bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 15239: Patient Self-Care Mediates the Relationship Between Caregiver Contributions and Symptom Burden in Heart Failure
Authors: Locatelli Giulia , Iovino Paolo , Jurgens Corrine Y , Alvaro Rosaria , Uchmanowicz Izabella , Rasero Laura , Riegel Barbara J , Vellone Ercole
Published: December 2023

Introduction:
Patients with heart failure (HF) experience high symptom burden that can be mitigated with adequate self-care. The situation-specific theory of caregiver contribution to HF self-care suggests that caregivers have a key role in improving patient symptom burden.

Hypothesis:
a) caregiver contribution to self-care influences patient self-care; b) patient self-care influences symptom burden; c) patient self-care mediates the relationship between caregiver contribution to self-care and symptom burden.

Methods:
Secondary analysis of baseline and three-months data from the MOTIVATE-HF trial, which enrolled 510 HF patient-caregiver dyads in Italy. Data were collected using the Self-Care of HF Index v.6.2, the Caregiver Contribution to Self-Care of HF Index, and the HF Somatic Perception Scale. Autoregressive longitudinal path analysis with contemporaneous mediation was used to test study hypotheses.

Results:
On average, caregivers were 54 ± 15.46 years and mainly female (74.5%), while patients were 72.4 ± 12.28 years and mainly male (68%). Better caregiver contribution to self-care maintenance was associated with better patient self-care maintenance (β=0.280, p<0.001), which, in turn, was associated with lower symptom burden (β=-0.280, p<0.001). Patient self-care maintenance mediated the effect of caregiver contribution to self-care maintenance on symptom burden (β=-0.079, 95% BC bootstrapped CI: -0.130, -0.043). Better caregiver contribution to self-care management was associated with better patient self-care management (β=0.238, p=0.006). The model accounted for 37% of the variance in symptom burden (p<0.001).

Conclusions:
Targeting caregivers to increase their contribution to self-care can increase patient self-care and, consequently, lower patients’ HF symptom burden.
Abstract 15250: Increased CD81 is Associated With Enhanced Apoptosis in Acute Kidney Injuries Induced by Candesartan/Low Salt Diet
Authors: Duan Haonan , Wang Ping , Ren Zhiyun , Wang Weiwan , Jia YuTao , Zhang Mingzhuo , Wang Xiaoyan
Published: December 2023

Introduction:
Our previous studies have demonstrated that the upregulation of renal CD81 (cluster of differentiation 81), contributes to the sustained hypertension observed in LPS-preeclampsia rats with kidney injuries. Candesartan (Can) lowers blood pressure by selectively blocking type 1 angiotensin II receptors and results in acute kidney injury (AKI) when used together with dietary sodium restriction. Various cell deaths including apoptosis and necrosis are involved in the pathogenesis of AKI.

Hypothesis:
Renal CD81 may increased in candesartan/low salt diet(LS+Can) model via activation of apoptosis.

Methods:
Male SD rats aged 8-10 weeks were fed with LS (0.01% NaCl) or normal salt diets (NS, 0.8% NaCl) (6-10rats/group) respectively for 7 days.All rats were intraperitoneally injected with candesartan (1mg/kg/d) simultaneously.Systolic blood pressure(SBP) was monitored with tail-cuff method.The rats were sacrificed by over-anesthesia after the samples of blood and urine (metabolic cage) were collected.The kidneys were immediately removed for immunoblotting, and TUNEL(TdT-mediated dUTP Nick-End Labeling) measurements.P<0.05 was considered significant for 2 group comparison with t-test.

Results:
Compared with rats on NS+Can, the serum creatinine (20.3±0.3 vs 50.8±4.2 mmol/L) and BUN(4.05±0.2 vs 18.6±2.5 mmol/L) were more than doubled in LS+Can rats ;Creatinine clearance was decreased (100±4.1 vs 40.8±3.7ml/min); systolic blood pressures was lowered slightly (101.7±1.7 vs 88.9±2.7mmHg, n=7-8). Renal CD81 protein abundance by immunoblotting was increased (258.8±52.4,% of control, n=6/group,p<0.05, same as below).At the same time, there were increases in apoptosis-associated proteins including bax(312.6±71.5),caspase-3(124.6±6) ,cleaved caspase3(133.8±9.6) in Can+LS group.The rate of tunel-positive cells was elevated in the Can+LS group. (100.0±8.5 vs 482.72±59.4,p<0.05,n=10/group).However, necrosis-related inflammatory factors, including Interleukin-6,tumor necrosis factor-α, were not affected in the rat kidneys from LS+Can treated rats.

Conclusions:
Our findings suggest that Increased CD81 may be associated with enhanced apoptosis in rat kidneys with acute kidney injuries.
Abstract 15271: Modification of Cardiomyocyte Lateral Membrane Composition Promotes Cardiac Function by Regulating Connexome Organization
Authors: BLANDIN Camille , Dilanian Gilles , MOUGENOT Nathalie , CHARDONNET Solenne , HATEM Stéphane N , Gravez Basile jules , FONTAINE Vincent , BOBIN Pierre , VILLARD Eric , BALSE Elise
Published: December 2023

Introduction:
Loss of contacts between adjacent cardiomyocytes is detrimental to proper electromechanical function. For instance, connexome remodeling is a common feature of both acquired and inherited cardiac arrhythmias. We have shown that the lateral membrane-specific scaffolding protein CASK regulates the trafficking and targeting of certain connexome components, notably the sodium channel.

Question:
Does compartmentalization of the cardiomyocyte membrane involves lateral membrane proteins? Our hypothesis is that CASK, due to its association with costamere and its developmental expression gradient, may be involved in a more global control of connexome organization.

Aims:
To demonstrate that CASK, a lateral membrane-specific protein, is crucial for the development and maintenance of connexome integrity.

Method:
Viral constructs were designed to inhibit the expression of CASK in vivo (AAV-shCASK) and in vitro (Ad-shCASK) both in murine and human cardiomyocytes.

