bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 13779: Microvascular Endothelial Function, Long-Term Dietary Intervention and Cardiovascular Risk of Recurrence: From the CORDIOPREV Study
Authors: Millan-Orge Marta , torres-Peña Jose D , Arenas-Larriva Antonio P , Quintana-Navarro Gracia M , Peña-Orihuela Patricia , Alcala-Diaz Juan F , KATSIKI NIKIK , Lopez-Miranda Jose , Perez-Martinez Pablo , Delgado Lista Francisco Javier
Published: April 2024

Introduction:
Microvascular circulation controls tissue perfusion. Its dysfunction is implicated in damage to the myocardium and is a predictor of cardiovascular events. It has been shown that short-term dietary interventions may influence microvascular endothelial function (MEF) in some populations. There is a lack of evidence on the long-term effect of healthy diet patterns on MEF in patients with coronary heart disease (CHD) and on whether this effect is modified by the risk of CHD recurrence.

Hypothesis:
the consumption of healthy diets (Mediterranean diet or Low-fat diet) improves the MEF of CHD patients in the long term, and this effect is interrelated with the risk of CHD recurrence.

Methods:
In the CORDIOPREV study, dietary intervention with a Mediterranean diet or a low-fat diet is being carried out in 1002 patients with CHD for 7 years. The effect of this dietary intervention on basal microvascular flow and the area of hyperemia reactive to hypoxia was evaluated in 664 patients by laser-Doppler flowmetry at baseline and after 6 years of intervention. The risk of recurrence of CHD in patients was evaluated according to the TRS2P risk score.

Results:
Basal flow and reactive hyperemia area improved after the dietary intervention in the population (basal flow 97.78 ± 2.79 vs. 179.31 ± 5.06 arbitrary perfusion units, 83.38% increase, p<0.001) (reactive hyperemia 4233.3 ± 127.73 vs. 9695.9 ± 205.23 arbitrary perfusion units per time, 129.04% increase, p<0.001), without finding differences due to the diet (p>0.05 for the diet-effect). When patients were stratified to low, medium or high risk of recurrence, the basal flow was similarly increased in all three groups, but the reactive hyperemia area was improved to a greater extent in patients in the low-risk group compared with those in the medium or high risk groups.

Conclusion:
Long-term consumption of a healthy dietary pattern improves MEF in patients with CHD, and this improvement is greater in patients in the low-risk category for cardiovascular recurrence compared with those in the medium and high-risk groups.
Abstract 13783: Predictors and Prognostic Implications of Stress Cardiomyopathy in Aneurysmal Sub-Arachnoid Hemorrhage: Findings From a 14-year Prospective Registry
Authors: Vallabhajosyula Saarwaani , Katta Renuka Reddy , Michelena Hector I , Rabinstein Alejandro A
Published: April 2024

Objective:
Stress cardiomyopathy(SCM) occurs between 4-15% in aneurysmal sub-arachnoid hemorrhage(aSAH). Predictors and prognostic implications of SCM in aSAH remains incompletely known.

Methods:
Adult patients between January 2006-December 2019 with diagnosis of aSAH and echocardiogram during same admission were identified from a prospectively maintained aSAH registry. Presence of SCM was confirmed using the echocardiographic criteria. Severity of aSAH was categorized using the modified Fisher(mFisher) and the World Federation of Neurological Scale(WFNS).

Results:
Among 570 aSAH patients during study period, 194 aSAH cases had echocardiography and 37(19%) of them had SCM. In comparison to aSAH without SCM, aSAH with SCM were mainly females(76% vs 62%;
p=
0.12) and postmenopausal(57±12 vs 59±13 years;
p=
0.39). Echocardiographic findings in
Table
. aSAH with SCM was associated with WFNS grade>3(68% vs 42%;
p=
0.005) and mFisher grade>2(87% vs 81%;
p=
0.39), intraventricular hemorrhage(IVH)(81% vs 64%;
p=
0.04) and larger size of the ruptured aneurysm(8±5 vs 6±4;
p=
0.04). Medical management, microsurgical clipping and endovascular coil embolization rates were similar in patients with and without SCM, yet patients with SCM had lower rates of disposition to home(8% vs 27%;
p
=0.02) and higher in-hospital mortality(41% vs 25%,
p=
0.05). On multivariate analysis, ruptured ophthalmic artery aneurysms had 13-times higher odds for formation of SCM(OR 13.43 [1.22-147.8];
p=
0.02).

Conclusion:
aSAH with SCM predominantly occurred in postmenopausal females with larger aneurysms, and higher severity of bleeds. Ophthalmic artery aneurysms were associated with substantially increased risk of SCM after adjustment for aSAH severity. Despite similar treatment rates, SCM was associated with higher in-hospital mortality. These findings will require further confirmation in a larger subset of aSAH with SCM patients.
Abstract 13795: Deep Learning of Electrocardiogram Waveforms for Diagnosis of Heart Failure With Reduced Left Ventricular Ejection Fraction
Authors: Choi Jung Min , Lee Sungjae , Chang Mineok , Lee Hae-young
Published: April 2024

Introduction:
A deep learning-aided electrocardiogram (Deep-ECG) was trained to identify left ventricular systolic dysfunction (LVSD) of ejection fraction (EF) less than 40%. We evaluated the performance of Deep-ECG among patients with symptomatic heart failure (HF) in Korean acute HF registry.

Hypothesis:
Deep-ECG may be useful for identifying EF in HF with reduced EF (HFrEF).

Methods:
We included 1,292 symptomatic HF patients from 2011 to 2014 who underwent echocardiography and ECG within 30 days. The performance of Deep-ECG for LVSD was determined using receiver-operator characteristic curve (AUC) values.

