bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 13958: Evolocumab Alters Vascular Function in Patients With Cardiovascular Disease
Authors: Kannenkeril Dennis , Bosch Agnes , Striepe kristina , Berner Laura , Pietschner Robert , Kolwelter Julie , Ott Christian , Schiffer Mario , Achenbach Stephan , Schmieder Roland E
Published: June 2023

Background:
The aim of this study was to analyze the effect of evolocumab on vascular function and structure in patients with cardiovascular disease.

Methods:
This was a prospective, double-blinded, randomized, controlled study (NCT03626831) including patients with cardiovascular disease and treated with statins. Patients were consecutively randomized (1:1) to either evolocumab treatment (420mg was administrated twice during the study) or placebo. All patients underwent vascular examination at baseline, and after 1, 4 and 8 weeks of treatment by the SphygmoCor XCEL System (pulse wave analysis) and the UNEX EF 18G system (endothelial function). Endothelial function parameter such as flow-mediated vasodilation (FMD), low flow-mediated vasoconstriction (L-FMC) and vasoactive range (VAR) were measured. Moreover, pulse wave analysis parameters such as central systolic pressure, central pulse pressure, augmentation index, pulse wave velocity were measured.

Results:
103 patients with a mean age of 66.2 (±7.7) years and a mean LDL-cholesterol of 98.2 (±19.1) mg/dl completed the study. LDL-cholesterol decreased significantly already after 1 week of treatment with evolocumab compared to baseline (-47.4 (±13.1) mg/dl). Endothelial function parameter (VAR) increased after 8 weeks of treatment with evolocumab compared to baseline (p=0.034), whereas there was no significant change at 1 and 4 weeks after treatment. Moreover, an improvement in VAR from baseline at week 8 was found with evolocumab compared to placebo (p=0.045). No change in the pulse wave analysis parameters were found with treatment. In a subgroup analysis, in patients with age ≤67 years, lower systolic blood pressure (≤125 mmHg) or higher baseline LDL-cholesterol (>95 mg/dl), significant evolocumab treatment effect was found in VAR improvement (p=0.006, p=0.049 and p=0.042, respectively) from baseline at week 8.

Conclusion:
Our data indicate that endothelial function could be improved with evolocumab treatment in high-risk patients with preexisting cardiovascular disease and on statin therapy. Our results contribute to the mechanistic explanation why lower incidence of the cardiovascular composite endpoint has been demonstrated in the FOURIER study.
Abstract 13973: Human iPSC-Derived Multi-Cell-Type Engineered Heart Tissues as an
in vitro
Model to Study Pathological Cardiac Hypertrophy
Authors: Wrona Kinga M , Albert Alba M. M , Eckardt Dominik , Herbel Christoph , Krause Julia , Starbatty Jutta , Hemkemeyer Sandra A A , Frye Maike , Cuello Friederike , Eschenhagen Thomas , Hirt Marc N
Published: June 2023

Introduction
Pathological cardiac hypertrophy has not been fully recapitulated in the
in vitro
settings. Currently used
in vitro
models are presumably oversimplified since the vast majority are based on iPSC-derived cardiomyocytes (CMs) exclusively and do not include any cardiac non-myocytes. The aim of this study was to generate engineered heart tissues (EHTs) containing five hiPSC-derived cardiac cell types, i.e., CMs, endothelial cells (ECs), macrophages (Mϕs), fibroblasts (FBs), and smooth muscle cells (SMCs) and treat them with prohypertrophic compounds.

Methods:
Mesoderm induction preceded all cell-type-specific differentiation steps. CMs were then generated by Wnt signaling inhibition and ECs by VEGF stimulation. Mϕ differentiation required treatment with IL-3+M-CSF. FBs and SMCs were generated by Wnt pathway activation followed by bFGF or TGFβ+bFGF stimulation. The characterization of different iPSC-derivatives and EHTs was based on the MICS (MACSima Imaging Cycling Staining) technology and profiling of hallmark genes and proteins. To study the response to prohypertrophic stimuli, EHTs were treated with 20 μM phenylephrine (PE) and 50 nM endothelin-1 (ET-1) for 9-10 days.

Results:
The expression of cell-type-specific markers and functional assays were the determinants of successful differentiation. For instance, CMs were identified based on cTnT expression and contractile capabilities, Mϕs by expression of CD68 and phagocytic activity, and ECs by CD31 expression and tube formation abilities. Multi-cell-type EHTs were assembled from 60% CMs, 20% ECs, 10% Mϕs, 5% FBs and 5% SMCs. These EHTs displayed accelerated development, i.e., faster remodeling and earlier onset of beating compared to CM-only EHTs. Preliminary results show that multi-cell-type EHTs exhibited higher maximal forces and increased stiffness compared to CM-only controls. The exposure to PE+ET-1 led to a decrease in force, activation of the hypertrophic gene program, and elevation of NT-pro BNP production.

Conclusions:
We successfully generated functional multi-cell-type EHTs containing five hiPSC-derived cardiac cell types. Upon hypertrophic stimulation, these EHTs developed a pathological phenotype that resembles the hallmarks of a failing human heart.
Abstract 14: A Novel Pharmacologic Peptide Improved Survival And Neurologic Outcomes After Swine PEA
Authors: Oberdier Matt T , Li Jing , Ambinder Daniel , Suzuki Masahito , Tumarkin Ethan , Fink Sarah , Zhu Xiangdong , JUSTICE CODY , Vanden Hoek Terry L , Halperin Henry R
Published: June 2023

Introduction:
Successful outcomes following cardiac arrest and CPR are between 5 and 15%. No pharmacologic agent has been shown to improve survival with good neurologic function. A pharmacologic agent that favorably influences heart and brain metabolism following arrest would be ideal. Our group has produced a peptide, TAT-PHLPP9c, that enhances the activity of Akt by inhibiting PH domain leucine-rich repeat phosphatase (PHLPP). Activation of this pathway prevents cardiac stunning and cerebral edema by limiting the release of taurine and glutamate, respectively.