Results:
In vivo, echocardiography phenotyping of CASK invalidated rats at the neonatal stage revealed, at the adult stage, eccentric ventricular remodeling associated with increased stroke volume and increased cardiac output suggestive of athlete’s heart phenotype. Hemodynamic measurements (pressure-volume loops) confirmed that CASK invalidation increases both myocardium contractility and compliance. Proteomic analysis showed that CASK invalidation in vitro strongly modify immature cardiomyocyte proteome, notably junction signaling. Immunostaining experiments on cultured neonatal rat cardiomyocytes and adult rat hearts confirmed that CASK is required for the correct organization of myofibrils and favors connexome organization. Remarkably, CASK invalidation in a human
in vitro
model of arrhythmogenic cardiomyopathy (hiPSC-CM

PKP2
+/-

) rescues desmosome assembly.

Conclusion:
CASK regulates the organization of myofibrils and connexome, with major functional consequences for cardiac performance. Our results suggest for the first time the existence of a crosstalk between lateral membrane and connexome proteins. Therefore, targeting CASK to promote electromechanical coupling of cardiomyocytes could be promising in the context of cardiac remodeling.
Abstract 15272: What's in a Name: Comparison of Dd-cfDNA Technologies Following Heart Transplantation
Authors: Hsi Brian , van Zyl Johanna , Shakoor Hira , Farsakh Dana , Alam Amit , Hall Shelley
Published: December 2023

Introduction:
Little is known about the comparative differences between the Allosure (CareDx) and Prospera (Natera) donor derived cell-free DNA (dd-cfDNA) assays following heart transplantation.

Methods:
A retrospective analysis of all patients that had both dd-cfDNA assays simultaneously performed between February 2022 and December 2023 were reviewed. A total of 233 samples obtained between 18 to 506 days post-transplant from 46 patients were reviewed. Agreement between Allosure and Prospera assays were compared utilizing their thresholds indicative of an abnormality of 0.12% (Allosure) and 0.15% (Prospera).

Results:
Baseline patient characteristics include median age 60 years and 59% male. There were a total of 12 biopsy specimens available with both dd-cfDNA assays. There was substantial agreement between both dd-cfDNA assays (91% agreement, Cohens kappa 0.75). Both dd-cfDNA assays were correctly suggestive of rejection when biopsy was available. Differences in elevations of dd-cfDNA were noted in cases outside of rejection and were not consistent in 20/233 samples when utilizing their cutoff values of 0.12% for Allosure and 0.15% for Prospera (McNemar’s p = 0.01)(Table 1). This discordance was due to increased classification of abnormal results with the lower threshold value for Allosure. When using identical threshold values of 0.12% or 0.15% for the two assays, this discordance is no longer present (p = 0.82 and p = 1.00, respectively).

Conclusions:
Both dd-cfDNA assays can be utilized for surveillance of rejection following heart transplantation. Understanding differences between the two assays is important and requires further larger studies to validate these preliminary findings.
Abstract 15280: Does Weight Reduction Drive the Reduction in Blood Pressure in People Living With Obesity Treated With Tirzepatide?: Insights From SURMOUNT-1 Study
Authors: Sattar Naveed , de Lemos James A , Linetzky Bruno , Sharma Palash , Malik Raleigh , Bunck Mathijs , Ahmad Nadia , Stefanski Adam
Published: December 2023

Background:
Tirzepatide (TZP) is a GIP/GLP-1 receptor agonist indicated for the treatment of type 2 diabetes and in development for chronic weight management. In SURMOUNT-1, in participants with obesity or overweight, TZP 5, 10 and 15 mg reduced body weight (-15 to -20.9%), SBP (-7 to -8.2 mmHg) and DBP (-4.6 to -5.5 mmHg) after 72 weeks of intervention.

Aim:
To assess the effects of TZP on SBP and DBP by baseline (BL) blood pressure (BP) levels and to evaluate the contribution of weight loss to the effect.

Methods:
Adults with a BMI ≥30 kg/m2, or ≥27 kg/m2 and ≥ 1 diagnosed weight-related complication, excluding diabetes, received TZP (5, 10, or 15 mg) or placebo (PBO) for 72 weeks. Participants with a valid BL BP value and ≥1 post-BL value were included in the analysis using the efficacy analysis set (excluding off-treatment data). Changes from BL through 72 weeks in SBP and DBP were compared between pooled TZP doses and PBO with mixed models for repeated measures (MMRM) by BL BP levels. The proportion of participants reaching recommended BP thresholds was also evaluated. Post-hoc mediation analyses evaluated the weight-loss dependent, and independent, effects of TZP in SBP and DBP reduction.

Results:
Regardless of BL BP values, pooled TZP showed consistent SBP and DBP reduction at 72 weeks from BL, relative to PBO (Figure 1a). At 72 weeks, a greater proportion of TZP treated participants achieved recommended SBP and DBP levels than participants treated with PBO (Figure 1b), nearly doubling the proportion of patients with normal BP values. Changes in body weight with SBP (r=0.24) and DBP (r=0.24) were moderately correlated. Mediation analysis indicated that SBP and DBP reductions were primarily mediated through weight loss (77% and 99% respectively).

Conclusions:
Effects of TZP on blood pressure were consistent regardless of SBP or DBP values at BL, increasing the proportion of patients reaching normal BP levels. Reductions in SBP and DBP were substantially mediated by weight reduction.
Abstract 15283: QRS Voltage in Precordial Leads Predicts Survival After Cardiac Resynchronization Therapy in Non-Left Bundle Branch Block Patients
Authors: Apetrei Csilla-Andrea , Avram Teodora , Sarb Adriana Daniela , Zehan Iulia , Moldovan Madalina , Sorin Pop , Gusetu Gabriel , Mocanu Lorena , Coseriu Giorgia , Burde Andrada , Schiop-Tentea Patricia C , Blendea Dan
Published: December 2023

Introduction:
The QRS complex reflects the summation of all instantaneous electrical forces during ventricular depolarization. In patients with intraventricular conduction abnormalities, whether left bundle branch block (LBBB) or non-LBBB, the propagation of the electrical wavefront is dyssynchronous and unopposed and is thereby associated with an increase in the QRS voltage in the precordial leads.

