bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 16702: Associations Between Knowledge, Attitudes, and Practices and Blood Pressure Control Among Iraqi and Syrian Refugees in the United States
Authors: Alharthi Abeer , Ogungbe Oluwabunmi , Behnam Rawnaq , Dennison Himmelfarb Cheryl , Commodore-Mensah Yvonne , al-rousan tala
Published: December 2023

Introduction:
Displacement due to war or persecution has resulted in an unprecedented refugee crisis. Refugees face increased cardiovascular disease risk and poor blood pressure (BP) control. Yet, insights into their knowledge, attitudes, and practices (KAP) influencing BP management are limited.

Objective:
To examine associations between KAP and BP control among Iraqi and Syrian refugees resettled in the United States. Method: Refugees from Iraq and Syria diagnosed with hypertension were recruited using a patient list at a federally qualified health center in San Diego. They completed a KAP survey and measured home BP (HMBP) using digital cuffs for at least 3 days/week for 4 weeks. Scores were computed for each KAP sub-scale; knowledge (0-16), attitude (1-20), and practice (1-8). Scores were categorized into quartiles (poor-excellent). The outcome was BP control calculated from an average of HMBP readings over 3 days for 4 weeks. Mixed effect logistic regression was used to assess the relationship between each KAP quartile and BP control (<130/80 mmHg).

Results:
Final analysis included 95 refugees (79% Iraqis, 21% Syrians). Participants were male (56%), with mean age 58.4 (±16.34) years, 86% unemployed, 22% had at least a Bachelor's degree, 66% had limited English proficiency and only 3.6% had annual income ≥$35,000. The mean scores were as follows: BP 129/79 mmHg, with 61% having uncontrolled BP, knowledge 13.2 (± 2.37), attitude 14.6 (± 2.38), and practice 6.5 (± 1.17). Higher knowledge correlated with higher odds of BP control (adjusted Odds ratio (aOR): 1.89,95% Confidence Interval (CI): 1.39 - 2.55). Those who had fair and good attitude had lower odds of BP control (aOR: 0.63, 95% CI: 0.52 0.77; OR: 0.58, CI: 0.45 - 0.75) respectively (Table).

Conclusion:
Findings suggest poorer BP knowledge correlates with BP control in Syrian and Iraqi refugees who are receiving BP care. Tailored health interventions for refugees are needed to promote cardiovascular health equity.
Abstract 16706: Women With Coronary Vascular Dysfunction Have Heightened Emotional Responses to Mental Stress With Attenuated Recovery
Authors: Vatsa Nishant , Dave Esha , Thaker Vishrut S , Fatade Yetunde A , Wei Janet , Shufelt Chrisandra , Minissian Margo B , Bairey Merz C Noel N , Mehta Puja K
Published: December 2023

Introduction:
Coronary vascular dysfunction (CVaD) is associated with major adverse outcomes, recurrent chest pain, and can be triggered by mental stress.

Hypothesis:
We hypothesized that women with CVaD have heightened emotional response and attenuated recovery compared to reference control (RC) women.

Methods:
Women diagnosed with CVaD (cases, n=57, age: 57±1 years) by abnormal adenosine or acetylcholine response during invasive coronary function testing were enrolled in Cardiac Autonomic Nervous System Study and compared to age-matched, asymptomatic RCs women (n=25, age: 56±3 years), free of cardiac or risk factor history. All underwent two 4-minute standardized mental stress tests - anger recall and mental arithmetic - followed by 15 minutes of recovery. Emotional arousal (tension, anxious, depressed) and chest pain were assessed via self-reported Likert scale at baseline, after stress, and after recovery. The difference between post-stress or post-recovery and baseline scores was used to evaluate stress provocation and recovery. Increased differences indicate more provocation or recovery attenuation. We utilized multivariate models adjusted for anti-anginal medications, statins, and aspirin or traditional cardiovascular risk factors and chest pain to assess associations between CVaD and chest pain or emotional arousal, respectively.

Results:
The two groups did not differ in hemodynamic response to mental stress (p>0.05). In multivariate models, CVaD status was associated with more stress-provoked chest pain (β 1.24 [0.1, 2.4], p=0.03) and more attenuated chest pain recovery (β 1.5 [0.6, 2.3], p=0.001) than RC. Similarly, after adjustment, cases were associated with more stress-provoked anxiety (β 1.2 [0.2, 2.2], p=0.02) and tension (β 1.2 [0.001, 2.4], p=0.05) while having more attenuated recovery of anxiety (β 1.1 [0.1, 2.0], p=0.02) and tension (β 1.1 [0.2, 2.0], p=0.02) compared to RC. There were no differences in feelings of depression between the two groups.

Conclusions:
Response to mental stress is heightened with attenuated recovery in women with CVaD. An improved understanding of mechanisms in stress response and CVaD is needed for potential therapeutic targets that may improve angina and quality of life.
Abstract 16717: Managing Myxedema Coma: A Challenging Case of Cardiogenic Shock Culminating in Orthotopic Heart Transplantation
Authors: Lin Allan , Guntaka Saimanoj , Vaysblat Michael , Bae Suhwoo , Ng Jason , Pierce Matthew
Published: December 2023

Background:
Myxedema coma (MC) is a rare manifestation of severe hypothyroidism often seen in elderly female patients. While the sequelae of MC can lead to multi-organ involvement and eventual failure, irreversible Heart Failure (HF) is rarely seen. This case culminated in orthotopic heart transplant (OHT) for definitive treatment.

