bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 9747: Gastrointestinal Bleeding in Acute Myocardial Infarction Patients Undergoing Coronary Artery Bypass Graft Surgery; A National Study
Authors: Verma Renuka , Kumar Nomesh , Ramphul Kamleshun , Ramphul Yogeshwaree , Kumari Komal , Sombans Shaheen , Mejias Stephanie G , Ali Syed Rashid , Lohana Petras , Arti Fnu
Published: June 2023

Introduction:
While gastrointestinal (GI) bleeding is a possible surgical complication, there is a paucity of information on the incidence and risk among Acute Myocardial Infarction (AMI) patients undergoing Coronary artery bypass graft surgery (CABG).

Methods:
We queried the 2019 National Inpatient Sample to identify cases of GI bleeding among AMI patients undergoing CABG. Patient characteristics and risk factors were estimated using multiple logistic regression.

Results:
Our analysis found that 48590 patients with AMI underwent CABG, and 865 (1.8%) gastrointestinal bleeding events were recorded. It was more prevalent among Whites (aOR 1.462, p=0.012) and Hispanics (aOR 2.436, p<0.01), patients of ages >60 (aOR 1.591, p<0.01), with a diagnosis of supraventricular tachycardia (aOR 1.688, p<0.01), paroxysmal atrial fibrillation (aOR 1.670, p<0.01), cirrhosis (aOR 3.363, p<0.01), acute kidney injury (aOR 1.864, p<0.01), covered by Medicare (aOR 1.494, p=0.010), and with peripheral vascular disease (aOR 1.731, p<0.01). Meanwhile, patients with hypertension (aOR 0.573, p<0.01), smokers (aOR 0.744, p<0.01), hyperlipidemia (aOR 0.477, p<0.01), and obesity (aOR0.799, p<0.01) reported lower risks. A mortality rate of 12.7% was observed. Females (aOR 1.967, p=0.017), cirrhosis (aOR 5.521, p<0.01), acute kidney injury (aOR 3.657, p<0.01), ventricular tachycardia (aOR 2.002, p=0.033), paroxysmal atrial fibrillation (aOR 2.535, p<0.01), and hyperkalemia (aOR 2.397, p=0.013) predisposed to greater inpatient deaths, while diabetes (aOR 0. 491, p<0.01) and hyperlipidemia (aOR 0. 198, p<0.01) showed a reduced risk. Finally, a higher overall risk of inpatient death was seen among AMI patients who underwent CABG if they had GI bleeding (aOR 2.674, p<0.01).

Conclusions:
GI bleeding can lead to a poor outcome among AMI patients who underwent CABG during their hospitalization. We also found several factors predisposing these patients to such events.
Abstract 9764: Simultaneous Assessment of Coronary Flow Reserve and Left Ventricular Strain During Vasodilator Stress Measured by
13
N-ammonia Positron Emission Tomography/Magnetic Resonance Imaging
Authors: Kiko Takatoyo , Endo Keiichiro , Fukushima Kenji , Takeishi Yasuchika
Published: June 2023

Introduction:
Hybrid positron emission tomography (PET)/magnetic resonance imaging (MRI) is able to yield important information regarding molecular and functional imaging in a one-stop examination. The aim of this study was to investigate the relationship between coronary flow reserve (CFR) and left ventricular longitudinal strain (LVLS) using simultaneous acquisitions on hybrid
13
N-ammonia PET/MRI.

Methods:
Thirty-eight patients with suspected coronary artery disease (CAD) who underwent
13
N-ammonia PET/MRI were enrolled. Vasodilator stress was induced by intravenous injection of adenosine. CFR was calculated from dynamic acquisition of
13
N-ammonia PET. LVLS was evaluated by feature-tracked MRI. Myocardial flow reserve (MFR) and LVLS values were based on a 17-segment model and three coronary territories, left anterior descending artery (LAD), left circumflex artery (LCx), and right coronary artery (RCA).

Results:
We analyzed 577 myocardial segments in the left ventricle. LVLS under vasodilator stress was significantly increased compared with LVLS at rest in myocardial segments with MFR ≥2.0 (P<0.01), whereas there were no changes between LVLS under stress and LVLS at rest in the segments with MFR < 2.0 (P=0.24). Similarly, regional values of LVLS under vasodilator stress were significantly increased compared with those measured at rest in the coronary territories of LAD (P<0.01), LCx (P<0.01), and RCA (P<0.01) with MFR ≥ 2.0, whereas there were no differences between LVLS at rest and LVLS under stress in those territories with CFR < 2.0 (P=0.45). These data revealed that left ventricular strain under vasodilator stress was impaired in segments with lower CFR.

Conclusion:
Simultaneous assessment of regional CFR and LV strain was feasible using by
13
N-ammonia PET/MRI.
13
N-ammonia PET/MRI was able to detect not only impaired CFR but also morphological abnormalities, which may improve diagnostic and predictive capacity in patients with CAD.
Abstract 9771: Trends in Blood Pressure Treatment Intensification in Older Adults With Hypertension in the United States, 2008-2018
Authors: Chiu Nicholas , Chiu Leonard , Aggarwal Rahul , Raber Inbar , Bhatt Deepak L , Mukamal Ken J
Published: June 2023

Introduction:
Hypertension control has worsened in recent years, yet trends for appropriate blood pressure intensification practices for older adults is unknown.

Hypothesis:
We determine the proportion of ambulatory visits where older adults with hypertension were appropriately intensified on anti-hypertensives over the past decade. We hypothesize that treatment intensification may not have improved over time.

Methods:
Data from National Ambulatory Medical Care Survey (NAMCS, 2008-2018) were used. NAMCS is a nationally representative sample of ambulatory medical visits. Adults ages 60 years or older were included. Appropriate antihypertensive intensification was defined as the addition of an antihypertensive for a blood pressure reading above target. We examined appropriate intensification by blood pressure targets set by the ACC/AHA, the ESC, and the ACP/AAFP guidelines for older adults. Further, we defined an additional all-inclusive criterion meeting all three guidelines.

