bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 14296: Agatston Aortic Valve Calcium Score and the Prediction of Transcatheter Aortic Valve Replacement Complications: A Systematic Review and Meta-Analysis
Authors: Saleh Yehia , Al-abcha Abdullah , Saleh Yehia , Faza Nadeen N , Little Stephen H , Chang Su Min
Published: April 2024

Introduction:
Aortic valve calcium score (AVCS) is used to determine aortic stenosis severity, but whether it affects transcatheter aortic valve replacement (TAVR) complications is not well studied.

Methods:
We conducted a literature search in PubMed using the key words “Aortic valve”, “Calcium score”, “Aortic stenosis”, “Computed tomography”,” Calcification”, “Calcium”, “TAVR”, “TAVI”, “Outcomes”, “Complications” up to December, 31
st
, 2020. Several studies assessed the different factors affecting TAVR outcomes, of these, AVCS was usually found to be one of them. Only a few studies investigated the effect of AVCS on TAVR outcomes. We included studies classifying their patient cohort into high and low AVCS. These studies used the Agatston AVCS derived from non-contrast computed tomography (CT) in patients with native aortic valves and they investigated the TAVR outcomes in both groups.

Results:
Three studies were included in our meta-analysis with a total number of 1839 patients. Our pooled analysis showed a similar risk of 30-day mortality (low AVCS 2% vs high AVCS 2.5%, P=0.63), Permanent pacemaker implantation (low AVCS 13.3 % vs high AVCS 11.9 %, P=0.73), Stroke (low AVCS 2.54% vs high AVCS 2.3%, P=0.69), and Major vascular complications (low AVCS 7.3% vs high AVCS 5.5%, P=0.60).

Conclusion:
The severity of Aortic valve calcification calculated by the Agatston AVCS had no impact on 30-day mortality, stroke, major vascular complications, or the need for a permanent pacemaker after TAVR is performed.
Abstract 14356: Trends of Acute Myocardial Infarction Mortality Rates in the United States From 1999-2019: A Retrospective Study
Authors: Venepally Nithin R , Dang Thao , Agasthi Pradyumna , Sierra Juan , Matute Carlos , Khetarpal Banveet K , Bakhati Bibek , Sai Mungara , Jha Govind , Arsanjani Reza
Published: April 2024

Introduction:
In the current study, we examined the temporal trends in mortality across gender, race, and 10-year age groups over last two-decades.

Methods:
We conducted a retrospective population-based study using Centers for Disease Control and Prevention database. Subjects with underlying cause of death from AMI were identified using validated ICD10 codes. Age adjusted mortality rates were calculated for gender and race whereas crude rates were calculated for 10-year age group. Using Poisson regression, we estimated the rate ratio between race/ethnicity pairs adjusting for age and sex in order to analyze temporal trend.

Results:
We identified 2,709,173 subjects with reported underlying cause of death as AMI between January-2000 to December-2019 of which 54.7% were males (n=1,483,163). The age adjusted mortality rate per 100,000 was higher in males compared to females (52.4% vs 30.7%, OR: 1.66 [1.45-1.89]). Among ethnicities African American (AA) population had the highest age adjusted mortality rate per 100,000 [Table 1]. As expected, age group >85 years had the highest mortality rate per 100,000 constituting 30% of total deaths (78% of total deaths were noted in >65yr age group). AMI age adjusted mortality rates/100,000 showed significant decline across gender and race with highest decline in female population (66.5% decline). Highest percentage decline in mortality was noted in AA female population (68.2%) whereas in males it was the white population (62%). In females, highest percentage decline in mortality was noted in 75-84 age-group (70%) while it was >85 age-group (67%) in males.

Conclusion:
Over last two decades there has been a significant decline in AMI mortality rates across gender and race. AA continue to have higher age adjusted mortality rate among both male and female population (38% and 22% respectively). Further studies are needed to identify and provide targeted prevention and intervention strategies in high-risk populations.
Abstract 14360: Clinical Significance of the Assessment of Valvular Calcification Using
18
F-sodium Fluoride Positron Emission Tomography
Authors: Aoyama Rie , Kameyama Masashi , Ishikawa Joji , Harada Kazumasa
Published: April 2024

Introduction:
With an aging population, valvular heart disease (VHD) of a degenerative etiology has been increasing. Although calcification of valves and mitral annulus (MAC) increase in the elderly, these calcification lesions are considered as one of the causes of embolic stroke of undetermined source (ESUS). On the other hand, it is difficult to evaluate the instability of calcification using echocardiology or CT and to clarify the relationship between the instability of calcification and the onset of cerebral infarction.
18
F-Sodium Fluoride (
18
F-NaF) is a Positron Emission Tomography (PET) tracer acts as a marker of newly developing calcium in the cardiovascular system. Therefore, we evaluated the qualitative evaluation of calcification lesions using NAF and the onset of cerebral infarction.

Methods/Results:
One hundred and twenty-five preoperative orthopedic patients (78.0±6.3 years old, 13 male) underwent
18
F-NaF-PET/CT and echocardiography between February 2015 and March 2019 and the accumulation was analyzed in each calcification. MAC was admitted in 46 patients, Aortic valve calcification was in 22 patients, and Mitral valve calcification was in 48 patients. The accumulation of
18
F-NaF on calcified lesions was admitted in 41, 33, 48 patients, each. History or new onset of cerebral infarction was in 14 patients, and among them 13 patients (92.9%) had the accumulation of
18
F-NaF on calcified lesions. Calcification with the accumulation of
18
F-NaF was correlated with cerebral infarction (p<0.01 by chi-square) and the uptake grade of
18
F-NaF on calcification was linearly correlated with the onset of cerebral infarction.