Hypothesis:
Neurologic outcomes following PEA arrest in swine will be improved by the administration of TAT-PHLPP9c during CPR.

Methods:
24 female pigs (30-35 kg) were anesthetized, mechanically ventilated, and catheterized. Pulseless electrical activity (PEA) was induced by inflating balloons at proximal positions in the left anterior descending and right coronary arteries to full occlusion. After an average PEA period of 7 minutes, ACLS was initiated with mechanical ventilation and vest CPR. For the controls (n=12), boluses of 0.5 mg epinephrine were administered via the venous line after one and three minutes of support. For the peptide treated animals (n=12), boluses of 7.5 mg/kg TAT-PHLPP9c were also given at one and three minutes of CPR. The balloons were deflated and removed after two minutes of support. ACLS continued until ROSC was achieved. Animals were recovered post-anesthesia and classified as neurologically intact or not intact based on behavior norms for healthy pigs. Animals with ROSC that were neurologically intact were survived overnight.

Results:
ROSC was more common in the peptide group, but this difference was not significant (8 control versus 12 peptide, P=0.0932). Survival was significantly more frequent in the peptide group (0 control vs. 11 peptide, P<0.00001), and all survivors were neurologically intact.

Conclusion:
Peptide administration during CPR is promising as a means of improving survival and neurologic outcomes following PEA arrest.
Abstract 14007: Sodium-Dependent Glucose Transporters 2 Inhibition Ameliorates Obesity-Induced Metabolic Changes and Cardiomyopathy
Authors: Hsu Ling-Wei , Lee Christin , Chen Yan-Ting , Hsieh Sung-Chun , Liu Ping-yen
Published: June 2023

Introduction:
Inhibition of renal sodium-glucose cotransporter-2 (SGLT2) reduces urinary glucose reabsorption to decrease glycemia. Recent large-scale trials have shown that SGLT2 inhibitors provide cardio protection beyond lowering glucose.

Hypothesis:
Treating SGLT2 inhibitor (SGLT2i) reduces the cardiovascular risk in type 2 diabetes that indicates the potential correlation of SGLT2i in cardiomyopathy mediating metabolic effects.

Methods:
Male 8 weeks old C57/BL6 mice were fed high fat diet (> 60% of fat) for 4 months, and treated SGLT2i, canagliflozin (CANA) in the third and the fourth month. Measured its blood glucose, body weight and echocardiology every month. Moreover, analyzed the lipid contents in its plasma, the adipose tissue, liver and heart, and also examine the cardiomyopathy markers and its potential signaling pathways. Furthermore, palmitate acid (PA) was treated to H9c2 cells to mimic a high lipid environment, and validate its potential signaling pathways.

Results:
Treatments of high fat diet-induced obese mice with the CANA reduced blood glucose, body weight and adiposity. Moreover, CANA reversed the obesity-induced cardiomyopathy including heart weight ratio, echocardiology and cardiomyopathy markers (
Col1
,
Col4
,
Icam1
and
Myh7
). Furthermore, CANA increased AKT phosphorylation which is the one of the key pathways, and reduces apoptosis in cardiomyopathy. To investigate the potential mechanisms of metabolic changes in cardiomyopathy by CANA, we searched the hepatic RNA expression from high fat diet induced obesity mice by GEO profiles online. FGF21, a hepatokine increased in CANA action by hepatic and adipose tissue lipolysis, next circulated to the heart, and induced AKT phosphorylation to reduce apoptosis. CANA increased plasma and hepatic FGF21 in obese mice. Further treating recombinant FGF21 in H9c2 differentiated cardiomyocyte like cells with palmitic acid, FGF21 reduced cardiomyocyte apoptosis via AKT phosphorylation.

Conclusions:
These data demonstrated that SGLT2 inhibition ameliorates metabolic changes and apoptosis via FGF21-AKT pathway in cardiomyopathy.
Abstract 14045: Implementation of High-Sensitivity Cardiac Troponin Assay in Emergency Department Increases Myocardial Infarction Diagnosis and Utilization of Invasive Cardiac Procedures: An Insight From Middle East/ Gulf Region
Authors: DABABO NOUR , almahmeed Nada , Edris Ahmad , AbdelWareth Laila , Manla Yosef , Lee St John Terrence , Al Badarin Firas
Published: June 2023

Introduction:
Utilization of high-sensitivity cardiac troponin T (hsT) assays facilitates evaluation of patients with suspected acute coronary syndrome in emergency department (ED) by expediting clinical-decision making and disposition. While the utility of (hsT) has been previously shown, data from the Middle East/ Gulf region (MEG) are limited. We aimed to evaluate the association between hsT implementation and changes in resource use at a tertiary care center in MEG.

Methods:
Consecutive patients evaluated in ED using hsT (hsT era) or conventional troponin assays (pre-hsT era) were identified. Discharge diagnosis of myocardial infarction (MI), utilization of invasive and non-invasive testing (cardiac CT, perfusion imaging and stress echocardiography) during index admission was determined using ICD codes. Unadjusted rates of these outcomes in addition to in-hospital mortality were compared before and after adoption of hsT assays using appropriate tests.

