bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 15292: The Association Between High Serum Uric Acid Level and New-Onset Atrial Fibrillation After Coronary Artery Bypass Grafting
Authors: Pan Yilin , Liu Linqi , Hua Kun , Yang Xiubin
Published: December 2023

Introduction:
Postoperative atrial fibrillation (POAF) is a common complication of cardiac surgery, increasing stroke risk, morbidity, and mortality. At present, the specific pathogenesis of POAF remains to be fully elucidated. Though the potential impact of uric acid on atrial fibrillation has been suggested, the relationship between serum uric acid (SUA) levels and POAF in patients undergoing coronary artery bypass graft surgery (CABG) remains unclear.

Hypothesis:
This study investigates the potential association between SUA levels and the incidence of POAF in patients who have undergone CABG.

Methods:
We conducted a retrospective, observational cohort study (NCT05888168) that included 16,682 patients who underwent CABG at Beijing Anzhen Hospital from January 2018 to December 2021. Patients with a previous history of atrial fibrillation or requiring concomitant cardiac surgery were excluded. A cox regression model was used to determine predictors of POAF, with confounding variables adjusted via multivariable adjustment, inverse probability of treatment weighting, and propensity score matching.

Results:
The analysis encompassed 12,293 patients. SUA level values were 328 [273.6, 389.9] μmol/L and high SUA level (≥370μmol/L) were found in 3919 (31.88%) patients. The incidence of POAF was significantly higher in patients with high SUA level compared to those without (32.69% versus 29.53%, P<0.001). High SUA level was associated with an increased hazard ratio (HR) of POAF (HR [95%CI]: 1.21 [1.13-1.30]). These results were confirmed through inverse probability of treatment weighting and propensity score matching analyses.

Conclusions:
High SUA level is predictive of POAF in CABG patients, even after adjusting for age, sex, cardiovascular risk factors, medical therapy, echocardiographic parameters, and laboratory markers.
Abstract 15295: Myocardin Condensation Drives Cell Lineage Specification During Cardiogenesis
Authors: Gan Peiheng , Eppert Mikayla , De La Cruz Nancy , Veettil Reshma , SHAH AKANSHA , Pradhan Prashant , Bezprozvannaya Svetlana , Bassel-Duby Rhonda S , Liu Ning , Olson Eric N , Sabari Benjamin R
Published: December 2023

During cardiovascular development, cells make switch-like decisions to activate the expression of new gene programs leading to lineage specification. The mechanisms underlying these decisive choices remain unclear. Myocardin is a cardiomyocyte and smooth muscle cell specific transcriptional coactivator, which is necessary and important for activating cardiovascular genes. We show that Myocardin activates lineage-specific gene programs by concentration-dependent and switch-like formation of nuclear condensates. By modeling the natural changes in Myocardin concentration during development, coupled with quantitative fluorescence microscopy, single-cell resolution reporter assays, and cellular differentiation assays, we demonstrate that condensate formation is directly linked to transcriptional activation and cardiovascular lineage specification. During cardiomyocyte and smooth muscle cell differentiation, the formation of Myocardin condensates precedes activation of cell identity genes and these condensates are present at sites of cell identity gene transcription. Myocardin condensates form, activate gene expression, and specify cell state at critical concentration thresholds, dependent upon the C-terminal disordered region of Myocardin. Disrupting condensate formation by manipulating the sequence of this region abolishes gene activation, which can be rescued by replacing this region with condensate-forming disordered regions from other unrelated proteins. Our work demonstrates that Myocardin condensation at critical concentrations enables switch-like changes in gene expression programs, providing new insights into cardiomyocyte and smooth muscle cell lineage specification during cardiovascular development.
Abstract 15307: Sex-Specific Cognitive Effects of Intensive Systolic Blood Pressure Lowering in Patients With and Without Diabetes Mellitus
Authors: Ding Qinglan , Huber Jessica , Lu Yuan , Lee Min Kyung , Hammers Dustin , Lin Haiqun
Published: December 2023

Background:
The SPRINT trial demonstrated that intensive systolic blood pressure (SBP) lowering (<120 mm Hg) reduced risk of mild cognitive impairment compared to standard SBP control (<140 mm Hg). However, the ACCORD-BP trial did not show the same effect in patients with diabetes.

Aims:
This study aimed to 1) determine the impact of intensive SBP on cognitive impairment in patients with and without diabetes by analyzing individual patient data of ACCORD-BP and SPRINT, using three cognitive domains and the same follow-up durations, and 2) assess potential sex differences in the effect of intensive SBP lowering on cognitive function in patients with and without diabetes.

Methods/Approach:
We pooled individual patient data from the SPRINT and ACCORD-BP and standardized cognitive outcomes at baseline, 20-24 months, and 40-48 months post-randomization. Both studies randomized hypertensive patients to intensive SBP control or standard SBP control. Cognitive outcomes included general cognitive function, cognitive processing speed, and memory. Linear mixed models were employed, adjusting for covariates such as age, baseline BMI, SBP, eGFR and LDL. Analyses were repeated separately for patients with and without diabetes and for men and women.

Results:
The study cohort comprised of 10,800 patients (mean age 67.2 ±9.1 years; mean baseline SBP:139.6 ± 15.6 mmHg, with 14.7% having diabetes and 61.8% being women. Patients without diabetes in the intensive SBP control group had an accelerated decline in processing speed decline compared to the standard control group (P time*treatment interaction=0.02). Patients with diabetes exhibited similar rates of decline in all cognitive outcomes across treatment groups. Stratifying by sex, intensive SBP control was associated with improved memory in female patients (estimated sd=0.07 (0.03), p=0.06), and faster decline in processing speed in male patients. (p=0.03).

