bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 17633: Age and Racial Disparities in Gastrointestinal Bleeding Incidence Among Atrial Fibrillation Patients on Direct Oral Anticoagulants: A Retrospective Cohort Study
Authors: Nwankwo Obinna T , Eun Yong , Nwankwo Chizoba N , Raiszadeh Farbod
Published: December 2023

Introduction:
Atrial fibrillation (Afib), a major cause of morbidity and mortality, particularly affects the elderly. Direct oral anticoagulants (DOACs), despite being the preferred stroke risk reduction treatment in Afib patients, often result in gastrointestinal bleeding. This study aims to examine the incidence of this side effect across age and racial groups.

Hypothesis:
The risk of gastrointestinal bleeding while on DOACs increases with age. Racial variation in GI bleeding in Afib patients taking DOACs exists due to non-modifiable and modifiable risk factors.

Methods:
Utilizing the 'All of Us' national database, we conducted a retrospective cohort study of 6,961 Afib patients who started DOACs from 2018 to 2023. EHR data including ICD-9/10 codes and medication history were used to conduct the analysis. Patients who developed gastrointestinal bleeding after the introduction of DOACs within this period were identified. Incidence rates were further analyzed according to age and race.

Results:
Out of 6,961 Afib patients on DOACs, 791 developed gastrointestinal bleeding (21.9 cases per 1000 person-year). The incidence rate was highest among patients aged under 50 years (36.8 cases per 1000 person-year) and those over 80 years (24.0 cases per 1000 person-year). Patients aged 60-70 years had the lowest incidence rate (19.7 cases per 1000 person-year). Racial analysis revealed African-Americans had the highest incidence rates (29.3 cases per 1000 person-year), followed by Asians (21.9 cases per 1000 person-year), and Whites (19.6 cases per 1000 person-year; p<0.001).

Conclusions:
Our study revealed a bimodal peak in GI bleeding incidence in patients on DOACs for Afib, with heightened risk in those under 50 years and above 80 years. Racial disparities were also evident, with African-Americans at the highest risk. These findings underscore the need for further research to elucidate risk factors, particularly in younger patients and specific racial groups.
Abstract 17657: The Effect of Medical Therapy on Reducing the Risk of Pacing Induced Cardiomyopathy
Authors: Agha Mahdi , Rikhi Rishi , Hari Krupal , Bodziock George , Bhave Prashant
Published: December 2023

Introduction:
Right ventricular (RV) pacing results in left ventricular dyssynchrony that can lead to pacing induced cardiomyopathy (PICM). The risk of PICM increases with RV pacing burden. No prior trials have investigated the effect of medical therapy on preventing PICM in patients with high RV pacing burden. The goal of this study was to investigate whether ACE inhibitors (ACEI), angiotensin receptor blockers (ARB), and beta blockers (BB) reduce the risk of PICM in patients with high RV pacing burden.

Methods:
This was a retrospective study which included patients with normal ejection fraction (EF) and complete heart block who underwent single- or dual-chamber pacemaker placement at Wake Forest Baptist Medical Center between 1992 - 2013. Exclusion criteria were age <18 and myocardial infarction. The medical therapy group included patients who received ACEI/ARB, BB, or both. The control group included patients who received neither ACEI/ARB nor BB. The primary endpoint was PICM, which was defined as upgrade to a biventricular device or reduction in EF by ≥10% without another etiology identified. Follow-up was 10 years or until development of PICM. Kaplan-Meier and multivariable Cox proportional hazards ratio survival analysis was performed.

Results:
The study included 642 patients. Average age was 71 ± 14. Females were 51%. ACEI/ARB only was prescribed for 80 (12%), BB only was prescribed for 55 (9%), and both were prescribed for 114 (18%). PICM occurred in 12 out of a total of 249 in the medical therapy group (4.8%) and 28 out of a total of 393 in the control group (7.1%). The risk of PICM was significantly lower in the medical therapy group compared to the control group (HR 0.34, 95% CI 0.16 - 0.71, P<0.01) in a model fully adjusted for age, sex, hypertension, diabetes mellitus, chronic kidney disease, and atrial fibrillation.

Conclusions:
In patients who have high RV pacing burden, medical therapy with ACEI/ARB and BB appears to reduce the risk of PICM.
Abstract 17669: Prevailing Racial, Regional, and Income-Based Disparities in Cardiovascular Outcomes in Postmenopausal Women Hospitalized With SARS-CoV-2 in 2020
Authors: Chauhan Shaylika , Dhavapalani Dhayashri , Senapati Sidhartha G , Allala Manoj R , Shah Viraj R , Thakkar Kamya U , Podduturi Pavan Vihar Reddy , Shah Hem , Damera Abhiram Rao , Guddeti Ananth V , Desai Rupak
Published: December 2023

Introduction:
Racial, regional, and income disparities have been shown to impact cardiovascular outcomes in postmenopausal women with SARS-CoV-2. Addressing these disparities can improve healthcare equity and outcomes for this vulnerable population.

Methods:
A retrospective cohort study utilized data from the National Inpatient Sample (NIS)-2020 to examine female patients aged over 55 years who were admitted to hospitals in 2020. The study focused on primary endpoints, specifically major cardiac and cerebrovascular events (MACCE) including all-cause mortality, AMI, cardiac arrest, and stroke. Multivariable logistic regression was used to evaluate the association between demographic factors and cardiovascular outcomes, after controlling for confounding variables.

Results:
Of the total 547,225 postmenopausal women hospitalized with SARS-CoV-2, 19.8% had MACCE. Racial disparities were significant, as Native American, Hispanic, Asian and African American women exhibited higher rates of MACCE compared to Caucasian women, with odds ratios (OR) of 1.63 (95% CI: 1.33-1.98, p<0.001), 1.25 (95% CI: 1.18-1.32, p<0.001), 1.17 (95% CI: 1.07-1.28, p<0.001), and 1.11 (95% CI: 1.06-1.17, p<0.001), respectively. Regional variations were also observed, with the Northeast region demonstrating a higher prevalence of cardiovascular complications compared to the West (OR: 1.22, 95% CI: 1.14-1.32, p<0.001). Additionally, income level played a significant role, as women from the first- and second-income quartiles had higher MACCE rates compared to those in the fourth quartile (OR: 1.19, 95% CI: 1.12-1.26, p<0.001; OR: 1.09, 95% CI: 1.03-1.15, p<0.001).

