bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 9844: Virtual Outreach Facilitates Blood Pressure Self-Monitoring Among Black Men at a Federally Qualified Health Center
Authors: Murray Evan M , Gadiraju Ashwin , Gupta Rohan , Tarakji Anthony , Au Sandra , tounsel Daniel , Whitehurst Unique , Granger Bradi B , Biola Holly
Published: April 2024

Introduction:
Rates of uncontrolled hypertension are higher in Black men than in the general population. Prior studies have shown that home self-monitoring of blood pressure (SMBP), in addition to clinical support and education, helps patients lower their blood pressure (BP). This study evaluated a SMBP program for Black men with hypertension at a Federally Qualified Health Center (FQHC).

Hypothesis:
We hypothesized that virtual outreach would increase SMBP adoption and lower BP among Black Men at a FQHC.

Methods:
Black men >18 years old with severe hypertension (>160 mmHg systolic or > 100 mmHg diastolic) were contacted by student volunteers and offered a free BP cuff with program enrollment. Students attempted
>
4 calls with each participant over the course of 2 plan-do-study-act (PDSA) cycles. Students provided BP education and asked participants to report SMBP readings. Univariate analyses were performed to explore the effect of our SMBP program on clinic BPs.

Results:
Of 258 eligible, 137 (53.1%) were successfully contacted and 82 (31.8%) received a BP cuff. By the end of PDSA cycle 2, 52 men (20.2%) had reported a BP reading to their student caller. For those who had an updated BP documented in the medical record after cycle 1, subsequent office systolic BP changed by an average of -24.9 (95% CI: -30.8, -19.0) mmHg for the 37 men who used their BP cuff (p<0.001) and by -21.4 (95% CI: -25.1, -16.8) mmHg for the 108 men who did not (p<0.001). The reduction in BP was larger for the group that used BP cuffs (difference -3.5 [95% CI: -12.1, 5.1] mmHg, p=0.35), but this change was not statistically significant.

Conclusions:
Creating partnerships via virtual communication between university students and community members led to adoption of SMBP among Black men. BP reduction trended greater in the group that began self-monitoring, but difficulty in follow-up and a small sample size limited statistical power.
Abstract 9846: Association Between Neutrophil Activity and Incident Heart Failure: The Atherosclerosis Risk in Communities Study
Authors: Buckley Leo F , Dorbala Pranav , Claggett Brian , Libby Peter , Tang Weihong , Coresh Josef , Ballantyne Christie M , Hoogeveen Ron C , Yu Bing , Shah Amil M
Published: April 2024

Introduction:
Inflammation-reduction with colchicine improves outcomes in coronary disease, possibly through effects on neutrophil activity. Inflammation also may contribute to incident heart failure (HF) and the association of neutrophil activity with HF is unclear. We assessed the association between 10 neutrophil-associated proteins that were altered by colchicine in two previous proteomic studies with incident HF.

Methods:
We studied 10,317 ARIC participants who were free of HF and had aptamer-based proteomic measurements (Somalogic, Colorado) at Visit 3 (1993-1995). Candidate proteins were included in a LASSO Cox regression model which were used to derive a neutrophil activity score. The association of the neutrophil activity score with incident HF was then assessed after adjustment for age, sex, race, study field center, hypertension, smoking history, diabetes, coronary disease, BMI, Visit 3 blood pressure, eGFR, and hsCRP and neutrophil-to-lymphocyte ratio.

Results:
The mean age was 60±6 years, 54% were women and 20% were black. Over a mean follow-up of 13 years, 1314 participants developed incident HF. Five of the 10 candidate proteins were associated with incident HF in multivariable uni-protein models (myeloperoxidase, suPAR, antichymotrypsin, BPIP, S100A12) at p <0.05. LASSO model retained 4 proteins (suPAR, antichymotrypsin, BPIP, S100A12), from which a neutrophil activity score was developed. Higher neutrophil activity score was associated with older age, higher prevalence of cardiovascular comorbidities, and higher hsCRP. Higher neutrophil activity score was associated with greater risk of incident HF in multivariable models after adjustment for clinical risk factors, hsCRP and neutrophil-to-lymphocyte ratio (
Figure
).

