bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 14017: Clinical Characteristics and Treatment Patterns in Patients With Heart Failure: Results From the Icareme Middle East and Africa Cohort
Authors: Zarif Bassem , Cavusoglu Yuksel , Al Badarin Firas , Akwanalo Constantine , Naidu Kuven , Reja Ahmed , Khawaldeh AbdelKareem , Atallah Paola , Goncalves Susana , Vasnawala Hardik , HADAOUI Ahmed
Published: December 2023

Introduction:
Heart failure (HF) is a leading global health problem affecting more than 64 million people worldwide. Co-existing cardiovascular renal and metabolic (CVRM) diseases confer poorer prognosis with an increased risk of outcomes. Although Middle East and Africa (MEA) region bears a disproportionately high burden of CVRM diseases, there is a scarcity of real-world data on patients’ characteristics, risk factors, and management practices.

Aims:
To describe the clinical features, comorbidities, and treatment patterns in patients with HF from the MEA-HF cohort of iCaReMe Registry.

Methods:
iCaReMe Registry is a multinational, prospective, observational study (NCT03549754) collecting data on the management and quality of care of patients with HF, HTN, T2D and or CKD. We included in this baseline cross-sectional analysis data of HF patients enrolled between Feb 2018 and Dec 2022 from 8 countries (Egypt, Ethiopia, Jordan, Kenya, Lebanon, South Africa, Turkey, and United Arab Emirates).

Results:
: Overall, 2239 adults (mean±SD age of 58.4±12.6 years, 61.7% males) with HF were enrolled. Of the 85.7% patients with available LVEF data, 67.6% had HFrEF; 83.8% had NYHA class II-IV symptoms. Comorbidities included HTN (56.4%), T2D (50.3%), CAD (47.8%), dyslipidemia (33.0%), and CKD (26.5%). Mean UACR was 516.1 mg/g and mean eGFR was 70.7 ml/min/1.73m
2
reported in 13.8% and 80.9% of patients respectively. Overall, 24.1% had history of hospitalization for heart failure. The prescribed treatments at baseline included ACEi/ARB (72.1%), beta-blockers (74.8%), diuretics (65.2%), aldosterone antagonists (45.1%), SGLT2i (41.3%) and ARNI (18.8%).

Conclusions:
The substantial prevalence of CV comorbidities across the ejection fraction spectrum justifies the need to improve heart failure care with the strengthening of the use of therapies with morbidity and mortality proven benefits.
Abstract 14018: Prevalence of Cardiac Arrhythmias in Transgender and Nonbinary Adult Community Health Center Patients
Authors: Shapira-Daniels Ayelet , King Dana S , Reisner Sari , Beach Lauren B , Eromosele Oseiwe 'Benjamin' B , Ravichandran Sandhiya , Helm Robert , Benjamin Emelia J , Streed Carl
Published: December 2023

Background:
Sex differences in cardiac arrhythmias are well-established and partly attributed to sex hormones.

Aim:
We aimed to explore the prevalence of arrhythmias in transgender and nonbinary (
TGNB
) adults.

Methods:
This cross-sectional study utilized patient electronic medical records from a single community healthcare center specializing in TGNB care. Adults aged ≥18 years with ≥2 medical visits between January 1, 2010, and December 31, 2021, were categorized into self-reported gender groups as TGNB (transgender man[TGM], transgender woman[TGW], nonbinary-assigned male at birth, nonbinary-assigned female at birth) and cisgender (cisgender man[CisM] or cisgender woman[CisW]). We categorized arrhythmias as atrial, ventricular, or other. Descriptive statistics characterized the prevalence of arrhythmias by gender group. Age- and race-adjusted Firth-type logistic regression models compared TGNB patients to CisM and CisW. The prevalence of arrhythmias was also descriptively explored in nonbinary people and in TGNB people with a gender-affirming hormone therapy (GAHT) prescription.

Results:
Among 49,862 adults, 7121 (14%) identified as TGNB persons. Participants were young (median age 28 years-old) and prevalence of arrhythmias was low (0.7-1.4% in nonbinary persons, 1.4-1.5% in transgender persons). Adjusting for age and race, TGM and TGW had a similar risk of arrhythmias compared to CisM (TGW: OR=0.89 (0.63-1.24), p=0.52; TGM: OR=1.17 (0.82-1.62), p=0.37), but statistically significantly higher odds of arrhythmias compared to CisW (TGW: OR=1.65 (1.13-2.34), p=0.01; TGM: OR=2.15 (1.48-3.04), p<0.01). Prevalence of arrhythmias appeared similar among TGNB adults who used GAHT and those who did not (1.5% vs 1.9% in TGM, 1.2% vs 2.1% in TGW).

Conclusion:
Further research examining arrhythmias in TGNB patients and across gender minority subgroups is warranted, including longitudinal studies evaluating the potential impact of GAHT.
Abstract 14021: Micra VR Leadless vs. Single-Chamber Transvenous Pacing Outcomes in the Medicare Advantage Population
Authors: Longacre Colleen , Higuera Lucas , Crossley George H , El-Chami Mikhael F
Published: December 2023

Introduction:
Medicare Advantage (MA) patients are typically healthier and report better outcomes compared to fee-for-service (FFS) Medicare patients. While the benefits of leadless pacing have been demonstrated in the FFS population, no study has evaluated leadless pacemakers in the 100% MA population.

Hypothesis:
The benefits of leadless pacing extend to the MA patient population.

Aims:
To compare patient characteristics and outcomes between Micra VR and single-chamber transvenous pacing among MA patients vs. FFS patients.