Conclusions:
This study reveals significant racial, regional, and income disparities in cardiovascular outcomes among postmenopausal women with SARS-CoV-2. Targeted interventions and further research are necessary to improve healthcare equity and outcomes in vulnerable populations.
Abstract 17674: Serum Brain-Derived Neurotropic Factor Levels Predict the Recurrences of Atrial Fibrillation Following Catheter Ablation
Authors: Nodera Minoru , Kakehashi Shota , Mukai Moe , Aoyama Daisetsu , Hasegawa Kanae , Uzui Hiroyasu , Tada Hiroshi
Published: December 2023

Background:
Brain-derived neurotropic factor (BDNF) is a growth factor with roles within the nervous system and cardiovascular system. It has been reported that serum BDNF is decreased in diseases related to persistent stress, such as chronic inflammation. Atrial fibrillation (AF) is also considered to be one of the diseases related to chronic inflammation, although the relationship between serum BDNF and AF remains unclear.

Methods:
This prospective study included 68 consecutive patients (44 men; 69 [58-69] years) who underwent first session of paroxysmal AF ablation. Before and 3 months after the ablation, blood samples were obtained to measure the several biomarkers that are known to be related to AF in addition to serum BDNF. AF recurrence was defined as the appearance of AF after 3 month blanking period following the ablation.

Results:
The serum BDNF levels before ablation were significantly increased after AF ablation (3.5 [1.6-16.6] ng/ml vs. 22.1 [16.2-27.4] ng/ml, p<0.001). During follow-up period of 10±2 months, AF recurrence occurred in 5 (7%) patients. The serum BDNF at 3 months post-ablation were significantly lower in patients with recurrent AF than in those without (19.6 [13.8-20.8] ng/ml vs. 22.0 [17.5-27.1] ng/ml, p=0.019). Furthermore, the serum BDNF at 3 months post-ablation was an independent predictor of AF recurrence (odds ratio 0.912, 95% confidence interval 0.835-0.996, p=0.040). According to the ROC curve analysis, the serum BDNF at 3 months post-ablation <22.0 ng/ml was associated with AF recurrence with 100% sensitivity and 54% specificity (area under the curve=0.817, p=0.019). Kaplan-Meier survival curve showed that the recurrence rate of AF was higher in the group L (the serum BDNF at 3 months post-ablation <22.0 ng/ml) than the group H at 3 months post-ablation >22.0 ng/ml) (p = 0.02) [figure 1].

Conclusions:
Lower serum BDNF levels at 3 months after blanking period following the AF ablation might be a predictor of AF recurrence.
Abstract 17706: Role of p62/SQSTM1 on Acute Ischemia-Induced Arrhythmias After Chronic Smoke in Mice
Authors: Hwang Hyun Seok , Centner Ann , Ukhanov Vladimir , Zhao Joanne , Cejas Carbonell Alexis , Valera Isela , Parvatiyar Michelle , Salazar Gloria
Published: December 2023

Introduction:
Cigarette smoke presents a high-risk factor for coronary heart disease development. Cigarette smoke is often linked with increased susceptibility to cardiac ischemia and arrhythmias. p62/SQSTM1 is a stress-sensing protein responsible for proteasomal degradation that maintains redox homeostasis during cardiac tissue injury. However, its exact mechanism for arrhythmia development is not clear.

Hypothesis:
Here we tested the biological role of p62/SQSTM1 mice on cardiac ischemia injury-induced arrhythmogenesis after chronic cigarette smoke exposure.

Methods:
Mice (global p62/SQSTM1 deletion mice; p62/SQSTM1
-/-
, 4 months old age) were exposed to cigarette smoke (9.4 mg tar/0.726 mg nicotine) for 16 weeks. Afterward, we utilized ischemia-reperfusion (IR) injury in intact hearts to test the risk of arrhythmias.

Results:
The smoke-exposed p62/SQSTM1
-/-
isolated hearts (8 months old age) significantly reduced the incidence of ventricular arrhythmias compared to hearts obtained from p62/SQSTM1
+/+
mice post-IR during the first 15 minutes reperfusion (% of mice with ventricular arrhythmias, p62/SQSTM1
+/+
; 7/10 hearts, p62/SQSTM1
-/-
; 2/8 hearts*, * <0.05). Abnormal Ca
2+
regulation in cardiomyocytes is triggering diastolic delayed afterdepolarizations and often leads to ventricular tachycardia. Therefore, we tested cellular Ca
2+
regulation with acute cigarette smoke extract (CSE) exposures in cardiomyocytes. p62/SQSTM1
-/-
cardiomyocytes for 30 minutes exposed to CSE significantly alleviated CSE-induced spontaneous Ca
2+
waves (% of cardiomyocytes with spontaneous Ca
2+
waves, p62/SQSTM1
+/+
; 6/13 cells, p62SQSTM1
-/-
; 1/15 cells*, * <0.05).

Conclusions:
Overall, our results suggest that the deletion of p62/SQSTM1 protein has a protective effect on acute cardiac ischemia-induced arrhythmogenesis after chronic cigarette smoke in mice.
Abstract 17707: The Association of Atrial Fibrillation With Tricuspid Regurgitation Progression is Age-Dependent
Authors: Loutati Ranel Yosef , Ben-Zekry Sagit , Fefer Paul , Mazor Efrat , Klempfner Robert , Barbash Israel , Guetta Victor , Segev Amit , Kuperstein Rafael , Maor Elad
Published: December 2023

Background:
The prevalence of significant Tricuspid Regurgitation (TR) in individuals with Atrial Fibrillation (AF) is notably high. This analysis aimed to investigate the association of AF with TR progression after more than 10 years, and to ascertain influencing factors of this association.