Conclusions:
Increased neutrophil activity may contribute to incident heart failure in the community. These findings provide a putative mechanism by which treatment with colchicine may influence risk of HF.
Abstract 9860: P38MAPK Deficiency in VSMCs Mitigates Abdominal Aortic Aneurysm and Atherosclerosis Progression via Promoting MKL1 Ubiquitin Proteasome Degradation
Authors: Shan Shengshuai , Zhao Jinjing , Gao Pan , Slivano Orazio , Zhang Wei , Long Xiaochun
Published: April 2024

Cardiovascular diseases (CVD) are the leading cause of death in developed countries. Two major manifestations of CVD are aortic aneurysm and atherosclerosis, which are devastating and lack effective pharmacological therapy. The stress responsive pathway, p38 mitogen-activated protein kinase (MAPK), has been reported as a pivotal regulator in diverse processes, including cell proliferation, migration, inflammation, and apoptosis, contributing to cardiovascular development and pathology. However, a detailed understanding of the mechanistic role of p38MAPK in vascular smooth muscle cells (VSMCs) in the pathogenesis of aortic aneurysm and atherosclerosis has yet to be elucidated. Using a VSMC-specific lineage tracing reporter system, we showed that the phosphorylated form of p38MAPK (p-p38MAPK) was markedly elevated in VSMCs of aneurysmal vessels. VSMC-specific p38α (
Mapk14
) knockout mice displayed attenuated abdominal aortic aneurysm (AAA) and atherosclerotic lesion formation compared to wild-type control mice. Further, loss of MAPK14 in VSMCs abolished the protein expression of multiple ER stress markers, including BIP, Protein Disulfide Isomerase (PDI), and ATF4, which was accompanied by the downregulation of the cleaved Caspase-3 and upregulation of BCL2 protein. This indicates a crucial role of p38MAPK in potentiating ER stress and apoptosis. Interestingly, aortas from VSMC-MAPK14 null mice displayed dramatically reduced protein levels of MKL1, a vital transcription factor with a well-recognized role in promoting AAA and atherosclerosis progression via regulating vascular apoptosis. In vitro, deficiency of p38MAPK in VSMCs via siRNA or SB203580, a selective inhibitor of p38MAPK pathway, downregulated whereas forced expression of MKK6 (activates p38MAPK) increased MKL1 protein expression. Finally, activation of p38MAPK inhibited MKL1 ubiquitination, which was partially rescued by SB203580. Collectively, our data demonstrated a critical role of VSMC-p38MAPK in promoting AAA and atherosclerosis progression, likely through stabilization of MKL1 via p38MAPK-dependent inhibition of MKL1 ubiquitin proteasome degradation.
Abstract 9867: Associations of Urinary Isoprostane Levels with Prevalence and Progression of Coronary Artery Calcification and Carotid Plaque in the Multi-Ethnic Study of Atherosclerosis (mesa)
Authors: Wallace Ryan , Zhao Di , Ogunmoroti Oluseye , Guallar Eliseo , Post Wendy , Vaidya Dhananjay , Heravi Amir S , Ying Wendy , Ndumele Chiadi E , Lima Joao A , Ouyang Pamela , Budoff Matthew , Allison Matthew , Hoogeveen Ron C , Michos Erin
Published: April 2024

Introduction:
Urinary isoprostanes reflect oxidative stress, which is implicated in the pathogenesis of atherosclerotic cardiovascular disease (ASCVD). Coronary artery calcium (CAC) & carotid plaque are markers of subclinical atherosclerosis and prognostic of ASCVD risk. We examined if the urinary isoprostane iPF2α-III and its metabolite iPF2α-III-M were associated with CAC & carotid plaque.

Hypothesis:
Higher urinary isoprostanes are associated with a greater prevalence, incidence, burden, and progression of CAC & carotid plaque.

