bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 232: The Association Between Amplitude Spectrum Area And An Automated External Defibrillator Algorithm’s Detection Of Ventricular Fibrillation During Cardiopulmonary Resuscitation
Authors: Burgett Kevin , Liu Chenguang , Gehman Stacy , Jorgenson Dawn
Published: June 2023

Introduction:
Prior studies have reported the performance of a Philips analysis-through-CPR (ATC) shock determination algorithm during chest compressions (CCs). Amplitude spectrum area (AMSA), calculated for ventricular fibrillation (VF) rhythms, has also been reported as a predictor of defibrillation success. This study evaluated how AMSA scores for VF rhythms are associated with the performance of the shock determination ATC algorithm.

Methods:
A total of 838 VF rhythms were extracted from 304 adult patients recorded by Philips FR3 AEDs and Philips MRx defibrillators from multiple Emergency Medical Service (EMS) systems. Each extracted VF rhythm contained at least 11 seconds (s) of data recorded during CCs, followed by at least 2 s of CPR-free ECG data used to retrospectively calculate an AMSA score for the rhythm before the onset of a shock. VF rhythms were split into three groups according to their AMSA score: Low (<6 mV*Hz), Medium (6-15 mV*Hz), High (>15 mV*Hz). We evaluated the sensitivity of the ATC algorithm during CCs for each AMSA range.

Results:
During the 11s period with active CCs, 77.8% (Table 1) of all VF rhythms were identified by the ATC algorithm. The remaining unidentified VF rhythms (22.2%) would require a pause in CPR for a hands-off analysis. The median AMSA score for identified VF rhythms was significantly greater than the unidentified VF rhythms (7.8 vs. 6.1 [mV*Hz], p < .001). The sensitivities during CCs for VF rhythms in the Low, Medium, and High AMSA score ranges were 66.4%, 82.6%, and 88.1%, respectively.

Conclusions:
The present study has shown the association between Philips ATC algorithm’s sensitivity of identifying VF during CCs and the corresponding AMSA score. Such results suggest that when the ATC algorithm identifies a shockable rhythm during CCs, this rhythm’s AMSA score is likely to be high resulting in a higher likelihood of shock success.
Abstract 251: Brain Computed Tomography After In-Hospital Cardiac Arrest
Authors: Ratay Cecelia R , Callaway Clifton W , Elmer Jonathan , Flickinger Kate , Coppler Patrick J
Published: June 2023

Background:
Brain computed tomography (CT) is useful to identify early cerebral edema after cardiac arrest and neurological causes arrest. Most early CT data come from out-of-hospital cardiac arrest (OHCA). The prevalence of edema and neurological causes of arrest is unknown after in-hospital cardiac arrest (IHCA).

Purpose:
To compare the frequency of edema and neurologic causes of arrest after IHCA and OHCA.

Methods:
We identified patients treated at a single medical center between January 2010 and August 2020 who had a brain CT within 24 hours of arrest. We abstracted age, sex, initial cardiac rhythm, duration of arrest, and survival to hospital discharge in all patients, and cause of death in decedents. We measured grey to white matter ratio (GWR) at the level of the basal ganglia. We categorized GWR as normal (1.30), mild edema (>1.20 and <1.30), and severe (1.20). We compared age, duration of arrest, GWR and edema category by arrest location using Wilcoxon-Rank-Sum and Fisher’s Exact tests.

Results:
Of 2,413 subjects (464 (19%) IHCA and 1949 (81%) OHCA), 1,725 had a brain CT within 24 hours of collapse (IHCA n=157, 9%; OHCA n=1,568, 91%) and were included. Subjects who suffered IHCA were significantly older (median 64 [interquartile range (IQR) 54 - 74] years vs 59 [IQR 49-70] years), had shorter CPR durations (IHCA median 10 [IQR 5-18] vs OHCA median 21 [IQR 13 - 34], p <0.001) and higher GWR (IHCA median 1.33 [1.29 - 1.41], OHCA median 1.3 [1.20 - 1.36], p<0.001). Severe edema was less common in IHCA (n=8, 5%) than OHCA (n=270, 24%). Mild edema was common after IHCA (n=49, 32%). Few CT scans revealed a neurological etiology of arrest (IHCA n=3, 2%; OHCA n=63, 4%). In-hospital death increased with edema, (no edema, n=48, 50%; mild, n=36, 73%; severe, n=8, 100%). Among deaths, 50% were attributed to perceived poor neurological prognosis.

Conclusions:
While severe edema is not as common as after OHCA, mild edema is relatively common after IHCA. Preventing and treating cerebral edema is important for survivors of IHCA.
Abstract 289: Temporal Trends In The Incidence And Outcomes Of In-hospital Cardiac Arrest In Patients Hospitalized With Liver Cirrhosis In The Us: Analysis Of The Nationwide Inpatient Sample From 2010-2019
Authors: Olanipekun Titilope , Chris-Olaiya Abimbola , Bhardwaj Abhishek , Abe Temidayo , Effoe Valery S , Kapoor Aanchal
Published: June 2023

Introduction:
Liver cirrhosis affects an estimated 1 in 400 adults in the US with significant morbidity and mortality. There is limited data on the incidence and outcomes of in-hospital cardiac arrest (IHCA) in liver cirrhosis-related hospitalizations.

Methods:
Using the appropriate international classification of disease codes, we queried the nationwide inpatient database to identify patients hospitalized with a primary diagnosis of liver cirrhosis who experienced IHCA and underwent cardiopulmonary resuscitation, between 2010 and 2019, We evaluated the temporal trends in the in-hospital outcomes using Cochrane -Armitage test, and factors associated with survival to hospital discharge using logistic regression analysis.