Methods:
Electrocardiographic reports linked to clinical data (N=52,389; 2007-2012) were reviewed. Only patients with apparently normal left heart and with ECG and echocardiographic reports at baseline and at after a minimum of 5 years were included. The primary outcome was the occurrence of new significant TR in a follow-up echocardiogram.

Results:
The final study included 5,691 patients with a median age of 62 (IQR: 53-70), 845 (14%) of whom had baseline AF. During a median follow-up period of 12 years, 279 (5%) patients developed significant TR. Patients with AF were 6 times more likely to develop significant TR in a univariate model (95% CI 5.3-6.8,p <.001). A multivariate model demonstrated that AF, older age, female sex and pulmonary pressures were all associated with increased risk of TR progression (p<.001 for all). The association of AF with future TR was age-dependent such that among patients older than 60, AF was associated with 3.6-fold increased risk compared with 4.5-fold increased risk among younger adults (p for interaction=0.01). During follow up, 1,197 (21%) patients died. Kaplan-Meier analysis revealed increased mortality risk with significant TR and/or AF (log-rank p<.001 for both). Multiarvariate Cox analysis demonstrated that compared to significant TR patients without AF, the combination of TR and AF was associated with a significant 42% higher risk of death during follow up (p=0.04).

Conclusions:
The association of AF with TR progression after more than 10 years of follow up is more prominent among younger patients. This emphasize the importance of TR screening in AF patients and implementing interventions to mitigate TR progression and improve outcomes.
Abstract 17716: Comprehensive Cardiac Rehabilitation Following Myocardial Infarction Improves Clinical Outcomes Regardless of Exercise Capacity in a Long-Term Follow-Up
Authors: Hiruma Takashi , Nakayama Atsuko , Sakamoto Junko , Hori Kentaro , Nanasato Mamoru , Hosoda Toru , Isobe Mitsuaki
Published: December 2023

Background:
Reduced exercise capacity is recognized as a prognostic indicator of adverse outcomes in patients with myocardial infarction (MI). However, there is limited research evaluating the effectiveness of comprehensive cardiac rehabilitation (CR) in this population. Here, we show for the first time that participation in CR can improve the prognosis of MI patients with reduced exercise capacity in a long-term study.

Methods:
This cohort study included 610 consecutive patients with MI who underwent percutaneous coronary intervention (PCI) between 2008 and 2015. Patients who received supervised CR were divided into two groups according to the duration of CR: the non-CR group (only hospitalization) and the CR group (continued to outpatient-CR). Within the CR group, patients were further divided into a reduced exercise capacity group (% predicted peak VO2 <80%) and a preserved exercise capacity group (≥80%). Comprehensive CR consisted of a 150-day supervised exercise program at the anaerobic threshold (AT) performed in the hospital under the supervision of a multidisciplinary team. Major adverse cardiovascular events (MACE) were compared among groups.

Results:
Mean follow-up was 6.1 ± 4.0 years. The MI patients were divided into three groups: the non-CR group (n = 180), the CR group with reduced exercise capacity (n = 241, peak VO2: 17.2 ± 3.9 ml/min/kg) and with preserved exercise capacity (n = 147, peak VO2: 23.1 ± 4.6 ml/min/kg). There was no significant difference in the improvement of the lower limb exercise capacity index, AT, peak VO2 and risk of MACE between the CR groups with reduced and preserved exercise capacity. However, the risk of MACE was lower in the CR groups compared with the non-CR group (log-rank p = 0.014). Multivariable Cox regression analysis showed that chronic kidney disease (aHR 1.89, 95% CI 1.19-3.01, p < 0.01), non-Killip class 1 (aHR 1.90, 95% CI 1.01-3.57, p = 0.047) and CR participation (aHR 0.57, 95% CI 0.36-0.90, p = 0.015) were independent predictors of MACE.

Conclusions:
Comprehensive CR after PCI in patients with MI effectively reduces the occurrence of MACE, regardless of their exercise capacity. We should also actively encourage patients with low exercise capacity to participate in comprehensive CR.
Abstract 17730: Facilitated Peer Mentoring: A Novel Model for Promoting Equitable and Inclusive Mentoring for Underrepresented Trainees in Academic Medicine
Authors: Osabutey Anita , Fatade Yetunde A , Olakunle Oreoluwa , Crumbs Tre'Cherie A , Campbell Martin L , Amah Chidi , Sanyi Allen , Steele Nathan R , Azobou Tonleu Franck H , Okoh Alexis K , Ogunniyi Modele O ,   On Behalf of The Ogunniyi Rsch Group, Emory Univ Sch of Medicine
Published: December 2023

Introduction:
Underrepresented minoritized(URM) cardiologists represent less than 8% of the US cardiology workforce. A positive role model, access to mentorship, and a diverse workforce influences the choice of cardiology as a subspecialty. Recognizing this, we established a novel facilitated peer-mentoring research group, the “Ogunniyi Research Group (ORG),” with the goal of creating a supportive and inclusive learning environment for trainees to develop cardiovascular research proficiencies.

Methods:
Our team consists of a lead mentor(cardiologist), 2 co-facilitators(cardiology fellows), and 4 resident-led teams of medical students and residents(Figure 1). Our mission is to advance cardiovascular health and equity through research, advocacy, and service; built on core pillars of mentorship, scholarship, leadership, community, and service. Mentees complete an individual development plan and meet regularly with the lead mentor to ensure milestones are met. Teams engage in research and quality improvement projects, which are reviewed at virtual monthly meetings. Quarterly academic medicine research seminars focus on building research skills.

