bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 11668: Trends in Statin Use for Primary Prevention by Race/Ethnicity and ASCVD Risk in the US: 2013-2020
Authors: Jacobs Joshua A , Addo Daniel K , Zheutlin Alexander R , Derington Catherine G , Essien Utibe R , Navar Ann M , Hernandez Inmaculada , Lloyd-Jones Donald M , King Jordan B , Rao Shreya , Herrick Jennifer S , Bress Adam P , Pandey Ambarish
Published: June 2023

Introduction:
The burden of ASCVD is higher among non-Hispanic Black (NHB) and Hispanic vs. non-Hispanic White (NHW) US adults, potentially due to differences in use of preventive medications such as statins. We evaluated patterns in statin use for primary prevention by self-identified race/ethnicity (NHB, NHW, and Hispanic) according to 10-year ASCVD risk using the Pooled Cohort Equations.

Methods:
This serial, cross-sectional analysis included NHANES participants from 2013-2020 age 40-75 years without ASCVD, diabetes, LDL ≥190 mg/dL, or missing data for estimation of 10-year ASCVD risk. Statin use was determined by interviewer pill bottle review. Poisson regression estimated adjusted prevalence ratios for statin use associated with race/ethnicity and ASCVD risk categories (5-<7.5%, 7.5-<20%, and ≥20%); all analyses incorporated NHANES survey weights.

Results:
A total of 3,088 participants representing 37.8 million US adults (mean age 62 y, 38% women, 13% NHB, 11% Hispanic, 76% NHW) were included. Overall, statin use was lower in NHB (20.0%) and Hispanic (15.4%) than NHW adults (27.9%). Within all ASCVD risk categories, the odds of statin use were significantly lower among NHB and Hispanic vs. NHW adults (Figure). Within each race/ethnicity group, the use of statins increased across increasing ASCVD risk strata, with a significantly greater utilization among those with ASCVD risk ≥20% (vs. ASCVD risk 5-<7.5%) (Figure). Statin use was stable over time and within race/ethnicity and risk strata (p>0.05 for all NHANES cycles).

Conclusions:
Overall statin use for primary prevention based on 10-year ASCVD risk was low in all race/ethnicity groups regardless of predicted ASCVD risk, though undertreatment was most severe in NHB and Hispanic adults. Improvements in equitable utilization of statins for primary prevention in Black and Hispanic adults are needed to address disparities in ASCVD.
Abstract 11701: Generalizability of the Victoria Trial and the US FDA Label for Vericiguat to Patients Hospitalized for Heart Failure With Reduced Ejection Fraction in the United States
Authors: Khan Mohammad S , Xu Haolin , Fonarow Gregg C , Lautsch Dominik , Hilkert Robert J , Tan Xi , Allen Larry A , Devore Adam D , Alhanti Brooke , Pina Ileana L , Albert Nancy M , Butler Javed , Greene Stephen J
Published: June 2023

Background:
In January 2021, vericiguat was approved by US FDA to reduce the risk of cardiovascular death and HF hospitalization following a recent worsening HF event based on results of the VICTORIA trial. Limited data are available characterizing generalizability to US clinical practice.

Methods:
We studied patients hospitalized with HF with reduced ejection fraction (HFrEF) <45% across 525 sites in the Get With The Guidelines (GWTG)-HF registry between January 2014 - December 2020. We excluded patients who left against medical advice, transferred to an acute care facility or to hospice care, or had missing critical data elements. We applied approximate FDA label criteria (excluding eGFR<15 mL/min/1.73 m
2
, dialysis, or heart transplantation or mechanical circulatory support) and eligibility criteria of the VICTORIA trial to the GWTG-HF sample.

Results:
Among 241,057 patients with EF<45% in GWTG-HF, 221,730 (92%) could be candidates for vericiguat under the FDA label and 92,249 (38%) would have been eligible for VICTORIA. The most frequent reason for ineligibility in the FDA label was eGFR<15 mL/min/1.73 m
2
(n=13,747; 5.7%). Sex, race, and clinical characteristics were generally similar between GWTG-HF registry participants, FDA label candidates, and VICTORIA trial eligible patients (
Table
). Among patients age ≥65 years linked to Medicare, 12-month mortality, HF hospitalization, and all-cause hospitalization were similar across the three groups.

Conclusions:
These data from a large US hospitalized HF registry suggest that more than 9 out of 10 patients hospitalized for HFrEF may be candidates for vericiguat based on the FDA label. Patients meeting and not meeting VICTORIA trial eligibility criteria had similar characteristics and outcomes, supporting generalizability of the FDA label and the VICTORIA trial to US practice. Medicare beneficiaries hospitalized for HFrEF and eligible for vericiguat face high post-discharge mortality and readmission rates.
Abstract 11724: Echocardiographic Predictors and Outcomes of Multiple Vegetations in Infective Endocarditis
Authors: Mishra Ajay K , Al-Seykal Ibragim , Bhattad Pradnya Brijmohan B , Sharma Nitish , George Anu Anna , Sargent Jen , Kranis Mark
Published: June 2023

Introduction:
Infective endocarditis (IE) is a life-threatening infection with an annual mortality of 40%. Embolic events reported in up to 80% of patients. Vegetations of > 10 mm size are associated with increased embolic events and poor prognosis. There is a paucity of literature on the association of multiple vegetations with outcomeHypothesis: We aimed to study the echocardiographic (ECHO) features and outcomes associated with the presence of multiple vegetationsMethods: In this retrospective, single-center, case-control study patients diagnosed with IE were recruited from June 2017 to June 2019. A total of 84 patients were diagnosed to have IE, of whom 67 with vegetation were identified. Baseline demographic, clinical, laboratory, and ECHO parameters were reviewed. Outcomes that were studied included recurrent admission, embolic phenomenon, and mortality.