Conclusions:
The accumulation of
18
F-NaF may predict the instability of calcification and the risk of cerebral infarction.
Abstract 14365: Interrogating Diastolic Dysfunction Using a Novel Stem Cell Model of Restrictive Cardiomyopathy
Authors: Staudt David W , Serrano Ricardo , Feyen Dries , Mercola Mark
Published: April 2024

Introduction:
Diastolic dysfunction is an important cause of morbidity and mortality in both children and adults. Unfortunately, investigation of new therapies is limited by a lack of
in vitro
models of diastolic dysfunction. Idiopathic Restrictive Cardiomyopathy (RCM) is a serious genetic condition in which children have an isolated defect in myocardial relaxation. Though some of the genetic lesions have been identified, there is still an incomplete understanding of the mechanisms that lead to diastolic dysfunction in this condition.

Hypothesis:
Cardiomyocytes from human induced pluripotent stem cells (hiPSC-CMs) derived from patients with RCM will provide an
in vitro
model of diastolic dysfunction and will allow elucidation of cellular and molecular pathways involved in myocardial relaxation.

Methods:
Patients with RCM and a known pathogenic sarcomeric mutation were identified through speaking with providers in our heart failure and cardiac transplant program. hiPSCs were derived from patient blood samples and differentiated into cardiomyocytes. Isogenic controls were generated using CRISPR-mediated homologous directed repair. Calcium handling, contraction kinetics, and resting tension of RCM hiPSC-CMs were compared to control hiPSC-CMs on substrates with defined stiffness using high-throughput quantitative imaging techniques.

Results:
hiPSC-CMs derived from a patient with a pathogenic mutation in troponin T (TNNT2) display prolonged calcium kinetics and relaxation times compared to controls, as well as increased resting tension.

Conclusions:
RCM hiPSC-CMs represent a novel model of diastolic dysfunction that can be interrogated on a high-throughput platform. We plan to use these cells to perform proteome-scale functional screens, providing a novel opportunity to discover previously unknown contributors to diastolic dysfunction.
Abstract 14370: Mortality Among Patients With Heart Failure After Initiation of Hemodialysis
Authors: Hirsch Joshua R , Al Rifai Mahmoud , Navaneethan Sankar , Deswal Anita M
Published: April 2024

Introduction:
Patients with kidney failure on hemodialysis (HD) have a high risk of cardiovascular (CV) events and a high burden of heart failure (HF) morbidity and mortality. Standard HF therapies have not been proven to have similar benefits in patients with kidney failure. While comorbid HF and kidney failure requiring HD portends poor prognosis, the survival for patients with pre-existing HF who start HD and its relationship to left ventricular ejection fraction (EF) has not been well-described.

Methods:
We included patients with a diagnosis of HF (ICD-9/10 codes confirmed by chart review) and chronic kidney disease (CKD) seen at a tertiary care VA medical center and subsequently initiated on HD between 1/2005 and 12/2017. Echocardiographic data, including baseline and follow-up EF and baseline clinical data at time of HD initiation, and date of death or last follow-up were collected using chart review. Time to event analysis for all-cause mortality from date of HD initiation was conducted.

Results:
The cohort included 356 patients (mean age 66.2 ± 9.0 years, 96.6% male, 55.6% CAD, 20% CABG). HF with preserved EF (HFpEF; EF≥50%) was the most common HF subgroup (62%), followed by HF with reduced EF (HFrEF; EF≤40%) and HF with mid-range EF (HFmrEF; EF 41-49%) (23% and 15%, respectively). Mean time from HF diagnosis to HD start was 1.75 ± 1.95 years. Compared to HFrEF, HFpEF patients had shorter time to HD start (1.60 vs. 2.12 years, p=0.046). The overall survival after initiation of HD for patients with pre-existing HF was 80.9% at 1-year, 64.2% at 2-year, and 37.0% at 5-year follow-up. Median survival was longest for HFpEF (4.1 years), followed by HFmrEF (3.2 years) and HFrEF (1.6 years) (
Figure
).

Conclusions:
Patients with pre-existing HF and CKD who transition to HD experience significant mortality, with HFrEF patients having substantially worse survival. Further study of HF optimization prior to and after HD initiation is needed, especially in the highest risk HFrEF patients.
Abstract 14393: Deep Learning and Patient-Derived hiPSC Cardiomyocytes to Predict Drug Proarrhythmia
Authors: Serrano Ricardo , Feyen Dries A , Bruyneel Arne A , Hnatiuk Hnatiuk Anna P , Vu Michelle M , Amatya Prashila L , Perea-Gil Isaac , Prado Maricela , Seeger Timon , Wu Joseph C , Karakikes Ioannis , Mercola Mark
Published: April 2024

Introduction:
Drug safety initiatives globally have endorsed human iPSC-derived cardiomyocytes (hiPSC-CMs) as an in vitro model for predicting drug-induced cardiac arrhythmia. However, the extent to which human-defined features of in vitro arrhythmia, such as action potential prolongation and after depolarizations, predict actual clinical risk has been much debated.

Hypothesis:
Deep learning can be used to discriminate features of in vitro action potential features that associate with dangerous drugs and distinguish them from features evoked by safe drugs. Furthermore, the deep learning algorithm should be able to discern the influence of myopathic gene variants on drug-induced arrhythmia.

Methods:
We trained a deep neural network (DNN) to detect
in vitro
features of electrophysiological recordings induced by drugs with established clinical risk. The 40 drugs used in the study comprised high, intermediate, and low risk. Action potentials were optically recorded for each drug at 8 concentrations in iPSC-CMs from 3 healthy donors and in isogenic iPSC-CMs carrying 5 gene variants that cause dilated and hypertrophic cardiomyopathies. Multiple differentiation batches were evaluated for each.

Results:
The trained DNN accurately classified reference drugs according to high, intermediate, and low arrhythmic risk in people. The risk profile of the test drugs was similar across hiPSC-CMs from different healthy donors. The introduction of gene variants associated with arrhythmogenic cardiomyopathies increased the propensity of certain intermediate and high-risk drugs to induce arrhythmia.