Results:
26 trainees participated during the 2021-22 and 2022-23 academic year. Most trainees (>95%) self-identified as Black, with equal sex representation. Major accomplishments include >16 abstracts presented at conferences, co-authorship on >10 publications, and several prestigious awards, grants, honors, and scholarships. 4 team members were selected as chief medical residents. To date, we have secured 100% residency and cardiology fellowship match rate.

Conclusion:
Our novel, multilevel, facilitated peer mentoring group has increased access to research and professional development opportunities, especially for URM trainees interested in cardiology. The ORG can serve as a model sustainable pathway for equitable mentorship, promoting diversity and inclusion in the cardiology workforce.
Abstract 17748: Lipoprotein(a) and Oxidized Phospholipids on Lipoproteins and Cardiovascular Outcomes in Patients With Chronic Coronary Syndrome Treated With Colchicine
Authors: Mohammadnia Niekbachsh , Broekhoven Amber van , Bax Willem A , Eikelboom John W , Mosterd Arend , Yang Xiaohong , Tijssen Jan G , Thompson Peter L , de Kleijn Dominique , El Messaoudi Saloua , Tsimikas Sotirios , Yeang Calvin , Cornel Jan H
Published: December 2023

Introduction:
Lipoproteins carrying pro-inflammatory oxidized phospholipids (OxPL), exemplified by lipoprotein(a) [Lp(a)], contribute to residual risk for major adverse cardiovascular events (MACE) in patients with chronic coronary syndrome (CCS) despite optimal medical treatment.

Hypothesis:
Anti-inflammatory colchicine therapy modifies MACE in patients with elevated Lp(a), OxPL on apo(a) [OxPL-apo(a)], and OxPL on apoB containing lipoproteins (OxPL-apoB).

Aims
To study the relationship of Lp(a), OxPL-apo(a) and OxPL-apoB with MACE in 1777 LoDoCo2 trial participants with CCS randomized to colchicine or placebo.

Methods:
End of study but not baseline samples were available. Because Lp(a), OxPL-apo(a) and OxPL-apoB levels are strongly genetically determined, we assumed that end of study values would reflect baseline values. The primary endpoint was a composite of MI, ischemic CVA or ischemia driven coronary revascularization. Cox regression was used to compare the incidence of the primary endpoint by Lp(a) dichotomized at 125 nmol/L and OxPL-apo(a) and OxPL-apoB in tertiles.

Results:
At study end, median (IQR) on-colchicine Lp(a), OxPL-apo(a), and OxPL-apoB levels in nmol/L were 22.4 (7.2-102.7), 7.8 (2.0-34.5) and 3.1 (1.3-6.3), similar to on-placebo levels of 23.9 (9.9-95.7), 8.8 (2.7-34.0), and 3.1 (1.4-5.9), respectively (p = 0.20, 0.98 and 0.18). MACE reduction with colchicine was independent of Lp(a) and OxPL-apo(a) (P
interaction
= 0.92 and 0.66 respectively). However, the largest MACE reduction was present in the highest vs lowest OxPL-apoB tertile (
Figure
, P
interaction
< 0.05).

Conclusions:
The benefit of colchicine in reducing MACE was highest in subjects with elevated OxPL-apoB, suggesting colchicine may be most effective in subjects with heightened oxidation-driven inflammation. These findings may be hypothesis-generating and require validation in larger trials with baseline biomarker assessment including CRP and IL-6.
Abstract 17773: Novel Partition Scores Identify Pathways Implicated in Clonal Hematopoiesis of Indeterminate Potential (CHIP) Mediated Heart Failure
Authors: Chen Nathan , Shen Miles , Rao Veena , Ivey Miranda Juan , Tan Zhen , Wei Wei , Testani Jeffrey M , Halene Stephanie , Gu Jianlei , Zhao Hongyu , Hwa John , Jha Alokkumar , Kwan Jennifer M
Published: December 2023

Background:
Peripheral blood somatic genetic variants such as those in clonal hematopoiesis of indeterminate potential (CHIP) increase the risk of both ischemic and non-ischemic cardiomyopathy but mechanisms beyond inflammation are unclear.

Research question/Objectives:
We sought to understand the prevalence and impact of CHIP and extended somatic variants (ExSV) using a new deep learning algorithm in heart failure patients on the outcome of all-cause mortality and leverage novel partition scores to identify pathways involved.

Methods:
CHIP and ExSV were evaluated using a novel proprietary deep learning algorithm in a heart failure cohort at Yale using whole exome sequencing and somatic variants identified were validated using UKB and TOPMED cohorts. Cox regression including somatic variants on the outcome of death was performed. Partition score analysis integrating patient demographics, co-morbidities, genomic and transcriptomic data was performed to identify traits and biological pathways implicated in heart failure

Results:
CHIP was highly prevalent in the 189 patient Yale heart failure cohort at 42% with mean age of 66. Fifty percent had diabetes and 46% had CAD. Using UKB and TOPMED cohorts, novel “CHIP-like” somatic variants were identified that conferred increased or decreased risk of heart failure. Some ExSV were associated with increased risk of death. Partition score assessment identified top traits associated with increased risk of heart failure, including LDL, triglycerides, diabetes, BMI and CAD and pathway analysis identified that metabolic pathways including cholesterol metabolism, glucose signaling and AMPK were implicated in the heart failure phenotype mediated by somatic variants (Table).

Conclusions:
CHIP and ExSV are prevalent in heart failure patients, impact the outcome of death and metabolic pathways are implicated in mediating the effects of somatic variants/CHIP in heart failure
Abstract 17782: Reverse Remodeling as a Survival Predictor in Chagas Cardiomyopathy
Authors: Sampaio de Sousa Lira Maria Tereza S , Furquim Silas , Catto De Marchi Daniel , Maciel Pamela Camara S , Dantas Rafael , Fernandes Fabio , Ferreira Silvia Moreira Ayub Ferreira , Lima Eduardo G , Bocchi Edimar A
Published: December 2023

Introduction:
Chagas cardiomyopathy (CC) has a worse prognosis than other etiologies. Reverse remodeling (RR) is consistently associated with better mortality and morbidity outcomes in heart failure with reduced ejection fraction (HFrEF) of non-chagasic etiology. Still, the impact on CC has been poorly studied.