Methods:
MA Encounter data was used to identify patients implanted with a Micra VR leadless pacemaker (N=4,970), or a single-chamber transvenous pacemaker (N=6,615) from 2017-2019. Logistic regression was used to compare unadjusted and propensity score overlap weight-adjusted 30-day complication rates. Cox models were used to compare 2-year chronic complications and reinterventions between groups. MA results were compared to results of the Micra Coverage with Evidence Development (CED) study of FFS patients.

Results:
MA Micra VR patients had a higher comorbidity burden (mean Charlson Comorbidity Index (CCI) 5.3 vs. 4.9, P<0.001) and higher rates of end-stage renal disease (ESRD) (7.3% vs. 1.5%, P<0.001) compared to transvenous patients. After adjusting for patient differences, Micra VR patients had similar rates of acute complications at 30 days (adj. 7.0% vs. 6.8%, P=0.76). At 2 years, Micra VR patients had significantly lower adjusted rates of chronic complications (adj. HR 0.75, 95% CI: 0.61-0.91, P<0.001) and reinterventions (adj. HR 0.57, 95% CI: 0.44-0.75, P<0.001) and there was no difference in adjusted all-cause mortality (adj. HR 1.05, 95% CI: 0.97, 1.14, P=0.26). Compared to FFS patients, MA patients had lower rates of ESRD (7.3% vs. 12.0%) and lower rates of emergency admission (5.4% vs. 12.0%), though their overall comorbidity burden was similar (mean CCI 5.3 vs. 5.1). The comparative benefits compared to transvenous were similar in magnitude in the MA vs. FFS populations.

Conclusion:
Compared to transvenous pacing, MA patients treated with a Micra VR leadless pacemaker had reductions in chronic complications and reinterventions at 2 years of similar magnitude to those observed in the Medicare FFS population.
Abstract 14030: Hemodynamic Metrics Can Be Accurately Assessed by a Non-Invasive Sensor Patch: The Portable Technology for Wireless Cardiomyopathy Tracking (Patchwrk) Study
Authors: Loring Zak , Bolus Nicholas B , Torstrick Brennan B , Wilson Danielle , LeFevre Melissa , Atwater Brett , Kelsey Anita M , Piccini Jonathan P
Published: December 2023

Background:
Echocardiographic timing intervals provide valuable prognostic information in patients with pre-clinical cardiac dysfunction. Diastolic filling time (DFT) can identify left bundle branch block (LBBB) patients at higher risk for cardiomyopathy. The need for specialized equipment limits the utility of echo in longitudinal assessment.

Hypothesis:
A non-invasive multimodal sensor Sansa patch will enable accurate assessment of hemodynamic parameters such as DFT, ejection time (ET), and pre-ejection period (PEP).

Methods:
Fifty patients scheduled for clinically indicated echocardiography were prospectively enrolled and had simultaneous application of the Sansa patch at the time of echocardiography. Timing intervals were analyzed using continuous wave (CW), pulsed wave (PW), and tissue Doppler imaging (TDI). Data from the Sansa electrocardiogram (ECG), seismocardiogram (SCG), and phonocardiogram (PCG) were independently analyzed to identify valve openings/closures to estimate DFT, ET and PEP. Agreement between echo and Sansa estimates was assessed using the coefficient of determination (R
2
) and compared with agreement between different echo views.

Results:
Forty-six of the 50 patients (92%) had data of sufficient quality for analysis. The mean ejection fraction was 53±8% and 11 patients (24%) had LBBB. By echo, the mean DFT, ET, and PEP were 408±137 milliseconds (ms), 297±35ms, and 107±32ms respectively. Sansa estimates for DFT, ET and PEP were 431±135ms, 286±43ms, and 89±34ms respectively. The R
2
for Sansa DFT compared to echo was 0.85. Comparing TDI and PW estimates of DFT within the same patients demonstrated an R
2
of 0.82.

Conclusion:
Non-invasive Sansa patch monitoring accurately identified key cardiac timing intervals within the error observed between standard echo views. These measures have prognostic value and monitoring them in the ambulatory setting may allow early cardiomyopathy detection and upstream intervention.
Abstract 14060: Health Disparities in Exercise Performance in Tetralogy of Fallot
Authors: Jones Andrea L , xiao rui , Stephens Paul , Mercer-Rosa Laura M , Weiss PAmela
Published: December 2023

Introduction:
Patients with tetralogy of Fallot (TOF) from disadvantaged racial and ethnic groups are reported to have worse outcomes, including worse exercise performance. The underlying mechanisms are not fully understood.

Hypothesis:
We hypothesize that the association of exercise performance with race is mediated by socioeconomic factors.

Methods:
We conducted a single center retrospective cohort study of TOF patients aged 8 - 30 years who underwent maximal exercise stress testing (EST) from 2007 - 2020. The primary outcome was percent-predicted maximum oxygen consumption (VO2). Addresses were geocoded. The Childhood Opportunity Index (COI) and its three domains represented neighborhood socioeconomic status. Generalized linear models and mediation analysis were used (Figure).

Results:
We included 154 subjects who underwent 273 ESTs (Table). Correcting for age at EST, sex, outflow tract repair type, and body mass index, those of non-Hispanic Black race had an 8.6% lower percent-predicted VO2 (95% CI -15.0, -2.2) than those of non-Hispanic white race. Mediation analysis showed that the COI mediates 90% of this relationship. By domain, Education is the strongest mediator and alone can account for 75% of this relationship.

Conclusions:
Disparities exist in exercise performance after TOF repair. Neighborhood-level factors, in particular related to Education, are significant mediators of the relationship between race and exercise performance in TOF. A detailed understanding of the driving mechanisms underlying health disparities, particularly those that are modifiable, is critical to eliminating those disparities at both the patient and societal levels.
Abstract 14077: Anticoagulation Following Percutaneous Coronary Intervention in Acute Coronary Syndrome: A Systematic Review and Meta-Analysis
Authors: Yousaf Amman , Ahsan Muhammad J , Ahmad Soban , Latif Azka , Ahsan Muhammad Zoraiz , Qavi Ahmed , Ghali Magdi G , Ardhanari Sivakumar , Goldsweig Andrew M
Published: December 2023

Introduction:
To maximize reperfusion and thrombus breakdown, anticoagulation therapy may be continued after percutaneous coronary intervention (PCI) in patients presenting with acute coronary syndrome (ACS). However, limited evidence exists to support this practice.