Results:
From 2008-2018, appropriate treatment intensification by ACC/AHA guidelines occurred at 11.1% (95% CI:9.8-12.5%) of visits, decreasing from 13.6% (95% CI:15.6-28.7%) of visits in 2008-2009 to 10.4% (95% CI:10.9-26.4%) in 2015-2018. Appropriate intensification by ESC occurred at 14.2% (12.1-16.6%) of visits over 2008-2018, decreasing from 16.9% (95% CI:13.5-21.0%) in 2008-2009 to 12.5% (95% CI:7.4-20.3%) from 2015-2018. Appropriate intensification by AAFP/ACP occurred at 18.9% (16.2-22.0%) of visits over 2008-2018, decreasing from 24.7% (95% CI:20.2-29.0%) in 2008-2009 to 14.9% (95% CI:9.0-23.7%) from 2015-2018. By all-inclusive criteria, intensification trended towards worsening with time: odds ratio: 0.93 (95% CI:0.87-1.00; p=0.07).

Conclusions:
Appropriate treatment intensification for older adults with hypertension in the US was suboptimal over the past decade despite growing trial evidence showing beneficial effects for intensive blood-pressure control in older adults. Strategies to mitigate therapeutic inertia are needed, and clinical practices should make concerted efforts to improve appropriate treatment intensification in older adults.
Abstract 9785: Association Between Initiation of Cardiac Rehabilitation After Hospitalization for Heart Failure and 1-Year Survival Among Medicare Beneficiaries
Authors: Lee Kristen , Lindenauer Peter , Priya Aruna , Pekow Penelope , D’Aunno Thomas , Mazor Kathy , Pack Quinn R , Khan Sadiya S , Lagu Tara
Published: June 2023

Introduction:
Cardiac rehabilitation (CR) reduces hospitalization risk in patients with reduced ejection fraction heart failure (HF). The CR HF mortality impact remains unclear.

Methods:
We identified Medicare beneficiaries diagnosed with HF between 2014-2017 who were hospitalized with HF diagnosis in 2017. Primary exposure was CR initiation within 180 days of HF hospitalization discharge in 2017; primary outcome was all-cause mortality within 1 year. In full cohort,Cox regression modeled time from discharge to death with time-varying exposure to CR, adjusting for unbalanced characteristics and propensity to initiate CR. We applied propensity score weighting and stratification methods. Using propensity score for CR receipt and survival to the day of CR initiation, we matched 1730 patients who started CR within 180 days to 1730 who did not and modeled survival from CR initiation. We examined association between CR initiation and mortality following CR in a landmark cohort and assessed dose-response relationship between session number and mortality. We conducted sub-group analyses limited to patients with systolic HF ICD code.

Results:
Of 116,302 HF patients (mean age 82 years, 54% women) admitted at 4,119 hospitals, only 1.5% initiated CR in 6 months. Overall 35% of patients died within 1 year; 10.7% among those who initiated CR within 180 days and 35.2% among those who did not. CR initiation within 180 days was associated with survival benefit in full and landmark cohorts as well as in the propensity-matched analysis hazard ratio [HR]: 0.39, 95% CI: 0.33-0.47;
P
< 0.001 Among patients who initiated CR within 180 days and survived more than 180 days, completing 3 CR sessions was associated with lower death risk HR: 0.91 95% CI, 0.87- 0.95. In patients with systolic HF, HR: was 0.47, 95% CI 0.41-0.54;
P
< 0.001.

Conclusions:
Few patients (1.5%) with HF enrolled in CR within 180 days after hospitalization. CR initiation was associated with reduced 1-year mortality risk.
Abstract 9795: The Association Between Albumin and Outcomes in Heart Failure and Secondary Mitral Regurgitation: Insights From the COAPT Trial
Authors: Feng Kent Y , Ambrosy Andrew P , Li Ditian , Kong Jeremy , Zaroff Jonathan , Mishell Jacob , Ku Ivy A , Scotti Andrea , Coisne Augustin , Redfors Bjorn , Mack Michael , Abraham William T , Lindenfeld Joann , Stone Gregg
Published: June 2023

Background:
Low serum albumin level is associated with increased morbidity and mortality in numerous chronic diseases, but the relationship between albumin and outcomes in heart failure (HF) and secondary mitral regurgitation (SMR) has not been previously described.

Methods:
The Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (COAPT) trial was a multicenter, randomized, controlled, parallel-group, open-label study that evaluated the efficacy and safety of transcatheter edge-to-edge repair (TEER) with the MitraClip + guideline-directed medical therapy (GDMT) versus GDMT alone in patients with symptomatic HF and moderate-to-severe or severe SMR. Baseline serum albumin level was obtained at enrollment.

Results:
Among 614 patients enrolled in COAPT, 559 (91.0%) had a baseline albumin level (median 4.0 g/dL [interquartile range: 3.7-4.2 g/dL]). Patients with albumin <4.0 g/dL compared with ≥4.0 g/dL were older (mean 73.7 years vs. 70.6), more likely to have ischemic cardiomyopathy (65.0% vs. 555.2%) and a hospitalization within the prior year (72.9% vs. 62.9%). After multivariable adjustment, patients with albumin <4.0 g/dL compared to ≥4.0 g/dL had higher 2-year rates of all-cause mortality (41.7% vs. 28.8%; HR 1.46, 95% CI 1.06-2.02; p=0.022; Figure Panel A), but no significant differences in the composite of all-cause mortality or hospitalization for HF (HHF), HHF alone, or all-cause hospitalizations (all p>0.05; Figure Panel B). There were no significant interactions between albumin and the relative efficacy of TEER + GDMT versus GDMT alone with respect to clinical outcomes (all p-interactions >0.05; Figure Panel B).