Conclusions:
The effects of intensive SBP control on general cognitive function were comparable between patients with and without diabetes and between men and women. While intensive SBP control was associated with accelerated decline in cognitive processing speed in patients without diabetes, it was linked to improved memory in female patients.
Abstract 15313: Prognostic Impact of Intravascular Imaging-Guided Percutaneous Coronary Intervention in Chronic Total Occlusion
Authors: Lee Sangyeub , Kim Sang Min , Bae Jang-whan
Published: December 2023

Background:
Limited data exist regarding use of intravascular image during chronic total occlusion (CTO) intervention.

Objectives:
Current study investigated the prognostic impact of intravascular imaging-guided PCI in CTO lesions.

Methods:
Study population was derived from the RENOVATE-COMPLEX-PCI (n=1639) which demonstrated superiority of intravascular imaging-guided PCI than angiography-guided PCI in patients with complex coronary artery lesions. Current prespecified study selected patients who underwent CTO intervention and clinical outcomes were compared between intravascular imaging-guided PCI and angiography-guided PCI groups.

Results:
Among 1639 patients, 319 patients with CTO underwent intravascular imaging-guided PCI (n=220) or angiography-guided PCI (n=99). At a median follow-up of 2.1 years (interquartile range 1.1-3.0 years), the risk of TVF was significantly lower in intravascular imaging-guided PCI group than in the angiography-guided PCI group (5.0% vs. 13.5%; HR 0.303; 95% CI 0.130-0.710, P=0.006). When patients in imaging-guided PCI group were divided according to stent optimization, both patients with (1.3% vs. 13.5%; HR 0.14; 95% CI 0.02-0.56; P=0.003) and without (6.8% vs. 13.5%; HR 0.41; 95% CI 0.17-0.99; P=0.049) stent optimization had significantly lower risk of TVF than the angiography-guided PCI group.

Conclusions:
In patients with CTO, intravascular imaging-guided PCI was associated with reduced risk of TVF. Graded risk of TVF according to stent optimization by intravascular imaging supports the importance of intravascular imaging-guided PCI and achievement of stent optimization in CTO intervention.
Abstract 15316: Neonatal Mesenchymal Stem Cells Ameliorate Cardiac Fibrosis and Diastolic Dysfunction in HFpEF via Expanding CD4
+
CD25
+
Foxp3
+
T
regs
Authors: Ge Zhi-Dong , Mishra Rachana , Fu Xuebin , Sharma Sudhish , Filipp Mallory , Chen Ling , Saha Progyaparamita , Wai Ching Man , Shao Ning-Yi , Sinha Anshuman , Bilewska Agata , Guru Sameer A , Stefanowicz Artur , Ciolak Emily , Simms Lydia , Mehta Vivek M , Gunasekaran Muthukumar , Shah Sanjiv J , Thorp Edward B , Kaushal Sunjay
Published: December 2023

Introduction:
We have demonstrated that neonatal mesenchymal stem cells (nMSCs) extracted from human neonatal cardiac tissues and their exosomes, secretome, potently decrease cardiac fibrosis and improve cardiac function in the rat model of myocardial infarction. CD4
+
CD25
+
Foxp3
+
(forkhead box 3) regulatory T cells (T
regs
) are recently shown to regulate the formation of cardiac fibrosis in myocardial infarction. How nMSCs and secretome affect cardiac fibrosis and T
regs
of animals with heart failure with preserved ejection fraction (HFpEF) is unknown.

Hypothesis:
We hypothesized that nMSCs and secretome ameliorate cardiac fibrosis and diastolic dysfunction in HFpEF by regulating cardiac T
regs
.

Methods:
C57BL/6 mice were fed 60% high-fat diet and L-NAME to induce HFpEF or normal chow as a control. Left ventricular morphology and function were evaluated using an echocardiography. After the mice developed HFpEF, the animals were injected 10
6
nMSCs, 10 mg/kg of secretome, or equivalent amounts of vehicle as a control via tail vein. Myocardial fibrosis was quantified in trichrome-stained heart sections. Circulating and cardiac T
regs
were measured on a FACSCanto II cytometer. Fingolimod at a dose of 3 mg/kg was intraperitoneally injected daily for 18 days.

Results:
C57BL/6 mice fed high-fat diet and L-NAME for 5 weeks developed obesity, myocardial fibrosis, left ventricular hypertrophy and diastolic dysfunction (increases in mitral E/e’ ratio), and exercise intolerance with > 50% of left ventricular ejection fraction. Compared to the HFpEF mice receiving vehicle, either nMSCs or secretome significantly decreased cardiac interstitial fibrosis and mitral E/e’ ratio and increased cardiac CD4
+
CD25
+
FoxP3
+
T
regs
from 1 to 4 weeks post treatment. Importantly, either nMSCs or secretome enhanced the exercise speed and distance of the HFpEF mice. Fingolimod significantly decreased circulating and cardiac T
regs
in the HFpEF mice, which blocked the beneficial effects of nMSCs and secretome on cardiac fibrosis and diastolic function.

Conclusions:
nMSCs and secretome ameliorate cardiac fibrosis and diastolic dysfunction by expanding CD4
+
CD25
+
FoxP3
+
T
reg
s
in HFpEF. These results suggest that nMSCS and secretome have high therapeutic potential for HFpEF.
Abstract 15319: Impact of Atherosclerotic Cardiovascular Disease Risk Factors on Pregnancy Outcomes in Women With Heart Disease
Authors: Fernandez Campos Beatriz Aldara , Grewal Jasmine , Kiess Marla C , Pfaller-Eiwegger Birgit , Massarella Danielle , Siu Samuel C , Silversides Candice
Published: December 2023

Introduction:
The impact of atherosclerotic cardiovascular disease (ASCVD) risk factors on pregnancy outcomes in women with pre-existing heart disease (HD) has not been examined.

Aim:
To determine the risk of major adverse cardiovascular events (MACE), preeclampsia and fetal events in women with HD stratified according to the presence of ASCVD risk factors.

