bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 11099: Body Mass Index and Association With Unguided De-Escalation From Ticagrelor to Clopidogrel in the TALOS-AMI Trial
Authors: Bu Seonghyeon , Lim Sungmin , Jang Jaehyuk , Ahn Hyo-Suk , Kim Chan Joon , Lee Jong-Min , Park Mahn Won , Hwang Byung-Hee , Lee Kwan Yong , Choo Eunho , Chang Kiyuk
Published: June 2023

Introduction:
Potent antiplatelet therapy has a high bleeding risk after acute myocardial infarction, so de-escalation from ticagrelor to clopidogrel has recently been introduced. But, optimal de-escalation strategy according to BMI is unclear.

Method
In TALOS-AMI trial, patients with acute myocardial infarction receiving aspirin and ticagrelor after index percutaneous coronary intervention (PCI) were investigated. This post hoc study determined the efficacy and safety of de-escalation (clopidogrel plus aspirin) compared with active control (ticagrelor plus aspirin) across a range of patient BMIs.

Results
Among 2,686 randomized patients, 1,558 (58.0%) had 18.5 ≤BMI <25 kg/m2, 935 (34.8%) had 25 ≤ BMI < 30 kg/m2, and 154 (5.7%) had BMI ≥ 30 kg/m2. The combination of clopidogrel plus aspirin compared with ticagrelor plus aspirin reduced in the primary outcome led by bleeding events reduction, in 18.5 ≤BMI <25 kg/m2. For 18.5 ≤BMI <25 kg/m2: 4.3% vs. 7.9%; hazard ratio (HR): 0.516 (95% confidential interval [CI]: 0.334 to 0.797); 25 ≤ BMI <30 kg/m2: 4.9% vs. 7.1%; HR: 0.674 (95% CI: 0.389 to 1.166); BMI ≥30 kg/m2: 1.2% vs. 4.2%; HR: 0.284 (95% CI: 0.029 to 2.792).

Conclusion
In conclusion, our results suggest that in the patients of 18.5 kg/m2 ≤BMI <25 kg/m2, with acute myocardial infarction after index PCI, de-escalation strategy is better net clinical outcome, mainly by reducing the bleeding events. But, there are no differences between two groups BMI ≥25 kg/m2.
Abstract 11112: Frailty is Associated With Increased Mid-Term Mortality After Cabg, Independent of Age: A Nationwide Analysis of the Veteran Affairs Data
Authors: Deo Salil , Kochar Ajar , Charest Brian , Petermann-Rocha Fanny , Elgudin Yakov , Chu Danny , Yeh Robert W , Rao Sunil V , Kim Dae Hyun , Driver Jane , Hall Daniel , Orkaby Ariela R
Published: June 2023

Introduction:
Guidelines recommend considering patient age when choosing coronary revascularization strategies. However, compared with pre-operative frailty, chronologic age provides limited insight into perioperative risk as the population ages.

Hypothesis:
In Veterans, pre-operative frailty, independent of age, will influence 5-year mortality after coronary artery bypass grafting surgery (CABG).

Methods:
Using the validated VA frailty index (VA-FI), we grouped patients into non-frail (0 - 0.1), pre-frail (>0.1 - 0.2), and frail (>0.2) categories. To determine the association between frailty categories and 5-year mortality we fit a multi-level adjusted Cox proportional hazards model using non-frail patients as the referent. We obtained days in hospital (DIH) in the first postoperative year for all groups and compared results with the Wilcoxon test.

Results:
Among 13,554 patients (2016 - 2020) who underwent CABG (mean age 67 years; 98.5% males, 79% white), 54% 36% and 22% had diabetes mellitus, chronic kidney disease and heart failure respectively. The mean pre-operative VA-FI was 0.21(0.1); 31% were pre-frail and 47% were frail. Frailty prevalence was highest in those <60 years (741/1,416 (52%) compared with 60 - 80 years (2,151/8,735 (25%)) and >80 (79/511 (15%)). The 5-year mortality rate (per 1000 patient-years) was higher in frail patients [54.4 (51.4, 57.7); HR (95% CI) 1.75 (1.54,2.00)] and pre-frail [35 (32.1, 38.3); HR 1.2 (1.08,1.34)] than non-frail patients [27.1 (24, 30.6)]. Compared with non-frail patients (mean 2.7
+
11.6 days), pre-frail (3.9
+
13.9; p < 0.01) and frail (6.3
+
17.6; p < 0.01) spend more days in the hospital in the first post-operative year.

Conclusions:
Irrespective of age, frailty and pre-frailty were prevalent among US Veterans undergoing CABG and were associated with increased mortality risk and longer hospital length of stay, highlighting the need to evaluate for frailty, even among young patients.
Abstract 11115: Impella Preserves Systemic, Coronary, and Cerebral Blood Flows During Ventricular Fibrillation by Establishing the Acute Fontan Circulation
Authors: Yokota Shohei , Maruhashi Takaaki , Matsushita Hiroki , Kakuuchi Midori , Yokoi Aimi , Nishiura Akitsugu , meihua Li , Kawada Toru , Uemura Kazunori , Saku Keita
Published: June 2023

Introduction:
The ventricular fibrillation (VF) often occurs in acute heart failure patients with Impella support, percutaneous transvalvular left ventricular assist device. Although Impella can preserve blood pressure in some VF patients, the hemodynamic mechanism of Impella during VF remains unclear.

Aim:
In this study, we examined the impact of Impella on hemodynamics and cerebral and coronary blood flows in a goat model of VF. We also addressed the optimal blood volume status to maintain the Impella circulation during VF.

Methods:
In six goats, we inserted Impella CP via the left carotid artery. We simultaneously recorded right (RAP) and left atrial pressure (LAP), central blood pressure at ascending aorta (CBP), and the blood flows of pulmonary artery (PA), left coronary circumflex artery (LCX), and right carotid artery (CA). The VF was induced by direct current. We compared the impact of Impella support level (P0, P4 and P8) on hemodynamics and each blood flow. Under P8-Impella supported VF condition, we withdrew blood continuously and observed the left ventricular (LV) suction point at which a frequent negative LV pressure occurred.