Results:
Twenty-three (34%) patients were noted to have multiple vegetations, 13 (56.5 %) were male and 10 (43.5%) were female. The mean age of these patients was 50. Eight (35%) had a prior episode of IE. ECHO features of moderate to severe valvular regurgitation (OR:4), presence of pacemaker lead (OR:4.8), impaired LV relaxation, (OR:4), and elevated PASP (OR:2.2) are associated with higher odds of multiple vegetations. Of these moderate to severe valvular regurgitation (p: 0.028), pacemaker lead (p-0.039) and impaired relaxation (p-0.028) were statistically significant. These patients were noted to have an increased association of recurrent admissions (OR:3.6), recurrent bacteremia (OR:2.4), embolic phenomenon (OR:2.5), ICU stay (OR:2.8), hypotension (OR:2.1), surgical intervention (OR:2.8) and device removal (OR:4.8). Of this device removal (p-0.039) and recurrent admissions (0.017) were statistically significantConclusions: This study highlights the associations of echocardiographic predictors and outcomes in patients with IE having multiple vegetations. ECHO features of moderate to severe regurgitation, presence of pacemaker lead, impaired LV relaxation, and elevated PASP and outcomes including recurrent admissions and device removal were found to be associated with multiple vegetations
Abstract 11726: Atrial Arrythmia Recurrence in Patients After Left Atrial Ablation is Associated With Epicardial Connections and Directly Correlated to Reduced Left Ventricular Ejection Fraction
Authors: Carcora Yaser , Zhi Emily , Murthy Smitha , Li Stephanie , Adabag Selcuk , Tholakanahalli Venkatakrishna N
Published: June 2023

Introduction:
Heart Failure with Reduced Ejection Fraction has a positive association with atrial arrhythmia incidence and recurrence. However, this has not been studied in atrial fibrillation (AF) and atrial tachycardia (AT) patients who underwent left atrial radiofrequency ablation(RFA) and were subsequently found to have epicardial connections(EC).

Hypothesis:
Heart Failure with Reduced Ejection Fraction was associated with an increased recurrence of atrial tachyarrythmias in patients with epicardial connections.

Methods:
We studied 40 consecutive patients with persistent atrial arrhythmias who underwent RFA for AF and AT at our center. Epicardial connections were determined by high density mapping, missing isochrones and activation patterns. Clinical, echocardiographic and activation mapping pattern characteristics were collected.

Results:
Forty patients were found to have EC (Table 1). The association of EC and echocardiographic parameters were assessed. Reduced Left Ventricular Ejection Fraction was associated with an increased recurrence of atrial tachyarrhythmias in patients due to epicardial connections((HR:1.25(1.05-1.48)) (Table 2).

Conclusions:
Reduced Left Ventricular Ejection Fraction is positively correlated with atrial tachyarrythmia recurrence in patients due to epicardial connections.
Abstract 11756: Tracking High-Density Lipoprotein Functionality in Diabetic and Non-Diabetic Patients With Toe Amputations
Authors: Lotfollahi Zahra , Tan Joanne T , Dawson Joe , Fitridge Robert , Bursill Christina A
Published: June 2023

Introduction:
High-density lipoprotein cholesterol (HDL-c) levels have an established inverse association with cardiovascular event risk. More recently, the focus has shifted to HDL functionality as an improved metric of its predictive value and is impaired in patients with coronary arterial disease. HDL-c levels have been reported to inversely associate with the risk of amputation in patients with diabetic foot ulcers (DFUs), but whether HDL functionality is predictive of wound closure success is currently unknown.

Methods:
Eighteen diabetic and eight non-diabetic patients with toe/s amputations had blood collected at: (1) the time of surgery, (2) four weeks and (3) six months post-amputation. Wound areas were tracked until closure by 3D camera. Blood was collected from 20 healthy age and gender-matched participants. From blood, HDL was isolated and its functionality tested via (1) cholesterol efflux from macrophages, and (2) anti-inflammatory and (3) pro-angiogenic effects in endothelial cells.

Results:
Wound closure was faster in non-diabetic than diabetic amputation patients at four weeks (186.6%,
P
=0.12). Diabetic HDL promoted less cholesterol efflux at four-weeks (37.8%,
P
<0.05) and six-months (45.6%,
P
<0.01) post-amputation, compared to non-diabetic HDL. Incubation of non-diabetic HDL with endothelial cells caused greater reductions in inflammatory markers
RELA
(51.4%,
P
<0.01),
CCL5
(46.9%,
P
<0.01),
CCL2
(15.3%,
P
<0.05) and
ICAM-1
(33.1%,
P
<0.05) than non-diabetic HDL. Non-diabetic HDL elicited greater endothelial cell angiogenesis with increased Matrigel tubule number at four weeks post amputation (46.15%,
P
<0.05), compared to diabetic HDL. There were significant correlations between the rate of wound closure and HDL-c levels (R
2
= +0.62,
P
<0.05),
CCL2
(R = -0.64,
P
<0.05) and
ICAM-1
(R = -0.71,
P
<0.05).

Conclusion:
In toe amputation patients, HDL-c levels and inflammatory HDL functionality markers associate with the rate of wound closure. HDL from diabetic patients had impaired cholesterol efflux capacity, reduced anti-inflammatory effects and was less able to promote angiogenesis, compared to non-diabetic HDL.
Abstract 11771: Impact of Overweight/Obesity/Higher Body Mass Index on Long-Term Major Adverse Cardiac Outcomes Following Chronic Total Occlusion-Percutaneous Coronary Interventions- A Systematic Review and Meta-Analysis
Authors: Desai Rupak , Vasavada Advait , Mahajan Kshitij , guddeti ananth vallabh , Surpur Swapnil , Raza Syed Mohammad Moosi , Patlolla Mani Chandan Reddy , Fatima Ehrima , Bambhroliya Zarna , Gbemudu Paul , Vyas Ankit
Published: June 2023

Background:
Obesity is usually associated with worse cardiovascular outcomes. However, fewer studies have evaluated its impact on long-term major adverse cardiovascular events (MACE) following CTO PCI. We conducted a meta-analysis to assess the same.