Methods:
1097 MESA participants free of ASCVD had urinary isoprostanes measured at baseline. All participants underwent cardiac CT at baseline; 1083 underwent repeat CT ~10 yrs later. CAC was measured by Agatston scoring. All participants had carotid ultrasound (US) at baseline; 837 underwent repeat carotid US ~10 yrs later. Carotid plaque score (CPS) was defined as the number of carotid segments containing plaque. Isoprostane levels were divided into tertiles. Relative risk regression and linear mixed effect models determined prevalence/incidence and burden/progression respectively of CAC & CPS.

Results:
Mean age of participants at baseline was 62.2 (8.3) yrs; 49% were women. There was no association of isoprostanes with CAC at baseline. There was a positive, but not statistically significant association, comparing the highest vs lowest tertiles of iPF2α-III-M and CAC progression over 10 yrs (Fig 1a). There was a statistically significant association comparing the highest vs lowest tertiles of isoprostanes with prevalence and burden of carotid plaque at baseline, but not with CPS incidence/progression (Fig 1b).

Conclusions:
In this multiethnic cohort, urinary isoprostanes were weakly but positively associated with carotid plaque burden and prevalence in cross sectional analysis and also showed a non-significant trend toward CAC progression, suggesting this measure of oxidative stress may be associated with ASCVD.
Abstract 9878: Higher Rates of Cardiac Arrest with Lower Inpatient Mortality Following Hospitalizations for ST-Elevation Myocardial Infarction Among Young Cannabis Users (18-44 Years): A Nationwide Propensity-Matched Analysis
Authors: Desai Rupak , Gandhi Zainab J , Sachdeva Sonali , Yar Khan Nibras , Bhatt Nilay R , Jabar Ali Jamila Begum , Binkam Mounika , Asfeen Ummul , Kumar Gautam , Sachdeva Rajesh
Published: April 2024

Introduction:
Given the rising use of unmonitored cannabis use in the young population and scarcity of data on the subject, we aimed to compare the outcomes of ST-elevation myocardial infarction (STEMI) admissions in patients with vs without cannabis use disorder (CUD+ vs. CUD-).

Methods:
The National Inpatient Sample (October2015-2017) was queried to identify STEMI admissions in young patients with CUD vs without CUD using relevant ICD-10 codes. Propensity-matched cohorts were obtained adjusting for sociodemographic, hospital characteristics, cardiovascular/extracardiac comorbidities. Primary endpoints were in-hospital mortality and complications, whereas secondary endpoints were discharge disposition, mean length of stay (LOS) and hospital cost.

Results:
Matched cohorts, STEMI-CUD+ (n=940) and STEMI-CUD- (n=940) were comparable in terms of age, sex, race and rate of non-elective admissions
(Table 1)
. The rates of hypertension (52.1% vs. 46.3%) and hyperlipidemia (39.9% vs 34.6%) were higher in the STEMI-CUD+ cohort (p<0.05) with comparable rates of other risk factors (diabetes mellitus, smoking, and obesity). Post-STEMI MACCE was significantly higher (23.9% vs. 19.1%, p=0.012) including cardiac arrest (from ventricular tachyarrhythmias, 14.4% vs 10.6%, p=0.015), though with lower all-cause mortality (2.7% vs 4.8%, p=0.015) compared to CUD- cohort. Although complication rates of cardiogenic shock (9.6% vs 8.5%), arrhythmias (22.3% vs 19.7%), and stroke (3.7% vs. 2.7%) were higher in the CUD+ cohort, the statistical significance was not achieved.

Conclusions:
This nationwide multicenter analysis demonstrated that CUD+ cohort among young STEMI admissions had higher rates of hypertension, hyperlipidemia and MACCE including cardiac arrest without translating into higher inpatient mortality compared to CUD- cohort. Future large-scale prospective studies are invited to investigate and confirm these findings.
Abstract 9882: Cannabis Use Poses Alarming Risk of Atrial Tachyarrhythmia and Stroke in Young Patients with Obesity Associated Obstructive Sleep Apnea: A Propensity-Score Matched Analysis
Authors: Desai Rupak , Gandhi Zainab J , Went Terry R , Wiltshire Dwayne , Allagoa Theresa , Garg Vibhor , Chhina Arashpreet , Deshmukh Abhishek , Kumar Gautam , Sachdeva Rajesh
Published: April 2024

Introduction:
Obesity is a known risk factor and causes worse cardiovascular outcomes in obstructive sleep apnea. With the growing use of cannabis in the US, so we aimed to assess the impact of cannabis use disorder (CUD) on risk of atrial tachyarrhythmias (atrial fibrillation, AF; atrial fibrillation, AFL) and stroke in young patients with obesity-associated obstructive sleep apnea (OOSA).

