bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 11624: Body Fat and Cardiometabolic Disease Burden in Adults With Normal Body Mass Index
Authors: chen zhuo , Li Jingen , Medina-Inojosa Betsy , Medina-Inojosa Jose R , Lara-Breitinger Kyla , Somers Virend K , Acosta Andres , Lerman Amir , Lopez-Jimenez Francisco
Published: December 2023

Background:
The role of body adiposity on metabolic dysregulation in subjects with normal body mass index (BMI) is still under debate with limited population-based evidence.

Hypothesis:
Body adiposity measured by dual x-ray absorptiometry (DEXA) is associated with metabolic disorders in normal-weight individuals.

Methods:
We evaluated a sample of adults aged 20-65 who underwent DEXA in the US National Health and Nutrition Examination Surveys from 1999-2006 and 2011-2018. We excluded those with history of cardiovascular disease, cancer, and chronic obstructive pulmonary disease. Weighted logistic regression was performed to test the association between body fat percentage (BF%) and metabolic disorders [e.g., insulin resistance (IR), metabolic syndrome (MS), dyslipidemia, type 2 diabetes mellitus (DM), hypertension]. Models were adjusted for potential confounders while considering complex survey design and were further stratified by sex and BF% as tertiles in normal-weight individuals. IR was tested as a secondary analysis to evaluate the effect on the predicted risk.

Results:
We included 20,613 individuals (51.5% men, 65.4% non-Hispanic whites), mean age ± SE was 39.42±0.22 years, and 6,424 were normal weight by BMI and represented our study sample. The overall BF% in these subjects measured by DEXA was 28.41±0.19%. In our cohort, metabolic disorders were prevalent in 2.1% to 40.4% of patients (Table 1). Every 10-unit % increase in total BF% was associated with a higher risk for IR, MS, dyslipidemia in the normal weight BMI group (Table 1). Metabolic disorders were associated with BF% tertiles (Figure 1). IR was significantly associated with body fat across all BF% tertiles for men and highest tertiles for women (Figure 2).
Conclusion(s):
Less than 1/3 of subjects in a representative national sample had a normal BMI. Even in these “normal weight” subjects, increases in body adiposity are significantly associated with increased cardiometabolic disease burden.
Abstract 11631: Subclinical Atherosclerosis Risk of Isolated Diastolic Hypertension in Young Adults
Authors: Wan Jindong , Liu Sen , Yang Yi , Wang Xinquan , Zhou Peng , Wang Peijian
Published: December 2023

Aim:
Hypertension among young adults is common. Little is known regarding subclinical atherosclerosis development associated with isolated diastolic hypertension (IDH) among young adults. This study aimed to assess the relationship between IDH and some surrogate markers of subclinical atherosclerosis in young adults.

Methods:
From January 2018 to December 2022, we consecutively enrolled 576 IDH individuals (aged 18 to 39 years) without cardiovascular complications and 576 normotensive subjects matched for age, sex and body mass index (BMI). Each participant underwent anthropometric measurements, serum biochemistry evaluation, 24-h ambulatory blood pressure (BP) monitoring, echocardiography, and carotid ultrasonography. Surrogate markers of subclinical atherosclerosis included carotid intima-media thickness (cIMT), ankle-brachial index (ABI), coronary calcification, and biochemical parameters. IDH was defined as diastolic BP ≥ 90 mmHg and systolic BP < 140 mmHg.

Results:
Individuals with IDH had higher cIMT, greater ABI, and a higher frequency of coronary calcification and albuminuria (all P < 0.05). IDH was correlated with cIMT, ABI, coronary calcification, and albuminuria (Pearson’s correlation coefficients: 0.471, 0.365, 0.411, and 0.268, respectively; all P < 0.05). Compared with normotensive individuals, IDH was related to odds ratios of 2.09 (95% confidence interval [CI], 1.21-3.16), 2.72 (95% CI, 1.52-4.56), 1.78 (95% CI,1.15-2.89), and 1.26 (95% CI, 0.48-2.05) for cIMT, ABI, coronary calcification, and albuminuria, respectively.

Conclusion:
Our findings emphasize the importance of assessing IDH in young adults to identify high-risk individuals for preventing subclinical atherosclerosis complications.
Abstract 11680: Presenilin 1 Deletion in Smooth Muscle Cells Ameliorates Hypermuscularization and Stenosis in Elastin Aortopathy
Authors: Saito Junichi , Dave Jui M , Lau Freddy D , Greif Daniel M
Published: December 2023

Introduction:
Smooth muscle cell (SMC) accumulation is central to the pathogenesis of elastin-defective arterial diseases, such as atherosclerosis, pulmonary hypertension and supravalvular aortic stenosis (SVAS). We previously demonstrated that elastin deficiency activates the Notch pathway in aortic SMCs, resulting in hypermuscularization and stenosis. Activation of Notch is catalyzed by the enzyme gamma-secretase, but the role of specific catalytic subunits presenilin (PSEN)-1 or PSEN-2 in elastin aortopathy is not defined.

Psen1
(-/-)

mice die shortly after birth with intracranial hemorrhage and bone abnormalities, while

Psen2
(-/-)

mice are viable.

Methods:
Western blot and qRT-PCR for PSEN-1 and -2 were performed on human aortic SMCs in culture and wildtype and elastin null aortas at postnatal day (P) 0.5. Genetic deletion of cell type-specific
Psen1
and/or global
Psen2
was performed on the elastin mutant background. For SMC- or endothelial cell (EC)-specific
Psen1
deletion, pregnant dams were injected with tamoxifen at embryonic days 14.5 and 15.5, and elastin mutant pups carrying no Cre,

Acta2-CreER
T2

, or

Cdh5-CreER
T2

were analyzed at P0.5.