Conclusions:
In patients with HF and severe SMR enrolled in the COAPT trial, low serum albumin levels were common and were an independent predictor of mortality. MitraClip treatment provided a similar benefit regardless of baseline albumin level.
Abstract 9799: Financial Status, Fatalism and Self-Care of Cardiovascular Disease Risk Factors Among Rural Adults Living in Socioeconomically Distressed Areas
Authors: Hodges Dustin , Biddle Martha J , Chung Misook L , Feltner Frances J , Lennie Terry A , Miller Jennifer , Mudd Martin Gia , Smith Jennifer , Wu Jiarong R , Moser Debra K
Published: June 2023

Background:
Adults with fewer financial resources often have poor self-care. Fatalism is a belief that events in life are determined by outside forces. Rural adults commonly have fewer financial resources than urban dwellers and are often stereotyped as fatalistic about their health. Our aim was to determine whether fatalism mediates the association of financial status with cardiovascular disease (CVD) self-care in rural adults in economically distressed areas.

Hypothesis:
We hypothesized that those with fewer financial resources would have poorer self-care and fatalism would mediate this relationship.

Methods:
We enrolled 1118 adults (mean age 53 ± 15 years; 75.6% female) at risk for CVD. Financial status was reflected by individuals’ perceptions of how well they made “ends meet” with their financial resources (i.e., more than enough, enough, or not enough to make ends meet), fatalism by CVD-Fatalism Instrument, and self-care of CVD risk factors by Medical Outcomes Study-Specific Adherence Scale. We used conditional process analysis with PROCESS macro and 5000 bootstrap samples.

Results:
Financial status was associated directly with self-care. Those with with not enough to make ends meet (C' = -3.51, p = .003) and those with enough (C' = -1.57, p = .016) compared to those with more than enough had worse self-care. Fatalism was associated with self-care. Those hose with higher levels of fatalism had worse self-care (b = -1.78, p = .001). Financial status was indirectly associated with self-care through fatalism. Compared to those with more than enough, those with not enough (indirect effect = -.269, CI = -.609, -.021) and enough (indirect effect = -.182, CI = - .376, -.041) had higher fatalism levels and thus worse self-care.

Conclusion:
Poor financial status drives fatalism in rural dwellers, which in turn results in poor self-care.
Abstract 9801: Late Onset Phrenic Nerve Injury Post PPM Placement
Authors: As Sayaideh Mohammad , Matthia Eldon L , Jones Riley
Published: June 2023

Background:
Transient phrenic nerve paralysis is a known immediate complication of cardiac implantable electronic device implants. Proposed mechanisms include direct nerve injury during venipuncture, nerve compression from a mediastinal hematoma, or local anesthetic instillation. However, the authors present a rare case of phrenic nerve injury as a late complication of permanent pacemaker (PPM) placement after excluding other etiologies.

Case Summary:
A 39 year-old female with a history of hypertension and diabetes underwent dual-chamber permanent pacemaker (PPM) placement due to sinus node dysfunction. She presented a year later with a subacute onset of progressive dyspnea on exertion that worsened over the four days prior to admission. Dyspnea was associated with right neck and shoulder pain. Chest radiography at presentation showed elevated right hemidiaphragm. A fluoroscopic sniff test confirmed right hemidiaphragm paralysis. Chest computed tomography revealed no anatomic abnormalities. Magnetic resonance imaging of the cervical spine showed no spinal cord or nerve root lesions. Electromyography confirmed right phrenic nerve injury as the etiology of elevated right hemidiaphragm. She continued to experience exertional dyspnea and orthopnea. Thoracic surgery scheduled the patient for insertion of a diaphragmatic pacemaker. She was discharged pending her surgery.

Discussion:
Late onset diaphragmatic paralysis due to phrenic nerve injury is a rare complication of PPM insertion. The mechanism of phrenic nerve injury from PPM insertion is unclear. It may result from direct or indirect phrenic nerve micro-injury by the relatively stiff pacemaker leads or peel-away introducers, resulting in slow Wallerian degeneration of the phrenic nerve fibers. In addition, microhematomas, undetected by chest computed tomography, inflammatory or thrombotic changes of the subclavian vein or the superior vena cava may influence the adjacent phrenic nerve.
Abstract 9811: A Novel Analysis of Patient, Provider, and Utilization Factors Associated With an Electronic Health Record (EHR)-Embedded Guideline-Directed Medical Therapy Score
Authors: Martyn Trejeeve , Saef Joshua , Khot Umesh N , Brophy Todd , Martinez Kathryn A , West Lucianne , Cari Cristiani , Block-Beach Hunter , Hohman Jessica , Kapadia Samir R , Tang Wai Hong W , Babiuch Christopher , Estep Jerry , Starling Randall
Published: June 2023

Introduction:
Health systems have had limited success in improving on the suboptimal use of medical therapy for heart failure (HF).

Hypothesis:
We sought to understand if Guideline-Directed Medical Therapy (GDMT) scoring in combination with EHR-based HF registry data could be utilized to delineate system factors associated with higher or lower GDMT scores.

Methods:
We performed a cross-sectional analysis of patients with ≥ 2 outpatient encounter for heart failure (HF) in the prior 24 months. Total GDMT score was based on the absence, presence, and dosage of pertinent medications (Fig.1). Multivariable logistic regression analysis of patient, provider, and acute utilization factors associated with GDMT score above the median was performed.

