bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 11600: Association Between Obesity and Risk of Total and Obesity-Related Cancer in Persons With Incident Cardiovascular Disease
Authors: Malik Sarah , Guha Avirup , Wang Xiaoling , Weintraub Neal L , Harris Ryan A , Datta Biplab , Moore Justin , Nain Priyanshu , Patel Sagar , Coughlin Steven , Polter Elizabeth , Prizment Anna , Blaes Anne , Florido Roberta , Kutty Shelby , Alonso Alvaro , Joshu Corinne , Platz Elizabeth
Published: December 2023

Introduction:
Cardiovascular disease (CVD) and cancer often occur in the same people, in part due to shared risk factors. In a Global Burden of Disease analysis of cohorts from >180 countries, obesity was a top 3 modifiable risk factor for CVD and cancer. Beyond shared risk factors, CVD pathophysiologies may synergize with obesity to influence carcinogenesis. If so, an excess cancer risk in obese persons with CVD has implications for clinical management.

Hypothesis:
Obesity is positively associated with obesity-related cancer (ObCa) risk in persons with incident CVD independent of shared risk factors.

Methods:
We used data from the Atherosclerosis Risk in Communities (ARIC) study, a cohort with 28 years of cancer follow-up. The analytic cohort was 5127 participants with incident CVD among whom 1511 were diagnosed with a first primary cancer. Follow up began at incident CVD diagnosis date after visit 1. Obesity was classified by BMI, waist circumference (WC), and waist-to-hip ratio (WHR) measured by trained technicians. We calculated incidence rate differences (RD) between obesity groups adjusted for age, sex, and center. The obesity-cancer association was estimated using Fine-Gray regression adjusted for shared risk factors, including smoking.

Results:
In people with CVD, cancer incidence was higher in the obese (BMI: RD=226.6/100,000 person-years) than normal weight group. In people with CVD, obesity was suggestively positively associated with ObCa (Table 1). In females with CVD, obesity was associated with increased ObCa risk. Associations were null in males, including after excluding prostate cancer.

Conclusion:
In this prospective study, obesity is positively associated with ObCa risk in women with incident CVD independent of shared risk factors. More work is needed to investigate why the association appeared in women only, and to identify possible mechanisms by which CVD pathophysiologies may interact with obesity to produce cancer risk.
Abstract 11603: Reexamining the Incidence and Predictors of Radiation Induced Cardiac Implantable Electronic Device Malfunction in Cancer Patients and Streamlining Management
Authors: Koduri Amit , Chauhan Siddharth , Chacon Portillo Martin A , Amatullah Atia , Miller Chase , strang amanda , tsai january , vachhani shital , THAKAR DILIP , Pollard Julianne , Kry Stephen , Shah Shalin , Wagner Darla , Lopez Donelo , Song Juhee , Shah Khatera , Iliescu Cezar , Durand Jean-Bernard , Deswal Anita , Karimzad Kaveh
Published: December 2023

Background:
Historically, the reported incidence of Cardiac Implantable Electronic Device (CIED) malfunction during Radiotherapy (RT) is estimated to range from 3% to 20%. However, most of these studies had small sample sizes and may have overestimated the clinical impact of this problem. In this retrospective study, we examined the incidence of device reset and transient signal interference due to RT in a large cohort of patients. In addition, we studied the feasibility of a novel method of monitoring CIEDs during RT: pulse check method (PCM).

Methods:
From 1/2015 to 4/2023, patients with CIEDs requiring RT at a tertiary cancer center were identified. CIEDs were checked prior to RT. Candidate patients were managed with PCM, which involves programming the lower pacing rate at 75 bpm (slightly faster than lower rate of pacing during reset mode). Pulse checks were performed after each fraction of RT. Patients with heart rate less than 75 bpm had immediate device interrogation to assess for reset. After completion of RT, devices were interrogated and CIED programming returned to original settings.

Results:
Our study reviewed 720 patients with CIEDs undergoing 837 courses (560 pacemakers and 277 defibrillators) of RT, of which the majority (85%) were managed with PCM. Neutron producing RT (proton and photon with >10MV beam energy) was used in 189 (22.6%) cases, and 9 (1.1%) devices experienced reset. All resets were recoverable and occurred in the setting of neutron-producing radiation, especially proton therapy [OR 12.06 (3.37 - 43.10), p-value 0.0001]. Site of radiation, type of device, and number of RT fractions did not predict reset. No transient signal interference or oversensing events occurred during RT.

Conclusions:
CIED malfunction is a rare complication of RT, occurring in the setting of neutron producing radiation, with no serious clinical consequence. Transient signal interference and oversensing during RT was not observed to be a clinical concern in contemporary devices. Thus, asynchronous pacing in pacer dependent patients and deactivation of defibrillator tachy-therapy during RT is not necessary. PCM is a practical and cost-effective way to monitor CIEDs during RT.
Abstract 11606: Association Between Poor Quality Diet and Stroke Amongst Cardiovascular Diseases in US Adult Population
Authors: SUN HONGBING
Published: December 2023

Background:
Poor quality diet has been suggested to be related to cardiovascular diseases (CVD). However, relationships between poor quality diet and types of CVD and mortality from CVD are still understudied. The aim of the study was to examine the association of diet quality and CVD.

Method:
Diet quality was measured by the total Healthy Eating Index (HEI) 2015 scores and HEI-2015 scores of the 13 individual food components based on the 1
st
day 24-hour dietary recalls of the US National Health and Nutrition Examination Survey cycles between 1999 and 2020. HEI-2015 scores were calculated for 66,952 adults, including 6390 reported having CVD: heart failure, coronary heart disease, angina/angina pectoris, heart attack and stroke, and 1985 deceased with CVD as the underlying cause of death by 2019. Odds ratios of reporting CVD and hazard ratio of death from CVD using HEI-2015 score, sex, age, smoking status, alcohol consumption, education, marital status, body mass index, physical activities and income to poverty ratio as covariates were calculated.