Results:
PSEN-1 and -2 are upregulated in aortic SMCs with elastin deficiency in human and mouse. Global
Psen2
deletion partially attenuates Notch downstream gene expression and SMC proliferation, mitigating elastin aortopathy while
Psen1
deletion in SMCs more significantly inhibits this aortopathy and improves survival of elastin null pups. In contrast,
Psen1
deletion in ECs does not improve aortic disease. The combination of global
Psen2
deletion and SMC-specific
Psen1
deletion has additive rescue effects on elastin aortopathy. In addition, SMC-specific
Psen1
deletion rescues hypermuscularization in newborns heterozygous for the elastin null gene, which genetically mimics human SVAS.

Conclusions:
Elastin insufficiency in SMCs leads to upregulation of PSEN-1 and -2, which induce Notch signaling and SMC proliferation. Among PSEN subunits and vascular cell types, SMC PSEN-1 plays the major role in elastin aortopathy. Selective inhibition of SMC PSEN-1 may be an attractive therapeutic strategy for SVAS to improve efficacy and mitigate off-target effects of gamma-secretase blockade.
Abstract 11697: Combined-Energy Pulmonary Vein Isolation and Posterior Wall Isolation for Persistent Atrial Fibrillation: Results of a 3-year Follow-Up
Authors: Jiang Michael N , Nguyen Heajung L , Bender Aron , Macias Carlos , Bradfield Jason , Khakpour Houman , Vaseghi Marmar , Krokhaleva Yuliya , Buch Eric F
Published: December 2023

Introduction:
Pulmonary vein isolation (PVI) is the cornerstone of catheter ablation for paroxysmal atrial fibrillation (AF), but the optimal ablation strategy for persistent AF (PsAF) remains controversial.

Hypothesis:
The purpose of this study was to investigate whether combined-energy cryoballoon (CB) PVI and radiofrequency (RF) left atrial posterior wall isolation (LAPWI) at index ablation of PsAF yields higher success than PVI alone.

Methods:
Patients with persistent AF (n = 186) who underwent catheter ablation between 2016 and 2019 at a single large academic medical center were retrospectively reviewed. Patients with congenital heart disease or prior left atrial ablation or surgery were excluded. Combined-energy ablation (n=92) consisted of CB antral PVI followed by RF roof and floor lines to achieve LAPWI, along with isolation inside the box as needed. The control group had PVI only (n=94) with either CB (n=57) or RF (n=37). The primary endpoint was 12-, 24-, and 36-month freedom from any documented atrial tachyarrhythmia over 30 seconds after a 90-day blanking period following catheter ablation, compared by Kaplan-Meier analysis. Secondary endpoints included AF burden, procedural parameters, and complications.

Results:
The primary endpoint of 12-month freedom from any atrial tachyarrhythmia was higher for the combined-energy group vs the control group (79.1% vs 58.2%, p = 0.009). This improvement was sustained at 24 months (63.0% vs 45.8%) and at 36 months (60.3% vs 43.1%) and remained significant after adjustment for clinical covariates (adjusted HR 0.45, 95% confidence interval 0.22-0.95; p = 0.03). There was no significant difference in procedure time or complication rates, however fluoroscopy time was shorter with combined-energy ablation (p<.001).

Conclusions:
In this single center experience, combined-energy CB-PVI and RF-LAPWI was associated with reduced AF recurrence compared to PVI with a single energy source.
Abstract 11702: Development of Artificial Intelligence-Based Slow-Motion Echocardiography and Clinical Usefulness for Evaluating Regional Wall Motion Abnormalities
Authors: Sahashi Yuki , Watanabe Takatomo , Endo Susumu , Ishihara Takeshi , Takeshita Ryo , Sekine Ayako , Fukuoka Daisuke , Hara Takeshi , Okura Hiroyuki
Published: December 2023

Introduction:
Improvement in accuracy and image readability of stress echocardiography needs to be addressed, given that the accuracy depends on the physicians’ experience and image quality. The study aimed to develop an artificial intelligence (AI) based slow-motion echocardiography by inter-image interpolation and evaluate the clinical usefulness for detecting regional wall motion abnormalities (RWMAs).

Methods:
An AI-based image interpolation pipeline was developed with the optical flow calculation between echocardiographic images and predicting in-between images. In a cohort of patients with RWMA (n=25) and healthy volunteers (n=25), the accuracy for detecting RWMAs and image-reliabilities among four cardiologists was evaluated using slow-motion and conventional exercise stress echocardiography.

Results:
The development of slow-motion echocardiography were successfully performed at any arbitrary-time steps (e.g., 0.125x, 0.25x, and 0.5x). The accuracy for detecting RWMAs was numerically improved, while not statistically significant (87.5% in slow-motion echocardiography vs 81.0% in conventional stress echocardiography, odds ratio: 1.43 (95% confidence interval 0.78-2.62, p=0.25). Inter-reader agreement analysis demonstrated the level of agreements (Fleiss’s Kappa) for detecting RWMAs was 0.66 (95%CI: 0.55-0.77) in slow-motion echocardiography, and 0.53 (95%CI: 0.42-0.65) in conventional stress echocardiography. As for the four-point scale subjectively-evaluated image readability, the mean score was significantly improved using slow-motion echocardiography (2.11±0.73vs 1.70±0.78, p<0.001).

Conclusions:
Slow-motion echocardiography was successfully developed. There was no significant improvement in the accuracy for detecting RWMAs using the developed slow-motion echocardiography, while the image readability and inter-reader agreement were improved.
Abstract 11731: Efficacy of a New Generation Fast-Pullback, High-Frequency Intracoronary Optical Coherence Tomography Imaging on the Reduction of Contrast Medium in Clinical Practice
Authors: Uemura Shiro , Nishi Takeshi , Ughi Giovanni , Okamoto Hiroshi , Yamada Ryotaro , Kume Teruyoshi
Published: December 2023

Introduction:
Intracoronary optical coherence tomography (OCT) is an imaging modality that uses near-infrared light to generate high-resolution images, and now plays an important role in research and clinical practice as it provides insights into vascular biology and diagnostic guidance for percutaneous intervention (PCI). An existing concern is that OCT imaging could increase the total amount of contrast media administered during the procedure, resulting in adverse outcomes such as impairment of renal function or worsening of heart failure in some patients.