Results:
Among 21,149 and 18,979 ED encounters before and after implementation hsT, mean patient age was 53.8 ± 18.1 and 53.3 ±17.8, (P=.09), respectively. The introduction of hsT assay was associated with a 23% increase in MI diagnosis (3.7% vs 3.0%; P<.001), 13% increase in invasive angiography use (4.4% vs. 3.9%; P=.02), and a concomitant 70% reduction in use of non-invasive studies (0.02% vs. 0.07%; P=.02). Additionally, mortality during index admission was significantly higher in the hsT era (1.3% vs. 1.1%; P=.01).

Conclusion:
Introduction of hsT assay at a single-center in MEG increased MI diagnosis and identified patients who are at increased risk of death. Furthermore, it was associated with greater use of invasive cardiac procedures. Whether more aggressive management during index hospitalization in this population is associated with favorable long-term outcomes requires additional studies.
Abstract 14073: Hypercalcemia Induced Reversible LBBB
Authors: Sankar Parvathy Ravi , Menon Venu
Published: June 2023

Background:
Parathyroid hormone (PTH) and calcitriol are the two hormones responsible for calcium and phosphate homeostasis. PTH exerts its effect on the renal tubular calcium reabsorption and bone resorption. PTH secretion is modulated by calcium acting on the sensitive calcium-sensing receptor on the parathyroid cells. Primary hyperparathyroidism has been linked to hypertension and valvular calcification. Structural changes are also seen including elevated left ventricular mass, diastolic dysfunction and myocardial calcification.

Case presentation:
A 61-year old female with hyperlipidemia and osteoporosis presented with polyarticular joint pain and diffuse myalgia noted to have elevated PTH of 90 pg/ml and elevated Ca of 10.1 mg/dl. Her calcium levels has ranged from 10.1 to 11.2 mg/dl and her PTH ranged from 90 to 113 pg/ml. She had a negative sestamibi scan, and thyroid ultrasound showed fusiform lesion measuring 0.82 x 0.36 in the right posterior neck suspicious for a parathyroid adenoma with the plan made for resection. The diagnosis at this time was primary hyperparathyroidism induced hypercalcemia. She developed exertional dizziness and was found to have a new LBBB and reduced ejection fraction of 40-45% with a small fixed defect in the septal area which was attributed to the LBBB. She was initiated on metoprolol succinate 25 mg, irbesartan 75 mg, atorvastatin 40 mg and aspirin 81 mg because of the reduced systolic function. SPECT was negative for ischemia with a fixed decreased uptake of the septum. She underwent right lower parathyroid excision on 11/2021 with normalization of calcium to 9.4 mg/dl and PTH to 9 pg/ml with resolution of the LBBB and systolic function in 2/2021 improving to 48%.

Discussion:
Calcium plays a key role in cardiac excitation, depolarization, repolarization, and also coupling of these signals to mechanical contraction via calcium induced calcium release and myofibril cross linking. In this case, calcium was only mildly elevated to cause a partial conduction defect. Literature is lacking on whether there is a threshold level for calcium that predisposes to varying degrees of conduction disease. This case also highlights the temporal nature of symptom resolution following parathyroid surgery with resolution of the LBBB.
Abstract 14098: Early Recurrence Following Resolution of a Watchman Device Related Thrombus
Authors: Nand Nikita , Diab Mohamed , Jain Deeptanshu , shamaki garba rimamskep , Corteville David
Published: June 2023

Introduction:
Left atrial appendage occlusion devices are widely used as stroke prevention alternative to oral anticoagulation in patients with atrial fibrillation (AF). Recently, there has been growing concern for device related thrombus (DRT) and the associated risk for stroke and systemic embolism. Studies have mentioned the incidence, predictors, and risk factors for DRT post left atrial appendage occlusion devices. However, not much is known about DRT recurrence, and reports describing such events despite anticoagulation are very limited.

Methods:
This report describes early DRT recurrence post WATCHMAN implantation following initial treatment to resolution of DRT with anticoagulation.

Results:
A 79-year-old woman with permanent atrial fibrillation and no identifiable risk factors for DRT, underwent WATCHMAN implantation . TEE at 45 days showed a well-seated WATCHMAN device with no peri-device leak but revealed a DRT on the surface of the device, confirmed by CT angiography. Patient was prescribed Eliquis for 3 months and aspirin 325 mg daily was continued. Complete resolution of DRT was noted on a repeat CT scan 3 months later and Eliquis was discontinued. She returned approximately 1 months later (and few weeks after completing her 3-month course of Eliquis) for a repeat TEE, which now revealed a new recurrent DRT.

Conclusions:
This report adds to the current literature about early DRT recurrence and possible emphasis on continued anticoagulation following first DRT to prevent recurrence. Although several risk factors have been identified to predict DRT, it is unclear which patients are at increased risk for recurrence of DRT. Patient and procedural factors and the choice of oral anticoagulation seem to play a role.

Figure 1:
Appearance of device related thrombus on cardiac computed tomography (CT). Illustration of a hypo attenuated thickening on the surface of the left atrial appendage occlusion device suggestive of device related thrombus.
Abstract 14135: Neighborhood Socioeconomic Status and Heart Failure or All-Cause Readmission Within a Safety-Net System
Authors: Jeon Diane , Ma Yifei , Thakkar Anjali , Durstenfeld Matthew S , Hsue Priscilla
Published: June 2023

Introduction:
Neighborhood socioeconomic status (NSES) independently predicts higher rates of heart failure (HF) readmission, but whether this is true in a safety-net system is uncertain.

Methods:
We conducted a retrospective EHR-based cohort study of adults with HF between 2001-2019 at a municipal safety-net hospital in SF using Fine-Gray survival models. Most recent residential addresses were geocoded. NSES index is a composite measure including income, education, employment, and housing scaled to the SF Bay Area as quintiles (1=lowest, 5=highest).