Methods:
An electronic search was conducted using MEDLINE and EMBASE databases from inception to March 19th, 2023. Eligible studies comparing 30-day outcomes of post-procedural anticoagulation (PPAC) with no PPAC after PCI in patients with ACS were screened for inclusion. The primary outcome was 30-day mortality. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were estimated using a random-effect model.

Results:
Total 6 studies (3 observational, 3 post-hoc analyses of randomized controlled trials) with 61,901 patients (PPAC=38,900, no PPAC=23,001) were selected. There were no significant differences in all-cause mortality (RR 0.79 [0.52-1.19], P=0.26), cardiac mortality (RR 0.69 [0.43-1.11], P=0.13), myocardial infarction (RR 0.86 [0.61-1.21] P=0.39), stroke (RR 1.18 [0.87-1.59], P=0.29), and major bleeding (RR 0.91 [0.65-1.27], P=0.58) between PPAC and no PPAC groups. However, PPAC was associated with a higher rate of stent thrombosis at 30 days (RR 1.34 [1.04-1.73], P=0.02).

Conclusions:
Overall, PPAC following PCI for ACS did not improve survival or cardiovascular morbidity. However, there was a slightly higher incidence of stent thrombosis in the PPAC cohort. Further randomized studies are necessary to confirm these findings.
Abstract 14103: Neighborhood Environmental Burden and Cardiovascular Health in the United States
Authors: Liu Michael , Patel Vishal R , Zheng ZhaoNian , Wadhera Rishi K
Published: December 2023

Introduction:
Little is known about the association between cumulative environmental burden and cardiovascular health.

Methods:
This national study of 71,659 US census tracts linked the CDC environmental burden index and social vulnerability index (SVI) to 2020 PLACES. Mixed-effects linear regression models were used to determine associations between cumulative environmental burden (air pollution, hazardous/toxic sites, built environment, transportation infrastructure, water pollution) and cardiovascular risk factors (hypertension, diabetes, obesity) and diseases (coronary heart disease, stroke) after adjustment for age, sex, SVI, rurality, region, and health care access.

Results:
Neighborhoods with the highest environmental burden (quartile 4), compared to those with the lowest burden (quartile 1), had greater SVI scores (0.64 vs 0.42) and a higher proportion of racial/ethnic minorities (34% vs 12%). After adjustment, quartile 4 neighborhoods had significantly higher rates of cardiovascular risk factors than quartile 1 neighborhoods, including hypertension (32.8% vs 32.1%, adjusted difference: 0.84% [95% CI: 0.71-0.98]), diabetes (12.2% vs 10.7%, 0.62% [0.53-0.70]), and obesity (33.6% vs 30.9%, 0.77% [0.60-0.94]). Similarly, quartile 4 neighborhoods had higher rates of cardiovascular diseases
(Figure)
. Results were consistent after geospatial- and covariate-based matching of quartile 4 and 1 neighborhoods. Associations between increasing environmental burden quartiles and cardiovascular risk factors and diseases were significantly more pronounced in most versus least socially vulnerable neighborhoods.

Conclusion:
Across US neighborhoods, cumulative environmental burden was dose-dependently associated with higher rates of cardiovascular risk factors and diseases, particularly in socially vulnerable communities. Efforts addressing poor environmental conditions may improve cardiovascular health and reduce inequities.
Abstract 14113: Impact of Clinician Telemedicine Use on Diagnostic Testing for Heart Failure Patients
Authors: Joshi Mugdha , Koos Harrison , Sandhu Alexander T , Scheinker David , Rodriguez Fatima , Kalwani Neil M
Published: December 2023

Introduction:
Previous studies have reported decreased diagnostic testing with telemedicine visits early in the COVID-19 pandemic. The effect of telemedicine use on diagnostic testing for a panel of heart failure (HF) patients is unknown. We sought to use clinician-level variation in telemedicine use over time to determine the association of telemedicine care delivery with changes in diagnostic testing for HF patients.

Methods:
Patients with HF diagnostic codes seen at an academic cardiovascular center from May 2019 to Nov 2022 were included. Clinicians performing the majority of cardiology visits for at least 10 HF patients were identified. Early pandemic visits (March 2020-May 2020) were excluded. The remaining time was divided into 4 10-month periods with the first ending before the pandemic. We used a linear regression model with clinician and period fixed effects to estimate the association of the fraction of a clinician’s visits delivered by telemedicine in each period with the number of orders for Holter monitors, EKGs, transthoracic echocardiograms (TTEs), and laboratory tests per visit.

Results:
There were 6,420 patients seen by 45 clinicians. Clinician telemedicine fraction across periods ranged from 0 to 100 percent. Mean telemedicine fraction decreased from 55.4% to 34.6% from periods 2 to 4. A 25-percentage point increase in telemedicine use was associated with significantly fewer orders for EKGs (-0.078 orders/visit) and TTEs (-0.021 orders/visit), representing decreases of 33% and 13% relative to period 1 respectively. Higher telemedicine use was associated with non-significant decreases in orders for Holter monitors and laboratory tests (Table).

