bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 282: Extracorporeal Resuscitation For Out-of-Hospital Cardiac Arrest Patients: Analysis By Time-Dependent Propensity Score Matching Using Nationwide Database In Japan
Authors: Okada Yohei , Komukai Sho , Nishioka Norihiro , Kiguchi Takeyuki , Kitamura Tetsuhisa , Iwami Taku ,   CRITICAL study investigators
Published: June 2023

Background:
Extracorporeal cardiopulmonary resuscitation (ECPR) has been focused as a rescue therapy for the refractory cardiac arrest patients; however, little is known about the effect of ECPR on survival. The aim of this study is to evaluate the association between ECPR and the survival among the out-of-hospital cardiac arrest patients.

Method:
This was the secondary analysis of JAAM-OHCA registry which is a nationwide multicenter prospective study collecting the data of out-of-hospital cardiac arrest patients from July 2012 to December 2019. The study participant were adult (≥18 years) cardiac arrest patients due to internal medical cause. Initial cardiac rhythm was stratified as initial shockable and non-shockable rhythm. Patients received ECPR were sequentially matched with the patients who had not yet received within the same minutes (control) based on the time-dependent propensity scores calculated from the patient characteristics to eliminate the resuscitation time bias. Odds ratio with 95% confidence interval (CI) of ECPR for the 30-day survival were calculated by conditional logistic model.

Results:
Of 57,754 patients in the JAAM-OHCA registry, 1,826 matched cohort with initial shockable rhythm (913 treated with ECPR and 913 control) and 740 matched cohort with initial non-shockable rhythm (370 treated with ECPR and 370 control) were eligible for analysis. Their characteristics between with ECPR and control were well balanced. In the matched cohort with initial shockable rhythm, 30-day survival was 24.6% (225/913) in the patients with ECPR and 16.3% (149/913) in the control. In the matched cohort with initial non-shockable rhythm, 30-day survival was 11.9% (44/370) in the patients with ECPR and 2.4% (9/370) in the control. Odds ratio of with ECPR for 30-day survival was 1.76 [95%CI: 1.38-2.25] in shockable rhythm and 5.37 [95%CI: 2.53- 11.43] in non-shockable rhythm, referred to the control.

Conclusion:
This time-dependent propensity score sequential matching analysis suggested that ECPR was associated with the 30-day survival outcomes among the out-of-hospital cardiac arrest patients with both initial shockable and non-shockable rhythms.
Abstract 9229: Childhood Opportunity Level Predicts Early and Late Outcomes Following Surgery for Congenital Heart Disease
Authors: Sengupta Aditya , Gauvreau Kimberlee , Bucholz Emily M , Newburger Jane W , Del Nido Pedro J , Nathan Meena
Published: June 2023

Introduction:
The multifaceted pathways through which a child’s environment impacts outcomes following congenital cardiac surgery remain incompletely characterized.

Hypothesis:
We hypothesized that childhood opportunity, measured using a US census-track-based, nationally-normed composite metric of contemporary neighborhood opportunity comprising 29 indicators across three domains (education, health or environment, and socioeconomic), would be a predictor of outcomes following congenital heart surgery.

Methods:
This was a single center, retrospective review of all patients who underwent congenital cardiac surgery from 01/2011-01/2020. Outcomes included pre-discharge (early) mortality, postoperative hospital length-of-stay (PHLOS), inpatient cost, post-discharge (late) mortality, and late unplanned reintervention. The primary predictor was child opportunity level (COL), categorized as very low, low, moderate, high, and very high. Associations were evaluated using multivariable logistic regression, generalized linear, Cox regression, or competing risk models.

Results:
Of 6133 patients, there were 124 (2.0%) early deaths, median PHLOS was 7 days (IQR 5-13 days), and median cost was $76,000 (IQR $50,000-$130,000). No significant association between COL and early mortality was noted (p=0.21). Children with very low and low COL had significantly longer hospitalizations and incurred higher costs compared to those with very high COL (all p<0.05). At up to 10.5 years of follow-up, very low COL patients had a significantly greater risk of late death (HR 1.7, 95% CI 1.1-2.6, p=0.030) and reintervention (SHR 1.9, 95% CI 1.5-2.3, p<0.001), versus those with very high COL (
Figure 1
).

Conclusions:
Child opportunity is independently associated with outcomes following congenital heart surgery. Children from resource-limited settings thus constitute an especially high-risk cohort that warrants closer surveillance and tailored interventions.
Abstract 9230: Intraoperative Residual Lesion Score Predicts Major Residua at Discharge and Early Unplanned Reinterventions Following Congenital Heart Surgery
Authors: Sengupta Aditya , Gauvreau Kimberlee , Kohlsaat Katherine , Colan Steven , Newburger Jane W , Del Nido Pedro J , Nathan Meena
Published: June 2023

Introduction:
The Residual Lesion Score (RLS) has recently been validated as an important predictor of outcomes following congenital heart surgery. However, its reliance on the pre-discharge echocardiogram limits its utility. We assessed the intraoperative RLS (IO-RLS) as a predictor of outcomes following congenital cardiac surgery.

Hypothesis:
We hypothesized that IO-RLS would be an independent predictor of outcomes following congenital heart surgery.

Methods:
This was a single center, retrospective review of consecutive patients who underwent congenital cardiac surgery from 01/2011-12/2019. For each index operation, IO-RLS was assigned per the intraoperative echocardiogram using previously published criteria: Class 1, no residua; Class 2, minor residua; Class 3, major residua. Outcomes included major pre-discharge residua or in-hospital unplanned reintervention (primary) and unplanned reinterventions at 1-year post-surgery (secondary). Associations were evaluated using multivariable logistic regression, adjusting for age, prematurity, Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) mortality category, and case complexity.