Aims:
We sought to investigate whether a novel, fast-pullback, high-frequency OCT (HF-OCT) enables acquisitions with a reduced amount of contrast agents while retaining the same qualitative and quantitative lesion assessment to conventional OCT.

Methods:
This study is a single-center, prospective, observational study including 10 patients with stable coronary artery disease. A total of 28 individual coronary arteries were assessed by both fast-pullback HF-OCT and by conventional OCT. The fast-pullback, HF-OCT system consists of a 1.8-Fr Vis-Rx® Micro-Imaging Catheter and an HF-OCT Imaging console (Gentuity LLC, Sudbury, MA).

Results:
The contrast volume used in each OCT run for the HF-OCT system was significantly lower than for the conventional OCT system (5.0±0.0 vs. 7.8±0.7ml, P<0.001). No significant difference was found in the median value of the clear image length between the 2 OCT systems (74 mm [IQR; 63, 81], 74 mm [IQR; 71, 75], P=0.89). Fast-pullback HF-OCT showed comparable measurements to conventional OCT, including minimum lumen area (3.27±1.53 vs. 3.21±1.53 mm2, P=0.27), proximal reference area (7.03±2.28 vs. 7.03±2.34 mm2, P=0.96), and distal reference area (5.93±1.96 vs. 6.03±2.02 mm2, P=0.23). Qualitative OCT findings were comparable between the fast-pullback HF-OCT runs and conventional OCT with respect to identifying lipid-rich plaques, calcifications, layered plaques, macrophages, and cholesterol crystals.

Conclusions:
With the fast pullback function of a novel HF-OCT imaging system, we acquired OCT images using a significantly lower amount of contrast volume while retaining a comparable qualitative and quantitative lesion assessment to conventional OCT.
Abstract 11805: Hidden Hazards: Unraveling Risk Factors for New-Onset Acute Heart Failure in Liver Transplant Recipients
Authors: Al Sudani Hussein , Boris James , Casipit Bruce Adrian , Adekayode Christine , Staniszewski Margaret , Hannoodee Sally , Lo Kevin Bryan U , bonita Raphael
Published: December 2023

Introduction:
Heart failure with reduced ejection fraction (HFrEF) following liver transplantation (LT) is associated with increased morbidity and mortality. Early identification and optimization of risk factors associated with development of heart failure in LT recipients could improve cardiac and liver transplant outcomes.

Hypothesis:
The study's primary objectives were to ascertain the incidence of new-onset HFrEF post-liver transplant, identify the associated risk factors and understand their clinical outcomes. We hypothesized that certain demographic and clinical factors may predispose liver transplant recipients to develop new-onset HFrEF.

Methods:
Our retrospective cohort study included 568 liver transplant recipients at our center. Patients were categorized based on whether or not they developed new-onset HFrEF post LT We utilized descriptive statistics, chi-square tests, and logistic regression analyses to investigate potential associations between patient demographics, clinical risk factors and the development of new HFrEF .

Results:
The incidence of acute heart failure post-transplant was 8% (n=43). Within this group, 51% had HFrEF (LVEF<40%), 37% HFmrEF (LVEF 40-49%),12% HF with preserved EF. LVEF was significantly lower in the new-onset HF group [40(30-45) vs 60(55-65), p<0.001]. Median time to HF onset was 25 days. Coronary artery disease (OR 2.53, 95% CI 1.01-6.35, p=0.04) and malignancy history (OR 2.35, 95% CI 1.15-4.81, p=0.02) were significant predictors of new onset HFrEF. New onset HFrEF was associated with higher 180-day mortality (14% vs 6%, OR 2.57, 95% CI 1.00-6.56, p=0.048).

Conclusions:
Coronary artery disease and history of malignancy were identified as risk factors for new-onset HFrEF post-LT. Additional research is needed to better understand the impact of CAD and malignancy on cardiac and liver transplant outcomes that may result in improved patient care.
Abstract 11840: Outcomes and Disparities of Asian Patients With Severe Chronic Kidney Disease Admitted for Heart Failure
Authors: Tan Samuel , Siu Wenchy , Kumar Shasawat , Adinugraha Paulus
Published: December 2023

Introduction:
Socioeconomic disparities in cardiovascular and renal disease pose global public health challenges Despite its large population, Asia lacks proportional representation in heart failure (HF) data, limiting our understanding of risk factors and outcomes for Asians with HF and severe CKD. This study aims to explore the sex, racial, and ethnic differences in in-hospital all-cause mortality, baseline risk factors, and in-hospital complications among Asian patients admitted for HF with CKD.

Hypothesis:
Asian patients with CKD admitted for HF are linked with increased mortality, in-hospital complications, higher costs, and a longer length of stay compared to non-Asian patients.

Methods:
This retrospective study included patients 18 or older with heart failure and CKD 3-5 on discharge from 2016 to 2019. Multivariate logistic regression calculated the odds ratio (OR) adjusting for Elixhauser co-morbidities, age, and sex. The primary outcome was disparities in racial/ethnic, sex, and age of in-hospital mortality of patients admitted for HF complicated by CKD.

