bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 13564: Novel Electrocardiogram Generating Technique Using Artificial Intelligence: From 2-lead to 12-lead
Authors: Lee Hak Seung , Jo Yong-Yeon , Kang Sora , Jang Jong-Hwan , Son Jeong Min , Lee Min Sung , Kwon Joon-Myoung
Published: June 2023

Introduction:
Based on the development of AI (artificial intelligence) and big data, an emerging number of methods achieved outstanding performance in myocardial infarction (MI) diagnosis by an electrocardiogram (ECG). However, conventional interpretation methods have low reliability for detecting MI and are challenging to apply to 2 leads of wearable devices.

Objectives:
To evaluate whether the novel method can facilitate MI diagnosis by only 2-lead ECG.

Methods:
We propose T2T (from 2-lead to 12-lead), a deep generative model that simulates a standard 12-lead ECG from an input of two asynchronous leads by generating ten leads. (
Figure a
) We used and selected 15,012 ECGs (9,527 normal, 5,485 samples with any MI) from the Physikalisch-Technische Bundesanstalt dataset. This dataset was split into stratified training, validation, and test sets with a ratio of 7:1:2. Three models using 2-lead, T2T, and 12-lead ECG were developed and validated to predict a diagnosis of MI, and their accuracy was compared.

Results:
The area under the receiver operating characteristic curves of the 2-lead, T2T and 12-lead ECG were 0.937, 0.948, and 0.960, respectively.
Figure b
shows representative cases over a two-second window, where the green and pink lines are the signals from the original ECG and T2T. The generated signals have less noise (seen in aVR and aVL in 2a and V4, V5, and V6) and baseline wander. For the V1 and V5 leads generated by T2T, the differences in amplitude are 6.4% and 7.3%, respectively, and the missing positional errors are under 10 ms.

Conclusions:
Novel ECG T2T algorithm demonstrated favorable performance in detecting MI using 12-lead ECG.
Figure a.
ECGT2T model architecture. The model is comprised of style, mapping, generative, and discriminative networks. Each network is built with residual blocks.
Figure b.
Representative samples of ECG T2T. The green line denotes the original signal, while the pink line represents the signals generated by ECGT2T.
Abstract 13594: A Decade Trend, Sex, Racial and Economic Disparities in Acute Myocardial Infarction Hospitalizations in the United States
Authors: Bello Jeremiah , Adedoyin Adewale , Sana Muhammad Khawar , Babalola Funmilola , Shaka Abdultawab , Olakunde Tomilola I , ASEMOTA IRIAGBONSE , Shaka Hafeez
Published: June 2023

Introduction:
Reports have shown socioeconomic healthcare disparities among patients with cardiovascular diseases. We studied the trends in AMI hospitalization burden and outcomes over a decade with a focus on disparities in outcomes. This would provide epidemiologic data to assess the impact of current guidelines and recommendations on the general population.

Methods:
This was a trend study of the National Inpatient database from 2010 to 2019. We searched for AMI as the reason for hospitalization using the ICD codes. We estimated trends, inpatient mortality, mean length of hospital stay (LOS) and mean total hospital charges (THC) over the period. We performed a stratified analysis in categories: sex (male and female), race (Caucasians, Blacks, Hispanics), and median household income for patient's zip code (low-income quartile [LIQ] vs high-income quartile [HIQ]) to assess disparities in outcomes. Multivariable regression analysis adjusted for age and sex was used to obtain trend statistics on outcomes.

Results:
There were about 6,158,738 hospitalizations for AMI over the study period with females making up 38.2%. Yearly hospitalizations increased from 1,851 - 1,983 per 100,000 adult hospitalizations from 2010 to 2019 (p<0.001). There was a significant increase in hospitalizations among men from 60.4% in 2010 to 63.4% in 2019 (p<0.001). The proportion of AMI increased by 37% in Hispanics, 15% in Blacks, and 8% in Caucasians. The LIQ patients had a 6.2% increase while the HIQ had a 7.0% decrease in AMI hospitalizations. The mortality rate over the decade was 4.9%. Females had a mortality rate of 5.6% compared to 4.5% in Males. The LIQ average mortality was 5.0% compared to 4.9 in the HIQ. There was a significant decrease in the overall mortality from 5.3% in 2010 to 4.5% in 2019 (p<0.001). The mortality in females decreased by 20.3% (p<0.001) compared to 11.5% in males (p<0.001). Adjusted for inflation, there was a 41.8% increase in the THC over the study period.

Conclusion:
Hospitalization incidence for AMI appears to be rising among males, Hispanics, and LIQ patients. Information from this study brings awareness to ongoing disparities in AMI hospitalizations. We recommend multidisciplinary and sustained efforts to eliminate socioeconomic disparities in healthcare
Abstract 13629: Unique Age- and Sex-Specific Patterns Identified for Prodromal Symptoms of Sudden Cardiac Arrest
Authors: Dizon Bernadine , Reinier Kyndaron , Chugh Harpriya , Seifer Madison , Bhanji Ziana , Grogan Tristan , Elashoff David , Sorenson Chad , Sargsyan Arayik S , Uy-Evanado Audrey , Norby Faye L , Salvucci Angelo , Jui Jonathan , Chugh Sumeet S
Published: June 2023

Introduction:
The majority of individuals who suffer sudden cardiac arrest (SCA) display prodromal symptoms in the preceding hours, days and weeks. These could potentially improve risk assessment for SCA, making it important to explore the influence of age and sex on symptom manifestation.

Hypothesis:
Prodromal symptoms of SCA are different based on age and sex.

Methods:
We included cases of witnessed SCA (ages 35-85) attended by emergency medical services following 911 calls made in Ventura County, CA (2015-2021). SCA was defined as a sudden, unexpected pulseless condition of likely cardiac origin; non-cardiac etiology were excluded. All cases were required to have at least one inclusion symptom recorded in the EMS narrative at the time of the 911 call. These were acute coronary syndrome (ACS) or SCA symptoms reported in the published literature. We constructed mutually exclusive symptom groups in hierarchical order: chest pain, dyspnea, syncope/palpitations, and other. We compared symptoms in middle age (35-64y) and older (65-85y) cases using chi-square tests.