Results:
As shown in Fig. 1 and 2, Impella maintained hemodynamics flow-dependently, indicating the establishment of acute Fontan circulation. In P8-Impella support, systemic (PA flow), LCX and CA blood flows were preserved by 50.1±27.7, 50.7±12.5 and 67.3±5.6%. from baseline, respectively. The blood volume reduction induced the suction of Impella (Fig. 3) at RAP below 9.9±1.9 mmHg.

Conclusions:
Impella establishes the acute Fontan circulation and preserves hemodynamics including coronary and cerebral blood flows during VF. The optimal blood volume status should be considered to maintain the Impella operation during VF.
Abstract 11117: Phase 1 Danon Disease Results: The First Single Dose Intravenous (IV) Gene Therapy (RP-A501) With Recombinant Adeno-Associated Virus (AAV9:LAMP2B) for a Monogenic Cardiomyopathy
Authors: Rossano Joseph , Taylor Matthew , Lin Kimberly , Epstein Shilpi , Battiprolu Pavan , Ricks David , Waldron Abigail , Schwartz Jonathan , Greenberg Barry
Published: June 2023

Background:
Danon disease (DD) is a rare X-linked monogenic cardiomyopathy and multisystemic disorder caused by mutations in the LAMP2 gene. Male DD patients (pts) develop severe progressive hypertrophic cardiomyopathy (HCM), left ventricular (LV) dysfunction and arrhythmias resulting in a median mortality below age 20 years (y).

Methods:
This open-label, single-dose, phase 1 trial enrolled male DD pts with a LAMP2 mutation and cardiomyopathy in two age groups: ≥15 y and 8-14 y. Pts received IV infusion of RP-A501, an adeno-associated virus with a normal copy of the human LAMP2B gene (AAV9:LAMP2B), at doses of 6.7 x 1013 GC/kg (low dose) and 1.1 x 1014 GC/kg (high dose). Immunomodulation (IM) included prednisone and rituximab, with additional sirolimus for the most recently treated pediatric pts.

Results:
Between June 2019 and March 2022, 7 males with DD age 11.7 - 21.1y (median 18.3y; N=5 adult and N=2 pediatric) received RP-A501 (N=5 low dose and N=2 high dose). 83% of pts were NYHA Class II; one was NYHA Class III. IM compliance was confirmed in 6/7 pts. All pts are alive and stable at 3-30 months (m) follow-up. One adult pt with baseline LV systolic dysfunction required heart transplant at 5m post RP-A501, most likely related to DD progression. All adverse events (AEs) related to RP-A501 or IM were manageable and reversible. No RP-A501-related SAEs were observed in the pediatric pts. On baseline endomyocardial biopsy, no pts had significant LAMP2B expression; 100% (N=6/6) of evaluable pts had cardiac LAMP2B expression within 6m of therapy with improved myocardial structure in 5/6. Pts evaluable beyond 6m had stabilized or improved BNP (N=5/5), troponin (N=5/5), and LV ejection fraction (N=5/5) by 6-12m, and stabilized/improved LV wall thickness (N=4/4) and NYHA Class (N=4/4) by 12-18m. These findings persist up to 30m post RP-A501.

Conclusions:
Results from this phase 1 trial in DD demonstrate that B- and T-lymphocyte directed immunomodulation enables safe IV RP-A501 gene therapy administration, resulting in cardiomyocyte transduction, LAMP2B expression, improved autophagy, and improved/stabilized serologic, echocardiographic and clinical parameters associated with survival in HCM. Updated results will be presented.
Abstract 11136: Diagnostic and Therapeutic Practices of Pulmonary Arterial Hypertension in Patients With Sarcoidosis in the United States: A Nationwide Registry Study
Authors: As Sayaideh Mohammad , Younis Moustafa , Alzghoul Bashar
Published: June 2023

Introduction:
Patients with advanced sarcoidosis may develop Pulmonary Hypertension (PH). Sarcoidosis related PH was most frequently seen in patients with fibrotic disease and comes with increased mortality. We describe diagnostic modalities and management strategies used in patients with sarcoidosis associated PH in the United States (US).

Methods:
We conducted a retrospective study based on a national registry investigating 3,835 respondents to the Foundation for Sarcoidosis Research (FSR-SARC). The registry includes patient surveys completed between June 2014 and August 2019. Summary and univariate analyses were performed.

Results:
A total of 211 (6%) patients with PH with a mean (±SD) age of 42 (13) years were identified; 139 (66%) were women, 126 (60%) Caucasian and 69 black (33%). Patients with PH were younger (mean age, years +-SD) {42+-13 vs 44+-12; p=0.008}. Patients with PH were more likely to be women (OR: 1.5, 95%CI:1.1-2.0, p=0.006) and less likely to be Caucasian (Caucasian: 5%, Black: 16%, other:15%, p<0.0001).PH therapy: 27 (13%) received phosphodiesterase inhibitors including sildenafil or tadalafil, 12 (6%) received endothelin receptor antagonist including ambrisentan, macitentan or bosentan, 5 (2.4%) received IV therapy including Treprostinil, iloprost or epoprostenol, 3 (1.4%) inhaled treprostinil, 2 (0.9%) received an oral prostacyclin and 2 (0.9%) received riociguat. Sarcoidosis therapy received by patients with PH: 166 (79%) steroids, 96 (46%) cytotoxic medications and/or 40 (19%) TNF inhibitor. Patients with PH were more likely to receive cytotoxic medications (OR: 1.5, 95%CI:1.1-1.9, p=0.008) and TNF inhibitors (OR: 1.7, 95%CI:1.2-2.4, p=0.004). However, there was no significant difference in steroid use between patients with and without PH (OR: 1.2, 95%CI:0.9-1.7, p=0.30).