Results:
Diet quality measured by HEI-2015 score of US population was significantly lower in adults with CVD than in adults without CVD, particularly in those with stroke. For those aged 18 to 44 years old with reported stroke (total HEI-2015 score 44.1, 95%CI 41.6-46.6), their consumptions of added sugar and saturated fat were significantly higher than those without CVD (total HEI-2015 score 48, 95%CI 47.6-48.4). For those aged 18 to 44 years old surveyed and deceased by 2019 with CVD as the underlying cause of death (total HEI-2015 score 43.2, 95%CI, 40.7-45.8), their consumption of added sugar was significantly higher than those still alive (total HEI-2015 score 48 95%CI 47.6-48.4). Risk of having stroke, as indicated by the odds ratios (0.98, 95%CI 0.98-0.99) was significantly lower in those with higher total HEI-2015 scores. Associations between diet and CVD of other age groups (45-64, >64 years old) are not as significant.

Conclusions:
There is an apparent association between poor quality diet and having CVD, particularly stroke. High consumptions of added sugar, refined grain, salt and saturated fat are the general contributors to the poor-quality diet in US adult population.
Abstract 11609: Developing a Novel Method for Measuring Relative Lung Perfusion at the Catheterization Laboratory
Authors: Barak-Corren Yuval , Herz Christian , Lasso Andras , Dori Yoav , Tang Jie , Long Christopher , Long Christopher , Callahan Ryan , Rome Jonathan , Gillespie Matthew , Jolley Matthew , Obyrne Michael L
Published: December 2023

Background:
Maldistribution of pulmonary blood flow (Qp) is common in patients with congenital heart disease and is associated with worse clinical outcomes. Currently, measurement of Qp-split can only be performed outside the catheterization laboratory, using either lung perfusion scans or cardiac magnetic resonance imaging.

Aim:
We sought to develop and evaluate a tool for measuring Qp-split using readily available fluoroscopy sequences.

Methods:
A retrospective cohort study of patients with conotruncal anomalies who underwent perfusion scan and subsequent cardiac catheterization. Inclusion criteria were non-selective angiogram of pulmonary vasculature, oblique angulation ≤20°, and an adequate view of both lung fields. A method was developed and implemented in 3D Slicer to calculate the amount of contrast that entered each lung field from the start of contrast-injection and until the onset of levophase. The predicted perfusion distribution was compared to the distribution measured by lung scan.

Results:
In total 32% (79/249) of screened studies met inclusion criteria. There was strong correlation between the predicted Qp-split and the measured Qp-split (R
2
=0.83, p<0.001) with median absolute error (MAE) of 6%. Bias was not systematically worse at either extreme of flow distribution. Factors associated with better prediction were smaller BSA, younger age, right ventricle (vs. pulmonary artery) angiograms, and cranial angulations ≤20°. In cases with one or more of these conditions (n=40), the prediction achieved R
2
=0.87, MAE of 5.5%, and 78% of predictions were within 10% of true flow.

Conclusions:
Data from conventional angiograms can be used to provide accurate real-time measurement of relative perfusion of the left and right lungs. This has the potential to reduce unnecessary testing, associated costs, and radiation exposure.
Abstract 11637: Using Dielectric Sensing in Making Discharge Decision for Patients With Heart Failure
Authors: McLane Richard D , Stultz Angela D , Pauly Daniel F
Published: December 2023

Introduction:
Decompensated heart failure is a leading cause of hospitalization in the United States and is driven by high readmission rates. Despite numerous advancements in diagnosing and treating advanced heart failure, there remains a lack of validated measures to predict patient volume status and readmission rates. Remote dielectric sensing (ReDS) is a non-invasive, radiation-free measure of lung fluid content.

Hypothesis:
We aim to assess the utility of ReDS in guiding clinical management and as a quantitative metric to predict 30-day readmission rates. We predict normalization of lung fluid value before discharge will have a lower 30-day readmission rate than patients with no normal value before discharge.

Methods:
Lung fluid values were collected using ReDS vests for 1,224 patients with advanced heart failure. Our retrospective analysis compared patients with normalization of lung fluid values during admission to patients without normalization of these measures to determine a difference in readmission rates between groups. Secondary analyses were performed to assess the effects of other clinical markers, including ejection fraction and age, on lung fluid values and 30-day readmission rates for individual patients.

Results:
The primary comparison between patients with normal lung fluid values at discharge and patients without normalization of lung fluid values revealed a trend towards lower readmission for those with normalization of lung fluid values (16.6% vs. 29.2%, p=0.07). No differences were observed in patients who had non-normal repeat lung fluid values before discharge and those who did not receive a repeat measure (29.2% vs. 29.8%, p=0.88). Readmitted patients had a higher initial lung fluid value (45±6.6 versus 44 ± 5.9, p=0.02). No differences in lung fluid values at discharge or changes during hospitalization were observed.

Conclusions:
Remote dielectric sensing may predict lower readmission rates in patients whose values normalize during admission compared to patients with non-normalized values. Future prospective studies are necessary to determine the full utility of ReDS in the clinical setting.
Abstract 11652: The Addition of Social Determinants of Health to Coronary Heart Disease Risk Prediction
Authors: Murphy Brittany S , Nam Yunbi , McClelland Robyn , Acquah Isaac , Cainzos Achirica Miguel , Nasir Khurram , Aldrich Melinda , Defilippis Andrew P
Published: December 2023

Introduction:
Coronary heart disease (CHD) remains a leading cause of death worldwide, with an unequal distribution of this burden placed on individuals of lower socioeconomic status. Individual social determinants of health (SDoH) have been shown to be associated with CHD; however, whether the addition of SDoH can improve current CHD risk prediction algorithms has not been delineated.

Hypothesis:
We hypothesize that the addition of SDoH to the Multi-Ethnic Study of Atherosclerosis (MESA) risk score improves the prediction of 10-year CHD events.