Methods:
PUBMED, Scopus, and EMBASE were systematically searched for studies reporting long-term (at least >1 year) outcomes with obesity vs no obesity in patients with CTO PCI. MACE events [all-cause mortality, cardiac mortality, revascularization, restenosis/reocclusion, recurrent angina pectoris (RAP), target-vessel myocardial infarction (MI), heart failure, cardiac death, or ischemia-driven target-vessel revascularization (TVR) were the primary endpoint. Pooled odds ratios (OR) and heterogeneity were assessed with random-effects models and I2 statistics respectively. Subgroup analysis was performed to assess the risk by age group and follow-up duration. The leave-one-study-out method was used for sensitivity analysis.

Results:
After an initial electronic search of thirty-two studies, five studies were selected, and between 2016 to 2021 selected were included in the final analysis. The sample size consisted of 5022 patients with a median age of 63. No significant impact of higher BMI/obesity was seen overall on a median duration of 2.6 yrs [OR(95% CI)= 0.95 (0.82-1.11), p=0.53, I
2
= 90.86%)]
(Fig 1).
However, on a subgroup analysis, the geriatric age group (≥65 yrs) demonstrated an "Obesity Paradox" effect on MACE after CTO PCI, [OR (95%CI)=0.64 (0.47-0.88), I
2=
42.13, p<0.01]. There was no difference in a subgroup analysis based on follow-up duration (≥3 years [OR (95%CI)=0.73 (0.42-1.27)] vs <3 years OR (95%CI)=1.04 (0.84-1.27)].

Conclusions:
Although higher BMI/obesity was not associated with overall long-term MACE in CTO PCI, the subgroup analysis demonstrated the "Obesity Paradox" (protective) effect in studies with a predominantly geriatric population.
Abstract 11784: The Estimated Appendicular Skeletal Muscle Mass Predicts Adverse Outcomes in Patients Under 65 Years With Coronary Artery Disease
Authors: nishio ryota , Tomotaka Dohi , Fukase Tatsuya , Takeuchi Mitsuhiro , Takahashi Norihito , Hirohisa Endo , Doi Shinichiro , Okai Iwao , Iwata Hiroshi , Okazaki Shinya , MIYAUCHI Katsumi , Daida Hiroyuki , Minamino Tohru
Published: June 2023

Background:
The impact of frailty, evaluated by the appendicular skeletal muscle mass (ASM) has been recognized as a predictor of adverse prognosis in elder patients with coronary artery disease (CAD). In recent years, formulas for estimating ASM using height, weight, sex, and age have been proposed for Asian population. However, a simple equation for estimating ASM has not been well validated in clinical, especially in younger patients.

Methods:
We enrolled 811 patients under 65 years with CAD who underwent percutaneous coronary intervention (PCI) at our hospital between 2010 and 2017. The mean age was 57 years and 89.6% were men. Patients were divided into 2 groups based on each ASM index (ASMI). Low ASMI was defined as the 20% lowest percentile of the study population (low ASMI; male <7.6 and female <5.5, high ASMI; male 7.6≤ and female 5.5≤). ASM was calculated by the following formula: 0.193 х bodyweight + 0.107хheight – 4.157 х gender – 0.037 х age – 2.631. Primary endpoint was 4P MACE (cardiovascular death, non-fatal myocardial infarction and non-fatal stroke and admission for heart failure).

Results:
During the median follow-up period of 5.2 years, cumulative incidence of events were significantly higher in the low ASMI group (Figure). After adjustment for important covariates, patients in the low ASMI groups had significantly higher all-cause mortality and MACE than those in the high ASMI groups (Crude; HR 1.98, 95% CI 1.16-3.24, p = 0.014, Model 1; HR 1.91, 95% CI 1.11-3.16, p = 0.02, Model 2; HR 2.23, 95% CI 1.18-4.02, p = 0.015) Conclusions: A low ASMI evaluated by a simple equation is an independent predictor of 4P MACE in younger patients with CAD.
Abstract 11785: Phenotype Features of Coronary Atheroma in Association With an Elevated Activity of Pericoronary Adipose Tissue (Insights From Computed Coronary Angiography and Near-Infrared Spectroscopy Analysis)
Authors: Kitahara Satoshi , Kataoka Yu , Miura Hiroyuki , Nishii Tatsuya , MURAI KOTA , Iwai Takamasa , Sawada Kenichiro , Matama Hideo , Honda Satoshi , Fujino Masashi , Yoneda Shuichi , Takagi Kensuke , Otsuka Fumiyuki , Asaumi Yasuhide , Fujino Yusuke , Tsujita Kenichi , Noguchi Teruo
Published: June 2023

Introduction:
Inflammation has been considered to promote atheroma instability. Coronary computed tomography angiography (CCTA) visualizes pericoronary adipose tissue (PCAT) attenuation, which reflects coronary artery inflammation. While PCAT attenuation has been reported to predict future coronary events, phenotypic features of coronary atheroma exhibiting high PCAT attenuation remains to be fully elucidated yet.

Objective:
To characterize coronary atheroma with a greater vascular inflammation.

Methods:
We retrospectively analyzed culprit lesions in 69 CAD patients receiving PCI from the REASSURE-NIRS registry (NCT04864171). Culprit lesions were evaluated by both CCTA and near-infrared spectroscopy/intravascular ultrasound (NIRS/IVUS) imaging prior to PCI. PCAT attenuation at proximal RCA (PCAT
RCA
) and NIRS/IVUS-derived plaque measures were compared in patients with PCAT
RCA
attenuation ≥ and < -78.3 HU (median).

Results:
Culprit lesions with PCAT
RCA
attenuation ≥ -78.3HU exhibited a greater frequency of maxLCBI
4mm
≥400 (66 vs. 26%, p<0.01), plaque burden ≥70% (94 vs. 74%, p=0.02) and spotty calcification (49 vs. 6%, p<0.01). whereas positive remodeling (63 vs. 41%, p=0.07) did not differ between two groups. On multivariate analysis, maxLCBI
4mm
>400 (OR=4.07; 95%CI=1.12-14.74, p=0.03), plaque burden ≥70% (OR=7.87; 95%CI=1.01-61.26, p=0.04), and spotty calcification (OR=14.33; 95%CI=2.37-86.73, p<0.01) independently predicted high PCAT
RCA
attenuation. Of note, while the presence of only one plaque feature did not necessarily elevate PCAT
RCA
attenuation (p=0.22), lesions harbouring two or more features were significantly associated with higher PCAT
RCA
attenuation (Figure).