Results:
Mean age was 67.8±14.4 years and 56% of patients were men. HFrEF, HF with mid-range EF and HF with preserved EF(HFpEF) was present in 42.3%, 17.9% and 39.8%, respectively. Using the optimal cut-off by Youden’s index, AUC value was 0.844 for identifying HFrEF among HF patients. AUC values were significantly higher for patients with normal AV conduction (0.872 vs. 0.759, p =0.002) and normal interventricular conduction (0.848 vs. 0.812, p=0.037) when compared to each conduction delay. Interestingly, corrective (true-positive) results in Deep-ECG for LVSD were acquired in patients bigger LV end systolic dimension (LVESD) than in false negative group (54.4±10.1mm vs. 49.7±8.7mm, p<0.001).

Conclusions:
The Deep-ECG algorithm had very good discrimination for HFrEF in real world HF cohort. This algorithm may be useful for identification of LVSD in resource-limited settings.

Figure 1. Scatterplot demonstrating LVESD and the performance of Deep-ECG for identifying LVSD (LVEF < 40%)
Abstract 13796: Diffuse Regional Strain Abnormalities Despite Normal Ejection Fraction Suggestive of Occult Myocardial Dysfunction in Multisystem Inflammatory Syndrome in Children
Authors: Lee Simon , Wright Lydia , Blaney Cristin , Cooper Amy , Low Samantha , Dimes Catherine , Erdem Guliz , Lee Marc , Hor Kan N
Published: April 2024

Background:
Multisystem Inflammatory Syndrome in Children (MIS-C) patients frequently present with significant hypotension and ventricular dysfunction. While they appear to recover quickly after treatment of MIS-C, long-term sequelae of the myocardium are unknown. We aimed to evaluate ventricular function longitudinally using TTE and CMR.

Methods:
Retrospective review was performed of all patients with MIS-C who underwent CMR from September 2020 to May 2021. Measures of ventricular size and function during admission, 2-week, and 6-week follow up by TTE as well as global and regional longitudinal strain, as measured by Strain ENCoded imaging (SENC) by CMR were analyzed. The magnitude of strain is expressed as an absolute value, with >17% considered normal.

Results:
Nineteen patients (13.9±1.9 years, 63% males) with MIS-C underwent CMR. Troponin leak was seen in 16/19 (84%), 15/19 (79%) had ventricular dysfunction, 3/19 (16%) had coronary abnormality, and 1/19 (5%) required ECMO. All patients had normalized function at 2- and 6-week visits (mean LVEF 62±6.3% on TTE at 6-weeks). Group 1 (n=2) had CMR during hospital admission (5, 11 days), Group 2 (n=13) during early outpatient follow-up (median 34 days, range 15-59 days), and Group 3 (n=5) during later outpatient follow-up (median 98 days, range 72-231 days). All patients had normal LVEF on CMR. LVGLS by SENC was significantly impaired throughout follow up. The mean LVGLS of Group 1, Group 2, and Group 3 were 15±0.8%, 15.4±2.4%, and 16.6±1.6%, respectively. The mean number LV segments (from the AHA modified 16 segment model) with abnormal LS in each group were 10±2, 9.2±3.2, and 8.6±2, respectively.

Conclusions:
There were significant global and regional strain abnormalities despite normalized LVEF on TTE and CMR. This represents occult myocardial dysfunction after MIS-C. It is unclear if these findings will persist. Longitudinal studies are needed to monitor for progression or resolution of these findings.
Abstract 13855: Invasive Versus Conservative Strategy For Stable Coronary Artery Disease In Patients With Heart Failure
Authors: Sharma Nitish K , Dai Qiying , Bose Abhishek , Alseykal Ibragim , shah neeta , Ramsaran Eddison
Published: April 2024

Introduction:
Patients with stable ischemic heart disease (SIHD) and intermediate to high-risk stress tests with underlying heart failure (HF) are at increased risk for cardiovascular death, nonfatal myocardial infarction, or hospitalization for unstable angina and HF. In this patient population, the decision to pursue an early invasive strategy versus continuing medical management remains unclear. To evaluate this conundrum further, we performed a retrospective analysis.

Method:
We followed 308 SIHD patients with both reduced and preserved ejection fraction HF for a period of at least 16 months. All patients were classified as intermediate to high-risk based on their nuclear stress test results. They were further divided based on whether they underwent an initial invasive strategy versus medical management. A multivariable Cox regression analysis was performed to compare the primary outcome of all-cause mortality and cardiac mortality between the two groups.

Results:
Patients undergoing an initial invasive strategy were younger (70.64 ± 10.94 vs. 73.7 ± 12.04 years, P = 0.021), with a positive family history (24.4% vs 13.3%, p=0.023) and more likely to have high-risk nuclear stress tests (53.3% vs. 35.9%, p = 0.004) and prior percutaneous coronary intervention (35.0% vs. 23.4%, p =0.04) compared to the medical therapy group. Peripheral Vascular Disease (PVD) was more common in medical treatment group (35.2% vs.17.8%, p=0.001). During follow-up, all-cause death was 19.4% (n=35) vs. 33.6% (n=43), and cardiac death was 3.3% (n=6) vs.15.6% (n=20) in the invasive and medical therapy groups respectively. There was no difference in the all-cause mortality between the two groups, but cardiac mortality was noted to be lower in the invasive strategy group (Figure 1 & 2).

Conclusions:
In our patient population with SIHD and HF, pursuing an early invasive strategy provided cardiac mortality benefit when compared to conservative medical therapy.
Abstract 13856: Hydrogen Sulfide Donor, SG1002, Preserves Left Ventricular Global Function and Contractile Reserve in a Mouse Model of Doxorubicin Cardiotoxicity
Authors: Mauro Adolfo G , Hunter Katherine , Schultz Taylor I , Kraskauskas Donatas , Toldo Stefano , Salloum Fadi N
Published: April 2024

Background:
Despite being one of the most widely used chemotherapeutic agents, Doxorubicin [DOX] is limited by its dose-dependent side effects, including cardiotoxicity and heart failure (HF). Reactive oxygen species, inflammation, mitochondrial dysfunction, and dysregulated autophagy have been proposed as potential mediators of cardiotoxicity. Hydrogen sulfide (H
2
S) has been shown to promote mitochondrial stability and reduce inflammation in the setting of myocardial infarction.