Conclusions:
Non-Caucasian, younger females with sarcoidosis were more at risk for PH. Phosphodiesterase inhibitors are the most commonly used class in this population. Patients with PH were more likely to receive more aggressive sarcoidosis therapy with cytotoxic meds +/-TNF inhibitors.
Abstract 11143: Symptom Experience in Women With Ischemia and No Obstructive Coronary Artery Disease: A Mixed Methods Approach
Authors: Thandra Sneha , Dave Esha K , Gaignard Scott , Leon Ana , Schwartz Arielle , Higgins Melinda , Mehta Puja K , Kimble Laura P
Published: June 2023

Introduction:
Women with myocardial ischemia but no obstructive coronary artery disease (INOCA) often have coronary microvascular dysfunction, a condition associated with adverse cardiovascular outcomes. INOCA patients have recurrent chest pain and reduced quality of life, but therapeutic strategies to treat INOCA are poorly defined. In this study we used mixed methods to gain an understanding of their symptom patterns and burden clustered with other co-morbid conditions, while considering their overall symptom experience with having chronic angina.

Methods:
Twenty-four women diagnosed with INOCA based on coronary angiography were enrolled. Qualitative telephone interviews were conducted, recorded, and transcribed verbatim. First and second cycle coding was then used to analyze the qualitative data. Baseline demographics, risk factors, and angina burden by the Seattle Angina Questionnaire (SAQ) were assessed and descriptive statistics were performed.

Results:
Mean age was 53.2±10.8 years and body mass index was 30.8±6.9 kg/m
2
. Cardiac risk factors were prevalent with 43% hypertension, 57% hyperlipidemia, and 22% diabetes. SAQ scores indicated high angina burden and poor quality of life: 37.7±24.3 (physical limitation), 35.2±31.5 (angina stability), 41.3±23.2 (quality of life). Elemental qualitative coding and analysis identified four major themes: Invisible inscrutable threat, Longing for a normal/safe life, Rejecting labels, and “It has a toll”. A majority (75%) expressed both emotional burden and explicit frustration and dissatisfaction around their diagnosis.

Conclusion:
Qualitative and quantitative data supported that despite high symptom burden and poor quality of life, patients felt that they were frequently not believed, and that knowledge was limited to manage their condition. Research to close this persistent knowledge gap and to prioritize symptom management to help INOCA patients regain as much normalcy as possible is needed.
Abstract 11180: Assessing the Impact of the Covid-19 Pandemic Shelter in Place on Glycemic Control and Blood Pressure in Diabetic Patients
Authors: Bommireddi Akshay , Merchant Maqdooda , Huynh Jennifer , Cai Amie , Yamamoto Kyle , Vu joseph , Pursnani Seema
Published: June 2023

Introduction:
The impact of the COVID-19 pandemic state and county orders for home isolation and social distancing on glycemic control in diabetics is yet to be understood. We aimed to evaluate the impact of California’s 2019 shelter-in-place (SiP) order (mandated from March to June 2020) on glycemic control, blood pressure, and body mass index in the Kaiser Permanente Northern California (KPNC) diabetic population.

Methods:
This is a retrospective cohort study of Kaiser Permanente Northern California members, age ≥ 18 years old with a diagnosis of type 1 or type 2 diabetes prior to 2019. We evaluated the change in glycated hemoglobin (HbA1c), body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), use of oral hypoglycemic agent (OHA), and use of insulin for diabetics, stratified by pre-SiP HbA1c level (<7, 7-8, 8-9, 9-10, and >10%) prior to and following the SiP order.

Results:
A total of 168,621 diabetics were included. Prior to the SiP, the mean HbA1c was 7.45 (1.48)%, with a mean BMI of 31.81 (7.29), SBP 133.04 (13.84), DBP 70.79 (9.97), 72.06% OHA users and 28.64% insulin users. Following SiP, the mean HbA1c was 7.49 (1.57)%, BMI 31.51 (7.39), SBP 134.12 (15.68) and DBP 71.30 (10.52), and 72.41% OHA users and 29.25% insulin users. A marginal decrease in BMI, was seen across all groups. Increases in HbA1c, SBP, DBP were highest in the HbA1c<7% and 7-8% groups (p<0.0001, Table 1).

Conclusions:
Marginal increases in HbA1c, SBP and DBP were seen in this diabetic cohort following the California 2020 SiP order. Increased use of OHA and insulin were seen following SiP, with insulin initiation in the highest HbA1c groups. The study helps to identify diabetics in our Northern California cohort that require more intensive management in the post-pandemic era. Further studies will help characterize long-term impacts on risk factors and incident cardiovascular disease.
Abstract 11186: Clinical Presentation and Outcome of Myocarditis After Covid-19 Vaccination Among Adolescents: A Systematic Review and Meta-Analysis
Authors: Masuda Kaihei , Yasuhara Jun , Aikawa Tadao , Takagi Hisato , Kuno Toshiki
Published: June 2023

Introduction:
The association of the COVID-19 vaccination with myocarditis has been reported in adolescents. However, evidence of myocarditis after COVID-19 vaccination among adolescents is scarce compared to adults. We aimed to investigate the clinical features and outcomes of COVID-19 mRNA vaccination-related myocarditis in adolescents.

Methods:
PubMed and EMBASE were searched through April 2022 to investigate the characteristics of vaccine-associated myocarditis in adolescent patients (aged 12-20 years) through observational studies, case series, and correspondence according to PRISMA guidelines. Data regarding patient characteristics, the type, and dose of the vaccine, laboratory data, imaging studies, mortality, and treatments were extracted from each article. One-group meta-analysis in a random-effects model was performed.

