bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 12789: Age-Related Disparities in Complications Among Women With Peripartum Cardiomyopathy
Authors: Akkaramani Sudhamai , Memon Rahat A , Ramphul Kamleshun , Ahmed Raheel , Aggarwal Shruti , Dhaliwal Jasninder S , Ahmad Hasan , Farhan Muzammil , Hasan Ali , Hassan Azeem , Sombans Shaheen , Sakthivel Hemamalini , Lohana Petras
Published: December 2023

Introduction:
While the exact pathogenesis of peripartum cardiomyopathy, a potentially life-threatening condition, is still unknown, its incidence is rising globally. We sought to understand the differences in outcomes and complications based on age.

Hypothesis:
Older women with peripartum cardiomyopathy would have adverse outcomes and complications.

Methods:
Our study sample consisted of females diagnosed with peripartum cardiomyopathy that required hospitalization care. Records from the 2016-2020 National Inpatient Sample were used for our study. They were divided into two age-based cohorts: 15-29 years and 30-40 years. We evaluated differences in complications between the two groups using multivariable regression.

Results:
Our analysis consisted of 20520 females diagnosed with peripartum cardiomyopathy, divided as 57.2% in the cohort of ages 30-40 and 42.7% between 15-29 years. Several differences in patient characteristics and comorbidities were noted, as reported in Table 1. Furthermore, patients of ages 30-40 demonstrated higher odds of reporting acute ischemic stroke (aOR 1.354, 95% CI 1.038-1.767, p=0.026) while having a reduced risk of cardiogenic shock (aOR 0.787, 95% CI 0.688-0.901, p<0.01), as compared to those of ages 15-29. No statistically significant differences were noted for events of acute kidney injury (aOR 1.074, 95% CI 0.976-1.182, p=0.143), acute pulmonary edema (aOR 1.147, 95% CI 0.988-1.332, p=0.071), or mortality (aOR 0.978, 95% CI 0.742-1.290, p=0.877) (Table 2).

Conclusions:
Peripartum cardiomyopathy is a serious condition that requires appropriate care and management. Our study linked cases of ages 30-40 years with increased odds of acute ischemic stroke but lower odds of cardiogenic shock. Physicians should therefore be encouraged to monitor and screen as appropriate to improve outcomes closely.
Abstract 12796: N-Terminal Pro-B-Type Natriuretic Peptide Levels for Determining Long Term Prognosis in Patients With Non-ST-Elevation Myocardial Infarction (NSTEMI); a Systematic Review and Meta-Analysis
Authors: Shrestha Abhigan Babu B , Mainali Nischal , Shrestha Shubham , Shrestha Sajina , Karki Dr. Bikash , Neupane Sushil , Jha Bhaskar , Jha Apurwa , Sedhai Yub Raj , Halder Anupam , Asija Ankush , SHRESTHA SHUMNEVA , Bhattarai Suju , Jaiswal Vikash
Published: December 2023

Introduction:
The utilization of the biomarker N-Terminal Pro-B-Type Natriuretic Peptide (NT-proBNP) holds diagnostic value for identifying heart failure and acute coronary syndromes. However, its long-term prognostic significance in patients with non-ST-elevation Myocardial Infarction (NSTEMI), a subtype of acute coronary syndromes, remains inadequately explored.

Hypothesis:
This meta-analysis aims to investigate the correlation between NT-proBNP levels and the subsequent occurrence of adverse clinical outcomes in individuals with NSTEMI.

Methods:
A systematic search was conducted on PubMed, Google Scholar, Science Direct, Cochrane, and Embase, encompassing articles published until June 2023. The highest recorded NT-proBNP value was utilized for analysis, considering a follow-up duration of at least 30 days. Odds ratios (OR) were synthesized using the random-effects DerSimonian-Laird model, with statistical significance set at a p-value <0.05.

Results:
The study involved 8 articles, comprising a total of 7,921 patients, of whom 7,161 were diagnosed with NSTEMI. The analysis examined the relationship between NT-proBNP levels and clinical outcomes in NSTEMI patients over an average follow-up period of 19.85 months. Elevated NT-proBNP levels exhibited a significant association with increased odds of Major Adverse Cardiac Events (MACE) [OR 2.56, 95% CI: 1.58-3.53, I2=94.06%, p<0.001], all-cause mortality [OR 2.54, 95% CI: 0.53-4.55, I2=76.96%, p=0.01], and myocardial infarction (MI) [OR 1.10, 95% CI: 0.56-1.63, I2=0.00%, p<0.001].

Conclusions:
The elevated NT-proBNP levels in patients with NSTEMI are significantly associated with long-term adverse cardiovascular outcomes. Consequently, NT-proBNP can serve as a valuable tool for assessing the risk of unfavorable cardiac events. However, further extensive investigations are warranted to validate these results on a larger scale.
Abstract 12811: Incidence and Phenotypic Predictors of Arrhythmias in Idiopathic Pulmonary Arterial Hypertension
Authors: Reddy Ashwin , Middleton Jennifer , Nethercott Sarah , Polwarth Gary , Pepke-Zaba Joanna , Martin Claire , Rothman Alex M , Toshner Mark ,   National Cohort Study of Idiopathic and HeritablePAH Collaboration,   UniPHy Clinical Trials Network
Published: December 2023

Introduction:
Arrhythmias are common in patients with idiopathic pulmonary arterial hypertension (IPAH). However prospective analysis of arrhythmias in a large cohort of IPAH patients using implantable cardiac monitors (ICMs) is lacking.

Aims:
Establish the rate of arrhythmias in a prospective cohort of IPAH patients using ICMs. Determine factors that predict arrhythmia occurrence in IPAH. Elucidate whether arrhythmia incidence is related to adverse outcomes.