Methods:
In 6,286 individuals from the MESA cohort, we evaluated the additional predictive value of SDoH beyond the traditional factors included in the existing MESA Risk Score. SDoH considered were employment, family income, house tenure, financial strain, education, marital status, social support, chronic stress, discrimination, neighborhood characteristics, healthcare access, and health insurance, which were organized into five composite domains. A penalized Cox proportional hazards model was used to select SDoH variables with the potential to improve prediction, then an unpenalized Cox regression model was fitted with traditional risk factors plus the selected SDoH variables.

Results:
Statistically significant differences in the distribution of SDoH were observed between racial and ethnic groups. Notably, unfavorable SDoH were concentrated in Black and Hispanic/Latino persons. Economic stability, education, and community and social context were associated with CHD events. The area under the curve (AUC) for prediction of a 10-year CHD event was 0.816 without SDoH factors and 0.818 with the addition of SDoH.

Conclusions:
Racial and ethnic differences in social determinants of health were obsserved. Economic stability, education, and community and social context were significantly associated with cardiovascular events, however the addition of SDoH did not significantly improve CHD risk prediction.
Abstract 11661: Genotypic and Phenotypic Guided Antiarrhythmic Drug Management of Multifocal Premature Ventricular Contractions
Authors: Gopi Arun , Ahamed Hisham , Lee Bridget , Mahtani Arun , Brider Jamarcus , Gabrah Kirollos , Doty Brandon , Al-Hindi Feross , Nair Devi
Published: December 2023

Introduction:
Antiarrhythmic selection for progressive and intractable PVCs unresponsive to first and second line regimens can prove challenging. Genetic analysis assists by targeting specific genes, such as the SCN5a gene, which encodes for the alpha subunit of cardiac sodium channel NaV1.5. Mutations are associated with autosomal dominant phenotypes of multifocal ectopic Purkinje-related premature Contractions (MEPPCs).

Case:
A 38 year old female with a history of syncope and moderate left ventricular systolic dysfunction status post AICD and a family history of SCD presented for follow-up with complaints of frequent palpitations. ECG and a 72 hour Holter monitor had multifocal PVCs of purkinje origin with a burden of 31%. Despite a therapeutic trial with sotalol and amiodarone in various doses, she remained unresponsive with multifocal purkinje-related PVCs. TTE revealed global LV hypokinesia with worsening LVEF, and a cardiac MRI revealed features suggestive of a dilated cardiomyopathy (DCM) phenotype. Whole exome DNA analysis showed a heterozygous missense mutation pArg814Tryp on exon 16 of the SCN5A gene. Her specific variant, R814W, is a gain-of-function variant responsible for the hyperexcitability of the Purkinje fibers, making it amenable to sodium channel blockade with flecainide. After starting gene-directed flecainide, her PVC burden drastically reduced from 31% to 3% on repeat Holter monitor after 2 months. She has remained asymptomatic with an improved LVEF.

Discussion:
This is a unique case of SCN5A channelopathy with a MEPPC phenotype demonstrating a dramatic response to genotype guided management of multifocal PVCs. Clinicians should include such phenotypes in their differentials for patients that fail first and second line treatment regimens and have significant family history. It is essential to offer genetic testing to patients with a MEPPC phenotype in a DCM setting to choose the appropriate therapy and prevent SCD.
Abstract 11668: Transcriptomic Analysis Reveals Sex Differences in Gene Expression Profiling of Stenotic Aortic Valves
Authors: Le Nezet Emma , Voisine Martine , Tam Rose , LI Zhonglin , Gaudreault Nathalie , Cote Nancy , Theriault Sebastien , Bosse Yohan , Clavel Marie-Annick A
Published: December 2023

Introduction:
In aortic stenosis (AS), women present less aortic valve calcification and more aortic valve fibrosis than men for the same hemodynamic severity. However, the specific mediators that drive the fibro-calcific differences between men and women remain unclear. We aim to assess the transcriptome of stenotic aortic valves explanted during aortic valve replacement, according to patient’s sex.

Methods:
Transcriptomic profile was obtained from 240 explanted human aortic valves. Among these 240 patients (120 women and 120 men), 62 women were matched with 62 men for age (within 2 years), body mass index (within 2 kg/m
2
), arterial pressure (within 10/5 mmHg), diabetes (exact), hypertension (exact) and AS severity (Table 1). Genes were classified in 6 key processes of AS development: oxidative stress, inflammation, lipid metabolism, fibrosis, apoptosis and calcification following a literature review.

Results:
One hundred and ninety (190) genes were differently regulated between men and women: 132 on autosomes and 58 on sexual chromosomes. Among these genes, 106 were over-expressed and 84 were under-expressed in women compared to men (Figure 1). Different genes involved in processes of inflammation, lipid metabolism and calcification were up-regulated both in women and men (women:
NET1
,
KIF1A, CES1, RCN2;
men:
FERMT3, APOD, CPAMD8, STC2
). Genes involved in apoptosis (
SFRP4
) and fibrosis processes (
TGFβ2
,
FRAS1
) were overexpressed in women.

Conclusions:
This study provides evidence that sex may influence aortic valve gene expression through different mechanisms in females and males, favoring pro-fibrotic and pro-apoptotic processes in women.
Abstract 11693: Comparison of In-Hospital Outcomes in Infective Endocarditis Patients With and Without Embolic Stroke
Authors: Maraey Ahmed , alhalaseh saleh , Alziadin Nmair , T Raju Apoorva , Alwarawrah Zaid , Mann Sabrina A , Al Wahadneh Omar
Published: December 2023

Introduction:
Infective endocarditis (IE) is a critical condition that can lead to complications such as embolic stroke. This study aimed to compare the in-hospital outcomes between IE patients with and without embolic stroke.

Methods:
We conducted a retrospective analysis using the National Inpatient Sample database from 2016 to 2020. We identified admissions with a principal diagnosis of IE, with embolic stroke as a secondary diagnosis. In-hospital outcomes, including mortality, length of stay, and total charge, were analyzed after adjusting for patients' demographics, hospital characteristics, and chronic comorbidities, including heart failure, hypertension, diabetes, chronic kidney disease, smoking, and hyperlipidemia.