Methods:
We studied a consecutive cohort of pregnant women with heart disease. ASCVD risk factors included any of the following: obesity, hypertension, dyslipidemia, diabetes or smoking. Primary outcomes were MACE (heart failure, cardiac arrest, CV death, stroke and myocardial infarction), preeclampsia and adverse fetal events (pre-term birth, small for gestational age, intraventricular hemorrhage, neonatal death and respiratory distress syndrome). Univariate logistic regression was used to determine the odds of adverse outcomes.

Results:
In total, 1656 pregnancies (congenital heart disease n=1041, acquired heart disease n= 420, isolated arrhythmia n=195) were included. At least one ASCVD risk factor was present in 24% of pregnancies. Overall, MACE occurred in 7.1%, preeclampsia in 4.3% and adverse fetal events in 30.1% of the pregnancies. Compared to pregnancies in women without ASCVD risk factors, those with ASCVD risk factors were more likely to have pregnancies complicated by MACE (9.7% vs 6.3%, p= 0.025), preeclampsia (8.3% vs 3.4%, p < 0.001), and fetal events (38.5% vs 27.5%, p <0.001). There were differences in maternal and fetal outcomes with or without ASCVD risk factors when stratified by diagnosis (acquired heart disease, congenital heart disease, isolated arrhythmias) (Figure 1).

Conclusions:
The presence of ASCVD risk factors in women with heart disease is associated with worse maternal and fetal outcomes. Modification of ASCVD risk factors may improve pregnancy outcomes.
Abstract 15339: CAD Polygenic Risk Score and Incident Complex Coronary Revascularization in Adults With Atherosclerosis
Authors: Singal Sachit , Kamanu Frederick , Melloni Giorgio , Roselli Carolina , Giugliano Robert , Ellinor Patrick T , Sabatine Marc S , Ruff Christian T , Marston Nicholas A , Bergmark Brian A
Published: December 2023

Introduction:
A CAD polygenic risk score (CAD PRS) was previously shown to predict major vascular events among patients with established ASCVD. Whether genetic risk can predict the need for complex coronary revascularization procedures, including complex PCI or CABG, has not been established.

Methods:
The FOURIER trial randomized 27,564 patients with established ASCVD to evolocumab or placebo with a median follow-up of 2.2 years. Of these, 14,298 had genotype data and were used in this analysis. The CAD PRS was previously derived in a CAD GWAS and includes 2,293,205 SNPs. Clinical records were reviewed for coronary revascularization events to determine procedural characteristics and coronary anatomy. Complex revascularization was defined as complex PCI [multivessel PCI, >3 lesions, >3 stents, total stent length >60mm, or bifurcation PCI] or CABG. Associations between the CAD PRS and revascularization events were analyzed by PRS quintile.

Results:
Patients with higher CAD PRS were significantly more likely to undergo complex coronary revascularization than those with low genetic risk (Q5 vs Q1: HR 1.71; 95% CI 1.23-2.37; P=0.002) (Fig A), with a greater than 2-fold higher risk of complex PCI (HR 2.11; 1.33-3.35) and a numerically higher risk of CABG (HR 1.28; 0.80-2.05). These findings were directionally consistent for the individual components of complex PCI, including multivessel PCI (HR 1.71; 0.97-3.00), > 3 lesions (HR 1.85; 0.73-4.68), > 3 stents (HR 3.77; 1.75-8.12), stent length >60 mm (HR 2.07; 0.88-4.87), and bifurcation PCI (HR 2.17; 0.39-11.98) (Fig B).

Conclusions:
Among patients with established ASCVD, a CAD PRS predicted incident complex coronary revascularization procedures. Genetic prediction of advanced coronary disease requiring specific complex interventions has not previously been shown, and these findings may have the potential to yield novel approaches for reducing the need for these high-risk and costly procedures.
Abstract 15359: Impact of App-Based Monitoring and Remote Patient Management Services on Real-World Cardiac Device Clinic Workflow
Authors: Nicolle Emmanuelle , Beadle Roger , Hughes Susan , Rosemas Sarah C , Sims Jason , De Melis Mirko
Published: December 2023

Introduction:
Remote monitoring (RM) is recommended as standard of care for follow-up of patients implanted with cardiac devices. International medical societies have advised that reducing the frequency of or eliminating routine in-office visits is possible, if RM compliance is ensured. With the growing patient population, staff workload to manage RM is increasing. Solutions are needed to alleviate clinic burden.

Hypothesis:
A technology and service-enabled workflow including app-based monitoring, patient support, and monitoring and triaging services can positively impact clinic efficiency and satisfaction.

Methods:
A workflow survey for LINQ II insertable cardiac monitor (ICM) was undertaken, including questions about RM. Respondents were clinicians at 66 clinics in UK/Ireland, managing an average of 563 ICM patients per clinic.

Results:
With app-based monitoring, workflow was rated as somewhat or much more efficient for 72% of users, with reduction in phone calls and disconnected patients highlighted as improvements (Table). The patient support service, including RM education, ordering the appropriate monitor, initial set-up, troubleshooting, and answering patient phone calls, saved 30.6 mins per implanted patient. The monitoring and triaging service had a positive efficiency impact for 69% of users. A majority of respondents were moderately or extremely satisfied with the RM solutions offered: 88% for being provided different options (app/hardware), 75% for users of the support service and 71% for users of the monitoring/triaging service. App-based monitoring was considered moderately or extremely easy by 77% of users and 79% were moderately or extremely satisfied with it.