Results:
7,091,054 weighted liver cirrhosis hospitalizations were identified during the study period. The IHCA incidence rate was 1.4% with a mean age (SD) of 59 years (12) and males were predominantly affected (59.9%). There was an upward trend in IHCA incidence during the study period (1.3% in 2010 to 1.5% in 2019, p < 0.001). The overall survival to hospital discharge rate was 22.2%. No significant change in the mortality trend during the study period. Most of the survivors were discharged to a long-term acute care facility (46.4%) followed by home discharge without the need for home health (24.7%) and short-term acute facilities (12.6%). Factors associated with lower odds of survival to hospital discharge were age > 65 years OR 0.71, 95% CI 0.67 - 0.75, P < 0.001), Black (OR 0.94, 95% CI 0.91 - 0.99, P=0.012) and Hispanic race (OR 0.78, 95% CI 0.74 - 0.81, P < 0.001), and severe comorbidity index (OR 0.63, 95% CI 0.59 - 0.65, P < 0.001).

Conclusion:
Between 2010 and 2019, we found a slight increase in the IHCA incidence rate among patients hospitalized with liver cirrhosis. Only about one out of 5 patients survived hospital discharge, and this did not change during the study period. Low socioeconomic status and higher comorbidity burden were associated with lower odds of survival. More research is needed to identify strategies that may improve survival outcomes in IHCA among liver cirrhosis patients.
Abstract 295: Availability Of Automatic Defibrillators And Volunteer Responders For Out-of-hospital Cardiac Arrest In Denmark
Authors: Christensen Nanna B , Folke Fredrik , Kjoelbye Julie S , Torp-Pedersen Christian , Gregers Mads Christian Tofte , Juul Grabmayr Anne , Jakobsen Louise K , Bundgaard Ringgren Kristian , Andelius Linn , Malta Hansen Carolina
Published: June 2023

Introduction:
Public automatic defibrillators (AEDs) and bystander resuscitation (CPR) are critical for cardiac arrest survival. We examined how availability of AEDs and volunteer responders that can be summoned with an app have developed following many national initiatives to improve survival.

Methods:
All OHCA (Out-of-Hospital Cardiac Arrest) registered with coordinates within the Danish Cardiac Arrest Registry (2016-2020) were included. This study assessed coverage of 1) AEDs and 2) volunteer responders at 12 noon for home and public OHCAs. Coverage was defined as ≥ 1 AED and ≥ 4 volunteer responders within 200, 500, or 1,800 meters using straight line distance from the OHCA.

Results:
A total of 22,330 OHCAs were included. At 12 noon, 33,180 volunteer responders (572/100,000 inhabitants) and 22,418 AEDs (387/100,000 inhabitants) were available. More OHCA were covered with AEDs compared to volunteer responders for all distances. A significant difference was found in AED coverage in public compared to home arrests for all distances (p for difference at all distances <0.05). Opposite, no difference was found in volunteer responder coverage for home compared to public arrests at 1,800 and 500 meters (p for difference >0.05). Figure 1 illustrates AED and volunteer responder coverage for home and public arrest.

Conclusion:
Following the implementation of a national volunteer responder program and strategic placement of AEDs in Denmark, most historical OHCAs were covered by AEDs and volunteer responders within 1,800 meters. Although we have more volunteer responders per 100,000 inhabitants compared to AEDs, we found more than half (53%) of all OHCA were covered with AEDs within 200 meters whereas only 16% of all OHCAs were covered by volunteer responders within 200 meters. These findings indicate strategic AED placement in Denmark, but further efforts regarding volunteer responder recruitment are needed to increase coverage of the historical OHCA in Denmark.
Abstract 302: Esophageal Saturation Monitoring More Accurately Detects Severe Tissue Hypoxia Than Near-infrared Spectroscopy
Authors: Sack Kristen , Garcia Mancebo Julia , Romfh Padraic , Kheir John
Published: June 2023

Introduction:
Balance between oxygen delivery and demand is typically assessed based on venous oxyhemoglobin saturation (SvO2), which requires repeated blood sampling from a central location. Alternative, non-invasive methods such as near-infrared spectroscopy (NIRS) demonstrate poor sensitivity to tissue hypoxia.

Methods:
We explored the possibility of measuring regional tissue oxyhemoglobin saturation in the esophagus (EsSO2) using a new, linear probe using resonance Raman spectroscopy (RRS, 420 nm excitatory light, A) to quantify the fraction of oxyhemoglobin. The RRS probe was passed from the mouth into the mid-esophagus in Yorkshire swine (n=7, weight 11.2-13.4 kg). Cerebral (cNIRS) and splanchnic NIRS (sNIRS, Somanetics) were continuously recorded. Swine underwent complete asphyxia by endotracheal tube occlusion for 12 minutes, during which time they were resuscitated using CPR and drugs. EsSO2, cNIRS, sNIRS were compared with SO2 based on arterial blood gas co-oximetry (SaO2). For the purpose of analysis, SaO2 was considered functionally equivalent to SvO2 due to the obligate intrapulmonary (veno-arterial) shunting in this physiology.

Results:
During asphyxia, SO2 rapidly declined to nearly 0%. This was reflected in EsSO2, but cNIRS and sNIRS decreased to a lesser extent (B). EsSO2 exhibited a strong correlation with SO2 (r
2
=0.63, p<0.001) compared to sNIRS (r
2
=0.53, p<0.001) and cNIRS (r
2
=0.06, p=0.106, C). Defining SO2 <30% as the presence of critical hypoxia, EsSO2 had a higher sensitivity than both the sNIRS and cNIRS (D). EsSO2 was <30 in 100% (33/33) of timepoints in which critical hypoxia was present, significantly more sensitive than rSO2 based on cNIRS (which was <30 in 58% (19/33) of timepoints) and sNIRS (<30 in 24% (8/33) of timepoints).