Results:
22 observational studies were identified, including 861 cases of vaccine-associated myocarditis. The mean age was 16.0 (95%CI, 15.5-16.5), and the male was predominant at 90.8%. Three-quarters of myocarditis occurred after the second dose (78.2%, 95% CI, 62.4- 94.0). The incident rate was higher after the second dose (12.7 -118.7 per million persons) than the first dose (0.6-10.0 per million persons). Chest pain (85.2%) was the common presenting symptom. Although 16.0% of patients (51/302) had left ventricular (LV) systolic dysfunction (LV ejection fraction [EF] < 55%), most of the cases (40/289) were mildly reduced LVEF as 45-54% (12.0% of total patients). Interestingly, cardiac magnetic resonance imaging revealed late gadolinium enhancement in 80.5% (95% CI, 65.7-95.2) of the cases. Overall, 92.8% of patients required hospitalization, and 14.7% required intensive care unit admission. However, no in-hospital mortality was observed (0/230), and the length of stay at the hospital was less than 5 days.

Conclusions:
This systematic review and meta-analysis demonstrate a low incident rate and largely favorable outcomes of COVID-19 vaccine-associated myocarditis in adolescents. Our findings would help better understand myocarditis following COVID-19 mRNA vaccination among adolescents and decision-making for parents with vaccine hesitancy.
Abstract 11199: Disparities in Screening for Postpartum Depression - Insights From American Heart Association Research Goes Red Registry
Authors: Kwapong Yaa A , Boakye Ellen , Mallya Pratheek , Zhao Juan , Akel William , Ouyang Pamela , Blumenthal Roger S , Khandelwal Abha , Kinzy Claire , Mehta Laxmi S , Roger Veronique L , Hall Jennifer L , Sharma Garima
Published: June 2023

Introduction:
Postpartum depression (PPD) affects 1 in 5 women in the United States and is associated with cardiovascular disease. Disparities in PPD screening have not been well studied. We investigated the level of self-reported screening, diagnosis of PPD, and disparities in screening.

Methods:
We utilized data from participants enrolled in the AHA Research Goes Red Registry, an online research platform powered by Verily, who responded to the Fertility and Pregnancy survey. Of the 3128 women who had responded as of May 2022, 311 participants were self-identified as postpartum women and were included in this analysis. The definition of postpartum in the survey was
“I have been pregnant within the last 12 months
”. The survey included questions on PPD screening and diagnosis. We used chi-squared testing to examine differences by race-ethnicity, education, income, and proximity to healthcare in PPD screening.

Results:
Among the 311 postpartum women (mean age: 33.3 ± 4.8 years), 83% recalled being screened for PPD. Of the 311 women, 15% reported a diagnosis of PPD, of which 92% received treatment. There were no significant differences in PPD screening by race-ethnicity: non-Hispanic White (82%), non-Hispanic Black (83%), Asian (88%), Hispanic (80%) (p=0.91), possibly limited by sample size (Fig 1a). Similarly, there were no significant differences by educational status (p=0.22) (Fig 1b) or income (p=0.53) (Fig 1c). Women who lived in a big city with access to many hospitals had higher proportion of screening (88%), while rural area dwellers had the least (74%, p=0.54) (Fig 1d).

Conclusion:
Among this multiracial cohort of postpartum women, the prevalence of self-reported screening and diagnosis of PPD was 83% and 15%, respectively. The prevalence of screening did not significantly differ by race-ethnicity, education, income, and proximity to healthcare. Future larger studies were suggested to explore screening of PPD by race and other social determinants of health.
Abstract 11203: Blood Metabolomes as Non-Invasive Biomarkers and Targets of Metabolic Interventions for Doxorubicin- and Trastuzumab-Induced Heart Failure
Authors: Thonusin Chanisa , Nawara Wichwara , Khuanjing Thawatchai , Prathumsap Nanthip , Arinno Apiwan , Ongnok Benjamin , Arunsak Busarin , Sriwichaiin Sirawit , Chattipakorn Siriporn , Chattipakorn Nipon
Published: June 2023

Introduction:
Cardiac metabolic impairment is a critical component of heart failure pathophysiology. However, our understanding on the blood metabolomics and their potential as non-invasive metabolic biomarkers in doxorubicin- and trastuzumab-induced heart failure remains limited. In this study, we identified the changes in blood metabolome levels as well as their associations with cardiac dysfunction and cardiac injury in rats with doxorubicin- and trastuzumab-induced cardiotoxicity.

Methods:
8-week-old male Wistar rats were divided into 4 groups (n=6/group) to receive intraperitoneal injection with either 1) 3 mg/kg/day of normal saline solution (NSS) at days 0, 4, 8, 15, 22, and 29 (control group for doxorubicin), 2) 3 mg/kg/day of doxorubicin at days 0, 4, 8, 15, 22, and 29 (doxorubicin group), 3) 4 mg/kg/day of NSS at days 0-6 (control group for trastuzumab), and 4) 4 mg/kg/day of trastuzumab at days 0-6 (trastuzumab group). Four days after the last injected dose, cardiac function was evaluated. The rats were then sacrificed to collect blood and heart for the quantitation of 107 serum and 100 cardiac metabolome levels, respectively, using mass spectrometry-based targeted metabolomics.

Results:
Strong relationships between 72 and 61 cardiac versus serum metabolomes were found in doxorubicin and trastuzumab groups, respectively. Correlations between cardiac function and cardiac injury versus 28 and 58 serum metabolomes were also shown in doxorubicin and trastuzumab groups, respectively. Importantly, patterns of metabolome change were different between doxorubicin and trastuzumab groups (Figure).