Hypothesis:
The aim of this study was to assess the impact of cardiac resynchronization therapy (CRT) on QRS voltage and its ability to predict survival in non-LBBB patients who are known to have lower response rates to conventional CRT.

Methods:
Twelve-lead EKGs were analyzed in 101 consecutive non-LBBB patients (age 65±12 years, 79 men, LVEF 22±4%, QRS width 154±21ms) who received CRT for a median duration of 43 months.

Results:
During the follow-up period 39 patients died. Total QRS amplitude in leads V2-V4 decreased significantly with CRT (values preimplant/immediately postimplant, P<0.001 for all changes): lead V2 2.1±0.9mV/0.9±0.7mV, lead V3 2.3±0.8mV/1.4±0.7mV, and lead V4 1.4±0.7mV/0.8±0.6mV. Patients in whom the total QRS amplitude in lead V4 decreased with CRT had significantly better survival than patients in whom it increased or did not change (Figure). Changes in QRS amplitude in lead V4 correlated with changes in LVEF over a period of 6 months post implant (r=-0.439, p=0.017). Total QRS amplitude in lead V4 and its change with CRT independently predicted event free survival in multivariate Cox models that included age, gender, baseline LVEF and the change in QRS duration.

Conclusion:
A reduction in the QRS voltage in the precordial lead V4 is predictive of response to CRT in non-LBBB patients.
Abstract 15290: Race Stratified Prevalence and Predictors of Major Adverse Cardiac and Cerebrovascular Events in a Nationwide Multicentric Elderly Cohort Hospitalized With Heart Failure With Preserved Ejection Fraction From 2016-2019
Authors: Mondal Avilash , Parmar Poojan , DADANA SRIHARSHA , Bollu Bhaswanth , Dong Qiming , Mylavarapu Maneeth , Shafi Nimra , Kali Abeera , Khan Muhammad Hassan , Shanker Srija , butt Samia , Desai Rupak
Published: December 2023

Background:
Race-stratified predictors of adverse cardiovascular and cerebral events in heart failure with preserved ejection fraction (HFpEF) have never been described before.

Methods:
Using the National Inpatient Sample (2016-2019), we identified hospitalizations among elderly (>=65 years) HFpEF patients using relevant ICD-10 codes. Prevalence and trends of MACCE events were identified across sex and race from 2016 to 2019. Logistic regression analysis was used to estimate predictors of MACCE events across different racial groups. P<0.05 is considered significant.

Results:
Of 6,134,669 total elderly HFpEF, 21% (n=780,615, males=13.5%) had MACCE events during hospitalization. MACCE events showed an uptrend from 2016-2019 across both males, females (13.5% vs.12.2%) and all racial groups with most difference seen in Native Americans (10.7 to 14.8%) and the least in Whites (12.0% to 12.9%) (Fig. 1). After stratification by race, hypertension had the highest odds of predicting a significant MACCE event in Hispanics (OR 2.06), while diabetes in whites (OR 1.05). Paradoxically, hyperlipidemia was associated with significant lower odds of MACCE in whites (OR 0.94), blacks (OR 0.94), and hispanics (OR 0.93), and smoking in whites (OR 0.78), blacks (OR 0.72), hispanics (OR 0.77), and asians (OR 0.77) (Table 1).

Conclusion:
Cardiovascular events in elderly HFpEF patients increased over the past four years, with Native Americans being the most affected. Hypertension was found to be the strongest predictor in hispanics, whereas in whites it was diabetes. Future studies are warranted to investigate the predictors of MACCE in specific racial groups to curtail worse outcomes.
Abstract 15294: Preliminary Results of the Sit Less Program for Patients With Coronary Artery Disease: A Pilot Randomized Controlled Trial
Authors: Park Chorong , Doyle Abigail , Jean Jason , Mogos Mulubrhan F , Muchira James M , Ahn Soojung , Su Han , Sheng Ying , Piano Mariann R , Mulvaney Shelagh
Published: December 2023

Introduction:
Coronary artery disease (CAD) patients spend on average 10-14 hours per day sitting, which is higher than the recommended 8 hours of sitting. Independent of physical activity levels, higher levels of daily sitting are associated with adverse cardiometabolic outcomes. This study evaluated the feasibility and preliminary efficacy of a multi-technology-based Sit Less program in reducing sitting time (ST) and increasing breaks in ST in CAD patients.

Methods:
CAD patients were randomized to a control (n=8) or a 12-week Sit Less program (n=11). Sit Less included one in-person counseling session, a Fitbit, a smart water bottle (used to break prolonged ST via frequent restroom visits), and tailored weekly text messages. Feasibility was assessed via text message response rate and program satisfaction. Primary outcomes included changes in total daily ST, prolonged ST (total time spent in sitting bouts of >30 mins and >60 mins), and sit-to-stand transitions (all measured using activPAL). Cardiometabolic biomarkers included BMI, blood pressure, insulin, HbA1c, and lipids. Pre-post group differences were examined using independent t-tests.

Results:
All participants completed the study (15 male, 66±10yrs, mean ST = 10.4 hours/day). Out of the 11 Sit Less participants, 82% responded to all text messages and expressed satisfaction with the program. Significant pre-post group differences were found for total daily ST and prolonged ST (Figure 1). The Sit Less group had 36 minutes reduction in total ST and 3.4 more sit-to-stand transitions, while the control group had 47 minutes increase in total ST and 1 fewer sit-to-stand transitions. No significant differences in cardiometabolic markers were found within or between groups.