Conclusion:
EsSO2 accurately detects critical hypoxic states, more so than cNIRS or sNIRS, and may represent an alternative, continuous, less invasive approach to central venous monitoring.
Abstract 326: Epidemiology Of Pediatric Out-of-hospital Cardiac Arrest In Ontario, Canada
Authors: Tijssen Janice , McClean Marisha , Le Britney , Lam Melody , To Teresa
Published: June 2023

Introduction:
There are no epidemiological studies of Pediatric Out-of-Hospital Cardiac Arrest (POHCA) in Canada for at least 20 years. Understanding who has a POHCA event is key to prevention, education, and management strategies.

Methods:
In this retrospective cohort study, we used a validated algorithm applied to large hospital administrative databases to describe the epidemiology of pediatric (age 1 day to < 18 years) OHCA in Ontario, Canada, from 2004-2020, by pre-existing comorbidities, sociodemographic features, and outcomes.

Results:
The cohort included 1,839 unique pediatric patients with a POHCA event with a median age of 2 (0-12) years and 721 patients (39.2%) less than 1 year. Males accounted for 61.1% (n=1,123) of the cohort. Incidence was 4.2/100,000 with a gradual increase over the study period. Thirty percent (n=560) of the cohort lived in a neighborhood in the lowest income quintile, while 13.6% (n=251) lived in a neighborhood in the highest income quintile. Seventy five percent (n=1,380) lived in an urban setting. Seventy nine percent (n=1,444) first presented to a non-teaching, non-pediatric hospital following the POHCA event. The majority (n=1,533, 83.4%) of patients did not have significant comorbidities prior to the POHCA. The most common comorbidity was congenital cardiac malformation for 147 (8.0%) of patients. Three hundred and thirty-three (18.1%) survived hospital admission, and 132 (7.2%) survived to hospital discharge. Less than 6 patients had a subsequent POHCA in the year following the index event.

Conclusions:
This is the largest Canadian POHCA cohort and the first to describe incidence, comorbidities, and sociodemographic characteristics for this population. This is the first study to use a validated algorithm to create a POHCA cohort using large hospital administrative databases. We found a gradual increase in annual incidence over 17 years, POHCA mostly occurred in healthy children, and survival was lower than other reported cohorts. There were more than double the number of children with POHCA events living in the lowest income quintile neighborhoods compared to the highest income quintile neighborhoods. Most children with POHCA presented to non-teaching, non-pediatric hospitals first.
Abstract 9223: Self-Reported Efficacy in Patient-Physician Interaction in Relation to Anxiety, Patient Activation, and Self-Rated Health Among Smartwatch Users: The Pulsewatch Study
Authors: Mehawej Jordy , Tran Khanh-van T , Filippaios Andreas , Paul Tenes , Dai Qiying , Ding Eric , Wilson Sakeina , Naeem Syed , Saczynski Jane , Lessard Darleen , Hariri Essa , Mensah Otabil Edith , Noorishirazi Kamran , Beniek Carly , Soni Apurv , McManus David D
Published: June 2023

Introduction:
Early detection of AF is critical for stroke prevention. Several commercially available smartwatches are FDA cleared for AF detection; however, little is known about how use of a smartwatch impacts patient-physician relationships or patient anxiety, patient activation, and patient health-related quality of life.

Hypothesis:
Low self-reported efficacy in patient-physician interaction is associated with worse patient activation, increased anxiety, and lower self-rated quality of life.

Methods:
Data were used from the Pulsewatch study, a two-phased randomized controlled trial, which enrolled adults (>50 years of age) with no contraindication to anticoagulation. The Perceived Efficacy in Patient-Physician Interactions (PEPPI) was used to assess patient confidence in physician interaction at baseline. Generalized Anxiety Disorder-7 Scale, Consumer Health Activation Index, and Short-Form Health Survey were utilized to examine anxiety, patient activation, and physical and mental health status, at baseline, 14, and 44 days, respectively. We used a mixed-effects repeated measures linear regression models to assess changes in anxiety, patient activation, and physical and mental health status in relation to self-reported efficacy in physician interaction, adjusting for confounding variables, over the study period.

Results:
A total of 93 participants (average age 64.1 ± 8.9 years; 43.0% female; 88.2% non-Hispanic white) were included in this analysis. 60% (n=56) of participants reported high perceived efficacy in patient-physician interaction. In the fully adjusted models, high perceived efficacy, vs low, was associated with an increased patient activation and mental health status (β 12.0, p-value <0.001; β 3.39, p-value <0.05, respectively), but was not associated with anxiety or physical health status (β -0.61, p-value 0.46; β 0.64, p-value 0.77).

Conclusions:
Our observation that higher self-efficacy leads to improved patient activation and mental health among stroke survivors suggest that self-efficacy is an important psychosocial marker. Efforts to improve perceived efficacy in patient-physician interaction in may lead to better clinical outcomes.
Abstract 9226: Stroke in Bicuspid Aortic Valve
Authors: Huntley Geoffrey D , Michelena Hector I , Thaden Jeremy J , ALKURASHI ADHAM K , Pislaru Sorin , Pochettino Alberto , Crestanello Juan A , Maleszewski Joseph J , Brown Robert D , Nkomo Vuyisile T
Published: June 2023

Background:
The bicuspid aortic valve (BAV) exhibits abnormal geometry and transvalvular flow and is susceptible to calcification with subsequent cardioembolic stroke from calcific embolic material. However, the description of embolic ischemic strokes in patients with BAV is limited to case reports.

Methods:
Consecutive patients from 1975-2015 with BAV (n=5401) at our institution were retrospectively identified. Patients with ischemic stroke before aortic valve replacement (AVR) were analyzed, and the stroke was characterized. Patients were grouped according to stroke etiology: calcific embolism from a BAV (BAV stroke); large artery atherosclerotic or lacunar stroke (LA stroke); and non-BAV, non-large artery embolic stroke (nLA stroke).