Results:
Of 404 SCA cases that met analysis criteria, 122 (30%) were female. Women comprised 22% of the middle-age group and 37% of the older group. In the middle-age group, chest pain was the most common symptom among men (48%) but was half as common in women (24%, p<0.01, Figure). Among middle-aged women, dyspnea was the most common symptom (39%) and significantly higher compared to men (22%, p <0.05). Chest pain prevalence was lower in both sexes in the older group (31% in men vs 20% in women). We observed no significant differences in dyspnea by sex in the older group, nor differences in syncope/palpitations or other symptoms in either group by sex.

Conclusions:
We observed unique pre-SCA prodromal symptom patterns after stratifying by age and sex, most notable in middle age. These findings suggest the importance of considering age and sex while developing SCA prediction algorithms that include prodromal symptoms.
Abstract 13631: Cardiovascular Risk Profile Among Reproductive Aged Women in the United States: The Behavioral Risk Factor Surveillance System (2015-2020)
Authors: Boakye Ellen , Kwapong Yaa A , Khan Sadiya S , Mamas Mamas , Perak Amanda , Douglas Pamela S , Natarajan Pradeep , Blumenthal Roger , Nasir Khurram , Hays Allison , Blaha Michael J , Sharma Garima
Published: June 2023

Introduction:
Suboptimal cardiovascular health (CVH) is associated with adverse pregnancy outcomes and long-term CV risk. Studies examining contemporary trends in CV risk factors (RF) and suboptimal CVH among US women of reproductive age are limited.

Methods:
We used the 2015 - 2020 Behavioral Risk Factor Surveillance System, a nationally representative survey of US adults, to conduct this serial cross-sectional study. We restricted our sample to nonpregnant reproductive-aged women (18-44 years) without CVD (n=336,102). We calculated the prevalence of each CV RF (current smoking, hypertension, diabetes, hypercholesterolemia, physical inactivity, poor diet, and overweight/obesity) and suboptimal CVH (≥2 RF) for each year and examined trends between 2015 and 2020

Results:
Between 2015 and 2020, diabetes prevalence remained relatively stable (2.9% to 3.0%; p=0.09) while overweight/obesity prevalence increased (53.1% to 58.4%; p<0.001). Conversely, prevalence of current smoking declined (16.0% to 12.4%; p<0.001). Also, between 2015 and 2019, hypertension prevalence remained stable (9.9% to 10.1%; p=0.57) while there was an increase in the prevalence of physical inactivity (49.1% to 51.6%; p<0.001) and poor diet (80.2% to 81.6%; p=0.003) but a decline in prevalence of hypercholesterolemia (16.2% to 12.6%; p<0.001). The prevalence of suboptimal CVH increased modestly from 72.4% (71.6%-73.3%) in 2015 to 75.9% (75%-76.7%) in 2019 (p<0.001). Significant increases in the prevalence of suboptimal CVH were observed among non-Hispanic White (69.8% to 72.6%) and Hispanic (75.1% to 80.3%) but not among non-Hispanic Black (82.7% to 83.7%) and Asian women (68.1% to 73.2%). State-level prevalence of suboptimal CVH in 2019 varied significantly

Conclusions:
There has been a modest increase in suboptimal CVH among US women of reproductive age. Thus, preventive efforts are needed to improve CVH in women, particularly among subgroups at increased risk of suboptimal CVH.
Abstract 13655: Relationship of Health-Related Social Needs, Social Determinants of Health, and Hospital Readmission Following Atrial Fibrillation Ablation
Authors: Holland Eva M , Walters Ryan W , Kim Michael H
Published: June 2023

Introduction:
Prior data report female sex, race, and impoverished populations by income and insurance status as less likely to receive atrial fibrillation (AF) ablation. Beyond this disparity, the impact of Social Determinants of Health (SocDH) in those that receive AF ablation and clinical outcomes is unknown. Using Health-Related Social Needs (HRSNs) as an indicator of SocDH, we assessed hospital readmissions after AF ablation.

Methods:
The 2010-2019 Nationwide Readmissions Database was queried for ICD-9/10 procedure and diagnosis codes for hospitalizations in which an adult patient underwent AF ablation and then stratified by presence of HRSNs (housing, socioeconomic status [SES], family, employment, and psychosocial) using Z-codes. Outcomes included all-cause 90-day readmission, and length of stay (LOS) and cost at index hospitalization. Unadjusted and adjusted regression models were estimated controlling for age, sex, and comorbidity burden.

Results:
An estimated 215,640 hospitalizations included AF ablation, of which 0.3% included a patient with a HRSN where housing and SES insecurity were the two most common HRSNs (43% and 40%, respectively). Hospitalizations including a HRSN tended to include younger patients (63 vs. 67 years), male (70% vs. 61%), a lower income quartile, with less private insurance (10% vs. 30%; all p < .001). HRSNs were associated with a 84% higher unadjusted odds of readmission (p < .001); although, this association was reduced to 15% after adjustment (p = .299). Readmission causes were identical between groups (18% and 15%, respectively). At index hospitalization, after adjustment, HRSNs were associated with 76% longer LOS (p < .001) and 7% higher hospital cost (p = .024).