Results:
A total of 62,200 admissions with IE were identified, of which 4,460 (7.2%) developed embolic stroke, with females accounting for 38% of the cohort. Patients who developed embolic stroke had a significantly higher risk of mortality (OR: 2.4, 95% CI: 1.8-3.1, P=0.000), longer length of stay (18 days, Coefficient: 5.8, 95% CI: 4.6-7.0, P=0.000), and higher total charge (285,285, Coefficient: 121,586, 95% CI: 98,119-145,054, P=0.000).

Conclusion:
Our study found that IE patients who experienced embolic stroke had significantly worse outcomes, including higher mortality rates, prolonged length of stay, and increased financial burden. These findings emphasize the need for targeted interventions and close monitoring for this high-risk subgroup to improve patient outcomes and resource utilization.
Abstract 11707: Differences in Erythrocyte Morphology in Thrombus From Infarct-Related Artery: Cardioembolic Thrombosis vs. Atherothrombosis, Pathological Analyses From MITO Study
Authors: Koizumi Tomomi , Kato Noriyuki , Yukinori Inadome , Tabata Fumimasa , Yamazaki Tomosato , Ono Masao ,   The MITO Study Investigators
Published: December 2023

Introduction:
Diagnosis of cardioembolic thrombosis is important because anticoagulant therapy is recommended for its secondary prevention. However, it is difficult to make a clear distinction in the pathogenesis between cardioembolic thrombosis and atherothrombosis. It has been reported that CD163 positive macrophage which related hemoglobin-haptoglobin complex was more involved in cardioembolic thrombus than atherothrombosis.

Hypothesis:
Erythrocyte morphology and its hemolysis in thrombus are associated with difference in thrombus formation between cardioembolic thrombosis and atherothrombosis.

Methods:
The Macrophage in Thrombus (MITO) study is an observational study examining pathological and biological differences of arterial thrombus between sinus rhythm (SR) and atrial fibrillation (AF). Patients with acute thromboembolic stroke (ATS) or ST elevation myocardial infarction (STEMI) whose solid thrombus could be retrieved from the infarct-related artery were enrolled. Patients were divided into 2 groups as follows; Group C; ATS with AF (presumed cardioembolic thrombosis) and Group A; STEMI with SR: (presumed atherothrombosis), and compared erythrocyte morphology score; 1: erythrocyte morphology is maintained; 2: The erythrocyte morphology is not maintained, but part of its fragment are seen; and 3: The erythrocyte morphology is not maintained at all in the thrombus seen by х40. Circulating blood counts (CBC), haptoglobin and soluble CD163 were measured all the patients.

Results:
The score of Group C (n=20) was significantly higher than that of Group A (n=28) (p<0.01)Figure. Laboratory findings are shown in the Table.

Conclusions:
Erythrocyte morphology disruption was thought to be more involved in cardioembolic thrombus formation. Erythrocyte morphology and CBC with soluble CD163 level are likely to help distinguish cardioembolic thrombus from atherothrombus.
Abstract 11768: Regression of Inflammation by Cardiac Magnetic Resonance in Chronic Chagasic Patients Treated With Benznidazole
Authors: Silva Silvana , Barros Marcio V , Nunes Maria D , Silva Lea , Edvardsen Thor , Araujo Fernanda , Souza Filho Carlos , Coelho Rodrigues Fernandes Fernanda , Venturim Porto Gabriel , Lacerda Henrique , de Barros Moretzsohn João Pedro , Veiga Thiago , Sabino Ester Cerdeira , Ribeiro Antonio L
Published: December 2023

Introduction:
Chagas disease (CD) is a neglected disease caused by
Trypanosoma cruzi
(
T. cruzi
), and benznidazole (BZN) is the most prescribed trypanocidal drug in Brazil in function of its best tolerability profile. While treatment with this drug is effective in acute disease, there is no consensus on its effectiveness in adults with chronic infection. Although it is now accepted that treatment directed against
T. cruzi
is necessary to avoid the long-term sequelae of the disease, the lack of reliable markers for assessment of treatment efficacy is a major obstacle to evaluating new drugs.

Hypothesis:
the objective of this study is to determine if BZN treatment reduces cardiac inflammation/fibrosis as assessed by magnetic resonance imaging (MRI), using parametric mapping techniques.

Methods:
Prospective, multi-center study of chronic CD patients underwent MRI T1 and T2 mapping and extracellular volume measurement (ECV) using the modified Look-Locker inversion recovery (MOLLI) sequence, undergoing treatment with BZN, at a dose of 300 mg/kg daily divided into two doses and taken for 60 days. Absolute change T1 and T2 mapping, ECV, left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV) and left ventricle ejection fraction (LVEF) were analyzed from baseline to 6-month follow-up.

Results:
53 patients (females 83%, 53.9 ± 11.9 years old) were studied. LVEDV (149 ± 27ml vs 147 ± 29ml, p = 0.52), LVESV (66 ± 29 vs 64 ± 15, p = 0.65) and LVEF (55 ± 11% vs 57 ± 8%, p = 0,28) did not change between baseline and post treatment. Native T1 time showed reduced values among anterior (1030 ± 41ms vs 1011 ± 52ms, p = 0.011), septal (1052 ± 53ms vs 1006 ± 38ms, p = 0.000) and lateral (1042 ± 55ms vs 1019 ± 44ms, p = 0.003) LV walls. T2 mapping showed reduction in LV septal wall (53 ± 4ms vs 52 ± 3ms, p = 0.005). ECV showed significant reduction from baseline to 6-month follow-up (29.9 ± 3,3% vs 28.2 ± 3.5%, p = 0.0001).