Conclusion:
The Sit Less program was feasible in CAD patients and the intervention reduced total and prolonged ST. Large-scale trials are needed to assess the program's effectiveness in reducing sitting and improving cardiometabolic outcomes.
Abstract 15296: Incidence and Predictive Factors for Left Ventricular Dysfunction After Transcatheter Device Closure of Patent Ductus Arteriosus in Extremely Low Birth Weight Infants
Authors: Adamson Marissa E , Ligon Allen , Hamrick Shannon , Mills Marcos , Bhombal Shazia , Hash Sarah E , Michelfelder Erik
Published: December 2023

Background:
Left ventricular (LV) dysfunction is a known complication after ligation or device closure of patent ductus arteriosus (PDA). Recently, an increasing number of premature and extremely low birth weight (ELBW) infants undergo transcatheter device closure of PDAs. Afterload sensitivity of the immature myocardium may be expected to result in important changes in LV ejection fraction (EF) post-procedure. Aim: To evaluate incidence and magnitude of LV dysfunction after device closure of PDA in ELBW infants.

Methods:
Subjects undergoing PDA device closure from 2020-2022 who were ELBW (<1 kg) and extremely premature (gestational age <29 weeks) at birth were included. A single cardiologist reviewed each pre- and post-intervention echocardiogram and calculated LVEF. Mildly depressed function was defined as an LVEF <53%, moderately depressed as LVEF <40% and severely depressed as LVEF <30%.

Results:
There were 62 subjects who met inclusion criteria. Mean gestational age and birth weight were 24.8 weeks and 646 g, respectively. Mean age and weight at intervention were 7.9 weeks and 1718 g, respectively. All patients had normal LVEF pre-procedure (mean LVEF 68%) with a significant decline post-procedure to 60% (p<0.001) (Figure). Post-procedure, 80.6% of subjects maintained normal LVEF. Of 12 subjects who developed depressed function, 83% (n=10) had mildly depressed function and 17% (n=2) had moderately depressed function. There was no significant difference in post-procedure LV dysfunction in relation to pre-procedural PDA size, left atrial dilation, or LV dilation on univariate analysis. All subjects recovered function without additional inotropic support with a median time to observed normal LVEF of 5 days.

Conclusions:
LV dysfunction develops in 19% of ELBW infants undergoing PDA device occlusion, is usually mild in severity, and normalizes in all subjects. The size of PDA or degree of left heart dilation does not predict LV dysfunction in this population.
Abstract 15298: Epidemiology and microRNA Predictors of Infection After Heart Transplantation
Authors: Lohmar Brendan J , BAGCHI PRAMITA , Dimond Matthew , Goldberg Jason , Tanna Sajal , deFilippi Christopher , Valantine Hannah , Agbor-Enoh Sean , Shah Palak
Published: December 2023

Background:
Infection rates are high in heart transplant (HT) patients due to the need for immunosuppressive medication. MicroRNAs (miR) are non-coding RNAs, that regulate gene expression and are promising biomarkers for identifying patients at risk for infection.

Hypothesis:
MiR profiles can identify HT patients who are at increased risk for developing an infection.

Methods:
HT patients who were prospectively enrolled from 2015-2018 had miR-sequencing performed. Incident infection after HT hospital discharge along with the epidemiologic characteristics of the infection were collected from the EMR. An opportunistic infection (OI) is an infection which is less virulent in a healthy host but can cause severe disease in those immunosuppressed. A time-to-event analysis was performed using miR expression at two weeks post-HT in multivariable modeling, and the Benjamini-Hochberg procedure was used to correct for false discovery.

Results:
The cohort included 46 patients with a median age of 56 years (IQR: 49, 62), 33% (N=15) were Female sex, 41% (N=19) were Black, and 80% (N=37) were supported with an LVAD prior to HT. Post-HT infection occurred in 59% of patients (N=27) and median time to infection was 341 days (IQR: 85, 859). Hospitalization was required in 56% (N=15) of infections. Respiratory tract and OIs were the most common infection type (Figure A). The most common microorganisms implicated were CMV (28%) and SARS-COV-2 (19%) (Figure B). After correction for false discovery, we identified 15 miRs associated with infection risk. The 5 miRs with strongest effect size and their corresponding hazard ratios include: miR-21 2.5(95% CI: 1.3, 4.7), miR-130b 8.6 (95%CI: 1.9, 39.3), miR-192 0.3 (95%CI: 0.1, 0.6), miR-218 2.6 (95%CI: 1.3, 5.1) and miR-484 0.3 (95%CI: 0.1, 0.7).

Conclusion:
While the burden of post-HT infections is high and contributes to patient morbidity, novel plasma miRs can potentially play a role in identifying patients at risk for infections after HT.
Abstract 15299: Cardiogenic Shock and Flash Pulmonary Edema in an Uncommon Nonischemic Nonmyxomatous Spontaneous Rupture of Anterolateral Mitral Valve Papillary Muscle
Authors: Hartman Steven D , Donatelle Marissa A , Vedantam Karthik , Arreaza Caraballo Javier , Escolar Esteban
Published: December 2023

Introduction:
Mitral valve papillary muscle rupture is a rare condition that presents a cardiac emergency requiring rapid identification and treatment. Here we present a case of flash pulmonary edema and cardiogenic shock from severe mitral regurgitation (MR) secondary to spontaneous rupture of the anterolateral papillary muscle.

Case Presentation:
A 48-year-old female with hypertension presented to the ED with acute shortness of breath. In the ED, she was tachycardiac, hypertensive, tachypnic and saturating 75% on room air. On physical exam a 3/6 systolic murmur was present at the apex. ECG had no signs of ischemia. TTE showed severe MR with a fail anterior mitral leaflet. The patient was intubated and taken emergently to the cath lab for intra-aortic balloon pump placement, TEE (Figure 1A) and coronary angiogram, which was normal (Figure 1B, 1C). She was taken to the OR for successful mitral valve replacement surgery.