Results:
There were 83/5401 (1.5%) patients with ischemic stroke. Mean age was 54 ± 12 years and 28% were female. Stroke etiology was BAV stroke in 26/83 (31%), LA stroke in 23/83 (28%), nLA stroke in 30/83 (36%), and other in 4/83 (5%). Stroke was embolic in 72/83 (87%), as shown in Figure 1. CHA
2
DS
2
-VASc score was not different in patients with BAV stroke (1.4 ± 1.2) versus nLA stroke (1.8 ± 1.2, p=0.188) but was higher in LA stroke (2.3 ± 1.2, p=0.005 vs. BAV stroke). Recurrent stroke occurred in 41% overall (50% BAV stroke vs. 30% LA stroke vs. 47% nLA stroke, both p=NS vs. BAV stroke). BAV stroke was more commonly located in the retinal circulation (39% BAV stroke vs. 13% LA stroke [p=0.044] vs. 0% nLA stroke [p=0.002]). Patients with BAV and LA stroke were more likely to have moderate-to-severe aortic stenosis and undergo AVR sooner after stroke compared to patients with nLA stroke.

Conclusions:
Stroke is an important complication in patients with BAV. The most common type of stroke in BAV is embolic. Greater than one-third of embolic stroke resulted from embolism from a calcific aortic valve. Patients with BAV stroke commonly have a history of recurrent cerebral ischemic events, severe valvular disease, and proceed to AVR soon after stroke.
Abstract 9231: Contribution of Echocardiographic Abnormalities to Cardiac Sarcoidosis Diagnosis According to Past and Contemporary Diagnostic Criteria
Authors: Tremblay John , Judson Marc , Torosoff Mikhail
Published: June 2023

Introduction:
Cardiac sarcoidosis (CS) guidelines were originally published in 1993 by the Japanese Ministry of Health and Welfare (JMHW) and updated in 2006 and 2017. The updated guidelines consider several echocardiographic abnormalities as major diagnostic CS criteria. Contribution of this change to CS diagnosis has not been well investigated.

Methods:
A case control, single tertiary medical center study included 571 sarcoidosis patients (52.7% females, 58.9+/-12.6 years old) with documented extracardiac sarcoidosis and completed electrocardiogram and imaging assessment. Echocardiographic abnormalities consistent with CS were left ventricular (LV) dilation (LVD), LV aneurysms (LVA), LV wall motion abnormalities (LVWMA), LV hypertrophy (LVH), right ventricular hypertrophy (RVH), focal thinning of the anterior septum, and LV ejection fraction (EF) less than 50%. Frequency of echocardiographic abnormalities according to 1993, 2006 and 2017 CS diagnostic criteria were compared.

Results:
Most common echocardiographic abnormalities were reduced LVEF and LVH, occurring in more than 14 and 12% of CS patients. LVD and LVWMA occurred 8 and 7%, followed by uncommon RVH, LVA, and septal thinning (Table). Despite being common in CS, only LVD, LWMA, and reduced LVEF significantly (p<0.001) contributed to the CS diagnosis, while LVH did not (p=0.609). Alternatively, while LV aneurysm and septal thinning were uncommon, they significantly contributed to CS diagnosis (p<0.001). RVH was very uncommon and did not affect CS diagnosis.

Conclusions:
CS diagnostic criteria highlights the importance of cardiac imaging in suspected CS. Commonly seen echocardiographic findings of CS include EF<50%, LVWMA, and LV dilation significantly contribute to CS diagnosis. Of less commonly seen abnormalities, RVH utility appears to be low, while LVA and septal thinning may be helpful. Echocardiography remains an integral part in evaluating individuals with suspected CS.
Abstract 9243: Brain-Targeted Mechanical Intervention Using Passive Head Motion Can Have an Antihypertensive Effect
Authors: Sawada Yasuhiro , Sakitani Naoyoshi , Maekawa Takahiro , Yoshino Daisuke , Takano Kouji , Shinohara Keisuke , Kishi Takuya , Konno Ayumu , Hirai Hirokazu , Ayaori Makoto , Inanami Hirohiko , Tomiyasu Koji , Ogata Toru , Tsuchimochi Hirotsugu , Sato Shinya , Saito Shigeyoshi , Yoshino Kohzoh , Funamoto Kenichi , Ochi Hiroki , Shinohara Masahiro , Nagao Motoshi
Published: June 2023

Introduction:
Exercise is known to be effective as a therapeutic/preventative measure for numerous physical disorders and diseases including hypertension. However, the mechanisms underlying the antihypertensive effect of exercise remain to be elucidated.

Hypothesis:
The positive effects of exercise may be mediated by mechanical forces generated during exercise activities. Exercise-mimicking mechanical intervention may have an antihypertensive effect.

Methods:
We conducted animal experiments in which we reproduced mechanical accelerations generated in the head during moderate-velocity running. We performed in vitro experiments using cultured cells to determine what type of mechanical force was responsible for the antihypertensive effect of mechanical intervention. We carried out clinical studies to validate the clinical relevance of our findings.

Results:
Passive head motion (PHM) in hypertensive rats, which reproduced the mechanical accelerations generated in their heads during moderate-velocity treadmill running, decreased the expression of angiotensin II type 1 receptor (AT1R) in astrocytes in the rostral ventrolateral medulla (RVLM), thereby lowering their blood pressure. PHM generated interstitial fluid movement that was estimated to exert shear stress with an average magnitude of <1 Pa on the cells in the rat medulla. Fluid shear stress of a sub-Pa magnitude decreased the AT1R expression in cultured astrocytes. Inhibition of interstitial fluid movement following hydrogel introduction to the RVLM eliminated the antihypertensive effects of PHM and treadmill running. Vertically oscillating chair riding by hypertensive adult humans, which reproduced the mechanical accelerations generated in their heads during light jogging, lowered their blood pressure.