Results:
Of 6786 patients, 4743 (69.9%), 1903 (28.0%), and 140 (2.1%) patients had Class 1, 2, and 3 lesions, respectively. The primary outcome was observed in 988 (14.6%) patients. Both Class 2 and 3 patients had greater risk of the primary outcome (
Figure 1A
), compared to Class 1 patients. The predicted probability of major pre-discharge residua or in-hospital reintervention by STAT score and IO-RLS is shown in
Figure 1B
. At 1-year follow-up, 924 (13.6%) patients required reinterventions. IO-RLS Class 2 (OR 1.3, 95% CI 1.1-1.5, p=0.002) and Class 3 (OR 2.4, 95% CI 1.6-3.7, p<0.001) patients had greater risk of the secondary outcome, versus Class 1 patients.

Conclusions:
IO-RLS may be an important adjunct for self-assessment and quality improvement in congenital heart surgery.
Abstract 9234: Evaluating the Association Between Perceived Discrimination and Health Status Outcomes Among Young Adults Hospitalized for Acute Myocardial Infarction
Authors: Arakaki Andrew J , Dreyer Rachel P , Murphy Terrence , Wang Katie , Krumholz Harlan M , Lu Yuan , Adejumo Philip , Mori Makoto , DONOFRIO Gail , Spertus John , Lichtman Judith H
Published: June 2023

Background:
Perceived discrimination is associated with several risk factors for acute myocardial infarction (AMI), but little is known about the association between discrimination and health status outcomes post-AMI.

Methods:
We analyzed the 1- and 12-month health status of 2,670 young (≤ 55 years) adults recovering from an AMI enrolled in the VIRGO study (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients). Perceived discrimination was assessed using the Everyday Discrimination Scale (EDS). General health status was measured using the Short Form 12 Physical and Mental Component Scores (PCS and MCS). Disease-specific health status was measured using the following domains of the Seattle Angina Questionnaire (SAQ): treatment satisfaction (TS), quality of life (QL) and dichotomous forms of the physical limitation and angina frequency domain scores (score < 100). Lower scores indicate worse health status. Multivariable linear regression of the PCS, MCS, TS, and QL scores and multivariable logistic regression of the dichotomous forms of physical limitation and angina frequency were used to assess their adjusted associations with perceived discrimination.

Results:
Nearly 35.0% of the cohort reported discrimination (EDS > 0). At 1-month post-AMI, increased EDS score was significantly associated with lower MCS, TS, and QL scores and higher odds of physical limitation and angina after adjustment
(Figure)
. At 12-months post-AMI, increased EDS score retained its significant associations with lower MCS and QL scores and higher odds of physical limitation and angina, but not its association with TS
(Figure)
. The EDS score was not associated with PCS at either 1- or 12-months post-AMI.

Conclusions:
Perceived discrimination was associated with worse mental health and disease-specific health status one year after AMI after adjusting important confounders. Further work to understand the source and how to mitigate perceived discrimination is needed.
Abstract 9260: Rate of Progression of Aortic Stenosis in Patients With Cirrhosis
Authors: Elsner Nathaniel J , Nazif Abdulrahman , Arman Huseyin E , Ali Saad , Revtyak George , Kalra Ankur , Zenisek Joseph , Sinha Anjan , Kreutz Rolf , Frick Kyle
Published: June 2023

Introduction:
There is currently no published data studying the effect that cirrhosis may have on the rate of progression of aortic stenosis (AS). We hypothesize that AS may have accelerated progression in patients with cirrhosis compared with the general population due to high stroke volumes, hyperdynamic left ventricular function, and a pro-inflammatory state. The aim of this study is to determine the rate of progression of AS in patients with cirrhosis, elucidate risk factors, and assess progression based on the severity of cirrhosis as determined by Model for End Stage Liver Disease (MELD-Na) scores.

Methods:
This single center retrospective study included 48 patients with the diagnosis of cirrhosis and at least mild AS confirmed by two or more transthoracic echocardiograms (TTEs) taken ≥ 6 months apart. Historical data describing rates of AS progression in non-cirrhotic patients were used for comparison.

Results:
There was not a significant difference in the rate of AS progression between patients with cirrhosis and those without (table). Using univariate regression analysis, the yearly rate of aortic valve area (AVA) decline was positively correlated with the diagnosis of hyperlipidemia (HLD) (r=.228, P=0.047, B=0.116), initial AVA (r=0.504, P<0.001, B=0.224), initial left ventricular outflow track to aortic valve velocity time integral ratio (LVOT:AV VTI) (r=0.519, P<0.001, B=0.75) and initial left-ventricular stroke volume index (LV-SVI) (r=0.385, P=0.0070, B=0.0070). The yearly decrease of the LVOT:AV peak velocity ratio was inversely correlated with beta-blocker use (r=0.313, P=0.030, B=-0.047). There was not a significant relationship between MELD-Na scores and the rate of AS progression.

Conclusion:
Patients with cirrhosis can expect a similar rate of AS progression compared with those without cirrhosis. A higher initial LV-SVI and a history of HLD were both associated with faster AS progression in our study cohort.
Abstract 9316: Association of Racial and Educational Isolation on Outcomes in Infants With Congenital Heart Disease
Authors: Sooy-Mossey Meredith , Sethi Neeta , Mulder Hillary , Chiswell Karen , Hoffman Timothy M , Hartman Robert , Walsh Michael , Welke Karl , Paolillo Joseph A , Sarno Lauren , Sang Charlie J , Osgood Claire , DOttavio Alfred , Li Jennifer S , Miranda Marie Lynn
Published: June 2023

Introduction:
While race and socioeconomic status influence health outcomes in children with CHD, it is unknown whether neighborhood factors have additional effects
.