Case Presentation:
A 23-year-old male presented with worsening RUQ abdominal pain for 2 weeks. In the ED, he had PEA arrest and with ROSC, he was admitted to the CCU for presumed cardiogenic shock, with labs remarkable for lactate 7.5 mmol/L, pro-BNP 6104 pg/mL, and markedly elevated serum creatinine and LFTs. The patient exhibited HF symptoms for 9 months before admission, manifesting as worsening LE edema, fatigue, and weight gain. He was also noted to have untreated hypothyroidism with repeat TSH of 857 μIU/mL on admission, indicating MC as a potential trigger for worsening HF. TTE revealed severe biventricular dysfunction with global hypokinesis and LVEF of 10-15%. Inotropic support was initiated with dobutamine, with RHC showing CVP 11 mmHg, RV 23/11 mmHg, PA 32/22 mmHg, PCWP 25 mmHg, and CI 2.3 LPM/m
2
. Subsequent deterioration in CI and MVO2 necessitated IABP placement and vasopressor support, and later rescue VA-ECMO with atrial septostomy, aiming for OHT. Endocrine evaluation confirmed primary hypothyroidism, and the patient received high-dose levothyroxine, T3, and stress-dosed steroids. While there have been instances where cardiac consequences of myxedema HF were reversed by thyroid administration, his significantly dilated left ventricular internal dimension at end diastole, as well as complications of ECMO (bleeding) expedited his transplant evaluation. OHT was successfully performed on hospital day 14. Continuous improvement in thyroid function studies was observed throughout the treatment course with levothyroxine therapy.

Discussion:
Worsening HF in the setting of MC, particularly in a male patient, is an uncommon presentation that requires prompt action. This patient required mechanical support as an eventual bridge to OHT with simultaneous treatment for hypothyroidism, illustrating the complexity of the case and the interventions necessary for a positive outcome in an uncommon clinical scenario.
Abstract 16718: Association of Elevated Lipoprotein A With Adverse Cardiovascular Events Following Percutaneous Coronary Intervention
Authors: Oliver Walter , Besser Stephanie A , Berman Adam N , Biery David W , Shiyovich Arthur , Abdelrahman Khaled , Hainer Jon , Laychak Shelby , Huck Daniel M , Weber Brittany N , Di Carli Marcelo F , Cannon Christopher P , Bhatt Deepak L , Blankstein Ron
Published: December 2023

Background:
Patients who undergo percutaneous coronary intervention (PCI) are at increased risk for subsequent cardiovascular (CV) events. Elevated lipoprotein A [Lp(a)] is associated with atherothrombotic disease; however, its role in risk stratification for patients with prior PCI is unknown.

Methods:
Patients with prior PCI were identified in the Mass General Brigham Lp(a) Registry, a retrospective cohort that included patients who had Lp(a) measured as part of routine care from 2000-2019 and excluded those with severe renal dysfunction (eGFR < 15 mL/min/m
2
, dialysis, or renal transplant) or a malignant neoplasm diagnosis (excepting non-melanoma skin cancers). Lp(a) percentile groups were derived as follows: 1st-50th (ref), 51st-70th, 71st-90th, 91st-100th. The primary outcome was a composite of CV death or myocardial infarction (MI).

Results:
A total of 2,389 patients with prior PCI were included with a median follow-up period of 12.8 years. Median age was 60 and 583 (24.4%) were women. Higher Lp(a) percentile group was associated with increased incidence of the primary outcome with patients in the 71
st
-90
th
percentile (112-215 nmol/L) having a HR of 1.39 (95% CI: 1.15-1.69, p = 0.001) and patients in the 91
st
-100
th
percentile (≥ 216 nmol/L) having a HR: 1.61 (95% CI: 1.26-2.06, p < 0.001). Findings remained significant after adjustment for age, sex, smoking, diabetes, chronic kidney disease, and insulin use with adjusted HR of 1.25 (95% CI: 1.03-1.53, p = 0.024) and adjusted HR of 1.63 (95% CI: 1.27-2.10, p < 0.001) for the 71
st
-90
th
and 91
st
-100
th
percentiles, respectively. A similar magnitude of association was observed in evaluating Lp(a) and CV death alone (Figure).

Conclusions:
Elevated Lp(a) is strongly and independently associated with increased risk of CV death or MI among patients with prior PCI in a stepwise manner that persists over time. Findings support the use of Lp(a) screening in patients with prior PCI to enhance risk stratification.
Abstract 16722: Performance Evaluation of ChatGPT 4.0 on Cardiovascular Clinical Cases From the USMLE Step 2CK and Step 3 of the National Board of Medical Examiners
Authors: Kassab Joseph , Massad Christopher , Kapadia Vishwum , El Hajjar Abdel Hadi , El Dahdah Joseph , Chedid El Helou Michel , Haroun Elio , Ramchand Jay , Harb Serge C
Published: December 2023

Introduction:
As the prominence of online chat-based artificial intelligence (AI) platforms increases, medical students and residents in training may be inclined to utilize these tools as supplementary resources while preparing for their United States Medical Licensing Board (USMLE) examinations.

Hypothesis:
The aim of this study was to assess the performance of ChatGPT 4.0 in responding to cardiovascular (CV) clinical vignettes from USMLE sample questions provided by the National Board of Medical Examiners (NBME).

Methods:
We extracted the 31 CV clinical vignettes from the official NBME USMLE Step 2 Clinical Knowledge and Step 3 self-assessments, and submitted them to ChatGPT 4.0. The clinical cases encompassed a range of topics such as preventive medicine, congenital heart disease, valvular heart disease, electrophysiology, heart failure, and pericardial disease. Each of the 31 cases had a MCQ: 29/31 had at least 5 answer choices, while the remaining 2 had 4 answer choices each. The performance of the AI model was assessed using the NBME-provided answers. Subsequently, two experienced cardiologists independently reviewed the explanations provided by the model for each case and classified them as “accurate” - if they aligned with appropriate guidelines, and as “inaccurate” if they conveyed incorrect or inappropriate information.

Results:
The AI model attained a grade of 90.3% (28/31). The initial agreement between the 2 reviewers was near perfect with a Cohen’s Kappa of 0.85. Any identified discrepancies were subsequently addressed and resolved. Of the correctly answered questions, accurate explanations were provided by the AI model in 89.2% of cases (25/28).