Conclusions:
Greater clinician telemedicine use was associated with decreased diagnostic testing orders per visit for HF patients. Further research is needed to characterize the value of these potentially avoided tests and understand the impact of telemedicine on the quality of care for HF patients.
Abstract 14123: Cardiovascular Disease Incidence Among Female Veterans by Sexual Orientation and Race
Authors: Duncan Meredith S , Streed Carl G , Heier Kory R , O'Leary John R , Skanderson Melissa , Goulet Joseph L
Published: December 2023

Introduction:
Studies of cardiovascular disease (CVD) in sexual minority (SM) women (i.e., lesbian, bisexual) vs. heterosexual women are limited by small sample sizes and lack of objective CVD ascertainment. Small samples also hinder study at the intersection of race and sexual orientation on CVD events. We used the Veterans Healthcare Administration Lesbian, Gay, Bisexual, Transgender Electronic Health Record cohort to fill these knowledge gaps.

Methods:
We studied 132,571 female cisgender veterans who were free of prevalent CVD and classified as SM or non-SM by a natural language processing tool. We defined incident CVD as first instance of AMI, ischemic stroke, cardiac revascularization, or CVD death between baseline and date of death or 8/31/22. We stratified sample statistics by SM status and race. We used Cox proportional hazards regression to assess the intersection of sexual orientation and race with incident CVD; we adjusted for Hispanic ethnicity and age. Based on the minority stress model, non-SM White women were the referent.

Results:
Within races, traditional CVD risk factors were similarly distributed by SM status but SM women had greater prevalence of stress-associated characteristics like substance use, depression, and anxiety. Regardless of sexual orientation, Asian women had lower CVD risk than non-SM White women, while Black/African American women had persistently increased CVD risk (
Table
). White lesbians had increased CVD risk vs. their non-SM counterparts. Unclassified SM women of American Native race or multiple races also had increased CVD incidence vs. non-SM White women.

Conclusion:
This is one of the first studies to examine the intersection of sexual orientation and race on CVD risk in female veterans. CVD risk appears increased or decreased in certain racial groups regardless of sexual orientation but this is not always true and invites further study into the mechanisms by which stress results in inequitable CVD events across groups.
Abstract 14132: Thirty-Six Month Results in Patients With Resistant Hypertension After Endovascular Ultrasound Renal Denervation in the RADIANCE-HTN TRIO Trial
Authors: Bloch Michael J , Kirtane Ajay J , AZIZI MICHEL , Mahfoud Felix , Basile Jan N , Daemen Joost , Saxena Manish , Gosse Philippe , Sanghvi Kintur , Schmieder Roland E
Published: December 2023

Background:
Endovascular ultrasound renal denervation (uRDN) has been shown to reduce blood pressure (BP) and medication burden in patients with resistant hypertension in the multicenter, blinded, randomized, sham-controlled RADIANCE-HTN TRIO trial through 6 months. We report the 36-month safety and durability of treatment effect on office BP (OBP) in the patients treated with uRDN.

Methods:
Patients with hypertension resistant to a 3-drug single-pill confirmed by daytime ambulatory BP ≥135/85 mmHg were randomized to uRDN (n=69) or sham procedure (n=67). From 2-5 months, if monthly home BP was ≥135/85 mmHg, prespecified standardized stepped-care antihypertensive treatment including an aldosterone antagonist (AA) was started under blinding to treatment assignment. After 6 months, patients were unblinded and received antihypertensive medications (AHM) at treating physicians’ discretion. We assessed changes in OBP of the uRDN group at 36 months vs. baseline and screening.

Results:
Forty-nine of 69 (71%) patients (age: 53.0 ± 7.4 years; 18% female) originally randomized to uRDN completed their 36-month follow-up. OBP at screening in those patients was 159/103 ± 15/10 mmHg on a mean of 3.9 AHM with 33% of patients on AA. Baseline OBP after starting the single-pill combination was 153/99 mmHg. At 36 months OBP changed by -14.5/-9.0 mmHg from screening (p<0.001 for both) and -8.0/-5.0 mmHg from baseline (p=0.007; p=0.02) on a mean of 3.7 AHM with 41% of patients on AA. At 36 months, OBP change from baseline was irrespective of whether or not patients were taking AA. Given ambulatory BP was used to qualify patients at baseline, some patients had OBP <140/90 mmHg. For those with baseline OBP ≥140/90 (n=39), change in OBP at 36 months from baseline was -12.9/-7.4 mmHg (p<0.001 for both) on mean 3.6 AHM. No new uRDN-related long-term safety concerns were identified.

Conclusion:
In patients with resistant hypertension, the effectiveness and safety of uRDN were durable to 36 months.
Abstract 14133: Use of Computed Tomography Coronary Angiography in Pre-Operative Risk Assessment in Non-Cardiac Surgeries
Authors: Shah Rajendra P , yadav ritu , Duhan Sanchit , Patel Neel N , Raheela Fnu , AlJaroudi Wael , Paul Timir K , Alraies M Chadi C
Published: December 2023

Introduction:
Computed Tomography Coronary Angiography (CTCA) has emerged as a promising tool for detecting and evaluating coronary artery diseases (CAD). However, the role of CTCA for risk assessment tool for patients undergoing noncardiac surgeries is unknown.

Methods:
We searched databases like PubMed and Google Scholar to compile the literature including reviews, meta-analyses, scientific articles, and guidelines, describing the use of CTCA in the diagnosis and evaluation of cardiac risk assessment in noncardiac surgeries.

Results:
Based on our literature review we found that CTCA is a promising adjunctive tool for preoperative assessment in noncardiac surgeries to evaluate cardiac risk with high sensitivity and negative predictive value. VISION-CTA sub study showed that CTCA combined with Myocardial Perfusion Imaging (MPI) predicts major adverse cardiac events within 30 days of surgery with higher accuracy than either test alone. McCarthy KJ et al found an increase in the proportion of CTCAs performed from before 2018, 2018 to post 2018, (3%, 6.3%, and 26.3% respectively; p <0.001) and obstructive CAD diagnosis using CTCA (0%, 30%, and 51.4% respectively; p = 0.04). Hence supporting a shift to non-invasive CTCA for pre-operative assessment of liver transplant candidates. According to Ahn J et al, CTCA shows 100% sensitivity and 99.3% negative predictive value in predicting major adverse cardiac events and can be used to stratify intermediate risk noncardiac surgery patients.