Results:
This study involved 510,525 patients, revealing Hispanics (OR: 0.791; CI: 07125-0.8747; p<0.001) and African Americans (OR: 0.664; CI: 0.608-0.7258; p<0.001) were associated with significantly lower mortality compared to Asians. Controlling for age and gender, Asians with HF & CKD had significantly higher odds of diabetes, hyperlipidemia, and hypertension compared to non-Asians. Asian males with HF and CKD were associated with significantly higher odds of mortality (OR: 1.072; CI: 1.037-1.109; p<0.001) and cardiovascular co-morbidities including atrial fibrillation, coronary bypass graft, implantable pacemaker, and chronic ischemic heart disease compared to non-Asian males. Asians, compared to non-Asians, were associated with significantly higher odds of acute MI, acute kidney injury, sepsis, and PRBC transfusion when controlling for Elixhauser co-morbidities.

Conclusions:
This study reveals significant health disparities among Asian patients with HF and CKD. The significant difference in odds of mortality and cardiovascular co-morbidities indicates the need for further research regarding the possible causality of such disparities.
Abstract 11906: Targeting Metabolic Alterations in Smooth Muscle Cells Associated With an
Acta2
Pathogenic Variant Prevents Moyamoya-Like Cerebrovascular Disease
Authors: Kaw Anita , WU TING , Zhou Zhen , Starosolski Zbigniew , Pedroza Albert J , Kaw Kaveeta , Marrelli Sean P , Ghaghada Ketan , Kwartler Callie , Milewicz Dianna M
Published: December 2023

Pathogenic variants disrupting arginine 179 (
R179
) in
ACTA2
(encodes smooth muscle α-actin) predispose to moyamoya (
MMD
)-like cerebrovascular disease, characterized by occlusion of the distal internal carotid arteries by cells that stain positive for smooth muscle cell (
SMC
) markers. SMCs explanted from mice with a SMC-specific knock-in of the
Acta2
R179C mutation (

Acta2
SMC-R179C/+

[PMID: 35878552]) fail to fully differentiate, maintain stem cell marker expression, and proliferate and migrate faster than wild-type (
WT
) SMCs. Consistent with a stem cell-like phenotype, Seahorse assays and metabolomics analyses found that
Acta2
SMC-R179C/+
SMCs have increased glycolytic flux and decreased oxidative respiration (
OXPHOS
) associated with reduced mitochondrial DNA (
mtDNA
) and complex I activity when compared to WT SMCs. Exposing
Acta2
SMC-R179C/+
SMCs to nicotinamide riboside (
NR
), a NAD+ analogue, decreases glycolysis and increases OXPHOS by enhancing complex I activity, and with this metabolic switch,
Acta2
SMC-R179C/+
SMCs increase differentiation and decrease migration. With left carotid artery ligation (
LCAL
), 21% of
Acta2
SMC-R179C/+
mice die of strokes within 5 days, and at postop day 21, 100% of the surviving
Acta2
SMC-R179C/+
mice have enlarged left carotid arteries occluded with cells positive for SMC marker; compared to only 8% of the WT mice. The
Acta2
SMC-R179C/+
mice 21 days post LCAL also have increased leptomeningeal collateral remodeling and Circle of Willis (CoW) narrowing and straightening based on CT imaging with liposomal-iodinated contrast agent. NR treatment reduces deaths with LCAL in the mutant mice (p=0.20), resolves intraluminal occlusive lesion formation (p<0.05), attenuates CoW narrowing and straightening (p<0.05), and prevents aberrant collateral remodeling (p<0.001). These results define the pathogenesis of MMD lesions associated with
ACTA2
R179 variants: the mutation disrupts the differentiation of stem cells into SMCs, leading to increased SMC migration and proliferation and MMD-like lesions with LCAL, and identify a potential therapeutic that alters SMC metabolism to drive differentiation and decrease migration, and ultimately attenuate MMD-like cerebrovascular disease in
Acta2
SMC-R179C/+
mice.
Abstract 11979: Cardiac MRI Adds Value in Discerning Pediatric Heart Transplant Rejection and Its Management
Authors: Olivieri Laura , Ceneri Nicolle , Hamann Karin , Berger John T , Loke Yue-Hin , Vegulla Ravi , Downing Tacy E , Kanter Joshua , Staffa Steven , Zurakowski David , Cross Russell
Published: December 2023

Introduction:
Endomyocardial biopsy (EMB) drives rejection diagnosis in pediatric heart transplant patients but is subject to false negatives and carries risk. Cardiac MRI can detect and quantify myocardial fibrosis and edema with T1 and T2 mapping.

Hypothesis:
Cardiac MRI may improve discernment of acute rejection in pediatric transplant patients.

Methods:
Pediatric heart transplant patients referred for clinically indicated EMB underwent noncontrast MRI with T1 +T2 mapping prior to EMB. Segmental T1 and T2 values were measured for base/mid/apex segments. Mean and peak T1+ T2 were quantified per encounter. Rejection treatment was per institutional protocol, and categorized as (A) no changes, (B) oral therapy initiated, or (C) IV therapy initiated. Treatment decisions were blinded to MRI results. Treatment category and T1+T2 were compared with Fisher’s exact test and logistic regression.

Results:
89 encounters in 34 patients (median age 13.2y (IQR 8.3-16.8), BSA 1.39 m2 (1.09-1.65), 44.1% female) were successfully completed, with treatment groups A 11%, B 8%, C 81%. Median T1
mean
and T1
peak
values were (1022 ms (994-1040) and 1077 ms (1056, 1113)), respectively. Median T2
mean
and T2
peak
values were (50.4 ms (48.4-53.2) and 57.4 ms (53.1-60.8)), respectively. Higher T2
mean
and T2
peak
predict need for IV therapy; the strongest discriminator was T2
mean
> 54.5 (AUC = 0.801, 95% CI: 0.630, 0.972) Table 1. T1
mean
and T1
peak
were not significant in predicting rejection requiring IV therapy. Adding T1
mean
to T2
mean
did not improve the AUC (0.804 (95% CI: 0.637, 0.971), DeLong p=0.74). Finally, the odds ratio of new IV rejection therapy for T2
mean
values > 54.5 ms is 16.1 (95% confidence interval: 3.6 - 72.6, p<0.001).