Hypothesis:
To determine if the orally active, slow-releasing H
2
S-compound SG1002 attenuates DOX-induced cardiotoxicity.

Methods:
Following baseline echocardiography, male C57BL mice (12 weeks old) were treated with DOX (5 doses of 5mg/kg, ip; once a week) over 5 weeks. One week before the first DOX treatment, mice were placed onSG1002-enriched chow to achieve a dosage of 40 mg/kg/day for the duration of the study. The control group received normal chow. Mice were followed up to 5 weeks after the last DOX treatment. Left ventricular (LV) function was assessed via echocardiography, including LV global longitudinal strain [GLS]. Contractile reserve was measured as a percent increase in LV ejection fraction (LVEF) following isoproterenol challenge (10ng/mouse).

Results:
The cumulative dose of 25mg/kg of DOX led to impaired cardiac contractile reserve in control mice, which was preserved in SG1002-fed mice (Fig.A). Despite no changes observed in LVEF throughout the study, LV GLS detected early signs of cardiac dyssynchrony following the DOX regimen (Fig.B). SG1002 treatment prevented the early decline in cardiac function following chemotherapy.

Conclusion:
Our results indicate that LV GLS and cardiac contractile reserve are able to detect early changes in LV contractility due to cardiotoxicity following DOX treatment, which can be prevented with SG1002. This further highlights the importance of early screening with advanced imaging to identify signs of cardiotoxicity.
Abstract 13858: Improving the Compliance With the Use of ST Elevation Myocardial Infarction Cardiogenic Shock Protocol in an Urban Inner City Teaching Hospital- A Quality Initiative
Authors: Ghetiya Shreya V , Al-Turk Bashar , Patel Pujan , Velarde Gladys R , Pineda Andres
Published: April 2024

Background:
5-10% of STEMI are complicated by Cardiogenic shock (CGS). From multiple shock initiative across the country, the survival is shown to improve from 50% to 70-80%.Problem: 1) To evaluate the outcomes and identify gaps in treatment of STEMI complicated with CGS at our institution between Jan, 2018 to Dec, 2019. Based on this, a STEMI shock protocol was implemented at our institution. 2) After its implementation on 7/1/2020, the compliance with its use was measured and the goal is to increase from 30% (July - Dec) to 70% by the end of June 2021.

Method:
178 cases with STEMI between 1/1/2018 to 12/31/2019 were reviewed.Patients were classified into: Identified CGS (A), Unidentified CGS (B, those that met criteria), Non-CGS (C, no criteria for CGS). Basic demographics, in-hospital mortality, 30-day mortality, length-of-stay (LOS), incidence of acute kidney injury (AKI) & acute liver injury (ALI) were measured.

Results:
In group A: average LOS was 16 d, mean LVEDP was 25 mmHg and in-hospital mortality/30-day mortality was 56.2% (9 pts)/62.5% (10 pts). 100% (16) had AKI, 25% (4) required new hemodialysis during that admission, 93.8% (15) had ALI and 100% (16) required vasopressors/inotropes.In group B: average LOS was 6 d, mean LVEDP was 24.5 mmHg and in-hospital mortality/30-day mortality was 0%/8.7% (2 pts).In group C: average LOS was 4 d, mean LVEDP was 20.6 mmHg and in-hospital/30-day mortality was 0%. After its implementation, the compliance rate was measured. It was estimated about 30%. A survey of 14 questions was sent out to all the involved providers. A Pareto chart was created and based on it, we provided more educational trainings, feedback programs and implemented order sets in the electronic medical record system. We will continue to measure improvement in the compliance over next PDSA cycles. This will ultimately help us evaluate any improvement in the outcomes in STEMI-CGS patients.

Conclusions:
This is a unique quality improvement project which will help improve patient outcomes in STEMI CGS patients. This is an attempt to standardize the care in our institution with a goal to early identify them and initiate measures derived from evidence-based practice.
Abstract 13859: Efficacy and Safety of Ticagrelor Monotherapy versus Dual Antiplatelet Therapy After Percutaneous Coronary Intervention With Drug Eluting Stent in Patients With Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis
Authors: David Billy Joseph B , Gerodias Ferdinand R , Tanedo Althea , Tee John Derrik
Published: April 2024

Introduction:
Dual AntiplateletTherapy(DAPT) with aspirinanda P2Y12inhibitoris the currentstandardofcareforthe preventionofthromboticeventsinpatientsundergoingpercutaneouscoronaryintervention(PCI). Type2Diabetes Mellitus (DM) patientsare a subgroupofpopulationwith higher risk ofbleedinganddevelopmentofthromboticeventsafter PCI. There is currentlylimited data onthe efficacy andsafety ofTicagrelormonotherapyinterms of bleeding and thrombotic event risk aftera short-course DAPT among DM patients undergoing PCI.

Methods:
A comprehensiveandrelevantsearch ofrandomizedcontrolledtrials (RCT) was conducted.Outcomemeasures formajorbleeding,myocardialinfarctionandall-cause mortalitywere extracted andanalyzedusingarandom effects model via Review Manager V5.3.

Results:
A totalofthree RCTs, with 7482subjects were analyzed.There were nosignificantdifferencesinmajorbleeding(p=0.26)andmyocardialinfarction(p=0.66)eventsbetweenthe TicagrelorandDAPT groups.However,there was a higher rate ofall-cause mortalityinthe DAPT group,which was statistically significant(RR 0.76[95%CI:0.59-0.98], p=0.03).
Figure 1
Forestplotcomparison: Ticagrelor Monotherapyversus DAPT onBleedingRisk usingthe BleedingAcademic Research Consortium (BARC) 3 to 5
Figure 2
Forest plot comparison: Ticagrelor Monotherapyversus DAPT onAll Cause Mortality
Figure 3
Forest plot comparison:Ticagrelor Monotherapyversus DAPT on Myocardial Infarction

Conclusion:
TicagrelormonotherapyandDAPT have similar rates ofmajorbleedingandmyocardialinfarctionamongDM patientsundergoingPCI with DES after initialshort-courseDAPT. However, DAPT strategy had a higherincidenceofall-cause mortality, which suggests that Ticagrelormonotherapymay be a preferableantiplateletstrategyin DM patients undergoing PCI.
Abstract 13896: Trends in Aortic Dissection Mortality Rates by Sex and Age in the United States, 1999-2019
Authors: Nazir Salik , Cash Ayla , Minhas Abdul , Ariss Robert W , Jneid Hani
Published: April 2024

Introduction:
Despite evolving medical risk assessment and surgical interventions, acute aortic dissection (AD) remains a life-threatening condition with a high mortality. Here, we report sex and age-stratified AD mortality rates in the United States.