Conclusion:
Brain-targeted mechanical intervention can have an antihypertensive effect by modulating the function of RVLM astrocytes through interstitial fluid shear stress.
Abstract 9251: Associations Between Ultra- or Minimally-Processed Food Intake and Three Adiposity Indicators Among US Adults: Nhanes 2011-16
Authors: Zhang Zefeng , Kahn Henry S , Jackson Sandra , Martinez Euridice , Gillespie Cathleen , Yang Quanhe
Published: June 2023

Objectives:
Ultra-processed food (UPF) intake is associated with BMI, but effects on regional adipose depots or related to minimally-processed food (MPF) intake are unknown. We examined associations between calories consumed (%kcal) from UPF or MPF and three adiposity indicators: supine sagittal abdominal diameter/height ratio (SADHtR, estimates visceral adiposity), waist circumference/height ratio (WHtR, estimates abdominal adiposity), and BMI.

Methods:
Cross-sectional data came from 12 297 adults aged ≥20 years in the National Health and Nutrition Examination Survey 2011-2016. NOVA classification identified UPF and MPF dietary items using 24-hr dietary recall, and usual %kcal from UPF and MPF were estimated by National Cancer Institute methods. Each adiposity indicator was scaled to its sex-specific tertile distribution. We evaluated the associations between %kcal from UPFs and MPFs and each adiposity indicator using multivariable linear and multinomial logistic regression models.

Results:
The multivariable-adjusted, standardized β-coefficients per 10% increase in UPF intake were 0.0926, 0.0846, and 0.0791 for SADHtR, WHtR, and BMI respectively (all P<0.001; P>0.26 for pairwise differences). For MPF intake the β-coefficients were -0.0901, -0.0806 and -0.0688 (all P<0.001; P>0.18 for pairwise differences). The adjusted odds ratios (95% CI) for adiposity tertile 3
vs
. tertile 1 (comparing UPF intake quartiles 2, 3 and 4 to quartile 1) were 1.33 (1.22-1.45), 1.67 (1.43-1.95), and 2.24 (1.76-2.86), respectively, for SADHtR; 1.31 (1.19-1.44), 1.62 (1.37-1.91), and 2.13 (1.63-2.78) for WHtR; and 1.27 (1.16-1.39), 1.53 (1.31-1.79), and 1.96 (1.53-2.51) for BMI. MPF intake showed inverse associations with all three adiposity indicators with similar trends in association strength. Neither UPF nor MPF models had interactions by sex or age groups.

Conclusions:
Among US adults, the indicators of abdominal and visceral adiposity were positively associated with UPF intake and inversely associated with MPF intake. These findings support public programs to discourage consumption of UPFs and to encourage MPF consumption.
Abstract 9267: Modified Protocol of Niferidil Administration for Rhythm Restoration in Patients With Paroxysm of Atrial Fibrillation
Authors: Dzaurova Khava , Mironov Nikolay , Yuricheva Yulia , Vlodzyanovskiy Vladislav , Gagloeva Diana , Zelberg Maxim , Sokolov Sergey , Golitsyn Sergey
Published: June 2023

Introduction:
Niferidil is a new Russian class III antiarrhythmic drug, which in clinical trials has shown a high efficiency of restoration of sinus rhythm (SR) in persistent AF (87%), not inferior to electrical cardioversion. Currently, a three-stage scheme of drug administration is used (10 μg / kg - 10 μg / kg - 10 μg / kg). In a number of patients, SR is restored before the end of the first dose of the drug, which indicates the effectiveness of an even lower dose (5 μg / kg) of the drug, which has not been studied in clinical trials.

Objective:
To evaluate the effectiveness and safety of the modified protocol of niferidil administration in patients with paroxysmal AF.

Methods:
Included 87 patients with paroxysmal, 42 of them were men, mean age 63 [57;70]. After exclusion of contraindications, all patients received niferidil according to the following scheme. The initial dose of niferidil was 5 μg/kg of body weight, if AF did not terminate after 15 minutes (min.), niferidil was additionally administered at a dose of 5 μg/kg (total dose of 10 μg/kg). If SR was not restored patients received subsequent injections of niferidil 10 μg/kg, each after 15 min. (maximal total dose of 30 μg/kg). Injections were discontinued in case of SR restoration, QTc>500ms or proarrhythmia. All patients underwent continuous ECG monitoring within 24 hours to assess effectiveness and safety of niferidil.

Results:
SR was restored in 81 out of 87 patients (cumulative effectiveness of niferidil in doses up to 30 μg / kg was 93,1 %. 49,4 % of them restored SR after administration of 5 μg/kg dose, 66 (77 %) - after 10 μg/kg dose, 77 (88,5 %) - after 20 μg/kg dose, 81 (93,1 %) - after 30 μg/kg dose. In none of the cases was there any development of life-threatening ventricular arrhythmias. Prolongation of the QTc>500 ms was recorded in 14 patients (16%). Bradyarrhythmias after SR recovery were reported in 6 patients (6,8 %). In all cases sinus bradycardia was asymptomatic.

Conclusions:
The modified protocol of cardioversion allows SR to be restored in a significant number of AF patient’s lower doses of niferidil. The drug is highly effective in the treatment of paroxysmal AF, while in almost half of the cases, SR is restored after the administration after drug dose - 5 μg / kg. None of the patients developed Torsades de pointes.
Abstract 9301: Comparative Effectiveness and Safety of Direct Oral Anticoagulants versus Warfarin in Patients With Chronic Kidney Disease Stage III and Atrial Fibrillation
Authors: Boivin Proulx Laurie-Anne , Langlet Aurélie , Dorais Marc , Perreault Sylvie
Published: June 2023

Introduction:
The effectiveness and safety of direct oral anticoagulants (DOACs) in atrial fibrillation (AF) patients with stage III chronic kidney disease (CKD) is still questioned. This study assessed the comparative effectiveness and safety of DOACs vs warfarin in stage III CKD AF patients.

Methods:
A cohort of patients with inpatient or outpatient coding for AF who were newly prescribed an oral anticoagulant (OAC) was created using Quebec provincial administrative databases from 2011-2017. The primary effectiveness outcome was a composite of ischemic stroke, systemic embolism and death and the primary safety outcome was a composite of intracranial, gastrointestinal and major bleeding from other sites in the first year after OAC initiation. Treatment groups were compared using inverse-probability-of-treatment-weighting Cox proportional-hazards models at under-treatment analysis.