Conclusions:
This survey suggests that app-based RM, patient support and monitoring and triaging services provide satisfaction and workflow efficiency improvements. Enabling time savings for RM is key to optimize management of the growing population of implanted patients.
Abstract 15377: Traditional Cardiovascular Risk Factors Do Not Fully Explain the Risk of CAD Population in Colombia
Authors: Gil Aldana Victor , Torres-Florez Juan D , Paez-Canro Carol
Published: December 2023

Introduction:
Major cardiovascular events occur even having reached LDL-C goals. Tolima department has the highest rate of cardiovascular mortality within Colombia.

Hypothesis:
in patients who underwent percutaneous coronary intervention (PCI) in a healthcare institution in Ibague Colombia, there is an increasing cardiovascular risk regardless of
traditional risk
factors.

Methods:
Descriptive, retrospective analysis of a cohort of patients with coronary artery disease (CAD) with PCI between 2020-2023. A multiple logistic regression model was developed, adjusted for predictors of CAD (Figure 1). Data was analyzed through R-4.3.0, JASP0.17.1 and Python3.11.

Results:
A sample size of 463 patients who underwent PCI was assessed (Table 1). Dyslipidemia was the most prevalent risk factor 43.2%(n=200). Mean LDL-C was 102, mean HDL was 38 and mean triglycerides was 186. The most incident coronary heart disease was NSTEMI 50.5%(n=234). Data was fitted into a logistic regression model accounting for comorbidities, risk factors and lipid profile values. Regression coefficients computed for CAD were around 0.07. Independent variables explain approximately 7 up to 16.1% of the variance observed in the dependent variable (Figure 1).

Conclusions:
In primary and secondary prevention for CAD, there is a high prevalence of risk factors. Although risk factors impact the outcome, they account for a relatively little variability within the model. Results imply that there are other key factors that contribute to the outcome and may not be measured currently. Further studies must be developed to evaluate markers in residual risk that may have an impact on the prognosis of patients with CAD.
Abstract 15401: Artificial Intelligence-Enabled Exercise-CMR for Evaluation of Cardiac Functional Reserve in Heart Failure
Authors: Ghanbari Fahime , Street Jordan A , Yoon Siyeop , Morales Manuel A , Rodriguez Jennifer , Yue Jennifer , Assana Salah , Nakamori Shiro , Robbins Jeremy M , Tsao Connie W , Gopal Deepa M , Systrom David , Waxman Aaron B , Manning Warren J , Nezafat Reza
Published: December 2023

Introduction:
Exercise unmasks pathophysiological markers in heart failure (HF), not evident at rest. Exercise CMR (Ex-CMR) has the potential to offer an accurate and reproducible assessment of cardiac functional reserve in HF.

Objective:
To study the cardiac functional reserve in HF using an artificial intelligence (AI) enabled exercise CMR imaging protocol.

Method:
We prospectively recruited patients with an established clinical diagnosis of HF and healthy adults. Subjects were imaged at rest and immediately post-exercise using a supine ergometer positioned on the CMR scan. The imaging protocol included free-breathing, real-time, highly accelerated cine short-axis images covering the entire LV. Cine images were collected with a spatial resolution of 1.9 х 1.9 mm
2
and temporal resolution of 38.8 ms using a 14.8-fold acceleration using an in-house inline deep learning reconstruction. Pre- and post-exercise biventricular volumetric and functional parameters and their corresponding percentage changes were calculated.

Results:
The study included 77 subjects, consisting of 37 HF patients (24 males; 60 ± 12 years) [HFpEF, n=13; HFmrEF, n=5; HFimpEF, n=13; and HFrEF, n=6], and 40 healthy adult (20 males; 45 ± 16 years). Changes in LV end-diastolic and end-systolic volume among subgroups revealed distinct clusters (Fig 1). These findings corresponded to a blunted to a modest rise in stroke volume (SV) observed in HFpEF and HFmrEF patients, respectively, while HFimpEF and HFrEF patients exhibited a mildly to excessively higher SV rise compared to other subgroups (Fig 1). HFpEF and HFmrEF showed no improvement in SV index beyond 10 ml/m
2
. Patients with known post capillary pulmonary hypertension demonstrated an inadequate right ventricle response in preload recruitment, contributing to a blunted increase in RV SV (Fig 1).

Conclusion:
Our AI-enabled, high-accelerated Ex-CMR imaging protocol reveals a distinctive biventricular functional reserve response in HF.
Abstract 15416: High Neighbourhood-Level Material Deprivation is Associated With Increased Rates of Cardiovascular Outcomes in Patients With ASCVD: A Population-Based Cohort Study
Authors: Sheth Maya S , Jeong Irene , Chu Anna , Basque Shalane , Fang Jiming , Austin Peter C , McNaughton Candace D , Abdel-Qadir Husam M , Ko Dennis T , Lee Douglas S , Udell Jacob A
Published: December 2023

Background:
Disparities in atherosclerotic cardiovascular disease (ASCVD) may persist even in jurisdictions with universal health care. The aim of this study was to examine the relationship between material deprivation and cardiovascular (CV) events in a population with established ASCVD.

Methods:
This population-based cohort study identified individuals in Ontario, Canada ≥66 years old as of January 1, 2019, with an ASCVD event in the prior 10 years. The primary exposure was neighbourhood-level material deprivation, denoting the inability to attain basic material needs, categorized into quintiles, from Q1 (least deprived) to Q5 (most deprived). Cause-specific hazard models estimated the association between material deprivation and CV outcomes over 3 years, adjusted for baseline characteristics. Trend tests across deprivation quintiles were performed.