Conclusions:
CTCA is a valuable risk assessment tool in patients undergoing noncardiac surgery because of its high sensitivity and negative predictive value. There is a need for further research and guidelines for using CTCA as a risk assessment tool in noncardiac surgeries.
Abstract 14145: The Zinc Transporter ZIP7 Plays a Critical Role in Ferrotposis Induced by Ischemia/Reperfusion in Mouse Hearts
Authors: Zhang Hualu , Zhang Shuya , Xu Zhelong
Published: December 2023

Background:
Although ferroptosis has been proposed to play a role in myocardial ischemia/reperfusion (I/R) injury, the exact molecular mechanism by which ferroptosis is induced by I/R remains unclear.

Hypothesis:
We tested the hypothesis that upregulation of the zinc transporter ZIP7 at reperfusion triggers ferroptosis by downregulating the mitochondrial GPX4 (mtGPX4) via the guanine-rich sequence-binding factor 1 (GRSF1) and increasing mitochondrial iron accumulation through inhibition of the mitochondrial iron importer degradation.

Aims:
To determine if ZIP7 plays a role in I/R-induced ferroptosis and to investigate the underlying molecular mechanism.

Methods:
Mouse hearts were subjected to I/R
in vivo
. The cardiac-specific
Slc39a7
conditional knockout mice (ZIP7 cKO) were generated by adopting the CRISPR/Cas9 system. Adult mouse cardiomyocytes were isolated enzymatically. Ferroptosis was evaluated by detecting PTGS2, MDA, and BODIPY C11. Mitochondrial Fe
2+
was determined with Mito-FerroGreen fluorescent probe.

Results:
I/R upregulated ZIP7 expression and induced ferroptosis as indicated by the increases in PTGS2 mRNA expression (290.90 ± 52.78 % of control), MDA (152.10 ± 15.07 % of control) and BODIPY C11 (130.68 ± 5.52 % of control) levels, which was prevented by ZIP7 cKO. ZIP7 cKO also mitigated doxorubicin-induced ferroptosis. ZIP7 cKO upregulated mtGPX4 expression (123.40±3.26 % of I/R) and increased mitochondrial GRSF1 expression (150.90±8.51 % of I/R) at reperfusion. In addition, knockout of GRSF1 inhibited GPX4 expression (54.73±5.44 % of control). Moreover, ZIP7 cKO prevented the accumulation of Fe
2+
within mitochondria (44.15±2.46 % of I/R) and promoted the degradation of SLC25A37 (62.57±8.03% of I/R) and SLC25A28 (69.82±3.10 % of I/R) at reperfusion.

Conclusions:
Upregulation of ZIP7 contributes to the induction of ferroptosis at reperfusion presumably by reducing mtGPX4 expression via GRSF1and increasing Fe
2+
accumulation within mitochondria through inhibition of SLC25A37 and SLC25A28 degradation.
Abstract 14177: Alarming Burden and Disparities of MACCE in Postmenopausal Women of a Contemporary Nationwide Cohort, 2020
Authors: Sampath Shrikanth , Srivastava Archit , Suchday Pooja , Bhanushali Aditi K , MEHTA KAMYA , Behera Alkananda , Eppalapally Akhil kumar , Bollampalli Ram Prasanjith Reddy , Desai Rupak
Published: December 2023

Background:
Cardiovascular disease is the leading cause of death worldwide, with a notable impact on postmenopausal women. However, contemporary large-scale population-based data for the burden and disparities of Major Adverse Cardiovascular and Cerebrovascular Events (MACCE) in this population remains limited.

Methods:
The National Inpatient Sample (2020, ICD10 codes, age>55 years) was queried to identify postmenopausal women's hospitalizations. Socio-demographics, racial subgroups, comorbidities, and MACCE rates were retrieved with a more granular comparative analysis in postmenopausal women. A p<0.05 was considered statistically significant.

Results:
Of the total 8435195 postmenopausal women hospitalizations (median age 75 years), 1021375 (12.1%) were identified with MACCE. MACCE cohort, in comparison to non-MACCE cohort, had significantly higher prevalence of hypertension (77.1% vs 71.3), diabetes (39.8% vs 34.0%), hyperlipidemia (53.7% vs 48.4%), PVD (9.8% vs 7.1%), prior MI (8.3 vs 5.7%), prior TIA/stroke (10.5 vs 9%) and CKD (29.4 vs 23.4%). Significant clinical predictors for all-cause mortality were found to be race Asian/PI vs white ( 1.31 [1.09-1.18]), median household income national quartile (1.16 [1.13-1.20]), hypertension (1.18[1.16-1.20]) diabetes (1.20 [1.19-1.22]), hyperlipidemia (1.12[1.11-1.14]), prior MI (1.37[1.34-1.40]) and prior TIA stroke (1.0 5 [1.03-1.07] (all p<0.05).