Methods:
The National Inpatient Sample (2015Oct-2017) with relevant ICD-10 codes were used to identify admissions among young adults (18-44 years) with OOSA. We then matched (1:1) two cohorts of cannabis use disorder (CUD+) vs. without (CUD-) with controlling potential sociodemographic confounders. Primary outcomes of interest were frequency and risk of atrial tachyarrhythmias and stroke assessed by multivariable analysis.

Results:
Of 7470 demographically-matched OOSA admissions, CUD+ and CUD- cohorts had 3735 hospitalizations in each cohort. Both cohorts were comparable mean age of 38 years and CUD+ cohort more frequently included male (66.6% vs. 53.5%), African American (40.0% vs. 30.1%) patients admitted non-electively (92.3% vs. 84.5%). Rates of drug abuse, hypertension, smoking and chronic pulmonary disease were higher but diabetes mellitus, hyperlipidemia, and renal failure were lower in CUD+ cohort vs. CUD- cohort (p<0.001). The frequency of AF/AFL (5.7% vs 7.4%) related admissions were lower; however, the risk of AF/AFL (OR:1.64, 95%CI:1.17-2.30, p=0.004) and stroke (OR:4.41, 95%CI:1.41-13.77, p<0.011) admissions were significantly higher in the OOSA-CUD+ cohort vs. CUD- cohort in the multivariable analysis controlled for relevant cardiovascular/extracardiac comorbidities and concomitant alcohol/drug abuse and smoking.

Conclusions:
This propensity-matched analysis highlights that recreational cannabis use in young patients with OOSA may alarmingly increase emergency hospitalizations and independently increase the risk of AF/AFL and stroke.
Abstract 9885: Overestimation of Anticoagulant Benefit in Patients with Atrial Fibrillation and Low Life Expectancy: Evidence from 12 Randomized Trials
Authors: Shah Sachin J , van Walraven Carl , Hobbs FD Richard , Connolly Stuart J , Singer Daniel E
Published: April 2024

Introduction:
Formative anticoagulant RCTs for stroke prevention in atrial fibrillation (AF) were completed before the advent of competing risk methods. Neglecting the competing risk of death can overestimate treatment benefit. This is noteworthy because many patients with AF are frail with limited life expectancy. We determined the overestimation of anticoagulant benefit as a function of life expectancy.

Methods:
We used patient-level data from 12 anticoagulant RCTs that compared warfarin vs. aspirin or placebo. We estimated each patient’s life expectancy using CDC life tables modified for age, sex, comorbidities, and trial enrollment year. We predicted cumulative stroke incidence with and without anticoagulants at 3 years using a Cox model treating death as a censoring event (“standard model”) and again using a Fine-Gray model treating death as a competing event (“competing risk model”). For each patient, we plot the absolute and relative standard model overestimation compared to the competing risk model. We describe the relationship between life expectancy and log-transformed benefit overestimation (Figure A, B).

Results:
For the 9548 patients (35% women, mean age 74yrs), the median life expectancy was 11.4yrs (IQR 8.4, 15.3). The overall estimated reduction in stroke incidence at 3 years was 7.7% using a standard model and 6.3% using a competing risk model. The absolute and relative overestimation of the standard model increased exponentially as life expectancy decreased. For example, with a life expectancy of 3 years, a standard model would overestimate absolute benefit by 2.8% (95%CI 2.7-2.9%) and the relative benefit by 29.4% (95%CI 29.3-29.4%).