Results:
Among 2,507 individuals with index HF hospitalization, 179 (7.1%) were readmitted within 30 days for HF and 374 (14.9%) for any cause. Within 1 year, 639 (25.5%) were readmitted for HF and 1,185 (47.3%) for any cause. In unadjusted analyses, NSES is associated with HF readmission at 30 days (p=0.013) or 1 year (p=0.021) and all-cause readmission at 30 days (p=0.0015) or 1 year (p=0.0049). Adjusted for demographics, substance use, and comorbidities, Quintile 1 has 58% higher risk of HF readmission (HR=1.58, 95% CI 1.07-2.33, p=0.021) and 56% higher risk of all-cause readmission (HR=1.56, 95% CI 1.19-2.05, p=0.001) over 1 year than Quintile 5. Similarly, compared to Quintile 5, all quintiles have higher risk of all-cause readmission over 1 year from Quintile 2 (HR=1.53, 95% CI 1.16-2.03, p=0.003) to Quintile 4 (HR=1.50, 95% CI 1.10-2.03, p=0.010). Including GDMT prescription does not change these results.

Conclusion:
NSES is associated with a higher risk of HF and all-cause readmissions over 1 year in a safety-net hospital. Further studies should investigate NSES domains to identify interventions and address disparities.
Abstract 14157: Effects of Follistatin on the Regulation of Vascular Function by Perivascular Adipose Tissue in a Model of Essential Hypertension
Authors: Kuganathan Ann , Leal Marcos , Lu Vincent , Gao Bo , Dickhout Jeffrey , Krepinsky Joan C
Published: June 2023

Introduction:
We previously showed that follistatin (FST), a potent activin inhibitor, lowers BP in the spontaneously hypertensive rat (SHR), a model of essential HTN. This was associated with improved vessel structure (reduced collagen) and function (reduced hypercontractility and improved endothelium-dependent relaxation). FST also reduced vascular oxidative stress (ROS).

Perivascular adipose tissue (PVAT) is known to regulate vascular tone. FST induces browning and thus increased thermogenic activity of peripheral adipose tissue. Transition from white to brown adipose tissue is associated with decreased risk of CVD. Here, we assess FST effects on PVAT and its regulation of SHR vascular function.

Methods:
SHR were treated with FST from 12-20 weeks of age. Normotensive WKY rats served as controls. Mesenteric resistance arteries were isolated with or without intact PVAT. Vessel function was assessed using wire myography. In separate studies, white mesenteric and brown aortic PVAT, or peripheral fat depots, were isolated from WKY rats. These were introduced to WKY mesenteric vessels to study PVAT-isolated function.

Results:
Intact PVAT augmented constriction to KCl in SHR, but not WKY arteries, an effect prevented by FST. Improvement in endothelium-dependent vasodilation in FST-treated SHR was PVAT-dependent. SHR PVAT had increased adipocyte size and ROS (by DHE), both reversed by FST. Isolated PVAT from WKY incubated with pyocyanin (30’) to induce ROS augmented the KCl response, suggesting that FST inhibition of PVAT oxidative stress in HTN restores beneficial vascular effects. Incubation of WKY vessels with brown PVAT inhibited constriction to KCl more effectively than did white PVAT. Interestingly, peripheral white adipose (inguinal) did not have any anticontractile effect. Brown adipose (interscapular) effects were intermediate.

Conclusions:
Improvement in anticontractile effects of PVAT by FST in resistance vessels is associated with reduced PVAT oxidative stress. Brown PVAT is more effective than white PVAT in inhibiting vessel contraction, and unlike white PVAT, peripheral white adipose does not have anticontractile effects. Future work will assess effects of FST on PVAT browning, and whether browning itself can improve BP.
Abstract 14167: Safety Profile of Leadless Pacemaker in Comparison to Conventional Transvenous Pacemaker: A Systemic Review and Meta-Analysis
Authors: Shtembari Jurgen , Shrestha Dhan B , Awal Shila , Raut Anuradha , Gyawali Pratik
Published: June 2023

Introduction:
Recently, there has been a dramatic surge of interest in leadless pacemakers (LP). Although benefits of LP versus transvenous pacemakers (TVP) have been reported in small institutional and some registry-based studies, the systematic comparison and pooling of data remain limited. Therefore, we sought to meta-analyze the safety and benefit of leadless pacemakers over conventional transvenous pacemaker systems.

Method:
We followed PRISMA guidelines to conduct the study. The study protocol has been registered in the PROSPERO (CRD42022325376). Databases were searched for published literature from inception to April 12, 2022. Comparative studies on TVP with LP reporting device-related, cardiac, vascular, thoracic complications, and infection were included. Studies were analyzed using RevMan 5.4.1 with odds ratios (OR) to assess overall complications, device dislodgement, reintervention, and other complications. The I-squared (I
2
) test was used to assess the heterogeneity.

Result
Total 879 studies were imported from databases. After the removal of 265 duplicates, 614 papers were screened for eligibility. Among 41 papers screened for full text, 17 meet the inclusion criteria. There were 50% lower odds of overall complications in the LP group (OR 0.50, 95% CI 0.32 to 0.78; n = 20825). Similarly, 73% lower odds of device dislodgment (OR 0.27, 95% CI 0.14 to 0.50; n = 6897), 46% lower odds of re-intervention (OR 0.54, 95% CI 0.45 to 0.64; n= 17009), 87% lower odds of pneumothorax (OR 0.13, 95% CI 0.03 to 0.57; n = 4261), however 2.08 higher odds of pericardial effusion (OR 2.08, 95% CI 1.04 to 4.16; n = 4842) observed in LP group.