Results:
Among 6,454 HF patients who had a documented echocardiographic LVEF ≤40 in in the prior 24 months, we observed that having a GDMT score ≥ 4 was associated with having a HF physician encounter (OR:2.02, 95%CI: 1.77-2.32), having two cardiology visits (any sub-specialty) within the prior 12 months (OR: 1.44,95%CI: 1.26-1.65), fewer all-cause (OR: 0.91, 95%CI: 0.87-0.94) and HF-specific hospitalizations (OR:0.64, 95%CI: 0.53-0.75), and higher eGFR (OR: 1.18, 95%CI: 1.12-1.25) (Fig. 2).

Conclusions:
GDMT scoring that is embedded in an EHR-Based Heart Failure Registry can help to define system-specific system factors associated with, the use of optimal HF medical therapy. Connectivity to cardiology, particularly HF specialists, was independently associated with higher GDMT score in our health system.
Abstract 9829: Exercise-Induced CITED4 Expression is Necessary for Regional Remodeling of Cardiac Microstructural Tissue Helicity
Authors: Eder Robert , Van Den Boomen Maaike , Yurista Salva , Rodríguez Yaiel , Islam Mohammad R , Chen Yin-Ching I , Trager Lena , Coll-Font Jaume , Cheng Leo , LI Haobo , Rosenzweig Anthony , Wrann Christiane , Nguyen Christopher
Published: June 2023

Background:
Exercise promotes cardioprotective benefits for the adult heart; however, the exercise-induced molecular and microstructural remodeling processes have yet to be fully characterized. This study sought to define the spatial interactions between molecular and microstructural remodeling that are induced by exercise and might result in cardiac protection by evaluating regional correlations of expressed cardiac CITED4, a transcriptional co-regulator previously shown to increase in hearts with exercise, and myocardial architecture mapping with diffusion tensor cardiac MRI (DT-CMR).

Methods:
In the first cohort, male wild-type C57BL/6J mice were housed with or without free access to a running wheel. In the second cohort, CITED4 cardiomyocyte specific knockout (KO) mice were generated along with control littermates (fl/fl mice) and the methods were repeated. After 8-weeks of voluntary wheel running, the mice were euthanized and their hearts were excised, scanned at 14.1 T MRI, and sectioned. RNA Fluorescent
in situ
hybridization (RNA-FISH) was used to detect CITED4 and all slides were counterstained with DAPI. All experiments were performed under approval of the IACUC of the Massachusetts General Hospital.

Results:
The exercised group of cohort 1 showed a significant increase in CITED4 expression and microstructural DT-CMR markers in the lateral wall of the left ventricle (p<0.05 for all). In particular, myofiber orientation, evaluated as helicity (helix angle transmurality), was significantly increased within the exercised group (p<0.05), indicating beneficial changes in the myocardial microstructure. Cohort 2 demonstrated that CITED4 was required for these changes to take place, as the CITED4 knock out exercise group did not replicate the same structural changes seen in cohort 1, while the fl/fl control mice reproduced the expected changes in tissue microstructure following exercise.

Conclusion:
Exercise induces a regional increase in CITED4 expression that coincides with microstructural remodeling. In addition, we have demonstrated that CITED4 is required for these beneficial exercise-induced microstructural changes to occur.
Abstract 9835: Multi-Modality Imaging Assessment of Microbubbles and Cerebral Emboli in Left Ventricular Pulsed Field Ablation
Authors: Alkukhun Laith , Sandhu Uday Gajjandra , Kheiri Babikir , Zhao Yan , Chiang Kirby , Castellvi Quim , Stenzel Peter , woltjer randall , BARAJAS RAMON , Nazer Babak
Published: June 2023

Introduction:
Pulsed field ablation (PFA) may have a superior safety profile compared to other ablation technologies, but the high-voltage electrical fields have the potential to cause gaseous microbubbles (MB), which may be associated with cerebral emboli. In this study, we evaluate the MB burden of a monopolar, biphasic PFA system (CENTAURI, Galaxy Medical), that delivers a waveform designed to limit MB generation.

Methods:
After anticoagulation with heparin, healthy and chronic MI swine (30 day survival after 90 minute coronary balloon occlusion) underwent PFA in the LV using an open-irrigated focal catheter under intra-cardiac echocardiography (ICE) guidance and monitoring of MBs. Two additional healthy control swine received 0.5 and 1 ml of air MBs through the lumen of the ablation catheter. Swine underwent brain MRI before and after PFA (or control air MB injection) with T1, T2, FLAIR, ADC and susceptibility- and diffusion-weighted imaging (DWI) interpreted by a neuroradiologist blinded to treatment group. Gross pathology and histology of brains with any MRI findings was performed by a neuropathologist.

Results:
Four healthy swine underwent 50 PFA applications and 5 chronic MI swine underwent 74 applications. No PFA-related MB formation was noted on ICE. Both control swine developed multiple acute emboli in the left thalamus and caudate on DWI, ADC and FLAIR brain MRI sequences in response to air MB injection (Figure). Of the 9 PFA swine, there were no ADC nor FLAIR sequence abnormalities. There was one instance of a hyperintense focus in the left putamen on the DWI trace image, but absence of ADC or FLAIR affirmation suggested it was artifact. Gross pathology and histopathology of this region did not detect any abnormalities (Figure).

Conclusion:
Catheter air MB injection caused MR-detectable cerebral emboli in swine. Focal monopolar biphasic PFA with CENTAURI does not generate MBs observable on ICE, and did not cause cerebral emboli in healthy or post-infarct LVs.
Abstract 9850: Predictors of Inpatient Mortality for Patients Admitted With Traumatic Femoral Artery Injury
Authors: Mohamad Alahmad Mohamad Alhoda , Goyal Amandeep , Morad Abdulrahman
Published: June 2023

Introduction:
Femoral artery injury (FAI) after trauma is one of the most common vascular injuries evaluated in Trauma Centers. Data at the national level are lacking.