Conclusions:
Average T2 values (cutoff > 54.5 ms) were efficacious at identifying need for IV treatment for rejection in pediatric heart transplant patients, regardless of T1 values. MRI is a promising noninvasive test to identify children at risk of rejection.
Abstract 11993: Integrative Analysis of Single-Cell Transcriptomics and Polygenic Risk Scores Uncovers Vascular Smooth Muscle Cell Heterogeneity in Human Aortic Aneurisms
Authors: Pepin Mark E , Vellari S.K. , Atri D.S. , Reddy Ankith , Sias-Garcia Oscar , Hamel Andrew R , Billaud Marie , Lee-Kim Vivian , Segre Ayellet , Gupta Rajat
Published: December 2023

Background:
Atherosclerosis is accompanied by distinct vascular phenotypes that underly its initiation and progression, though their contribution to its pathogenesis is currently unknown. By integrating polygenetic risk profiles from genome-wide association studies (GWAS) of vascular disease with single-cell transcriptional analyses, it is possible to implicate causal cellular subpopulations and functional states.

Hypothesis:
We sought to build a more precise understanding of the cellular mechanisms underlying vascular disease in humans by combining single-nuclear RNA-sequencing (snRNA-seq) data from vascular tissue with known polygenic risk loci associated with vascular disease.

Methods:
We performed snRNA-seq on five flash-frozen human aortas, implementing a novel dissociation method to isolate and sequence 14,228 quality-controlled nuclei from three thoracic aortic aneurysms and two samples without known aortopathy, obtained from patients aged 37-70 years. Cell types were defined using canonical gene markers, and non-linear dimensional reduction via tSNE was employed to identify transcriptional sub-phenotypes. The identified pathological programs were validated using polygenic risk and by integrating GWAS data from other vascular single-nuclear transcriptomic datasets.

Results:
Our analysis revealed ten distinct clusters representing all major vascular cell populations, with vascular smooth muscle cells (VSMCs) and myofibroblasts emerging as the most relevant cell types in relation to vascular disease based on polygenic risk. Within the VSMC population, two distinct subpopulations exhibited differential expression of genes related to the extracellular matrix, contractility, and proliferation. RNA-trajectory analysis further uncovered a continuum of gene expression linking VSMC1, VSMC2, and myofibroblast transcriptional clusters.

Conclusions:
This study validates novel methods for identifying pathologic VSMC states associated with vascular disease and implicates phenotypic switching as a pathogenic mechanism. We highlight genes and pathways associated with endothelial cell and VSMC state transitions that are enriched in GWAS of coronary artery disease (CAD).
Abstract 11994: Lithotripsy-Assisted Transcatheter Aortic Valve Implantation: An Emerging Approach to Vascular Access Issues in Severe Peripheral Arterial Disease
Authors: Shah Meet , Patel Zeel K , Hossain Afif , Patel Sarthak , Sharma Abhishek
Published: December 2023

Introduction:
Advances in minimally invasive valvular interventions like transcatheter aortic valve implantation (TAVI) allow for treatment of an increasingly older population. Severe calcific iliofemoral peripheral arterial disease (PAD) can preclude large sheath introduction necessary in TAVI. Conventional peripheral angioplasty has limited efficacy in these situations given its high-pressure dilation, which increases the risk of vascular complications. Intravascular shockwave lithotripsy (IVL) for PAD is an emerging and safe alternative for vascular access.

Case Description:
A 90-year-old man with severe symptomatic aortic stenosis (AS), coronary artery disease (CAD) status-post CABG and extensive PAD was referred for TAVI following balloon aortic valvuloplasty. Transthoracic echocardiogram showed severe, low-flow, low-gradient AS despite recent balloon aortic valvuloplasty. Abdominal imaging showed severe atherosclerosis and calcification of the bilateral common and external iliac arteries. Prior to TAVI, peripheral angiogram was performed, followed by IVL for a total of nine runs, each for fifteen seconds with a 7x60mm balloon to the right iliac and femoral arteries. Then, the right femoral groin sheath was upsized from six to eighteen French, followed by deployment of a 29mm Medtronic Evolute Pro+ self-expanding bioprosthetic aortic valve. Following successful TAVI, the patient was discharged home on aspirin and clopidogrel.

Conclusion:
IVL utilizes pulsatile mechanical shockwaves to modify plaque burden without altering arterial elasticity or structural integrity, which greatly reduces the risk for vascular complications in severely calcified arteries. The DISRUPT-PAD-III trial showed IVL was superior to percutaneous transluminal angioplasty with fewer complications in patients with calcified PAD. Therefore, IVL can be a safe alternative approach for PAD limiting vascular access in percutaneous valvular interventions.
Abstract 11999: COVID-19 Increases the Risk of New Myocardial Infarction in Patients With Prior Myocardial Infarction
Authors: El-Menyar Ayman , Ramzee Ahmed , Asim Mohammad , Al-thani Hassan , Rizoli Sandro
Published: December 2023

Introduction:
The pathology of coagulopathy in patients with COVID-19 infection is not fully understood and it is believed to differ from the other critical illness.

Hypothesis:
we aimed to investigate the incidence and type of thromboembolic events (TEE) and particularly myocardial infarction (MI) in patients who were hospitalized with Covid-19 infection with a prior MI. We hypothesized that Covid-19 infection increases the rate of new TEE in this population regardless of age and gender.