Conclusions:
For the first time, we observe favorable changes in CMR ECV, T1 and T2 mapping induced by benznidazole therapy in chronic Chagas disease patients. These findings suggest that there may be an opportunity to decrease fibrosis/inflammation in chronic CD patients with the use of this therapeutic approach.
Abstract 11799: Sex Disparities in Characteristics and Outcomes in Patients Admitted With Takayasu Arteritis
Authors: Aggarwal Shruti , Memon Rahat A , Dhaliwal Jasninder S , Ramphul Kamleshun , Sombans Shaheen , Ravalani Abhimanyu , Sakthivel Hemamalini
Published: December 2023

Introduction:
Takayasu Arteritis (TA) is a rare form of chronic and progressive granulomatous vasculitis, mainly affecting the aorta and its branches. It is known to be more prevalent in young females of childbearing age. Our study compares potential disparities between Males and Females with TA.

Methods:
Our study focused on patients diagnosed with TA admitted between 2016-2020 via the National Inpatient Sample. We compared the prevalence of different comorbidities between Males and Females . Logistic models allowed us to evaluate any differences between outcomes between the two groups.

Results:
We found 7210 patients with TA in the United States, comprising 1575 (21.8%) males and 5635(78.2%) females. Females were older (mean age 45.67 years) than Males( mean age 43.29 years, p<0.01), but with a lower mean Charlson Comorbidity Index (CCI) score (2.45 in females and 2.75 in males, p<0.01). Considerable differences in patient characteristics were also observed, as described in Table 1. Overall Males were also more likely than females to report events of aortic aneurysms (aOR 1.959, 95% CI 1.607-2.389, p<0.01), aortic dissections (aOR 3.147, 95% CI 2.337-4.238, p<0.01), acute kidney injury (AKI) (aOR 1.589, 95% CI 1.344-1.879, p<0.01), acute limb ischemia (aOR 1.896, 95% CI 1.138-3.160, p=0.014), and death (aOR 1.381, 95% CI 1.012-1.883, p=0.042). However, no differences were noted in events of major adverse cardiac events (MACE) (aOR 1.028, 95% CI 0.838-1.257, p=0.807).

Conclusions:
Males had less prevalence of TA than Females but still reported a higher likelihood of complications of aortitis, i.e., Aortic aneurysms as well as dissection. The greater incidence of AKI in males may be linked to direct insult to the vessels or secondary to their comorbidities. Even though no differences in MACE were seen between the two sexes, male patients had higher mortality.
Abstract 11897: Admission Rates for Pediatric Supraventricular Tachycardia From the Emergency Department Are Affected by Primary Insurance Payor: An Analysis of the NEDS Database
Authors: Hakimi Mathew , Mondal Antara , Ampah Steve , Obyrne Michael L , Janson Christopher
Published: December 2023

Introduction:
Supraventricular tachycardia (SVT) is the most common arrhythmia in children and often requires emergency department (ED) care. Recent data highlight disparities in access to care for pediatric patients with SVT, though the association of socioeconomic factors with ED outcomes remains unclear.

Hypothesis:
Outcomes of ED encounters for pediatric SVT will differ by insurance payor.

Methods:
We performed a retrospective cohort study utilizing encounter-level data from the 2006-2018 US Nationwide Emergency Department Sample (NEDS). All encounters for patients age 0-18 years with a primary diagnosis of SVT were evaluated, excluding those with diagnoses of congenital heart disease or cardiomyopathy. The primary exposure was insurance payor: private vs. public. The primary outcome was hospital admission/transfer. Secondary outcomes included inpatient length of stay (LOS), procedures (cardioversion, catheter ablation), and mortality. Logistic regression models evaluated the association of payor with outcomes, including the following covariates: age, hospital teaching status, hospital region, patient residence, and patient income.

Results:
A total of 38,896 ED encounters were analyzed: median age 11.5 years (IQR 6-15); 48% male; 53% private payor, 38% public payor. Encounters with public payor had a higher rate of admit/transfer than private (24% vs. 18%, p<0.0001). There were no differences in LOS (2.5 days public vs. 1.8 days private, p= 0.6) or procedures by payor; there were no mortalities. In multivariate analysis, public payor was an independent predictor of admission/transfer (OR 1.6, 95% CI 1.2-2.2). Patient age was also associated with admission/transfer, with all age groups less likely to undergo admission/transfer compared to age < 1 year: age 1-4, OR 0.3, 95% CI 0.2-0.6; age 5-8, OR 0.1, 95% CI 0.1-0.2; age 9-12, OR 0.1, 95% CI 0.1-0.2; age 13-18, OR 0.1, 95% CI 0.1-0.2.

Conclusions:
This analysis demonstrates that public payor is associated with higher rates of hospital admission/transfer for pediatric SVT, independent of age. Though we cannot evaluate why publicly insured patients are admitted more often, it may be due to more severe illness caused by delays in care for SVT. If so, this should be a target for intervention.
Abstract 11936: Cardiorenal Prognostic Significance of IGFBP-7 Concentrations in Chronic Heart Failure: Findings From EMPEROR-Pooled
Authors: Mohebi Reza , Januzzi James L ,   EMPEROR Committees and Investigators
Published: December 2023

Introduction:
Insulin-like growth factor binding protein-7 (IGFBP-7) is a biomarker of tissue senescence with a role in heart failure (HF) pathophysiology. We examined the association of IGFBP-7 with risk of HF hospitalization or cardiovascular (CV) death and progression of renal disease in the EMPEROR-Reduced and EMPEROR-Preserved Trials.

Methods:
IGFBP-7 was measured in serum samples in the placebo and empaglifozin arms at baseline (N= 561, 564), 12 weeks (N=558, 557) and 52 weeks (N=355, 358). IGFBP-7 was measured using Roche Cobas Elecsys assay within the Biomarker Research Agreement of Boehringer Ingelheim, the sponsor of the EMPEROR trials and Roche Diagnostics International Ltd. Association between IGFBP-7 and risk of HF hospitalization or CV death, estimated glomerular filtration rate (eGFR) slope, and renal composite outcome of sustained eGFR reduction ≥40% or end-stage renal disease were evaluated using multivariable modeling.