Hypothesis:
Using previously developed measures of racial and educational isolation indices (RII, EII), we predict that measures of social isolation implemented at the census block level are associated with increased complications, resource utilization and death in infants with CHD.

Methods
We identified patients < 1 year old undergoing CHD surgery in the CDC- NC CHD Surveillance database (2007-2012). We used negative binomial and logistic regression models to assess the case-mix adjusted associations between RII and EII and length of stay (LOS), mortality, post-operative complications, and resource utilization. RII used non-Hispanic White (NHW) race and EII used completed college as the reference groups (scale 0-1). Higher values of RII and EII indicate that NHBs are living in mostly NHB neighborhoods and non-college educated individuals are living in neighborhoods composed of mostly non-college educated individuals, respectively.

Results:
We included 1,217 infants who had CHD surgery at a mean age of 61 days (22% Black race, 14% Hispanic, and 34% Medicaid). Overall median RII (25
th
-75
th
) score was 0.18 (0.09-0.32) and EII was 0.79 (0.67-0.86). After adjusting for age, sex, race, ethnicity, disease severity, preterm birth and LOS, there was an association between RII and outpatient encounter with decreased utilization as RII increases up to 0.3 (p<0.001), then increased utilization as RII increases beyond 0.3 (p=0.017). NHB infants had increased LOS (p<0.001), other complications (p=0.025), ≥1 ED visit (p=0.059), and death (p=0.02) compared to NHW infants when controlling for RII. There was an association with a significantly increased risk of ≥1 ED visit (p=0.001) at EII above 0.8.

Conclusions:
RII is associated with outpatient encounters in a non-linear fashion. Black race is associated with longer LOS, complications, ED visits and death after adjusting for patient factors including RII. These differences may be caused by differential access to resources or community support. Investigation into effective interventions to improve health equity is essential.
Abstract 9317: Variability in Non-Vitamin K Oral Anticoagulant Dose Adjustment According to Renal Formulae and Clinical Outcomes in Atrial Fibrillation Patients: Insights From ORBIT-AF II
Authors: Yao Ren Jie Robert , Holmes DaJuanicia , Andrade Jason , Levin Adeera , Piccini Jonathan P , Fordyce Christopher
Published: June 2023

Background:
Non-Vitamin K Oral Anticoagulants (NOACs) require dose adjustment based on kidney function. Glomerular filtration rate (eGFR) is most commonly used in clinical practice, but product monographs recommend the use of Cockcroft-Gault creatinine clearance equation (eCrCl) for dose adjustment. We sought to evaluate misclassification of NOAC renal dosing using eGFR versus eCrCl.

Methods:
We included patients enrolled in the ORBIT-AF II trial. eGFR was calculated using both the MDRD and CKD-EPI formulae. Dose adjustments and eligibility were based on landmark trials. Dosing was considered inappropriate when use of eGFR resulted in a lower (under-treatment) or higher (over-treatment) dose than that recommended by eCrCl. Agreement in NOAC dosing between eCrCl and eGFR was assessed. The primary outcome of major adverse cardiovascular and neurological events (MACNE) was a composite of cardiovascular death, stroke or systemic embolism, and myocardial infarction. Sensitivity analysis was performed for the subgroup of patients with CKD (eCrCl<60 ml/min).

Results:
Among 8,727 in the overall cohort, agreement between CrCl and eGFR was observed in 93.5-93.8% of patients. Among 2,184 patients with CKD, the agreement between eCrCl and eGFR was 79.9-80.7%. Dosing misclassification was observed in 11.5% of rivaroxaban and 1.1% of dabigatran and apixaban treated patients. Patients receiving an inappropriate NOAC dose had a lower mean eCrCl and eGFR. Undertreated patients were older and of lower body weight compared to overtreated and appropriately dosed patients. Dosing misclassification was more frequent in the CKD population (41.9% of rivaroxaban, 5.7% of dabigatran and 4.6% apixaban patients). At one-year, undertreated patients in the CKD group had significantly greater MACNE [adjusted HR 2.90 (1.09-7.75) compared to appropriate NOAC dosing group p = 0.03].

Conclusions:
The prevalence of NOAC dosing misclassification NOACs was high when using eGFR, particularly among those with CKD. Among patients with CKD, potential undertreatment due to inappropriate and off-label renal formulae may result in worse clinical outcomes. These findings highlight the importance of using eCrCl, and not eGFR, for dose-adjustment in all AF patients receiving NOACs.
Abstract 9373: Single Evaluation of Body Mass-Corrected Estimated Plasma Volume at Discharge Predicts Prognosis of Heart Failure Patients
Authors: Kuroda Kazuhiro , Tanaka Masamichi , Yumoto Akihisa , Fuke Soichiro
Published: June 2023

Background:
Estimated plasma volume(ePV) is a parameter of body fluid volume trends in the same patient and also an indicator for residual congestion. Patients with heart failure often have difficulty achieving adequate body fluid volume. We investigated the post-discharge prognosis of heart failure patients with a one-time evaluation of ePV at discharge corrected for body mass index (BMI).

Methods:
This is a single-center, prospective observational study. A total of consecutive 1268 heart failure hospitalizations, excluding acute coronary syndromes, from January 2018 to December 2021 were included. We evaluated 767 patients, excluding repeat hospitalizations of the same patient (366 cases), in-hospital deaths (54 cases), transfers for cardiac surgery and forced discharges (39 cases), and missing data (42 cases). A prognosis investigation was conducted for patients who haven’t visited our hospital for more than one year. BMI and ePV (ml, Hakim's formula) were calculated from height, weight, and hematocrit at discharge. Survival analysis was performed with ePV divided by BMI (ePV/BMI). Primary endpoint was composite of all-cause mortality and heart failure re-hospitalization.