Conclusions:
HRSNs/SocDH were associated with significant cost and LOS increases during index AF Ablation hospitalization. All-cause 90-day readmissions were increased, but not significant after adjustment for clinical factors. Compared to the general AF population, those receiving AF ablations had lower prevalence of HRSNs (0.3 vs. 0.9%). Further study on the impact of HRSNs in AF patients regarding rhythm control, AF ablation, and clinical outcomes is needed. A lower prevalence of HRSNs suggests a disparity in AF ablation application.
Abstract 13676: Sublingual Nitroglycerin Lowers Aortic Augmentation Pressure at Rest and During Exercise in Patients With HFpEF
Authors: Wakeham Denis J , Hughes Seamus B , Bagga Joetsaroop S , Balmain Bryce N , Tomlinson Andrew R , Babb Tony G , Macnamara James P , Hearon Christopher M , Levine Benjamin D , Sarma Satyam
Published: June 2023

Infusion or inhalation of organic nitrates lower ascending aortic pressures, and reduce mid-late systolic afterload via a reduction in augmentation pressure (aAP, the difference between the first [aP1] and second [aP2] peaks of the aortic pressure waveform) at rest and during exercise in patients with heart failure and preserved ejection fraction (HFpEF). Sublingual nitroglycerin (NTG) is more accessible for patients as compared to the infusion or inhalation of nitrates. It is unknown whether NTG spray (400μg) elicits these same effects as organic nitrates on aortic hemodynamics at rest and during exercise. Therefore, in 15 patients with HFpEF (age, 71 ± 6 years; 10 women; BMI 39.2 ± 6.2 kg/m
2
), as part of our ongoing clinical trial, we measured beat-by-beat radial artery blood pressure and estimated aortic pressure in real-time via a generalized inverse transfer function (SphygmoCor). Data were collected in the seated upright position at rest and throughout six-minutes of cycling at 20 Watts during either a placebo or NTG condition (randomized order). Stroke volume (SV) was calculated from cardiac output (Qc, acetylene rebreathe) and heart rate (ECG). NTG lowered stroke volume at rest, but not during exercise (Table); however, SV responses to exercise were similar (Placebo: Δ22 ± 19 vs NTG: Δ25 ± 18 ml,
P
= 0.1991). Aortic diastolic pressure was not different at rest with NTG compared to placebo (Table). aP1 and aP2 were lower at rest with NTG, with greater reductions in aP2 (Table). NTG lowered aAP during rest (Placebo: 11 ± 11 vs NTG: 0 ± 14 mmHg,
P
= 0.0002) and exercise (Placebo: 12 ± 11 vs NTG: 4 ± 12 mmHg,
P
< 0.0001). These results suggest patients with HFpEF do not augment SV responses to exercise despite a lower aAP contribution to (mid-late) systolic afterload with NTG. The inability to take advantage of a lower aAP during exercise may reflect impairments in contractile function and end-systolic reserve.
Abstract 13699: Bivalirudin versus Heparin in Patients With NSTEMI Undergoing PCI: Individual-Patient-Data Pooled Analysis of the 5 Major Randomized Trials
Authors: Bikdeli Behnood , Valgimigli Marco , Erlinge David , Kastrati Adnan , Steg Philippe G , Yaling Han , Stables Rod , Mehran Roxana , Frigoli Enrico , James Stefan K , patrick GOLDSTEIN , Li Yi , Shahzad Adeel , Schuepke Stefanie , Chen Shmuel , Mehdipoor Ghazaleh , Redfors Bjorn , Crowley Aaron , Zhou Zhipeng , Stone Gregg
Published: June 2023

Background:
Whether there are treatment tradeoffs between bivalirudin and heparin in patients with NSTEMI undergoing PCI is controversial. Study-level meta-analyses lack granularity to provide conclusive answers or assess subgroups.

Methods:
We performed an
individual-patient-data
pooled analysis from all 5 large (n >1000) RCTs of bivalirudin vs heparin in NSTEMI patients undergoing PCI (MATRIX, VALIDATE-SWEDEHEART, ISAR-REACT 4, ACUITY, BRIGHT). The primary efficacy outcome was the 30-day rate of all-cause mortality. Other prespecified outcomes included 30-day serious bleeding, 1-year mortality, and 30-day and 1-year MACCE, and net adverse clinical events (NACE). Subgroup analyses were performed according to access site and post-PCI bivalirudin infusion.

Results:
A total of 12,155 patients with NSTEMI undergoing PCI were randomized to bivalirudin alone (n=6,040, 52.3% with a post-PCI infusion) or to heparin (n=6,115, 53.2% with planned use of a GPIIb/IIIa inhibitor). Thirty-day mortality was not significantly different between bivalirudin vs heparin (aHR: 1.21; 95% CI: 0.84-1.73). There was a lower risk of 30-day serious bleeding with bivalirudin vs heparin (aHR: 0.63; 95% CI: 0.52, 0.76). At 1-year follow-up, there was no significant difference between bivalirudin and heparin for all-cause mortality (aHR: 0.97; 95% CI: 0.79, 1.19), MACCE (aHR: 1.03; 95% CI: 0.94, 1.13) or NACE (aHR: 0.92 0.84, 1.00). There were no significant differences between bivalirudin or heparin in the rates of MI or stent thrombosis (Table). Findings were consistent irrespective of access site (femoral vs radial), and post-PCI infusion of bivalirudin.

Conclusions:
In patients with NSTEMI undergoing PCI, procedural anticoagulation with bivalirudin was not associated with improvements in 30-day or 1-year mortality or MACCE compared with heparin with or without GPIIb/IIIa inhibitor, although serious bleeding was reduced. Full analyses will be presented at AHA 2022.
Abstract 13710: Acute Beneficial Effects of a Rho-Kinase Inhibitor, Fasudil in Patients With Pulmonary Hypertension Due to Left Heart Disease
Authors: Ishiyama Masaki , Fujimoto Naoki , Sato Toru , Omori Taku , Moriwaki Keishi , Sugiura Emiyo , Ogihara Yoshito , Nakamori Shiro , Kurita Tairo , Dohi Kaoru
Published: June 2023

Introduction:
The prognosis of reactive pulmonary hypertension (PH) due to left heart disease is poor, and the pathogenesis of the disease is not well understood. Rho-Kinase inhibitor, fasudil dilates vascular smooth muscle and may improve pulmonary hypertension. We evaluated the acute effects of fasudil on hemodynamic parameters in patients with pulmonary hypertension due to left heart disease prospectively.