Conclusions:
Deep learning can identify in vitro arrhythmic features that correlate with clinical arrhythmia and discern the influence of pathological gene variants on drug-induced arrhythmia.
Abstract 14397: Severity of Sleep Apnea in Patients Receiving Catheter Ablation of Atrial Fibrillation: A Comparison of Home Sleep Apnea Test and Polysomnography
Authors: Tanaka Nobuaki , Okada Masato , Tanaka Koji , Hirao Yuko , Harada Shinichi , Iwakura Katsuomi , Fujii Kenshi , OKAMURA ATSUNORI
Published: April 2024

Introduction:
Sleep apnea is highly prevalent in patients referred for catheter ablation (CA) of atrial fibrillation (AF). A watch-type peripheral arterial tonometry (WP) as a home sleep apnea test demonstrates a high degree correlation of the apnea-hypopnea index (AHI) with Polysomnography (PSG), but the evidence of the accuracy in patients with AF is not adequate.

Methods:
This was a single-center, retrospective, observational study. The data were derived from screening tests using WP for sleep apnea, which was routinely performed in patients scheduled to receive CA of AF in our institution. After excluding patients already diagnosed with sleep apnea, we enrolled 464 consecutive patients (age 65±11 years, 76.5% male, and 54.9% of non-paroxysmal AF) who underwent both WP and PSG. PSG was performed after the CA during hospitalization. We compared the AHI using WP with that using PSG in patients receiving CA of AF. The severity of the sleep apnea was stratified as follows: normal (AHI<5), mild (5≤AHI<15), moderate (15≤AHI<30), and severe (30≤AHI).

Results:
The AHI using WP (WP-AHI) was 25.9±12.7, and that using PSG was 31.4±18.9. There was a moderate correlation between the WP-AHI and AHI (r=0.48). According to the WP-AHI, the number of patients with normal, mild, moderate, and severe sleep apnea were 4 (0.9%), 85 (18.3%), 236 (50.9%), and 139 (30.0%), respectively. According to the AHI, there were 20 (4.3%), 70 (15.1%), 162 (34.9%), and 212 (45.7%) patients with normal, mild, moderate, and severe sleep apnea, respectively. In 85 patients with mild sleep apnea evaluated by WP, 38 (44.7%) and 15 (17.7%) patients were classified as moderate and severe using PSG. In 236 patients with moderate sleep apnea evaluated by WP, 100 (42.4%) were classified as severe using PSG.

Conclusions:
The AHI using WP was smaller than that using PSG. Further, a certain proportion of patients with mild or moderate sleep apnea using WP were diagnosed with severe sleep apnea evaluated by PSG.
Abstract 14424: Association of Beta-1 Adrenergic Receptor Autoantibodies With Heart Failure Risk in Systemic Sclerosis
Authors: Zagouras Alexia A , Chaikijurajai Thanat , Morales Rommel , Chatterjee Soumya , Tang Wai Hong W
Published: April 2024

Introduction:
Systemic sclerosis (SSc) is associated with the greatest independent risk of heart failure (HF) among systemic autoimmune diseases. Cardiac involvement in SSc also includes cardiomyopathy (CM), diastolic dysfunction (DD), and arrhythmias. Diffuse cutaneous SSc (dcSSc) is associated with greater cardiac risk than limited cutaneous SSc (lcSSc). Prior studies have examined the pathogenic roles of anti-beta-1 adrenergic receptor autoantibodies (β1AR-AAbs) and the protective role of the IgG3 subclass of β1AR-AAbs in HF. We aimed to investigate the associations between β1AR-AAb IgG/IgG3 seropositivity and disease phenotype in an SSc cohort.

Methods:
Serum samples were collected with informed consent from SSc patients with and without cardiac involvement, as approved by the Cleveland Clinic Institutional Review Board. Enzyme-linked immunosorbent assays were performed to investigate the presence of circulating IgG and IgG3 subtype β1AR-AAbs. Average optical density (OD) was compared between SSc and healthy control samples to establish seropositivity at the 2x control threshold level. Proportions of patients positive for β1AR-AAbs in different groups were compared using Fisher’s exact test.

Results:
Samples were collected from 36 SSc patients, of whom 20 (56%) had lcSSc and 15 (42%) had dcSSc. Cardiac involvement included HF, CM, DD, and arrhythmia, at least one of which was documented in 9 patients (25%). Of the total SSc cohort, 11 (31%) and 7 (19%) were positive for anti-β1AR IgG and IgG3 respectively. Between SSc patients with and without cardiac involvement, there was no significant difference in IgG or IgG3 positivity. There was a significant increase in IgG3 positivity in the lcSSc group compared to the dcSSc group at the 2x control threshold (p = 0.0125).

Conclusions:
High anti-β1AR IgG3 positivity is associated with less severe disease category (lcSSc vs. dcSSc) in our SSc cohort, supporting prior evidence of the protective role of the IgG3 subtype. A larger sample size will allow for further investigation of the associations between IgG/IgG3 β1AR-AAbs and cardiac involvement in SSc.
Abstract 14430: 5-year Outcomes After Transcatheter & Surgical Aortic Valve Replacement in Advanced Chronic Kidney Disease Patients
Authors: Pakhchanian Haig , Raiker Rahul , Boustany Osama , Acharya Deepak , Mukherjee Amrita , Lee Kwan S , Chatterjee Arka
Published: April 2024

Introduction:
Advanced chronic kidney disease (CKD4,5) patients are known to have increased morbidity and mortality when undergoing surgical procedures. While short term outcomes among patients undergoing transcatheter (TAVR) or surgical aortic valve replacement (SAVR) have been studied, research assessing long term outcomes are scant. Therefore, the goal was to assess 5-year outcomes for these patients undergoing TAVR or SAVR.