Methods:
Death certificate data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database were used to determine all-cause AD-related mortality trends from 1999 to 2019 among adults older than twenty-five. For the age stratified analysis, crude mortality rates (CMRs) per 100,000 people were calculated for five sub-groups (25-39, 40-54, 55-69, 70-84, and ≥ 85 years old). For the sex stratified analysis, age-adjusted mortality rates (AAMRs) per 100,000 people were calculated for males and females. Annual percentage change (APC) with 95% confidence intervals (CI) were calculated for both analyses.

Results:
Female AAMRs decreased between 1999 and 2012 (APC -1.5 [95% CI -1.8 to -1.1]) and increased between 2012 and 2019 (APC 3.1 [95% CI 2.3 to 4]). Similarly, male AAMRs decreased between 1999 and 2013 (APC -1.6 [95% CI -2 to -1.3]) and increased between 2013 and 2019 (APC 2.6 [95% CI 1.4-3.8]). Male AAMRs were consistently higher than female AAMRs (Figure 1). CMRs for those 25-39 and 40-54 increased significantly between 1999 and 2019 (APC 1.3 [95% CI 0.9 to 1.8] and APC 1.3 [95% CI 0.9 to 1.7], respectively). Among individuals 55-69, 70-84, and ≥85 years old, CMRs between 1999 and 2012 decreased significantly. However, CMRs for these three groups increased significantly between 2012 and 2019, with those ≥85 years old having the highest APC during this period (APC 3.8 [95% CI 2.4 to 5.2]).

Conclusions:
AD death rates are increasing among all sex and age subgroups over the past decade. To mitigate the burden of AD-related mortality, future studies are needed to examine the reasons for these observed trends.
Abstract 13899: Isolated Tricuspid Valve Endocarditis Within A Patient Population At High Risk Of Intravenous Drug Use: A Retrospective Cohort Study
Authors: Zaid Jordan , Foster Michael W , Clemons David , Mitzner Jennifer , Doktor Katherine , Fraimow Henry , Ragupathi Loheetha , Ginsberg Fredric L
Published: April 2024

Introduction:
Tricuspid valve endocarditis (TVE) is associated with intravenous drug use (IVDU) and complicated by numerous disease processes and societal impacts. Our academic medical center treats many TVE patients, predominantly with history of IVDU. We hypothesize that adverse outcomes related to TVE are associated with myriad co-morbidities and that a multidisciplinary approach integrating addiction medicine may improve outcomes and decrease in-hospital mortality.

Methods:
We conducted a medical record query of patients found to have infective endocarditis involving only the tricuspid valve and treated between July 2018 and January 2021. Baseline demographic data, characteristics and complications of TVE, echocardiographic data, and clinical outcomes were measured.

Results:
A total of 73 TVE patients were included; 32 were male, 41 were female. Mean age was 36.6 ± 11.8 years. Fifty (68%) patients reported a definite history of IVDU. TVE was associated with tricuspid regurgitation (TR) but TR severity did not correlate with worse outcome (p=0.238). Comorbidities included pulmonary septic emboli, heart failure (HF), pulmonary embolism, abscess, respiratory failure, cardiac arrest, and pneumonia. Staphylococcus aureus was the most common pathogen (57/80, 71.3%) with similar rates of MSSA and MRSA. Factors associated with in-hospital mortality included presence of prosthetic TV (p=0.005), prior diagnosis of HF (p=0.012), and MRSA infection (p=0.028). (Table 1) Medication-assisted treatment of opioid use disorder was associated with a lower rate of leaving the hospital against medical advice (p=0.006).

Conclusions:
Given the complexity of disease processes associated with TVE, a multidisciplinary approach to management is necessary. A prospective study following this vulnerable patient population in the inpatient and outpatient setting is warranted to further decrease the morbidity and mortality associated with this devastating disease.
Abstract 13909: Multi-Marker Risk Assessment in Patients Hospitalized With Coronavirus Disease-2019:
Results From the American Heart Association COVID-19 Cardiovascular Disease Registry
Authors: Bhatt Ankeet , Bohula Erin , Daniels Lori , De Lemos James A , Goodrich Erica , Morrow David A
Published: April 2024

Introduction:
The pathobiology of inflammation, thrombosis, and myocardial injury associated with SARS-CoV2 may be assessed by circulating biomarkers. However, their relative prognostic importance has been incompletely described.

Methods:
We analyzed data from pts hospitalized with COVID-19 in Jan to Nov, 2020 at 107 US hospitals in the AHA COVID-19 Cardiovascular (CV) Disease Registry who had biomarker data for D-Dimer, CRP, ferritin, natriuretic peptides [NP], or cTn at admission. We assessed the association between each biomarker by quintile [Q] and odds of in-hospital death and a composite of CV death, myocarditis, AMI, HF, or ischemic stroke. cTn quintiles were indexed to the assay-specific 99
th
%ile ref limits. Multivariable logistic regression determined the relative prognostic performance of each biomarker.