Methods:
From 2016 June to 2022 May, 100 consecutive patients requiring hospitalization for worsening chronic heart failure were enrolled. All patients underwent invasive hemodynamic measurement though right heart catheterization.In patients with mean pulmonary arterial pressure greater than 25 mmHg at baseline, 30 mg of fasudil was administered intravenously for 30 minutes. The hemodynamic measurements were performed at baseline and after 30 minutes of fasudil. PH due to left heart disease is defined as mean pulmonary arterial pressure (mPAP) ≥25mmHg and mean pulmonary capillary wedge pressure (mPCWP) >15mmHg. Patients with PH were classified into 2 types, depending on the elevation of pulmonary vascular resistance (PVR) or the diastolic pressure gradient (DPG): Reactive-PH with elevated PVR (>3.0 Wood units: WU) and/or DPG (>7mmHg), and Passive-PH with normal PVR (≤3.0 WU) and DPG (≤7mmHg).

Results:
Fifty patients (mean age 70 years; 14 women and 36 men) received administration of fasudil. 30 patients had Passive-PH, and 20 patients had Reactive-PH. PVR significantly decreased after administration of fasudil in both Passive-PH and Reactive-PH group (1.7 to 1.4 WU, 3.5 to 2.7 WU, P<0.001). The rate of change in PVR after administration of fasudil was significantly higher in the Reactive-PH group compared to the Passive-PH group (33% vs 21 %, P<0.05). mPAP and cardiac index significantly improved in both Passive-PH (34±8.5 vs. 28±8.2 mmHg, 2.7±0.7 vs. 2.9±0.8 l/min/m
2
, p<0.05) and Reactive-PH group (41±7.9 vs. 33±9.0 mmHg, 2.2±0.6 vs. 2.4±0.6 l/min/m
2
, p<0.05). Mean blood pressure and arterial oxygen saturation were unaffected by fasudil (87 to 84 mmHg, 99 to 90 mmHg, 98 to 97%, 97 to 97%, not significant).

Conclusions:
Fasudil improves pulmonary hypertension due to left heart disease without any detrimental effects on hemodynamics.
Abstract 13711: Cardiomyopathy Complicated by Constriction Resulting in Transplant Listing
Authors: Pietrowicz Rylie , Ibrahim Michel , Hamad Eman A , Rakita Val , Hoosain Jamael
Published: June 2023

Introduction
We describe a case of severe cardiomyopathy complicated by pericardial constriction resulting from epicardial VT ablation requiring heart transplant listing.

Case Presentation
A 43-year-old with a history of silent MI, LV aneurysm and thrombus, cardiomyopathy (EF 15%), Stage C heart failure, and VT on amiodarone initially presented with symptomatic VT requiring AICD therapy.

He underwent epicardial ablation with no immediate complications. Post-ablation, he developed polymorphic VT prompting LHC revealing new LAD artery stenosis treated with stents. He was discharged on DAPT and warfarin.

He subsequently re-presented with worsening dyspnea, lethargy, and edema. Invasive hemodynamics revealed elevated filling pressures and cardiogenic shock with constrictive physiology. Milrinone and aggressive diuresis were initiated with mild improvement in symptoms. Echocardiogram and cardiac MRI confirmed diagnosis of constrictive pericarditis and presence of hemopericardium.

Discussion
Multidisciplinary discussions were held to determine treatment. Management of constrictive pericarditis with pericardial stripping was considered. The high-risk nature of the procedure with unknown benefit, his age, and now Stage D heart failure made sternotomy a potential increased risk for future cardiac transplant. Ultimately, decision was made for pericardiocentesis, treatment with colchicine, a switch from triple therapy to warfarin and aspirin, and listing for transplant. Surveillance RHC 6 weeks post hospitalization showed resolution of constrictive physiology and normal cardiac output on milrinone.
Abstract 13724: Development of VS-041 as a Precision Medicine Targeting Cardiac-Relevant Matrix Metalloproteases (MMPs) in Heart Failure With Preserved Ejection Fraction (HFpEF)
Authors: Plonowski Artur , Pratt Benjamin , Krupa Magdalena , Lipinski Piotr , Herbert Mark
Published: June 2023

Introduction.
HFpEF is a heterogeneous syndrome, with several underlying etiologic and pathophysiologic factors. As “one size fits all” therapies are not equally efficacious across various HFpEF comorbidities, a precision medicine approach can offer a disease modifying treatment for HFpEF subpopulation stratified for specific molecular targets. Expression of MMP2, 9, and 13 in heart is elevated in HFpEF patients with hypertension, diabetes or coronary disease, and their levels in plasma correlate with survival, suggesting utility as predictive biomarkers. Genetic ablation of MMP2, 9, and 13 leads to a robust antifibrotic effect in the myocardium. Inhibition of MMP2, 9, and 13 directly regulates of Ca
2+
transients and protects sarcomere function.

Hypothesis.
We present preclinical profile of VS-041, a novel and narrow-spectrum MMP inhibitor, as a drug candidate for HFpEF patients with elevated levels of MMP2, 9, and 13.

Methods and Results.
VS-041, optimized with computer-aided drug design methods, shows single-digit IC
50
against MMP2 (1nM), MMP9 (2nM) and MMP13 (1nM), and maintains >300-fold selectivity against MMP1 and TACE. In isolated cardiomyocytes VS-041 reduces contractility deficit due to fast pacing. With high predicted metabolic bioavailability (MF%=90), >80% target occupancy by VS-041 is estimated after 50 mg/kg PO dose in rats. VS-041 demonstrated robust efficacy in Dahl Salt Sensitive rat model of hypertension and HFpEF after dosing at 25 or 50 mg/kg PO for 5 wks in a therapeutic mode (after 1-wk of high salt lead-in). VS-041 had no effect on blood pressure or ejection fraction confirming a direct effect on diastolic function. In Doppler mitral inflow, analysis of the isovolumic relaxation time and the E/A ratio of peak velocity of filling waves revealed 40% improvement in diastolic function. LV fibrosis was dose-proportionally decreased based on PSR morphometry. No adverse effects were observed after 5 weeks of dosing.