Methods:
A retrospective cohort study was done using TriNetX, a national federated real time database of 69 million records. Patient cohorts were identified if they met the criteria for CKD and underwent TAVR or SAVR up until May 2016 for 5 year follow up. A 1:1 matched propensity score analysis was conducted, adjusting for comorbidities and demographics, to calculate adjusted Risk Ratios (aRR) with 95% confidence intervals (CI) for complications of interest. Kaplan Meir (KM) analysis was done to calculate survival probability in 5 years among the 2 cohorts.

Results:
In a matched sample of 355 patients in each cohort, the TAVR did not show any significant differences in mortality (RR[CI]): (1.07[0.89-1.28]) compared to the SAVR Group. However, KM analysis revealed a significantly lower 5-year survival probability compared to the SAVR group (p<0.035). There were no statistically significant differences among the 2 cohorts in other assessed long-term complications such as stroke (0.67[0.42-1.05]) and new pacemaker placement (1.31[0.81-2.17]). However, redo TAVR/SAVR was higher in the TAVR cohort than the SAVR cohort (3.1[1.54-6.23]).

Conclusions:
5-year mortality appears to be similar in advanced CKD patients but repeat TAVR/SAVR were much higher suggesting decreased longevity of TAVR valves in this population.
Abstract 14436: Effects of Uncertainty in Border Delineation on GLS
BL
versus LVEF
Authors: ODell Walter , Abraham Shoba , Lucas Daniela , Siva Kumar Shruti
Published: April 2024

Background:
There are many clinical scenarios in which early detection of small changes in cardiac function can be critical in determining a patient’s treatment. Two of the most common imaging-based metrics in the clinic are LVEF and border-length-based GLS (GLS
BL
). The aim of this project was to analyze the inherent biases and uncertainties in GLS
BL
relative to LVEF with respect to uncertainties in delineation of the endocardial border.

Methods:
I
n silico
3D human LV endocardial surface models were created at end-diastole and end-systole based on MRIs of a healthy human volunteer. Twelve virtual long-axis imaging slices (in a radially-prescribed) were projected through the surface models to generate noise-free endocardial contour points. To simulate border delineation uncertainty, the set of endocardial contour points was subjected to inward and outward shifts of 1-5 mm, incrementally (Fig 1A). The expected uncertainty when using EC is around 3 mm. The % error vs. offsets were calculated for bi-plane GLS
BL
, bi-plane area-length LVEF
AL
, and bi-plane method-of-disks LVEF
MOD
, with 3D conformal surface-fit LVEF
SURF
as ground-truth.

Results:
The GLS
BL
%error vs. offset was linear (R
2
= 1.000) with a slope of 4.92 (Fig. 1B). Each of the LVEF measures were quadratic with offset (R
2
= 1.000), with slopes: LVEF
AL
: 6.68; LVEF
MOD
: 6.71; and LVEF
SURF
: 10.26.

Conclusions:
GLS
BL
is less sensitive to boundary delineation uncertainty than LVEF, due to the linear vs. quadratic dependence on offset. LVEF
AL
and LVEF
MOD
consistently underestimate true LVEF, making them less sensitive to boundary uncertainty. However, if border uncertainty is negligible, then LVEF is more sensitive than GLS
BL
to small changes in LV volume, and LVEF
SURF
is more sensitive than either LVEF
AL
and LVEF
MOD
.
Abstract 14458: Plasma Gasotransmitter Levels in Atrial Fibrillation
Authors: Kolluru Gopi , Watts Megan , Mohammad Zoya , Ahmad Javaria , Thevuthasan Sindhu , Dherange Parinita , Pardue Sibile , Kevil Christopher , Dominic Paari
Published: April 2024

Introduction:
Atrial fibrillation (AF) is associated with oxidative stress. Hydrogen sulfide and nitric oxide (NOx) are gasotransmitters involved in cardiovascular redox homeostasis. Free sulfide is increased in the plasma of human patients with atrial fibrillation. Although nitric oxide synthase expression and polymorphism has been studied in atrial fibrillation, NOx levels have not been measured in AF patients

Hypothesis:
AF is associated with altered NOx levels, and sulfide: nitrite ratio.

Methods:
Free NOx, total NOx, and nitrotyrosine levels were measured in patients without AF (n = 65), paroxysmal AF (PAF, n = 26) and persistent AF (n = 25) and compared between groups. Previously published sulfide levels from these patients were used to calculate free sulfide: total NOx ratio. Clinical characteristics of these patients were compared. Student’s t-test and nominal logistic regression were used for statistical analysis.

Results:
The patients without AF were younger but comparable to AF patients with regard to race, sex, diabetes, sleep apnea, and smoking history. Patients with AF were more likely to have hypertension (82% versus 54% non-AF patients, p = 0.002) and heart failure (47% versus 25% of non-AF, p = 0.02). On the other hand, non-AF patients were more likely to have coronary artery disease and/or peripheral arterial disease (43% versus 17% in patients with AF, p = 0.005). Compared to non-AF patients, AF patients had significantly lower total NOx (212 vs 268nM, p=0.005), free NOx (192 vs 237nM, p=0.039), and total sulfide: total NOx ratio (0.028 vs 0.020, p<0.01). Compared to PAF patients, persistent AF patients had further significant reduction in total NOx (177 vs 243nM, p=0.04). At 3-month follow up, free NOx levels increased from baseline in patients who underwent successful conversion to normal sinus rhythm (n=11, p=0.048). Levels of oxidative stress marker, nitrotyrosine, trended higher in patients with AF compared to non-AF patients (1.10 vs 1.01 p=0.08). Multivariable logistic regression showed that total NOx was associated with AF independent of age, sex, race, HTN, DM and heart failure (OR per 10nM decrease in NOx= 1.04, CI=1.001-1.094, p=0.0471*)