Results:
14,200 qualifying patients filled a claim for a new OAC prescription; 7,592 for warfarin 1,110 for rivaroxaban 20 mg, 2,084 for apixaban 5 mg and 1,674 for apixaban 2.5 mg. Rivaroxaban 20 mg was associated with a similar composite effectiveness (hazard ratio [HR] 0.84; 95% confidence intervals [CI] 0.62-1.12) and composite safety risk (HR 1.09; 95% CI 0.74-1.62) compared to warfarin (Figure 1). Apixaban 5 mg was associated with a lower composite effectiveness (HR 0.68; 95% CI 0.53-0.86), but similar composite safety risk (HR 0.89; 95% CI 0.64-1.22), whereas apixaban 2.5 mg was associated with a similar composite effectiveness (HR 0.97; 95% CI 0.78-1.21), but lower composite safety risk (HR 0.56; 95% CI 0.37-0.85).

Conclusions:
In comparison to warfarin, rivaroxaban and apixaban appear to be effective and safe in stage III CKD patients with AF.
Abstract 9311: Disparities in Resource Utilization by Families of Children With Complex Cardiac Conditions
Authors: Chou Francisca L , Donovan Denis J , Weller Rachel J , Fremed Michael , Glickstein julie S , Krishnan Usha S
Published: June 2023

Introduction:
There are limited data documenting the various sources of medical information that families use to learn about complex pediatric cardiac conditions. Our study aims to characterize the types of resources families use to learn about complex cardiac conditions and to identify disparities in the use of these resources.

Hypothesis:
We hypothesize that there are significant variations in the types of resources utilized by families from different educational and socioeconomic backgrounds.

Methods:
A survey evaluating resources families use to better understand complex cardiac conditions was administered to caretakers and pediatric patients at Morgan Stanley Children’s Hospital. Pediatric patients with prior diagnoses of congenital heart disease, cardiac arrhythmia, and/or heart failure were included. Caretakers’ levels of education (less than 16 years vs. 16 years or more) and patients’ medical insurance types (public vs. private) were compared to the utilization of resources.

Results:
Surveys completed by 137 caretakers and 27 pediatric patients were analyzed. Websites were utilized by 72% of caretakers and 56% of pediatric patients. A significantly higher percentage of responders with private insurance and higher education reported using websites, healthcare professionals, and their personal network to learn about pediatric cardiac lesions (by insurance p=0.009, p=0.001, p=0.006; by education p=0.022, p<0.001, p=0.018). A significantly larger percentage of responders with private medical insurance and with higher education reported using a digital device such as a computer or tablet compared to responders with public medical insurance and less than 16 years of education (p<0.001, p<0.001, respectively). Additionally, a significantly larger percentage of caretakers with higher education reported using a smartphone when compared to caretakers with less than 16 years of education (p=0.006).

Conclusions:
Both level of education and insurance status correlate with the utilization of informative resources and digital devices by families seeking to learn more about complex cardiac conditions in children.
Abstract 9312: Factors That Predict the Choice of Oral Anticoagulants in Men and Women With Atrial Fibrillation
Authors: Boivin Proulx Laurie-Anne , Langlet Aurélie , Legault Catherine , Dorais Marc , Perreault Sylvie
Published: June 2023

Introduction:
Potential sex-specific differences in oral anticoagulation (OAC) initiation among atrial fibrillation (AF) patients discharged from hospital into the community have not previously been investigated. This study identified sex-specific factors associated with OAC initiation in patients with AF.

Methods:
Using hospitalization and drug databases, we built a cohort of AF patients having been hospitalized and then discharged to the community between 2014 and 2017 in Québec, Canada. The primary outcome was the choice of OAC (warfarin, high-dose or low-dose DOAC) initiated upon hospital discharge, based on the first claim at the index date. Multivariate logistic regression was used to identify predictors of low-dose and standard-dose DOAC vs warfarin initiation, and low-dose vs standard-dose DOACs initiation.

Results:
32,050 patients were included, from whom 16,896 (53%) were women. In both sexes, warfarin initiation decreased while DOACs initiation increased over time. 17.3%, 29.0% and 53.7% of women were started on warfarin, low-dose and standard-dose DOACs, respectively while 15.6%, 16.6% and 67.8% of men were started on warfarin, low-dose and standard-dose DOACs, respectively. Year of initiation was a predictor of DOACs (odds ratios (ORs): from 1.40 to 8.37) (vs warfarin initiation in both sex (Table 1). Older age predicted the use of low-dose DOACs vs warfarin in both sex (ORs: from 1.65 to 3.99 age 65-79 and from 1.83 to 10.29 in age ≥80), while a CHA
2
DS
2
-VASc score ≥3 predicted the use of low-dose DOACs in women only (ORs from 1.98 to 2.49). Age ≥80 (ORs: from 17.99 to 64.82) and chronic kidney disease (CKD) (ORs from 2.82 to 7.42) predicted the use of low-dose DOACs vs standard DOACs in both sex (ORs: from 2.64 to 3.29 age.