Conclusions:
For patients with low life expectancy, the anticoagulant benefit is substantially overestimated using standard survival methods. While anticoagulants reduce the risk of stroke, decision tools should account for life expectancy when estimating benefits for patients with AF.
Abstract 9886: Use of a Smartwatch and App Designed by Stroke Survivors for Atrial Fibrillation Detection in Older Adults After Stroke/Transient Ischemic Event: Preliminary Findings from an Ongoing Randomized Clinical Trial
Authors: Ding Eric Y , Han Dong , Dickson Emily L , DiMezza Danielle , Scott Jessica , Mohagheghian Fahimeh , Peitzsch Andrew , Saczynski Jane , Moonis Majaz , Fitzgibbons Timothy P , Barton Bruce , Chon Ki , McManus David D
Published: April 2024

Background:
Atrial fibrillation (AF) is a common cause of ischemic stroke that, though critical to diagnose and treat, often goes undetected. Smartwatches are capable of AF detection, but little is known about their use among stroke survivors. In collaboration with stroke survivors and clinicians, we designed a smartphone-smartwatch system for AF detection. In our ongoing clinical trial, we are examining the performance and user experience of the system in older stroke survivors.

Hypothesis:
The system will be accurate for AF detection among stroke survivors compared to 14-day ECG patch monitoring; participants will find the system usable and will adhere to daily use over 30 days.

Methods:
The Pulsewatch study is an ongoing two-phased randomized controlled trial with randomization at two timepoints into control or intervention groups. Phase I (14 days) assesses accuracy and usability of the smartwatch and study app. Phase II (30 days) examines watch wear adherence. The intervention group receives a smartwatch with embedded AF detection and a smartphone app for rhythm and symptom tracking. Eligibility criteria are:
>
50 years old, ischemic stroke in the past decade, and no major contraindications to anticoagulation therapy. System accuracy for AF detection is compared to an ECG patch monitor, and usability is assessed via the System Usability Scale. Adherence is defined as daily watch wear time over the monitoring period.

Results:
To date, 69 participants have been randomized into phase I and 36 into phase II (mean age 65, 41% female, 87% White). The smartwatch system demonstrated a sensitivity of 66.7% (95% CI: 9.4 - 99.2) and specificity of 92.6% (95% CI: 82.1 - 97.9) for detection of 3 AF cases over the 14 day period (91.2% accuracy) compared to the ECG patch. The mean usability score was 65/100 and on average, participants wore the watch on 12/30 days for an average of 1.8 hours (SD 0.7) daily.

Conclusion:
A smartwatch and app dyad demonstrated reasonable accuracy for AF detection and high usability, though adherence was modest. Use of commercial wearables for AF detection among stroke patients shows promise, but additional data from the ongoing Pulsewatch clinical trial will continue to inform strategies to maximize adherence to these devices among older adults.
Abstract 9897: Whole Genome Sequence Analysis of the Plasma Proteome in Black Adults
Authors: Katz Daniel H
Published: April 2024

Introduction:
Plasma proteins are critical mediators of cardiovascular processes and are the targets of many drugs. Previous efforts to characterize the genetic architecture of the plasma proteome have been limited by a focus on individuals of European descent and leveraged genotyping arrays and imputation.

Hypothesis:
Whole genome sequence analysis of the plasma proteome in individuals with greater African ancestry will increase power to identify novel genetic determinants.

Methods:
Proteomic profiling of 1,301 proteins was performed in 1852 Black adults from the Jackson Heart Study using aptamer-based proteomics (SomaScan®). Whole genome sequencing association analysis was ascertained for all variants with minor allele count ≥ 5. Results were validated using an alternative, antibody-based, proteomic platform (Olink®) as well as replicated in the Multi-Ethnic Study of Atherosclerosis and the HERITAGE Family Study.