Conclusion:
More vulnerable plaque phenotypes were observed in patients with PCAT
RCA
attenuation. Our findings suggest PCAT
RCA
attenuation as the presence of profound disease substrate, which potentially benefits from anti-inflammatory agents.
Abstract 11823: Are Disease-Specific Patient-Reported Outcomes Measures (PROMs) Used in Cardio Genetics? A Review
Authors: Van Pottelberghe Sarah , Kupper Nina , Scheirlynck Esther , Amin A.S. , Callus Edward , Biller Ruth , Hofman Nynke , Nekkebroeck Julie , Van Dooren Sonia , Hes Frederik , Wilde Arthur A , van der Crabben Saskia
Published: June 2023

Background:
Besides hard medical outcomes in patients with inherited cardiac conditions (ICC). it is crucial to focus on the patient-reported outcomes (PRO) as well. These patients may have a disease-specific need due to ICC-related distress concerning family members and reproductive choices. We evaluated which PRO scales are currently used in cardiogenetics.

Methods:
From three datasets (PubMed, PsychINFO, and Web of Science), eligible studies published between 2008-2022 were selected as described in the review protocol (PROSPERO 2021 CRD42021271384). The quality of studies was assessed (https://pubmed.ncbi.nlm.nih.gov/27082055 ) and analyzed for the primary outcome variable of patient-reported outcomes.

Results:
Eighteen out of 232 articles were selected for data extraction; 9 studies used a cross-sectional design, and population characteristics and outcome measures varied. The risk of bias was high or unclear in 77% of the studies. All studies mainly used two questionnaires in combination or alone: the short form of medical outcomes survey (SF-36), a generic PROM that reports on health status and the Hospital Anxiety and Depression Scale (HADS), a standard measure of psychological well-being. Thirteen studies using SF-36 showed lower scores on the mental health component in patients with ICC versus population norms. Ten studies using HADS showed a prevalence of clinically significant anxiety (17-47%) and depression (8.3% to 28%) which are higher than the population norm (8.3% and 6.3%).

Conclusion:
Our results from only a few published studies indicate that although psychological morbidity in ICC patients is high, measurements are non-specific, variable, and generic and address overall health, instead of addressing factors specific to ICC, such as heritability. We propose to develop a disease-specific PROM for cardiogenetics to evaluate the heritability factor in patients with ICC to implement in the care pathway and optimize patient-centred care.
Abstract 11828: Contemporary Temporal Trends in Cardiovascular Events Among Elderly Patients Hospitalized With Autoimmune Disorders and Concomitant Recreational Cannabis Use
Authors: Katukuri Nishanth , Mohammed Adil S , Kanagala Sai Gautham , Gurram Priyatham , Ashfaque Mariam , Sofia Amara , Kauser Humaira , Sayyeda Qudsia , Arepalli Satya Sai Venkata Lakshmi , Mondal Avilash , Desai Rupak
Published: June 2023

Background:
The role of Cannabis in autoimmune diseases (AD) has been previously discussed due to its anti-inflammatory properties, however, cardiovascular events in elderly patients with AD are not well studied with habitual recreational cannabis usage or cannabis use disorder (CUD).

Methods:
We queried the National Inpatient Sample (2016-2019) for geriatric AD patients with vs. without CUD. Propensity score-matched analysis (1:1) was used to compare comorbidities, major adverse cardiac and cerebrovascular events [MACCE: all-cause mortality, acute myocardial infarction (AMI), cardiac arrest and acute ischemic stroke (AIS)], and healthcare resource utilization in the CUD vs. non-CUD cohort with AD.

Results:
Of 11350 elderly admissions with AD, propensity-matched cohorts consisted of 5675 patients with CUD (49.1% male) and without CUD (26.7% male). Both groups had comparable ages (median 69 years), racial groups (>70% white), and income quartiles. CUD cohort showed higher rates of hypertension, PVD, smoking, alcohol abuse, drug abuse, depression, and prior MI (p<0.005) compared to the non-CUD cohort. The CUD cohort had higher rate of transfers to other care facilities (2.6% vs. 1.9%, p≤0.001), prolonged hospital stays, and higher cost, the adjusted odds were not significant for MACCE (OR 1.22, 95%CI 0.88-1.69, p=0.24), all-cause mortality (OR 0.74, 95%CI 0.37-1.46, p=0.34), AMI (OR 1.52, 95%CI 0.95-2.43, p=0.08), AIS (OR 1.19, 95%CI 0.69-2.17, p=0.57), or cardiac arrest (OR 1.34, 95%CI 0.55-3.26, p=0.51), compared to non-CUD elderly AD cohort. The CUD cohort often had routine discharges (52.7% vs. 47.4%, p≤0.001) compared to the non-CUD cohort.

Conclusions:
This nationwide propensity-matched analysis did not reveal worse cardiovascular outcomes in older AD patients with CUD. Future large-scale prospective studies are needed to validate these findings and evaluate the long-term effects of medicinal/recreational cannabis usage in these individuals.
Abstract 11829: Cardiac Arrhythmias and Associated Mortality Risks in Alzheimer's Disease Patients Following STEMI and NSTEMI Hospitalization
Authors: Kumar Nomesh , Ramphul Kamleshun , Joynauth Jyotsnav , Verma Renuka , Mejias Stephanie G , Kumari Komal , Ramphul Yogeshwaree , Bawna fnu , Elmahal Mohammed , Jawaid Batool , Shah Syed Hamad Ali , Sombans Shaheen , Arti Fnu , Lohana Petras
Published: June 2023

Introduction:
Little is known about the outcomes of patients with Alzheimer’s disease (AD) following acute myocardial infarction (AMI).