Hypothesis:
RR improves survival in patients with CC.

Methods:
From January 2006 to September 2021, the medical records of 1049 patients with positive serology for Trypansosoma cruzi infection associated with left ventricular ejection fraction (LVEF) <40% were reviewed. RR was defined as a 10% absolute increase in LVEF or absolute LVEF > 40% on the second echocardiogram. Participants were divided into 2 groups: negative RR (NRR) and positive RR (PRR).

Results:
221 patients had PRR and 828 NRR. At baseline, the median age in the PRR group was 59 years versus 56 years in the NRR (p <0.001), with 48.2% males in the RRP group versus 58.9% in the RRN (p 0.005). Regarding treatment, only the use of furosemide showed a difference (63.3% in the PRR and 75.4% in the NRR; p <0.001). Regarding baseline ECOTT: the median of LVEF was 30.5% in PRR and 29% in NRR (p <0.001), median LV Diastolic Diameter (DD) (PRR 60 mm; NRR 64mm; p <0.001); median LV Systolic Diameter (SD) (PRR 50 mm; NRR 55 mm); the presence of moderate to severe mitral insufficiency (PRR 37.8%; NRR 50.6%; p <0.001). In the second ECOTT, the PRR group had a median LVEF of 41%, LVDD of 58 mm, and LVSD of 44 mm. In both the univariate analysis and the adjustment made by the multivariate analysis by COX regression, the PRR was an independent predictor associated with all-cause death (HR 0.625, 95% CI 0.421-0.928; p 0.020). Median survival time (and 95% CI) was 8,8 (8,4-9,2) years in the NRR group and 11,4 (10,8-13,8) in the PRR group. Survival was significantly better for PRR than NRR (p <0.001, pairwise Log-Rank comparison).

Conclusions:
This study suggests a positive association between PRR and increased survival in patients with CHD and HFrEF. Previously published studies didn’t demonstrate this association, possibly due to the small number of patients included.
Abstract 17786: Transcatheter Atrial Septal Defect With Deficient Retro-Aortic Rim Closure Success Rate and Complication is Similar to Other Anatomical Variants: Meta-Analysis
Authors: Fadah Kahtan , Brockman Michael , Chandupatla Nihar , Nguyen Bryan , Roongsritong Chanwit , Siddiqui Tariq
Published: December 2023

Introduction:
Atrial septal defect (ASD) is a common congenital cardiac malformation resulting from incomplete fusion of one of the multiple embryological structures. Though surgical repair when indicated had been the norm, technological advances over the years have led to the current availability of transcatheter closure of the ASD. This alternative approach has been associated with lower complications and mortality but the procedural success and outcome are variable dependent upon anatomical features.

Hypothesis:
Several reports have linked deficiency of retro-aortic rim to higher complications, particularly aortic erosion in patients undergoing transcatheter ASD closure. Recent retrospective studies have however suggested otherwise. We herein performed meta-analysis of existing data on the success rate and adverse events following transcatheter closure of ASDs in patients with deficient retro-aortic rims (DRAR) in an attempt to provide general recommendations on the optimal approach for this common anatomic variant.

Methods:
Twelve relevant studies of ASD with DRAR were identified utilizing PubMed. Each of the twelve studies was closely reviewed for major adverse events including cardiovascular mortality, mortality from non-cardiovascular causes, device erosions, device embolization, residual shunting post-ASD repair, and other complications. The incident of each major adverse events was subsequently tabulated. Five of these reports directly compared the failure rates of ASD closure between patients with and without DRAR. A Mantel-Haenszel random effect meta-analysis was performed on these five publications.

Results:
Of the total 4,621 transcatheter-based approach ASD closures included, the rate of major adverse events was 5.14%. There was no significant difference in the procedural failure rate between those with and without DRAR (
relative risk =1.14,
95% CI[0.39 3.35], p=0.811
), (heterogeneity, I
2
=74.75%).

Conclusions:
Our meta-analysis suggests that transcatheter ASD closure could be performed in patients with deficient retro-aortic rim ASD with expected similar rates of adverse events and success rates as in other anatomical variants.
Abstract 17793: Remotely Delivered Weight Loss and Exercise Intervention to Improve Cardiovascular Risk in Older Patients With Rheumatoid Arthritis
Authors: Ross Leanna M , Andonian Brian J , Sudnick Alyssa M , Johnson Johanna L , Pieper Carl F , Bales Connie W , Porter Starr Kathryn N , Kraus William E , Huffman Kim M
Published: December 2023

Background:
Persons with rheumatoid arthritis (RA) face two-fold increases in CVD, due to traditional risk factors - e.g., hypertension, dyslipidemia, obesity, and physical inactivity - and RA systemic inflammation. Despite improvements in pharmacologic management of inflammatory disease activity, the increased prevalence of RA CVD persists. Thus, developing innovative, non-pharmacologic interventions to improve clinical care is critical. The goal of the SWET-RA trial was to identify the effects of a 16-wk remotely supervised weight loss and exercise training (SWET) intervention on metabolic syndrome in older persons (60-80 years) with RA and overweight/obesity (BMI 28-40 kg/m
2
).

Methods:
Participants were randomized to SWET (n =10) or a counseling health as treatment (CHAT) control group (n=10). Using video conference and mobile applications, the SWET group completed aerobic training (150 min/wk moderate-to-vigorous), resistance training (2 days/wk), and a hypocaloric diet (7% weight loss goal). The CHAT group completed two counseling visits for diet and exercise followed by monthly check-ins. Metabolic syndrome
z
-scores (MSSc) were derived from fasting glucose, triglycerides (TG), HDL-cholesterol (HDL-C), waist circumference (WC), and mean arterial pressure. Within groups, Wilcoxon signed rank tests assessed significance of post- minus pre-intervention change scores (p<0.05). Between group comparisons were assessed using regression modeling controlling for baseline.