Discussion:
The rapid clinical decline and emergent management of patients who develop cardiogenic shock with pulmonary edema from acute non-ischemic papillary muscle rupture presents a significant challenge for clinicians. The cause of papillary muscle rupture most often occurs due an ischemic event, but can occur spontaneously as in this case. Rapid identification of the etiology of the clinical symptoms is of upmost importance to increase chances of survival. On review, 11 cases have been published between 2000-2015 discussing nonischemic nonmyxomatous spontaneous papillary muscle rupture of which the majority had a posterior muscle rupture. In our case, the 48-year old patient only had mild chordal calcification and essential hypertension and presented with nonischemic nonmyxomatous rupture of the anterolateral muscle. With prompt identification and urgent multidisciplinary team intervention, the patient was eventually discharged after replacement and is doing well at 6 months follow-up.
Abstract 15311: Predict Factors Affected With In-Hospital Clinical Outcomes Between Endovascular Therapy and Fogarty Thrombectomy for Patients With Acute Limb Ischemia: A Large Number Analysis Based on JROAD-DPC Database
Authors: Ozawa Takaaki , Yanishi Kenji , Seki Tomotsugu , Yoshimura Jun , Goto Daiki , Kawamata Hirofumi , Tsubata Hideo , Nakanishi Naohiko , Nakamura Takeshi , Zen Kan , Matoba Satoaki
Published: December 2023

Background:
The etiology of acute limb ischemia (ALI) has been often reported to be embolism caused by atrial fibrillation (Af) and/or atrial flutter (AFL), and thrombosis caused by atherosclerosis. Although endovascular therapy (EVT) or fogarty thrombectomy (Fogarty) is recommended as a primary treatment for patients with ALI, which treatment should be chosen is still controversial.

Aim:
To evaluate differences of clinical outcomes between primary treatments for patients with ALI, and identify prognostic predictors.

Methods:
This was a retrospective study based on the database in the JROAD-DPC (Japanese Registry of All Cardiac and Vascular Diseases and the Diagnosis Procedure Combination). Figure.1 showed the flow chart of this study. Comparison with EVT-alone and Fogarty-alone group was analyzed using propensity score matching with 16 clinically relevant covariates. Clinical outcomes were death, major adverse cardiovascular events (MACE; myocardial infarction, coronary intervention, heart failure, stroke, cerebral hemorrhage), bleeding complications with bleeding academic research consortium (BARC) type 3-5, and any amputation.

Results:
Figure2-4 showed the results of this study. Figure.3 demonstrated that bleeding complications and any amputation in Fogarty-alone group were significantly less than EVT-alone group. Figure.4 revealed that Fogarty tended to decrease an amputation-free survival rate in ALI patients who had no history of peripheral artery disease (PAD) and not administered an antiplatelet before onset.

Conclusions:
Fogarty should be selected as the primary treatment as much as possible for ALI patients, especially those without PAD.
Abstract 15315: Cardiac MRI Tissue Characterization for Intra-Cardiac Thrombi Therapeutic Response in Systemic Cancer Patients
Authors: Jain Raina , Park Michael , Liberman Nicole , Agoglia Hannah , Kim Jiwon , Steingart Richard , Liu Jennifer , Weinsaft Jonathan W , Chan Angel T
Published: December 2023

Introduction:
Cardiac MRI (CMR) is often used to identify thrombi (C
THR
) based on absence of contrast enhancement but its utility as a predictor of therapeutic response of anticoagulation (AC) is unknown.

Methods:
Adult (≥18yo) pts with systemic cancer were matched 1:1 for cancer etiology/stage and presence/absence of C
THR
on CMR. Cine-CMR assessed cardiac structure/function and localization of C
THR
. Contrast-enhanced CMR (0.2 mmol/kg gadolinium) was performed for identification of C
THR
and quantitative tissue properties. C
THR
resolution was evaluated on serial TTE at a time point of 3 months post CMR; clinical f/u and anticoagulation therapy were determined by chart review.

Results:
189 pts (54±16 yo; 50% M) were studied, 106 with C
THR
and 83 without. Cancer etiology varied (heme 30%
Abstract 15320: Trends in Pulmonary Embolism-Related Mortality in the United States Before and During the COVID-19 Pandemic
Authors: Kaushik Milan , Li Haibin , Qian Frank , Carroll Brett
Published: December 2023

Introduction:
Infection with severe acute respiratory syndrome-coronavirus-2 (SARS-CoV2) and the subsequent development of COVID-19 is associated with an increased risk of pulmonary embolisms (PE). We sought to determine the trends in PE-related mortality in the United States from 1999 to 2021.

Methods:
We analyzed all deaths occurring in the US using the US Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database from 1999 to 2021. The Multiple Cause-of-Death Public Use record death certificates were used to select PEs as the primary or contributing cause of death using relevant ICD-10 codes. PE-related age-adjusted mortality rates (AAMR) per 100,000 persons were calculated and standardized to the US population in 2000. We calculated annual percent changes (APC) and corresponding 95% confidence intervals (CI). We also conducted subgroup analyses to examine mortality trends by age, sex, and racial/ethnic groups.

Results:
From 1999 to 2013 and between 2013 and 2019, APC for PE-related mortality remained relatively stable, corresponding to -0.4% (95% CI: -0.6 to -0.2) and 1.3% (95% CI: 0.6 to 2.1), respectively. Between 2019 and 2021, PE-related mortality increased from 9.2 to 14.1 per 100,000 populations per year, corresponding to an APC of 21.7% (95% CI: 18.3 to 25.3). There was a similar pattern of increase among individuals < or ≥65 years. Men had a significantly greater increase in APC, 24.6% (95% CI: 20.5 to 28.9), when compared to women, 18.9% (95% CI: 15.0 to 22.9). All racial/ethnic groups experienced an increase in PE-related mortality between 2019 and 2021 but the increase was more pronounced among minority groups including Non-Hispanic Blacks, Hispanics and Native American/Alaskan Natives.

Conclusion:
PE-related mortality significantly increased during the COVID pandemic, and the increase was disproportionately greater among men and racial/ethnic minorities.
Abstract 15321: Association Between Cardiovascular Risk Factors, Social Determinants of Health and Cardio-Ankle Vascular Index (CAVI) Scores Among African-American Adults: The FAITH! Heart Health+ (HH+) Study
Authors: Thomas Victoria E , Kullo Iftikhar J , Lalika Mathias , McCoy Carrie R , Johnson Matthew P , Hayes Sharonne N , Jones Clarence , Cooper Lisa A , Patten Christi A , Brewer LaPrincess C
Published: December 2023

Background
Cardio-ankle vascular index (CAVI) is a measure of arterial stiffness associated with cardiovascular (CV) events and mortality. African American (AA) adults have a higher prevalence of CV risk factors (RFs) and adverse social determinants of health (SDOH) leading to a higher CV mortality risk than White adults. These disparities may be associated with arterial stiffness, however limited research exists on the association of CV RFs, SDOH, and CAVI among AAs.