Methods:
We used Nationwide Inpatient Sample (NIS) data for 2016-2019 in our cross-sectional study. First, we extracted all cases older than 18-years that include the diagnosis of FAI. Then, we kept only the observations with a primary diagnostic category suggestive of trauma or cases that have a concurrent presence of trauma-related diagnoses. Baseline characteristics were evaluated as well as predictors of inpatient mortality. Exclusion criteria included transferred out cases and elective admissions. Appropriate survey and domain analyses were applied to obtain and study national estimates using SAS 9.4.

Results:
We identified 3,850 weighted admissions that contain a diagnosis of traumatic FAI. The mean age of surviving patients was 37-years (84% were male) in comparison to the mean age of 45-years (80% were male) for non-survival (p<0.0001). African American patients represented the majority (40%), followed by Caucasians (36%). Most patients were of low socioeconomic status (47%) and receiving Medicaid (37%). In-patient mortality was high, 9.5%, and more than 75% of death was within a week of admission. Although documentation of associated femoral vein, nerve, or femur injuries was not statistically significant, age >40-years, presence of comorbidities (especially cirrhosis), and intubation (indicating critical illness with acute respiratory failure or low Glasco-coma scale) were associated with inpatient mortality (p<0.0001). Lower extremity amputation (BKA/ AKA) was associated with higher mortality (not statistically significant). Neither open nor percutaneous femoral artery procedures (individually or combined) were associated with favored outcomes. On the other hand, thigh procedures on musculoskeletal tissues (muscles, fascia, femur) were associated with higher survival. The Area Under the Curve (AUC) of our model was 0.84.

Conclusions:
Our study suggests that young African American males are more likely to have traumatic FAI. Independent mortality predictors are age, Elixhauser comorbidities, and femur, muscular, soft tissues, and fascia procedures.
Abstract 9851: Lnc
APAT
Promotes Lipid Phagocytosis and Monocyte Adhesion in Atherosclerosis Through miR-107/NOR1 Axis
Authors: Kamili Adalaiti , Han Shuang , Chen Yu , Zhang Weili
Published: June 2023

Introduction:
Atherosclerosis is a chronic inflammatory disorder characterized by excessive lipid deposition in the arterial intima. MicroRNA (miR)-107 was reported to inhibit the development of atherosclerosis, but it is unclear whether miR-107 regulate lipid phagocytosis of macrophages.

Hypothesis:
In the present study, we hypothesized that the potential interaction of
lncAPAT
and miR-107 may regulates the development of atherosclerosis.

Methods and results:
We used real-time quantitative PCR (RT-qPCR) to determine the expression levels of miR-107 in peripheral blood mononuclear cells (PBMCs) from patients with coronary artery atherosclerosis and control subjects without plaque. Bioinformatics analysis, dual-luciferase reporter and RNA immunoprecipitation (RIP) assays were used to verify the interaction between lncRNA atherosclerotic plaque instability-associated transcript (lnc
APAT
) and miR-107. We found that miR-107 was highly expressed in the PBMCs of patients with atherosclerotic plaques, and that lnc
APAT
acted as a competing endogenous RNA to decrease the expression of miR-107. In addition, miR-107 inhibited monocyte adhesion and lipid phagocytosis of macrophages, while lnc
APAT
promoted monocyte adhesion and lipid phagocytosis via binding with miR-107. Further experiments identified neuron-derived orphan receptor 1 (NOR1) as a downstream target of miR-107 that was up-regulated by lnc
APAT
. In vitro and in vivo studies revealed that lnc
APAT
promoted monocyte adhesion and lipid phagocytosis of macrophages by functioning as a ceRNA to up-regulate NOR1 by sponging miR-107.

Conclusions:
Our study demonstrates that
lncAPAT
regulates the miR-107/NOR1 axis to promote lipid phagocytosis by macrophages, indicating that it may serve as a potential therapeutic target for atherosclerotic disease.
Abstract 9873: Erroneous Electrocardiographic Interpretations and Its Clinical Implications
Authors: Shaik Ayesha , Patel Nirav , Alvarez Chikezie , Panza Gregory , Baker William , Mcmahon Sean , Kluger Jeffrey
Published: June 2023

Introduction:
Advancement of artificial intelligence (AI) has aided clinicians in the interpretation of electrocardiograms (ECGs) serving as an essential tool to provide rapid triage and care. However, in some cases, AI can misinterpret an ECG and may mislead the interpreting physician. Therefore, we aimed to describe the rate of ECG misinterpretation and its potential clinical impact in patient's management

Methods:
We performed a retrospective descriptive analysis of misinterpreted ECGs and its clinical impact from May 28, 2020 to May 9, 2021. An electrophysiologist screened ECGs with confirmed diagnosis of atrial fibrillation (AF), sinus tachycardia (ST), sinus bradycardia (SB), intraventricular conduction delay (IVCD), and premature atrial contraction (PAC) that were performed in the emergency department. We then classified the misinterpreted ECGs as pseudo-AF, ST, SB, IVCD, or PAC into the correct diagnosis, and reviewed the misinterpreted ECGs and medical records to evaluate inappropriate use of antiarrhythmic drugs (AAD), beta-blockers (BB), calcium channel blockers (CCB), anticoagulation, or resource utilization of cardiology and/or electrophysiology (EP) consultation.

Results:
A total of 4,969 ECGs were screened with diagnoses of AF (2,282), IVCD (296), PAC (972), SB (895), and ST (638). Among these, 101 ECGs (2.02%) were misinterpreted. Pseudo-AF (58%) was the most common followed by pseudo-PAC (15%), pseudo-ST (13%), pseudo-IVCD (8%) and pseudo-SB (6%). Patients with misinterpreted ECGs were aged 76.6±11.6yr with male (52.5%) predominance and hypertension being the most prevalent (83.2%) comorbid condition. The misinterpretation of ECGs led to the inappropriate use of BB (19.8%), CCB (5.0%), AAD therapy (7.9%), anticoagulation (30.7%) in patients with pseudo-AF, as well as inappropriate resource utilization including cardiology (41.6%) and EP (8.9%) consultations.