Results:
Among 195,742 individuals with established ASCVD (median age 76 years, 37.3% female), individuals in the most deprived neighbourhoods (Q5) had higher rates of co-morbid conditions and CV disease, including myocardial infarction (MI), angina, peripheral artery disease, and coronary artery bypass grafts, compared to those in the least deprived neighbourhoods (Q1). Q5 residents had higher hazards of the composite outcome of all-cause death, MI, or stroke (hazard ratio [HR], 1.20 [95% CI, 1.16-1.24]), and component outcomes: all-cause death (HR, 1.23 [95% CI, 1.19-1.28]), MI (HR, 1.20 [95% CI, 1.11-1.31]), stroke (HR, 1.13 [95% CI, 1.03-1.23]), and heart failure (HR, 1.22 [95% CI, 1.16-1.28]), compared to Q1 residents. There were no significant differences for Q5 versus Q1 for coronary revascularization (HR, 0.97 [95% CI, 0.90-1.04]). We observed a progressive increase in risk across each quintile of deprivation (P-trend <0.05 for all outcomes).

Conclusion:
Despite universal health care, increasing deprivation was independently associated with higher rates of CV outcomes.
Abstract 15431: Barriers to Percutaneous Coronary Intervention in Sub Saharan Africa: A Call to Action
Authors: Ebengho Ikponmwosa G , Irorere Osaivbie E , Eromosele Oseiwe 'Benjamin' B , Ebengho Judith O
Published: December 2023

Introduction:
Myocardial infarction incidence is rising in Sub-Saharan Africa (SSA). Currently, 80% of the world cardiovascular disease mortality burden is by low- and middle-income countries. SSA countries have limited access to trained interventional cardiologists and medical centers where Percutaneous Coronary Intervention (PCI) is performed.

Methods:
In this review, Google Scholar and PubMed were used to search literature on PCI in SSA. Selection criteria were manuscripts published between 2013-2023, written in English language, and addressed the hurdles with PCI.

Results:
Between April 2010 and March 2019, patients presenting to a PCI-capable center in Abidjan, Côte d’Ivoire had a median delay of 20 hours from onset of symptoms to admission. This was 53.2 hours in Senegal, 4.35 days in Burkina-Faso, and 6.6 days in Tanzania, while it was between 2.3 to 3.6 hours in South Africa. In terms of availability of PCI-capable centers in East and Central Africa; Kenya, Ethiopia Tanzania, and Uganda 5, 3, 2, and 1 center (s) respectively. In West Africa; Nigeria, Senegal, Ghana, Côte d’Ivoire and Cameroon had 6, 4, 2, 1, and 1 center(s), respectively. The average cost of an uncomplicated PCI of a single vessel occlusion costs up to $3500 (R65,000/1,612,000). In SSA, due to limited access to medical insurance, the proportion of direct out-of-pocket payments in total health expenditure remains above 40%.

Conclusions:
Minimizing ST-elevation Myocardial Infarction care and PCI delay should be a public health priority, as it a matter of public health interest and global health equity. There is a need for research into understanding better ways to improve access to STEMI care in Africa.
Abstract 15432: Racial and Sex Disparities in Age-Adjusted Mortality in COVID-19 Patients With Atrial Fibrillation in the United States
Authors: Carver Caleb , Deshpande Saurabh , Ramphul Kamleshun , Khan Hassan , Ahmed Raheel , Salloum Mohammad Nour , Agboola Olayinka , Obeng-Gyimah Edmond , Schuler Brian , Khanji Mohammed , Sawatari Hiroyuki , Wafa Syed Emir Irfan , Somers Virend K , Padmanabhan Deepak , Providencia Rui , Chahal Anwar
Published: December 2023

Introduction:
While Coronavirus disease 2019 (COVID-19) primarily affects the respiratory system but can impact the cardiovascular system can triggering various complications.

Hypothesis:
To investigate the trend in age-adjusted mortality rates (AAMRs) in patients with atrial fibrillation(AF) among COVID-19-positive patients (CPP) by race and sex.

Methods:
Trends in AAMRs (per 100,000) from all-cause in patients with AF between April to December 2016-2020 were evaluated via the National Inpatient Sample and the US Census Bureau. The AAMRs among CPP with AF in 2020 was also evaluated between racial and sex cohorts.

Results:
A gradual rise in AAMR(all causes) in patients with AF was observed between 2016-2019, with a 49.4% overall rise between 2019(271 per 100,000) and 2020(405 per 100,000) (
Table 1a and Figure
). Around 250475 COVID-19-positive patients had AF, and 24.2% of cases did not survive their hospitalization (vs. 10.9% in those without AF, p<0.01, aOR 1.457, 95% CI 1.438-1.477). Among CPP males and females with AF that died, White females and males were the oldest, while Black males and females reported the highest mean Charlson Comorbidity Index (CCI) score (
Table 1b
).Furthermore, among the CPP with AF in 2020, Hispanics reported a higher AAMR (119.6 per 100,000) than Whites(111.1 per 100,000) and Blacks(101.9 per 100,000). AAMRs in males were higher in Hispanic males (144.8 per 100,000), followed by White males (129.7 per 100,000), and Black males (110 per 100,000). However, the AAMRs in females were highest in Black females (91.3 per 100,000), followed by White females (88.3 per 100,000) and Hispanic females (87.0 per 100,000). (
Table 1c
)

Conclusions:
AAMRs in patients with AF are on the rise and a sharp growth was seen during the first year of the pandemic. AAMRs among CPP patients with AF were highest among Black females and Hispanic males, while White males and females were oldest and Black males and females reported the highest CCI scores.
Abstract 15454: Socioeconomic Disparities and Healthcare Utilization Differ Significantly Among Cardiovascular Diseases in Medicare Patients: Medicare Current Beneficiary Survey (MCBS), 2020
Authors: Won Daniel , Walker James , Workman Connor , Ramesh Ashvita , Liu Tom , Lloyd-Jones Donald M , Malaisrie S C
Published: December 2023

Introduction:
Socioeconomic factors impact access to healthcare and patient care, particularly for patients with cardiovascular diseases (CVD). Understanding the differences in healthcare utilization and financial burden among patients with CVD is essential for developing targeted interventions and policies to improve patient care and reduce the financial burden of CVD.