Conclusions:
Women were more likely than men to received low-dose DOACs and the decision to initiate low- vs standard-dose DOACs was mainly driven by age, CKD status (in both sexes) and a high CHA
2
DS
2
-VASc score (in women only).
Abstract 9330: Improving Knowledge, Competence, and Confidence of Physicians Related to Antithrombotic Therapy in Cardiovascular Disease With Curriculum-Based Online Education
Authors: Harris Margaret , Lacouture Michael
Published: June 2023

We sought to determine if a curriculum of online continuing medical education (CME) activities presented in multiple delivery formats could improve the clinical knowledge, competence, and confidence of cardiologists related to the use of antithrombotic therapy in patients with chronic CAD, PAD, and VTE. The curriculum consisted of 13 online, CME-certified activities in multiple delivery formats. Education effect was assessed with a repeated pairs pre-/post-assessment study including a 3-item, multiple choice, knowledge/competence questionnaire and one confidence assessment question, with each participant serving as his/her own control. To assess changes in knowledge, competence, and confidence data from all clinicians who completed both pre- and post-questions were aggregated across activities and stratified by learning theme. McNemar’s test or paired samples t-test (P <.05) assessed educational effect. The activities launched from March 24, 2021 to August 2, 2021 and data were collected for up to 12 weeks for each activity. The education reached 4,847 cardiologists. Overall, there were significant relative improvements in knowledge/competence (35%, P <.001). related to understanding of recent clinical trial data regarding the use of antithrombotic therapy in patients with chronic CAD/PAD, understanding of the latest guideline-based recommendations for the use of antithrombotic therapy in patients with chronic CAD/PAD, understanding of the latest guideline-based recommendations for VTE prophylaxis in hospitalized medically ill patients, tailoring antithrombotic therapy in patients with chronic CAD/PAD, and individualizing VTE prevention strategies in hospitalized medically ill patients. Pre-vs-post gains in confidence were seen for tailoring antithrombotic therapy in patients with chronic CAD/PAD (50% improvement, P <.001); Individualizing VTE prevention strategies in hospitalized medically ill patients (83% improvement, P <.001). The online, CME-certified curriculum resulted in significant gains in knowledge/competence and confidence among cardiologists. These results demonstrate the effectiveness of curriculum-based education designed to address specific gaps in care.
Abstract 9337: The Association of Echo Parameters With Health Status in Patients With Obstructive Hypertrophic Cardiomyopathy. Insights From the Explorer-HCM Trial
Authors: Arnold Suzanne V , Gosch Kensey , Dolan Chantal , Fine Jennifer T , Masri Ahmad , Saberi Sara , Wang Andrew , Elliott Perry M , Hegde Sheila , Lam Jenny , Sehnert Amy J , Bach Richard , Spertus John A
Published: June 2023

Introduction:
The EXPLORER-HCM trial showed mavacamten, a direct cardiac myosin inhibitor, improved the health status of patients with obstructive hypertrophic cardiomyopathy (HCM). To explore physiologic mechanisms for this improvement, we examined cross-sectional and longitudinal associations of echocardiographic parameters with health status.

Methods:
EXPLORER-HCM was a 13-country, double-blind randomized trial of mavacamten or placebo for 30 weeks in symptomatic patients with obstructive HCM and peak LVOT gradient ≥50 mmHg. Health status was assessed with the Kansas City Cardiomyopathy Questionnaire-overall summary score (KCCQ-OS, range 0-100, higher=better). Using a series of multivariable linear regression models, we examined the association of 1) echo parameters with KCCQ-OS at baseline and 2) change in echo parameters with change in KCCQ-OS. Nonlinear associations were explored with cubic splines. As this was a mechanistic analysis, treatment was not included.

Results:
Among 196 patients (mean age 58±12 years, 39% women), mean KCCQ-OS was 67±18 at baseline and 76±19 at 30 weeks; mean change of 10±16 points. At baseline, only interventricular septal thickness (IVST) was significantly associated with KCCQ-OS in adjusted analyses (1.2-point decrease in KCCQ-OS per 1 mm higher IVST; 95% CI -2.2 to -0.2, p=0.015). However, when comparing changes in echo parameters with changes in KCCQ-os, decreases in LVOT gradient at rest, LVOT gradient post-exercise, LVOT gradient with Valsalva, LV mass, posterior wall thickness, and IVST were each associated with significant improvements in KCCQ-OS (FIGURE). Measures of diastolic function were not associated with KCCQ-OS, either cross-sectionally or longitudinally.

Conclusions:
Among patients with obstructive HCM, reductions in LVOT gradients, LV mass, and wall thickness (IVST>posterior wall) were associated with significant improvements in patients’ symptoms, function, and quality of life.
Abstract 9359: Orai1 Inhibitors as Potential Treatments for Pulmonary Arterial Hypertension
Authors: Masson Bastien , Le Ribeuz Helene , Sabourin Jessica , Laubry Loann , Woodhouse Emily , Foster Richard , Ruchon Yann , Dutheil Mary , boet angele , Ghigna Maria-Rosa , Gooroochurn Hans , Thomas de Montpreville Vincent , Mercier Olaf M , Beech David J , Benitah Jean-Pierre , bailey marc , Humbert Marc , Montani David , capuano veronique , Antigny Fabrice
Published: June 2023

Rationale:
Pulmonary arterial hypertension (PAH) is characterized by progressive distal pulmonary artery (PA) obstruction, leading to right ventricular hypertrophy and failure. Exacerbated intracellular calcium (Ca
2+
) signaling contributes to abnormalities in PA smooth muscle cells (PASMCs), including aberrant proliferation, apoptosis resistance, exacerbated migration, and arterial contractility. Store-operated Ca
2+
entry (SOCE) is involved in Ca
2+
homeostasis in PASMCs, but its properties in PAH are unclear.

Methods:
Using a combination of Ca
2+
imaging, molecular biology,
in vitro
,
ex vivo
, and
in vivo
approaches, we investigated the roles of SOCE channel Orai1 in PA remodeling in PAH, and determined the consequences of pharmacological Orai1 inhibition
in vivo
using experimental models of pulmonary hypertension (PH).

Results:
Human PASMCs (hPASMCs) from patients with PAH (PAH-hPASMCs) showed upregulation of SOCE and Orai1 expression, in which ERK1/2, nuclear factor of activated T cells (NFAT), and nuclear factor-kappa B (NFκB) were contributing factors. Using siRNA and two Orai1 inhibitors, we found that Orai1 inhibition reduced SOCE, mitochondrial Ca
2+
entry, aberrant proliferation, apoptosis resistance, migration, and excessive calcineurin activity in PAH-hPASMCs. Orai1 inhibitors reduced agonist-evoked constriction in human PAs. In experimental rat models of PH evoked by chronic-hypoxia or monocrotaline or Sugen/hypoxia, administration of Orai1 inhibitors (BTP2, JPIII, or 5J4) protected against PH.