Results:
Study participants with IGFBP-7 levels in the third tertile had a higher risk clinical profile compared to those with lower values. Empagliflozin was not meaningfully associated with change in IGFBP7 at 12 or 52 weeks. In Cox proportional hazards models adjusted for clinical variables, N-terminal pro-B type natriuretic peptide and high-sensitivity cardiac troponin T, baseline IGFBP-7 values above the second tertile predicted a higher risk of HF hospitalization or CV death (HR: 2.00 95% CI 1.28-3.10, p=0.002), higher rate of eGFR decline (β estimate: -2.45, 95% CI: -3.40 - -1.50, p for trend =0.005) and higher risk of renal composite endpoint (HR: 4.66, 95% CI: 1.61-13.53, p=0.005). Empagliflozin reduced risk for CV death/HF hospitalization irrespective of baseline IGFBP-7 (p-trend across IGFBP-7 tertiles=0.26). Concentrations of IGFBP-7 were moderately correlated with other prognostic HF biomarkers of tissue remodeling including fatty acid binding protein-3, growth differentiation factor-15, and angiopoietin-2.

Conclusions:
IGBP-7 was correlated with worse clinical presentation and associated with adverse cardiovascular outcomes even in models adjusted for conventional biomarkers. Empagliflozin did not significantly affect IGFBP-7 levels over time.
Abstract 11954: Predictors of Adverse Outcome in STEMI Patients Post-PCI With Cardiogenic Shock Requiring Intra-Aortic Balloon Pump Support
Authors: Mann Sabrina A , alhalaseh saleh , Alziadin Nmair , T Raju Apoorva , Al Wahadneh Omar
Published: December 2023

Introduction:
Cardiogenic shock is a serious complication of ST-segment elevation myocardial infarction (STEMI), however clinical and demographic factors may further impact outcomes. This study investigated how age, gender, income, comorbidities, and arrhythmias affect mortality of STEMI patients receiving intra-aortic balloon pumps (IABP) for management of cardiogenic shock.

Methods:
This retrospective study used the National Inpatient Sample (NIS) database from 2016 to 2020. We identified STEMI admissions as the principal diagnosis and cardiogenic shock as the secondary diagnosis. Patients who received IABP support were included using the ICD-10 Procedure Coding System (PCS) code 5A02210. Logistic linear regression was used to analyze the data while adjusting for confounding variables such as age, sex, and comorbidities.

Results:
Of the 24,915 admissions with STEMI requiring IABP post PCI, the average age was 65, 29.5% were female, 28.8% died and 51.7% patients had congestive heart failure. The highest mortality rate was associated with liver disease, followed by left bundle branch block, age over 65, ventricular fibrillation, renal failure, female gender, peripheral vascular disease (PVD), and ventricular tachycardia (table 1). Income in the bottom 25
th
percentile also had increased mortality.

Conclusion:
This study identified several predictors of adverse outcomes in post-PCI STEMI patients with cardiogenic shock requiring IABP support, including ventricular fibrillation, ventricular tachycardia, left bundle branch block, peripheral vascular disease, renal failure, liver disease, age 65 or older, female, and low income. These findings may aid in the management of STEMI patients with cardiogenic shock by allowing healthcare providers to identify patients at high risk for adverse outcomes and tailor their treatment accordingly.
Abstract 11995: Contemporary Guideline-Directed Medical Therapy (GDMT) for Heart Failure is Associated With A Reduced Incidence of New-Onset Atrial Fibrillation
Authors: Tokutome Masaki , Matsukawa Ryuichi , Itonaga Junpei , Koga Eiichi , Hara Ayano , Kisanuki Hiroshi , Sada Masashi , Okabe Kosuke , Okahara Arihide , kawai Shunsuke , Ogawa Kiyohiro , Matsuura Hirohide , Mukai Yasushi
Published: December 2023

Backgrounds:
Heart Failure (HF) is a risk factor for new-onset atrial fibrillation (AF), and the new-onset AF is associated with a worse prognosis in HF patients. It has been reported that renin-angiotensin system inhibitor (RASi), β-blocker, mineral-corticoid receptor antagonist (MRA) and Sodium-glucose cotransporter 2 inhibitors (SGLT2i) prevent the new-onset AF in HF patients. However, significance of contemporary guideline-directed medical therapy (GDMT) for HF (RASi/ARNI + β-blocker + MRA + SGLT2i) on new-onset AF is unknown. We investigated the impact of GDMT for HF on new-onset AF.

Methods and Results:
We retrospectively studied the long-term (The mean follow-up was 603 ± 410 days) incidence of new-onset AF in HFrEF and HFmrEF patients without episode of AF (n=410) admitted to our hospital due to decompensated HF between 2015 and 2022. Patients were divided into 2 groups; patients treated with ≦2 HF drugs (n=192) and patients with ≧3 HF drugs (n=218) after discharge. The incidence of new-onset AF was significantly fewer in the ≧3 HF drugs group (HR 0.36, 95%CI 0.16-0.82). A multivariate analysis revealed that ≧3 HF drugs use was an independent negative predictor of new-onset AF (HR 0.38, 95%CI 0.15-0.98, P=0.04). Even after a propensity score matching of clinical variables, the incidence of new-onset AF was consistently fewer in the ≧3 HF drugs group (HR 0.39, 95%CI 0.15-1.00, P=0.04). Finally, comparing between patients with and without new-onset AF, new-onset AF was significantly associated with re-hospitalization for HF (HR 5.41, 95%CI 3.32-8.89, P<0.001) and all-cause death (HR 2.36, 95%CI 0.98-5.68, P=0.047) in the studied population.