Methods:
This cross-sectional study used the 2020 Medicare Current Beneficiary Survey (MCBS) to analyze disparities in socioeconomic factors among Medicare beneficiaries with various CVD. A survey-weighted logistic model was used to compare the proportion of socioeconomic factors between patients with and without hypertension (HTN), atherosclerosis (ASVD), angina, myocardial infarction (MI), heart failure (HF), and valvular disease or arrhythmias.

Results:
A significantly higher proportion of Medicare patients with HTN, ASVD, angina, HF and valvular disease/arrythmias attended >10 office visits per year (p<0.001) than those without (Figure 1A). Medicare patients with CVD reported greater difficulty paying medical bills (p<0.001), and those with MI and HF were significantly more likely to delay care due to cost (p<0.05). However, <4% of Medicare patients reported skipping or having difficulty affording blood pressure medications due to cost (Figure 1B, 1C).

Conclusions:
Medicare beneficiaries with CVD have significantly more office visits and difficulty paying medical bills, which imposes a substantial financial burden. However, reducing blood pressure medication costs is unlikely to substantially reduce the financial burden of CVD for Medicare patients with hypertension.
Abstract 15460: Relationship Between Sex and the Effects of Left Atrial Volume Index on Risk of Atrial Fibrillation Recurrence After Ablation
Authors: Lee Kevin , Minga Iva , Varley Allyson , Thorne Christopher , Osorio Jose , Singleton Matthew J , Silverstein Joshua , Metzl Mark
Published: December 2023

Introduction:
Atrial fibrillation (AF) is the most common arrhythmia and can be treated with ablation. However, recurrence after ablation remains common. We seek to use a large, real-world population to assess left atrial volume index (LAVi) as a risk factor for AF recurrence in men and women.

Methods:
The REAL-AF registry is a large, multicenter prospective registry enrolling patients undergoing AF ablation at high volume centers. Data from a total of 2666 patients (mean age 66 ± 11 years) receiving index ablations for both paroxysmal and persistent AF from the REAL-AF registry were separated into male (
n
= 1548) and female (
n
= 1118). The patients in each group were then divided into quartiles (Q1M, Q2M, Q3M, and Q4M for male and Q1F, Q2F, Q3F, and Q4F for female patients) based on LAVi obtained during ablation mapping. Hazard ratios (HR) were calculated per quartile for the development of AF recurrence within 12 months, controlling for the age of the patient and the physician performing the ablation.

Results:
Of the male patients, 176 (11%) were found to have a recurrence of AF while this occurred in 146 (13%) of the female patients. Results and quartile cutoffs are shown in table 1. For men and women, those with LAVi in Q4M and Q4F were at significantly higher risk of developing recurrent AF when compared to Q1M and Q4F (HR = 1.99 [1.24 - 3.18] and 1.97 [1.12 - 3.45] respectively). Men in Q4M also had a significantly higher risk of recurrence compared to Q2M (HR = 1.87 [1.20 - 2.92]) and a trend toward higher risk compared to Q3M (HR = 1.4 [0.95 - 2.13]). In contrast, women in Q2F had a significantly higher risk of recurrence (HR = 1.80 [1.08 - 2.99]) and Q3F had a trend toward higher risk (HR = 1.65 [0.95 - 2.87]) when compared to Q1F.

Conclusion:
There are gender differences in AF recurrence based on LAVi. Men tend to have a higher risk of recurrence only at the highest quartile of LAVi size while women tend to have a higher risk of recurrence at any size LAVi above the smallest quartile.
Abstract 15468: Factor VII Induced Coronary Thrombosis
Authors: Pushparaji Bala , Achuthanandan Supraja , Cordeiro Nikhil , De Leon De La Cruz Nicole S , Hashmi Arsalan , Friedman Michael
Published: December 2023

Case Description:
69-year-old male with a history of factor VII deficiency and coronary artery disease (CAD) with a stent in the distal left anterior descending (LAD) artery, underwent diagnostic laparoscopy for suspected appendiceal carcinoma. He is a non-smoker, has good exercise tolerance and takes aspirin only three times a week, due to epistaxis. Post-surgery, he complained of 10/10 substernal chest pain. Initial troponin (TnI) was 0.11 ng/dL, peaking at >80 ng/dL in 2 hours. EKG was compatible with an anterior wall STEMI. An emergent coronary angiogram showed a patent distal LAD stent and a 99% occlusive lesion in the mid-LAD, which was treated with a drug-eluting stent. With careful clinical judgment and hematology consultation, dual antiplatelet therapy was continued despite a history of coagulopathy. On probing, it was discovered that the patient received two doses of recombinant factor VII (rVII) prior to the surgery to reduce operative bleeding.

Discussion:
Recombinant factor VII is known to cause serious arterial and venous thromboembolic events. This risk increases to almost 10% in patients who are elderly with concomitant vascular disease. In our patient with prior history of CAD and in the setting of acute surgical stress, exogenous factor VII unbalanced the coagulation system leading to a STEMI. Surgical teams should be aware of the detrimental consequences of administration of rVII in high cardiovascular risk patients and seek alternative hemostatic strategies. Prothrombotic agents should be used with caution and close monitoring for acute coronary syndromes, especially in patients with a high risk of CAD.
Abstract 15509: “Root” Endothelial Cells: A Novel Population That Regulates Lung Capillary and Artery Maintenance and Repair
Authors: James Joel , Dekan Aleksandr , Niihori Maki , Valuparampil Varghes Mathews , Rafikova Olga , Rafikov Ruslan
Published: December 2023

Introduction:
Pulmonary capillary endothelial cells (ECs) are vital for various lung functions, such as maintaining the capillary network, promoting angiogenesis and facilitating gas and nutrient exchange. Recent advancements in single-cell transcriptomics have uncovered novel populations of general capillary ECs (gCaps) in the lungs. Understanding specialized EC types provides valuable insights into pulmonary vascular diseases. We aimed to challenge current understanding of the regenerative capabilities of lung resident ECs.