Methods:
A retrospective analysis was conducted for all adult patients (≥18 years of age) admitted for treatment in quarantine centers with COVID-19 infection and developed TEE during the hospital course between February and August 2020. Patients were categorized based on the history of prior MI, age (<55 vs ≥55) and gender. The type of TEE was specified

Results:
Between February and August 2020, 16,903 patients with COVD-19 infection were admitted in the country and 210 (1.2%) developed TEE (89% were males, 55% were <55 years old, 72% were south Asians, and 80.5% had prior MI). Out of patients with prior MI, 92.5% developed another MI (Figure 1). DVT and portal vein thrombosis were common than new MI in patients without prior MI (Figure 2). New MI was more evident in young male patients who had prior MI; however, it was also reported in young males with no prior MI. No new MI was noted in females with no prior MI.

Conclusions:
the rate of TEE, particularly MI, increases after Covid-19 infection in patients with prior MI. Age and gender had great impact on the occurrence of TEE as well.
Abstract 12012: Adverse Social Determinants of Health Are Associated With Increased Risk of Uncontrolled Hypertension Among Cancer Patients in Rural Georgia: A Prospective Cohort Study
Authors: Nain Priyanshu , Stabellini Nickolas , Yerraguntla Sandeep , Gopu Gaurav , Bhave Aditya , Seth Lakshya , Patel Vraj , Jiang Stephanie , Malik Sarah , Weintraub Neal L , Montero Alberto J , Fofanah Alusine , Cullen Jennifer , Agarwal Neeraj , Wang Xiaoling , Ky Bonnie , Baldassarre Lauren A , Harris Ryan A , Guha Avirup
Published: December 2023

Introduction:
The role of social determinants of health (SDOH) in the short-term control of hypertension (HTN) in cancer patients is unknown. Understanding the role of SDOH is important for equitable care of cancer patients, especially in the rural US.

Hypothesis:
High SDOH scores are associated with uncontrolled HTN in hypertensive cancer patients.

Methods:
We performed a prospective observational study at a tertiary care cancer center cardio-oncology clinic. Patients with cancer and HTN were asked to complete the Protocol for Responding to & Assessing Patients' Assets, Risks & Experiences (PRAPARE) questionnaire on their first visit. Blood pressure (BP) readings were taken at 2 follow-up visits. Uncontrolled HTN was defined as SBP≥130 mmHg and/or DBP≥80 mmHg with corroborated home blood pressure readings. Patients who did not perform home readings but had elevated BP at 2
nd
visit were considered uncontrolled. The goals were the same regardless of cancer treatment. The SDOH score was calculated using PRAPARE SDH Risk Tally Score. We performed Cox proportional hazards regression adjusting for age, gender, and metastasis to identify the role of SDOH on short-term HTN control. The adversity cutoff for the SDOH score was informed by spline regressions.

Results:
In the cohort of 175 patients, median age was 66 (IQR 58-75) years, 55% were females, 42.2% were Non-Hispanic Black patients and 20.5% had breast cancer. Mean SDOH score was 6±3. The median duration of follow-up was 91 days (55-139). Uncontrolled HTN was noted in 59.4% of patients at their 2nd visit. For each 1-point increase in the SDOH score, uncontrolled hypertension increased by 9% (HR=1.09, 95% CI=1.03-1.15, p=0.002).

Conclusions:
Rural cardio-oncology patients with HTN have a high burden of SDOH. These study findings help identify contributors of SDOH that limit optimal HTN control in this population, allowing for better risk stratification and preventive intervention in clinical practice.
Abstract 12035: Impact of Viruses on Donor Derived Cell Free DNA After Heart Transplantation
Authors: Alam Amit , van Zyl Johanna , Patlolla Srikant , Shakoor Hira , Farsakh Dana , Astorga Brenda , Abdelrehim Ahmad , Hanks Abbey , Moore Shane , Hall Shelley
Published: December 2023

Introduction:
Little is known about the relationship between active viral infections and donor-derived cell free DNA (dd-cfDNA) levels in patients following heart transplantation.

Methods:
Paired respiratory viral panel, cytomegalovirus (CMV) or other for-cause viral studies and dd-cfDNA (AlloSure) results were prospectively collected on single-organ heart transplant recipients enrolled between August 2022 and March 2023. The levels of dd-cfDNA were compared between patients with positive and negative viral results at enrollment.

Results:
Of 44 patients enrolled, 18 tested positive with viral infections. Baseline characteristics were comparable between groups (median age 61 years, 73% male). The median time post-transplant was 289 days in patients with viral infections and 126 days in those without infections (p=0.046). None of the patients had concerns for concomitant rejection or graft dysfunction at time of their viral infection. Viral infection cases included 10 CMV, 1 Hepatitis-B and CMV, 3 Epstein-Barr virus (EBV), 2 Influenza, 1 Respiratory Syncytial virus (RSV), and 1 Coronavirus-19. Allomap gene-expression profile scores were similar between groups (p=0.15); whereas dd-cfDNA levels were significantly higher in patients with viral infections compared to controls (p=0.002). Table 1, Figure 1

Conclusion:
Active viral infections can raise the level of dd-cfDNA levels in patients following heart transplantation. Further studies are needed to validate these preliminary findings.
Abstract 12037: Impact of Age on Hospital Outcomes After Catheter Ablation for Ventricular Tachycardia
Authors: Tan Min Choon , Kiwan Chrystina , Yeo Yong Hao , Ang Qi Xuan , Fatunde Olubadewa , Lee Justin Z , Tolat Aneesh , Sorajja Dan
Published: December 2023

Background:
Catheter ablation for ventricular tachycardia (VT) has been increasingly performed over the past decades. However, the real-world data on the safety profile of this procedure among elderly patients is limited.

Objective:
This study aimed to evaluate the procedural outcomes and 30-day readmission among those aged 18-64 years versus those aged ≥65 years who underwent catheter ablation of VT.