Conclusions:
The high performance of ChatGPT 4.0, suggests it could be an effective additional CV study resource for residents and medical students preparing for the USMLE Step 2 CK and Step 3 exams.
Abstract 16725: Cost-Effectiveness Analysis of Intensive Treatment of Systolic Hypertension: Results From Sprint Patient-Level Data
Authors: Zhang Zugui , Bellows Brandon K , Bress Adam P , Moran Andrew E , Zhang Yiyi , Derington Catherine , Kolm Paul , Weintraub William S
Published: December 2023

Background:
The Systolic Blood Pressure Intervention Trial (SPRINT) showed that treating patients at high risk for cardiovascular events but without diabetes or a history of stroke to a systolic blood pressure (SBP) target goal of <120 mm Hg (Intensive Care, IC), compared with <140 mm Hg (Standard Care, SC), resulted in lower rates of fatal and nonfatal major cardiovascular events and death. We examined the cost-effectiveness of IC vs SC over a life-time horizon, based on patient-level data, from a health-sector perspective.

Methods:
Patient-level data from SPRINT were used to calculate and estimate cost, effectiveness, quality adjusted life years (QALY), and the incremental cost-effectiveness ratio (ICER). For participants who died during the trial, life years and QALYs were estimated from in-trial analysis; for who survived to the end of the trial, pooled, harmonized data from six epidemiologic cohorts included in the National Heart, Lung, and Blood Institute Pooled Cohorts Study was used to estimate risk of lifetime primary fatal and non-fatal events and calculate life-years. Published utilities estimates were used to calculate QALYs. For participants without SPRINT lifetime primary event estimates, we applied multiple imputation method via machine learning to impute the life-years and QALYs. The ICER was expressed as cost per QALY gained.

Results:
IC participants were estimated to gain an average of 0.51 QALY (95% CI: 0.21, 0.81) relative to SC participants. Estimated total lifetime costs were $17,449 higher with IC (95% CI: $10,697, $24,201) than SC. The ICER for IC vs SC was $34,214 per QALY gained, with 68.5% of bootstrap-derived estimates <$50,000/QALY. The results from multiple imputation chained equations for addressing missing data showed that IC is cost effectiveness at $50,000/QALY. Across various scenario analyses, we consistently found a more than 60% probability that IC is cost-effective over a lifetime when the willingness-to-pay value exceeds $100,000 per QALY.

Conclusions:
Based on participant-level trial and epidemiologic cohort data, IC is cost-effective, with significant clinical benefit at acceptable higher lifetime cost. Recommending intensive SBP targets in patients at high CVD risk is an effective, high-value therapy.
Abstract 16744: Antibody Responses to Myocardial Antigens Released in the Context of a Myocardial Infarction
Authors: Siegel Johanna
Published: December 2023

Our study aims to investigate antigen-specific B cell responses after myocardial infarction. Recent research has indicated that B cells and myocardial antibodies may contribute to the development of ischemic heart failure and dampen post-myocardial infarction repair. However, the antigen specificity of these myocardial antibodies remains unknown. To produce high-affinity antibodies, B cells typically undergo multiple rounds of somatic hypermutation and selection processes within the germinal center (GC) reactions of secondary lymphoid organs. Therefore, we sought to characterize the germinal center B cell responses and to examine the repertoire of B cell receptors (BCR) in C57BL/6J mice subjected to experimental myocardial infarction. Flow cytometry analyses showed increased frequencies of GC B cells in infarcted mice at 5 and 14 days post-surgery. However, sham-operated mice also showed similar increase in GC frequencies on day 14 post-surgery. Single-cell RNA/BCR sequencing analyses enabled the identification of GC B cell and plasma cell (antibody secreting) populations expressing unique B cell receptors in infarcted mice that were not found in sham-operated mice. Over time, the number of GC B cells increased accompanied by a progressive clonal expansion, indicating the development of antigen-driven B cell responses. By examining immunoglobulin variable gene rearrangements within single B cells, we identified distinct B cell lineages expressing mutated antigen receptors suggestive of affinity maturation. Selected BCRs of interested were then cloned into immunoglobulin expression vectors and expressed in immortalized human embryonic kidney cells. When incubated with histological myocardial slices, one of these unique BCR expressed showed binding to myocardial antigens. These findings support the notion that myocardial infarction can trigger germinal center B cell responses, which then lead to the production of high-affinity heart-specific antibodies. Moreover, the ‘track-and-clone’ approach herein described could help unraveling the antigen specificity and functional significance of these myocardial antibodies.
Abstract 16764: Changes in Triglyceride Levels During Omega-3 Fatty Acid Supplementation, and Incident Cardiovascular Events: Secondary Analysis From the OMEMI Trial
Authors: Myhre Peder L , Kalstad Are , Tveit Sjur Hansen , Laake Kristian , Nilsen Dennis , Tveit Arnljot , Solheim Svein , Seljeflot Ingebjørg
Published: December 2023

Background:
Elevated triglyceride levels are associated with increased cardiovascular risk. Omega-3 polyunsaturated fatty acids (n-3PUFA) are known to reduce triglyceride levels, but whether changes in triglycerides mediate any cardiovascular effects of n-3PUFA, remains unclear.

Methods:
In the randomized controlled OMEMI trial, 1014 elderly (70-82 years) patients with a recent acute myocardial infarction (AMI) were treated with 1.8 g/day of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) or placebo (corn oil) for two years, and followed for the primary outcome of MACE (AMI, coronary revascularization, stroke, heart failure hospitalization or all-cause death). Relative changes in triglycerides from baseline to 3 months (n=920, 91%), were associated with incident MACE (N=175) using landmark Cox regression models.