Methods:
Highly enriched ECs isolated from rat and mouse lungs underwent single-cell transcriptomics to explore EC population diversity.

Results:
UMAP annotation of ECs identified five novel general capillary cell populations (gCaps A-E). Lineage confirmation was achieved by Apelin receptor expression. Two distinct zonations (AV-zonation) were observed between pulmonary artery and vein ECs, with specific gCaps phenotypes (A: Clic4+, B: Flot1+, D: Scn7a+, E: Lingo2+), indicating a gradual phenotypic transition from arterial to vein ECs. Within the AV-zonation, a small population of gCapB (Flot1+) cells, resided at the interface of small artery ECs and gCap A and D, exhibiting characteristics of Root cells. RNA velocity analysis suggested Root cells as the origin of capillary and arterial cell lineages. PAGA analysis revealed high transcriptional similarity between gCapB and gCaps A, D, E and arterial cells, suggesting gCapB's role in capillary and arteriole formation and repair. Root cells exhibited upregulation of transcription factors Fos and Jun, promoting EC proliferation and angiogenesis, along with the Foxo and associated cell cycle regulation pathways. Root cells also displayed high G2M and S scores, indicating mitotic activity, supporting their role as the origin of capillary and arterial ECs. Elevated expression of CDKn1a and 1c, crucial for stem cell maintenance and differentiation further implied the repair potential of Root cells.

Conclusions:
Root Cells (gCapB) play a crucial role in regulating capillary and arteriole formation and repair by serving as a source of capillary and arterial ECs. These findings enhance our understanding of pulmonary vascular maintenance and repair mechanisms.
Abstract 15524: SARS-CoV-2 Spike Protein Stimulates Macropinocytosis in Murine and Human Macrophages
Authors: Ahn Wonmo , Pandey Ajay , -MMCC- PUSHPANKUR GHOSHAL , Singla Bhupesh , Simon Abigayle B , Derella Cassandra C , Harris Ryan A , Lucas Rudolf , Csanyi Gabor
Published: December 2023

Coronavirus Disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The emergence of this virus has led to millions of deaths and the long-term cardiovascular and respiratory consequences of COVID-19 continue to pose a massive threat to public health. While recent studies have demonstrated that SARS-CoV-2 may enter kidney epithelial cells via angiotensin converting enzyme 2 (ACE2)-independent mechanisms by inducing receptor-independent macropinocytosis, it is currently unknown whether this process also occurs in cell types directly relevant to SARS-CoV-2-associated cardiovascular disease or pneumonia. Here, we investigated the ability of SARS-CoV-2 spike protein subunits to stimulate macropinocytosis in alveolar epithelial cells and macrophages. Flow cytometry analysis of fluid-phase marker internalization demonstrated that SARS-CoV-2 spike protein subunits S1, the receptor binding domain (RBD) of S1, and S2 stimulate macropinocytosis in both human and murine macrophages, but not in human lung epithelial cells. Pharmacological and genetic inhibition of macropinocytosis substantially decreased spike protein-induced macropinocytosis in macrophages both
in vitro
and
in vivo
. High resolution scanning electron microscopy (SEM) imaging confirmed spike protein-induced plasma membrane activities characteristic of macropinocytosis. Mechanistic studies demonstrated that inhibition of protein kinase C and phosphoinositide 3-kinase in macrophages blocks SARS-CoV-2 spike protein-induced macropinocytosis. Further, pharmacological blockade of ACE2 did not inhibit macropinocytosis in SARS-CoV-2 spike protein-treated cells. To our knowledge, these results demonstrate for the first time that SARS-CoV-2 spike protein subunits stimulate macropinocytosis in macrophages. These results may contribute to a better understanding of SARS-CoV-2 infection and its cardiovascular and respiratory complications.
Abstract 15554: Three-Year Incidence of Pacemaker Implantation in Patients With Atrial Fibrillation and Sinus Node Dysfunction Receiving Ablation versus Antiarrhythmic Drugs
Authors: okumus nazli , Iglesias Maximiliano , Khanna Rahul , Rong Yiran , Karim Saima
Published: December 2023

Introduction:
Around one in five patients with atrial fibrillation (AF) has a diagnosis of sinus node dysfunction (SND).

Hypothesis:
There will be lower incidence of pacemaker implantation (PPM) among patients with AF and SND who undergo catheter ablation (CA) compared to anti-arrhythmic drugs (AAD).

Methods:
Data were collected from 2014-2022 utilizing Optum Clinformatics database, an administrative claims database for commercially insured and Medicare Advantage beneficiaries in the United States. Adult patients with concomitant AF and SND, and prior history of taking at least one AAD were identified and classified into CA or AAD cohort based for subsequent treatment. Patients were excluded if they had a prior history of PPM, implantable cardiac defibrillator, catheter or surgical ablation, AV nodal ablation, valvular procedure, left atrial appendage occlusion, or high grade/complete heart block. Inverse probability treatment weighting technique was applied to balance sociodemographic and clinical comorbid characteristics between the cohorts. Weighted Cox regression model was used to evaluate the differential risk of incident PPM. Sub-analyses were performed by AF type (paroxysmal and persistent AF).

Results:
There were 1,206 patients in AAD cohort and 1,624 patients in CA cohort. Incidence rate (per 1,000 person-year) of PPM was 55.8 (95% CI 47.1-64.5) for CA cohort and 117.8 (95% CI 101.7-133.9) for AAD cohort and the 3-year cumulative incidence of PPM was 23.1% (95% CI 20.0%-26.2%) and 13.8% (95% CI 11.6%-15.9%), respectively. Weighted Cox regression model indicated that CA had 43% lower risk of incident PPM compared to AADs (hazard ratio [HR] 0.57; 95% CI 0.46-0.71). Those with paroxysmal AF (HR 0.48; 95% CI 0.34-0.69) had lower need for PPM compared to persistent AF (HR 0.57; 95% CI 0.40-0.81).