Conclusions.
Preclinical pharmacology and safety profile of VS-041 support its nomination as clinical candidate and initiation of IND-enabling studies. VS-041 has potential to be first-in-class precision medicine treatment for HFPEF patients with elevated levels of cardiac-relevant MMP2, 9 and 13.
Abstract 13749: Association of Left Atrial Hemodynamics by Cardiac Magnetic Resonance With Clinical Outcomes in Patients With Non-Ischemic Cardiomyopathy
Authors: Munir Muhammad S , Benjamin Mina M , Thompson Michael , Shah Parth , Khalil Maria , Kinno Menhel , Syed Mushabbar A
Published: June 2023

Introduction:
Left atrial hemodynamics are associated with clinical outcomes in a variety of cardiac conditions. We sought to assess the association of LA function and strain by cardiac magnetic resonance (CMR) in patients with non-ischemic cardiomyopathy (NICM) with clinical outcomes.

Methods:
We retrospectively evaluated 92 patients who were diagnosed with NICM and 50 controls without significant cardiovascular disease who underwent clinically indicated CMR and echocardiography. CMR was used to calculate indexed LA volumes (LAVi), ejection fraction (EF) and expansion index as well as measure LA reservoir (εR), conduit (εCD), and contractile strain (εCT). A multivariate regression analysis was performed with an endpoint of heart failure hospitalization (HFH).
Results:
Mean age for NICM patients was 59.6 ± 15.9 (64% males, 73% whites) versus 52.2 ± 12.4 (34% male, 64% white) for controls. Median follow-up was 58.9 months (IQR 57.1). LA EF and all LA strain components were significantly lower in NICM compared to controls (Table 1). On univariate analysis, mitral regurgitation, left and right ventricular EF, late gadolinium enhancement, εR, εCD, minimum and maximum LAVi were significantly associated with HFH. On multivariate analysis, after adjusting for the factors above and entering the LA parameters one at a time, εR was the only factor significantly associated with HFH (OR 0.98, CI 0.96-1.0). Adjusted Cox proportional hazard model for εR dociles (Median εR ~ 18) had a significant χ2 statistic of 21.1, p=0.03 (Figure).

Conclusion:
LA strain was significantly reduced in patients with NICM. Among all LA strain components, only εR was independently associated with HFH.
Abstract 13752: Coronary Artery Bypass Grafting Demonstrates Lower Mortality Rates Compared to Percutaneous Coronary Intervention for Multivessel Coronary Artery Disease: An Updated Systematic Review and Meta-Analysis
Authors: Elfaituri Muhammed K , Khaled Ala , BENGHATNSH AHMED TAREK SAEED , Msherghi Ahmed , Elfaituri Ahmed , Omran Elham , Faraj Hazem Abdelkarem
Published: June 2023

Introduction:
Treating individuals with stable multivessel coronary artery disease (CAD) and retained ventricular function is still debatable. Percutaneous coronary intervention (PCI) and coronary bypass grafting (CABG) are all options for treatment, and they are all employed in tandem with rigorous secondary prevention. One technique's significant long-term mortality benefit over the other is still debatable for multivessel disease management.

Hypothesis:
To compare the long-term mortality and complications of coronary artery bypass graft (CABG) versus Percutaneous Coronary Intervention (PCI) among patients with multivessel disease.

Methods:
Pubmed/Medline, EMBASE, Cochrane, Web of Science, Scopus, and grey literature were searched in March 2022. We only included randomized clinical trials (RCTs) that reported the outcome differences between CABG and PCI. The primary outcome was long-term all-cause mortality. The secondary outcomes were re-intervention rate and major adverse cardiac events (MACE). The statistical analysis was performed using Comprehensive Meta-analysis software version 3.

Results:
A total of 6 Randomized Control Trails (RCTs) studies were included in the analysis comprising 7,126 patients (3558 PCI and 3568 CABG). The median follow up period was 6.33 years. Long-term mortality from any cause (after 2 years follow up or more) was significantly higher in PCI group compared to CABG group (HR: 1.44; 95% CI, 1.25-1.67; P < 0.01; I
2
= 18.78%). This trend was consistent among diabetic patients (HR: 1.39; 95% CI, 1.14-1.69; P < 0.01; I
2
= 23.73%). CABG procedure was associated with lower rate of additional or repeat intervention (RR: 0.25; 95% CI, 0.17-0.37; P < 0.01; I
2
= 74.4%). Cardiovascular-specific mortality and MACE were lower among CABG group compared to PCI (RR: 0.77; 95% CI, 0.58-0.95; P < 0.01; I
2
= 0%), (RR: 0.77; 95% CI, 0.64-0.93; P < 0.01; I
2
= 0%), respectively.

Conclusions:
The study shows that CABG provides lower long-term mortality rates, including diabetic patients, a lower rate of repeat intervention, and lower major adverse cardiac events. Therefore, CABG is an effective and safe approach for patients with multivessel diseases compared to PCI, especially in the long term.
Abstract 13753: Higher Social Vulnerability Index is Associated With Increased Mortality Following Cardiac Arrest
Authors: Chobufo Muchi Ditah , Rahman Ebad , Mbome Yolande , Gabriel Andre , Mahtani Arun , Atti Varunsiri , balla sudarshan
Published: June 2023

Introduction:
Cardiac arrest(CA) is a strong predictor of death. Survival following CA depends on timely initiation of quality cardiopulmonary resuscitation (CPR) and post CA care. The availability of competent individuals, resources and necessary services may be greatly influenced by the characteristics of the communities in which the indexed CA occurs. The Social Vulnerability Index(SVI) is a robust index which reliably ranks counties based on diverse parameters on a scale from 0 to 1. The higher the SVI, the more disadvantaged the community is.

Hypothesis:
We hypothesize that there is a positive correlation between CA related AAMR( expressed per 100,000 persons) and SVI in the USA.