Results:
17,829 (83% of total) had admission values reported for at least 1 of the 5 key biomarkers (n= 2422 with values for all). Each biomarker revealed a gradient of mortality risk from Q1 to Q5: D-dimer 17-35%, CRP 11-30%, ferritin 11-29%, cTn 13-42%, and NPs 7-35% (p
trend
for each <0.001;
Panel A
). After adjustment for all biomarkers, the highest values (Q5) of NP, CRP, and cTn independently identified pts at greater odds of death (
Panel B
) and the highest values of NP, CRP, cTn and D-dimer identified greater odds of the CV composite. After further adjustment for clinical variables, Q5 values for NPs (OR:4.07, 95% CI: 2.40 to 6.92) and CRP (OR: 2.43, 95% CI:1.62 to 3.66) retained the strongest prognostic value for death; NP (OR:6.79, 95% CI: 3.56 to 12.94) and cTn (OR:4.44, 95% CI:2.75 to 7.18) were associated with the greatest odds of the CV composite.

Conclusions:
Among pts hospitalized with COVID-19, high levels of NPs, CRP and hsTn at the time of admission were associated with the greatest risk of death, independent of other biomarkers and clinical variables, whereas D-dimer and ferritin did not offer independent prognostic information for mortality.
Abstract 13912: ECG-DualNet: A MultiLabel Model for Automated Diagnosis on Both Electrocardiographic Signals and Printed 12-lead Electrocardiograms
Authors: Sangha Veer , Khera Rohan
Published: April 2024

Background:
Electrocardiograms (ECGs) are frequently stored as printed images, but tools developed for artificial intelligence (AI)-based automated diagnosis and patient phenotyping exclusively rely on signal data, limiting their application.

Methods:
We developed a model that simultaneously incorporates both signal and image-based ECG data in clinical diagnosis and patient phenotyping. We used all 12-lead ECGs from a large deidentified database from Brazil, with signals transformed to a standard 12-lead ECG image. Both ECG signals and images were randomly subset into training, validation and test sets (90%-5%-5%). We used 6 physician-defined clinical labels spanning rhythm and conduction disorders as labels (atrial fibrillation [AF], sinus tachy/bradycardia [ST/SB], 1
st
degree AV block [1dAVB], RBBB, LBBB). In addition, ECG-based identification of patient sex was assessed as a higher dimensional label. Convolutional Neural Networks were constructed with custom Inception net architecture for signals and EfficientNet-B3 for images. Model performance was evaluated in the holdout test set and US-based external validation dataset, PTB-XL.

Results:
The derivation dataset included 2,228,236 ECGs in 1,506,112 individuals (mean age 54y, 60% female). The ECG-DualNet model successfully labeled all 6 clinical diagnoses and patient gender with a high model performance (AUC of .81-.99 for signal and .92-.99 for images, F1 scores, .31-.78, and .49-82) in the 111,412 held-out test ECGs (Fig A-B). In external validation, with 21,785 ECGs, the model had excellent performance on both ECG signals and images (AUCs .75-.99 and .89-.99, F1 scores, .25-82, and .44-.86) (Fig C-D).

Conclusion:
A novel multilabel dual signal and image-based model achieved high performance in both clinical diagnosis and higher dimensional phenotypic labels across distinct ECG sources, with the ability to standardize automated diagnosis and patient phenotyping across ECG data formats.
Abstract 13914: Low-Density Lipoprotein Delivery of Microbial Small RNAs Drives Atherosclerosis Through Macrophage Toll-Like Receptor 8
Authors: Allen Ryan M , Michell Danielle L , Cavnar Ashley , Zhu Wanying , Makhijani Neil , Contreras Danielle M , Raby Chase , Semler Elizabeth M , DeJulius Carlisle , Castleberry Mark , Zhang Youmin , Ramirez Marisol , Zhao SHilin , Duvall Craig , Doran Amanda C , Sheng Quanhu , Linton Macrae F , Vickers Kasey C
Published: April 2024

Low-density lipoproteins (LDL) are a causal factor for atherosclerosis, a key pathological process in cardiovascular disease. Within atherosclerotic lesions, macrophages present a spectrum of phenotypes that mediate both disease pathogenesis and resolution. Inflammatory macrophage phenotypes are pro-atherogenic, but the natural factors that promote polarization remain to be identified. Here, we demonstrate that microbial small RNAs (msRNA) are enriched on LDL and drive pro-inflammatory macrophage polarization and cytokine secretion via activation of toll-like receptor 8 (TLR8). Removal of msRNA cargo during LDL reconstitution yields particles that are taken up by macrophages but fail to stimulate inflammatory activation. Using loss-of-function and gain-of-function studies, we demonstrate that TLR8 is both necessary and sufficient for LDL-induced activation of NF-kappa-B, a central regulator of inflammatory macrophage polarization. TLR8 recognition of msRNA was found to be antagonized by non-targeting locked-nucleic acids (nt-LNA). Pre-treatment of macrophages with a nt-LNA was found to prevent LDL-induced macrophage polarization
in vitro
, and re-organize lesion macrophage phenotypes
in vivo
, as determined by single-cell RNA sequencing. Critically, we demonstrate that nt-LNA treatment reduced plaque burden in 4-week and 10-week atherosclerosis progression studies in
Apoe
-/-
mice fed a western diet. Moreover, in a regression model using male and female Ldlr
-/-
mice with advanced lesions, nt-LNA treatment in combination with dietary intervention promoted lesion regression relative to mice receiving only dietary intervention. These results identify LDL-msRNA as stimuli for atherosclerosis-associated inflammation and support alternative functions of LDL beyond cholesterol transport.
Abstract 13916: The Obesity Paradox in ST-elevation Myocardial Infarction
Authors: Mattingly Georgia , Yildiz Mehmet , Lantz Rebekah , Okeson Brynn , Aguirre Frank V , Tannenbaum Mark , Garcia Santiago , Henry Timothy D , Quesada Odayme
Published: April 2024

Introduction:
In patients with known cardiovascular disease (CVD), body mass index (BMI)-defined obesity has been found to be protective against all-cause mortality and CVD events, commonly known as the “obesity paradox”. However, the role of BMI in STEMI outcomes remains poorly understood.