Conclusion
Meta-analysis of observational studies suggests that LP demonstrates a more favorable complication profile than TVP, although with higher rates of pericardial effusion. However, patient selection was not uniform between studies, and inferences remain limited.
Abstract 14198: Implementing an Effective Standardized Bystander Cardiopulmonary Resuscitation Protocol for Golf Courses
Authors: Casey Donald E , Baumgarten Clara
Published: June 2023

Introduction:
A golf course is the fifth most common public place for cardiac arrest (CA). Currently, no standardized protocol exists for bystander CPR in the event of full CA on a golf course. Informal interviews with golfers and golf course personnel strongly suggest incomplete and variable knowledge about what to do in accordance with most current guidelines.

Hypothesis:
We hypothesize that development and use of a standardized protocol for the three most critical first steps to assure a person’s survival of an on-golf course CA, including calling 911, initiating high quality bystander CPR with guideline based chest compressions and early defibrillation with a standardized automated external defibrillator (AED) will improve chances of surviving if playing partners, caddies and club staff are well prepared to respond urgently to such an emergency.

Methods:
We created a four-panel laminated infographic designed to fit easily into every golfer’s bag, assuring a readily available “911-CPR-AED” guide for lay bystanders to initiate chest compressions, notifying the Golf Shop Personnel for getting an AED and any BLS certified persons out to arrest site as fast as possible to deliver defibrillation, and simultaneously readying the golf course grounds crew to meet the arriving rescue ambulance at the front entrance to the course and escorting them quickly and safely out to the CA site. All aspects of this process were shared and approved by leaders of the closest Emergency Medical System (EMS) and hospital emergency department (ED).

Results:
We simulated with all key stakeholders a full on-course cardiac arrest and 911 call to EMS in accordance with the infographic protocol, including victim resuscitation of a standard CPR mannikin and onsite rescue by paramedics. Bystander CPR was immediately initiated, AED delivered at 3 minutes, ambulance arrival at 6 minutes and full advanced cardiac life support delivered at this time with return of blood pressure. EMS loaded the victim into the ambulance at 12 minutes and was escorted back to the front entrance of the course and then to the local ED. The 911-CPR-AED infographic has now been distributed to all golfers, caddies and staff.

Conclusion:
An effective, standard bystander CPR protocol now exists for use at any US golf course.
Abstract 14200: Pacemaker Dependent Patients Can Be Discharged With Active Fix Temporary Pacemakers Following CIED Extraction for Infection
Authors: Alkhalaileh Duna , Glover Anne , Krebsbach Angela , Verdick Christopher , Sandhu Uday Gajjandra , Alkukhun Laith , Jessel Peter , Henrikson Charles
Published: June 2023

Introduction:
Management of infected CIEDs includes removal of the device with adjunctive antibiotic therapy. Temporary device management has historically consisted of a balloon-tipped temporary pacemaker (TPM). In recent years, TPMs with an externalized standard permanent pacing generator and an active fixation permanent pacing lead have become an alternative option to the balloon tipped pacemaker. These patients are typically kept in the hospital; however, this temporary pacing system is very secure, and with adequate social supports, these patients can be discharged.

Methods:
We reviewed data from patients who had CEID extraction between July 2012 and October 2021 at Oregon Health and Science University, and identified patients who were pacer dependent, underwent extraction for infection, and were discharged with an active fix TPM via the right internal jugular. Data for this study were collected prospectively in an IRB-approved clinical and research database for all patients undergoing lead extraction procedures.

Results:
A total of 14 individuals were identified between July 2012 and October 2021. Of the 14 patients identified, the majority were male (57.1%), had a median age of 71 years, and had systemic infections (92.9%). The mean length of hospitalization was 12 days, with a follow up visit occurring 5 days after discharge on average. One patient was lost to follow up following discharge with a plan for reimplantation at an outside hospital. The remaining 13 patients were seen weekly in pacer clinic for device and site checks. The total duration of TPM implantation ranged from 6 days to 153 days, with a mean of 36 days. There were no complications including systemic or local infection from TPM implantation or from reimplant of a new permanent device.

Conclusions:
Discharging patients with TPMs is a safe, cost saving, and well-tolerated option for pacemaker dependent individuals while they await reimplant of a new permanent device. The active fix TPM allows for antibiotics to be given at home, opens hospital beds, and relieves pressure to reimplant a permanent device as soon as possible.
Abstract 14201: Decoding the Genetic Regulation of Cardiac Long Noncoding RNAs in Male and Female Mice Using Integrative Genomic Analysis
Authors: Touma Marlin , Cao Yang , Pan Calvin , Lusis Aldons J
Published: June 2023

Introduction:
Long non-coding RNAs (lncRNAs) are increasingly recognized as important regulators of mammalian heart development and potential contributors to human cardiovascular diseases by regulating RNA transcription and processing. However, the genetic regulation lncRNAs and their interactions with mRNAs are poorly understood.

Hypothesis:
Cardiac lncRNAs are genetically regulated and they differentially modulate mRNA expression in female vs male hearts.

Methods:
Deep RNA-seq was performed using Illumina HiSeqTM 4000 sequencer protocol. SNP Array was used for mouse genotyping. Weighted Gene Co-expression Network Analysis (WGCNA) was conducted using R. Association analyses were performed using FaST-LMM.

Results:
To elucidate lncRNA-mediated transcriptional regulation in heart, we performed integrated genomic analysis of RNA-seq derived transcriptome and SNP genotype data from the hybrid mouse diversity panel (HMDP) of adult male and female mice hearts across 100 strains. Using a 5% FDR
P
value threshold, genome-wide quantitative trait locus (eQTL) analysis detected total of 408513 and 404661 locally associated (within 1 Mb of genomic distance of a given gene) SNP-lncRNA pairs in female vs male heart, respectively, which corresponded to 6977 and 6357 unique lncRNAs in female vs male heart, respectively. After excluding those with distal eQTLs (
P
<4.1e-6), 2687 and 2684 cardiac lncRNAs with cis eQTLs were retained. WGNCA revealed distinct lncRNA-mRNA modules. From module-trait correlation analysis, 14 female and 5 male modules correlated with heart weight, body fat, or insulin resistance (Bicor >0.3,
P
<0.05). By applying eQTL analysis to the module eigengenes, 11 modules were identified with eigengenes QTLs (FDR<0.05). Lastly, a novel SNP-lncRNA-mRNA regulatory circuit involving the mitochondria transcription elongation factor,
TSFM,
was revealed from our analysis.