Results:
The median (Q1-Q3) baseline triglyceride concentration was 97 (74-135) mg/dL, and higher levels were associated with higher BMI, diabetes and heart failure, in multivariable models. After 3 months of treatment, triglycerides decreased by median -10% and 0% in the n-3PUFA and placebo groups, respectively, followed by relatively stable levels at 12 and 24 months (
Figure
). Greater triglyceride reductions at 3-months were associated with a lower risk of MACE in the n-3PUFA group (HR 1.98 [95%CI 1.23-3.17] per doubling, p=0.004;
Figure
), and this persisted after adjusting for baseline triglycerides, age, sex, BMI and comorbidities (HR 2.34 [1.37-3.98], p=0.002). Changes in triglycerides did not associate with MACE in the placebo group (HR 1.13 [0.63-2.02], p=0.68).

Conclusion:
Treatment with 1.8 g/day of EPA/DHA modestly reduced triglyceride levels and greater on-treatment triglyceride-reductions were associated with a lower risk of MACE. Although the overall OMEMI-trial was neutral, these findings suggest that n-3PUFA-related triglyceride changes may play a role with respect to cardiovascular outcomes.
Abstract 16773: The Association of Lp(a) and Standard Modifiable Cardiovascular Risk Factors (SMuRFs) With Incident Myocardial Infarction: The Mass General Brigham Lp(a) Registry
Authors: Shiyovich Arthur , Berman Adam N , Besser Stephanie A , Biery David W , Kaur Gurleen , Divakaran Sanjay , Singh Avinainder , Huck Daniel M , Weber Brittany N , Plutzky Jorge , Di Carli Marcelo , Nasir Khurram , Cannon Christopher P , Januzzi James L , Bhatt Deepak L , Blankstein Ron
Published: December 2023

Introduction:
Lp(a) is a robust predictor of coronary heart disease outcomes, with targeted therapies currently under investigation. However, there is a paucity of data regarding the risk of elevated Lp(a) in relation to other cardiovascular risk factors.

Objective:
To evaluate the association of high Lp(a) with standard modifiable risk factors (SMuRFs) for incident first acute myocardial infarction (AMI).

Methods:
This retrospective study utilized the MGB Lp(a) Registry which included patients ≥18 years with an Lp(a) measurement between 2000-2019. Exclusion criteria were severe kidney dysfunction, malignant neoplasm, and prior known atherosclerotic cardiovascular disease (ASCVD). Diabetes mellitus, hyperlipidemia, hypertension, and smoking were considered SMuRFs. High Lp(a) was defined as >90
th
percentile and low Lp(a) as <50
th
. The primary outcome was fatal or non-fatal AMI. A combination of natural language processing algorithms, ICD codes, and laboratory data were employed to identify the outcome and covariates.

Results:
A total of 6,238 patients met the eligibility criteria. The median age was 54 (IQR: 43-65) years and 45% were women. Overall, 23.7% had no SMuRFs and 17.8% had ≥3 SMuRFs. Over a median follow-up of 8.8 (IQR: 4.2-12.8) years, the incidence of AMI increased in a stepwise manner with higher number of SMuRFs among patients with high (logrank p=0.031) and low Lp(a) (logrank p<0.001). Across all SMuRFs subgroups, the incidence of AMI was significantly higher for patients with high Lp(a) vs. low Lp(a) (Figure 1). The risk of high Lp(a) was higher than the risk imposed by any of the SMuRFs and was similar to having two SMuRFs. Following adjustment for confounders and number of SMuRFs, high Lp(a) remained independently associated with the primary outcome (HR=2.9 (95%CI=2.0-4.3), p<0.001).

Conclusions:
Among patients with no prior ASCVD, high Lp(a) is independently associated with increased risk for first AMI regardless of the number of SMuRFs.
Abstract 16779: Tirzepatide Reduces High-Sensitivity C-reactive Protein in Patients With Type 2 Diabetes and High Cardiovascular Risk: A Post Hoc Analysis of the SURPASS-4 Trial
Authors: Bhatt Deepak L , Wilson Jonathan M , Wiese Russell J , Yang Zhengyu , Duffin Kevin L , Pavo Imre
Published: December 2023

Background:
People with type 2 diabetes (T2D) who have elevated levels of high-sensitivity C-reactive protein (hsCRP) face a greater risk of myocardial infarction and coronary death. Early data for tirzepatide (TZP), a GIP/GLP-1 receptor agonist, suggest a hsCRP lowering effect. Here, we compare the effect of TZP and insulin glargine (iGlar) on hsCRP in patients with T2D and established or high risk for cardiovascular (CV) disease.

Methods:
hsCRP concentration was quantified by immunoassay (Roche, Indianapolis, IN) with lower limits of detection at concentrations of 0.15 mg/L. Plasma was collected from 1995 fasted participants at baseline (329, 328, 338, and 1000 on 5, 10, 15 mg TZP and on iGlar, respectively) and 52 weeks in SURPASS-4. The % changes of hsCRP from baseline were estimated by mixed model with repeated measures. The shifts in hsCRP risk categories (hsCRP >3 mg/L or 1-3 mg/L versus <1 mg/L) from baseline to 52 weeks are reported. The linear relationship between % change from baseline of hsCRP and change in body mass index (BMI) was analyzed using Pearson correlation coefficient.

Results:
Baseline hsCRP (mean ± SD, 5.6 ± 12.5 mg/L) was elevated in this study population. Among the participants, 48%, 36%, and 16% were in the >3, 1-3 and <1 mg/L hsCRP categories, respectively. Participants in the elevated hsCRP categories had higher body weight and BMI at baseline. After 52 weeks of treatment, the 5, 10, 15 mg TZP and iGlar groups resulted in -38.0%, -44.2%, -47.8%, and 0.6% changes in the concentration of hsCRP, respectively. More TZP-treated patients improved their hsCRP categories when compared with iGlar-treated participants (Table). The reduction in hsCRP in the pooled TZP groups correlated with the reduction of BMI (r=0.07, p=0.049).