Conclusions:
In human PAH and experimental PH, Orai1 expression and activity are increased. Orai1 inhibition normalizes the PAH-hPASMC phenotype and attenuates PH in rat models, suggesting that Orai1 should be considered as a relevant therapeutic target for PAH.
Abstract 9371: Effectiveness of Endovascular Aneurysm Repair With Inferior Mesenteric Artery Embolization From Mid-Term Outcome of a Randomized Controlled Trial
Authors: Takeuchi Yuriko , Morikage Noriyasu , Ohtsuka Ryo , Ike Soichi , Mizoguchi Takahiro , Samura Makoto , Harada Takasuke , Suehiro Kotaro , HAMANO KIMIKAZU
Published: June 2023

Introduction:
Adequate management of type II endoleak (T2EL) has been widely discussed, and inferior mesenteric artery (IMA) embolization before endovascular aneurysm repair (EVAR) has been reported to reduce the T2EL. However, there have been no randomized controlled trials (RCT) confirming the efficacy. Thus, this study aimed to evaluate the effect of IMA embolization during EVAR in patients at high risk of T2EL in an RCT.

Methods:
This study included patients scheduled for elective EVAR between September 2014 and March 2018. Patients at high risk of T2EL (IMA patency with IMA ≥ 3 mm, LAs ≥ 2 mm, or an aortoiliac-type aneurysm) were prospectively randomized to receive EVAR with or without IMA embolization. The primary endpoint was T2EL occurrence during follow-up. The secondary endpoints were aneurysmal sac changes, adverse events from IMA embolization, and reintervention rate due to T2EL.

Results:
A total of 106 patients were randomized to the embolization group (group A, n = 53) or the nonembolization group (group B, n = 53). The technical success rate of IMA embolization was 88.7%, and no complications related to IMA embolization were observed. During the mean follow-up period—50.2 ± 21.9 months in group A and 52.9 ± 23.1 months in group B—the incidence of T2EL was significantly lower in the embolization group (23.9% in group A vs. 53.8% in group B; P < 0.0001). Sac diameter changes, the incidence of aneurysmal sac growth (≥5 mm) related to T2EL, and freedom from sac enlargement (≥5 mm) related to T2EL at 5 years were –6.5 ± 8.9 mm vs. –1.1 ± 13.1 mm, 6.5% vs. 25.0%, and 97.5% vs. 72.0% in groups A and B, respectively (P = 0.015; P = 0.025; P = 0.018), which show that both shrinkage of aneurysm and freedom from sac enlargement are significantly higher in group A. Although no significant difference was observed in the reintervention rate due to T2EL (0% in group A vs. 2% in group B; P = 0.344), a significant difference in sac enlargement (≥10 mm) related to T2EL was observed (0% in group A vs. 13.5% in group B; P = 0.010), suggesting that reintervention would need to be considered.

Conclusions:
The results demonstrated the effectiveness of IMA embolization during EVAR in high-risk patients for the prevention of T2EL, which is suggested for avoiding aneurysmal sac enlargement related to T2EL.
Abstract 9377: A Role for Targeted Colchicine Uptitration in Recurrent Pericarditis: A Ten-Year Experience of Treatment Refractory Disease at a Specialist Referral Center
Authors: Peet Claire J , Mapalo Bella R , Wood Michael R , Papadopoulou Charalampia , Kul Cinar Ovgu , Capon Francesca , Lachmann Helen
Published: June 2023

Introduction:
Recurrent pericarditis (RP) carries significant morbidity, both direct and indirect through corticosteroid dependence. Uptake of highly effective anti-interleukin-1 agents, anakinra and rilonacept, is limited by expertise and cost, leading to widespread corticosteroid use in cases refractory to low dose colchicine. Thus, effective, accessible approaches that minimise iatrogenic harm are needed. Consensus guidance for other autoinflammatory diseases recommends colchicine uptitration prior to addition of biologics, providing a potential approach in treatment-refractory RP.

Methods:
Retrospective review of RP case records at a tertiary center 2012-2022. Treatment-refractory RP was defined as active disease despite colchicine 1mg/24h or disease requiring other prophylactic drugs, and corticosteroid dependence as daily corticosteroid use for 6 months.

Results:
Of 111 cases, 71 (64.0%) were treatment-refractory at 1
st
review, of whom 32 (45.1%) were corticosteroid dependent. Median follow up was 15 months (IQR 4-35). Of treatment-refractory cases without corticosteroid dependence, 38/39 (97.4%) were treated with colchicine uptitration and 4/39 (10.3%) with anakinra; none became corticosteroid dependent. Of corticosteroid dependent cases, 27/32 (84.4%) were treated with colchicine uptitration and 11/32 (34.3%) with anakinra. Corticosteroids were discontinued in 18/32 (56.3%): 7/18 (38.9%) weaned with colchicine uptitration alone, 9/18 (50.0%) with anakinra and 2/18 (11.1%) with azathioprine. Median corticosteroid duration was 15.5 months (IQR 12-44.75) and corticosteroid toxicity occurred in 8/32 (25.0%). Among the 70/71 cases (98.6%) treated with colchicine (median maintenance dose 2 mg/24h (IQR 1.5-2)), permanent discontinuation was uncommon (3/70, 4.3%) and due to gastrointestinal symptoms; self-limiting liver transaminase elevation was common (28/70, 40.0%) but did not lead to discontinuation in any case.

Conclusions:
Colchicine uptitration enabled avoidance of new corticosteroid dependence, facilitated corticosteroid discontinuation and was well tolerated. This contrasts with the frequent toxicity seen with prolonged corticosteroid use and supports wider uptake of this approach in RP.