Conclusion:
Reduced NOx levels and increased free sulfide to NOx ratio are associated with AF.
Abstract 14470: Novel Autophagy Mechanisms of NP-6A4 Protection in Heart Disease Induced by Untreated Obesity
Authors: Boukhalfa Asma , Belenchia Anthony , De Marco Vincent , Liu Pei , Mooney Brian , Mehm Alexander , Tang Yinian , Ling Lauren , gavini madhavi , Chen Howard H , Pulakat Lakshmi
Published: April 2024

Introduction & Hypothesis:
Untreated obesity induces insulin resistance and heart disease affecting 42% of the US population. Autophagy, a conserved homeostatic process for cellular quality control, plays a critical role in maintaining health. Heart tissues of obese humans and rodent models show impaired autophagy. Drugs that can regulate autophagy are thus of high clinical significance. We reported recently that NP-6A4, a new peptide agonist of the cardiovascular protective angiotensin receptor AT2R, mitigated obesity-induced cardiac dysfunction and damage in rats with untreated obesity and pre-diabetes. We hypothesized that activation of autophagy by NP-6A4 is involved in NP-6A4-AT2R-induced cardioprotection in untreated obesity.

Methods & Results:
7-week old female ZDF rats fed high fat diet (D12468, Research Diet) for 6 weeks were randomized to receive either NP-6A4 (10mg/kg/day), NP6A4+AT2R antagonist PD123319 (PD, 5mg/kg/day) delivered subcutaneously (N=6/group), or vehicle (N=5) for 4 weeks. Echocardiography showed that NP-6A4 reduced abnormal E/A ratio from 2.1 to 1.45 (P<0.006), and isovolumic contraction (P<0.004) and relaxation times (P<0.02), and increased myocardial radial strain (P<0.019) and radial strain rate (P<0.033). PD reversed these effects. Immunohistochemistry (IHC) and Western blot analysis revealed a significant 5.9-fold increase (p<0.0006) in LC3 puncta (Fig. A-B) and 2.2-fold increase (p<0.0008) in lipidated autophagy marker LC3-II (Fig. C) compared to vehicle controls. The autophagy activation by NP-6A4 was not seen with the co-administration of PD (Fig. A-C). Cardiac proteome analysis showed that Sec16a, an important partner of autophagy initiators ULK1/2 is increased in ZDF rat heart by NP-6A4 (2.75 fold; P<0.020), but PD suppressed this effect.

Conclusions:
We identified NP-6A4’s dual targeting of AT2R and novel autophagy regulation to mitigate cardiac dysfunction induced by untreated obesity in female rats
Abstract 14477: Meta-Analysis of Studies Comparing Multivessel Percutaneous Coronary Intervention and Culprit Vessel Only Intervention Among Patients With Acute Myocardial Infarction and Cardiogenic Shock
Authors: Gill Gauravpal S , Sanz Sanchez Jorge , Abusnina Waiel , Kanmanthareddy Arun K , Garcia-Garcia Hector
Published: April 2024

Background:
Studies investigating mortality and adverse event outcomes in patients presenting with acute myocardial infarction (MI) in cardiogenic shock (CS) have reported conflicting results, and have primarily included patients with ST elevation MI. This meta-analysis investigates appropriate revascularization strategy in these patients.

Methods:
PubMed, Google Scholar, CINAHL and Cochrane databases were queried for studies comparing multivessel (MV) percutaneous coronary intervention (PCI) and culprit vessel (CV) PCI in patients with MI in CS. Data on outcomes from the selected studies were extracted and analyzed by means of random effects model. Two tailed p-value less than 0.05 was considered significant. Heterogeneity was assessed using I
2
test.

Results:
Twelve studies were included in the final analysis. There was no significant difference in short-term (OR 0.95, 95% CI [0.90-1.01]; p=0.09) or long-term (1.16 [0.95-1.41]; p=0.14) mortality between MV PCI and CV PCI (
Figure)
. Similarly, the odds of reinfarction (1.04 [0.58-1.85]; p=0.90) and stroke (1.08 [0.88-1.33]; p=0.46) were similar between the two groups. Although patients with MV PCI had lower odds of revascularization (0.46 [0.34-0.62]; p<0.01), they carried higher odds of new renal replacement therapy (1.30 [1.14-1.48]; p<0.01) and bleeding (1.25 [1.14-1.36]; p<0.01). Interestingly, on exclusion of study exclusively containing patients with non-ST elevation MI, odds of short-term mortality were higher (1.44 [1.28-1.62]; p<0.01) in the MV PCI group.

Conclusions:
Among patients with AMI and cardiogenic shock, there was no difference observed in short-term or long-term all-cause mortality, between MV PCI and CV PCI revascularization strategies. However, adopting the MV PCI strategy may lead to higher odds of bleeding and renal replacement therapy.
Abstract 14479: Progress Towards A Peroxidase-free Catalase Mimic
Authors: Tennyson Andrew G
Published: April 2024

Manganese complexes that exhibit catalase activity (i.e., catalyze the disproportionation of H
2
O
2
into ½ O
2
and H
2
O) are intrinsically also able to exhibit peroxidase activity (i.e., catalyze the oxidation of other molecules with H
2
O
2
as terminal oxidant). Both reactivity modes can be harnessed for therapeutically beneficial outcomes. For example, Mn-porphyrin complexes can both (
a
) protect healthy cells during radiotherapy by preventing a shift in cellular redox state to more oxidized potentials as well as (b) trigger cancer cell apoptosis by impelling a shift to more oxidized potentials. However, it is difficult to predict in advance which reactivity mode will predominate in a given biological environment. Herein we present a ruthenium complex with catalase activity 11.9-fold higher, stability to H
2
O
2
120-fold higher, and catalase/peroxidase selectivity 89.2-fold higher than the best values achieved by the synthetic MnSOD mimics.
Abstract 14483: Correlating Blood Type, Infection Risk, and Illness Severity in Patients With COVID-19
Authors: Yellapu Vikas , Daniel Shani V , Hindosh Naif L , Corwin Douglas , Snyder Richard , chalunkal mathai
Published: April 2024

Introduction:
There have been over 13 million cases of COVID-19 cases with a 2% mortality rate [1]. Over the past year there has been a significant progress in the understanding and management of COVID-19 infections. There are still many factors and complications of COVID-19 that have yet to be elucidated. There have been multiple studies looking at the possible link between ABO group type and increased risk of mortality. Many studies from China, Europe and Canada indicate that blood group “O” had lower risk of susceptibility and severe infection[2-4]. We wanted to identify weather this trend was applicable within our hospital network in Eastern Pennsylvania. We wanted to identify through retrospective analysis if there is an association between ABO type, Race, Gender, and mortality at 30-day or 90 days.