Methods:
We used the 2017 National Inpatient Sample, including patients ages ≥60 with a primary diagnosis of STEMI and NSTEMI and those with any diagnostic code for AD. Any differences between AD and non-AD patients were calculated via Chi-square tests. The mortality rates of each group and their odds ratio (aOR) adjusted via multivariable logistic regression were also found.

Results:
A total of 104,860 cases of STEMI and 352,120 patients of NSTEMI were identified, amongst which 1,130 and 5,810 also had a diagnosis of Alzheimer’s disease. The incidence of Atrial flutter (160 cases, 1416 cases per 10,000 AD patients with STEMI), atrial fibrillation (320 cases, 2832 cases per 10,000 AD patients with STEMI), and long QT syndrome (15 cases, 133 cases per 10,000 AD patients with STEMI) for STEMI patients were higher among the AD patients (p<0.05). The incidence of ventricular fibrillation was lower among the AD group (30 cases, 265 cases per 10,000 AD patients with STEMI) compared to the non-AD group (762 cases per 10,000, p<0.01). Among the NSTEMI patients, the ventricular fibrillation rate was lower among AD patients (30 cases, 52 cases per 10,000 AD patients with NSTEMI) compared to the non-AD group (120 cases per 10,000 cases, p<0.01), and a higher number of atrial fibrillation was seen in AD patients (1755 cases, 3021 cases per 10,000 AD patients with NSTEMI) compared to non-AD patients (2589 cases per 10,000 cases, p<0.01).Finally, 25.7% of all AD cases with STEMI died (aOR 2.68, 95% CI 2.33-3.08, p<0.01), while 9.6% of AD cases with NSTEMI did not survive their hospitalization (aOR 2.28, 95% CI 2.08-2.50, p<0.01).

Conclusions:
Our results provide a new perspective on arrhythmias following myocardial infarction and the risk of death in patients with Alzheimer’s disease. It may be linked with A-beta amyloid 40 and 42 in the myocardium or mutations in PSEN1 and PSEN2 genes. Clinically, AD should be considered significant comorbidity during the hospitalization for AMI, and regular cardiac monitoring may be helpful to avoid any deadly outcomes.
Abstract 11843: Association of Individual- And Neighborhood-Level Factors With Racial and Ethnic Differences in Cardiovascular Health During Early Pregnancy
Authors: Cameron Natalie A , Huang Xiaoning , Petito Lucia C , Ning Hongyan , Shah Nilay S , Yee Lynn M , Perak Amanda M , Kim Jin K , Haas David , Mercer Brian M , Parry Samuel , Saade George R , Silver Robert M , Simhan Hyagriv N , Wapner Ronald J , Greenland Philip , Lloyd-Jones Donald M , Kershaw Kiarri N , Grobman William A , Khan Sadiya S
Published: June 2023

Introduction:
Individual and neighborhood-level factors are associated with racial and ethnic differences in cardiovascular health (CVH). To identify strategies to improve maternal health, we determined the relative contributions of these factors to racial and ethnic differences in early pregnancy CVH.

Methods:
We included pregnant individuals from nuMoM2b, a multicenter cohort who self-identified as Hispanic, non-Hispanic Black (NHB), or non-Hispanic White (NHW). We applied a Blinder-Oaxaca decomposition to evaluate the extent to which socioeconomic and psychosocial factors, discrimination experiences, and area deprivation index statistically explain racial and ethnic differences in CVH (0-8 points, based on body mass index, blood pressure, diabetes, and smoking status) in the first trimester. This method utilizes a counterfactual approach to estimate the mean change in CVH in the Hispanic and NHB groups if covariates were set to the mean in the referent group (NHW). We calculated the percent explained by each factor by dividing the predicted mean change by the total CVH difference between groups*100.

Results:
Of 5,695 pregnant individuals, 12.3% were Hispanic, 8.9% NHB and 78.8% NHW. Mean CVH scores were 6.4 for Hispanic, 6.0 for NHB and 6.6 for NHB individuals. After adjusting for age and immigrant status, mean CVH scores were lower (worse) by 0.83 (95% CI 0.51-1.04) points in NHB individuals and 0.49 (95% CI 0.28-0.60) points in Hispanic individuals compared with NHW individuals. Differences in social and psychologic factors explained 87% of NHB-NHW differences and 71% of Hispanic-NHW differences in CVH scores
(FIGURE)
; socioeconomic factors explained the greatest difference in CVH between groups.

Conclusions:
Individual- and neighborhood-level social and psychologic factors statistically explained a clinically meaningful difference in CVH among racial and ethnic groups, which may inform strategies to optimize health in pregnant individuals.
Abstract 11852: Impact of Heart Failure on New Cancer Diagnosis and Cancer Mortality in Patients With Ischemic Heart Disease Who Underwent Percutaneous Coronary Intervention
Authors: Sakuma Yuya , Shimizu Takeshi , Kurosawa Yuta , Ohara Himika , Muto Yuki , Sato Yu , Kiko Takatoyo , Sato Akihiko , Misaka Tomofumi , Yoshihisa Akiomi , Yamaki Takayoshi , Nakazato Kazuhiko , Ishida Takafumi , Takeishi Yasuchika
Published: June 2023

Background:
Recently, it has been reported that heart failure may be associated with high risk for development of cancer. However, this theory is not definitive and more epidemiological data are needed. Here we investigated the impact of heart failure on the incidence of new cancer diagnosis and cancer mortality in patients with ischemic heart disease who underwent percutaneous coronary intervention (PCI).