Conclusions:
Tirzepatide treatment significantly lowers hsCRP in patients with T2D and increased CV risk versus baseline and iGlar. Substantially more participants shift to a lower hsCRP category when compared with insulin glargine.
Abstract 16781: The Duration of Anticoagulant Treatment and Its Association With HRQoL and Treatment Satisfaction in Patients With AF After TAVR: Results From ENVISAGE-TAVI AF
Authors: Hengstenberg Christian , Van Mieghem Nicolas , Wang Rosa , Ye Xiaomei , Shi Ling , Guo Shien , Chen Cathy , Jin James , Ye Xin , Unverdorben Martin , Dangas George
Published: December 2023

Introduction:
The ENVISAGE-TAVI AF (NCT02943785) trial compared edoxaban vs vitamin K antagonists in patients with atrial fibrillation (AF) after successful transcatheter aortic valve replacement (TAVR). The association between anticoagulation treatment duration and patient-reported outcomes (PROs) and treatment satisfaction is unclear.
Hypothesis
:
Longer duration of anticoagulation treatment may be positively associated with PROs and treatment satisfaction in patients from ENVISAGE-TAVI AF.

Methods:
HRQoL and treatment satisfaction were assessed by EQ-5D-3L, EQ-5D visual analogue scale (EQ-VAS), and the Perception Anticoagulant Treatment Questionnaire (PACT-Q). Patients were grouped by treatment duration: <6 months, 6 month-1 year (yr), 1-1.5 yrs, 1.5-2 yrs, and >2 yrs. A mixed-effect model for repeated measures assessed least square (LS) mean differences between treatment durations while controlling for relevant covariates.

Results:
Of 1426 patients enrolled in ENVISAGE-TAVI AF, 1147 (80.4%) and 1107 (77.4%) were included in the EQ-5D-5L and PACT-Q analysis sets. Baseline characteristics were similar across the treatment durations (
Table
). In patients receiving treatment >1.5 years, LS mean scores for EQ-5D-5L utility index (
P
= 0.012) and EQ-VAS (
P
= 0.002) at month 3 were significantly higher than those treated for <6 months. Prolonged treatment duration was associated with improved HRQoL and treatment satisfaction (
Figure
).

Conclusions:
Patients with AF and longer treatment duration after TAVR reported significantly higher HRQoL and treatment satisfaction vs shorter treatment duration. Further research is needed to determine causal effects.
Abstract 16793: The Impact of Late Gadolinium Enhancement on Sudden Death Risk Stratification in Older Patients With Hypertrophic Cardiomyopathy
Authors: Nakamori Shiro , Maron Martin , Rowin Ethan J , Jaafar Narjes , Chan Raymond H , Rodriguez Jennifer , Pradella Silvia , ZOCCHI CHIARA , olivotto iacopo , Kramer Daniel B , Ngo Long H , Manning Warren J , Nezafat Reza
Published: December 2023

Background:
Extensive late gadolinium enhancement (LGE) is now recognized as a risk factor for sudden cardiac death (SCD) in patients with hypertrophic cardiomyopathy (HCM). However, risk for SCD is very low in older (≥60 years) HCM patients, and therefore utility of assessing LGE for risk stratification in this subgroup of patients is uncertain.
Objectives:
We assessed the relationship between LGE and SCD in older HCM patients and compared this risk to younger patients.

Methods:
A total of 1735 HCM patients undergoing cardiovascular magnetic resonance (CMR) for initial evaluation from 4 medical centers were followed up for a median of 3.7 years. LGE was semiautomatically quantified by manually adjusting a grayscale threshold.

Results:
We identified 638 HCM patients ≥60 years of age (up to 90 years), with LGE present in 337 patients (53%), including 28 patients (4%) with extensive LGE occupying ≥15% of left ventricular mass. Neither the presence nor extent of LGE was associated with increased risk for SCD events (HR
ad
, 1.13; 95%CI, 0.20-6.44, p=0.89 and HR
ad
per 10% increase, 1.49; 95%CI, 0.46-3.28, p=0.38, respectively), even after adjustment for other relevant disease variables. The risk for SCD at five years was 4% in older HCM patients with extensive LGE ≥15%, and not different compared to older patients with less LGE (1.0%, p=0.25). The performance of the AHA/ACC SCD risk model was not enhanced in older HCM patients by the addition of LGE (continuous net reclassification index, 0.25; 95%CI, -0.35-0.85, p=0.42). In contrast, the extent of LGE was associated with increased SCD risk in patients <60 years, with extensive LGE associated with a 3-fold greater risk.

Conclusions:
The extent of LGE was not associated with increased SCD risk in HCM patients ≥60 years, even in the presence of other risk markers. These data suggest a limited role for CMR with LGE in older HCM patients to inform SCD risk stratification.
Abstract 16802: Disparities in the Prevalence of Atrial Fibrillation and Associated Risk Characteristics Among Black and White Acute Ischemic Stroke Patients Treated With Alteplase
Authors: Tantry Udaya , Rout Amit , Cutler Joan , Bliden Kevin , Duhan Sanchit , Walia Naval , Singh Sahib , Goel Swecha , Gurbel Paul , Ashley William W
Published: December 2023

Introduction:
Earlier studies addressing racial disparity in patients with acute ischemic stroke (AIS) and atrial fibrillation included significantly lower percentage of blacks. Demographics and post-intervention risk among white vs. black patients with AIS and AF have not been reported in a community hospital setup.

Methods:
In this retrospective analysis, baseline demographics, procedural characteristics and one-year clinical outcomes were collected from hospital database and compared between blacks and whites who are admitted with AIS and treated with alteplase.