Conclusions:
Misinterpretation of ECGs may lead to inappropriate medical therapies and increased resource utilization. Therefore, it is essential to encourage physicians to carefully examine AI interpreted ECG’s, especially those interpreted as having AF.
Abstract 9882: Mortality Risk Factors Among Takotsubo Syndrome Patients In The United States; Insight From The National Inpatient Sample
Authors: Kumar Nomesh , Verma Renuka , Ramphul Kamleshun , Ramphul Yogeshwaree , Kumari Komal , Sombans Shaheen , Mejias Stephanie G , Ali Syed Rashid , Joynauth Jyotsnav , Lohana Petras , Arti Fnu
Published: June 2023

Introduction:
Takotsubo cardiomyopathy, also known as Takotsubo syndrome and Broken heart syndrome, is a temporary cardiovascular abnormality affecting the apical region primarily. While most cases are believed to affect post-menopausal women, we sought to address the potential risk factors for mortality in the United States.

Method:
Our retrospective study included patients with a principal diagnosis of Takotsubo Syndrome (ICD-10 code “I51. 81”) from the 2019 National Inpatient Sample (NIS). We searched and compared various variables and risk factors for in-hospital death via their appropriate ICD-10 codes. The Multivariable analysis allowed us to identify and adjust possible risk factors for mortality. Finally, the mean age, mean length of stay(LOS), and mean charges were also calculated.

Results:
In 2019, there were 8920 cases of Takotsubo syndrome requiring hospitalization.140 patients died (1.57%). Females (aOR 0.499, 95% CI: 0.320-0.779, p<0.01) were less likely to die compared to males, while those with diabetes (aoR: 3.087, 95% CI: 2.140-4.454, p<0.01), hypertension (aOR: 1.716, 95% CI: 1.118-4.454, p=0.013), and chronic pulmonary disease (aOR: 1.545, 95% CI: 1.063-2.246, p=0.023) were risk factors for in-hospital mortality. Moreover, patients dying were older (mean age 75.54 vs. 67.11), had a prolonged (LOS 6.11 days vs. 3.56 days), and costlier (mean charge $132,421.97vs. $54,792.96) stay.

Conclusions:
While Takotsubo affected more females than males, males showed a higher mortality risk. Additional risk factors included diabetes, hypertension, and chronic pulmonary disease.
Abstract 9896: Living Alone is a Poor Prognostic Factor of Mortality Among Patients With Acute Myocardial Infarction
Authors: Fukumoto Daichi , Kanda Daisuke , Ikeda Yoshiyuki , Tokushige Akihiro , Ohmure Kenta , Sonoda Takeshi , Anzaki Kazuhiro , Ohishi Mitsuru
Published: June 2023

Introduction:
Acute myocardial infarction (AMI) has been a major cause of death worldwide. Recently, living alone as a proxy for social isolation has been considered to increase the risk of cardiovascular disease. We thus investigated the impact of living alone on mortality in AMI patients.

Methods:
Subjects comprised 277 AMI patients who underwent percutaneous coronary intervention (PCI). Associations between all-cause death after PCI and baseline characteristics including living alone and Global Registry of Acute Coronary Events (GRACE) risk score, which is widely used for estimating mortality in AMI patients, were assessed.

Results:
Eighty-three patients (30%) were living alone and 194 patients (70%) were not. Median duration of follow-up was 1153 days (interquartile range, 560-1566 days). Thirty patients died after PCI including 20 cardiac deaths. Patients living alone showed higher incidences of both all-cause and cardiac deaths compared with patients not living alone (18% vs. 8%, p = 0.019 and 14% vs. 4%, p = 0.004, respectively). Multivariate Cox proportional hazards regression analysis modeling using relevant factors from univariate analysis showed living alone [hazard ratio (HR), 2.60; 95% confidence interval (CI), 1.20-5.62; p = 0.016] and GRACE risk score (HR, 1.02; 95%CI, 1.01-1.03; p = 0.003) correlated significantly with all-cause death. The interaction of GRACE risk score and living alone showed a value of p = 0.25. The optimal cut-off on the receiver-operating characteristic curve of GRACE risk score for predicting all-cause death was 162. Cox proportional hazards modeling using GRACE risk score and living alone revealed that patients living alone with GRACE risk score ≥162 showed a significantly greater risk of all-cause death than patients not living alone with GRACE risk score <162 (HR 11.50; 95%CI 5.59-23.67; p < 0.001).

Conclusions:
Among AMI patients, living alone represents an independent risk factor for all-cause death after PCI, separate from GRACE risk score. In addition, AMI patients living alone with high GRACE risk scores may experience an additively increased risk of mortality after PCI.
Abstract 9899: Effects of Ambient Air Pollutants on Progression of Cardiac Structure and Function in the Echocardiographic Study of Latinos (Echo-SOL)
Authors: Leiser Claire L , Sotres-Alvarez Daniela , Spalt Elizabeth W , Hurwitz Barry E , Daviglus Martha L , Shook-Sa Bonnie , Rodriguez Carlos J , Kaufman Joel D
Published: June 2023

Background:
Air pollutants may affect cardiac function; effects preceding clinical diagnosis of heart failure are not understood. We assessed longitudinal associations between fine particulate matter (PM
2.5
), nitrogen dioxide (NO
2
) and cardiac structure and function among 1,660 participants in the Echocardiographic Study of Latinos, in the Hispanic Community Health Study/Study of Latinos.

Hypothesis:
Air pollution is associated with longitudinal changes in subclinical structure/function.