Results:
Following the intervention, the SWET group significantly improved TG and WC, yet reduced HDL-C; the CHAT group did not improve individual score components. Both groups significantly improved MSSc, with no between group differences.

Conclusion:
Results from this trial support the use of a remotely delivered program for older persons with RA and overweight/obesity. Both SWET and CHAT elicited improvements in a composite measure of CVD risk. Although SWET exceeded CHAT for reductions in TG and WC, HDL-C was reduced in SWET - possibly due to the hypocaloric diet - and increased in CHAT, likely accounting for the lack of MSSc group difference. More research is needed to distinguish the specific effects of exercise versus diet and weight loss for improving RA CVD risk.
Abstract 17799: Increasing Incidence of Atrial Fibrillation and Flutter in the United States: A Population-Based Time-Trend Analysis Using the Global Burden of Diseases Database, 2000-2019
Authors: Abughazaleh Saeed , Obeidat Omar , Alsakarneh Saqr , Tarawneh Mohammad , Abdalla Khalid
Published: December 2023

Introduction:
Atrial fibrillation (AF) and flutter (AFL) are the most common sustained arrhythmia in clinical practice. There is limited data on recent age and sex-specific incidence rates.

Aim:
This study aimed to analyze incidence rates of AF and AFL in the US, focusing on age and gender-specific trends using the Global Burden of Disease (GBD) 2019 database.

Methods:
Incidence data was obtained from the GBD 2019 database. Age-adjusted incidence rates were stratified by gender into males and females. Age-specific trends were assessed in two age sub-groups: younger adults (≤55 years) and older adults (>55 years). Time-trends, reported as annual percentage change (APC) and average APC (AAPC), were estimated using Joinpoint Regression Software (v.4.9.0.1, NCI) utilizing Monte Carlo permutation analysis.

Results:
607,599 patients were diagnosed with AF and AFL in the US in 2019. Overall, AF and AFL incidence rates have increased in older adults and but remained stable in younger adults (AAPC= 2.2 vs. 0.9; AAPC difference= 1.3, P<0.001). Age-specific trends were neither identical (P<0.001) nor parallel (P<0.001) suggesting that incidence rates are different and increasing at a greater rate in older adults compared to younger adults. However, for both men and women incidence rates have increased over the past two decades at the same rate (AAPC= 2.3 vs. 2.2: AAPC difference= 0.1, P=0.67).

Conclusions:
Our study showed that AF and AFL incidence increased over the past two decades. This increase is primarily driven by older adults. Further research is warranted to understand the factors contributing to this increase, especially in older adults.
Abstract 17804: Prediabetes and Stroke Risk in Hospitalized Non-Diabetic Geriatric Patients With Atrial Fibrillation: Unfurling the Association Through Population-Based Analysis
Authors: Sampath Shrikanth , Srivastava Archit , Suchday Pooja , Bhanushali Aditi K , Behera Alkananda , MEHTA KAMYA , Eppalapally Akhil kumar , Bollampalli Ram Prasanjith Reddy , Desai Rupak
Published: December 2023

Background:
The association of prediabetes (pDM) with stroke risk in non-diabetic geriatric patients with AF is unclear. The findings from this analysis contribute to a better understanding of the interrelation between pDM, AF, and stroke, highlighting the need for targeted interventions and risk management strategies in this vulnerable population.

Methods:
Utilizing the 2019 National Inpatient Sample and employing ICD-10 CM coding, we identified all non-diabetic geriatric admissions with AF. Patients were categorized into two groups: pDM+ and pDM-. The primary outcomes of interest were stroke incidence, odds and potential sex disparities in odds as a risk factor for stroke in geriatric patients with AF.

Results:
Of the total 218130 non-diabetic geriatric AF admissions, 3525(1.6%) had pDM. The pDM+ cohort was relatively younger (median 75 vs 77 years), and often consisted of females (57.9%; p<0.359), white (80.1%), and from the higher-income quartile (28.5%); (p<0.001). The preDM+ group had significantly higher rates of complicated HTN (50.2 vs 43.6%), hyperlipidemia (66.4 vs 53.7%), obesity (30.2 vs 13.6%), PVD (15.3 vs 9.9%), stroke (1.4 vs 0.8%). After adjusting for baseline characteristics/comorbidities, the pDM+ cohort with AF admissions showed a higher rate and significantly higher odds of stroke vs the pDM- cohort (1.4% vs. 0.8%, OR 2.00, 95%CI 1.06-3.77; p=0.033). On subgroup analyses, males had a stronger association (OR 5.48, 95%CI 1.43-21.02; p=0.013) vs. females.

Conclusion:
Our research revealed that geriatric patients hospitalized with AF who had concomitant pDM were twice likely to develop stroke, with male preponderance. Further research is warranted to develop tailored interventions to mitigate the risk of stroke in AF patients with pDM.
Abstract 17813: Markers of Cellular Damage, Inflammatory Response, Coagulation and Platelet Activity, and Apoptosis During Catheter Ablation for Atrial Fibrillation Using Radiofrequency and Pulsed-Field Energy
Authors: Osmancik Pavel P , Bacova Barbora , Kunstatova Veronika , Sochorova Veronika , Hozman Marek , Waldauf Petr , Hassouna Sabri , Karch Jakub , Vesela Jana , Poviser Lukas , Znojilova Lucie , Filipcova Vera , Herman Dalibor
Published: December 2023

Introduction:
Pulsed-field ablation (PFA) presents a new technology for the ablation of AF using non-thermal ablation energy. Ablation energies producing thermal injury are associated with an inflammatory response, platelet activation, and coagulation cascade activation. The study aimed to compare markers of cell damage and platelet and coagulation activation in patients undergoing PVI using PF and radiofrequency (RF) energy.