Methods:
Using the multiple causes of death database from the Centers for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiologic Research(1999-2020), we extracted county level deaths with any mention of CA with ICD-10 codes I46.0, I46.1, I46.9. County level SVI was obtained from CDC/ATSDR. SVI was stratified into quintiles. We fitted segmented regression models to evaluate the association between quintiles of SVI scores and CA-related age-adjusted mortality rate (AAMR, expressed per 100,000 persons). Analysis was done using STATA v17 and Joinpoint segmented regression softwares with p-values <0.05 considered statistically significant.

Results:
The CA related AAMR was 104.5 per 100,000 (95% CI 104.4 - 104.6) for the entire USA, decreasing from 132.9 (132.4 - 133.3) in 1999 to 104.5 (104.2 - 104.8) in 2020. We observed a monotonous increase in AAMR with increasing SVI as shown on figure 1 with an average quintile percentage change of 20.8% (95% CI 13.1 - 29.0) with a p-value of 0.003.

Conclusions:
Persons who suffer cardiac arrest in counties with higher SVI are more likely to die compared to those who suffer CA in counties with lower SVI. Further research is needed to identify and address the driving factors so as to reduce existing disparity. .
Abstract 13767: A Novel Pharmacological Inhibitor of Type 5 Adenylyl Cyclase Inhibitor Enhances Exercise Capacity and Protects Against Glucose Intolerance and Myocardial Ischemia
Authors: Zhang Jie , Vatner Dorothy E , Oydanich Marko , Smeraglia Vincent A , Roberge Jacques , Vatner Stephen F
Published: June 2023

Disruption of adenylyl cyclase 5 (AC5 KO) is a healthful longevity model; not only do the AC5 KO mice live a third longer than wild type (WT) mice, but are also protected against heart failure, obesity and diabetes and exercise intolerance. To translate to the clinics, we developed a new drug, C90, which inhibits AC5, and examined its effects on cardioprotection in pigs, exercise capacity and glucose tolerance in mice. C90 (30 mg/kg/day) or vehicle were chronically administered to age-matched C57/BL6 male mice via osmotic pump. After baseline exercise, the WT mice, all performing similarly, were divided into two groups; one that received C90 for 14 days and the other receiving vehicle for 14 days. After 14 days of C90 treatment, WT mice exhibited greater exercise capacity reflected by longer running distance (384 ± 27 m vs. 253 ± 16 m, p<0.05) and greater work to exhaustion (18.1 ± 1.5 J vs. 12.4 ± 0.7 J, p<0.05) than mice receiving vehicle. Sensitivity to glucose was measured using a glucose tolerance test in mice. Following 14-days treatment with C90 (30 mg/kg/day), the mice exhibited an overall improvement in glucose tolerance, measured as area under the curve (A.U.) for glucose levels following insulin injection, when compared to vehicle (6414 ± 890 A.U. vs. 9658 ± 1039 A.U., p<0.04). Furthermore, C90-treated mice had a lower fasting glucose level on a regular diet, when compared to vehicle (113 ± 6.5 mg/dl vs. 129 ± 4.2 mg/dl, p<0.05). The cardioprotective effects of C90 were previously demonstrated in mice. In the current study, we investigated the cardioprotective effects of C90 in a porcine model of ischemia/reperfusion (I/R). Ischemia was induced for 60 min coronary artery occlusion, followed by 3-hours reperfusion. C90 (1.2 mg/kg), infused 5 min following the start of the reperfusion led to a decreased infarct size/area at risk (INF/AAR) (21.6 ± 4.3% vs. 36.8 ± 2.9%, p<0.05) when compared to vehicle, with no difference between AAR/left ventricle between the C90 and vehicle groups. In view of its lower level of toxicity than other AC5 inhibitors, C90 is an excellent candidate for clinical development for pharmacological treatment of myocardial ischemia, glucose intolerance and exercise intolerance.
Abstract 138: Epinephrine Before Defibrillation In Adults With Shockable Rhythm Out-of-hospital Cardiac Arrest
Authors: Luo Shengyuan , Gu Liwen , Zhang Wanwan , Zhang Yongshu , Li Wankun , Qiu Feipeng , Xiong Yan , Idris Ahamed H
Published: June 2023

Introduction:
Guidelines recommend epinephrine treatment after the first defibrillation in the resuscitation of patients with shockable rhythm cardiac arrest. Degrees to which routine practice adheres to clinical guidelines can be variable.

Hypothesis:
Epinephrine was administered prior to defibrillation in a non-trivial proportion of patients with shockable rhythm out-of-hospital cardiac arrest (OHCA). Such practice is associated with worse outcomes.

Methods:
We conducted a retrospective study in a North American OHCA epidemiologic registry between 2011 and 2015. We assessed the proportion of participants with shockable rhythm OHCA who received pre-defibrillation epinephrine and described their characteristics. In a propensity-matched cohort, we used logistic regression to evaluate associations between pre-defibrillation epinephrine and outcomes, i.e., pre-hospital return of spontaneous circulation (ROSC), survival to hospital discharge, and favorable neurological outcome (modified Rankin Scale score ≤3) at discharge.

Results:
Of 6938 individuals with shockable rhythm OHCA, 522 (7.5%) received epinephrine before defibrillation. Comparing these patients to those who did not receive pre-defibrillation epinephrine, mean time from emergency medical services activation to first defibrillation was longer (17.5 vs 10.5 min) and a greater proportion received epinephrine intra-osseously (24 vs 20%). In total, 392 (75%) and 5119 (80%) gained prehospital ROSC, 78 (15%) and 1237 (19%) survived to hospital discharge, and 48 (9%) and 996 (16%) had favorable functional outcome at discharge respectively. In propensity-matched analysis, epinephrine use prior to defibrillation was associated with statistically insignificant increases in odds of prehospital ROSC (OR=1.20, 95%CI 0.89-1.61; p=0.23), survival (OR=1.46, 95%CI 0.98-2.17; p=0.06), and favorable neurological outcome at hospital discharge (OR=1.21, 95%CI 0.76-1.93; p=0.43).