Hypotheses
We hypothesized that CV RFs (eg, diabetes) and SDOH (eg, income) would be associated with CAVI among AA adults. Our secondary hypothesis was that AA adults would have a higher prevalence of abnormal CAVI scores (≥8.0) than White adults.

Methods
In the FAITH! HH+ study, CAVI measurements, CV RFs, and SDOH surveys were obtained. We collected CAVI readings and CV RFs from a secondary cohort of White adults (n=600), referred for echocardiography and without structural cardiac disease. The association of CV RFs, SDOH and CAVI scores among AAs was assessed via ANOVA and univariable linear regression. We compared CV RFs among both cohorts using Chi-squared tests and ANOVA, followed by comparing CAVI scores between cohorts using a multivariable linear regression model.

Results
In total, 48 AAs were included from the FAITH! HH+ cohort (mean age [SD]: 54.2 [11.5] years, 67.4% women). There was no significant association between CV RFs or SDOH with CAVI scores. In the 600 White adults assessed, mean age was 59.5 [14.7] years and 45.7% were women. Compared to White adults, AA participants had a lower burden of hyperlipidemia (43.5% vs 61.4%; p=0.017), but a higher burden of hypertension (73.9% vs 57.7%; p=0.031), diabetes (28.3% vs 9.3%; p<0.001), and obesity (71.7% obese vs 36.0%; p<0.001). There was no significant difference in CAVI scores between groups when adjusted for age, sex, and CV RFs (AA cohort: mean: 8.0 [1.4] vs White cohort: 8.4 [1.5]; p=0.790).

Conclusions
In this pilot study, SDOH and CV RFs were not associated with CAVI scores among AAs. There was no significant difference in CAVI scores between AA and White adults, despite a significantly higher burden of CV RFs in the AA cohort. Further studies are warranted to identify factors linked with onset and progression of arterial stiffness among AAs.
Abstract 15327: Clinical Outcomes of Methamphetamine-Associated Cardiomyopathy Compared to Ischemic Cardiomyopathy: A Single Institution Retrospective Longitudinal Study
Authors: Sung Michelle , Bernstein Hannah , Tranvu Khanhphi , Chau Edward , Allam Shamili , English Carter , Fan Dali , Munir Bilal , Srivatsa Uma N
Published: December 2023

Background:
Methamphetamine-associated cardiomyopathy (MAC) leads to significant morbidity and mortality. The benefit of implantable cardioverter-defibrillator (ICD) in this population is poorly characterized.

Aims:
To evaluate ICD use and outcomes in patients with MAC compared to ischemic cardiomyopathy (ICM).

Methods:
Electronic health record (EHR) was queried for all heart failure hospitalizations using ICD-9 codes between 2011 and 2019. Patients with an EF ≤ 35% were included. The MAC cohort was derived from this population and defined by ICD-9 code or positive urine toxicology and compared to ICM cohort. Baseline characteristics and outcomes were extracted from the EHR. MACE was defined as death, ventricular tachycardia, cardiac arrest, rehospitalization, atrial fibrillation (AF) or stroke.

Results:
The study included 294 patients in the MAC group and 373 patients in the ICM group. MAC patients were younger (56 vs 61 years, p<0.001) compared to ICM (table 1). Readmission rates for heart failure at one year were similar (13% vs 11.2%, p=ns). Significantly fewer patients with MAC had ICD for primary prevention (15.0% vs 27.9%, p<0.001). Mortality and AF were lower in MAC compared to ICM, however VT (2.38% vs 5.09%, p=0.072) and cardiac arrest (6.1% vs 7.8%, p=0.408) were similar between the two groups. MACE outcomes were worse in the ICM cohort (38.3% vs 21.1%, p=0.012) than MAC. In the MAC cohort, ICD presence was associated with 56.82% incidence of MACE compared to 40.00% without ICD (OR = 1.97, CI 1.032-3.77, p = 0.040) mainly due to higher AF hospitalization (22% vs 8%, p=0.01).

Conclusion:
ICM patients had higher mortality and atrial fibrillation compared to MAC. ICD implantation for primary prevention was not associated with reduced mortality, however this cohort had higher AF hospitalization. We need further studies to assess the benefit of ICD in MAC.
Abstract 15337: Study of Relationship Between Neighborhood Racial Segregation and Heart Failure Mortality
Authors: Richards Anna L , Badran Aya M , Towns Brandon T , Razi Rabia R , Chen Qiaoling , Nau Claudia , Lee Mingsum
Published: December 2023

Background
Upstream factors, including socioeconomic status, healthcare access, structural environment, contribute to the presence of disparities in cardiovascular outcomes. The impact of neighborhood-level racial segregation on cardiovascular outcomes is not well understood.

Research Question
The goal of this study was to evaluate the association between neighborhood racial segregation and heart failure mortality.

Methods/ Approach
This is a retrospective, cohort study performed at Kaiser Permanente Southern California that included patients hospitalized for heart failure between January 2010 and December 2017. Data regarding demographics, comorbidities, and outcomes, was linked to the diversity index from the US Census Bureau. This is a measure of racial segregation, the likelihood that any two people from an area will be from different race/ ethnicity groups. The cohort was divided into tertiles by diversity index. Mortality rates for each racial group was calculated. Multivariate logistic regression models were constructed to evaluate the association between race/ethnicity and mortality.