Methods and Results:
Consecutive 1787 patients with ischemic heart disease who underwent PCI were enrolled. Patients were divided into two groups according to the presence or absence of heart failure, and followed up for incidence of new cancer diagnosis and mortality due to cancer. Patients with heart failure (n = 434) were older (73.4 vs. 68.0 years, P < 0.001) and had higher prevalence of comorbidities such as anemia (63.2 vs. 40.2%, P < 0.001), chronic kidney disease (61.4 vs. 40.3%, P < 0.001), atrial fibrillation (20.7 vs. 14.0%, P = 0.001) and stroke (21.8 vs. 15.8%, P = 0.004) than those without heart failure (n = 1353). The percentage of smokers did not differ between two groups (P = 0.374). During follow up period (mean of 1528 days), there were 142 new cancer diagnoses and 60 cancer deaths. Of 142 new cancers, gastrointestinal cancer was the leading site (39.4%), followed by lung cancer (14.1%), prostate cancer (11.3%), liver or biliary tract cancer (10.6%), hematologic cancer (9.9%) and others. The incidence of new cancer diagnosis and cancer mortality were significantly higher in patients with heart failure than in those without heart failure (P < 0.001 and P = 0.001, respectively). In the multivariate analyses after adjusting for confounding factors including smoking, heart failure was an independent predictor of new cancer diagnosis and cancer death (hazard ratio 2.22, P < 0.001 and hazard ratio 1.78, P = 0.036, respectively).

Conclusion:
Heart failure was associated with incidence of new cancer and cancer death in patient with ischemic heart disease.
Abstract 11878: Two Life-Threatening Conditions: Myxedema Coma and Type A Aortic Dissection
Authors: Nayak Tanvi , mehta chris , whippo beth A , Vassallo Patricia
Published: June 2023

Case Presentation:
A 59-year-old female with a history of hypertension was brought to a local hospital after being found unresponsive at home. Computed tomography angiography (CTA) of the chest showed type A aortic dissection (TAAD) with maximal aortic dimension of 9.0 cm. She was transferred to our center for escalation of care. She had poor neurological status but stable hemodynamic status, without malperfusion or acute cerebrovascular accident. Lab studies showed severely elevated thyroid-stimulating hormone of 80.4 mIU/ML and free thyroxine 4 (T4) less than 0.2 ng/dL, indicating severe hypothyroidism consistent with myxedema coma. Due to her low functional baseline status, surgical repair was deferred. Anti-impulse therapy was initiated with short acting beta blocker and calcium channel blocker infusion to maintain control of heart rate (HR) and blood pressure (BP). Her clinical course was complicated by pulseless electrical arrest and acute renal failure. After 100 mcg of intravenous levothyroxine, she was extubated and regained renal function. After 40 days, she was discharged to an acute rehabilitation center. 6 weeks later, she showed marked improvement in her frailty index, and medications were optimized. She underwent elective aortic repair, coronary bypass surgery, and was discharged to home.

Discussion:
Due to the patient’s initial neurological status, repair of her TAAD with aneurysmal degeneration was deferred. She was later diagnosed with myxedema coma and her TAAD was deemed
chronic
rather than
acute
. Surgical repair of both acute and chronic TAAD remains the gold standard; however, medical therapy with strict control of HR and BP parameters may stabilize the patient for future surgical repair.
1,2
In this case, by treating the patient’s underlying hypothyroidism and managing risk factors, her surgical risk was reduced, and she underwent successful aortic repair, reporting drastically improved functional status and quality of life.
Abstract 11880: Effects of Left Atrial Function on Pulmonary Arterial Pressure in Acute Myocardial Infarction, Hypertrophic and Dilated Cardiomyopathy
Authors: Kim Minjeong , Chung Hyemoon , Kim In-Soo , Park Chul Hwan , Rim Se-Joong , Choi Eui-young
Published: June 2023

Introduction:
We evaluated differential contribution of the left atrial (LA) function by cardiovascular magnetic resonance (CMR) and left ventricular (LV) fibrosis to pulmonary arterial systolic pressure in hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM) and reperfused acute myocardial infarction (AMI).

Hypothesis:
The differential role of the LA function and LV fibrosis indices for pulmonary pressure elevation would be different in various myocardial diseases and there would be a predictive value in addition to the conventional echocardiographic parameters.

Methods:
Data of 370 patients with HCM (n=133), DCM (n=114) and reperfused AMI (n=123) who underwent both echocardiography and CMR were comprehensively reviewed. Phasic LA volumes, LA-global longitudinal strain (GLS), LA stiffness index, defined as E/e’/LA-GLS and extracellular volume fraction (ECV) of LV were measured using CMR.

Results:
E/e’ was correlated with PASP in all groups; however, the predicted value was significantly attenuated after adjusting for LA volume and LA strain in HCM and DCM, but remained significant in AMI. The LA stiffness index was related to PASP in HCM (p=0.01) and DCM (p=0.03) independent of LA volume index and E/e', but not in AMI. In DCM, ECV was significantly related to PASP (p<0.001) independent of LA volume index and E/e’.

Conclusions:
The LA function in HCM and DCM and LV fibrosis in DCM correlated with PASP independent of E/e’ and LA size, contrary to that in AMI. These results suggest the presence of left atrial dysfunction in non-ischemic cardiomyopathies and usefulness of ECV measurement in DCM for the comprehensive evaluation of LV diastolic function.
Abstract 11884: Comparison of Investigator-Reported and Adjudicated Events From SOLOIST-WHF and SCORED
Authors: Gaba Prakriti , Bhatt Deepak L , Steg Philippe G , Banks Phillip , Davies Michael J , Szarek Michael , Pitt Bertram ,   the SOLOIST-WHF and SCORED Investigators
Published: June 2023

Introduction:
Sotagliflozin reduced investigator reported cardiovascular (CV) deaths, hospitalizations for heart failure (HHF), and urgent visits for heart failure (UVHF) in SOLOIST-WHF and SCORED. The objective of the present analysis was to determine if the treatment effects on adjudicated events were consistent those on investigator reported events in each trial.

Methods:
SOLOIST-WHF and SCORED were Phase 3, multicenter, randomized, double-blind, trials evaluating sotagliflozin versus placebo in 1,222 patients with type 2 diabetes (T2D) admitted for a worsening heart failure event and in 10,584 patients with T2D, chronic kidney disease, and other CV risk factors, respectively. The primary composite endpoint was a composite of CV death, HHF, and UVHF. Treatment effects on investigator reported events and available adjudicated events were estimated in proportional hazards models.