Methods:
Left ventricular (LV) mass index, relative wall thickness, average global longitudinal strain (GLS), LV ejection fraction, e’, left atrial (LA) volume index, E/e’ ratio, and diastolic function grades were assessed by echocardiogram. Air pollution concentrations were estimated from validated spatio-temporal models at home locations, as mean concentrations of PM
2.5
and NO
2
for the year

prior to clinical visit 1 (V1, 2008-2011) and 2 (V2, 2015-2018). A mixed effects model was used to jointly model cross-sectional and longitudinal relationships between time-varying air pollution and continuous measures of CF, adjusted for baseline physical activity, gender, education, age, BMI, SBP, DBP, statin use, diabetes, and hypertension status and time-varying smoking and alcohol use, with random intercepts for clinical center and primary sampling unit.

Results:
Participants’ mean age was 56.4 years at V1; mean follow-up was 6.52 years. Mean PM
2.5
was 10.3 μg/m
3
at V1 and 8.8 μg/m
3
at V2. Mean NO
2
was 17.4 ppb at V1 and 14.3 at V2. Per interquartile range of pollutant, higher PM
2.5
and NO
2
were associated with a 0.52% (95% CI -0.16, 1.11) and 0.98% (95% CI 0.13, 1.23) increase in GLS, respectively. NO
2
was associated with -1.07% (95% CI -2.24, 0.10) decrease in LV ejection fraction. PM
2.5
was associated with a 0.75 (95% CI 0.39, 1.12) increase in e’ and a 1.25 (95% -1.95, -0.56) decrease in E/e’ ratio. No other associations with air pollution and echo measures were found.

Conclusion:
These findings suggest that air pollution is associated with longitudinal changes in GLS, LV ejection fraction, e’, and E/e’ ratio in a US Hispanic/Latino cohort, an important understudied population. Air pollution may represent a modifiable risk factor in the development of clinical heart failure.
Abstract 9902: Relationship Between Preoperative Hemodynamics, Fenestration, and Fontan Hospitalization Length of Stay
Authors: Hill Garick D , Ferguson Matthew , Flores Saul , Ginde Salil , Hill Kevin D , Johansen Michael , Newburger Jane W , Gao Zhiqian , Cnota James F
Published: June 2023

Introduction:
Using a multi-center Pediatric Heart Network dataset linking surgical (STS) and catheterization (IMPACT) data, we sought to evaluate factors associated with use of Fontan fenestration and the impact of fenestration on post-Fontan length of stay (LOS) in the context of pre-operative hemodynamics.

Methods:
Centers participated using a data sharing agreement permitting linkage of de-identified STS and IMPACT data. Patients 2-6 years old at Fontan surgery from 2010-2020 with catheterization <1 year prior were included. Multivariable logistic regression was used to evaluate factors associated with fenestration. Full model covariates included center, ventricular morphology, Fontan type (lateral tunnel [LT] vs extracardiac conduit [ECC]), age at Fontan, sex, race and hemodynamic variables. Post-Fontan LOS was analyzed by fenestration status across hemodynamic variables using non-parametric ANOVA and by multivariable linear regression.

Results:
The cohort included 702 patients (7 centers). Median age at Fontan was 3.4 years (IQR 2.7-4.2) with fenestration used in 465 (66.2%). In multivariable modeling, factors associated with fenestration included center (range 27-93% use, p<0.0001), Fontan type (OR 14.1 for LT, p<0.0001) and ventricular morphology (P=0.007). Addition of hemodynamic variables (mean pulmonary artery pressure [mPAP], end diastolic pressure and pulmonary vascular resistance index) did not improve the model (Figure). While Fenestration was independently associated with a decreased LOS (p=0.04), exploratory analysis demonstrated the benefit was most pronounced at mPAP ≥ 13mmHg (median 9 vs 12 days, p=0.001).

Conclusions:
There is wide center variability in use of Fontan fenestration that is not explained by pre-operative hemodynamics. Fenestration is independently associated with shorter LOS but those with mPAP ≥ 13 mmHg at pre-Fontan catheterization benefit the most from fenestration with shorter post-Fontan LOS.
Abstract 9921: E-cigarette Use and Markers of Endothelial Function in Diverse Young Adults From New York City: The VapeScan Study
Authors: Jiang Enoch X , Sangapalaarachchi Dona N , LoIacono Nancy J , Ilievski Vesna , Hawkins Diane , Oelsner Elizabeth , Navas-Acien Ana , Shimbo Daichi
Published: June 2023

Introduction:
Compared to traditional tobacco use, the cardiovascular effects of e-cigarette use, or vaping, an increasing behavior especially among young adults, are poorly understood. The ongoing VapeScan Longitudinal Study aims to determine the effects of vaping on participants’ endothelial health and other subclinical markers.

Hypothesis:
We hypothesized that e-cigarette use (alone or in combination with smoking), compared to never using e-cigarettes or smoking products, is associated with an adverse profile in markers of endothelial health in a diverse cohort of healthy young adults.

Methods:
We recruited 132 participants, aged 18-49 and residing in the greater New York area, between May 2021 and May 2022. Participants who were pregnant, had a history of cardiovascular or respiratory disease, smoked but did not vape, or formerly vaped, were excluded. Endothelial health was assessed via endothelium-dependent vasodilation using an EndoPAT2000 machine. Reactive Hyperemia Index (RHI) and Framingham RHI (fRHI) values were computed from the results. Participants missing EndoPAT data (n=3) were excluded from analysis, leaving 129 participants (17 vaping/never smoking, 19 vaping/former smoking, 24 vaping/smoking (dual use), and 69 never vaping/never smoking).

Results:
Participants’ median age was 26 years and 61% were female. Participants classified as vaping/never smoking and dual users were younger than the other groups (Table). Median levels of RHI and fRHI were lowest for dual users, although the differences across the four groups were not statistically significant (one-way ANOVA p-value = 0.27 for RHI and 0.10 for fRHI). Participants’ vaping/smoking status was not associated with RHI or fRHI in linear regression models adjusted for age and sex.