Results:
median of 372 days of post-discharge observation, 205 deaths, and 336 composite endpoints were observed. ePV/BMI was categorized into three quartiles [low group (65.34-96.8), middle group (96.9-111.9) and high group (112.0-175.8)]. Survival analysis by ePV/BMI three tertiles showed a combined endpoint of death + rehospitalization (48.8 vs 69.2 vs 74.9%, log-rank P<0.001) and death (11.7 vs 20.9 vs 24.7%, log-rank P<0.001) at three years, respectively. Multivariable Cox proportional hazard model with covariant univariable predictive factors (age, severe kidney dysfunction, beta-blocker, angiotensin-converting enzyme inhibitor, psychotropic or cognitive medicines, in-hospital blood transfusion, low nutritional status) shows higher ePV/BMI tertile (HR1.44, 95%CI:1.26-1.64, p<0.001), as well as the continuous variable of ePV/BMI (HR1.02, 95%CI:1.01-1.03, p<0.001), is a predictive factor of the composite endpoint.

Conclusion:
Even after therapeutic intervention, ePV/BMI at discharge is a useful predictor of heart failure outcome.
Abstract 9374: Machine Learning on Automated Measurement of 12 Leads Electrocardiography Can Predict Appropriate Shock in Patients With Implantable Cardioverter Defibrillator
Authors: Shimizu Masato , Isshiki Ami , Ryo Tateishi , Tsunoda Takahiro , Miyazaki Hiroko , Misu Yoshiki , Yamaguchi Masao , Yamakami Yosuke , Kato Nobutaka , Shimada Hiroshi , Kimura Shigeki , Fujii Hiroyuki , Suzuki Makoto , Nishizaki Mitsuhiro , Sasano Tetsuo
Published: June 2023

Introduction:
Prediction for appropriate shock in patients with implantable cardioverter defibrillator (ICD) is still challenging. We tried to predict the shock by machine learning (ML) model on automated microvolt-level measurement of 12-leads electrocardiography (ECG).

Hypothesis:
ML on 12-leads ECG can predict appropriate ICD shock.

Methods:
Consecutive 177 patients (61.5±14.4years, 141males, organic heart disease: 121cases) with ICD were enrolled. ECG was measured by ECAPs12c system (Nihon-Koden) at ICD implantation. Shock was defined as appropriate ICD shock and anti-tachycardia overdrive pacing. Statistic significant predictors were extracted by univariate Cox regression analysis. Because of many correlation/confounding/multicollinearity among the predictors, multivariate Cox was not performed, and machine learning (ML) predictive model was utilized to compare the importance of the predictors.

Results:
Fifty-six patients were treated by appropriate shock during the observation period (median during implantation to shock: 1.85years). Thirteen significant predictors were extracted, and T-axis showed the smallest P value of univariate Cox (P=0.0007). Random Forest Classifier model demonstrated high accuracy (0.740) and T-axis showed the most important role to build the model. Receiver operating characteristics (ROC) curve analysis indicated the cut-off value as 105 degree, and Kapan-Meier curve analysis demonstrated T-axis ≥105 degree group showed worse prognosis than T-axis >105 degree group.

Conclusions:
ML of microvolt-level measurement of 12-leads ECG potentially had high predictive value for appropriate shock of ICD, and T-axis played an essential role for the prediction.
Abstract 9397: Sex-Based Differences in Outcomes After Mitral Valve Repair for Severe Secondary Mitral Regurgitation
Authors: Nappi Francesco , Di magli Arnaldo , Nenna Antonio , Umberto Benedetto , Chello Massimo
Published: June 2023

Background:
Sex-based differences in outcomes after mitral valve repair for severe secondary ischemic mitral regurgitation (SIMR) is poorly understood. We examined differences in outcomes between men and women after mitral valve repair for severe SIMR.

Methods:
96 patients with SIMR were randomized to undergo either papillary muscle approximation (PMA) with restrictive mitral annuloplasty (RMA) or RMA alone to evaluate efficacy and safety. The primary endpoint was death and major adverse cardiac or cerebrovascular events (MACCE) at 5 years.

Results:
38 of the 96 enrolled (39.5%) were women. Five-year survival was 68% in women and 78% men (HR 1.48; 95% CI 0.67-3.24). Men and women had similar mortality rates in the PMA (HR 2.64; 95% CI 0.77-9.04) and RMA group (HR 0.93; 95%CI 0.31-2.78). Freedom from MACCE at 5 years was lower among women than men (6% vs 23%; HR 1.89; 95%CI 1.20-2.98). The hazard for MACCE was higher in women in the PMA group alone (HR 3.00; 95% CI 1.50-6.02). Freedom from treatment failure was similar between sexes (55% in women and 69% in men; HR 1.58; 95% CI 0.81-3.06). Similar functional status (26.3% vs 24.1%) and rehospitalization rates (23.7% vs 24.1%) were noted at 5 years. There were no significant differences in the percentage of change over 5 years in LVESD and LVEDD between the sexes.