Method:
Using the all-payer, nationally representative Nationwide Readmissions Database, our study included patients aged 18 years or older who underwent VT catheter ablation between 2017 and 2020. We divided the patients into non-elderly (18-64 years old) and elderly age groups (≥65 years old). We then analyzed the in-hospital procedural outcome and 30-day readmission between these groups.

Results:
Our study included 2075 (49.1%) non-elderly patients and 2153 (50.9%) elderly patients who underwent VT ablation. Following the procedure, elderly patients had significantly higher rates of prolonged index hospitalization (≥7 days) (35.5% vs 29.3%, p<0.01), non-home discharge (13.4% vs 6.0%, p<0.01), 30-day readmission (17.0% vs 11.4%, p<0.01), and early mortality (5.5% v 2.4%, p<0.01). The median cumulative cost of hospitalization was significantly higher in the elder groups ($40,230 vs. $37,612, p ≤0.01). There was no significant difference in the procedural complications between the two groups. Through multivariable analysis, the elderly group was associated with significantly higher odds of early mortality (OR: 7.50; CI 1.86 - 30.31, p=0.01), non-home discharge (OR: 2.41; CI: 1.93 - 3.00, p<0.01) and 30-day readmissions (OR: 1.58; CI 1.32 - 1.89, p<0.01).

Conclusion:
Our study suggests that elderly patients have poorer in-hospital outcome in early mortality, non-home discharge and 30-day readmissions following catheter ablation for VT. There was no significant difference between elderly and non-elderly groups in the procedural complications.
Abstract 12095: Efficacy, Safety, and Cardio-Protective Effect of GLP-1 Receptor Agonists Among Patients With Diabetes Mellitus: A Meta-Analysis and Meta-Regression
Authors: Jaiswal Vikash , Saleeb Marina , Agrawal Vibhor , Ang Song Peng , Shah Maitri , Patel Nirmit , Biswas Monodeep , Jaiswal Akash
Published: December 2023

Introduction:
Glucagon-like peptide-1 (GLP-1) receptor agonists have shown promising results in reducing the incidence of major adverse cardiovascular events (MACE) in patients with Diabetes Mellitus (DM). However, the reports of previous trials show inconsistent reports for other endpoints like myocardial infarction, stroke, and cancer.

Objective:
We sought to evaluate the efficacy and safety of GLP-1 receptor agonists among DM patients by including recently published trials evaluating cardiovascular outcomes.

Methods:
We performed a systematic literature search using PubMed, Embase, and Scopus for relevant articles from inception until 10th March 2022. Primary clinical outcomes were the incidence of MACE. The secondary efficacy outcomes were cardiovascular mortality (CVM), all-cause mortality (ACM), myocardial infarction (MI), stroke, and heart failure hospitalization (HFH).

Results:
A total of 8 randomized controlled trials with xx (518,105 GLP-1 RA vs. 6,817,729 placebo) patients were included in the analysis. The mean age of the patients with GLP-1 RA and the placebo group was 70.0 and 69.2 years. The mean follow-up duration was xx years. Pooled analysis shows that GLP-1 receptor agonists were associated with significant 14% reduction in MACE [HR 0.86, 95% CI (0.80-0.93), p<0.01], 17% reduction in stroke [HR 0.83, 95% CI (0.76-0.92), p<0.01], 10% reduction in MI [HR 0.90, 95% CI (0.83-0.99), p=0.02], 13% reduction in CVM [HR 0.87, 95% CI (0.81-0.94), p<0.01), 12% reduction in ACM [HR 0.88, 95% CI (0.83-0.93), p<0.01] and 9% reduction in HFH [HR 0.91, 95% CI (0.84-0.99), p=0.04] compared to that of placebo. Among safety outcomes, the risk of thyroid cancer was significantly higher in GLP-1 RA [OR 2.33, 95% CI (1.08-5.03), p=0.03) compared to placebo.

Conclusions:
GLP-1 receptor agonists significantly reduced MACE, MI, ACM, CVM, HFH, and stroke. However, the risk of thyroid cancer significantly increased in GLP-1 RA patients.
Abstract 12102: The Racial Disparity Among Congenital Heart Disease Patients Post Surgery: A Meta-Analysis
Authors: Jaiswal Vikash , Arora Ananya , Deb Novonil , Hanif Muhammad , Ang Song Peng , Nasir Yusra , Jaiswal Akash
Published: December 2023

Background:
Congenital heart disease (CHD), the most prevalent congenital disorder in newborns, is a leading cause of infant mortality. Mortality rates have declined over time with advancements in knowledge and management approaches. Despite these advancements, studies on racial disparities in CHD surgical mortality have yielded inconclusive results.

Objective:
We aim to evaluate the disparity among the clinical outcomes post-CHD surgery.

Methods:
A comprehensive literature search was conducted on PubMed, Embase, and Scopus utilizing predefined MeSH terms coupled with Boolean operators "AND" and "OR." The search strategy included the terms "congenital heart disease" AND "racial disparity" OR "minorities" OR "Black" OR "White" AND "mortality." Our meta-analysis sought observational studies published from inception until 10th March 2023 reporting post-surgical incidence of mortality in Black and White patients with CHD.

Results:
We identified 5 studies, including 79616 patients with CHD. Of these, 15124 Black patients and 64492 White patients (20% vs. 80%) underwent CHD surgery. All included patients were less than 18 years of age with a definitive diagnosis of CHD. The mean length of hospital stay was (11.5 vs. 10.10) days, respectively. The pooled analysis showed that Black patients with CHD have significantly higher odds of postoperative mortality (OR, 1.46(95%CI: 1.31-1.62), P<0.001) with low heterogeneity across the studies.