Conclusions:
Preliminary findings from the VapeScan Study support that subclinical measures of endothelial function are a promising tool to help identify early effects of tobacco product use in young adults.
Abstract 9997: Atrial Fibrillation and Supraventricular Tachycardia Are Predictors of Inpatient Mortality in Mechanically Ventilated Patients in the United States
Authors: Ehtesham Moiz , Khan Arshan , Riasat Maria , Shabbir Muhammad Asim
Published: June 2023

Objective:
Arrhythmias are a significant clinical challenge and can complicate hospital course for mechanically ventilated patients. We aimed to determine the burden of arrhythmias and their effect on inpatient outcomes in mechanically ventilated patients in the US.

Methods:
The national inpatient sample was retrospectively studied (2015-2019) to identify all mechanically ventilated patients aged >17. We further identified the following arrhythmias within each admission: atrial fibrillation (AF), non-sustained ventricular tachycardia (NSVT), supra-ventricular tachycardia (SVT), atrioventricular block (AVB) and ventricular fibrillation (VF). Primary outcomes were inpatient mortality rate, hospital length of stay (LOS) and total cost for each type of arrythmia. Demographic (age, sex, race) and clinical information (history of hypertension, stroke, myocardial infarction, obesity) was recorded. Data was studied in STATA 15 and multivariate logistic regression was used to estimate adjusted odds ratios (AOR) reported with p-value (significance=<0.05).

Results:
Our analysis included 1,745,867 weighted discharges of mechanically ventilated patients. Mean age was 65 years (56% male, 69% Caucasian). Most frequent arrythmia was AF (63% of all patients) and least common was AVB (11%). AF, VF, and SVT were associated with an increase in mortality (AOR: 3.52, 2.78, 1.45 respectively, p < 0.001). NSVT, AF, and SVT were associated with an increase in hospital LOS of 4.5, 3.2, and 2.8 days respectively (AOR 3.31, 2.94, 1.75 respectively, p<0.001). The adjusted inpatient cost was highest in patients with NSVT ($21,567, p<0.05). AVB and NSVT were not associated with an increase in mortality (p<0.05). On gender and race stratification, African American males had the highest mortality rate secondary to AF and VF (AOR: 3.54 and 4.21 respectively, p<0.001).

Conclusion:
We demonstrate that atrial fibrillation, ventricular fibrillation, and SVT are independently associated with increased mortality in mechanically ventilated patients. We also show that NSVT is associated with increase in hospital LOS in these patients. African American mechanically ventilated males had the highest mortality rates secondary to atrial and ventricular fibrillation.
John Calvin
Authors: McGee Iain
Published: June 2023

This article provides an overview and critique of John Calvin’s understanding of non-Christian philosophy and religions. I suggest Calvin’s thinking differed in three significant ways from early and medieval church belief. First, he gave a far less prominent place to the role of the demonic in religions. Second, Calvin rejected both traditional and Renaissance versions of the prisca theologia. Finally, it is noted that he explained glimmers of truth in non-Christian religion and philosophy by developing a rather unique understanding of human enlightenment as gifting from a specific role of the Logos rather than as enlightenment by the Logos per se.
Not a Bare Permission
Authors: Luke Sean
Published: June 2023

How does God ordain creaturely evil while preserving their freedom? In this article, I compare Calvin’s views on God’s relationship to evil with those of the English Reformed. I survey Calvin’s views from his commentaries and the Institutes, arguing that they share several salient features with the views of the English Reformed. However, I also note that the English Reformed more readily use the language of “contingency” and “divine permission” with respect to creaturely evil; this difference is reflected in the language of Westminster, which more closely reflects the language of the English Reformed instead of Calvin.
The Construal of Specificity in Modification in English
Authors: Hamawand Zeki
Published: June 2023

This study investigates the significance of the construal of specificity in syntax, particularly in modification. In Cognitive Grammar, conceptualizing a situation can be either specific or conversely schematic. Namely, the two conceptualizations focus attention on greater or lesser detail of certain aspects of a situation. Each conceptualization describes the same content but in a peculiar way, and thus results in a distinct meaning. Making use of the language resources, the speaker can map the conceptualizations into different modes of modification: syntactic device by which a noun is accompanied by preceding and/or following modifiers. The aim of the study is to show that the use of a linguistic expression is motivated by the particular construal imposed on its conceptual content relative to communicative purposes. One of the key findings of the study is that specificity intensifies a description and makes it concrete, whereas schematicity attenuates a description and makes it abstract.
Development and characterization of polyvinyl chloride/poly lactic acid blend based biodegradable polymeric films
Authors: Singh Sanjay Kumar , Chowdhury Abhishek , Thakur Rajeev Ranjan , Mangaraj Shukadev , Sami Rokayya , Aljahani Amani H. , Aljuraide N. I. , Helal Mahmoud
Published: June 2023

The present work aimed to decrease the environmental contamination, which is caused by solid non-degradable plastics waste. To overcome this serious global concern, the development, and characterization of a bio-degradable film by blending different proportions of the natural polymers
poly lactic acid (PLA) to the conventional petroleum polymer has been done. In this process, PLA was synthesized in the lab by condensation method and polyvinyl chloride (PVC)/PLA blends film was developed by solution casting method with and without adding compatibilizer as poly methyl methacrylate
(PMMA). The large domain size and two separate glass transition temperatures in the results indicated an immiscible blend form without a compatibilizer. The film developed with 30% PLA blended with PVC showed the highest biodegradability and it was observed that approximately 50% of the film
was degraded in 8 months. The shelf lives of tomatoes stored under PVC-PLA blended film were found to be 21 days at ambient temperature (25 °C) with preserved quality attributes.