Conclusion:
Women with SIMR who underwent mitral valve repair displayed no significant differences in the degree of five-year survival. MACCEs however, recurred more frequently in women.
Abstract 9401: Impact of Visceral Abdominal Tissue on Coronary Artery Disease as Defined by Quantitative Computed Tomographic Angiography
Authors: Karlsberg Daniel , Steyer Henry , Fisher Rebecca , Crabtree Tami , Min James K , Earls James , Rumberger John A
Published: June 2023

Introduction:
Obesity has long been associated with all-cause mortality and cardiovascular disease (CVD). Visceral abdominal tissue (VAT) has been proposed as an important CVD risk stratification metric and has been shown to correlate with the extent and severity of coronary artery plaque. This study aims to clarify the relationship between the presence and severity of VAT with the presence and severity of coronary artery plaque as defined by total plaque volume (TPV), calcified plaque (CP) volume, non-calcified plaque (NCP) volume, and high risk low-density non-calcified plaque (LD-NCP) using quantitative coronary computed tomography atherosclerosis imaging (AI-QCT).

Methods:
We reviewed 145 consecutive patients who had undergone CCTA and CT visceral fat analysis for health screening purposes. Atherosclerosis imaging - quantitative computed tomography (AI-QCT) was performed for TPV, percent atheroma volume (PAV), and the presence of stenosis. We segmented atherosclerosis by composition for CP, NCP and LD-NCP.

Results:
The mean age of the patients was 56.1 ± 8.5 years, 84.0% male. Overall, 3.5% had a history of diabetes, 19% hypertension, 38% dyslipidemia, 8% current smokers, and 34% had a family history of CAD. There was a stepwise progression of the median coronary plaque volume for each quartile of visceral fat including total plaque volume (Q1: 19.8, Q2: 48.1, Q3: 86.4, and Q4: 136.6 mm
3
(P=0.0098)), NCP (Q1: 15.7, Q2: 35.4, Q3: 86.4, and Q4: 136.6 mm
3
(P=0.0032)) and LD-NCP (Q1: 0.6, Q2: 0.81, Q3: 2.0, and Q4: 5.0 mm
3
(P<0.0001)).

Conclusion:
Our findings represent the first demonstration of a stepwise progression with regards to visceral abdominal tissue and total plaque volume, non-calcified plaque volume, and, particularly of note, low density non-calcified plaque volume. A stepwise progression as demonstrated here may indicate the future usefulness of VAT in CVD risk stratification and its role in longitudinal preventive care.
Abstract 9422: Tandem Deep Learning and Logistic Regression Models to Optimize Hypertrophic Cardiomyopathy Detection in Routine Clinical Practice
Authors: Maanja Maren , Siontis Konstantinos , Geske Jeffrey B , Ackerman Michael J , Arruda-Olson Adelaide A , Ommen Steve R , Attia Zachi , Friedman Paul , Noseworthy Peter A
Published: June 2023

Background:
An electrocardiogram (ECG)-based artificial intelligence (AI) algorithm has shown good performance in detecting hypertrophic cardiomyopathy (HCM AI-score). However, its clinical application may be challenging due to the low disease prevalence and potentially high false-positive rate when screening unenriched cohorts.

Aims:
To identify clinical characteristics associated with false-positive HCM AI-score results to improve screening tool application.

Methods:
From a cohort of 20,677 patients with a digital 12-lead ECG in routine clinical practice in 2021, we performed a detailed chart review of the 200 patients with highest HCM AI-score to determine their HCM status and collect clinical data. Stepwise forward logistic regression was used to create a clinical variable-based “candidacy for HCM screening” score (CHS score), differentiating true- and likely true-positive from likely false-positive HCM AI-score results. We then validated the CHS score in 200 patients with the highest HCM AI-scores from an independent cohort of 15,147 patients with an ECG in 2022.

Results:
Among the 200 patients in 2021 (median age 71 years, 48% female), 96 (48%) were likely false-positive HCM AI-score results, 71 (36%) definite or likely true-positive results, and 33 (16%) indeterminate. The CHS score included a history of surgical septal myectomy, coronary artery bypass graft surgery, cardiac valve replacement, and pacemaker, and had an AUC of 0.88 (95% CI 0.83-0.92) for the differentiation of true- versus false-positive AI results. In the 2022 cohort, the CHS score had an AUC of 0.82 (95% CI 0.76 - 0.88). After limiting the cohort to HCM candidates identified by the CHS score, the false-positive results rate was reduced to 27/114 (24%).

Conclusions:
By applying the CHS score to patients with positive HCM AI-screening results, the false-positive rate decreased from 49% to 24%. Utilizing a clinical model used in tandem with an AI model improved diagnostic yield.
Abstract 9438: Serial Troponin T and Long-Term Risks of Myocardial Infarction and Revascularization in Patients With Suspected Acute Coronary Syndrome
Authors: Pareek Manan , Kragholm Kristian , Kristensen Anna Meta D , Biering-Srensen Tor , Byrne Christina , Fosbol Emil L , Kober Lars , Gislason Gunnar , Olsen Niels Thue , Bhatt Deepak , Torp-Pedersen Christian
Published: June 2023

Introduction:
Long-term prognostic implications of serial high-sensitivity troponin concentrations in patients with suspected myocardial infarction (MI) are unknown.

Hypothesis:
To determine short- and long-term risks of MI and revascularization (PCI or CABG) according to high-sensitivity troponin T (hsTnT) concentrations and their changes from baseline, in patients with suspected acute coronary syndrome.

Methods:
Retrospective cohort study based on Danish national registries. We identified all patients discharged from the hospital with either MI, unstable angina, suspected MI, or chest pain from January 2012 through December 2019 and merged them with records of two serial hsTnT measurements obtained 1-7 hours apart. Absolute risks of MI and revascularization were calculated through multivariable logistic regression with average treatment effect modeling (G-formula), with patients stratified in groups according to normal and elevated concentrations and relative changes of 20% and 50% from baseline.