Conclusions:
Our findings highlight the potential role of blood metabolomes as non-invasive biomarkers to assess the severity and prognosis of doxorubicin- and trastuzumab-induced heart failure. These findings could lead to the development of metabolic targeted therapy specific for the cardioprotection during different phases of cancer treatment.
Abstract 11206: Adipose-Derived Mesenchymal Stem Cells Overexpressing PD-L1 and Akt Confer Myocardial Protection Through Upregulation of CD25
+
T Cells in a Rat Model of Acute Myocardial Infarction
Authors: Lin Yu-Kai , Lee An-sheng , Wu Mei-Yao , Chang Chia-Ming , Chen Yun-Fang , Lin Yen-Nien , Chen Wei-Yu , Shyu Woei-Cherng , Hsiao Lien-Cheng , Chang Kuan-Cheng
Published: June 2023

Background:
Translational studies showed positive results of stem cell therapy against myocardial infarction (MI)-induced cardiac dysfunction. Programmed death ligand 1 (PD-L1) is a key immune receptor, which modulates immune system and maintain the stability of coronary plaques. Akt is one of the signaling that exert its cardioprotective effect through regulating PD-L1. In the present study, we overexpressed PD-L1 and Akt in adipose-derived mesenchymal stem cells (AdMSC) and determined the protection against MI.

Methods and Results:
Adult Wistar rats were randomly separated into four groups: sham, MI, treatment of AdMSC or AdMSC overexpressed with PD-L1 and Akt (AdMSC-PDL1-Akt) immediately after MI. MI was induced by LAD ligation and ADMSC were injected into the heart around the area at risk. After 4 weeks, rats were examined by echocardiography, pressure-volume analysis, infarct size measurement, and immunohistochemistry to evaluate the efficacy of the ADMSCs on myocardium. Results demonstrated AdMSC-PDL1-Akt was more resistant to ROS
in vitro
, and could restore MI-induced contractile dysfunction
in vivo
by increasing ESPVR (P=0.048) and PRSW (P=0.015). AdMSC-PDL1-Akt could also protect hearts from MI-increased infarct size (P=0.002). Immunohistochemistry staining with caspase 3 and NFκB were upregulated in MI hearts and significantly reversed in AdMSC-PDL1-Akt group (P<0.001 and P=0.036). To clarify mechanisms underlying the effect of AdMSC-PDL1-Akt, we found it could induce normal T cells into CD25
+
regulatory T cells
in vitro
, which is in parallel with the data shown in our
in vivo
immunohistochemistry study that CD25 was upregulated in AdMSC-PDL1-Akt tissues (P=0.03).

Conclusions:
Overexpression of PD-L1 and Akt in AdMSC could increase its resistance to ROS-related apoptosis
in vitro
and enhance the protective effects against MI-induced cardiac dysfunction through modulation of T cells
in vivo
.

Keywords:
AdMSC; PD-L1; myocardial infarction; regulatory T cells
Abstract 11219: Female Patients Attending Female Cardiologist-Led Heart Clinic in Iraq: Clinical Landscape and Echocardiographic Data
Authors: Dakhil Zainab A , Skuk Moatamn
Published: June 2023

Introduction:
In Iraq, traditional and tribal rules prevent many women from having access to healthcare unless being managed exclusively by female doctors. So, lack of female cardiologists (FC) in Iraq deprived many women from proper cardiovascular care.Considering the absent Women′s Heart Clinics in Iraq and lack of data on female cardiac patients,we sought to provide data regarding demographic and echocardiographic characteristics of women attending a female cardiologist-led heart clinic (FC-LHC) in a first report from Iraq

Methods:
Women who attended a FC-LHC were included, clinical and echocardiographic characteristics were recorded.

Results:
n=213, mean age (46.5±16.6)year.Hypertension (HT) and dyslipidemia were most reported risk factors.History of gestational HT was most common sex-specific risk factor (figA).Women′s comorbidities differs with their social status as HT, DM, IHD and dyslipidemia were highest in widowed women (91.3%, 43.5%, 21.7% and 39.1% respectively). Consuming fast food≥4/week was highest in divorced (33.3%) and single women (23.1%). OCP was used by 5.2% of women; in general and 10.3% of married women at reproductive age; in particular. Prevalence of DM,IHD and LV dysfunction differs according to women′s education (figB). Palpitation (46.5%) and dyspnoea (30%) were most common presentations. Cardio-Obstetric and Cardio-Oncology services were offered in 5.2% and 5.6% respectively (figC). LV diastolic dysfunction and mitral regurgitation were most common echocardiographic abnormalities (figD).

Conclusion:
Younger women<65 years were more frequently attending FC-LHC.Prior history of gestational HT was the commonest sex-specific cardiovascular risk factor. Increasing diversity in cardiology workforce and establishing Women′s Heart Clinics that include FC are crucial in Iraq to promote focused cardiovascular care and education and to provide data for sex-specific research in cardiovascular management and outcomes
Abstract 11243: A Quality Improvement Project to Optimize the Use of Guideline Directed Medical Therapy in Patients With Heart Failure With Reduced Ejection Fraction in the Primary Care Setting
Authors: Bosah Arinze , Tanveer Ud Din Mian , Gadani Mrudula , Alpert Craig , Taffe Kevin
Published: June 2023

INTRODUCTION
The 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure provided clear support for the clinical use of ARNIs, ACEIs or ARBs in addition to evidence-based Beta Blockers (BB) and Aldosterone Antagonists (AA) in HFrEF, also known as Guideline-Directed Medical Therapy (GDMT). Despite the known benefits of GDMT, there still remains a significant gap in the use of GDMT in the ambulatory setting. We present a resident-driven quality improvement project to increase the percentage of patients that are on GDMT at target doses.

METHODS
We performed a root cause analysis and identified the potential barriers to optimal GDMT in HFrEF patients by use of an anonymous survey completed by clinic residents and attending physicians. We then sequentially introduced QI interventions to optimize GDMT, including provider education, clinical pharmacy referral, and involvement of registered nurses and health coaches to identify HFrEF patients for our patient care huddles. GDMT data was collected on October 1
st
, 2021 (baseline) and every 5 weeks until April 4
th
, 2022 (intervention data).