Methods:
ICMs were implanted into 80 IPAH patients across two UK centres. Arrhythmia and clinical worsening events (defined as death, transplant or hospitalisation due to PAH worsening) were prospectively recorded and characteristics associated with arrhythmia incidence identified. The arrhythmia rate in IPAH patients was compared to 72 age and sex-matched patients without IPAH who had ICMs implanted for clinical indications. Comparisons of data were performed using analysis of variance, χ2 or Kruskal-Wallis calculations as appropriate. The Cox proportional hazards model was used to resolve independent risk factors for significant arrhythmia occurrence. A two-tailed probability level of <0.05 was considered significant.

Results:
Over 186 patient-years follow-up 79 arrhythmia events were noted in 40% IPAH patients vs 78 events in 41% comparators. Arrhythmia incidence was related to right atrial (RA) enlargement at time of implant, baseline conduction disease and symptom reporting. Arrhythmia incidence predicted clinical worsening (figure).20% of patients had targeted arrhythmia intervention as a direct consequence of ILR studies. Only RA size was independently associated with clinically significant arrhythmia on multivariate analysis

Conclusion:
Arrhythmias are frequent in IPAH patients and predict worse outcomes. RA enlargement is independently associated with clinically significant arrhythmia incidence. IPAH should be considered a high-risk group for continuous monitoring studies.
Abstract 12820: The Use of Mineralocorticoid Receptor Antagonists but Not Renin-Angiotensin System Inhibitors is Associated With Better Outcomes in Patients With Heart Failure and Advanced Chronic Kidney Disease
Authors: Enzan Nobuyuki , Matsushima Shouji , Kaku Hidetaka , Tohyama Takeshi , Nagata Takuya , Ide Tomomi , Tsutsui Hiroyuki
Published: December 2023

Introduction:
The usefulness of mineralocorticoid receptor antagonists (MRA) or renin-angiotensin system (RAS) inhibitors in patients with heart failure and advanced chronic kidney disease (CKD) remains to be established. This study sought to determine whether MRA or RAS inhibitors could improve outcomes in HF and CKD patients.

Methods:
We analyzed HF patients enrolled in the Japanese Registry Of Acute Decompensated Heart Failure (JROADHF), a national database of HF. The primary outcome was composite of cardiovascular death or cardiovascular rehospitalization. In overall cohort, we used cubic spline analysis adjusted for potassium levels and other covariate to elucidate effects of MRA or RAS inhibitors on outcomes as a function of creatinine clearance. Next, we conducted propensity score matching within patients with creatinine clearance < 30 ml/min/m
2
.

Results:
Out of 9,637 eligible patients, 4,774/6,428 patients received MRA/RAS inhibitors, respectively. Cubic spline analysis showed that both MRA and RAS inhibitors were associated with better primary outcomes in patients with lower left ventricular ejection fraction, which was consistent with previous studies. It means that our dataset was concordant with other registries. MRA was associated with better outcomes in patients with lower creatinine clearance, and not in patients with higher creatinine clearance (Figure). Conversely, RAS inhibitors was associated with better outcomes only in patients with higher creatinine clearance. Among patients with creatinine clearance < 30 ml/min/m
2
, propensity score matching yielded 610 pairs. In these pairs, MRA was associated with lower incidence of cardiovascular events (399 vs. 486 incidence per 1,000 person-years; incidence rate ratio 0.821 [0.714-0.944]; P = 0.006).

Conclusions:
The use of MRA, not RAS inhibitors, was associated with better outcomes in patients with heart failure and advanced chronic kidney disease.
Abstract 12836: Safety and Efficacy of Left Atrial Appendage Occlusion in Patients With Chronic Kidney Disease: A Meta-Analysis
Authors: Ang Song Peng , Chia Jia Ee , Jaiswal Vikash , Chia Tong Hong , Iglesias Jose
Published: December 2023

Introduction:
Left atrial appendage occlusion (LAAO) has been recognized as an alternative to preventing thromboembolic stroke in selected patients with non-valvular atrial fibrillation (AF). However, limited evidence exists regarding the safety of LAAO in patients with chronic kidney disease (CKD). This meta-analysis aims to evaluate the safety and efficacy of LAAO in CKD patients.

Methods:
We conducted a comprehensive search across various electronic databases, including PubMed, Embase, and the Cochrane Library, to identify relevant studies comparing the outcomes of CKD and non-CKD patients undergoing LAAO. The outcomes of interest included procedural success, in-hospital mortality, major bleeding, stroke, transient ischemic attack (TIA), and pericardial effusion/tamponade. The outcomes were pooled using the Hartung-Knapp-Sidik-Jonkman random-effects model, and the results were expressed as odds ratios (OR) with their corresponding 95% confidence intervals (CI).

Results:
Seven studies involving 38,184 patients (5,742 CKD, 32,442 non-CKD) were included in the final analysis. The rate of procedural success (98.4% vs. 97.2%, OR 1.64, 95% CI: 0.78-3.45, p=0.19) was similar between both groups. Regarding procedural complications, there were no significant differences in terms of the risk of in-hospital mortality (OR 1.87, 95% CI: 0.60-5.82, p=0.28), stroke (OR 2.19, 95% CI: 0.76-6.29, p=0.15), TIA (OR 1.64, 95% CI: 0.78-3.45, p=0.19), major bleeding (OR 1.85, 95% CI: 0.78-4.42, p=0.16), or pericardial effusion/tamponade (OR 1.23, 95% CI: 0.76-2.00, p=0.39) between the two patient groups.