Conclusion:
This very first meta-analysis shows that Black patients are at increased risk of mortality post-CHD surgery compared to White patients.
Abstract 12112: Establishing a Minimally Clinically Important Difference Threshold for Health-Related Quality of Life in Atrial Fibrillation: The SAGE-AF Study
Authors: Pierre-Louis Isabelle C , Bamgbade Benita A , McManus David D , Lopez-Pintado Sara
Published: December 2023

Introduction:
Health related quality of life (HRQoL) is increasingly recognized as an important patient reported outcome but few research has focused on HRQoL meaningful changes overtime. Using data from Systematic Assessment of Geriatric Elements in Atrial Fibrillation, we identified clinically meaningful change over 1-year in older patients with AF and examined sociodemographic and geriatric factors associated with change.

Methods and Results:
Between 2016-18, 1,244 patients aged 65+ with atrial fibrillation (AF) were recruited from medical centers in Massachusetts and Georgia. At baseline and 1-year follow-up, patients completed validated HRQoL measure. We used a distribution-based approach to calculate a clinically meaningful threshold (9 points) and to define three groups: improve (N=154, 14%), stable, (N=617, 56%), and decline (N=326, 30%). Logistic regression was used to examine factors associated with clinically meaningful improvement and decline in HRQoL. CHA2DS2-VASC score was associated with an increased odds of HRQoL decline (adjusted odds ratio [AOR]= 1.16, 95% CI: 1.03, 1.32). Frailty (AOR= 1.89, 95% CI: 1.20, 2.92) and depression, (AOR=1.62, 95% CI: 1.17, 2.25) were associated with an increased odds of HRQoL improvement, while cognitive impairment (AOR= 0.72, 95% CI: 0.52, 0.99) was associated with a decreased odds of improvement in HRQoL.

Conclusions:
A change in HRQoL of 9-points was identified as clinically meaningful over 1-year in our cohort. The majority of patients remained stable in HRQoL over a year of follow-up. Understanding meaningful change in HRQoL can assist providers with knowing how to best treat their patients and develop strategies to improved or stabilize HRQoL.
Abstract 12140: Clinical Care for Life’s Essential 8 by Medical Specialty in the United States
Authors: Sussman Jeremy B , Sterling Madeline R , Johansen Michael E
Published: December 2023

Background:
The American Heart Association recognizes “Life’s Essential 8 (LE8)” as key to achieving cardiovascular health (CVH). Partnership between patients and clinicians will be vital to achieving LE8 and CVH, but one key question is which clinicians can influence their patients’ LE8. Here, we aimed to discover who provides clinical care for LE8 by clinician specialty.

Method:
We used all adult respondents from the nationally representative 2017-2019 Medical Expenditure Panel Survey. We classified visits to the specialties most relevant to LE8 care. Four LE8 measures represented what clinician type prescribed (1) statins, (2) diabetes mellitus medications, (3) anti-hypertensive medication, and (4) tobacco cessation medication (buproprion amongst tobacco users or varenicline). We assessed four other LE8 measures by which clinician saw a patient who reported: (1) low physical activity, defined as lack of moderate-vigorous physical activity 5 times per week, (2) obesity, (3) tobacco use, and (4) insomnia. We also evaluated report of a general check-up. We were unable to assess diet. We performed descriptive statistics with complex survey weights. The OhioHealth Institutional Review Board ruled the study exempt.

Results:
The study included 50,542 adults. Results, which are detailed in the table, found that for all measures, many people with gaps in LE8 saw neither a primary care doctor nor a cardiologist and between 2.5 and 5 times as many people with gaps in LE8 saw primary care without seeing a cardiologist than saw a cardiologist at all.

Discussion:
We found that primary care provides the large majority of medical care for all of LE8. Patients with gaps in LE8 who saw neither cardiology nor primary care were also common. Our findings emphasize how particular supporting primary care in their core functions of preventive care and chronic disease management will be key to achieving cardiovascular health.
Abstract 12163: Initiation of Guideline Directed Medical Therapy at Hospital Discharge Improves Outcomes in Heart Failure With Reduced Ejection Fraction
Authors: Huang Chi-Cheng , Wu Yen-Wen
Published: December 2023

Background:
HFrEF is associated with high morbidity and mortality. Current guidelines recommend early initiation of all GDMT, but critical gap exists in daily practice.

Research Questions:
We aimed to demonstrate the benefits of initiating all GDMT at hospital discharge. We also investigated factors that caused the suboptimal prescription of GDMT.

Methods:
This retrospective cohort study extracted data of all HFrEF patients admitted to a tertiary hospital in Taiwan from Jan. 2018 to Dec. 2019. Variables such as the date of mortality were collected by electronic medical records or by phone calls. Physicians would select a reason when patients were not given individual GDMT. Outcomes were analyzed according to the use of GDMT (0/1, 2, or 3-pillars).

Results:
A total of 343 patients were included in the analysis. We found that patients receiving 3-pillars GDMT had significantly better outcomes; they had the lowest risk of 1-year cardiovascular death (3%) or 6-month heart failure hospitalization (5%), but they only accounts for 60 - 80% of patients in every quarter. The main factors that limited the proportion of patients receiving 3-pillars GDMT were the lower prescription rate of ACEIs/ARBs (80.8%) and MRAs (84.0%). In patients not using ACEIs/ARBs, most physicians were worried about renal impairment (71.2%) or hypotension (24.2%). Meanwhile, patients were not given MRAs due to renal impairment (69.1%) or because they were considered asymptomatic (27.8%). Analysis on the eGFR of patients not receiving optimal GDMT revealed that 60.9% of them had stage 3-4 CKD; only the addition of ACEIs/ARBs resulted in a nonsignificant eGFR drop of 3.5 ml/min/1.73m
2
after 3 months.

Conclusions:
This study confirmed the advantage of starting 3-pillars GDMT early in HFrEF patients. It also revealed the underutilization of GDMT due to concerns of worsening renal function. Efforts should be made to address this disparity to improve the care of HFrEF patients in Taiwan