Results/ Data
There were 19,322 patients included in our analysis. After adjusting for demographics, socioeconomic markers, neighborhood characteristics, and comorbidities, higher mortality was noted for Black patients compared to White patients in the least diverse tertile (adjusted OR [95% CI]: 1.42 [1.15-1.74]). In the most diverse tertile, no significant difference between Black and White patients was observed (adjusted OR [95% CI] 1.02 [0.83-1.26]). Asian and White patients did not show a difference in mortality across tertiles. Hispanic patients had a statistically significant decreased mortality in the two more diverse tertiles.

Conclusion:
Heart failure mortality is lower in Black patients in more diverse neighborhoods. Further work is needed to look at the pathway that connects racial segregation to heart failure outcomes.
Abstract 15352: Deep Learning Model-Enabled Electrocardiogram to Localize Premature Ventricular Contractions in Patients Referred for Catheter Ablation
Authors: Dai Qiying , Wight John A , Kowlgi Gurukripa N , Greason Grace , Woelber Tiffany , Noseworthy Peter A , Friedman Paul , Asirvatham Samuel , Desimone Christopher V , Deshmukh Abhishek , Attia Zachi
Published: December 2023

Introduction:
Accurate pre-procedure localization of the premature ventricular contractions (PVCs) is critical in preparing for the ablation. So far, no tools exist for artificial intelligence guided PVC-localization.

Hypothesis:
Trained deep learning model will be able to predict the site of origin (SOO) of PVCs using 12 lead electrocardiogram (ECG).

Methods:
We analyzed 707 ECG-ablation pairs from 2403 patients who had at least one ECG flagged for PVCs in the 6 months prior to their procedure. First, we used a cohort of 100,000 ECGs without PVCs and 10,000 ECGs with PVCs to train a convolutional neural network (CNN) to isolate the ECG segments with PVCs in them from a 12-lead ECG (Figure 1). We then trained two models, one utilizing a 10-second 12-lead ECG, and the other with just the isolated PVC beats as input. The models were trained using the Keras framework with TensorFlow (Google).

Results:
The mean age of the patients in the cohort was 61.2 ± 15.0 years. 66.3 percent of patients underwent left ventricle ablation, 54.6 percent had outflow ablation, and 55.3 percent had ablation of sites with leftward axis (septal location for midline and left ventricle PVCs). The model trained on 10-second ECGs yielded validation and test AUCs of 0.941 and 0.931 for outflow, 0.898 and 0.891 for ventricle, and 0.863 and 0.846 for leftward axis (Figure 1A). The model trained on isolated segments containing PVC beats yielded validation and test AUCs of 0.966 and 0.957 for outflow, 0.879 and 0.907 for ventricle, and 0.846 and 0.829 for SOO for leftward axis (Figure 1B).

Conclusions:
We have trained an accurate convolutional neural network that can predict SOO using the surface ECG. Further fine-tuning would be needed to refine the model and develop prediction of specific sites.
Abstract 15358: Deletion of
Csf2
Accelerates Disease Progression in a Mouse Model of Arrhythmogenic Cardiomyopathy
Authors: Chelko Stephen P , Penna Vinay , Engel Morgan , Landim-Vieira Maicon , Centner Ann , Cannon Elisa N , Lavine Kory , Saffitz Jeffrey E
Published: December 2023

Arrhythmogenic cardiomyopathy (ACM) is a familial heart muscle disease driven by persistent innate immune signaling. We have shown that ventricular fibrosis and contractile dysfunction in
Dsg2

mut/

mut

mice, a model of ACM with homozygous knock-in of a variant in the gene for the desmosomal protein desmoglein-2, is mediated by activation of NFκB and actions of pro-inflammatory macrophages that express CCR2. To gain further insights into the roles of specific immune signaling pathways in the pathogenesis of ACM, we crossed
Dsg2

mut/

mut

mice with mice with germline deletion of
Csf2
which encodes GM-CSF. This factor acts to mobilize inflammatory cells to sites of injury.
Csf2

-/-

mice have a normal leukocyte repertoire and no apparent phenotype under basal conditions, but show reduced immune cell infiltration after MI associated with improved healing and cardiac function. Thus, we anticipated delayed onset and less severe disease in
Dsg2

mut/

mut

Csf2

-/-

mice compared with
Dsg2

mut/

mut

mice. In fact, the opposite occurred. By 8-weeks of age,
Dsg2

mut/

mut

Csf2

-/-

mice showed a marked increase in ventricular fibrosis (18.2±6.2% of section area; n=11; p<0.05 vs all) compared to
Dsg2

mut/

mut

(2.6±0.4%; n=27) or wildtype (WT) control (0.9±0.1%; n=18) mice.
Dsg2

mut/

mut

Csf2

-/-

mice also had reduced LV ejection fractions (49.6±8.3%; n=11; p<0.05 vs all) compared to
Dsg2

mut/

mut

(64.5±3.2%; n=27) or WT (81.8±1.0%; n=18) mice. Hearts of 8-week
Dsg2

mut/

mut

Csf2

-/-

mice contained increased levels of pro-inflammatory chemokines (CCL21, CXCL1), matrix metalloproteinases, osteopontin (Spp1) and periostin (Postn). Single nucleus RNA sequencing studies revealed increased numbers of Spp1
+
macrophages and Postn
+
fibroblasts, and a marked decrease in cDC2 dendritic cells in hearts of
Dsg2

mut/

mut

Csf2

-/-

mice compared to
Dsg2

mut/

mut

or WT mice. cDC2 dendritic cells are known to have anti-inflammatory actions. These results suggest that cDC2 cells, mobilized by GM-CSF, may act to mitigate disease onset and severity in ACM. If so, cDC2 cells could serve as a determinant of disease expression in ACM patients.
Abstract 15380: Diagnostic Performance of Ultrasonic Flow Ratio versus Quantitative Flow Ratio for Assessment of Coronary Artery Stenosis
Authors: Yang Cheng , Sui Yong-Gang , Qian Jie
Published: December 2023

Introduction:
Ultrasonic flow ratio (UFR) is a novel intravascular ultrasound (IVUS)-derived method for fast computation of fractional flow reserve (FFR) without pressure wires and adenosine.