Methods:
We identified n=568 patients between February 2020 to June 2020 that were admitted to the hospital for treatment of COVID-19 that also had historical data regarding ABO grouping. Demographics, length of stay, intubations, and smoking history. Once data was collected, statistical analysis was conducted with SPSS for means, standard deviations, and Chi-squared test for non-parametric testing.

Results:
The breakdown of blood groups in our populations was [ A: 35.1%, B: 11.6%, AB: 7.9%, O:45.3% ]. The average age of patients by blood group was [A:70.9±6 , B: 68.6±15, AB:66.3±12, O: 65±17], The percentage of females in each group is [A:45%, B: 35%, AB:67%, O:50%]. The mean BMI for all groups were 31±7 (p>0.05) and there was no significant difference between blood groups with length of stay [A:8±6.1 , B: 10.5±9.6, AB:8.3±6.7, O: 9±8 (p>0.05)] There was no significant difference in mortality rate among the blood groups during admission [ A: 26%, B: 16%, AB: 13%, O:24% (p=0.17)] or the rate of intubation [ A: 10%, B: 15%, AB: 11%, O:12% (p=0.72)].

Conclusion:
Our findings indicate there is no significant difference between mortality, inpatient length of stay, or proportion of intubations between different blood groups. Our population of blood groups was distributed close to distribution of blood group in the general population. While there have been studies that indicate there is a protective nature of type O blood group, we did not see this in our cohort.
Abstract 14494: 5 Year Outcomes After Transcatheter & Surgical Aortic Valve Replacements in Chronic Liver Disease Patients
Authors: Raiker Rahul , Pakhchanian Haig , DeYoung Charles , Chatterjee Arka
Published: April 2024

Introduction:
Chronic Liver Disease (CLD) patients are known to have increased morbidity and mortality when undergoing surgical procedures. While short term outcomes among patients undergoing transcatheter (TAVR) or surgical aortic valve replacement (SAVR) have been studied, research assessing long term outcomes are scant. Therefore, the goal was to assess 5-year complications among CLD patients undergoing TAVR or SAVR.

Methods:
A retrospective cohort study was done using TriNetX, a national federated real time database of 69 million records. Patient cohorts were identified if they met the criteria for CLD and underwent TAVR or SAVR up until May 2016 for 5 year follow up. An 1:1 matched propensity score analysis was conducted, adjusting for comorbidities and demographics, to calculate adjusted Risk Ratios (aRR) with 95% confidence intervals (CI) for complications of interest. Kaplan Meir (KM) analysis was done to calculate survival probability in 5 years among the 2 cohorts.

Results:
In a matched sample of 268 patients in each cohort, the TAVR group showed higher 5-year mortality (RR[CI]): (1.34[1.04-1.73]) compared to the SAVR Group. KM analysis also revealed a significantly lower survival probability in TAVR group (purple) compared to the SAVR group (green) (p<0.001).There were no statistically significant differences among the 2 cohorts in other assessed long-term complications such as stroke (0.66[0.39-1.1]), new pacemaker placement (0.85[0.49-1.44]), and redo TAVR/SAVR (1.3[0.58-2.9]).

Conclusions:
In CLD patients, there is a higher risk of mortality for patients undergoing TAVR vs SAVR. All other assessed complications revealed no significant difference. Additional research is needed to visit further longer-term impacts in CLD patients.
Abstract 6961: Anesthetic Management During Pre-Stage II Intracardiac Hemodynamic Assessment: An Analysis of the Single Ventricle Reconstruction Trial Dataset
Authors: Smith Andrew H , Healan Steven , Nicholson George , Lamb Fred S
Published: April 2024

Background:
Intracardiac hemodynamics are often obtained with cardiac catheterization prior to proceeding with Stage II palliation for infants with single ventricle anatomy. There is little data examining the hemodynamic impact of anesthetic strategy during catheterization.

Methods:
Data from the Pediatric Heart Network Single Ventricle Reconstruction Trial was used for analysis. In addition to anesthetic strategy, data reported from cardiac catheterization prior to Stage II palliation included mean systemic venous atrial pressure (MSVAP), end diastolic ventricular pressure (EDVP), pulmonary flow (Q
p
)/systemic flow (Q
s
) ratio, and indexed pulmonary vascular resistance (PVRi). Indexed systemic vascular resistance (SVRi), Q
p
, and Q
s
were calculated using available hemodynamic data.

Results:
Of 549 subjects, pre-Stage II cardiac catheterization data following palliation with a modified Blalock-Taussig-Thomas shunt (mBTTS) or right ventricle to pulmonary artery conduit (RV2PA) was available for 390, of which 219 had adequate hemodynamic data for inclusion in analysis. Intracardiac hemodynamic comparisons were made with respect to anesthetic approach and shunt type. Moderate sedation was utilized in 90 (41%) and general anesthesia in the remaining 129 subjects. A moderate sedation strategy was associated with significantly higher Q
p
/Q
s
(1.2 [0.9, 1.6] v. 1.0 [0.7, 1.3], p<0.001) and estimated SVRi (15 Wu•m
2
[11,19] v. 10 [7.8,15], p<0.001), a difference consistent among both mBTTS and RV2PA subgroups. There were no differences between anesthetic groups with respect to PVRi or calculated Q
s
in either shunt group. Independent of shunt type, PVRi, and patient weight at catheterization, moderate sedation at catheterization was associated with a two-fold odds of a reported Q
p
/Q
s
>1 (OR 2.03, 95%CI 1.13-3.63, p=0.017).