Results:
Rates of the investigator reported primary composite endpoint were higher in the SOLOIST-WHF trial compared with the SCORED trial. However, relative risk reductions for the investigator reported primary composite endpoint were similar between SCORED (0.67[0.53, 0.85]) and SOLOIST-WHF (0.75[0.63, 0.88]). All components of the endpoint positively contributed to the overall outcome, with HHF having the largest effect. When compared with adjudicated outcomes, results were generally similar between the primary and sensitivity analyses using various combinations of total or first occurrences (Figure).

Conclusions:
Sotagliflozin led to consistent and significant reductions in CV death, HHF, and UVHF in both randomized trials, as determined by blinded investigator-reported assessment as well as by independent, blinded adjudication. These results support the overall robustness of the findings for both trials.
Abstract 11887: Self-Pay Insurance Status is Associated With Failure of Medical Therapy in Patients With Acute Uncomplicated Type B Aortic Dissection
Authors: fazzone brian J , Anderson Erik , Hensley Sara , Weaver Martha , Neal Dan , Shah Samir , Scali Salvatore T , Huber Thomas , Upchurch Gilbert R R , Arnaoutakis George , Cooper Michol
Published: June 2023

Introduction:
Traditionally, acute uncomplicated type-B aortic dissections (auTBAD) are managed with best medical therapy. Recent literature has focused on identifying high-risk patients who might benefit from early endovascular repair based on dissection anatomy characteristics, but socioeconomic factors are less often considered despite relationships between disparities and vascular disease outcomes.

Aim:
To understand the presentation, management, follow-up, and outcomes among patients presenting with auTBAD, focusing on insurance status.

Methods:
In this single center, observational study, demographics, medication prescription patterns, follow-up, and outcomes of patients with auTBAD managed medically from 2013-2018 were analyzed. Patients with complicated, chronic, type-A dissection, PAU, or IMH were excluded. Area deprivation index (ADI) was determined from patient’s home addresses. Comparisons between age, ADI, prescription patterns, follow-up, and outcomes were made between groups based on payer status. Payer status was defined as insured or self-pay (i.e., no insurance).

Results:
57 patients presented with auTBAD and were managed medically. 30% of patients were self-pay. Self-pay patients were from areas with higher deprivation indices (74 vs 62, p = 0.041), presented with higher blood pressures (138 vs. 118 mmHg, p = 0.006), and were on fewer home antihypertensives (0.29 vs 0.95, p = 0.030). Self-pay patients required more antihypertensives at discharge (3.6 vs 3.0, p = 0.049) and were less likely to follow-up (29% vs. 70%, p = 0.008). Self-pay patients had worse freedom from aortic intervention (p = 0.023), were more likely to represent urgently or emergently for repair (75% vs 0%, 0.033), and trended towards earlier time to intervention (8.5 months vs. 30 months, p = 0.060).

Conclusions:
Self-pay insurance was associated with worse hypertensive disease characteristics, follow-up patterns, and long-term outcomes in patients presenting with auTBAD managed with medical therapy. These findings suggest prohibitive compliance and surveillance trends in this cohort, which underscores the importance of considering patient factors, particularly payer status, when deciding between auTBAD treatment options.
Abstract 11888: Interplay Between Metabolic Biomarkers, Adipose Tissue Depots and Coronary Artery Disease in the PROMISE Clinical Trial
Authors: Zhao Elizabeth , Giamberardino Stephanie , Pagidipati Neha J , Voora Deepak , Hoffmann Udo , Karady Julia , Ferencik Maros , Foldyna Borek , Douglas Pamela S , Shah Svati H
Published: June 2023

Background.
Visceral adipose depots such as hepatic steatosis (HS) and epicardial fat (EAT) have been implicated as markers for CVD. Higher BCAA have been implicated in HS progression, but the interplay between BCAA, different adipose tissue depots (ATDs) and CAD has not been evaluated. We leveraged the PROMISE clinical trial with centrally adjudicated coronary CTA imaging to determine relationships between ATDs, BCAA dysregulation and CAD.

Methods.
The PROMISE trial randomized 10,003 outpatients with stable chest pain to CTA vs. standard of care diagnostics. We included 4,019 participants with available CTA and biospecimens. ATDs (HS [presence/absence] and EAT volume) and CAD were determined by a CT core lab. NMR spectroscopy was used to measure serum BCAA (total). We determined association between (1) BMI and ATDs with obstructive CAD (
>
50% stenosis in a major epicardial coronary vessel); (2) BCAA and ATDs; and (3) BCAA and CAD, using univariate and multivariate regressions. Association between BCAA with time-to-incident CVD events (all-cause death, myocardial infarction, or unstable angina hospitalization) was performed using Cox proportional hazard models. Individual BCAA SNPs were used as the instruments for Mendelian randomization (MR) analyses to evaluate if BCAA are in the casual pathway for HS or CAD.

Results.
The population had a mean age of 60 years, BMI of 30.8, was 53% female, 27.1% had HS, 13.9% had CAD, and 15.4% had high risk coronary plaque. EAT was associated with CAD in the multivariate models (OR 1.004, 95% CI [1.00-1.01], p=0.019). HS was not associated with CAD. Total BCAA levels were associated with HS in multivariate models (OR 1.46, 95% CI [1.28-1.67], p<0.001), but BCAA were not associated with EAT. BCAA were associated with CAD in univariate (OR 1.18, CI 1.04-1.34, p<0.001), but were not associated with incident events. Mendelian randomization did not support the role of BCAA as in the casual pathway of HS or CAD.

Conclusions.
Leveraging a large clinical trial, we found that CTA-derived ATDs are associated with CAD. We further established the role of dysregulated BCAA catabolism in HS, although this relationship did not seem to be associated with or in the causal pathway of CAD.
Abstract 11890: Association Between State Marijuana Legalization Policies and Marijuana Use Reasoning Among Adults With Cardiovascular Disease, 2017-2020
Authors: Parekh Tarang , Lahan Shubham , Javed Zulqarnain , Cainzos Achirica Miguel , Nasir Khurram
Published: June 2023

Introduction:
The rapid adoption of marijuana legalization policies in states has forced clinicians to evaluate the health effects of marijuana due to increased availability; however, little is known about changes in marijuana use among adults with CVD after legalization (medical, recreational, dual) in the US.