Conclusions:
We present our efforts to investigate lncRNA-mediated regulation of gene expression in female vs male mouse heart across 100 different strains. Our results reveal novel associations on lncRNAs with complex clinical traits and provide resources to facilitate mechanistic exploration of lncRNAs contribution to cardiovascular diseases.
Abstract 14217: Needs Must: A Not-So Benign Pericardial Cyst
Authors: Nayak Tanvi , Cascino Gregory , Jankowski Madeline , Knight Bradley P , Maganti Kameswari
Published: June 2023

Mrs. Z is a 56-year-old woman with a long history of symptomatic paroxysmal supraventricular tachycardia (PSVT) who presented with neck and back pain. MRI of cervical and thoracic spine revealed an abnormal signal in the right mediastinal area. A chest CT demonstrated a lobulated 5.8 x 5.5 x 3.5 cm, fluid density lesion contiguous with the pericardium adjacent to right atrium (RA) and inferior venacava (IVC) without wall thickening or solid components, consistent with a pericardial cyst (PC). A transthoracic echo (Panel B) revealed normal left ventricular size and systolic function with an EF of 66%. An echolucency adjacent to the RA and IVC consistent with a pericardial cyst was noted without any extrinsic compression. Given her asymptomatic presentation and normal cardiac imaging, a shared decision was made to conservatively manage.Two years ago, she underwent ablation for AVNRT, followed by an ablation for atrial tachycardia (AT). She continues to have short, symptomatic runs of AT (
Panel A
). A recent CMR re-demonstrated a large, septated pericardial cyst (6.2 x 5 cm) abutting the RA and IVC (
Panel C
). Given her on-going symptomatic SVT, she is referred for robotically assisted thoracoscopic surgery despite stability in size.

Discussion:
PCs are rare but typically benign. They are the third most common and account for 6% of mediastinal masses. They can be congenital or acquired, simple or complex, and have a predilection for R costophrenic angle (50-70%) followed by the L costophrenic angle (28-38%). Although most are asymptomatic and diagnosed incidentally, they sometimes can result in symptoms such as chest pain, dyspnea, and paroxysmal tachyarrhythmias. Large PCs can lead to tamponade. If a PC is suspected by CXR or echo, cardiac CT or CMR are used for confirmation. Periodic imaging is recommended every 1-2 yr. Most PCs resolve spontaneously. Treatment options include aspiration or surgical resection. Minimally invasive surgical options appear to be the best.
Abstract 14227: Development of a Tool To Improve Risk Stratification of Patients With Atrial Fibrillation in the Emergency Department
Authors: Anderson Travis L , Armbruster Tiffany , Becker Ari , Rosman Lindsey , DeWalt Darren , Loehr Laura , Gehi Anil
Published: June 2023

Introduction:
Currently, no tool exists to help emergency department (ED) physicians determine which patients with atrial fibrillation (AF) may be low risk for adverse outcomes and potential candidates for expedited discharge.

Hypothesis:
A simple decision aid can assess 90-day risk for a combined outcome of mortality, stroke, or re-presentation to the ED in AF patients.

Methods:
Through multi-disciplinary meetings, clinically relevant and easily attainable factors were selected to risk stratify AF patients in the ED, including: primary ED diagnosis (AF or other), age, AF symptom severity (Canadian Cardiovascular Society - Symptom of AF [CCS-SAF]), heart rate, blood pressure, and laboratory assessment. Logistic regression analyses were used to develop a scoring tool.

Results:
Over 15 months (Jan 2015 - Mar 2016), 935 consecutive patients presenting to the ED of an academic medical center hospital (University of North Carolina) with AF were included in the cohort. Ninety days from presentation, there were 275 (29.4%) adverse events. In multivariable analyses, 4 factors were identified which independently associated events among all patients with AF: non-AF primary ED diagnosis, age, heart rate, and severe AF symptoms (CCS-SAF 4). Using a scoring tool with these 4 factors (range 0-18), a score ≥ 14 predicted events with 72% accuracy. Including only the 223 patients with a primary diagnosis of AF, using a scoring tool with 3 factors (age ≥ 70, heart rate ≥ 105, severe AF symptoms) a score ≥ 10 (range 0-13) predicted events with 78% accuracy (25% sensitivity, 95% specificity).

Conclusions:
A simple risk stratification scoring tool may be useful to determine patient disposition for AF patients in the ED. In patients with a primary diagnosis of AF, the scoring tool was particularly useful (95% specific) in identifying patients unlikely to have an event. Further analyses of larger data sets are required for validation.
Abstract 14231: Egg Consumption Induces Sex-Specific Changes in High-Density Lipoprotein Composition and Function
Authors: Huang Lindsey , Garcia Chelsea , Corvino Olivia , Woo Hayoung , Jang Hyungryun , Zhang Ruijie , Woodruff Rachael , Blesso Christopher , Lee Ji-Young , Palancia Esposito Christa , Andersen Catherine J
Published: June 2023

Introduction:
HDL composition is an important determinant of cardioprotective functions. Importantly, sex-specific differences in HDL composition and function have been observed. While diet represents a promising therapeutic strategy to optimize HDL composition and function, it is unclear whether the capacity to modulate HDL profiles through diet is sex-specific.