Methods:
The Midwest STEMI Consortium database of 15,039 consecutive STEMI activations between January 2010 and December 2020 consists of four regional STEMI centers. Using data from two centers with complete follow-up available, Minneapolis Heart Institute and The Christ Hospital, we examined differences by BMI groups defined as normal (18.5-24.9 kg/m
2
), overweight (25.0-29.9 kg/m
2
), and obese (≥30.0 kg/m
2
) in baseline characteristics, treatment, in-hospital death and 1-year MACE and mortality risk.

Results:
Among 4,682 patients (22% normal BMI, 36% overweight and 42% obese), obese patients were significantly younger but had higher rates of hypertension, diabetes, dyslipidemia, and were taking more cardiac medications prior to admission. Systolic and diastolic blood pressures, heart rate, and creatinine were highest in the obese subgroup. Obese patients had a higher rate of out of hospital cardiac arrest (9.2% vs. 9.6% vs. 12%, p=0.02) and a trend towards higher in-hospital death (5.7% vs. 4.7% vs. 6.4%, p=0.08). Overweight and obese patients had a lower risk of 1-year mortality (4.6% vs. 2.6% vs. 2.9%) and a trend towards lower 1-year MACE events (7.6% vs. 5.5% vs. 5.9%) compared to normal BMI patients (Figure).

Discussion:
Among individuals presenting with STEMI, despite more risk factors, higher rates of out of hospital cardiac arrest and a trend towards higher in-hospital death, overweight and obese patients had lower 1-year mortality consistent with the obesity paradox. Further research is needed to understand the obesity paradox in STEMI patients.
Abstract 13922: Association Between Quadrileaflet Tricuspid Valve and Location of Regurgitation Jet Origin in Patients With Functional Severe Tricuspid Regurgitation
Authors: Taku Omori , Kagawa Shunsuke , Uno Goki , Rader Florian , Siegel Robert J , Shiota Takahiro
Published: April 2024

Introduction:
It has been known that the posterior leaflet of the tricuspid valve (PTL) has several indentations or clefts in its free edge, giving the tricuspid valve (TV) equal to or more than four leaflets appearance. However, little is known about whether the indentations or clefts can be a location of tricuspid regurgitation (TR) jet origin in severe TR.

Hypothesis:
This study aimed to investigate the association between quadrileaflet TV and location of TR jet origin in patients with functional severe TR.

Methods:
We retrospectively studied 85 functional severe TR patients who underwent 3D transesophageal echocardiography which was performed using the EPIQ7 ultrasound system with a X8-2t probe (Philips Medical Systems). The morphology of the TV leaflets was ascertained using 3D volume-rendered images. Clefts extending over 50% of the depth of the leaflets were determined as a landmark between 2 adjacent leaflets. The location of TR jet origin and vena contracta area (VCA) were ascertained using real-time 3D color Doppler images. All images were analyzed by using QLAB 3D quantification software (Philips Medical Systems).

Results:
In 85 functional severe TR patients, a total of 3 (4%) patients with bileaflet, 60 (71%) patients with trileaflet and 22 (26%) patients with quadrileaflet were identified. All quadrileaflet TV had dichotomous PTLs (PTL 1 and PTL 2) and there was no patient who had equal to or more than five leaflets. In 22 patients with quadrileaflet, 10 (45%) patients showed TR jet origin located between PTL 1 and PTL 2 (Figure A). Also, quadrileaflet TV patients with TR jet origin located between PTL 1 and PTL 2 had significantly larger VCA than those without (185 vs. 62 mm2, P<0.001, Figure B).

Conclusions:
In patients with functional severe TR, one fourth patients showed quadrileaflet TV morphology. Furthermore, TR jet origin located between PTL 1 and PTL 2 can be seen only in a condition of TR beyond severe.
Abstract 13931: Upregulation of the AKT/mTOR Pathway in Premature Ventricular Contractions (PVC)-Induced Cardiomyopathy
Authors: Balderas Villalobos Jaime , Medina Contreras Juana Maria de Lourdes , Ramirez Rafael J , Samsó Montserrat , Tan Alex Y , Kaszala Karoly , Huizar José F , Eltit José M
Published: April 2024

Introduction:
Premature ventricular contractions (PVCs) are early ventricular depolarizations that, if frequent, can be associated with PVC-induced cardiomyopathy (PVC-CM). PVC-CM in our translational model is characterized by LV systolic dysfunction and eccentric hypertrophy. However, the mechanisms involved in this LV remodeling remain unknown.

Objectives:
Evaluate changes in cardiomyocyte size and sarcomere shortening, along with classical molecular pathways involved in pathological or physiological hypertrophy in the PVC-CM model.

Methods:
Pacemakers were implanted in healthy canines to reproduce 3 months of bigeminal PVCs (50% burden at 200-220 ms coupling interval). Isolated ventricular cardiomyocytes were electrically paced to measure sarcomere length. Formaldehyde-fixed LV sections were stained with WGA-AF633. Expression of β-MHC, ACTA1, ANP, calcineurin, AKT, mTOR, S6, 4EBP1, NFAT and their phosphorylated forms were measured by Western blot. Calcineurin activity was determined by colorimetry.

Results:
Cardiomyocyte area was larger in PVC group vs. sham (357.4 ± 12.9 μm
2
n= 121 vs. 271.8
+
7 μm
2
n = 161, p<0.001). Time to peak sarcomere contraction was longer in the PVC group (124.9
+
25.2 ms, n=101 vs 116.2
+
27.4 ms, n=61, p<0.05), whereas maximal cell shortening was similar between groups. Western blot analyses (n=6) showed significant increases in AKT expression (1
+
0.18 vs 1.6
+
0.43, p<0.001), and in its downstream effectors, S6 (1
+
0.26 vs 1.46
+
0.4, p<0.05) and 4EBP1 (1
+
0.3 vs 1.57
+
0.38, p<0.001) in the PVC group, without changes in mTOR. On the contrary, PVC group displayed a reduction in phosphorylated AKT (Ser473, 1
+
0.14 vs 0.77
+
0.26, p<0.05) and 4EBP1 (Thr37/46, 1
+
0.15 vs 0.75
+
0.1, p<0.001) without changes in S6 (Ser235/236) or mTOR (Ser2448) phosphorylation. The activity and expression of calcineurin, total and phospho- NFAT, and the expression of β-MHC, ACTA1, and ANP were not different.