Hypothesis:
PFA will be associated will more pronounced myocardial damage, but less pronounced activation of platelets and inflammation.

Methods:
Patients with AF indicated for PVI were enrolled and randomly assigned to undergo PVI using RF (CARTO Smart Touch, Biosense Webster, USA) or PF (Farapulse, Boston-Scientific, USA) energy. Markers of myocardial damage (high-sensitivity troponin I), apoptosis (Fas ligand, caspase-3), inflammation (interleukin-6), coagulation (D-dimers, Fibrin monomers, von Willebrand antigen and factor activity), platelet activation (P-selectin, activated Gp IIb/IIIa antigen and CD42b), and neuron axon damage (NGF-β) were measured before the procedure (T1), after transseptal puncture, (T2), after completing the ablation in the left atrium (T3), and one day after the procedure (T4).

Results:
Sixty-five patients were enrolled in the PFA (n=33) and RFA (n=32) groups. Both groups were similar in baseline characteristics (age 60.5±12.7 vs. 64.0±10.7 and 20 (60.6%) non-paroxysmal vs. 20 (62.5%) paroxysmal AF). Procedural and left atrial dwelling times were substantially shorter in the PFA group (55:09±11:57 vs. 151:19±41:25 min, p< 0.001; 36:00±8:05 vs. 115:58±36:49 min, p<0.001). Troponin release (1 d after the procedure) was substantially higher in the PFA group (10,102, IQR 8,272-14,207 vs. 1,006, IQR 603-1,433) and was ten times higher in PFA patients. However, during the procedure, markers of platelet activation, coagulation activation, and inflammation were similar between groups.

Conclusions:
PF ablation was associated with substantially more myocardial damage compared to radiofrequency ablation. However, coagulation activation, platelet activation, and inflammatory responses were similar.
Abstract 17842: 3D Visualization and Quantitative Assessment of the Pulmonary Arteries on CT Using Deep Learning Segmentation
Authors: Kim Jessica , Gupta Diviya , LeComte Matthew , Hsiao Albert , Hahn Lewis
Published: December 2023

Introduction:
Assessment of the pulmonary arteries (PA) on CT scan is typically qualitative and requires review of hundreds of images. PA segmentation would enable creation of 3D reconstructions that visualize the entire pulmonary arterial tree in a single image, similar to catheter angiography, and also enable quantification of pathophysiologic changes. Manual segmentation is very time-consuming, but deep-learning (DL) can automate the process.

Hypothesis:
A DL segmentation algorithm can be used to automatically generate 3D reconstructions of the PAs and quantify morphologic changes seen in Chronic Thromboembolic Pulmonary Hypertension (CTEPH) and Pulmonary Arterial Hypertension (PAH).

Methods:
A DL algorithm based on a 3D U-Net architecture which segments PAs larger than 2 mm was trained and validated on a total of 250 contrast-enhanced CT chest. The study group included 15 CTEPH and 15 PAH patients seen consecutively in pulmonary hypertension (PH) clinic in 2022 with prior CT chest and right heart catheterization, and 10 additional patients with prior CT chest and no evidence of PH on same day echo (normal). After running the DL algorithm on CTs, 3D renderings were created from segmentations and the relative volume of the central, interlobar, and segmental/subsegmental PAs was derived.

Results:
3D renderings of PAH and CTEPH patients showed larger central and interlobar PAs compared with those of normal patients, whereas segmental and subsegmental PAs were smaller and pruned in CTEPH patients (Figure). Quantitatively, the volume of the central and interlobar PAs was higher in CTEPH and PAH compared to normal (p < 0.05). The combined volume of segmental/subsegmental PAs was smaller in CTEPH patients relative to normal and PAH patients (p < 0.005).

Conclusions:
DL segmentation enables intuitive visualization and quantification of the morphologic changes to the PAs seen in conditions causing PH. This method may improve diagnosis and assessment of PH on CT.
Abstract 17876: Outcome of Ultrasound versus Fluroscopy Guided PPM Implantation
Authors: Pradhan Jiwan , Yusif Shakanti , Abbasi Hamidreza , Malik Nadim
Published: December 2023

Introduction:
Universal standard practice for venous access for implanting permanent pacemaker (PPM) is with fluoroscopy with venogram. Ultrasound (US) guided vascular access is increasingly encouraged to minimise radiation, contrast load and inadvertent injury to other structures. The incidence of US-guided vascular access related complications is unknown.

Goals:
To compare complications including radiation exposure with Ultrasound (US) guided vascular access, compared with fluoroscopy/venogram access.

Method:
Retrospective data of 205 consecutive patients implanted with PPM (elective and urgent) from August 2021 to August 2022 at single centre were collated for access-related complications and cumulative entire-procedure radiation dose.

Result:
149/205 (73%) patients underwent fluoroscopy guided subclavian/axillary/cephalic vein versus access and 55/205 (27%) US-guided access. Fluoroscopy guided access was associated with complication rate of 6.8% (14/205), compared with 0.97% (2/205) for US-guided access (p=0.3602; Fisher exact test). There were no differences in radiation dosage between the two groups (p=0.1917).

Conclusion:
There were no statistically significant differences in vascular access-related complications or radiation dose between fluoroscopy guided and US-guided venous access for PPM implantation. US-guided access was however associated with lower complication rates. Larger robust randomized controlled trials would be required to validate these finding.
Abstract 17891: Underutilization of Palliative Care Consults and End-of-Life Care Planning After Cardiogenic Shock
Authors: Sukumar Smrithi , Verma Serena , Chubrikova Oksana , Ramsay Alyssa , Khalil Abdurahman , Warraich Haider , Ton Van-Khue
Published: December 2023

Background:
Cardiogenic shock (CS) is associated with significant mortality. The 2022 ACC/AHA/HFSA guidelines discuss the importance of palliative care (PC) in advanced heart disease, but PC and end-of-life care (EOLC) integration after CS is not well characterized. We aimed to study the use of PC and EOLC planning after CS.