Results:
228 and 274 black patients with AIS admitted to our hospital during 2016 to 2021 were included in the analysis. Blacks compared to whites were younger (67 ±13 vs. 74 ± 14 years) and had lower prevalence of cardioembolism (49% vs. 61%), atrial fibrillation (10% vs. 34%), coronary artery disease (17% vs. 26%), prior coronary artery disease or myocardial infarction (17% vs. 26%), depression (16% vs. 25%), dyslipidemia (53% vs. 65%), ischemic risk at admission (6.1 ± 3.6 vs. 8.2 ± 3.8), and NIHSS-obtained (11±11 vs. 14±13), but higher prevalence of small vessel disease (15% vs. 7.9%), cryptogenic stroke (20% vs. 13%), diabetes (39% vs. 25%), smokers (26% vs. 14%), drug/alcohol abuse (21% vs. 9%), prior stroke (24% vs.15%) and one year recurrent ischemic stroke (4.7 % vs. 1.3%) (p<0.05 for all comparisons). Among patients with AF, blacks were of similar age compared to whites (75±13 vs. 79±14 years) and similar prevalence of cardioembolism (99% and 96%), prior myocardial infarction/coronary artery disease (26% vs. 30%) and obesity (59% vs. 48%, p=ns for all), but higher prevalence of prior stroke (48% vs. 20%), diabetes (41% vs. 22%), renal insufficiency 30% vs. 18%) and recurrent ischemic stroke (7.4% vs. 1.3%, p<0.05 for all).

Conclusions:
Blacks patients with AIS exhibit distinct demographics and higher prevalence of recurrent ischemic events compared to whites. Despite lower prevalence, blacks with AIS have higher prevalence of comorbidities and recurrent stroke events in the presence of AF. These data provide springboard for ongoing biomarker studies at our hospital to understand the racial disparity in the underlying pathophysiology of stroke and associated outcomes in blacks.
Abstract 16804: Nationalwide Trends and Predictors of Cardiogenic Shock in Takotsubo-Syndrome Related Admissions Stratified by Sex and Race: 2016-2019
Authors: Kanagala Sai Gautham , Mallapu Prathistitha , Vuddandam Dinesh Kumar , Muvva Durga Mounika , James Alpha , Adelli Raja Anvesh Reddy , Nallapothula Shantha , Chiluka Swetha , Polavarapu Vaibhavi , Mandadi Leela Krishna prasad , Kotharu Devi Meghana , Vyas Ankit , Jain Akhil , Desai Rupak
Published: December 2023

Background:
Sex and race disparities have been understudied in Takotsubo-Syndrome (TTS) patients with cardiogenic shock. The objective is to examine the recent trends and predictive factors associated with cardiogenic shock (CS) in patients with TTS, stratified by sex and race.

Methods:
We analyzed the admissions related to TTS from the National Inpatient Sample (NIS) 2016-2019 using the ICD-10-CM codes to examine the nationwide trends and predictors of cardiogenic shock taking into consideration the factors of sex and race.

Results:
Among a total of 96,405 TTS-related admissions, 5.9% (n=5,705) were diagnosed with CS. Individuals with CS were found to have a median age of 74 (with an interquartile range of 69-80), a higher proportion of males (21.2%), and a predominantly white racial background (83.2%), all of which were statistically significant(p<0.001). Furthermore, patients diagnosed with CS experienced significantly longer hospital stays (median [IQR] 8 [4-14] vs. 4 [2-7]), incurred higher costs (median [IQR] 14.5 [8.1-28.7] vs. 5.6 [3.3-10.3]) and showed higher mortality (29.4% vs 5%) compared to those without CS (p<0.001). The prevalence of all parameters depicted in Figure 1 showed a statistically significant increasing trend over the years(p<0.05), except for Hispanics. Subgroup analysis revealed that males who had diabetes had significantly increased odds of developing CS [OR 1.57, CI 1.15-2.13, p=0.005]. Also, white individuals with diabetes had higher chance of CS [OR 1.21, CI 1.03-1.42, p<0.05].

Conclusion:
Recent trends indicate a rise of CS among TTS related hospitalizations with a notable impact on different demographics such as sex and race, particularly among Asian and pacific islanders. Additionally, in-hospital mortality in patients with CS was six times higher compared to the ones without CS.
Abstract 16805: A Mental Health Curriculum for Pediatric Cardiology Fellows: Increasing Preparedness of Pediatric Cardiologists to Meet the Needs of Patients at Increased Risk
Authors: McCormick Amanda D , Owens Sonal T , Lim Heang M , Vitale Carolyn , Cousino Melissa K
Published: December 2023

Introduction:
Mental health (MH) is an important yet understudied area of care for patients with congenital heart disease (CHD). It is known that children and adults with CHD have increased incidence of MH disorders when compared to their peers. MH disorders are not reliably identified in the pediatrics population at large, and many children who would benefit from treatment of MH conditions do not receive appropriate care. Pediatric subspecialty fellows feel MH should be within their scope, but few feel competent in their ability to appropriately screen and make treatment referrals.

Research Question:
Does a didactic-based MH curriculum improve the preparedness of pediatric cardiology fellows to identify and refer patients at need for MH care?

Aims:
Determine the comfort of pediatric cardiology fellows with MH knowledge, screening, and treatment recommendations, before and after a didactic- based curriculum.

Methods:
A 9 session didactic based curriculum was designed by a multi-disciplinary team of experts, administered over 9 months (September 2021 - June 2022 and September 2022 - June 2023). Topics included MH and CHD Overview, MH Screening and Clinic-Based Interventions, Psychopharmacology, Delirium, Substance Abuse, Trauma-Informed Care, and Adult CHD and Transitional Care. An investigator designed survey was developed to assess fellow comfort with MH knowledge, screening, and treatment recommendation domains, and was administered at the beginning and end of the curriculum in each academic year.

Results:
24 fellows participated over 2 academic years, 14 completed the pre-post survey (11/17 in year 1, 3/6 in year 2). Most participants were in their first year of training (9/14, 57%). Overall, fellow comfort with MH topics increased significantly (mean score 2.89±0.46 vs. 3.4±0.4, p = 0.0005), with improved comfort in the MH knowledge and treatment recommendation domains (p = 0.003 and p = 0.001).