Aims:
The aim of this study was to evaluate the diagnostic performance of UFR and compare it with angiography-based quantitative flow ratio (QFR), using FFR as the reference standard.

Methods:
Patients who underwent coronary angiography, IVUS and FFR were analyzed. UFR and QFR was computed offline in a central core-lab by independent analysts blinded to FFR.

Results:
A total of 111 paired comparisons between UFR, QFR and FFR from 56 patients were analyzed. UFR showed a numerically better correlation (r=0.83 vs. 0.79; p=0.27) and significant better agreement (standard deviation of the difference=0.07 vs. 0.08; p=0.02) with FFR than QFR. Diagnostic accuracy, sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio for UFR to predict FFR was 92% (95% CI: 85%-96%), 85% (95% CI: 71%-94%), 97% (95% CI: 89%-99%), 95% (95% CI: 83%-99%), 90% (95% CI: 82%-95%), 27.6 (95% CI: 7.0-108.4), and 0.16 (95% CI: 0.08-0.31), respectively. The area under curve for UFR to predict an FFR ≤ 0.80 was 0.94, is equivalent to QFR (difference=0.04; p=0.23), and higher than minimal lumen area (difference=0.09, p=0.006). Diagnostic accuracy was not significantly different in bifurcation lesions, nor in non-bifurcation lesions.

Conclusions:
The UFR showed good diagnostic concordance with FFR, equivalent to QFR. The good diagnostic performance of UFR provides a potentiality for the integration of physiological assessment and intravascular imaging in real-world clinical practice.
Abstract 15387: Outpatient Intravenous Diuresis for Acute Exacerbation of Heart Failure: A Claims-Based Analysis
Authors: Russo Pierantonio , Sicilia Michael , Pfeifer Daniel , Rumantir Ryan , Mc Dermott Kevin
Published: December 2023

Introduction
There is evidence that selected patients with HF exacerbation can be treated with outpatient IV diuresis (OIVD), delaying or avoiding subsequent acute care services and reducing cost.

Hypothesis
In selected HF patients, OIVD reduces or delays hospitalization and lowers medical cost.

Methods
Retrospective claims analysis using the Truven Market Scan database of medical and pharmacy claims (200 million USA lives). We identified all patients with claims for HF (Oct 2015- Sept 2022) receiving OIVD within 12 months after HF diagnosis.OIVD was administered as single day or multiple days events (OIVD over 10-day window). Care episodes and cost within 12 months after initiation of OIVD were defined by location of care: Hospital, ER, Observation, Skilled Nursing Facilities (SNFS) Outpatient Clinics.

Results
Out of 924,174 patients (age 63.4; SD 14.8) with an ICD 10 for HF, 42,132 received OIVD in hospital clinics, other clinics, physician's offices andER/Observation. One OVID episode was documented in 37,178; multipe in 4,954 (1.4-1.5 episodes per patient). After initiation of OVID, 33,172 patients required care for HF in ER, Observation, Hospital and SNFS (average of 5.9 events per patient). Hospitalization and SNFS were delayed by a mean of 4.60 months from OIVD. The remaing 8,960 patients did not require subsequent acute care or SNFS services for HF. The cost per OIVD episode was higher for ER and Observation (range $952 -$1730) than for outpatient clinics (range $190 -$ 786). The cost of hospitalization ranged $14,500-$57,488.

Conclusions
In selected patients with HF, OIVD is effective in delaying or preventing use of acute care services and it is associated with cost avoidance. New care protocols are needed to expand the use of OIVD in outpatient clinics and even in the home as an alternative to ER/Observation/Inpatient.
Abstract 15388: Atrial Fibrillation Burden Reduction From Antiarrhythmic Drugs in Patients With Cardiac Implantable Electronic Devices
Authors: Schwartz Sarah M , Peigh Graham , Culler Kasen , Mathew Daniel , Verma Rhea , Lemma Betelehem , Passman Rod S
Published: December 2023

Introduction:
Efficacy of rhythm control treatments for atrial fibrillation (AF) is usually measured by time to recurrent AF, however reduction in AF burden is a more clinically relevant endpoint. Cardiac implantable electronic devices (CIEDs) provide continuous rhythm monitoring that allows for highly accurate measures of AF burden. Ablation has been shown to reduce AF burden by > 99% in CIED patients, but there are limited data on the impact of antiarrhythmic drug (AAD) therapy on AF burden.

Methods:
A single-center retrospective study of all CIED patients with new AAD initiation for AF between 4/2018-3/2022 was conducted. Patients with CIED-detected AF burden within 6 months pre- and 12 months post-AAD initiation were eligible for inclusion. CIED-detected AF burden was compared pre- and post-AAD initiation.

Results:
Of the 214 patients included in analysis (73.6 ± 11.8 yrs, 63% male, CHA
2
DS
2
-VASc 3.8 ± 1.6), there was a statistically significant reduction in AF burden following AAD initiation (pre-AAD 4.5% [IQR: 1.0%, 27.9%]; post-AAD 0.1% [IQR: 0%, 3.2%], p<0.001). Of patients prescribed amiodarone (n=148, 69%), the median AF burden decreased from 3.6% [IQR: 1.0%, 28.0%] to 0.1% [IQR: 0.0%, 2.5%] (p<0.001). Among patients on other AADs (flecainide n=22, 10%; sotolol n=21, 10%; dronedarone n=12, 6%; dofetilide n=8, 4%; propafenone n=3, 1%) the median AF burden decreased from 6.6% [IQR: 1.7%, 25.5%] to 0.2% [IQR: 0%, 3.5%] (p=0.028) (Figure). There was no significant difference in AF burden reduction between amiodarone and non-amiodarone AADs (amiodarone 90.9% [IQR: 0.0%, 100.0%], non-amiodarone AADs 74.0% [IQR: 0.0%, 99.9%], p=0.686).

Conclusions:
AADs significantly reduce CIED-measured AF burden, but this burden reduction is less than what is reported with ablation. There was no significant difference in AF burden reduction between cohorts of patients on amiodarone and non-amiodarone AADs.