Conclusion:
Among hospitalizations, Asian/Pacific Islanders, patients from the lowermost income quartile with co-existent hypertension, diabetes, hyperlipidemia, CKD, and cardiovascular comorbidities independently revealed the highest MACCE rates. Special emphasis needs to be laid on socio-demographics, comorbidities, and racial differences for CVD disease prevention, and risk factor modification in postmenopausal women.
Abstract 14181: Interhospital Transfer for Heart Failure in the United States: A Patient and Hospital-Level Analysis From GWTG-HF
Authors: Rudofker Eric W , Ayodele Iyanuoluwa B , Fonarow Gregg C , Ho Michael , Peterson Pamela , Joynt Maddox Karen E , Chiswell Karen , Greene Stephen J , Allen Larry A
Published: December 2023

Background:
Cardiovascular diseases, particularly heart failure (HF), are common reasons for interhospital transfer (IHT) in the United States. IHT targets patients requiring a higher level of care, and has been associated with increased cost, length of stay (LOS), and mortality. We aim to describe the characteristics and outcomes of patients undergoing IHT, as well as variation in the use of IHT across hospitals.

Methods:
Patients hospitalized for HF who were admitted from another hospital were compared to those who were not within the Get With The Guidelines-Heart Failure registry between January 2015 and June 2022. Hospital characteristics were obtained from the 2018 American Hospital Association Survey. Clinical data from the receiving hospital were analyzed.

Results:
Overall, 662,575 patients across 622 hospitals (156,263 patients at 127 transplant centers; 19,852 patients at 55 rural sites) were included, of which 36,375 (5.5%) arrived as IHT. IHT patients were younger (70.0 vs 73.0 years), more male (58 vs 52%), white (72 vs 66%), and more often had private insurance (31% vs 27%). IHT patients had a lower median left ventricular ejection fraction (37 vs 45%), median blood pressure (130/74 vs 139/77 mmHg), and a longer mean LOS (6.3 vs 5.0 days). In a multivariable model, IHT patients had higher in-hospital mortality (OR 1.85, 95% CI 1.76-1.95), were less likely to discharge home (OR 0.79, 95% CI 0.77-0.81), and were more likely to be prescribed most guideline-directed therapies (Figure).

Conclusions:
More than 1 in 20 patients hospitalized for HF was transferred from another hospital. Sex, racial, economic, and geographic differences exist in which HF patients get transferred, and rates of IHT varied across hospitals. IHT was associated with higher mortality and longer LOS compared with non-transferred patients.
Abstract 14188: Myopericarditis as the Initial Presentation of Systemic Lupus Erythematosus
Authors: George Bistees , Quintero Bisono Janina , Ormachea Kori , Singh Sandeep
Published: December 2023

Introduction:
Systemic lupus erythematosus (SLE) is an autoimmune disorder that can affect any organ. However, myocardial involvement is uncommon and rarely presents as the initial manifestation of SLE.

Case:
We present a case involving a 31-year-old male with no past medical history who presented to the emergency department with chest pain, fatigue, and intermittent swelling in his hands and feet. Initial workup was remarkable for high sensitivity troponin of 11, 821 and respiratory viral panel positive for parainfluenza.

Results:
Evaluation with left heart catheterization showed no obstructive coronary artery disease thus a cardiac MRI was obtained for further investigation. It showed late gadolinium enhancement involving the lateral apical wall extending to the apex as well as the lateral wall at the base (figure 1). The initial diagnosis was suspected to be viral-induced myopericarditis. However, he started developing accelerated acute kidney injury out of proportion to the current clinical presentation leading us to pursue rheumatological workup as it could explain the cardiac and renal pathologies. He was found to have ANA >= 1:2560, positive dsDNA, and positive anti-smith antibody. Kidney biopsy revealed diffuse spike formation on the glomerular basement membrane and focal endocapillary proliferation and segmental sclerosis consistent with lupus nephritis. He was started on prednisone and mycophenolate mofetil resulting in symptom and disease control.

Conclusion:
Myocardial involvement of SLE is uncommon and can be a life-threatening condition in the acute phase; however, the disease has an overall good prognosis with early treatment.
Abstract 14214: Comparative Analysis of Artificial Intelligence Techniques for ST Segment Elevation Myocardial Infarction and Their Risk of Mortality: A Nationwide Analysis
Authors: Patel Amar , Farooq Awais , Qureshi Muhammad , Farooq Shahryar , Liaqat Adnan , Brockman Michael , Saeed Yusuf
Published: December 2023

Introduction:
ST segment elevation myocardial infarction (STEMI) significantly contributes to patient morbidity and mortality nationwide. Determining which patient characteristics lead to an increased mortality rate is vital, and the use of artificial intelligence may highlight overlooked characteristics.
Purpose:
To investigate risk factor discordance between Multivariate Logistic Regression (MLR) and Multilayer Perceptron (MLP) Neural Networks in order to determine patient characteristics that lead to increased mortality.

Methods:
Patient data was collected from 2011-2018 from the National inpatient database (NIS) using International Classification of Disease Codes (ICD-9 and ICD-10). We selected patients hospitalized with STEMI. MLR and MLP models were used to tabulate adjusted odds ratios and Normalized Importance Scores respectively. Area under the curve (AUC) was calculated to determine if select comorbid conditions were associated with increased risk of mortality.

Results:
A total of 925,161 patients were included in our analysis. Our patient population was predominantly Caucasian, with males constituting 61% of our patient population. Notable contributors to mortality via MLR analysis include cardiogenic shock, AKI, ESRD, cirrhosis and pay status. Notable contributors to mortality via MLP analysis include cardiogenic shock, AKI, ESRD, hyperlipidemia and race. Overall MLP model classification accuracy is rated at 95.2%. Receiver operator AUC is calculated at 0.85.

Conclusion:
We found that patients STEMI had similar risk factors associated with mortality between MLR and MLP, however there was a discordance. This was predominantly in weighing certain socioeconomic risk factors as well as chronic comorbid conditions. This begets further analysis to optimize predictive capabilities.
Abstract 14223: Vector Analysis for Left Ventricular Wall Motion by Optical Flow With Echocardiographic Images in Myocardial Infarction Rat Model
Authors: Yasuo Miyagi , Tanabe Nari , Aminati Ryosuke , Murata Tomohiro , Ishii Yousuke
Published: December 2023

Background/Research Questions:
Alternative evaluation of cardiac function may be established in echocardiography-based vector analysis of the ventricular wall motion property. Vector acceleration and direction have the potential to assess cardiac kinetic energy and dynamics. Optical flow is suitable for vector analysis, because ventricular wall motion can be estimated as visible and quantitative vectors by optical flow from 2D echocardiographic images.