Results:
We identify 569 genetic associations between 479 proteins and 438 unique genetic regions at a Bonferroni-adjusted significance level of 3.8 х 10
-11
. These associations include 134 novel locus-protein relationships and an additional 205 novel sentinel variant-protein relationships. Novel cardiovascular findings include new protein associations at the
APOE
gene locus including ZAP70 (sentinel single nucleotide polymorphism [SNP] rs7412-T, β = 0.61±0.05, p-value = 3.27 х 10
-30
) and MMP-3 (β = -0.60±0.05, p = 1.67 х 10
-32
), as well as a completely novel pleiotropic locus at the
HPX
gene, associated with nine proteins. Further, the associations suggest new mechanisms of genetically mediated cardiovascular disease linked to African ancestry; we identify a novel association between variants linked to APOL1 associated chronic kidney and heart disease and the protein CKAP2 (rs73885319-G, β = 0.34±0.04, p = 1.34 х 10
-17
) as well as an association between ATTR amyloidosis and RBP4 levels in community dwelling individuals without heart failure.

Discussion:
Taken together, these results provide evidence for the functional importance of variants in non-European populations, and suggest new biological mechanisms for ancestry-specific determinants of lipids, coagulation and myocardial function.
Abstract 9906: Not All Heart Failure Patients Are Men, Not All Caregivers Are Women: Comparing Differences by Gender
Authors: Stawnychy Michael A , Vellone Ercole , Zeffiro Valentina , Riegel Barbara
Published: April 2024

Background:
Male patients with female caregivers are well represented in dyadic HF research. However, patient-caregiver dyads that are all male, all female, or female patients with male caregivers are not well described.

Aim:
Compare self-care, clinical, and psychosocial characteristics of patient-caregiver dyads based on the genders of dyad members.

Methods:
Secondary analysis of a cross-sectional study of patient-caregiver dyads (n=277) using the Caregiver Contribution to Self-Care of HF Index (CC-SCHFI) v2. Dyads were grouped by Patient-Caregiver gender: Male patient-Female caregiver, Female patient-Male caregiver, Female-Female, and Male-Male. Self-care was assessed using the Self-Care of Heart Failure Index and the matching CC-SCHFI. Standardized scores for both indexes range from 0-100 points; higher scores equal better self-care. Characteristics of dyad gender groups (comorbidities, HF duration, NYHA functional class, quality of life (QOL), age, marriage, habitation status, and length and type of caregiving relationship) were compared using chi-square, ANOVA and Kruskal-Wallis equality-of-populations rank tests.

Results:
Female caregivers of male patients were typically spouses (48%), whereas the majority of caregivers in other dyads were adult children/children-in-law (63-73%). Female patients cared for by female caregivers were older, not married and had worse physical QOL. Male and female caregivers of similar gender patients were younger (47.3±14.0 and 47.7±12.1), less likely to live with the patient and spent the fewest number of hours/day caregiving. Patients in these dyads were more likely to live alone and male patients had the lowest self-care monitoring (48.2±20.1 vs 59.2±18.3 for male patients with female caregivers,
p
=.06). Males caring for female patients had the lowest contribution to self-care maintenance (63.3±20.3,
p
=.04) and lower contributions to self-care monitoring, management, and self-efficacy.

Conclusion:
Patient-caregiver dyads of similar and mixed genders differ across a number of self-care, clinical, and psychosocial characteristics. Results suggest that dyad members’ genders may need to be considered in clinical and research practice.
Abstract 9938: Genetic Architecture and Precision Medicine of Atrial Fibrillation
Authors: Miyazawa Kazuo , Ito Kaoru , Zou Zhaonan , Matsunaga Hiroshi , Koyama Satoshi , IEKI Hirotaka , Ozaki Kouichi , Onouchi Yoshihiro , Oki Shinya , Akazawa Hiroshi , Komuro Issei
Published: April 2024