Hypothesis:
We hypothesized that daily consumption of different egg-based diets, which differentially impact HDL particle profiles and efflux capacity, would alter HDL composition and function in a sex-dependent manner.

Methods:
Healthy men and women (n = 26) participated in a 16-week randomized, crossover intervention trial (NCT03577223), in which they consumed a 4-week egg-free diet, followed by a 4-week diet containing either 3 whole eggs or 3 egg whites per day. Participants then followed a 4-week egg-free washout diet, before switching to the alternative whole egg or egg white diet treatment. Fasted blood samples were collected after each diet period to determine HDL particle profiles by NMR, serum paraoxonase 1 (PON1) lactonase activity, cholesterol efflux capacity, and HDL lipid and protein composition.

Results:
We observed sex-specific differences in HDL profiles following egg intake. In women, whole egg intake increased HDL-phosphatidylcholine and phosphatidylethanolamine content, whereas HDL-phosphatidylinositol and sphingomyelin were increased and decreased, respectively, in men. Similarly, egg diets differentially and sex-dependently altered HDL proteins implicated in cholesterol efflux capacity and cardiovascular disease risk. Whole egg intake increased HDL-apoAII, apoL1, apoM, and lowered serum amyloid P compared to the egg-free and egg white diets in women, whereas HDL-PON3 was increased by egg white intake in men. PON1 activity and cholesterol efflux capacity were increased following whole egg intake in women only. Independent of sex, changes in cholesterol efflux capacity between the egg white and whole egg periods were positively correlated with the number of total and small HDL particles.

Conclusions:
Modulation of HDL profiles by diet are sex-specific, with whole egg intake promoting more significant changes in HDL composition and function in women.
Abstract 14282: Outcomes Following Aortic Valve Replacement Among Kidney Transplant Recipients. A Systematic Review and Meta-Analysis
Authors: Ang Song Peng , Chia Jia Ee , Jaiswal Vikash , Mudwari Richa , Song David , Chia Tong Hong
Published: June 2023

Introduction:
While kidney transplant recipients (KTR) are high risk candidates for valve replacements, the safety of transcatheter aortic valve replacement (TAVR) is limited among this population as they are excluded from major trials. We aimed to compare the outcomes between TAVR and surgical aortic valve replacement (SAVR) among KTR by a systematic review and meta-analysis.

Methods:
We comprehensively searched PubMed, Embase, and Cochrane Library from its inception until April 20, 2022 for relevant studies. Outcomes were pooled using the DerSimonian and Laird random-effects model and reported as odd ratios (OR) or standardized mean difference (SMD) and 95% confidence intervals (CI).

Results:
6 studies involving 5,452 patients (1,956 TAVR, 3,496 SAVR) were included in the analysis. TAVR patients were older (69.4 years vs 62.8 years), were less likely to be male (66.7% vs 67.9%) and had a higher prevalence of most comorbidities including coronary artery diseases (78% vs 58%), heart failure (71% vs 42%) and diabetes mellitus (52% vs 45%). Compared with SAVR, KTR undergoing TAVR had significantly lower risk of in-hospital all-cause mortality (OR 0.51, 95% CI: 0.39 to 0.67, p<0.001), acute kidney injury (RR 0.49, 95% CI: 0.34 to 0.71, p<0.001), blood transfusion (OR 0.29, 95% CI: 0.19 to 0.55, p<0.001) and a shorter length of hospital stay (SMD -0.67, 95% CI: -1.10 to -0.24, p=0.002). In contrast, there was a higher need for permanent pacemaker implantation among the TAVR cohort compared to SAVR cohort (OR 3.44, 95% CI: 2.67-4.43, p<0.001).

Conclusions:
TAVR appeared to be a safe alternative compared to SAVR in KTR, with a lower rate of short-term mortality, AKI and length of hospitalization but a higher rate of permanent pacemaker implantation. Further studies are encouraged to study the long-term outcomes among these patients.
Abstract 14305: Long-Term Results of Left Atrial Ganglionated Plexi Ablation in Patients With Syncope and POTS
Authors: Das Mithilesh , Kumar Awaneesh , Vasilottos Nektarios
Published: June 2023

Background:
Cardioneuroablation (CNA) of atrial ganglionated plexi (GP) using radiofrequency anergy has shown to be effective in treating refractory neurocardiogenic syncope (NS) during a short-term follow-up. However, there is no study of CNA in patients with postural orthostatic tachycardia syndrome (POTS) with syncope.

Methods:
Eight patients (mean age 39+9 years, male: 62%) with treatment-refractory (NS: 4, POTS: 4) syncope underwent CNA of all 4 GPs of the left atrium and followed for 35
+
10 months.

Results:
All patients were non-responders to lifestyle modification and multiple drug therapies including (fludrocortisone, midodrine, beta-blockers, clonidine and pyridostigmine). Syncope recurred only in 3 (37.5%) patients after a mean duration of 34.9
+
15 months. Syncope recurred in 2 of 4 (50%) patients with NS and in 1 of 4 (25%) patients with POTS.

Conclusions:
Contrary to prior publications, syncope recurs in 37.5% patients during long-term follow up after CAN in both POTS and NS patients.
Abstract 14313: Improved NYHA Class and KCCQ-12 After Septal Myectomy in Patients With Obstructive Hypertrophic Cardiomyopathy
Authors: Cambron Julia Claire , Lin Lucy , Kim Morris , Rashdan Lana , Li Sarah , Zhao Yuanzi , Graham Kellie , Fischer Katherine , Nazer Babak , Heitner Stephen B , Song Howard K , Masri Ahmad
Published: June 2023

Introduction:
Patients with obstructive hypertrophic cardiomyopathy (oHCM) frequently present with heart failure symptoms refractory to medical therapy and require septal myectomy (SM). The magnitude of benefit from SM is thought to be better than the recently reported data from EXPLORER-HCM and REDWOOD-HCM trials. We prospectively investigated the association between SM, patient-reported 12-item Kansas City Cardiomyopathy Questionnaire (KCCQ-12) and physician-reported NYHA class in a community-based cohort of oHCM.