Methods:
Using a sample of 298,651 adults from 2017-2020 survey data from the Behavioral Risk Factor and Surveillance System (BRFSS), we estimated the prevalence of recent (past-month) marijuana use in eleven states among adults with and without CVD by marijuana legalization (ML) status of a state. Multivariate logistic regression models were conducted to examine factors associated with marijuana use by self-reported CVD status.

Results:
Recent marijuana use was higher among adults with CVD in ML states compared to non-ML states (10.7% vs. 6.4%). The mean days of marijuana use in the CVD cohort in ML-states were 17.2±15.5, and 16.1±13.7 days in non-ML-states. Medical use among CVD adults decreased from 57.4% in 2017 to 47% in 2020. In contrast, dual-use increased from 14.4% in 2017 to 30.9% in 2020. However, trends were different in ML vs non-ML states(Figure). Adults with CVD in ML-states had higher (OR=1.75, p<.001), while in non-ML states had lower (OR=0.81, p<0.05), odds of marijuana use compared to those without CVD in non-ML states (reference group). Among CVD adults who used marijuana, odds of medical use were 85% higher in ML-states (OR=1.85, p<0.05), while more than two-fold for recreational (OR=2.10, p<0.05) and 2.5-fold for dual-use (OR=2.53, p<0.05), than non-ML states.

Conclusions:
We found a higher prevalence and likelihood of marijuana use in adults with CVD living in legalized vs. non-legalized states, which was not unexpected. However, marginal decline in use for medical reasons in ML states with the increasing prevalence of recreational and dual-use in the CVD population requires greater attention to the risk/benefits of individual preferences.
Abstract 11892: Novel Measures of Arterial Stiffness and Wave Reflections Associate With Clinical Outcomes in Patients With Heart Failure
Authors: Steinberg Rebecca , Udeshi Eisha , Dickert Neal W , Quyyumi Arshed A , Chirinos Julio A , Morris Alanna A
Published: June 2023

Introduction:
Arterial stiffness and earlier wave reflections can increase afterload and impair cardiovascular function. Most prior studies have been performed in patients with preserved left ventricular (LV) function.

Hypothesis:
Novel measures of pulsatile arterial hemodynamics are predictive of worse clinical outcomes in patients with HFrEF.

Methods:
Patients with HFrEF (N=137, median age 56, 49% female, 58% Black) and age-matched healthy controls (N=124) underwent measurements of large artery stiffness and pulsatile arterial hemodynamics from 2015-2019 at a single study visit. Carotid-femoral pulse wave velocity (CF-PWV) and augmentation index (AIx) were assessed using high-fidelity applanation tonometry. In HFrEF patients, pressure-flow analyses were performed to derive aortic characteristic impedance (QZc), reflected wave transit time (RWTT), and wasted pressure effort (WPE). In HFrEF patients, Cox proportional hazards models examined associations between vascular function measures and 1) all-cause death and 2) a combined endpoint of left ventricular assist device (LVAD) implant, heart transplant (HT), and death at 2 years adjusted for race, BNP, and MAGGIC risk score.

Results:
Compared to controls, patients with HFrEF had similar CF-PWV (6.8+/-1.6 v. 7.0+/-1.6 m/s, P=0.4), and higher AIx normalized to a HR of 75 bpm (13+/-2% v. 22+/-2%, P<0.001). Among HFrEF patients, a shorter RWTT was associated with death (adjusted hazard ratio [aHR] 0.60, 95% confidence interval [CI] 0.37-0.97) and the combined endpoint of death/LVAD/HT (aHR 0.62, 95% CI 0.41-0.94) at 2 years (
Figure
). WPE/QZc, which represents the proportion of systolic load from wave reflection, was associated with the combined endpoint on multivariable analysis (aHR 1.40, 95% CI 1.02-1.93). AIx and PWV were not predictive of clinical outcomes.

Conclusion:
Increased LV systolic load from premature wave reflections is associated with adverse clinical outcomes in patients with HFrEF.
Abstract 119: Resuscitation Outcomes In Covid-19-associated Out-of-hospital Cardiac Arrest
Authors: Albrecht Kellen , Bartos Jason , Elliott Andrea M
Published: June 2023

BACKGROUND:
Since the beginning of the pandemic, there have been numerous reports of increased mortality in the setting of both in-hospital (IHCA) and out-of-hospital cardiac arrest (OHCA) in patients with novel coronavirus-19 (COVID-19) infection. Due to these alarming mortality rates, it has been proposed that resuscitation may represent futility when COVID-19 is suspected or confirmed in patients with cardiac arrest. However, it continues to remain unclear whether the currently available data is sufficient to be broadly applied to all patients and hospitals.

HYPOTHESIS:
In COVID-positive patients presenting after OHCA, resuscitation should be pursued and is not futile as has previously been suggested.

METHODS:
264 consecutive patients presenting to the University of Minnesota Medical Center were obtained from the Cardiac Arrest Registry to Enhance Survival (CARES) database from March 2020 through April 2022. Patient data was obtained retrospectively for COVID19 infection status, initial documented arrest rhythm, and survival to hospital discharge.

RESULTS:
264 patients were collected for analysis with 2 being excluded due to incomplete data. Of the remaining 262, 16 were found to be COVID-positive. Of these patients, 2 (12.5%) survived to hospital discharge compared to 72 (29.2%) in the group without COVID. In COVID-positive patients presenting with initially shockable rhythm (11 patients), survival was 18.2% compared with no survival noted in those with initially non-shockable rhythm. 9 patients with COVID were cannulated for ECMO, with 1 (11.1%) surviving to hospital discharge.

CONCLUSIONS:
This study provides insight into resuscitation in the setting of OHCA when COVID is suspected or confirmed. Though small in overall number of patients, our study indicates that resuscitation efforts in COVID-positive patients are not futile, as has previously been suggested.