Atrial fibrillation (AF) is the most common cardiac arrhythmia associated with increased risks of morbidity and mortality. We performed a large-scale genome-wide association study (GWAS) of 150,272 individuals of Japanese ancestry (9,826 cases and 140,446 controls) and identified five new susceptibility loci including Japanese-specific rare variants associated with the pathogenesis of cardiomyopathy. We then conducted a trans-ancestry meta-analysis of more than 1 million individuals including 77,690 cases and discovered 35 novel loci in total. Using the GWAS result, epigenetic-feature and gene-set analyses revealed the transcriptional landscape of AF, elucidating the underlying biological pathways. Additionally, we created polygenic risk scores (PRS) for AF, where PRS derived from trans-ancestry GWAS surpassed those derived from a single population. The PRS was associated with increased risk of long-term cardiovascular and stroke mortalities and segregated individuals with cardioembolic stroke in undiagnosed AF patients, suggesting that it may play an important role in early detection of subclinical AF or the pathophysiology underlying thromboembolism. Our results provide novel biological and clinical insights into AF genetics and broaden its clinical applications.
Abstract 9960: Soluble Low Density Lipoprotein Receptor-related Protein-1 Levels As A Potential Biomarker In Covid19
Authors: Agirbasli Mehmet , KORKMAZ RABIA , isman ferruh K
Published: April 2024

Introduction:
Low density lipoprotein receptor-related protein 1 (LRP1), is a multifunctional receptor. Soluble form (sLRP1) is measurable as a novel biomarker of inflammation and atherosclerosis. We hypothesize that sLRP1 levels can be associated with Covid19 disease onset and severity.

Methods:
We measured sLRP1 levels in 180 PCR positive, Covid19 patients admitted to the hospital (mean age 60± 19, M/F = 51/49). Controls (n=61) were selected from outpatients without significant comobidities.

Results:
Covid19 patients display significantly lower sLRP1 levels compared to the controls (p<0.001). Covid19 patients are stratified based on the severity of Covid19 such as emergency room (n=44), inpatient service (n=95) and intensive care (n=41). Median sLRP1 levels are 2.27, 1.26, 1.36, and 1.73 μg/ml for controls, emergency room, inpatient service and intensive care patients, respectively. sLRP1 levels rise as severity of Covid19 increases (p= 0.022) (Figure 1). Other biomarkers of inflammation such as CRP display similar trends (Figure 2). Median hsCRP levels are 8.2, 10.2 and 16.4 mg/L for emergency room, service and intensive care patients respectively (p<0.001).

Conclusions:
Previous studies indicate that LRP1 can be a defense mechanism in acute viral infections. Eliminating LRP1 by siRNA knockdown increases intracellular cholesterol and the infectious virus yield. LRP1 displays a bidirectional course in Covid19. Low sLRP1 can be a risk factor for Covid19. On the other hand, sLRP1 levels increase with disease severity as a defense response to infection. This work was supported by the Research Fund of Istanbul Medeniyet University (project number 1358).
Abstract 9974: Effect of Graves’ Disease on Female Probability Derived from Artificial Intelligence-Enabled Electrocardiograms in Women
Authors: Naser Jwan A , Attia Zachi , Pislaru Sorin , Stan Marius , Noseworthy Peter A , Friedman Paul , Lin Grace
Published: April 2024

Introduction:
Graves’ disease (GD) is known to cause menstrual changes and has been linked to infertility in women. This can be due to the increased production of androstenedione and testosterone induced by the excess thyroid hormone. However, screening for sex hormone levels in all women diagnosed with GD to identify patients more likely to have infertility is not cost-effective and not clinically indicated. AI-augmented ECG can identify the signature of female with an AUC of 0.97. In this model, AI- ECG gives a probability number between 0-100% of being female, with higher numbers indicating high probability of being female.

Hypothesis:
We hypothesized that this inexpensive AI ECG tool is reflective of hormonal levels and the resulting changes in menstrual cycle and fertility associated with GD in women.

Methods:
Patients diagnosed with GD (2009-2019) at our institution were included. Three intervals were identified: 1) Before GD: >2 months before GD diagnosis 2) During GD: within 2 months before GD and before attaining euthyroidism 3) After GD: after attaining euthyroidism. The matched-pairs t-test was used to compare probability of being a female; patients acted as their own controls. A subset analysis was done on females <45 years at GD diagnosis to study the association between female probability during GD and menstrual changes (defined as shorter, lighter, or newly irregular menstrual cycles).