Conclusions:
Our study demonstrates comparable safety and efficacy of LAAO in patients with CKD compared to those without CKD. Further large prospective studies are warranted to confirm these findings.
Abstract 12838: Mitochondrial Encephalomyopathy, Lactic Acidosis, and Stroke-Like Episodes (MELAS) and m.3243A>G Mutations Have Higher Prevalence of Wolff-Parkinson-White Syndrome
Authors: Liu Jia Yue , Numan mohammed T , Koenig Mary Kay
Published: December 2023

Background:
Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) is one of the most common mitochondrial disorders. Cardiovascular involvement has been reported in up to 30% of MELAS patients with varying clinical presentations from non-specific cardiogenic abnormalities to conduction abnormalities, cardiomyopathies, heart failure, fatal arrhythmias and cardiac death. Although conduction defects are a known complication, the frequency of Wolff-Parkinson-White (WPW) Syndrome among MELAS patients and mutations associated with MELAS is uncertain, and their association with cardiomyopathy and treatment outcomes have rarely been reported.

Methods:
A retrospective chart review of 50 MELAS patients from January 2007 to December 2022 from the Neuroscience Institute at University of Texas Houston was conducted. Medical histories, genetic testing, electrocardiograms, echocardiograms, and electrophysiology studies were reviewed.

Results:
43 patients were included (mean age 23.8, median age 18.5, range 2-58). Eight of 43 patients with MELAS (20 %), inclusive of one of 3 patients with m.4317A>G (33.3%) and seven of 40 patients with m.3243A>G variants had electrocardiographic findings consistent with WPW. Other conduction abnormalities were noted in ten of 20 patients (50%) with m.3243A>G with neurological involvement and six of 20 patients (30%) with m.3243A>G mutation without strokes. Four patients required electrophysiology studies with ablation (mean age 8.5, range 7-10), one for inappropriate sinus tachycardia resistant to several medications, and three patients with WPW syndrome all of whom required repeat ablations. Conduction abnormalities had a positive correlation with higher heteroplasmy levels (mean 35 % vs 51%, 95% CI -30.2 to -2.88, p=0.019). Six patients with MELAS had cardiomyopathy of varying severity which were all associated with conduction abnormalities, including two patients with WPW syndrome (p=0.014).

Conclusion:
The prevalence of WPW in patients with MELAS syndrome and the m.3243A>G variant appears much higher than in the normal population and may require multiple electrophysiology studies ablations to treat. Routine cardiology screening is recommended for early detection.
Abstract 12853: [
64
Cu]Cu-DOTATATE is Superior to [
68
Ga]Ga-NODAGA-E[c(RGDyK)]2 (RGD) PET/CT Imaging In Detection and Quantification of Atherosclerosis: A Retrospective Analysis of a Phase 2 Trial Cohort
Authors: Khare Harshvardhan A
Published: December 2023

Introduction:
Inflammation and angiogenesis are central to development of atherosclerosis. [
64
Cu]Cu-DOTATATE and [
68
Ga]Ga-NODAGA-E[c(RGDyK)]2 (RGD) are PET tracers that can non-invasively visualize somatostatin receptor subtype 2 (SSTR
2
) and α
v
β
3
integrin expression that represent inflammation and angiogenesis respectively.

Hypothesis:
Whether an imaging tracer of inflammation can be compared with a tracer of angiogenesis for detection and quantification of the atherosclerotic process in patients from a Phase II cancer trial cohort.

Methods:
A cohort of patients from Phase II trial were divided in three groups as controls (N=7), at risk (N=6) & diseased (N=7). PET/CT scans with two different tracers were performed in all subjects. The scans were retrospectively analyzed, and tracer uptake (mean of maximum target-to-background ratios (mTBRmax)) were determined in 6 arterial segments. In addition, plaques from patients (N=7) undergoing carotid endarterectomy (CEA) were studied with autoradiography and immunohistochemistry.

Results:
[
64
Cu]Cu-DOTATATE uptake in the disease group was significantly higher compared to the control group in the abdominal aorta (4.4 vs 2.1, p=0.02), thoracic aorta (3.0 vs 2.2, p=0.02), aortic arch (2.8 vs 2.2, p=0.03), left carotid artery (2.2 vs 1.3, p=0.02) and the average of all six aortic segments (2.7 vs 2.0, p=0.01) whereas all aortic segments in the disease group showed a higher but a non-significant difference compared to the control group with RGD uptake. A moderate correlation was found between the mean aortic uptake of [
64
Cu]Cu-DOTATATE & RGD (r=0.41, p=0.01) in patients from the disease group. SSTR
2
and α
v
β
3
expression was confirmed on ex vivo plaques along with tracer binding.

Conclusions:
An in vivo imaging marker of inflammation was superior to a marker of angiogenesis in discriminating levels of atherosclerosis. The two markers were weakly correlated in patients with known cardiovascular disease.
Abstract 12856: Electrocardiographic T Wave Inversion and Cardiac Structure and Function
Authors: Kamimura Daisuke , Yimer Wondwosen , Mentz Robert J , Butler Javed , Shah Amil M , Akbilgic Oguz , Kheirkhahan Mobin , Tio Maria Clarissa , Hamid Arsalan , Suzuki Takeki , Hall Michael E
Published: December 2023

Background:
Electrocardiographic T wave inversion (TWI) has been associated with incident heart failure (HF) in Black Americans without known coronary heart disease (CHD). The aim of this study was to investigate the relationship between TWI and left ventricular (LV) structure and function to evaluate cardiac changes that may precede symptomatic disease among Black Americans.

Methods:
Among 4134 Black American participants in the Jackson Heart Study without prevalent HF or CHD at baseline. We defined TWI as having negative T wave amplitudes in each lead of the 12-lead electrocardiogram. Outcomes of interest included echocardiographic LV structure (LV mass index, LVMI, LV diastolic dimension, LVDd and relative wall thickness, RWT) and LV function (LV ejection fraction, LVEF). We investigated the associations between TWI and LV structure and function using multiple linear regression analysis. For participants with missing values in any covariate of interest, values were imputed using multiple imputation by chained equations.