Conclusion:
The contemporary GDMT is associated with a reducing of new-onset AF in HF patients, which may be involved in the better outcomes with it.
Abstract 12028: Long-Term Repeat Intervention Incidence in Octogenarians After Robotic-Assisted Coronary Artery Bypass Grafting
Authors: Dokollari Aleksander , Sicouri Serge , Ramlawi Basel , Gemelli Marco , Kjelstrom Stephanie , Fatehi Hassanabad Ali , Goldman Scott , Montone Georgia , Torregrossa Gianluca , Rodriguez Roberto , Wertan Mary Ann , Sutter Francis
Published: December 2023

Introduction:
We aim to analyze long-term repeat intervention incidence in octogenarians undergoing robotic-assisted coronary artery bypass grafting (CABG).

Hypothesis:
We hypothesize that robotic-assisted CABG has a low incidence of repeat intervention compared to other clinical trials.

Methods:
All consecutive octogenarians (500 patients) undergoing robotic-assisted left internal thoracic artery (LITA) harvesting and CABG through a 4-cm left minithoracotomy with LITA to left anterior descending (LAD) artery anastomosis between 2005-2021 in a single center were included. Hybrid coronary revascularization (HCR) consists in robotic-assisted CABG followed by percutaneous coronary intervention (PCI) with DES in a non-LAD target within 7-days from the operation.

Results:
Preoperatively, mean age was 83 (±2.9) year-olds, and mean STS-PROM risk score was 3.6% (2.1- 6.6). Intraoperatively, 478 (95.6%) patients received 1 LITA, 14 (12.8%) received bilateral ITA, and 8 (1.6%) a saphenous venous graft. A total of 303 (60.6%) patients received multiple arterial revascularizations while 140 (28%) received HCR. A total of 376 (75.2%) patients were extubated in the operating room. Postoperatively, 2 (0.4%) patients experienced non-fatal stroke, 6 (1.2%) had reoperation for bleeding, and 12 (2.4%) had renal failure. There was no 30-day mortality while 1 (0.2%) patient had PCI with DES on LITA-LAD anastomosis due to graft failure. Mean-follow-up was 2.9-years while incidence of all-cause death was 103 (20.6%) patients, MACCE 136 (27.2%), stroke 8 (1.6%), myocardial infarction 16 (3.2%), and repeat intervention with stents 39 (7.8%) were low. There was no repeat surgical intervention while PCI with drug-eluting stents for new coronary disease was 15/39 (38.4%) patients.

Conclusions:
Robotic-assisted CABG in octogenarians evidenced a 7.8% incidence of repeat intervention with stents.
Abstract 12043: Neutrophil Extracellular Traps in Heart Tissue Drive Cardiac Dysfunction and Adverse Outcomes in Dilated Cardiomyopathy
Authors: Ichimura Shohei , Misaka Tomofumi , Ogawara Ryo , Nishiura Kazuto , Tani Tetsuya , Tomita Yusuke , Sato Yu , Miura Shunsuke , Yokokawa Tetsuro , Sato Takamasa , Oikawa Masayoshi , Kobayashi Atsushi , Yoshihisa Akiomi , Takeishi Yasuchika
Published: December 2023

Background:
Neutrophil extracellular traps (NETs) have emerged as crucial contributors to cardiovascular diseases, but the significance of NETs in heart failure remains unclear.

Aims:
We aimed to clarify the relevance of NETs in myocardial tissue in heart failure.

Methods and Results:
We studied consecutive 62 patients with idiopathic dilated cardiomyopathy (DCM) who underwent endomyocardial biopsy. Using immunohistochemistry, NETs were identified in heart tissue by detecting the colocalization of citrullinated histone H3, neutrophil elastase, and DAPI. DCM patients had significantly higher numbers of NETs per tissue area and per neutrophil compared to control subjects without heart failure (n=11,
Figure A
) (P < 0.05 and P < 0.05, respectively). When categorizing DCM patients based on the presence or absence of NETs, patients with NETs (n=32) had lower left ventricular ejection fraction and higher B-type natriuretic peptide levels than those without NETs (P < 0.05 and P < 0.05, respectively). Kaplan-Meier analysis revealed that NETs-positive DCM patients had lower event-free survival rates from the composite of cardiac events including cardiac deaths, decompensated heart failure, and left ventricular assist device implantation over a median 768-day follow-up (
Figure B
). In a multivariable Cox proportional hazard model, the presence of NETs independently associated with the risk of adverse cardiac events (hazard ratio, 5.96; P < 0.05).
Ex vivo
analysis revealed that NETs-containing conditioned medium from wild-type neutrophils impaired mitochondrial oxygen consumption in mouse adult cardiomyocytes (P < 0.05), while genetic ablation of peptidyl arginine deiminase 4, a molecule essential for NETs formation, abolished this effect.

Conclusion:
NETs in myocardial tissue contribute to cardiac dysfunction and adverse outcomes in DCM patients, potentially through mitochondrial dysfunction of cardiomyocytes.
Abstract 12063: Ad Hoc Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From the PROGRESS-CTO Registry
Authors: Simsek Bahadir , Rempakos Athanasios , Kostantinis Spyridon , Karacsonyi Judit , Rinfret Stephane , Jaber Wissam , Nicholson William , gorgulu sevket , Alaswad Khaldoon , Khatri Jaikirshan , Poommipanit Paul , Aygul Nazif , Krestyaninov Oleg , Khelimskii Dmitrii , URETSKY BARRY F , GOKTEKIN OMER , Dattilo Philip , Potluri Srinivasa , Al-Azizi Karim , Mutlu Deniz , Mastrodemos Olga C , Rangan Bavana V , Allana Salman S , Sandoval Yader , Burke M Nicholas , Brilakis Emmanouil S
Published: December 2023

Introduction:
Although discouraged, ad hoc chronic total occlusions (CTO) percutaneous coronary intervention (PCI) is occasionally performed.

Methods:
We examined the clinical, angiographic characteristics and procedural outcomes of patients who underwent ad hoc CTO PCI in the Prospective Global Registry for the Study of CTO Intervention (PROGRESS-CTO, NCT02061436).