Aims:
This study aimed to establish a vector analysis for ventricular wall motion via optical flow with echocardiography.

Methods:
Coronary artery ligation rat model was used in this study. Before surgery (Pre) and four weeks after surgery (MI), short axis echocardiographic images in mid portion were obtained and analyzed by optical flow for left ventricular regional wall motion. Vector accelerations and directions were measured in both systolic and diastolic phases. Vector directions were classified into inward (ID), outward (OD), and circumferential direction (counterclockwise: CC, clockwise: CW). Following echocardiography, a rat was sacrificed for histological evaluation.

Results:
Pathological myocardial infarction was noted in the anterolateral lesion. Comparing average vector accelerations, MI had significantly smaller acceleration vectors in both systolic and diastolic phase (Pre vs. MI in systolic: 0.006±0.002 vs. 0.002±0.001 mm/s
2
, P<0.001, Pre vs. MI in diastolic: 0.007±0.002 vs. 0.002±0.001 mm/s
2
, P<0.001). Regarding total vector direction, CC and CW significantly increased in MI (P<0.01). In the anterolateral lesion, ID and OD were the main vector directions in Pre. In contrast, CC and CW vectors significantly increased in MI (P<0.0001).

Conclusions:
Optical flow effectively visualized cardiac wall motions and quantify them as vectors in echocardiographic images. The technique clarified left ventricular wall vector property alterations between healthy and infarcted hearts.
Abstract 14233: Checkpoint Kinase 1 Combines PKM2 C-domain to Stimulate Endogenous Cardiomyocyte Renewal and Cardiac Repair by Activating Cardiac Metabolic Reprogramming in a Porcine Model of Myocardial Ischemia/Reperfusion Injury
Authors: wei tianwen
Published: December 2023

Background:
The regenerative capacity of adult mammalian hearts is limited. We previously reported CHK1 in adult mice could promote cardiac regeneration after MI. However, the specific mechanism of CHK1 needs more comprehensive and in-depth interpretation.

Methods:
I/R injury was induced in pigs, recombinant human checkpoint kinase 1 (rhCHK1) protein encapsulated in hydrogel was injected into the infarct border zone. The therapeutic efficacy of rhCHK1 was evaluated by echocardiography, cMRI, hematological indices and immunofluorescence. Multi-omics analysis were performed to explore the potential mechanisms of rhCHK1. Further, protein interaction prediction and CO-IP experiments were conducted to verify the specific interaction pattern and domains between CHK1 and PKM2. Hipsc-CMs and porcine were used for confirming whether rhCHK1 promotes cardiac regeneration through combining with the PKM2 C-domain.

Results:
RhCHK1 protein stimulated CMs proliferation and reduced cardiac inflammation at 3 dpi, improved cardiac function and attenuated ventricular remodeling, and reduced the infarct area at 28 dpi. Mechanistically, multiomics analysis showed that glycolysis and mTOR pathways were significantly enriched in this process. Further CO-IP experiments and protein docking prediction showed that CHK1 directly bound to and activated the S37 and Y105 sites of PKM2 to promote metabolic reprogramming. We further constructed plasmids that knock out different CHK1 and PKM2 domains, and transfected them into H293T cells for CO-IP experiments. It was found that the 391-476 domain of CHK1 directly binds to the 157-400 amino acids of PKM2. Further hipsc-CMs and pig experiments both demonstrated that CHK1 stimulates CMs renewal and cardiac repair by activating PKM2 C-domain-mediated cardiac metabolic reprogramming and mTORC1 pathway.

Conclusion:
This study demonstrates that rhCHK1 could combine with PKM2 391-476 amino acid domain to mediate metabolic reprogramming and mTORC1 pathways to promote CM proliferation and myocardial repair. This study is the first to clarify the specific functional mechanism of CHK1 in pigs. Our results underscore the potential of the local applied rhCHK1 as a safe and simple feasible treatment option for repairing heart.
Abstract 14250: ND-13, a Small DJ-1 Derived Peptide, Confers Cardioprotection by Targeting Mitochondrial Homeostasis
Authors: Prakash Aishwarya , Loo Sze Jie , Yu Fan , Cong Shuo , Beikoghli Kalkhoran Siavash , Crespo Avilan Gustavo Enrique , Offen Dani , Ramachandra Chrishan , Hernandez Resendiz Sauri , Hausenloy Derek
Published: December 2023

Objectives:
DJ-1 protein is a multifunctional protein with cardioprotective effects against acute myocardial ischemia-reperfusion injury (IRI). This study aims to elucidate whether ND-13, a small peptide derived from DJ-1, can confer acute cardioprotection after IRI by preserving mitochondrial homeostasis through improvements in mitochondrial respiratory capacity and regulating the balance between mitochondrial fusion/fission. By enhancing mitochondrial respiration and maintaining the integrity of the mitochondrial network, ND-13 may provide a novel therapeutic strategy for cardioprotection in cardiomyocytes following IRI.

Methods:
In vitro
,
ex vivo
and
in vivo
murine models of IRI were used to elucidate the cardioprotective effects of ND-13. Infarct size, cardiac function and mitochondrial function were assessed.