Results:
Complete data were available in 28,902 individuals (median age [25
th
-75
th
percentile] 65.2 [53.4-75.4] years, 11,632 [40.2%] women). The standardized risk of MI was highest in individuals with two elevated hsTnT concentrations (0-30 days: 54.1%, 31-365 days: 9.7%) and lowest in those with two normal values (0-30 days: 2.5%, 31-365 days: 0.4%). In the latter group, the risk of MI did not appear to depend on the relative hsTnT change between samples while in persons with two elevated hsTnT concentrations, the risks at both 0-30 days and 31-365 days increased in a stepwise fashion with more pronounced hsTnT rises. Individuals with a >20% to 50% fall also had a higher risk of MI than those with a less pronounced change while results were not significant for those with a >50% fall. Finally, individuals who went from a normal to an elevated hsTnT level and had a concomitant >50% rise had a significantly higher risk of MI at days 0-30 than those with a less pronounced rise. The standardized likelihood of undergoing coronary revascularization according to serial hsTnT concentrations followed the same pattern.

Conclusions:
Serial hsTnT measurements identify patients at long-term risk for both MI and revascularization.
Abstract 9460: Comparing Mortality Outcomes With Different Rate Controlling Agents in Patients With Atrial Fibrillation
Authors: Cordova Andres , Shmorgon Gary , Olonoff Danielle , Akula Sruti , Chaudhuri Debanik
Published: June 2023

Introduction:
There is lack of information regarding the mortality benefits between different medications in patients with permanent atrial fibrillation (AF).

Purpose:
We aimed to identify if there is any difference in mortality between the use of different rate controlling medications in patients with permanent AF.

Methods:
We identified patients with permanent AF without history of heart failure (HF) by using the TriNetX research database which provides information from electronic medical records from several health care institutions primarily based in the United States. Patients were divided in 4 cohorts, those taking metoprolol, diltiazem, carvedilol, or atenolol. Propensity score matching (PSM) was used to equilibrate the cohorts based on past medical history and medications. The cohorts were compared amongst each other after PSM.

Results:
There was no difference in mortality, emergency room visits, or hospitalizations with the use of different rate-controlling medications.

Conclusion:
This study suggests that there is no difference in mortality with the use of metoprolol, carvedilol, atenolol, or diltiazem in patients with permanent AF without history of HF.
Abstract 9482: Coronary Spasm in a Patient With Argininosuccinic Aciduria
Authors: Nagayoshi Yasuhiro , Nagano Haruka , Nishihara Taiki , morikawa kei , Nishi Masato , Sakaino Naritsugu , Nakayama Masafumi , Tsujita Kenichi
Published: June 2023

Case presentation:
A 39-year-old male patient was referred for the treatment of hypertension. The patient had been treated for argininosuccinic aciduria (ASA) since eight months of age. Therapeutic drugs including, L-arginine, sodium phenylbutyrate and antiepileptic drugs had been administered. A detailed medical history taking revealed that the patient sometimes complained of chest discomfort under psychological stress. A 12-lead electrocardiogram showed abnormal q waves in lead III and aVF. Transthoracic echocardiography showed hypokinesis of left ventricular posterior wall. Endothelial function was quantified with brachial artery flow-mediated dilatation (FMD). The patient’s FMD value was 2.4% (normal cut off value 7.0%). Coronary computed tomography angiography showed no significant coronary stenosis. Cardiac magnetic resonance revealed transmural late gadolinium enhancement in the mid-ventricular level of the left ventricular posterior wall. The patient was suspected to have prior myocardial infarction. The patient was started on amlodipine and irbesartan, however, he continued to complain of chest discomfort at rest. Cardiac catheterization was performed to make a definitive diagnosis. The acetylcholine spasm provocation test revealed diffuse left and right coronary vasospasm. Transient ST-segment elevation with chest discomfort was observed. The patient was diagnosed as having coronary spastic angina. Chest discomfort was disappeared after additional administration of isosorbide mononitrate.

Discussion:
ASA is a genetic disorder of the urea cycle, caused by deficiency of argininosuccinate lyase (ASL). Specific laboratory findings are hyperammonemia, argininosuccinic acidemia and low plasma arginine levels. ASL is required to utilize extracellular arginine for NOS-dependent NO synthesis in endothelial cell. Reduction of ASL enzymatic activity leads to decline in NO production even if arginine is supplemented. Efficacy of NO supplementation for treatment of long-term complications in ASA patients has been reported. The precise mechanisms of coronary spasm remain to be elucidated. Our case report might support the significance of endothelial function in the pathogenesis of coronary spasm.
Abstract 9485: Role of Fatty Acid Oxidation in Heart Function
Authors: Kim Chai-wan
Published: June 2023

Introduction:
More than 70% of the energy used by myocardial cells is from fatty acid oxidation (FAO), but excessive FAO may also cause cardiac dysfunction due to increased cardiac oxygen consumption. Inhibition of cardiac FAO has been tested in animal models and human subjects with chronic heart failure, but its absolute benefit is still unclear. Here, we generated myocyte-specific ACC1 and 2 knockout mice (ACC dHKO) to investigate the role of FAO in cardiac function.

Methods:
ACC dHKO were generated by crossing ACC1 and ACC2 floxed mice with Myh6-CRE transgenic mice. Cardiac FAO was measured by Langendorff perfusion. Etomoxir was administered to inhibit FA oxidation. FA composition and cardiolipins were measured by LC/MS and mitochondrial electron transport chain (mETC) was assessed using Seahorse.