Results:
In this cohort with median age 55 years and 65% women. The depth of the inverted T wave in leads I and aVL were positively associated with RWT (Figure). The depth of the inverted T waves in leads II, III, and aVF were associated with LVDd. The depth of the inverted T waves in all the leads except V1 and V2 were associated with LVMI, while T wave inversions in only aVF were associated with LVEF.

Conclusion:
The depth of inverted T waves in leads I and aVL (which were associated with incident HF with preserved EF) were associated with LV concentricity while T wave amplitudes in leads II, III, and aVF (which were associated with incident HF reduced EF) were associated with LV eccentricity. Simple electrocardiographic information may be useful for identifying patients at risk of HF (stage B/pre HF).
Abstract 12859: Clinical Correlates and Prognostic Value of B-type Natriuretic Peptide in Left Ventricular Assist Device Recipients With Cardiogenic Shock: Insights From INTERMACS
Authors: Shetty Naman S , Patel Nirav , Parcha Vibhu , Vekariya Nehal , Xie Rongbing , Arora Garima , Arora Pankaj
Published: December 2023

Introduction:
B-type natriuretic peptide (BNP) is a robust predictor of outcomes across the heart failure (HF) spectrum. However, data characterizing BNP levels in end-stage HF with cardiogenic shock (CS) is lacking. Furthermore, the prognostic value of BNP in left ventricular assist device (LVAD) receiving Stage D HF patients with CS has not been assessed previously.

Methods:
Continuous flow LVAD recipients with CS enrolled in INTERMACS between 2005 to 2017 were included. CS was defined as INTERMACS profile 1-3. The primary outcome of the study was long-term mortality. Long-term mortality was assessed in patients alive at 1-month post-surgery. Secondary outcomes included peri-operative mortality (<30 days of surgery), cardiovascular mortality, arrhythmia, and right HF. The cohort was stratified by quartiles of BNP levels. Multivariable Cox proportional hazard models, adjusted for age, sex, body mass index, INTERMACS profile, center volume, implantation year, device strategy, estimated glomerular filtration rate, employment status, and education level, were used to assess the association between BNP levels and outcomes.

Results:
Among 7,290 LVAD recipients with CS, the median pre-implantation BNP value was 859 (427, 1,614) pg/mL. Males [851(429, 1,557) pg/mL,
P
=0.07], non-Hispanic Blacks [777 (362, 1,514) pg/mL,
P
=<0.001], and obese [642 (311, 1,170) pg/mL,
P
=<0.001] patients had lower BNP values. Over a median follow-up of 14.7 (6.9, 28.7) months, the risk of long-term mortality was similar in the second [HR
adj
:1.06 (0.94-1.20)], third [HR
adj
:0.97 (0.85-1.10)], and fourth [HR
adj
:1.04 (0.91-1.18)] quartiles of BNP compared with the first quartile of BNP. Similarly, the risk of peri-operative mortality, cardiovascular mortality, arrhythmia, and right HF did not vary by the quartiles of BNP.

Conclusions:
BNP has poor prognostic value in LVAD recipients with CS and the value of routine measurement of BNP in this population needs further investigation.
Abstract 12861: Steroidal Mineralocorticoid Receptor Antagonist Treatment Patterns and Predictors of Discontinuation
Authors: Richard Emma , Desai Nihar R , Willey Vincent , Gay Alain , Scott Charlie , Folkerts Kerstin , Pessina Elena , Teng Chia-Chen , Oberprieler Nikolaus G
Published: December 2023

Introduction:
Steroidal mineralocorticoid receptor antagonists (sMRA), spironolactone and eplerenone, are indicated for several cardiovascular (CV) conditions, including heart failure and hypertension. However, adverse drug reactions may lead to discontinuation. This study aimed to explore sMRA treatment patterns and predictors of discontinuation.

Methods:
This retrospective observational study used administrative claims from the Healthcare Integrated Research Database® to identify naïve adult users of sMRAs between 01 Jan 2016 and 31 May 2021 with at least 12 months of continuous health plan enrollment before initiation. Five subgroups were identified based on comorbidities before sMRA initiation - heart failure with preserved or reduced ejection fraction (HFpEF/HFrEF), undetermined heart failure (undHF), chronic kidney disease (CKD) and type 2 diabetes (T2D), and nondiabetic-CKD (ndCKD). sMRA treatment patterns and discontinuation (i.e., no refill within two prescription cycles) were described. Multivariate logistic regression modeling was used to explore predictors (i.e., demographics, comorbidity burden, specialist prescribing, CV disease, and medications) of discontinuation in all sMRA users and subgroups separately.

Results:
We identified 224,100 sMRAs users (99% spironolactone), including 8,553 HFpEF, 19,636 HFrEF, 20,336 undHF, 11,336 CKD and T2D, and 10,134 ndCKD, patients. Over a median of 655 days, a dose change was observed in 23% of patients. A dose increase was more common than a decrease (16% vs. 7%), a trend that was observed across all subgroups. Overall, 73% of sMRA users discontinued treatment after a median of 90 days. Discontinuation in subgroups was lower; 62% in HFpEF, 58% in HFrEF, 61% in undHF, and 66% in both CKD subgroups. No specific factors were consistently associated with increased odds of sMRA discontinuation. However, increased comorbidity burden, use of other CV medications, and cardiologist prescribers significantly decreased the odds of discontinuation across most subgroups.

Conclusions:
Most naïve sMRA users discontinue therapy within six months of initiation. No demographic or clinical factors were consistently associated with increased odds of sMRA discontinuation.
Abstract 12895: Classification of Patients According to the Cardiometabolic-Based Chronic Disease Model in a Preventive Cardiology Center
Authors: Hernandez Sevillano Jose Joel , Babagoli Masih , Mellacheruvu Pranav , Chen Yitong , Liu Shelley , Johnson Janet , Fuster Valentin , mechanick Jeffrey
Published: December 2023

Introduction:
Cardiovascular disease results from complex interactions between metabolic drivers. The purpose of the novel cardiometabolic-based chronic disease model is to expose opportunities for early and sustainable prevention.

