophysiological properties of Cx43-S3E in DMD cardiomyocytes, and investigate a requirement for Cx43-S3A in the Colch-dependent improvement of the MT dynamics, uncovering a novel link between phospho-Cx43 and MT organization. Furthermore, the results suggest a novel target for the treatment of DMD-cardiomyopathy.