Results:
Of the 10,998 patients included in the registry, 899 (8.2%) underwent ad hoc CTO PCI. The incidence of ad hoc CTO PCI decreased from 18% in 2016 to 3% in 2022. Ad hoc CTO PCI patients had a lower prevalence of comorbidities and less complex angiographic characteristics demonstrated by lower J-CTO score (1.9 ± 1.2 vs 2.4 ± 1.3, p<0.001). In these patients, PROGRESS-CTO major adverse cardiovascular events (MACE) (1.9 ± 1.4 vs 2.5 ± 1.7), mortality (1.2 ± 1.0 vs 1.6 ± 1.1), and perforation (1.5 ± 1.2 ± 2.2 vs 1.5) scores were lower (p<0.001). Technical success was similar between the groups (86%). MACE were lower in the ad hoc CTO PCI group (0.8% vs 2.0%, p=0.009). Ad hoc CTO PCI was not associated with MACE after adjusting for potential confounders, odds ratio: 0.69 (95% confidence interval, 0.30-1.57). In patients with higher J-CTO scores, planned CTO PCI was associated with higher technical success (p<0.001) (Figure).

Conclusions:
Approximately 8% of CTO PCI procedures are performed ad hoc, usually in less complex lesions and patients with lower complication risk. While ad hoc CTO PCI might be appropriate for carefully selected cases, a staged approach is recommended for most CTO PCI.
Abstract 12116: Identifying the Underlying Causes of Unexplained Dyspnea at High Altitude Using Normobaric Hypoxia With Transthoracic Echocardiography
Authors: Stepanek Jan , Mahmoud Ahmed K. , FARINA JUAN M , Chao Chieh-Ju , Alsidawi Said , Ayoub Chadi , Barry Timothy , Wraith Rachel E , Brown Lisa S , Radavich Michael S , Curtisi Pamela J , Hartzendorf Patricia C , Lasota Elizabeth M , Umetsu Kyley N , Peterson Jill M , Karlson Kristin E , Breznak, BSN Karen K , Lester Steven J , Arsanjani Reza
Published: December 2023

Introduction:
Exposure to high altitude results in hypobaric hypoxia, leading to physiological changes in the cardiovascular system that may result in dyspnea. Hypoxic simulation testing (HSTs) simulates changes in physiology that occur at a specific altitude.

Hypothesis:
The use of transthoracic echocardiography (TTE) during HST can detect the raise in right-sided pressures revealing underlying causes of high-altitude dyspnea.

Methods:
We performed a prospective observational study of consecutive patients with unexplained dyspnea at high altitude who were referred to an aerospace medicine program at a single institution between August 2021 and March 2023. Reduced FiO
2
was administered for 20 minutes to simulate altitude levels specific to patients’ history. TTE images were obtained at baseline and during peak hypoxia to evaluate right ventricular (RV) function, RV systolic pressure, and any possible shunts.

Result:
The study included 27 patients, with a mean age of 64.7 ±14.4 years and 14 (51.9%) females. No significant abnormalities were seen on baseline TTE and no significant differences in blood pressure and heart rate between baseline and hypoxia simulation were detected. Notably, RV systolic pressure increased at peak hypoxia, while RV systolic function declined as shown by a decrease in S’ wave and TAPSE (
Figure 1
). Additionally, right to left shunts were present in 19 (70.4%) patients. Of these, four patients (21.1%) had shunts present at baseline with no changes at peak hypoxia, while the severity of shunts increased at peak hypoxia in eight cases (42.1%) and the shunts were only evident during hypoxia in seven patients (36.8%).

Conclusion:
TTE during HST provides valuable information by revealing the presence of symptomatic, sustained shunts and confirming the decline in RV hemodynamics explaining dyspnea at altitude. Further studies are necessary to establish the optimal clinical role of this physiologic method.
Abstract 12139: Left Ventricular Myocardial Work in Patients With Chagas Disease From a Quaternary Hospital in Brazil
Authors: dos Santos Felix Alex , Kasal Daniel B , Lustosa Rodolfo De Paula D , Rey Helena C , Bittencourt Marcelo I , Neves de Albuquerque Felipe , Sales Ana Luiza F , SPINETI PEDRO P , MOURILHE ROCHA RICARDO
Published: December 2023

Background:
Left ventricular (LV) function assessment in patients (pts) with Chagas disease (ChD) is challenging. LV ejection fraction (LVEF) as a marker of myocardial contractility in these pts has issues, and alterations in myocardial deformation (MD) may occur in early stages of cardiac disease (CD) before the decline of LVEF. LV global longitudinal strain (GLS) is a good parameter to evaluate LV MD, but is dependent on afterload. LV myocardial work (MW) is a technique which integrates afterload to the calculation of GLS

Purpose:
To analyze LV function using MW in pts with ChD

Methods:
39 pts with positive serology for ChD, (74,4% women, age 68,8 ± 9,7) followed in a quaternary Brazilian hospital, were divided in groups of stages of CD: G1 - normal Echocardiography (Echo) and ECG, G2 - alterations in ECG a/o Echo, normal LVEF, G3 - reduced LVEF. LV MW was measured integrating GLS with non-invasive blood pressure as an afterload index, for generation of pressure-strain loops by specific software(fig.1). Global work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE) were measured.

Results:
11 pts (28,2%) were in G1, 14 (35,9%) in G2, and 14 (35,9%) in G3. In overall population median values of MW were within normal ranges: GWI = 1760mmHg% (>968), GCW = 2046mmHg% (>1550), GWW= 178mmHg% (<331), GWE = 92 (>83). Values of GWI, GCW and GWE were significantly lower and GWW was higher in G3, compared to G1 and G2, translating into less LV mechanical efficiency (ME) in these pts with more advanced CD (table 1). Despite LVEF and GLS similar between G1 and G2, values of GCW were 12% lower in G2 compared to G1, which could point to a tendency of early alterations in these pts, although not reaching statistical significance (p > 0,05).

Conclusion:
In pts with advanced stages with Chagas CD (G3) there were significant alterations in parameters that evaluate ME, with reduced values of GWI, GCW and GWE, with higher GWW