Results:
ACC dHKO mice developed a dilated cardiomyopathy at 7-8 weeks, which progressed with age (A, B). Perfusion studies demonstrated that hearts from ACC mice exhibit increased FA oxidation. Cardiac fatty acid composition analysis showed a severe deficiency of cardiolipin due to a significant decrease in linoleic acid, presumably due to excessive FA oxidation (C). Cardiac mETC in ACC dHKO was significantly compromised compared to control mouse (D). Etomoxir, which blocks FAO, normalized levels of cardiac linoleic acid and cardiolipins, and prevented the development of the dilated cardiomyopathy in ACC dHKO (E).

Conclusions:
Deletion of ACCs in heart led to unrestrained FAO, mitochondrial dysfunction, and a dilated cardiomyopathy., which could be prevented by administration of drugs that suppress FA oxidation. This study provides evidence that elevated rates of mitochondrial FA oxidation can be detrimental and suggests that efforts to further increase FA oxidation in a failing heart may not enhance function.
Abstract 9506: Calpain Activation in Early Reperfusion Triggers Pyroptosis Resulting in Myocardial Ischemia/Reperfusion Injury
Authors: Cohen Michael V , Yang Ximing , Sayner Sarah , Audia Jonathon , Downey James
Published: June 2023

Sterile inflammation contributes to reperfusion injury. During myocardial ischemia/reperfusion (I/R), inflammasomes proteolytically activate caspase-1 (cas-1) which then kills cardiomyocytes by liberating N-terminal fragments of gasdermin D which form large pores in the sarcolemma (pyroptosis). We and others find hearts from cas-1 knockout (KO) mice have less myocardial infarction (MI) after I/R than those of wild type (WT) hearts. Pharmacologic cas-1 blockade when administered prior to ischemia or at the onset of reperfusion provides similar protection against MI but protection is lost when blockade is started 10min after reperfusion revealing that cas-1 does its killing in the first 10min of reperfusion. We wondered what could trigger cas-1 activation at reperfusion. Ca
++
floods myocytes at reperfusion making Ca
++
a suspect. We tested if adenyl cyclase isoform 10 (AC10), which is stimulated by Ca
++
and in one study promoted I/R injury in cardiomyocytes, could be responsible. However, there were no differences in infarct size among AC10
-/-
KO, AC10
-/+
heterozygous, and WT buffer-perfused mouse hearts after 50min global ischemia/2h reperfusion. Ca
++
also activates calpain which releases membrane-bound inactive procas-1 which is required for infammasome assembly. Adding calpain antagonist calpeptin (CPT) to the perfusate of isolated AC10
-/+
hearts reduced MI from 90% of risk zone to 55% (p<0.001). Cas-1 KO mouse hearts were similarly protected after I/R (40% infarction) and treating KO hearts with CPT resulted in no added protection suggesting both cas-1 and calpain are steps in the same mechanism of cell killing. This result was amplified by lack of added protection when mice received combined CPT and emricasan (EMRI), a pan-cas blocker. In contrast, EMRI plus preconditioning does give additive protection. Hence calpain activity in the initial minutes of reperfusion is also involved in injurious pyroptosis and may be a viable target in treatment of acute MI.
Abstract 9511: Sex Difference of Fibrous Cap Collagen Content in Patients With Coronary Artery Disease: An Intravascular Polarimetry Study
Authors: Otuska Kenichiro , van zandvoort laurens , Villiger Martin , Nadkarni Seemantini , Tanaka Atsushi , Fukuda Daiju , Daemen Joost , Bouma Brett E
Published: June 2023

Introduction:
Intracoronary optical coherence tomography (OCT) polarimetry (OCT-polarimetry) enables to provide polarization properties (birefringence and depolarization) of the tissues in the coronary arterial wall together with coronary plaque microstructures. Collagen and smooth muscle cells exhibit birefringence, while depolarization is increased by the presence of macrophages and lipid components.

Hypothesis:
We hypothesized that there exists sex difference in collagen content of coronary plaques by measuring polarization properties of the coronary arterial walls.

Methods:
We analyzed 41 coronary lesions imaged with intracoronary OCT-polarimetry in 38 patients with CAD (ACS, n = 24 and chronic CAD, n = 14). Conventional OCT analysis included lesion-level qualitative analysis (fibrous cap thickness, presence of plaque rupture, macrophages, thrombus, layered plaque, cholesterol crystals) and quantitative analysis (lipid-burden index, calcium arc and length, and vessel lumen area). Polarimetric analysis was performed on OCT cross-sectional images with the thinnest fibrous cap of the lesion, blinded to the conventional OCT analysis results. The measurements were compared between male (n = 27) and female (n =11) using a generalized linear model with generalized estimating equations.

Results:
In this study population, ACS was more frequently observed in female patients compared to male patients (91% v.s. 52%, p<0.05). There was no significant difference in the conventional OCT measurements, while male patients exhibited a greater lipid-index compared to female patients. Although depolarization was comparable between the two groups, significantly lower birefringence was observed in female patients as compared to male patients (p-values < 0.05). A GEE model demonstrated that birefringence was independently and positively associated with male sex (beta, 1.4; 95% confidence interval 0,42-2,4; p =0.005), even after adjusting for age, ACS, and lipid-burden index.

Conclusions:
This study is the first to report sex difference in the polarization properties of coronary plaque fibrous cap. Intracoronary OCT-polarimetry opens the possibility of elucidating the mechanism of plaque destabilization through collagen remodeling.
Abstract 9520: Referral From a Regional Facility is Associated With Higher One Year Mortality in Patients With Infected Cardiovascular Implantable Electronic Devices
Authors: Farooq Waseem , Kalot Mohamad , Bahuva Ronak , Pandey Rohan , Khan Aalia , Kerling David , Aftab Hamza , Gupta Shilpi , Smith Morgan , Kovacs Alexander , Mir Ali , Amuthan Ram , Sharma Umesh C
Published: June 2023

Introduction:
The use of Cardiac Implantable Electronic Devices (CIEDs) has increased considerably over the past few decades driven by evolving device technology and expanding indications. CIED infections are an important consideration given their clinical and economic impact.