Conclusion:
A didactic based MH curriculum improves the comfort and preparedness of pediatric cardiology fellows to address MH concerns of their patients. This curriculum will continue to be refined in topics over time but could be generalized to training programs nationally and across pediatric specialties to improve MH care for high-risk patients.
Abstract 16826: A Rare Case of an Emergent Third Valve in Valve Intervention
Authors: Godil Sara , AHMAD Basharat , Masri Abdallah , Thompson Cole , Paxos Mihail
Published: December 2023

Introduction:
Bioprosthetic valves are prone to structural degeneration due to an average lifetime of 10-15 years. Valve in Valve (VIV) TAVR has become an alternative to the high-risk surgical patients as the growing number of successful bioprosthetic valve placements and the deteriorations over time. Emergent VIV intervention effectiveness with prior multiple artificial valves is less studied.

Hypothesis:
We report a case of a 54-year-old male presenting with obstructive shock with history of substance abuse and bicuspid aortic valve status post bioprosthetic aortic valve with aortic root repair at age of 15(1983), aortic stenosis requiring repeat surgical bioprosthetic Aortic Valve Replacement (SAVR) (25 mm) at age 42(2011). Recalcitrant cardiogenic shock despite vasopressor. Emergent Heart catheterization showed mild coronary artery disease (CAD) and severe cardiomyopathy, Left Ventricle ejection Fraction 15-20%. Aortic valve Gradient was 80 mmHg. Transesophageal Echocardiography (TEE) ruled out endocarditis. Impella CP and Swan-Ganz catheter were placed for hemodynamic support and monitoring.

Methods:
The Heart Team approach was followed. Patient was at high risk of mortality and operative complications with redo sternotomy. He subsequently underwent valve in valve TAVR with self-expanding 26 mm valve. Prior surgical valve did not require fracturing post implantation.

Results:
Post Trans Aortic Valve Replacement (TAVR) the mean gradient on echocardiogram decreased to 10 mmHg and LVEF recovered to 55-60%. The patient was successfully weaned off Vaso-pressors and eventually discharged home.

Conclusion:
Most common cause of transcatheter bioprosthetic valve failure is stenosis from calcification and thrombosis. VIV TAVR in recent studies has proven to be safe with favorable outcomes. Our patient had already undergone two surgical valve interventions, presented with critical bioprosthetic valve stenosis requiring salvage TAVR for cardiogenic shock. After the Heart team approach, TAVR was opted as a more favorable option for the patient. Although, the life of a bioprosthetic valve results in multiple interventions but overall valve in Valve technique has been proven to provide expected results in emergent high-risk patients.
Abstract 16828: Plaque Rupture is Not Associated With Worse Clinical Outcomes in Contemporary Patients With Acute Coronary Syndrome
Authors: Asakura Kiyoshi , Minami Yoshiyasu , Nagata Takako , Katamine Masahiro , Muramatsu Yusuke , Kinoshita Daisuke , Fujiyoshi Kazuhiro , Ako Junya
Published: December 2023

Introduction:
The worse clinical outcomes in patients with plaque rupture (PR) than those with other pathogenesis of acute coronary syndrome (ACS) including plaque erosion and calcified plaque-related ACS have been reported.

Hypothesis:
The incidence of recurrent adverse events in patients with PR is not higher than other ACS patients in the contemporary clinical setting of secondary prevention using high-intensity statin.

Methods:
A total of 329 consecutive patients with ACS who underwent optical coherence tomography imaging of culprit lesions were included. Patients were classified into either the PR group (n = 133) or the non-PR group (n = 196). The incidence of major adverse cardiovascular events (MACE) at 1-year was compared between the two groups. MACE included cardiac death, non-fatal myocardial infarction, target vessel revascularization (TVR), and non-TVR.

Results:
The prevalence of ST-elevation myocardial infarction (STEMI) as the initial clinical presentation was significantly higher in the PR group than in the non-PR group (58.6 vs. 42.3 %, p = 0.005). The prescription rate of high-intensity statin and/or ezetimibe at discharge was comparable in the two groups (84.2 vs. 84.7 %, p = 1.000). The incidence of MACE at 1-year was significantly lower in the PR group than in the non-PR group (log-rank p = 0.009) (Panel A). In the non-PR group, the levels of body mass index (26.5 ± 2.9 vs. 24.0 ± 3.9 kg/m
2
, p = 0.004) and hemoglobin A1c (7.2 ± 2.5 vs. 6.4 ± 1.2 %, p = 0.021) were significantly higher in patients with MACE than in those without (Panel B).

Conclusions:
The incidence of MACE at 1-year in patients with PR was significantly lower than in those without PR in contemporary patients with ACS despite of the higher prevalence of baseline STEMI presentation. Further tailored optimization of secondary prevention against obesity and diabetes may be still required in ACS patients without PR.
Abstract 16830: Feasibility and Safety of Intracardiac Echocardiography Guidance in Mitral Transcatheter Edge-to-Edge Repair: Analysis of the National Inpatient Sample Data From 2015 to 2020
Authors: Khalouf Amani , Hashem Anas , Aggarwal Ankit , Salah Mohamed Mohamed , Kashou Anthony H , Bou Chaaya Rody , Rai Devesh , Little Stephen H , Naidu Srihari S , Goel Sachin S
Published: December 2023

Introduction:
Data on use of ICE guidance in TEER procedure is limited to case reports and small case series. Our study aims to assess the feasibility, safety, utilization patterns and clinical outcomes of mitral TEER procedure with ICE guidance using a nationally representative real-world cohort of patients.Hypothesis: There is no difference between ICE-guided TEER and TEE-guided TEER in the clinical outcomes and complications.

Methods:
This study used the National Inpatient Sample database from quarter 4 of 2015 to 2020. We used a propensity-matched analysis and adjusted odds ratios for in-hospital outcomes/complications. A P value of <0.05 was considered significant.