Conclusions:
Patients with AF and SND treated with CA were observed to have significantly lower risk of incident pacemaker implantation compared to those who had AAD.
Abstract 15581: Increasing Myocardial Carnosine Levels Reduces Adverse Remodeling During Heart Failure
Authors: Doelling Benjamin , Hoetker David , Brittian Kenneth , Brainard Robert E , Bhatnagar Aruni , Baba Shahid P
Published: December 2023

Background
: Lipid peroxidation products, such as acrolein, are highly toxic aldehydes generated during pathological remodeling and associated with heart failure. Until now, no translatable therapy has been tested to remove these toxic products from heart and examine the subsequent effects on failing hearts. The heart contains small histidyl dipeptides, such as carnosine (β-alanine-histidine), which bind lipid peroxidation products. Carnosine is decreased in failing hearts and its levels can be increased by supplementing the precursor, β-alanine. This study investigates the cardioprotective and translational potential of β-alanine supplementation in a transaortic constriction (TAC) model of heart failure.

Hypothesis
: Increasing myocardial carnosine via β-alanine supplementation will improve cardiac function during heart failure.

Approach
: Male wild-type C57BL/6J mice were treated either (a) water alone, (b) β-alanine 1 week prior to TAC, or (c) β-alanine (20g/L) in water 4 weeks post TAC. Supplementation of β-alanine was continued for 8 weeks, followed by serial echocardiography, biochemical, and mass spectrometry analysis.

Results
: Myocardial carnosine increased ~3-4-fold after 1 week of β-alanine feeding compared with water alone (p < 0.05). β-alanine pre-feeding compared with water alone, after 8 weeks of TAC, decreased left ventricular (LV) mass (β-alanine: 174 ± 29
vs
water: 241 ± 17 mg, p < 0.05) and LV inner diameter at systole (β-alanine: 2.2 ± 0.6
vs
water: 3.5 ± 0.4 mm, p < 0.05) and diastole (β-alanine: 3.5 ± 0.4
vs
water: 4.4 ± 0.3 mm, p < 0.05), and increased ejection fraction (β-alanine: 67 ± 14%
vs
water: 42 ± 9%, p < 0.05) and cardiac output (β-alanine:13.6 ± 2.6
vs
water: 10.7 ± 1.0 mL/min, p < 0.05). Post-TAC β-alanine intervention decreased LV mass (β-alanine :177 ± 8
vs
water: 214 ± 11 mg, p < 0.05), hypertrophic markers
Nppa
and
Myh7
, and increasingly removed acrolein from heart by conjugation (β-alanine: carnosine-propanal: 12.2 ± 0.4
vs
water: 0.7 ± 0.4 pmoles/mg protein, p < 0.0001).

Conclusion
: Increasing myocardial carnosine via oral supplementation alleviates pathological remodeling, possibly through quenching reactive aldehydes. These findings lay foundation to test the feasibility of β-alanine in heart failure patients.
Abstract 15587: Iimpact of Body Mass Index on Bleeding Events Patients Undergoing Percutaneous Coronary Intervention With or Without High Bleeding Risk
Authors: Gao Michael , Spirito Alessandro , Sartori Samantha , Vogel Birgit , Kamaleldin Karim , Nathani Mashal , Smith Kenneth F , Sharma Samin K , Kini Annapoorna , Dangas George , Mehran Roxana
Published: December 2023

Introduction:
High body mass index (BMI) values are associated with a lower risk of ischemic complications after percutaneous coronary intervention (PCI).
Hypothesis
:
Higher BMI values may correlate with fewer bleeding after PCI in patients meeting or not the High Bleeding Risk (HBR) criteria of the Academic Research Consortium (ARC).

Methods:
All patients undergoing PCI between 2012 and 2019 at the Mount Sinai Hospital were included and stratified in 5 BMI categories according to World Health Organization definition. Patients where considered at HBR if they fulfilled ≥1 major or ≥2 minor ARC-HBR criteria. The primary outcome was major bleeding, the secondary outcome was post-discharge major bleeding at 1 year after PCI. Risks for these outcomes were obtained using a multivariable Cox regression model adjusted for the ARC-HBR criteria.

Results:
Among 16,229 patients, 20.2% had a BMI ≥18.5-25 (normal), 40.7% had a BMI ≥25-30, 24.4% had a BMI ≥30-35, 9.2% had a BMI ≥35-40, and 4.8% had a BMI ≥40 kg/m
2
. The proportion of patients meeting the ARC-HBR criteria progressively decreased from 48% in the normal BMI group to 41% in the highest BMI group. As compared to the normal BMI group (6.0%), the 1-year risk of major bleeding was significantly lower (p<0.05) in the groups with BMI ≥25-30 (4.1%, adj. HR 0.73, 95% CI 0.60-0.88), with BMI ≥30-35 (3.5%, Adj. HR 0.62, 95% CI 0.49-0.77), with BMI ≥35-40 (4.2%; Adj. HR 0.72, 95% CI 0.54-0.9), while it was similar in the group of BMI ≥40 (4.9%, Adj. HR 0.83, 95% CI 0.58-1.18) (
A
). These differences were driven by lower rates of in-hospital bleeding in patients with BMI ≥25-40 kg/m
2
. Among HBR patients, 1-year rates of major bleeding were consistently above 4% in each BMI category, but relatively lower for BMI ≥25-40 kg/m
2
(
B
).

Conclusions:
BMI values between 25 and 40 kg/m
2
were associated with an attenuated risk of major bleeding at 1-year in patients undergoing PCI and this association was consistent among HBR individuals.