Hypothesis:
This study sought to assess the impact of regional referral versus direct presentation to expert tertiary care facility in patients with infected CIED.

Methods:
Retrospective analysis of a regional database of patients presenting with CIED infection to medical centers across Western New York, USA from 2012 - 2020. We compared the 1-year mortality among the patients presenting directly to expert tertiary care facilities versus those referred from regional facilities.

Results:
A total of 296 patients (74% male, age 69.2 ± 13.7) were included in the study of which 290 (98%) underwent CIED extraction (Table 1). Of the 296 patients, 99 (33.4%) presented from regional centers and 197 (66.5%) presented directly to expert centers. 24 (24.2%) patients referred from regional centers died within one year as compared to 28 (14.2%) patients presenting to expert tertiary care facilities (p=0.02) (Figure 1).

Conclusions:
In patients with CIED infections, referral from a regional facility is associated with worse outcomes. This may relate to the delay in definite management and underscores the importance of early identification and the need for a robust referral infrastructure to improve patient outcomes.
Abstract 9529: METTL3 Mediates Ang-II Induced Cardiac Hypertrophy Through Accelerating Pri-miR-221/222 Maturation in m6A Way
Authors: Zhang Rui , Qu Yangyang , Ji Zhenjun , Hao Chunshu , Su Yamin , Yao Yuyu , Zuo Wenjie , Chen Xi , Yang Mingming , Ma Genshan
Published: June 2023

Background:
METTL3, a core catalytic enzyme in m6A, is involved in a variety of cardiovascular diseases. However, whether and how METTL3 plays a role during Angiotensin II (Ang-II) induced myocardial hypertrophy is still unknown.

Methods:
Neonatal rat cardiomyocytes (NRCMs) and C57BL/6J mice were treated with Ang-II to induce myocardial hypertrophy. qRT-PCR and Western blots were used to detect the expression of RNAs and proteins. Genes function was verified by knockdown and/or overexpression respectively. Luciferase and RIP assays were used to verify interactions among multiple genes. Wheat germ agglutinin (WGA), hematoxylin and eosin (H&E) and immunofluorescence were used to examine myocardial size. m6A methylation was detected by a colorimetric kit.

Results:
METTL3 and miR-221/222 expression and m6A levels, were significantly increased in response to Ang-II stimulation. Knockdown of METTL3 or miR-221/222 could completely abolish the ability of NRCMs to undergo hypertrophy. The expression of miR-221/222 was positively regulated by METTL3, and the levels of pri-miR-221/222 that bind to DGCR8 or form m6A methylation were promoted by METTL3 in NRCMs. The effect of METTL3 knockdown on hypertrophy was antagonized by miR-221/222 overexpression. Mechanically, Wnt/β-catenin signaling was activated during hypertrophy and restrained by METTL3 or miR-221/222 inhibition. The Wnt/β-catenin antagonist DKK2 was directly targeted by miR-221/222, and the effect of miR-221/222 inhibitor on Wnt/β-catenin was abolished after inhibition of DKK2. Finally, AAV9-mediated cardiac METTL3 knockdown was able to attenuate Ang-II induced cardiac hypertrophy in mouse model.

Conclusions:
Our findings suggested that METTL3 positively modulates the pri-miR221/222 maturation process in m6A dependent way and subsequently activates Wnt/β-catenin signaling by inhibiting DKK2, thus promoting the Ang-II induced cardiac hypertrophy.
Abstract 9562: High Sensitivity C Reactive Protein and Recurrence After Catheter Ablation for Atrial Fibrillation: A Meta-Analysis
Authors: Jaroonpipatkul Surachat , Trongtorsak Angkawipa , Kewcharoen Jakrin , Thangjui Sittinun , Bunyawannukul Issaree , Pokawattana Apichai , Navaravong Leenhapong
Published: June 2023

Introduction:
The recurrence after atrial fibrillation (AF) ablation is not uncommon. High sensitivity C reactive protein (hs-CRP) is one of the widely used inflammatory markers. We conducted meta-analysis to find association between hs-CRP levels and AF recurrence after ablation.

Hypothesis:
Higher level of high sensitivity C reactive protein (hs-CRP) may predict the rate of AF recurrence.

Methods:
We searched PubMed, Embase and Wiley-Cochrane library from inception to January 1, 2022. Overall and subgroup analyses were performed. Weighted mean difference (WMD) and 95% confidence interval (CI) were used to evaluate the associations between hs-CRP levels and post-ablation AF recurrence. Statistical analysis was performed with Stata 14.0. The primary endpoint of this study is to investigate the association of AF recurrence after catheter ablation and hs-CRP levels.

Results:
We identified ten studies and total 789 patients were included (299 recurrent vs 490 non-recurrent patients). The mean age was 57.7 years (76.4 % male). There was no different in baseline hs-CRP levels between AF recurrence and non-recurrence groups (WMD = 0.05, 95% CI = -0.04-0.15, p = 0.045). However, higher follow-up CRP levels after ablation was associated with higher AF recurrence (WMD = 0.09, 95% CI = 0.03-0.15, p <0.001)(Figure 1 and 2).

Conclusions:
Higher post ablation hs-CRP level was associated with more AF recurrence. Hs-CRP may play a role as predictor of AF recurrence.