Hypothesis:
SM ± submitral valve repair is associated with improvement in NYHA class and KCCQ-12 but with a varying magnitude of benefit.

Methods:
We conducted a prospective cohort study of 108 patients with oHCM who underwent SM (48% women, age 59 (45, 67) years). KCCQ-12 and NYHA class were assessed prospectively prior to SM, at 1-3 months post-SM and at 4-12 months post-SM. KCCQ-12 is reported as an additive score. Data are reported as median values (IQR).

Results:
Pre-SM, LVEF was 70% (65, 75) while resting and Valsalva LVOT gradients were 42 (22, 90) and 87 (53, 119) mm Hg, respectively. Post-SM, median LVEF was 65% (60, 69) with respective resting and Valsalva LVOT gradients of 11 (8, 16) and 16 (11, 28) mm Hg (all p<0.001). NYHA Classes ≥III decreased in prevalence from 71% to 13% to 3% after SM (p<0.001). Pre-SM, KCCQ-12 was 39 (31, 48), which improved to 51 (41, 57) at 1-3 months post-SM and 58 (52, 63) at 4-12 months post-SM (p<0.001). Changes in NYHA Class distribution and KCCQ-12 scoring after SM are shown in Figure 1.

Conclusion:
SM was associated with significant improvement in KCCQ-12 and NYHA class in a community-based cohort of oHCM. The inability to conduct blinded NYHA class and KCCQ-12 assessment post-SM is a major limitation given EXPLORER-HCM showed 31% placebo effect on NYHA class. Further contemporary comparative studies of SM and cardiac myosin inhibitors are needed.
Abstract 14322: Sex Differences and Clinical Outcomes in Patients With Myocardial Infarction With Non-Obstructive Coronary Arteries. A Meta-Analysis
Authors: Chia Jia Ee , Chia Tong Hong , Ang Song Peng
Published: June 2023

Introduction:
While myocardial infarction with non-obstructive coronary arteries (MINOCA) is more common in women, it is unknown whether female sex is a risk factor for adverse outcomes in patients with MINOCA. We aimed to investigate the relationship between sex differences and outcomes of patients with MINOCA by a meta-analysis
Methods:
A systematic literature search was performed in PubMed, Embase and Cochrane databases from its inception until June 2, 2022 for relevant studies. Endpoints were pooled using the DerSimonian and Laird random-effects model as odd ratio (OR) with 95% confidence intervals (CI).

Results:
6 studies with 28,383 patients with MINOCA (11,223 men, 17,160 women) were included in the analysis. There was no significant difference in terms of all-cause mortality (OR 1.03, 95% CI 0.91-1.17, p=0.66), major adverse cardiovascular events (MACE)(OR 0.87, 95% CI 0.74-1.02, p=0.09), incidence of heart failure (OR 1.09, 95% CI 0.89-1.34, p=0.42), stroke (OR 1.09, 95% CI 0.89-1.34, p=0.42) and myocardial infarction (OR 1.09, 95% CI 0.89-1.32, p=0.41). Subgroup analysis based on follow-up period showed that men had a lower risk of MACE than women in subgroups of less than 1 year (OR 0.75, 95% CI 0.65-0.87, p=0.41) compared to that of more than 1 year (OR 0.97, 95% CI 0.87-1.09).

Conclusion:
Apart from lower short-term risk of MACE in men, there appears to be no significant sex-specific differences in the outcomes among patients with MINOCA.
Abstract 14324: Improving Rates of Uncontrolled Atrial Fibrillation Through Obstructive Sleep Apnea Screening and Management: Preliminary Data From the OFIB Institutional Quality Initiative
Authors: Thakker Ravi , Rasmussen Peter , Davis Elizabeth , Mai Steven , Javed Mahnoor , Abu Jazar Deaa , Salehin Salman , Patel Chandani , Garza Ivana , Chatila Khaled , Khalife Wissam , Jneid Hani , Sonstein Lindsay
Published: June 2023

Introduction:
Untreated obstructive sleep apnea (OSA) is a major cause of uncontrolled atrial fibrillation (AF). It represents a high prevalence and incidence, as well as significant cause of mortality. Uncontrolled AF with recurrent emergency department (ED) visits and inpatient admissions poses a burden to patient quality of life and increased risk of cardiovascular events, in addition to healthcare costs.

Hypothesis:
We aim to reduce ED visits and hospitalizations for General Internal Medicine resident clinic patients with OSA and uncontrolled AF over the next year by 10%.

Methods:
We identified approximately 382 patients with inclusion criteria of age 18-70 years with a history of both AF and OSA without documented CPAP use. Interventions included a week long educational session to all residents starting March 2022, standardizing CPAP device ordering/monitoring, and patient education. A protocol for sleep study ordering and CPAP titration was implemented across clinics. The next phase is inpatient screening and referrals.

Results:
Prior to our intervention date, 14.7% of our study population presented with uncontrolled AF in the past year. Since our interventions, 2.4% have presented with uncontrolled AF.

Conclusions:
Our preliminary interventions have shown a numerical trend towards decreasing rates of uncontrolled AF in patients with OSA at our institution. Our interventions are ongoing with periodic evaluation of outcomes. Our findings support the need for a comprehensive approach targeting both providers and patients.