Hypothesis:
The cardiometabolic-based chronic disease (CMBCD) model allows allocation of patients with stage 1 (“risk”), stage 2 (“predisease”), stage 3 (“disease”), and stage 4 (“complications”) of each of the four metabolic drivers - adiposity, dysglycemia, dyslipidemia, and hypertension.

Methods:
Patients with a visit at the Center for Cardiovascular Health at Mount Sinai Heart, a multidisciplinary preventive cardiology center, were classified according to the CMBCD model relative to baseline characteristics. The context of this classification is the determination, based on statistical and mechanistic corroboration, of a dominant driver to be used to subsequently determine response and sustainability rates.

Results:
The most frequent dominant driver was adiposity-based chronic disease, in 642 (76.9%) patients, followed by dysglycemia-based chronic disease, in 104 (12.5%), hypertension-based chronic disease in 76 (7.5%), and lipid-based chronic disease in 13 (1.3%). A very large proportion of patients with adiposity-, dysglycemia-, and hypertension-based chronic disease (49%, 57%, and 25%, respectively) present with “complications” of “predisease” and “disease”.

Conclusions:
Abnormal adiposity and dysglycemia have proximal roles in the pathogenesis of cardiovascular disease in the cardiometabolic-based chronic disease model. This presents a window of opportunity for early lifestyle prevention strategies.
Abstract 129: Gender Differences and Receipt of Telephone Cardiopulmonary Resuscitation of Suspected Out-of-Hospital Cardiac Arrests
Authors: Blewer Audrey L , Starks Monique A , King Heather , Hart Lauren , Van Vleet Lee , Patterson Charlotte , Altamirano Pedro , Siddiqui Fahad , Ostbye Truls , Prvu Janet A , Joiner Anjni
Published: December 2023

Introduction:
Women receive bystander cardiopulmonary resuscitation (CPR) less frequently in public. The gender of the person calling 911 and gender of the telecommunicator may influence receipt of telephone CPR for women with suspected out-of-hospital cardiac arrests (OHCA).

Objectives:
We sought to assess whether gender of the caller was associated with women’s receipt of CPR for suspected OHCA. Secondarily, we examined gender of the telecommunicator and the receipt of CPR by women with suspected OHCA. We hypothesized that receipt of CPR for women patients will be less when the caller is a woman compared to when a caller is a man, while gender of the telecommunicator will not affect the receipt of CPR by patient gender.

Methods:
We conducted a retrospective study of 911 calls of suspected OHCAs in Durham, NC (08/1/2021-10/31/2021). Calls were professionally transcribed. A database was created of the calls including gender of the caller, telecommunicator, and patient (assigned by coder as woman/man/other), as well as characteristics of initiation and receipt of CPR. Gender of the caller and gender of the telecommunicator were examined for their association with gender of the patient. Data were analyzed descriptively.

Results:
Eighty-eight calls were examined, representing 82 patients. Excluding pediatric arrests (<18 years old) and healthcare facility arrests, 79 were included. Of those, 36% of patients were women, mean age was 58±20, and 39% received bystander CPR (33% of women, 46% of men). Sixty percent of the callers were women and 70% of the calls were conducted by a women telecommunicator. Of the calls made by women, 25% of women patients received CPR compared to 48% of men. In contrast, of the calls made by men, 40% of women patients and 40% of men patients received CPR. Similarly, of the telecommunicators that were men, 40% of women patients and 40% of men patients received CPR. Of the telecommunicators that were women, 30% of the women patient’s received CPR compared to 47% of the men patients.

Conclusion:
Gender of the caller and telecommunicator may influence the likelihood of women’s versus men’s receipt of CPR. Further research is needed to understand whether gender bias impacts these interactions and what types of interventions could improve equity.
Abstract 12907: Aging Drives Cerebrovascular Network Remodeling and Functional Changes in the Mouse Brain
Authors: Zhang Qingguang , Bennett Hannah C , Wu Yuan-ting , Chon Uree , Pi Hyun-Jae , Drew Patrick J , Kim Yongsoo
Published: December 2023

Introduction:
Cerebrovascular dysfunction has been implicated in age-related cognitive decline and dementia, but the underlying vascular mechanisms are not well understood. An improved understanding of the nature of normal cerebrovascular aging is needed to help to establish the role that vascular dysfunction might play in cognitive decline and dementia.

Methods:
Here, we asked how normal aging differentially impacts the vascular structure and function in different brain areas in mice. We investigated structural changes in aged cerebrovascular networks and pericytes utilizing serial two-photon tomography (STPT). To further investigate potential remodeling of different vascular compartments and pericyte subtypes, we utilized tissue clearing, 3D immunolabeling, and light sheet fluorescence microscopy (LSFM) imaging. We also assessed how healthy aging impacts brain hemodynamics in response to voluntary locomotion and whisker stimulation in awake, head-fixed mice using wide field optical signal imaging and two-photon imaging. We tested mice of both sexes at 2-month, 18-month (early aging), and 24-month (late aging) of age.

Results:
Whole-brain vascular tracing using STPT showed an overall ~10% decrease in vascular length and branching density, and LSFM imaging with 3D immunolabeling further revealed increased arteriole tortuosity in aged brains. We also uncovered a selective vascular and pericyte loss in deep cortical layers, basal forebrain regions, and the hippocampal network. This may contribute to their regional vulnerabilities in neurodegenerative disorders. Moreover, our
in vivo
imaging in awake, head-fixed mice identified delayed neurovascular coupling response and inefficient oxygen delivery in aged brains.