Conclusions:
Data from a North American OHCA registry found that epinephrine can be administered prior to defibrillation in up to 7.5% of patients with shockable rhythm cardiac arrest. Such approach was not associated with worse outcomes in propensity-matched analysis.
Abstract 13803: Contribution of Clinical Trial Event Data by Data Source: Insights From the ADAPTABLE Trial
Authors: Rymer Jennifer A , Mulder Hillary , Wruck Lisa M , Munoz Daniel , Kripalani Sunil , Effron Mark B , gupta Kamal , Handberg Eileen M , Jain Sandeep , Girotra Saket , Whittle Jeffrey , Hess Rachel , Benziger Catherine , Knowlton Kirk U , Curtis Lesley , Roe Matthew T , Hammill Bradley G , Rothman Russell , Harrington Josephine , Hernandez Adrian F , Jones William
Published: June 2023

Introduction:
Pragmatic randomized controlled trials (RCT) often use multiple data sources to examine clinical events, but the relative contribution of data sources (patient-reported, electronic health records (EHR), private/public claims data) to clinical endpoint rates is often not examined.

Hypothesis:
We hypothesized that claims data would contribute the highest number of events relative to other data sources.

Methods:
The ADAPTABLE study was an open-label, pragmatic RCT that demonstrated no significant difference in major cardiovascular or bleeding events among patients with CV disease randomized to an aspirin dose of 81vs. 325 mg/daily. We assessed the clinical endpoint rates and contribution of clinical endpoints by data source among patients who had EHR, public and private insurance claims data, and/or patient-reported (portal) data.

Results:
Of 15,076 patients randomized, there were 1,412 patients with EHR-only data; 8,756 with portal and EHR data; and 4,291 patients with portal, EHR, and claims data (Medicare or private). Patients with EHR-only data were younger (63.7 years) compared to the other groups (65.6-71.1 years); and were more likely Black (10.6%) vs. the other groups (6.3%-9.7%), p<0.001. The table demonstrates trial clinical event rates by data source among patients with available portal, EHR, and claims data. Among patients with available portal, EHR, and claims data, Medicare claims data contributed the most events for the composite endpoint (77.5%) and all-cause death (97.3%), while EHR data contributed the most events for MI (74.3%), stroke (74.3%), and major bleed (73.3%).

Conclusions:
In a large pragmatic trial, Medicare claims data contributed the most clinical events for the primary composite outcome and all-cause death, when compared with other available data sources. Further work is needed to understand the data source combinations that most effectively provide clinical endpoint data in RCTs.
Abstract 13821: Genetic Identification of Homozygous Familial Hypercholesterolemia by Long-Read Sequencing Among Patients With Clinically Diagnosed Heterozygous Familial Hypercholesterolemia
Authors: Chaudhry Ahsen , Vesely Kristin , Cermakova Lubomira , Trinder Mark , Brunham Liam R
Published: June 2023

Background:
Homozygous Familial Hypercholesterolemia (HoFH) is a rare genetic disorder characterized by extremely elevated plasma low-density lipoprotein cholesterol (LDL-C) and accelerated atherosclerosis. Accurate identification of patients with HoFH is essential as they may be eligible for specialized treatments. The objective of this study was to identify and characterize patients with HoFH among patients with clinically diagnosed heterozygous FH (HeFH).

Methods:
We studied patients from the British Columbia FH Registry with a Dutch Lipid Clinic Network score ≥6 and no secondary cause of hypercholesterolemia. We performed targeted next-generation sequencing of the
LDLR
,
APOB
,
PCSK9
and
LDLRAP1
genes. Long-read sequencing of the
LDLR
gene was subsequently done for patients with >1 pathogenic
LDLR
variant to determine haplotypes. We examined lipid levels and cardiovascular events (unstable angina, myocardial infarction and coronary revascularization).

Results:
Among 705 patients with clinically diagnosed HeFH, we identified a single pathogenic variant in 300 (42.6%) patients and >1 pathogenic variant in the
LDLR
gene in 11 (1.6%) patients. We established a genetic diagnosis of HoFH in 6 (0.9%) patients (3 true homozygous and 3 compound heterozygous in trans). The mean baseline LDL-C of genetically identified HoFH patients was significantly higher than those with 1 variant. The prevalence of premature cardiovascular disease was numerically greater in the genetically identified HoFH group (29.4% vs 18.0%, p=0.2).

Conclusions:
In a cohort of patients with clinically diagnosed HeFH, genetic testing by long-read sequencing revealed that 0.9% had HoFH. These patients tended to have a more severe phenotype. Genetic testing of patients with clinical FH may identify patients with HoFH that had eluded clinical diagnosis.
Abstract 13827: Performance Characteristics of Natriuretic Peptides in Predicting Invasively Measured Intracardiac Filling Pressures in Patients With Cancer
Authors: Fatakdawala Mariya , Irizarry-Caro Jorge , Amatullah Atia , Yarrabothula Akshitha , Miller Chase , Wanna Charles , Mouhayar Elie , Iliescu Cezar , Palaskas Nicolas L , Deswal Anita M , Koutroumpakis Efstratios
Published: June 2023

Introduction:
Natriuretic peptides (NP) are routinely used for the diagnosis of heart failure. Studies have suggested higher levels of NP in patients with cancer, possibly driven by cancer associated inflammation. This study aims to assess the performance characteristics of natriuretic peptides in predicting invasively measured elevated intracardiac filling pressures in patients with cancer.

Methods:
Patients with cancer who underwent a right heart catheterization (RHC) at a tertiary cancer center from 10/2011 to 10/2021 were identified. Demographic characteristics, NP levels and invasive hemodynamic data were abstracted. Pulmonary capillary wedge pressure (PCWP)
>
15 mmHg and mean right atrial pressure (mRAP)
>
8 mmHg were defined as abnormal.