Hypothesis:
We assessed the hypothesis that PC consults and EOLC planning are underutilized after CS.

Methods:
This is a retrospective observational study of 63 consecutive patients at a quaternary care center in Boston diagnosed with CS between January and April 2022. CS onset and etiology were adjudicated by treating physicians.

Results:
Of 63 patients with CS (mean age 61±14 years, 30% Female, 73% White), 26 (41%) died during admission and 31 (49%) survived 1 year after CS onset. Only 6 patients (10%) received PC consults for EOLC considerations (consults placed on average 9 days from CS onset) (Table 1). Only 24 (38%) had documented advanced care plans after developing CS, of which 14 were documented by PC consultants. Of 44 patients with MCS or ICD placed, only 1 had a documented discussion about the option of discontinuing the therapy in the future. After CS, 28 (44%) had changes in resuscitation limits. Only 1 patient had their preferred location of death documented. Palliative inotropes were prescribed to 2 patients at discharge, and 3 patients were discharged to hospice. Readmission rates at 3 and 6 months were 24% and 36%, respectively.

Conclusions:
PC and EOLC planning are underutilized after CS, despite the significant mortality of CS. Secondary PC models may not be optimal for CS, given the acute presentation of CS and bimodal distribution of survival after onset. These data demonstrate a compelling need to address key considerations that impact EOLC after CS, such as resuscitation limits, duration of advanced therapies, and goal-concordant discharge locations. Further research is needed to explore optimal models of PC and EOLC integration after CS.
Abstract 17893: Deep Learning for the Prediction of Myocardial Scarring Through Electrocardiograms
Authors: Zhang Jeff , Zhang Hao , Jethani Neil , CHINITZ LARRY A , Aphinyanaphongs Yindalon , Jankelson Lior
Published: December 2023

Introduction:
Cardiac Magnetic Resonance Imaging (MRI) with Late Gadolinium enhancement (LGE), the gold standard for myocardial scarring evaluation, is limited by cost, time, and expertise required. The Electrocardiogram (ECG), in contrast, is a widely available and affordable diagnostic tool. We applied deep learning (DL) models to ECGs to directly predict the presence of LGE on MRI.

Methods:
Patients who underwent a cardiac MRI and had at least one ECG collected from 2012 to 2022 were considered. Patients were classified into positive and negative for myocardial scarring via their MRI reports, labeled by experts. Patients with non-specific scarring were excluded from the dataset. Patient ECGs most recent to their MRI were utilized as input for the model. MRI reports and ECG waveforms were collected from NYU Langone Health. We implemented a 34-layer Neural Network architecture, adapted from a state-of-the-art arrhythmia detection model, to learn from a 10 second ECG sampled at 250hz. We evaluated the model using area under the receiver-operating curve (AUROC), specificity, sensitivity, and precision.

Results:
8813 patients with MRI and ECG were included. 1559 were excluded due to non-specific scarring. 2739 patients were positive for scarring. Patients were split into a 70% train, 10% validation, and 20% test dataset. The deep learning model obtained a test set AUROC of 0.80 [95%CI, 0.77 - 0.81]. At 20% false positive rate, we obtained a sensitivity of 0.63, specificity of 0.80, and precision of 0.64.

Conclusions:
This study suggests that our DL model can predict for the presence of LGE from a surface ECG. A future direction of this work would be to evaluate the use of DL for the prediction of LGE location, quantity and specific phenotypes of myocardial disease.
Abstract 17913: Meta-Analysis of Atrial Fibrillation in Cardiac Sarcoidosis
Authors: Sama Carlson , Fongwen Noah , Chobufo Muchi Ditah , Hamirani Yasmin S , Mills James , Roberts Melissa , Greathouse Mark , Zeb Irfan , Kazienko Brian , balla sudarshan
Published: December 2023

Introduction:
Ventricular arrhythmias, including their association with
18
F-fluorodeoxy-glucose (FDG) uptake on positron emission tomography/computed tomography (PET/CT) has been extensively studied in patients with cardiac sarcoidosis (CS), whereas atrial involvement and related arrhythmias have not been thoroughly investigated despite evidence of their occurrence.

Research Questions/Aims:
We herein sought to assess the prevalence, incidence, and characteristics of atrial fibrillation (AF) in patients with CS. We also examined the predictors of atrial arrythmias as well as its association with atrial inflammation as detected by
18
FDG-PET/CT.

Methods:
PubMed/Medline, Web of Science, and Scopus were systematically queried from inception until April 26th, 2023. Using the random-effects model, separate Forest and Galbraith plots were generated for each effect size assessed. Heterogeneity was assessed using the I
2
statistics whilst Funnel plots and Egger’s test were used to assess for publication bias.

Results:
From a total of 8 studies comprising 978 patients with CS, a random effects meta-analysis approximated the pooled summary estimates for the prevalence of AF to be 23% (95% CI: 13%-34%). Paroxysmal AF was the most common subtype of AF (83%; 95% CI: 77%-90%), followed by persistent AF (17%; 95% CI: 10% - 23%) from a total of 5 studies. One study estimated the prevalence of permanent AF at 12.5% (95% CI: 3.5%- 28.9%). In 9 studies involving 545 patients with CS, the cumulative pooled incident rate of AF was estimated at 13%, 25%, and 23% at <2years, 2-4years, and >4years of follow-up respectively. Increased left atrial size and atrial
18
F-FDG uptake were identified as strong independent predictors for the development of atrial arrythmias in patients with CS on qualitative synthesis.

Conclusions:
The burden of AF and related arrythmias in CS patients is considerable, with a heightened risk for adverse outcomes. This necessitates close follow-up and predictive risk-stratification tools to guide the initiation of appropriate strategies, including therapeutic interventions for primary prevention of AF-related embolic phenomenon, especially in those with known clinical predictors.