Results:
A total of 38,770 weighted cases of mitral TEER were identified. Of the included patients 665 patients underwent ICE-guided TEER while 38,105 had TEE-guided TEER. There were no differences in the in-hospital mortality between both groups (2.5% vs. 3.0%, p=0.58). Adjusted odds of in-hospital mortality (aOR 0.83, 95%CI [0.42-1.64]) were not significantly different. There were no differences in periprocedural complications including cardiac (aOR 0.85, 95%CI [0.54-1.35]), bleeding (aOR 1.45, 95%CI [0.93-2.33]), respiratory (aOR 0.88, 95%CI [0.61-1.25]), and renal (aOR 0.89, 95%CI [0.66-1.20]) complications between patients undergoing ICE-guided versus TEE-guided TEER. There was no difference in GI complications between both groups (aOR 1.11, 95%CI [0.46-2.70]). The adjusted length of stay was less among ICE-guided TEER (median: 1 vs. 2, p<0.01) with no differences in costs of hospitalization ($137,312 vs. $153,773, p=0.06),

Conclusions:
In conclusion, ICE-guided mitral TEER is safe when compared with TEE guided TEER with no significant differences in in-hospital mortality, cardiac, bleeding, respiratory, and renal complications. The length of stay in ICE group is shorter as compared with the TEE group.
Abstract 16835: Plasma Proteomics and Risk of Incident HFpEF and HFrEF: The Atherosclerosis Risk in Communities Study
Authors: Lamberson Victoria , Yang Yimin , Myhre Peder L , Dorbala Pranav , Rasheed Humaira , Buckley Leo F , Claggett Brian , De Marzio Margherita , Glass Kimberly , Hoogeveen Ron C , Ballantyne Christie M , Coresh Josef , Yu Bing , Joseph Jacob , Sun Yan , Omland Torbjorn , Shah Amil M
Published: December 2023

Introduction:
Heart failure with preserved (HFpEF) and reduced (HFrEF) ejection fraction differ in pathophysiology and treatment response. Determining shared and unique protein biomarkers for these phenotypes can aid in understanding their biological mechanisms.

Methods:
We studied 4485 participants in the community-based Atherosclerosis Risk in Communities (ARIC) study who were free of HF and had aptamer-based proteomic measurements (SomaLogic, Boulder, CO) at study Visit 5 (2011-2013). For 4955 aptamers corresponding to 4712 unique proteins, we fit separate multivariable Cox proportional hazards regression models to test for associations with HFpEF and HFrEF. Replication of significant associations was conducted using data from the Norwegian Trøndelag Health Study (HUNT, n=3262). Two-sample Mendelian randomization (MR) was used to assess potential causal associations with HFpEF and HFrEF using summary statistics from the Million Veterans Program.

Results:
Mean age at Visit 5 was 75±5 years, 58% were women, and 17% reported Black race. At a median follow-up of 7.2 [IQR 5.6-7.8] years, 193 HFpEF and 157 HFrEF events occurred. After Bonferroni correction for multiple testing, 16 aptamers were significantly associated with both HFpEF and HFrEF, 45 were significantly associated with HFpEF only, and 9 aptamers were associated with HFrEF only (Figure). These associations replicated in HUNT (p<0.05) for 6 out of 45 proteins for HFpEF only, and 4 out of 9 proteins for HFrEF only. MR identified a potential causal effect of CD7 on HFrEF. No causal associations were found for HFpEF.

Conclusions:
Partially distinct sets of circulating plasma proteins associate with HFpEF and HFrEF. A greater proportion of these associations replicated for HFrEF (4 of 9) than HFpEF (6 of 45) in two distinct population studies, highlighting the heterogeneity of HFpEF. Further study of these proteins may lead to additional insights into the differing biology of these phenotypes.
Abstract 16838: Relation of Clinical Status in Heart Failure to Cardiac Lysophosphatidylethanolamine Accumulation in Hypertrophic Cardiomyopathy
Authors: Ikoma Takenori , Akita Keitaro , Unno Kyoko , Ohno Kazuto , Sato Ryota , Satoh Terumori , Iguchi Keisuke , Sakamoto Atsushi , Suwa Kenichiro , Maekawa Yuichiro
Published: December 2023

Background:
Patients with hypertrophic cardiomyopathy (HCM) represents diverse symptoms, morphology, and cardiovascular events. Although myocardium metabolism in patients with HCM has been studied, it is not well elucidated. In this study, we assessed the association between biomarkers, heart failure-related findings, genetic mutations, and myocardium lipid metabolism in HCM patients using imaging mass spectrometry.

Method:
We prospectively enrolled patients with HCM in Hamamatsu University hospital from July 2020 to October 2022. All patients underwent endomyocardial biopsy and genetic analysis. Obtained myocardial specimens were analyzed using a desorption electrospray ionization source attached to a mass spectrometer. Differences among groups were statistically evaluated with the Fisher’s exact test and Mann-Whitney U test. Correlations between the two values were analyzed using Spearman’s correlation coefficient values.

Results:
A total of 31 Japanese patients were enrolled in this study. These patients included 18 (58.0%) women, and the mean age was 67.6 ± 10.6 years. Genetic analysis revealed that six (19.4%) patients had pathogenic or likely pathogenic variant. (Frequency of causal genes was as follows: MYBPC3 2 [6.5%], TNNI3 2 [6.5%], MYH7 1 [3.2%], and MYOZ2 1 [3.2%].) We divided the patients into two groups according to their median intensity of candidate molecule to reveal between group differences. The group of high lysophosphatidylethanolamine (LPE) showed lower N-terminal pro-brain natriuretic peptide (NT-proBNP) levels (330.0 [147.0-614.0] pg/mL vs. 933.0 [699.5-2576.5] pg/mL, P = 0.001). A correlation was observed between the intensity of LPE and the NT-proBNP levels (r = -0.455, P = 0.012). There was no association between the presence of genetic mutations and New York Heart Association class and LPE intensity.

Conclusion:
HCM patients with the high intensity of LPE in myocardial tissue had relatively low NT-proBNP levels.