Conclusion:
The pathological calcineurin/NFAT/fetal genes pathway was unchanged in the PVC-induced eccentric hypertrophy. Thus, this hypertrophy is “atypical” characterized by an upregulation of the AKT/mTOR pathway and cellular hypertrophy, together with a paradoxical decrease in contractility and LV systolic dysfunction.
Abstract 13934: Ventricular Pulsed Field Ablation Using a Focal Lattice-Tip Catheter: The Impact of Repetitive Applications
Authors: Kawamura Iwanari , Koruth jacob s , Turagam Mohit , Musikantow Daniel , Chu Edward , Miller Marc , Whang William , Dukkipati Srinivas , Reddy Vivek Y
Published: April 2024

Introduction:
Pulsed field ablation (PFA) is being increasingly studied for catheter ablation of atrial arrhythmias. However, there is little published on the efficacy of
ventricular
PFA. Recently, a 7.5-Fr ablation catheter with a 9mm compressible lattice-tip linked to a magnetic electroanatomical mapping system has been introduced (Sphere-9 and HexaMap, Prism-1, respectively; Affera, Inc). In contrast to radiofrequency ablation, there is little understating how to create an adequate lesion depth on the myocardial using PFA. Accordingly, we assessed the feasibility and effectiveness of repetitive PFA pulses in creating ventricular lesions using the lattice-tip catheter in
porcine
preclinical studies.

Methods:
Under general anesthesia, low dose 1-sec PFA pulses were delivered in 4 healthy swine ventricles using lattice-tip catheter and its compatible PF generators (HexaPulse, Affera, Inc). Three strategies were assessed: 2, 3 or 4 applications at each location. Pulses were repeated at 10-15 sec intervals. After survival for ~ 24 hrs, swine were sacrificed humanely, and TTC staining was performed to ascertain lesion dimensions on gross pathology.

Results:
Discrete PFA lesions (n=51) were successfully delivered: 24 in the RV and 27 in the LV. Dimensions were obtained for 49 of 51 discrete lesions. Transmurality was observed in 9 of 23 (39%) RV and 1 of 26 (4%) LV lesions. Significantly larger ventricular lesions were noted with the 4-application strategy: length 17.6±3.9 mm, width 13.4±1.8 mm and depth 6.1±2.1 mm (see

Figure

). The myocardium was trabeculated at 40 of 49 lesion locations: all lesions projected uniformly into the tissue without surface gaps. No sustained ventricular arrhythmias were observed during PFA.

Conclusion:
Focal PFA using a lattice-tip ablation catheter revealed clinically-relevant ventricular lesions without complications; repetitive applications significantly increase lesion dimensions.
Abstract 13942: Racial Differences in 24-hour Urinary Sodium, Potassium, and Albumin: A Surrogate of Poor Cardiovascular Health Among American Adults
Authors: Parcha Vibhu , Patel Nirav , Heindl Brittain F , Kalra Rajat , Yadav Ishant , Gutierrez Orlando M , Arora Garima , Arora Pankaj
Published: April 2024

Introduction:
Higher urinary excretion of sodium and albumin, and lower urinary excretion of potassium, is associated with adverse cardiovascular (CV) events. The differences in 24h urinary sodium, potassium, and albumin between non-Hispanic Black (NHB) and NH White (NHW) individuals and their association with AHA Life Simple 7 metrics of ideal CV health (CVH) is unknown.

Methods:
We evaluated the 2014 National Health and Nutrition Survey restricted data to determine the 1) 24h urinary measures (sodium, potassium, and albumin) excretion in NHB and NHW participants, 2) association of urinary measures with ideal CVH and 3) their relative contribution to ideal CVH differences between racial groups. Multivariable-adjusted logistic regression analysis was performed to assess the association of 24h urinary measures with ideal CVH. Mediation analysis was used to determine the effect of 24h urinary measures on observed racial differences in ideal CVH.

Results:
Among 429 participants (mean age: 42.6 years, 61% NHB), the 24h urinary sodium, potassium, and albumin excretion were 256.7 (95% CI: 221.4-292.0) mg/dL, 134.8 (113.5-156.1) mg/dL, and 20.9 (3.5-38.3) mg/dL, respectively, in NHB individuals. In NHW individuals, the 24-hour urinary sodium, potassium, and albumin excretion were 209.4 (189.4-229.4) mg/dL, 135.0 (124.3-145.7) mg/dL, 22.9 (2.48-48.3) mg/dL, respectively. NHB individuals had lower odds of having ideal CVH (0.35 [0.21-0.60]). Higher 24h urinary sodium excretion was the only urinary measure associated with lower odds of ideal CVH (0.99 [0.99-1.00]; p=0.027). There was no interaction by race for the association of 24-hour urinary measures with ideal CVH. 24h urinary sodium mediated 25.5% (14.8-74.0%) of the association between race and ideal CVH.

Conclusions:
We present the race-stratified normative data for 24h urinary measures among American adults without CV disease and highlight the association of 24h urinary sodium with ideal CVH.
Abstract 13949: Voronoi Characteristics for the Improvement of Middle Cerebral Aneurysm Rupture Differentiation
Authors: Jiang JingFeng , Sunderland Kevin , Rezaeitaleshmahalleh Seyedmostafa , Tang Tang , Ahmed Azam S , Gemmete Joseph , pandey aditya
Published: April 2024

Introduction:
Surgical intervention for detected intracranial aneurysms (IA) cary risks to patients. Analysis of IA geometry may help clinicians differentiate IAs at high rupture risk versus ones likely to remain stable. Yet traditional geometric indices lack sufficient accuracy, stressing a need for novel indices.