RESULTS
Between October 1, 2021 and April 4, 2022, an average of 86 patients with HFrEF were analyzed from the resident clinic every month. Over the study period, the percentage of patients on any dose of GDMT increased from 73.3 to 77.8% (ARNI/ACEI/ARB); 84.1% to 88.2% (BB); and 45.5% to 50% (AA). The percentage of patients on target doses of GDMT increased from 21.7% to 25.9% (ARNI/ACEI/ARB); 8.7% to 16.2% (BB); and 34.8% to 42.4% (AA). The use of hydralazine/isosorbide in patients not on ARNI/ACEI/ARB improved from 12.5% to 24%.

CONCLUSIONS
A multi-disciplinary team approach shows a positive correlation in improving utilization of target doses of GDMT for HFrEF in the primary care setting. Significant gaps still remain in the utilization of GDMT, and further research is needed to identify targeted approaches to optimize outpatient medical therapy in the primary care setting.
Abstract 11252: Developing an Interactive Online Curriculum for Teaching Pediatric Electrocardiogram Interpretation
Authors: Zhang Shannon , Kiener Alex , Gallotti Roberto , Johnston Troy A , Sagiv Eyal
Published: June 2023

Introduction:
Interpretation of pediatric ECGs is a specific skill set that requires familiarity with normal electrographic changes in the developing heart, as well as recognition of a wide range of dysrhythmias or conduction alterations secondary to structural lesions. General pediatricians should use ECGs for various pediatric emergencies, common outpatient concerns and sports participation clearance. Previous studies showed that pediatric trainees are neither comfortable nor proficient in reading ECGs. We developed an interactive self- learning program for teaching pediatric ECG interpretation.

Methods:
In collaboration between pediatric residents and cardiologists, we created the curriculum, identifying high-yield topics, ‘red flags’ and age- related normal variances that are important to recognize. We built a 5-10-minute teaching module for each topic using Adobe Captivate. The modules were available online on a shared server. Participants were asked to take pre- and post-participation surveys and interpretation skill tests to define knowledge gaps and to focus our curricular development.

Results:
The pilot curriculum comprised of 14 high-yield topics, general and pediatric- focused. The modules included real ECG samples with multiple-choice questions testing specific electrographic aberrations, followed by audiovisual explanations. The pre-participation survey and test were completed by 57 participants: pediatric residents (59%) and others. Most reported that they do not feel comfortable with distinguishing normal from abnormal ECGs (77.2%), nor recognizing arrhythmias (75.5%) or identifying signs of structural abnormalities (98.3%). The mean test score was 5.13 ± 1.8 out of 10 questions answered correctly, with no significant difference between pediatric residents or other trainees (
p
=0.78).

Conclusions:
We present a newly developed educational program for ECG interpretation that centers on visual learning and pattern recognition of high yield findings in pediatrics. Initial surveys confirm the need for an accessible and engaging teaching tool and we have shared the online modules to be available outside of our institution. We intend to continue and develop the program as more feedback is received.
Abstract 11271: Post TAVR Outcomes Among Patient With Amyloidosis and Aortic Stenosis: A Meta Analysis
Authors: Jaiswal Vikash , Ang Song Peng , Kalra Kriti , Khan Nida , Joshi Amey , Jaiswal Akash , Vadiyala Mounika Reddy , Patel Nirmit , Chia Jia Ee , Raut Anuradha , Aziz Taiba , Manohar Hasitha
Published: June 2023

Introduction:
Aortic stenosis (AS) is one of the most prevalent valvular heart diseases globally. As many as 16% of AS patients have underlying cardiac amyloidosis (CA). To date, there is a paucity of data on outcomes among AS with concomitant CA patients post-TAVR.

Hypothesis:
This study aimed to evaluate the clinical outcomes post TAVR among patients with CA.

Methods:
We performed a systematic literature search of databases for relevant articles from inception until June 01, 2022. Unadjusted odds ratios (OR) were pooled using a random-effect model, and a p-value of <0.05 was considered statistically significant.

Results:
5 studies with 1,488 patients were involved in the final analysis. The mean age of patients among CA+AS and AS alone was (85 vs 80) years. The number of males affected with dual pathology was higher compared to AS alone (71% vs 59%). 29% of patients were having a right bundle branch block in the CA+AS group, while 12% were among AS alone. Mean IV Septal Thickness (1.53 vs 1.33), mean relative wall thickness (0.60 vs 0.40) and mean LA dimensions (5.19 vs 4.8) were higher among the CA+AS group compared with AS alone. At the mean follow up of 12 months the odds of in-hospital mortality (OR, 2.09(95% CI: 0.77-5.63), P = 0.15), stroke (OR, 0.46(95%CI: 0.06-3.60), P = 0.46), and vascular complication (OR, 0.19(95% CI: 0.01-3.40), P = 0.26) were comparable between both group. In contrast, the incidence of acute kidney injury (OR, 3.09(95% CI: 2.02-4.71), P<0.001), and major bleeding (OR, 1.74(95% CI: 1.02-2.98), P = 0.04) were significantly higher among CA+AS group compared to AS group following TAVR.

Conclusions:
TAVR appeared to be a safe procedure among patients diagnosed with amyloidosis in aortic stenosis with a similar mortality rate between both groups of patients. Further studies should aim at determining the optimal valve replacement strategy in AS patients with concomitant CA.
Abstract 11273: Comparison of Outcome Between Type 2 versus Type 1 Myocardial Infarction: A Systematic Review and Meta-Analysis
Authors: Jaiswal Vikash , Ang Song Peng , Ishak Angela , Nasir Yusra , Chia Jia Ee , Vadiyala Mounika Reddy , Naz Sidra , Kalra Kriti , Jaiswal Akash
Published: June 2023

Introduction:
Unlike type 1 myocardial infarction (T1MI) which is caused by plaque rupture and erosion, type 2 myocardial infarction (T2MI) is due to the mismatch between supply-demand of oxygen. To date, there were limited studies available and consequently, the outcomes of patients with T1MI compared to T2MI remained inconclusive.

Hypothesis:
We aimed to compare the outcomes of T1MI and T2MI patients in terms of mortality and adverse cardiovascular outcomes.