Conclusions:
Anesthetic strategy and alterations in SVRi represent an important consideration when evaluating hemodynamics in a shunt dependent single ventricle circulation. Future investigations may aid in understanding the relationship between anesthetic approach during catheterization and the resulting hemodynamic data employed in perioperative decision-making.
Abstract 6979: Thromboembolic Risk of Movable Ball Type Left Atrial Appendage Thrombi in Patients with Atrial Fibrillation Under Widespread Use of Anticoagulant Therapy
Authors: Sugitani Miho , Mine Takanao , Ishihara Masaharu
Published: April 2024

Background:
Left atrial appendage thrombi (LAAT), especially movable ball type LAAT, have been reported to be high-risk for thromboembolic events in patients with atrial fibrillation (AF). However, thromboembolic risk of the movable ball type LAAT under widespread use of anticoagulant therapy remains unclear.

Methods:
We retrospectively studied 71 LAAT patients taking anticoagulants out of 1508 consecutive patients who underwent t transesophageal echocardiography (TEE) prior to cardioversion or catheter ablation for AF. Patients with significant valvular disease and coagulation disorder were excluded. Clinical data, blood sample, and transthoracic echocardiography were evaluated at the time of TEE. The LAAT were classified into movable ball, fixed ball and mountain type LAAT by three independent observers.

Results:
Ten of 71 LAAT patients showed movable ball type LAAT and 14 patients had fixed ball type LAAT. During follow-up (39±33 months), one patient underwent emergency thrombectomy, 5 patients developed thromboembolic event, and 12 patients died. There were no differences in clinical data, blood sample data, transthoracic echocardiographic parameters, thrombectomy/thromboembolic event rate, and survival rate among types of LAAT (Figure).

Conclusion:
Thromboembolic risk of the movable ball type LAAT is the same as fixed type LAAT, in patients with atrial fibrillation under widespread use of anticoagulant therapy.
Abstract 6980: Peroxynitrite-Mediated Mitochondrial Autophagy is Activated for the Development of Global Cerebral Ischemia Induced by Cardiac Arrest
Authors: Li Yi , Chen Nan , Geng Cong , Lu Shiqi , Jin Jun
Published: April 2024

Introduction:
Mitochondrial dysfunction is implicated in ischemic brain after cardiac arrest, and the timely removal of damaged mitochondria is critical for cellular homeostasis. Mitochondrial autophagy is a mitochondrial quality control mechanism via selective degradation of mitochondria but its role in the ischemic brain remains controversial. Peroxynitrite, as a representative of reactive nitrogen species, is an important neurologic damage factor in the brain injury but its role in cardiac arrest is unknown.

Methods:
Male Sprague-Dawley rats underwent 8-minute asphyxial cardiac arrest and cardiopulmonary resuscitation. Survival, neurological deficit and mitochondrial function were assessed for up to 72 hours following cardiac arrest. Western blotting, immunofluorescence and enzyme-linked immunosorbent assay were used to evaluate activated mitochondrial autophagy and peroxynitrite production. To further explore the underlying mechanism, FeTMPyP was used to act as a peroxynitrite decomposition catalyst.

Results:
After resuscitation from cardiac arrest, PINK1/Parkin-induced mitochondrial autophagy was activated and peroxynitrite was increased in the ischemic brain. Peroxynitrite scavenger with FeTMPyP treatment significantly prevented the generation of peroxynitrite, inhibited mitochondrial autophagy activation, reduced neurological damages and improved mitochondrial and neurological outcome after cardiac arrest. Moreover, peroxynitrite induced serine 616 phosphorylation of Drp1 and Drp1 translocation to the mitochondria, which was responsible for mitochondrial autophagy activation.

Conclusions:
Mitochondrial autophagy activation mediated by peroxynitrite could be a key event in the pathogenesis of brain injury induced by cardiac arrest and provides a promising therapeutic strategy.
Abstract 6984: Cost Effectiveness of a 1-Hour High-Sensitivity Troponin-t Protocol in Suspected Acute Coronary Syndrome: A Trial-Based Analysis of the Rapid-tnt Randomised Trial
Authors: Chuang Anthony , Gnanamanickam Emmanuel , Lambrakis Kristina , Horsfall Matthew , Karnon Jonathan , Blyth Andrew , Seshadri Anil , Nguyen Mau , Briffa Tom G , Cullen Louise , Quinn Stephen , French John K , Chew Derek P
Published: April 2024

Introduction:
To better understand the economic impact of an accelerated 0/1-hour high-sensitivity troponin-T (hs-cTnT) protocol compared to conventional 0/3-hour protocol, we conducted a patient-level economic analysis of the RAPID-TnT randomised trial with a 12-month follow-up in patients presenting to emergency department (ED) with suspected acute coronary syndrome (ACS).

Methods:
An economic evaluation was conducted with 3265 patients randomised to either the 0/1-hour hs-cTnT protocol (n=1634) or the conventional 0/3-hour protocol (n=1631). The primary outcome measure was a composite of all-cause mortality and new/recurrent myocardial infarction (MI).