Hypothesis:
Adding novel Voronoi diagram-based indices (see Fig. 1) will improve IA differentiation.

Methods:
3D computational models were taken from 47 subjects with one medium-sized (4-10mm) middle cerebral artery (MCA) IA via 3D digital subtraction angiography data. 7 geometric indices for IAs (
e.g.
size, aspect ratio) were measured, alongside Voronoi analysis. In terms of the Voronoi diagram/sphere, each IA constitutes one or more spherical cores (large Inscribed sphere(s)) and many small protrusions. 2 variant curves denoting the inscribed spheres to small protrusion size’s relationships can be seen in Fig 1. Support vector machine with cross-validation (100 iterations) assessed Voronoi diagram-based curve’s strength for IA differentiation. The parsimonious model was determined as 3 geometric indices (volume, identified bulb, vessel diameter) and Voronoi characteristics.

Results:
Conventional IA geometric indices for ruptured vs unruptured differentiation showed limitations: 0.80 AUROC, 0.76 total accuracy. The addition of quantified Voronoi characteristics via both Voronoi curves augmented model strength for differentiation: 0.87 AUROC, 0.86 total accuracy.

Conclusions:
Preliminary analysis suggests including Voronoi characteristics for IA analyses improves rupture status prediction accuracy for medium-sized MCA aneurysms, which are more difficult to manage. Since Voronoi characteristics can be easily done in the clinical workflow, such an analysis may enrich the differentiation of IAs.
Abstract 13950: 5-years Mortality Of Heart Failure With Preserved, Mild Reduced, And Reduced Ejection Fractionin A 4880 Chinese Cohort
Authors: Huang Zhidong , Yang Yanfang , Chen Liling , Liu Jin , Liu Yong , Chen shiqun
Published: April 2024

Introduction:
There are limited data on the distribution and long-term prognosis in heart failure (HF) patients categorized by ejection fraction (EF) in China. Furthermore, available evidence conflicts with the outcome of HF patients with preserved EF (HFpEF), mild reduced EF (HFmrEF), and reduced EF (HFrEF). We aimed to characterize the 5-year prognosis in 3 HF phenotypes according to EF in a cohort of hospitalized HF patients in southern China.

Methods:
From January 2007 to December 2014, hospitalized patients who complicated with HF were enrolled in the Cardiorenal ImprovemeNt cohort study (CIN, ClinicalTrials.gov NCT04407936). HF types were defined as HFpEF (EF ≥50%), HFmrEF (EF 40%~49%) and HFrEF (EF <40%). Kaplan-Meier and Cox proportional hazards models were constructed to examine differences in 5-year prognosis in HF patients with different phenotypes.

Results:
A total of 4880 HF patients (mean age: 61.8±10.3, male: 64.7%) were included: 2768 (57%) had HFpEF, 1015 (21%) had HFmrEF, and 1097 (22%) had HFrEF. With 5 years of follow-up through the end of December 2019, 1624 (27.6%) patients died. After full adjustment, HFrEF was associated with an 85% risk increased in 5-year mortality than HFpEF and with a 32% risk increased in 5-year mortality than HFmrEF. HFmrEF was associated with a 40% increased risk of 5-year mortality compared to HFpEF. (HFrEF 25.2% vs. HFpEF 13.4%, adjusted hazard ratio (aHR): 1.85[95% confidence interval (CI): 1.45- 2.35]; HFmrEF 18.1% vs. HFpEF 13.4%, aHR: 1.4 [95% CI: 1.08 - 1.81]; in addition, HFrEF25.2% vs. HFmrEF 18.1%, aHR: 1.32[95% CI: 1.02 - 1.71]). When compared with other countries and regions, the distribution of HFrEF is relatively smaller.

Conclusions:
In this Chinese cohort, patients with HFrEF accounts for more than a fifth of HF patients. Lower EF category was independently associated with an increased risk of mortality. Further studies in prevention and intervention are needed for all of 3 HF phenotypes.
Abstract 13966: Chronic ICD Lead Removal From the Substernal Space is Feasible Without Complication
Authors: Haqqani Haris , Denman Russell , Prabhu Anil , Thompson Amy , Marshall Mark , Portway Bridget , Crozier Ian G
Published: April 2024

Introduction:
The transvenous ICD is the device standard for treatment of ventricular arrhythmias, but ICD lead extraction from the heart and vasculature has morbidity and mortality concerns. The extravascular ICD (EV ICD) with lead placement in the anterior mediastinum (substernal space) is in development as an alternative to transvenous ICD. Described is the first reported substernal lead removal experience from humans.

Hypothesis:
The anterior mediastinum, a soft tissue space absent major vascular elements, provides a suitable environment for chronic lead removal without complication.

Methods:
The first-in-human EV ICD pilot study was a prospective study conducted at 4 sites in Australia and New Zealand. Subjects with a class I or IIa indication for single-chamber ICD were implanted via minimally invasive technique, with the distal end of the lead placed substernally via an incision near the xiphoid, and the proximal end tunneled subcutaneously to a left midaxillary device.

Results:
A total of 21 patients underwent the EV ICD procedure, and 17 entered chronic follow-up after successful implant and testing. Among these 17 patients, 3 were electively explanted at 85, 114 and 310 days post-implant. Respectively, the first patient experienced a lead tip displacement resulting in P-wave oversensing and inappropriate shock; the second underwent elective chronic defibrillation testing 3 months post-implant, where a 10-Joule safety margin was not established; and the third experienced recurrent VT and intolerance to ATP due to high pacing threshold. Lead removals were conducted per HRS guidelines. The proximal end of the lead was removed from the device pocket to the xiphoid incision, with minor resistance noted in pulling the lead connector through the subcutaneous tunnel. Light traction was sufficient to remove the distal end of the lead from the substernal space, with minor tissue adhesions observed near the lead incision site. All leads were removed intact, and there were no adverse events associated with system removal.

Conclusions:
ICD lead removal from the substernal space is feasible through 310 days without adverse events. Further understanding from a larger patient population with greater implant duration will help verify these early results.