Conclusions:
Our study reveals aging-related brain-wide changes in vascular and mural cell types that can explain vulnerability and resilience of different brain areas in normal aging. Moreover, we identified an age-related decrease in brain oxygenation and delayed neurovascular coupling responses which can be linked with cognitive impairment in aged brains. These aging-related changes will serve as a common factor to understand many neurodegenerative disorders and cognition decline in the elderly population.
Abstract 12910: Exercise Hemodynamics Unmasks Stage C Heart Failure With Preserved Ejection Fraction and Impaired Peripheral Oxygen Extraction in Stage A/B Patients in a Safety-Net Center
Authors: Kroshian Garen , Lepson Joshua , Zombeck Stephanie , Truong Andy , Gavin Shannon , Nezafat Reza , Balady Gary , Nayor Matthew G , Fetterman Jessica L , Ayalon Nir , Gopal Deepa M
Published: December 2023

Introduction:
There is a gap in research evaluating hemodynamics and impaired peripheral oxygen extraction in Stage A/B HFpEF in diverse groups. We sought to characterize the prevalence of impaired cardiac/peripheral profiles in Stage A/B HFpEF at Boston Medical Center.

Hypothesis:
We hypothesize both abnormal cardiac and peripheral profiles will be unmasked in exercising Stage A/B HFpEF patients.

Methods:
Invasive cardiopulmonary exercise testing (iCPET) was performed in 30 individuals with Stage A/B HFpEF. Significant valvular or pulmonary disease were excluded. Criteria for an impaired cardiac profile, with reclassification to Stage C, included exercise PCWP ≥ 25 mmHg or ΔPCWP/ΔCO slope > 2 mmHg/L/min. An impaired peripheral profile was defined as O
2
extraction ratio (peak arterio-venous oxygen saturation difference)/ (1.34*rest hemoglobin*rest arterial O
2
saturation) < 50%. With an approved IRB, the analysis was conducted in R.

Results:
Cohort clinical data shown in
Table
with 47% non-white and 57% female patients. Exercise unmasked Stage C HFpEF in 23 (77%) of cases; 17% had an impaired peripheral profile (O
2
extraction ratio 43 ± 7) and 10% (3 out of 30 patients) had concomitant impaired cardiac and peripheral profiles. Both cardiac and peripheral metrics correlated to metabolic parameters: peak oxygen consumption correlated to PCWP (rho -0.52, p<0.004) and extraction ratio correlated to oxygen-uptake efficiency slope (rho 0.40, p=0.029).

Conclusions:
In our diverse cohort, a significant proportion of Stage A/B patients reclassified to Stage C HFpEF via invasive exercise testing; abnormal peripheral profiles were also noted. Impaired cardiac and peripheral profile metrics were related to metabolic parameters. Broader implementation of iCPET in early disease stages and attention to both cardiac and peripheral profiles in diverse populations will guide further HFpEF research in novel mechanisms and therapeutics.
Abstract 12920: Double Peak of Cardiac Troponin T in Non ST-Segment Elevation Myocardial Infarction
Authors: Daus Francesca , Pezzini Sara , Bianchi Alfredo , Lenatti Laura , bassanelli giorgio , Farina Andrea , Spoladore Roberto
Published: December 2023

Introduction:
cardiac biomarkers are the cornerstone of the biological definition of acute myocardial infarction. In previous literature it was shown that hs-Troponin T blood assay follows a typical biphasic kinetic in patients (pts) affected by ST segment elevation myocardial infarction (STEMI), treated by primary percutaneous coronary intervention (PCI), while this does not appear to be the case for creatinphosphokinase (CPK) and hs-Troponin I assays.

Hypothesis:
According to these previous data, we studied hs-troponin T and CPK kinetics in pts suffering from non-ST segment elevation myocardial infarction (NSTEMI).

Methods:
we retrospectively analysed blood samples for cardiac biomarkers in NSTEMI pts consecutively admitted to the coronary care unit of our institution from January 2022 to May 2023.

Results:
A total of 83 pts were included. 89% of pts were treated by PCI; 98% of these pts received PCI within 24 hours from hospital admission. Among the 83 enrolled pts, only 11% was treated by surgical revascularization and/or anti-ischemic pharmacological therapy. A double peak of hs-troponin T was observed only in pts treated by PCI (p=0,0001). In these pts the mean time to first hs-troponin T peak was at 35,84 ± 4,4 hours while the mean time to second hs-troponin T peak was at 78,62 ± 8,7 hours. CPK value at hospital admission was 208,6 ± 34,8 U/L while first hs-troponin T peak was 560,1 ± 112,9 ng/L; the second hs-troponin T peak was 240,3 ± 33,7 ng/L, in absence of CPK double peak.

Conclusions:
similarly to previous studies in STEMI pts, our data confirm the presence of hs-troponin T double peak, in the absence of CPK second dispersion, also in NSTEMI pts. The hs-troponin T second peak is strongly related to PCI procedure while pts undergoing conservative treatment or surgical coronary revascularization do not show such a kinetic. Another interesting issue is the absence of CPK second dispersion. This could suggest a potential trivial meaning of hs-troponin T second peak. Therefore, the second peak could not be of any significance for prognostic evaluation and appropriate timing of pts discharge from acute cardiac care units.
Abstract 12927: Impact of AAV-
MYBPC3
Gene Transfer on Heart Structure and Function in Human and Mouse Models of Hypertrophic Cardiomyopathy
Authors: Vitelli Catherine , Zhang Lening , Murphy Ryan , Blus Bartlomiej , Christianson Terri , Giaramita Alexander , Holtzinger John , Handyside Britta , May Hannah , Pham Ann , Nguyen Tu , Zhou Huiyu , Ntai Ioanna , Mearini Giulia , Ricotti Valeria , Voit Thomas , Eschenhagen Thomas , Carrier Lucie , Agarwal Pooja , Bunting Stuart , Sumandea Marius
Published: December 2023

Background:
Hypertrophic cardiomyopathy (HCM) is a life-threatening inherited heart disease characterized by left ventricular hypertrophy and diastolic dysfunction. The most common cause of HCM is genetic variants in
MYBPC3
, encoding cardiac myosin binding protein C (cMyBP-C), a sarcomeric protein with structural and regulatory roles. The majority of
MYBPC3
gene variants are truncating leading to protein haploinsufficiency.