Methods:
We performed a systematic literature search of databases for relevant articles from inception until March 20, 2022.

Results:
340,802 patients had T1MI while the remaining 52,855 patients had T2MI. Mean age was similar between both groups (T1MI: 69.4 years, T2MI: 71.8 years) while proportion of female was found to be more higher in T2MI (61% vs 38%). Our analysis revealed that patients with T1MI had a significantly lower odds of all-cause mortality (OR 0.44, 95%CI 0.34 to 0.56, p<0.001), in-hospital mortality (OR 0.63, 95%CI 0.46 to 0.86, p<0.001), 1-year mortality(OR 0.35, 95% CI 0.25 to 0.47, p<0.001) and MACE (OR 0.59, 95% CI 0.39 to 0.91, p=0.02). There was no significant difference in terms of 30-day mortality (OR 0.58, 95% CI 0.25 to 1.36, p=0.21), CV mortality (OR 0.95, 95% CI 0.68 to 1.32, p=0.74), all-cause readmission (OR 0.84, 95% CI 0.62 to 1.14, p=0.26) and readmission due to MI (OR 1.22, 95% CI 0.66 to 2.27, p=0.53) between both groups.

Conclusions:
Patients with T1MI had favourable outcomes in terms of mortality and MACE compared to that with T2MI patients. Further studies should aim at determining the optimal management strategy for these high-risk patients for better patient outcomes.
Abstract 11278: Association of Homocysteine and C-Reactive Protein With Post-Stroke Depression: A Meta Analysis and Meta Regression
Authors: Jaiswal Vikash , Ang Song Peng , Kainth Tejasvi , Ishak Angela , Joshi Amey , Kalra Kriti , MUKHERJEE DATTATREYA , Chia Jia Ee , Jaiswal Akash
Published: June 2023

Introduction:
Post-stroke depression (PSD) is a common neuropsychiatric complication of stroke with a high incidence of 31% and that is associated with poor functional outcomes and increased mortality. Its pathophysiology is poorly understood, however, evidence suggests that neuroinflammation in reaction to the stroke could play a role in the development of PSD.

Hypothesis:
To compare C-reactive protein (CRP), and homocysteine (Hcy) levels in post-stroke patients with and without depression.

Methods:
We systematically searched all electronic databases from inception until May 30th 2022 comparing baseline CRP and Hcy.

Results:
A total of 12 studies with 3,154 Patients were included in this analysis. The mean age of the overall cohort was 64.8 years with PSD patients appearing to be older than non-PSD patients (mean 67.3 years vs 63.8 years). In terms of gender distribution, there were more females in the PSD group compared with non-PSD groups (48.9% vs 40.7%). PSD patients were more likely to be widowed (18% vs 7.25%) and had a family history of psychiatric disorder (10.4% vs 4.4%) compared to non-PSD patients. Patients with PSD had higher levels of baseline CRP [SMD 0.86, (95% CI 0.65 to 1.08), p<0.001; I2=87%] and Hcy PSD [SMD 1.12, (95% CI 0.57 to 1.67), p<0.001; I2=96%] compared to patients without PSD. Meta-regression was performed using covariates including age, female gender, hypertension, diabetes mellitus, CAD, NIHSS, widowhood and family history of psychiatric disorder. Diabetes mellitus appeared to be the only significant effect modifier (coefficient 0.23, p=0.01) for the association between baseline CRP and PSD.

Conclusions:
Elevated baseline levels of CRP and Hcy were significantly higher in patients that developed PSD, suggesting that both could play a role in the pathophysiology of PSD and as a potential biomarker for diagnosing risk of depression
Abstract 11279: Reporting of Diversity and Inclusion in Clinical Trials of Exercise Therapy for Peripheral Vascular Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: Sundaram Kavin
Published: June 2023

Introduction:
Exercise therapy serves as a cornerstone of treatment for all patients with peripheral arterial disease (PAD); however, data suggest that women and minority groups with PAD suffer from disparate outcomes.

Hypothesis:
Randomized controlled trials (RCTs) of exercise therapy for PAD will demonstrate high rates of reporting and recruitment of women and minority groups.

Methods:
Databases were queried for RCTs that assessed the role of exercise therapy for PAD (Figure 1).

Results:
Only 2/47 (4%) of studies reported details of racial and ethnic subgroups (Figure 2). A meta-analysis of participation among non-white participants showed high heterogeneity (pooled effect 32%, I2 74%, p<0.01, Figure 3) Meta-analysis of female recruitment and participation showed significant heterogeneity (pooled effect 26%, I2 76%, p<0.01, Figure 4) with no improvement over time in meta-regression.

Conclusions:
Reporting and inclusion of women and minority groups remain low. Improved inclusion may help support the generalizability of the existing literature.
Abstract 11282: Artificial Intelligence Derived Algorithm to Screen for Ebstein’s Anomaly of the Tricuspid Valve Utilizing Echocardiography
Authors: Janga Chaitra , Liu Kan , Connolly Heidi M , McLeod Christopher J , Egbe Alexander C , Warnes Carole A , Friedman Paul , Asirvatham Samuel , Madhavan Malini
Published: June 2023

Introduction:
Ebstein’s anomaly (EA) is a rare congenital anomaly of the tricuspid valve associated with heart failure and arrhythmias. Currently available imaging modalities like transthoracic echocardiography, cardiac magnetic resonance imaging (MRI), or computerized tomography (CT) are not viable for screening large asymptomatic populations.

Hypothesis:
A deep learning algorithm, implemented using a convolutional neural network (CNN) applied to the standard 12-lead ECG can be used as an accurate screening tool for EA in children and adults.

Method:
We identified 1,154 EA patients and 21,430 age- and sex-matched controls (1:20 ratio) between 1987 - 2020. A CNN was trained, validated and tested using digital 12-lead ECGs in 70%, 10% and 20% of the cohort respectively, divided by random shuffling.