Results:
ND-13 was shown to confer cardioprotection in three distinct models of IRI: (i)
in vitro
, cardiomyocyte (CM) death was reduced by 42% (64±1% untreated vs 37±2% treated; p≤0.01); (ii)
ex vivo
Langendorrf, with 43% decrease in infarct size (51±6.4% untreated vs 29±8.8% treated; p≤0.05); (iii)
in vivo
, with 35% reduction in infarct size (49±6.4% untreated vs 32±5.0% treated; p≤0.0001). CMs treated with ND-13 in the
in vitro
model of IRI demonstrated a significant increase in mitochondrial respiration rates, (basal: untreated 37±3 vs treated 63±10 pmol/min/cells, p≤0.05; maximal: untreated 286±20 vs treated 494±53 pmol/min/cells, p≤0.001; and spare respiratory capacity: untreated 251±18 vs treated 421±43 pmol/min/cells, p≤0.001) and a significant increase in levels of cytosolic ATP (untreated 4.0 ± 0.3 vs treated 5.6 ± 0.5 μM, p≤0.05).

Conclusion:
We demonstrate for the first time, cardioprotection with the DJ-1-derived peptide, ND-13, and this beneficial effect appears to be mediated by its mitoprotective actions with enhanced mitochondrial respiratory efficiency and increased ATP production. Upcoming research aims to explore if ND-13 promotes oxidative phosphorylation by directly binding to complexes of the electron transport chain to maximize respiratory function or by enhancing pyruvate dehydrogenase activity, thereby potentially influencing the regulation of the fission/fusion process.
Abstract 14282: Electrocardiography Rules out Myocardial Abnormalities on Cardiac Magnetic Resonance Imaging in Post-Hospitalized COVID-19 Patients: A Multicenter Observational Study
Authors: Abd Samat Azlan Helmy , Mahmod Masliza , Lewandowski Adam J , Cassar Mark Philip , Akhtar Mohammed , Moss Alastair , Manisty Charlotte , Treibel Thomas , Ashkir Zakariye , McCracken Celeste , Lukaschuk Elena , Piechnik Stefan , Ferreira Vanessa , Xie Cheng , Cuthbertson Dan , Kemp Graham , Nikolaidou Chrysovalantou , Miller Christopher , Chiribiri Amedeo , O'Regan Declan , Francis Susan , Steeds Richard P , Weir-McCall Jonathan , Wild Jim M , Plein Sven , McCann Gerry , Evans Rachael , brightling chris , Neubauer Stefan , Raman Betty
Published: December 2023

Introduction:
The diagnostic performance of EKG in ruling out myocardial abnormalities following COVID-19 is unclear.

Aim:
To assess the ability of EKG to exclude cardiac abnormalities on cardiac magnetic resonance imaging (CMR) in post-hospitalised COVID-19 patients.

Methods:
Post-hospitalized patients (n=212) & comorbidities matched controls (n=38) underwent CMR and 12-lead EKG. EKG assessments included depolarization & repolarization abnormalities [
QTc
, corrected QT dispersion (
QTc disp
), JT (
JTc
) & T peak-end (
cTPe
) intervals]. CMR abnormalities were defined as reduced left ventricular ejection fraction (LVEF), high T1 & T2 Z scores and high extracellular volume and pathological late gadolinium enhancement.

Results:
At 5.6 months post-discharge, patients had a higher burden of EKG abnormalities vs controls (72.2% vs 42.1%, p=0.001
) (Figure A)
. CMR abnormalities were comparable despite patients having lower LVEF. Abnormal EKG findings and prolonged repolarization were more common in patients with CMR abnormalities vs patients with normal CMR and controls (
Figure A & B
). Area-under-the-receiver-operating curve (AUROC) of routine EKG abnormalities to discriminate abnormal CMR was 0.56 (95% CI 0.47-0.65), p=0.185. Inclusion of
JTc
&
QTc disp
improved the AUROC to 0.64 (95% CI 0.55-0.74), p=0.002. Inclusion of
JTc ≥340ms
&
QTc disp
≥40ms
improved the sensitivity from 81.6% to 99.9% with higher negative predictive value (84.7% to 99.9%) (
Figure A
).

Conclusions:
Post-hospitalized COVID-19 patients have more EKG abnormalities than comorbidities-matched controls. A normal EKG with normal repolarization is effective in ruling out significant CMR abnormalities.
Abstract 14302: Heart Logic Directed Uptitration of Guideline Directed Medical Therapy Improves EF Across All Device Categories
Authors: Pickett Robert A , Shannon Elizabeth , Kaiser Daniel W , Gandhi Jonathan , Lugo Ricardo M
Published: December 2023

Introduction:
Historically data for CHF management in ICD patients had been for adjustments in diuretics. GDMT changes are often limited due to BP, renal function, or concerns for hypotension.

Hypothesis:
Using the Heart Logic score on Boston Scientific ICDs we could up-titrate GDMT in a safe reliable fashion which would allow for further improvement in LVEF and avoid complications.

Methods:
30 patients with either a new implant or generator change (single, dual, or resynchronization) with a compatible ICD were enrolled. The alert threshold was lowered from the standard of 16 to 10. The goal was to identify patients before congestion occurred. All patients were followed with remote monitoring. When an alert occurred, a single class of GDMT was increased. If alert did not go back to zero on repeat transmission, then a second class of medicine was up-titrated, changed, or added. The patients were followed for one year with yearly echo.

Results:
30 patients were enrolled. 2 died during the year follow-up from end stage CHF after being turned down for transplant or MCS. 1 patient did not have a one year follow-up echo. A total of 47 medicine changes or up-titrations were made. The average EF improved from baseline 27.5% to 37.2%. There were no syncopal events, worsening renal function, or hyperkalemia reported. The only subjective complaints were transient dizziness.

Conclusions:
Heart Logic based medication management allows a safe mechanism for increase or change in GDMT in the CHF population. Up-titration is necessary for better outcomes in CHF care but is also often limited to subjective concerns regarding potential complications.