Hypothesis:
Transfer of a functional copy of
MYBPC3
to heart muscle deficient in cMyBP-C will lead to sustained improvements in cardiac function.

Aims:
To determine whether BMN 293 (AAV-hMYBPC3) can restore cMyBP-C levels in the sarcomere and halt and/or reverse disease progression in non-clinical models of genetic HCM due to
MYPBC3
deficiency.

Methods:
BMN 293 is an adeno-associated virus (AAV) vector that encodes wild-type human
MYBPC3
under the control of a cardiomyocyte-selective promoter. We transduced human iPSC-derived cardiomyocytes and engineered heart tissues (EHTs) carrying a compound heterozygous truncating
MYBPC3
mutation (MYBPC3
-/-
) with BMN 293 and assessed cMyBP-C levels and contractile parameters. We also systemically administered BMN 293 to MYBPC3
-/-
mice and assessed cardiac distribution of human cMyBP-C by molecular and histological methods and determined its impact on left ventricular hypertrophy and function by echocardiography and other imaging techniques.

Results:
BMN 293 transduction of human iPSC MYBPC3
-/-
cardiomyocytes and EHTs resulted in high levels of human
MYBPC3
mRNA and cMyBP-C protein, correct incorporation of cMyBP-C into the sarcomere, and complete normalization of contractile kinetics. BMN 293 was well tolerated in MYBPC3
-/-
mice and resulted in uniform restoration of cMyBP-C expression throughout the heart and significant correction of structural and functional cardiac abnormalities.

Conclusions:
A single IV infusion of BMN 293 to MYBPC3
-/-
mice resulted in early and sustained reduction in left ventricular hypertrophy and durable improvements in diastolic function.
Abstract 12946: Among Patients With Acute Coronary Syndromes, is the Risk of Hyperglycemia for In-Hospital Mortality Similar in Men and Women?
Authors: Nicolau Jose C , Castro Vintimilla Santiago A , Rosa Renato , Bertolin Adriadne J , Andrade Maria C , Salis Leonardo V , Montero Ribera Jorge L , Quintanilha Nadia R , Santos Glaylton S , Baracioli Luciano M , Giraldez Roberto R , Lima Felipe G , Pereira Cesar C , Nicolau Andre M , Furtado Remo H , Giugliano Robert P
Published: December 2023

Introduction:
Hyperglycemia is associated with higher in-hospital mortality in acute coronary syndromes (ACS) patients (pts). However, interaction between hyperglycemia, mortality and sex in ACS pts is poorly understood.

Hypothesis:
To analyze the relationship between hyperglycemia and in-hospital mortality stratified by sex.

Methods:
We analyzed 4633 ACS pts included in an administrative databank. Categorical variables were compared using the chi-square or Fisher exact tests as appropriate; continuous variables were compared by the Student’s t-test if Gaussian distribution, or Mann-Whitney test if not. Logistic regression test was used for the interaction analysis and adjusted models. ROC curves were developed and compared by the De Long test. The first glucose measurement obtained during hospitalization was utilized. Hyperglycemia was defined as glucose ≥126.5 mg/dL: best cut point, derived from the ROC curve for the whole population.

Results:
A) In comparison with men, women were older, with higher rates of hyperglycemia, hypertension and diabetes, and lower rates of prior MI, CABG, ST-elevation MI, and in-hospital PCI. B) As shown in figure there was a stronger association between hyperglycemia and in-hospital mortality in women (OR 3.34) than in men (OR 2.46 p-interaction <0.001). C) ROC analysis of the predictive value of hyperglycemia for in-hospital mortality showed areas under the curve (AUC) of 0.64 (95% CI 0.60-0.67), 0.62 (95% CI 0.58-0.66) and 0.66 (95% CI 0.61-0.71) resp. for the whole population, men, and women (P<0.01 for each), with no difference between men and women (P 0.23). D) Significant multivariate predictors of in-hospital mortality included: hyperglycemia, cardiogenic shock and age for both sexes; ST-elevation MI and in-hospital PCI only for men; and previous MI and in-hospital CABG only for women.

Conclusions:
In ACS pts, the association of hyperglycemia with higher in-hospital mortality is greater in women than in men.
Abstract 12956: Novel Digital Strategy for Improving Diversity in Cardiovascular Clinical Trials
Authors: Jain Sneha S , Perez Marco V , Nguyen Kaylin T , Hernandez Adrian F , Turakhia Mintu , Mahaffey Kenneth W
Published: December 2023

Background:
Diversity of trial participants is crucial for the generalizability of clinical trial findings. Cardiovascular trials often underrepresent non-white participants, women, and older individuals. Investigators for the Apple Heart Study (AHS) and the Project Baseline Health Study (PBHS) used a digital platform or ‘waiting room’ to invite interested individuals in the United States to learn about the study, sign an electronic consent, and provide some baseline information including assessment of key inclusion/exclusion criteria. For AHS, the direct-to-participant approach led to the recruitment of participants that were comparably aligned with the US census. For PBHS, participants were enrolled from a ‘waiting room’ using specific parameters to meet the pre-specified target of mimicking the US census for race and ethnicity.