Results:
The mean age was 26.68±19.23 years (41.8% aged < 18 years, 56.41% female) for the EA cohort and 28.36±18.65 years (37.2% aged <18 years, 55.67% female) for the control cohort. Following training and validation the area under the curve (AUC) for detecting EA in the testing cohort was 0.976 (95% CI 0.962 - 0.989) with prediction accuracy of 0.959. In subgroup analysis, the AUC was comparable in males (0.970, 95% CI 0.946-0.995) and females (0.979, 95% CI 0.964-0.994), those <18 (0.980, 95% CI 0.958-1.000) and ≥18 years old (0.972, 95% CI 0.954-0.989), as well as in those with right bundle branch block (RBBB) (0.969, 95% CI 0.950-0.989) and without RBBB (0.950, 95% CI 0.922-0.978) on ECG.

Conclusion:
Artificial intelligence enhanced ECG based detection of EA is possible with high diagnostic accuracy. Following further refinement and external validation, this algorithm can facilitate early detection of EA using ECGs, a widely available and inexpensive tool.

Figure:
Receiver operating characteristic (ROC) curve for the performance of the artificial intelligence CNN in detecting EA in the test cohort stratified by (A) age (< 18 and ≥ 18 years) and sex and (B) presence of RBBB.
Abstract 11287: Structural Remodeling Impairs Left Atrial Function in Patients With Atrial Fibrillation: A Cardiac MRI Study
Authors: Chahine Yaacoub , Macheret Fima , Bockus Lee , Kim Joonseok , Akoum Nazem W
Published: June 2023

Introduction:
Left atrial (LA) fibrosis and enlargement are hallmarks of structural remodeling that contribute to atrial fibrillation (AF) pathophysiology. Cardiac magnetic resonance (CMR) feature tracking has higher spatial resolution and better ability to define the endocardial border, overcoming the challenges related to speckle tracking echocardiography particularly the anatomic location of LA and thinness of the atrial wall. We aimed to assess the association of LA fibrosis and volume with LA function and compliance using CMR imaging.

Methods:
We analyzed CMR images of AF patients prior to their first catheter ablation. LA fibrosis was assessed using Late Gadolinium Enhancement CMR (Panel A). Feature tracking was applied to assess global longitudinal reservoir strain (GLRS) (Panel B). LA emptying fraction, LA volume index and LA sphericity index were measured using the Cine sequences. All CMR images were acquired in sinus rhythm.

Results:
101 patients were included in the study (61% male, mean age 62 years). Median LA volume index was 45.16 mL/m
2
[36.64, 56.5], LA fibrosis percentage was 15.5% [9.6, 19], LA sphericity index was 54.09% [46.44, 64.58] and GLRS was 17.4 [14.95, 20.1]. A Pearson correlation analysis showed that increased LA fibrosis was negatively associated with both GLRS and LA emptying fraction (R=-0.35, p<0.001 and R=-0.27, p=0.007 respectively). LA volume index was also negatively correlated with GLRS and LA emptying fraction (R=-0.37, p<0.001 and R=-0.54, p<0.001, respectively) (Panel C). Neither LA fibrosis nor LA volume index was associated with LA sphericity index (p=0.55 and p=0.4 respectively).

Conclusion:
LA structural remodeling including increased fibrosis and LA volume is associated with a worsening LA function by strain imaging on CMR. Fibrotic remodeling may lead to blood stasis and play a role in the pathophysiology of thromboembolic stroke associated with AF.
Abstract 11296: Non-Invasive Assessment of Liver Stiffness in Pulmonary Hypertension Patients - A New Marker for Right Ventricular Dysfunction
Authors: MARTINS ELIAURIA R , Melo Marcelo , Botelho Luis Fabio , Filho Jose Eymard Moraes de , Neto Agostinho , Bacal Fernando
Published: June 2023

INTRODUCTION
- Right ventricular dysfunction (RVD) is an important indicator of a poor Pulmonary Hypertension (PH) prognosis. Cardio-hepatic interaction in left heart failure (LHF) is discreet, however, research is lacking in right heart failure (RHF). The study rationale is that PH patients can evolve to RHF with increased pressure in right chambers and passive hepatic congestion, consequently leading to an increase in liver stiffness (LS).

OBJECTIVE
- Assess LS in precapillary patients compared to a healthy control group.

METHODOLOGY
- A transversal pilot study conducted from January 2020 to April 2022 with precapillary PH patients over age 18, diagnosed by right heart catheterization. Postcapillary PH secondary to schistosomiasis, liver disease and alcoholism were excluded. Results were paired with a healthy control group. Both groups underwent two-dimensional speckle tracking with strain echocardiogram (ECO) and shear wave hepatic elastography (HE) on a Phillips ultrasound. HE measurements were taken at two points; standard (SHE), supported by literature and widely used, and a central (CHE), located near the hepatic thread. In addition, the PH group underwent laboratory exams: liver function, BNP dose, complete blood count and kidney function.

Results:
PH group 31 patients: 26 women (84%) and 5 men (16%); average age 51.7 (24-81 years). PH group etiology: group I (63%), group IV (22.6%) and group III (16%). Degree of dyspnea: III (74%), II (16%) and I (6%). Control group 15 individuals: 10 women (67%) and 5 men (33%): 45.7 average age (27-61 years). PH group SHE median 5.93Kpa, IQR: 5.87, versus 3.69kpa for the control group (p<0.001) with IQR 0.82kpa. While PH group CHE was 8.03Kpa: IQR 6.10Kpa (p<0,001) versus 5.15Kpa, IQR 1.60Kpa in the control group. ECO parameters in PH patients, only the right ventricle free wall strain presented a moderate correlation with SHE, Pearson coefficient of -0.427 p<0.019. There is a high correlation between SHE and CHE, Pearson coefficient 0.887 p<0.001. PH group lab results did not indicate correlation with ECO nor HE.

CONCLUSION:
HE can be used as a new marker for RVD in PH patients.