Results:
Of 1240 patients who underwent a RHC, 740 had NTproBNP (41%) or BNP levels (23%) available within a median of 1 day (0-3, and 0-4 days, respectively) from the procedure. Of those, 46% were female, 70% were white, median age was 67 years (IQR: 58-74) and median BMI was 25.2 kg/m
2
(17.4-30.3). High PCWP was present in 58% of patients while an additional 15% had high mRAP with normal PCWP (73%). The area under the curve (AUC) of NTproBNP and BNP in predicting high PCWP was 0.626 (95% CI 0.578-0.675) and 0.681 (0.617-0.744), respectively. The AUC of NTproBNP and BNP in predicting high PCWP or high mRAP was 0.603 (0.549-0.657) and 0.690 (0.621-0.759), respectively. At 125 pg/ml, NTproBNP had a sensitivity of 95%, specificity 6%, positive predictive value (PPV) 57%, and negative predictive value (NPV) 48% for high PCWP and a sensitivity of 95%, specificity 9%, PPV of 74%, and NPV 41% for high PCWP or high mRAP. At 100 pg/ml, BNP had a sensitivity of 89%, specificity 25%, PPV 64%, and NPV 60% for high PCWP, and a sensitivity of 88%, specificity 28%, PPV 77%, and NPV 47% for high PCWP or high mRAP.

Conclusions:
NP at the standard cutoff levels are very sensitive in predicting elevated intracardiac filling pressures in patients with cancer. However, they can be falsely elevated in >70% of cancer patients with normal filling pressures. These caveats need to be considered when utilizing elevated levels of NP in the assessment of patients with cancer and dyspnea and/or edema.
Abstract 13881: Utility of Cardiac CT for Evaluation of Infectious Endocarditis
Authors: Jain Deeptanshu , Pendela Satish , Jain Tanya Sharma , Nand Nikita , Diab Mohamed , Corteville David
Published: June 2023

Background:
Infectious endocarditis (IE) usually presents with variable imaging findings and is associated with high morbidity and mortality. Transesophageal echocardiography (TEE) is the gold standard method for diagnosing IE. However, the presence of prosthetic or calcified valves poses a diagnostic challenge for detection of IE and associated structural abnormalities. In recent years, there is growing literature supporting cardiac CT scan as an adjunct to TEE in such cases. Studies have also shown that cardiac CT has significantly high sensitivity for detecting peri-annular complications.

Case
A 79 year old male who underwent transcatheter aortic valve replacement (TAVR) for severe aortic stenosis one year ago presented with a one week history of worsening confusion and fatigue. His prior medical history includes non-ischemic cardiomyopathy with low ejection fraction (30-35%), deep vein thrombosis (DVT) and pulmonary embolism (PE). Labs were notable for leucocytosis 27,300/uL and thrombocytopenia with platelet count 20,000/uL. Patient was bacteremic with blood cultures growing oxacillin-resistant Staphylococcus epidermidis. TEE revealed a small vegetation concerning for infection versus thrombus. A CT abdomen revealed a 3.8 cm splenic infarct. Tagged WBC scan was thereafter considered to help delineate, but came back negative.

Decision Making
In setting of thrombocytopenia, repeat TEE was deemed unsafe. Alternatively, the patient underwent cardiac CTA which revealed hypoattenuating leaflet thickening (HALT) involving >75% of aortic valve leaflets (Figure 1) with no perivalvular leak or abscess thereby confirming IE.

Conclusion
Cardiac CT offers distinct advantages and has emerged as a great adjunct to echocardiography for the workup of IE, especially in patients who have contraindications to TEE or with prosthetic valves where echocardiography is sub-optimal. The report further elucidates the role of cardiac CT as an imaging adjunct for IE.
Abstract 13931: Comparison of Inpatient Outcomes of Transcatheter Aortic Valve Replacement in Bicuspid versus Tricuspid Aortic Valve Stenosis: An Insight From National Inpatient Sample
Authors: Poudyal Abhushan , Park Dae Yong , Khanal Smriti , Shrestha Prajwal , Sharma Bharosa , Karki Sadichhya , Vij Aviral
Published: June 2023

Background:
TAVR is increasingly performed in patients with severe aortic stenosis (AS), including those with bicuspid aortic valve (BAV). There is a paucity of data on the safety and efficacy of TAVR in the latter group since they were excluded from the landmark trials which established TAVR as a favorable alternative to surgery. Prior studies have shown higher rates of permanent pacemaker placement (PPM) and paravalvular leak (PL) but comparable rates of embolic stroke (ES) and mortality in BAV patients who underwent TAVR when compared to those with tricuspid aortic valve (TAV). We examined the impact of aortic valve anatomy on inpatient mortality and complication rates using current data from the largest inpatient database in the United States.Methods:We queried the 2016-2019 National Inpatient Sample database to identify all patients over 18 years of age who underwent TAVR for AS. Patients were stratified to BAV and TAV groups using ICD-10 codes. Greedy nearest neighbor propensity score matching was performed based on demographics, Charlson comorbidity index, hospital characteristics, insurance status, and median income. Outcomes of interest included rates of mortality, PPM, PL, ES, and length of hospital stay (LOS).Results:Of 192,100 AS patients who underwent TAVR, 0.5% had BAV. After propensity score matching, 995 BAV and 995 TAV patients were included in the final analysis. The overall mortality rate was 1.5% with no significant difference between the two groups [OR 1.00 (0.20-5.060), p=1.00]. Rates of PPM were 10.1% in BAV and 8.5% in TAV patients with no significant difference [OR 1.20 (0.61-2.37), p=0.61]. Rates of PL were 1% in BAV and 0.5% in TAV patients with no significant difference [OR 2.01 (0.18-22.65), p=0.57]. Rate of ES was 1.5% in BAV patients; however, direct comparison to its propensity-matched TAV cohort was not feasible since the latter group had no events in this analysis. There was no significant difference in the LOS between the two groups.Conclusion:Insight from this large database suggests that in the current era, TAVR has similar short-term outcomes in both BAV and TAV patients. Further studies with long-term follow-up on valve function and the need for reintervention will be needed, especially since this involves younger patients.