Methods:
We describe the sex, age, and race/ethnicity of the population enrolled in AHS and PBHS. AHS was a completely siteless/virtual trial, while PBHS did traditional assessments at physical locations while also having virtual components.

Results:
A total of 419,297 participants were enrolled in just 8 months in the AHS and 2502 were enrolled in PBHS. The sex, age, and race/ethnicity of the study populations are shown (see Table). 42-55% were women, 11.6% were Hispanic, 8-16% were black, 6-10% were Asian and 63-68% were white. AHS enrolled from all 50 states, while PBHS enrolled from 4 locations in California and North Carolina.

Conclusion:
In two direct-to-participant clinical trials, we were able to recruit participants that were comparably aligned with the US census. The digital strategies used were successful in both siteless and traditional site-based research studies. The direct-to-participant recruitment approach and digital waiting room are potentially scalable methods for digital recruitment and enrollment to improve diversity in pivotal cardiovascular studies.
Abstract 12980: Left Ventricular Alterations in Neonatal Encephalopathy - A Case-Control Study Using 3D Echocardiography
Authors: Elias Pierre , Sahussarungsi Sariya , Thibert Ouma , Simoes Lopes-Letendre Gabriela , Wutthigate Punnanee , Ohayon Amanda , Moore Shiran S , Villegas Martinez Daniela , Simoneau Jessica , Henin Catherine , Mawad Wadi , Cavalle Tiscar , Wintermark PIa , Lapointe Anie , Altit Gabriel
Published: December 2023

Introduction:
Despite therapeutic hypothermia (TH), neonates with neonatal encephalopathy (NE) often present with multi-organ dysfunction, including cardiac alterations in the first days of life.

Objectives:
Describe the cardiac performance of neonates with moderate to severe NE treated with TH using three-dimensional echocardiography (3D-ECHO) relative to a control population without NE.

Methods:
Single-centre prospective case-control study of neonates with moderate to severe NE treated with TH between 2019 and 2021, compared to healthy neonates. The control group were newborns recruited in the nursery without need for resuscitation. 3D-ECHO was performed on day of life (DOL) 2. Left ventricular (LV) metrics were measured using 3D-Speckle Tracking Echocardiography. Descriptive statistics were used to compare the two groups.

Results:
We included 16 neonates with NE and 50 controls. Birthweight and gestational age at birth were similar (Table 1). Neonates with NE had lower systolic blood pressure (BP) but similar diastolic BP at ECHO, while 11/16 were exposed to cardiovascular medications at ECHO. These neonates had lower LV end-diastolic volume (4.2 [1.2] vs 5.0 [1.4] mL; p=0.04), lower stroke volume (2.2 [0.7] vs 2.9 [0.8] mL; p=0.002) and lower ejection fraction (52 [6] vs 56 [8] %; p=0.0008). These infants also had lower peak global circumferential strain (-25 [5] vs -28 [5] %; p=0.03). The association between NE and LV-ejection fraction remained significant after adjusting for weight (b=-5.7%, 95% Confidence Interval [-9.2; -2.2], p=0.002).

Conclusions:
Neonates with moderate to severe NE had reduced LV functional markers on DOL 2 as comparted to healthy controls. They had decreased systolic BP and LV end diastolic volume. These findings may be secondary to the asphyxia, catecholamines and medications exposure, or to TH. Future studies should consider 3D-ECHO as a modality to investigate these patients and the impact of therapeutic interventions.
Abstract 12984: Impact of Cardio-Ankle Vascular Index on New Cancer Diagnosis in Patients With Coronary Artery Disease
Authors: Shimizu Takeshi , Sakuma Yuya , Muto Yuki , Sato Yu , Kimishima Yusuke , Sato Akihiko , Misaka Tomofumi , Yoshihisa Akiomi , Yamaki Takayoshi , Nakazato Kazuhiko , Ishida Takafumi , Takeishi Yasuchika
Published: December 2023

Introduction:
Cardiovascular risk factors are associated with increased risk of future cancer. However, the relationship between quantitative parameters of atherosclerosis and the risk of future cancer is unclear. Here we investigated the association between cardio-ankle vascular index (CAVI), an indicator of arterial stiffness, and future new cancer diagnosis in patients with coronary artery disease.

Methods:
This was a prospective observational study which enrolled consecutive 1122 patients with coronary artery disease, excluding patients with atrial fibrillation or dialysis. According to the receiver operating characteristic curve analysis, the cut-off value of CAVI in predicting new cancer diagnosis was 8.70. We divided patients into two groups: the high-CAVI group (CAVI ≥ 8.70, n = 578, 51.6%) and the low-CAVI group (CAVI < 8.70, n = 544, 48.4%). We compared the patients’ characteristics and followed the incidence of new cancer diagnosis.

Results:
The high-CAVI group, as compared with the low-CAVI group, were older (72.3 vs. 64.0 years,
P
< 0.001) and had higher prevalence of diabetes mellitus (53.8 vs. 45.6%,
P
= 0.006), chronic kidney disease (47.1 vs. 32.5%,
P
< 0.001) and anemia (46.0 vs. 32.9%,
P
< 0.001). In contrast, there was no difference in the prevalence of smoking, hypertension, dyslipidemia, heart failure and history of malignancies between two groups. In the follow up period (mean of 2182 days), there were 141 new cancer diagnosis. The cumulative incidence of new cancer diagnosis was significantly higher in the high-CAVI group than in the low-CAVI group (
P
= 0.007). In the multivariable Cox proportional hazard analysis after adjusting for confounding factors, CAVI was found to be an independent predictor of new cancer diagnosis (hazard ratio 1.51, 95% confidence interval 1.05-2.17,
P
= 0.022).

Conclusions:
High CAVI is associated with the risk of future cancer in patients with coronary artery disease.