Results:
Mean per patients costs were numerically higher in the 0/1-hour arm compared to the conventional 0/3-hour arm (by $1830.56/patient, 95% confidence interval [95%CI]: $-1610.83 - 5271.96, P=0.30) with no statistically significant difference in primary outcome (0/1-hour: 62/1634 [3.8%], 0/3-hour: 82/1631 [5.0%], HR: 1.32 [95%CI: 095-1.83], P=0.1). The mean ED length of stay (LOS) was significantly lower in the 0/1-hour arm (by 0.63 hours/patient, 95%CI: 0.34-0.92, P<0.001), but the cost saving was offset but the higher cumulative emergency-related inpatient costs (by $2247.31/patient, 95%CI: -656.55 - 5151.18, P=0.12). Restricting the analysis to patients with hs-cTnT≤29ng/L, the mean per patients cost remained numerically higher in the 0/1-hour arm (by $1480.24/patient, 95%CI:$-1097.62 - 2058.10, P=0.26), but the reduction in ED LOS was more pronounced (by 0.75 hours/patient, 95%CI: 0.46-1.05, P<0.001).

Conclusions:
This economic evaluation suggest that there were no differences in costs and outcomes between the 0/1-hour hs-cTnT protocol and the conventional 0/3-hour protocol for the assessment of suspected ACS in ED after 1 year of follow-up from the Australian healthcare system perspective. Our observations suggest that the 0/1-hour hs-cTnT protocol improves initial ED efficiency with more rapid exclusion of ACS and discharge. However, the associated cost savings were offset by the subsequent emergency inpatient costs. Further refinements in cost-effective strategies to improve clinical outcomes whilst efficiently utilising healthcare resources is needed.
Abstract 8860: Influence of Age on In-Hospital and One-Year Mortality in Patients with Electrical Storm
Authors: Incognito Cameron , Posadas Kristine , Hedley Jeffrey , Parker Joshua , Menon Venu , Wazni Oussama , Rickard John , Tang Wai Hong
Published: April 2024

Introduction:
Electrical storm (ES) carries poor short- and long-term prognosis although there is limited evidence regarding outcomes of ES stratified by age.

Objective:
Primary outcomes include all-cause in-hospital and 1-year mortality of ES based on four age groups: < 55 years (1), age 55-64 (2), age 65-75 (3), and age < 75 years (4). We hypothesize that older patients (Groups 3, 4) will have worse short- and long-term mortality and higher rates of in-hospital complications.

Methods:
Single center, retrospective study including patients admitted to the coronary intensive care unit with ES between April 2014-2020. ES was defined as ≥ 3 isolated sustained ventricular arrhythmias (VA) or ICD therapies within 24 hours.

Results:
Of 214 patients admitted with ES, 44 (20.6%) were Group 1, 56 (26.2%) were Group 2, 70 (32.7%) were Group 3, and 44 (20.6%) were Group 4. The overall mean age was 64 ± 13 years. There was no significant difference between age groups regarding ejection fraction (p = 0.55) or prior history of VA (p = 0.48). There was a higher incidence of prior CAD (p = 0.0057) and worse PAINESD (p < 0.001) in the older groups. There was no significant difference in in-hospital complications between the four groups regarding multiorgan failure (p = 0.11), in-hospital cardiac arrest (p = 0.39), or cardiogenic shock (p = 0.27). There was no difference between the four groups in all-cause (20.5% vs. 12.5% vs. 12.9% vs. 20.5%; p = 0.51) or VA-induced in-hospital mortality (18.2% vs. 8.9% vs. 12.9% vs. 18.2%; p = 0.47). Using Group 1 as reference, only Group 4 had a significant difference in 365-day all-cause mortality (Figure 1; HR 1.94; 95% CI 1.0 - 3.8, p 0.049) but no difference in 365-day VT-free survival (Figure 2; p = 0.51).

Conclusions:
There is no difference in all-cause or VA-induced hospital mortality between age groups. There was a statistically significant increase in 365-day all-cause mortality between extremes of age, although there was no difference in 365-day VT-free survival.
Abstract 8878: Does Gender Mismatch Affect Pediatric Heart Transplant Survival Outcome?
Authors: Firoz Ahad , Kashem Mohammed , Jaigirdar Lamya , Zhao Huaqing , Toyoda Yoshiya
Published: April 2024

Introduction:
Despite conflicting results between studies, there have been many single-center analyses done to elucidate the relationship between gender mismatch and survival outcome following adult heart transplant (HTx). However, there are limited studies investigating how gender mismatch affects HTx survival in pediatric patients, particularly using a large database cohort.

Hypothesis:
Does donor-to-recipient gender match or mismatch affect pediatric HTx survival outcome?

Methods:
We retrospectively analyzed 10,619 pediatric patients (0-18yrs) from the UNOS database between 1987-2020. Patients were stratified into groups based on age (0-2yrs, 3-5yrs, 6-12yrs, and 13-18yrs) and recipient gender. Donor-to-recipient gender mismatch was then compared within each group using Kaplan Meier curves, log-rank test, and Cox regression model. A p-value of p<0.05 was considered significant.

Results:
Comparing donor-to-recipient groups, 34% were M:M, 22% F:M, 25% M:F, and 19% F:F. Summary analysis revealed the following data within each age group: 0-2yrs (n=4,390, 54% M), 3-5yrs (n=997, 55% M), 6-12yrs (n=2,193, 49% M), and 13-18yrs (n=3,039, 64% M). Kaplan Meier curves between donor-to-recipient genders for each age group are presented in Figure 1. Log-rank test results comparing donor:recipient gender combinations for all patients, as well as for male and female patients, respectively, are also listed in Figure 1 for each age group. All log-rank test p-values were insignificant. Additionally, all stratified groups had an insignificant Cox regression p-value.

Conclusions:
Our study demonstrates that there is no significant difference in survival outcome for any of the pediatric patient age groups 0-2yrs, 3-5yrs, 6-12yrs, and 13-18yrs between any donor:recipient gender combination. These findings suggest that gender, irrespective of donor vs. recipient sex, does not play a significant impact on pediatric HTx survival. Further studies are warranted.