Results:
154 females with ECGs both before and during GD were identified. AI ECG female probability decreased with GD diagnosis (85% vs. 77%, P<.001). On the other hand, 137 females with GD had ECGs during and after GD. Female probability increased after attaining euthyroidism (76% vs 83%, P=.005). Moreover, 72 females <45 years were identified; 30 (42%) developed menstrual changes and had significantly lower AI-ECG female probability [77 (58-94)% vs 98 (92-100)%, P<.001]

Conclusions:
AI-enabled ECG signature of female gender in women was altered by GD and was associated with menstrual changes, likely reflecting changes in sex hormone levels. Future studies to confirm its role in screening for infertility in women with GD are needed.
Abstract 9983: Thiamine Deficiency is Associated with Longer Length of Stay and Higher Hospitalization Cost in Patients with Atrial Fibrillation
Authors: Antwi-Amoabeng Daniel , Shittou Abdul-aziz , Ulanja Mark , Beutler Bryce , Ghuman Joban , Ghuman Jasmine , T. Gbadebo David
Published: April 2024

Introduction:
Chronic thiamine deficiency (TD) can cause changes in the myocardium through cellular hypotrophy, which may lead to arrhythmias. Although animal models have not revealed major electrical remodeling, supraventricular tachyarrhythmias are associated with low thiamine levels. TD is associated with chronic alcohol and loop diuretic use. The prevalence of TD in patients with supraventricular arrhythmias is unknown. We assessed the prevalence of TD among patients hospitalized for atrial fibrillation (AF) using data from the National Inpatient Sample (NIS) database between 2005 to 2015.

Hypothesis:
TD is prevalent in individuals with a history of chronic alcohol use and is associated with worse in-hospital outcomes.

Methods:
Using ICD-9 codes, we queried the NIS for discharge encounters involving adults with AF. We compared the differences in baseline characteristics and in-hospital outcomes between those with and without a diagnosis of TD using the Chi-Square test and the Wilcoxon rank-sum test as two-tailed at a 5% level of significance.

Results:
Of the 38,283,200 discharge encounters, 0.02% had a diagnosis of thiamine deficiency (N = 7,287). TD was common among white males, younger patients, and those with a history of chronic alcohol use. TD did not affect inpatient mortality but was associated with a longer hospital stay and a higher cost of care (Table 1).

Conclusions:
Among hospitalized patients with AF, TD does not affect in-hospital mortality but is associated with increased length of stay and cost of care. Further investigation is necessary to assess the effect of thiamine supplementation on AF burden and response to rate or rhythm control.
Abstract 9984: Stages of Valvular Heart Disease Among Older Adults in the Community: The Atherosclerosis Risk in Communities Study
Authors: Shelbaya Khaled , Claggett Brian , Dorbala Pranav , Skali Hicham , Solomon Scott , Matsushita Kuni , Konety Suma H , Mosley Thomas , Shah Amil M
Published: April 2024

Introduction:
AHA/ACC guidelines endorse the conceptual framework of valvular heart disease (VHD) stages to emphasize the progressive nature of VHD. However, to our knowledge, no community-based estimates of the prevalence of VHD stages exist, particularly in late-life when VHD prevalence is highest.

Methods:
Among 6,118 participants in the community-based Atherosclerosis Risk in Communities (ARIC) study who underwent comprehensive echocardiography at the 5
th
study visit (2011-2013), VHD stages were defined based on AHA/ACC guideline recommendations. The association of the VHD stage with the incidence of heart failure (HF), myocardial infarction (MI), stroke, atrial fibrillation (AF), and death post-Visit 5 were assessed using multivariable Cox proportional hazard models. Models were adjusted for age, sex, race, Field Center, hypertension, diabetes, prior MI, HF, body mass index, and systolic blood pressure.

Results:
The mean age was 76±5 years; 58% were women, 22% were Black. Stage A VHD was present in 39%, stage B in 17%, stage C/D in 1 %, and 0.7% had previously undergone valve replacement or repair. Mild mitral regurgitation was the most common single valvular lesion in Stage A (42%), while isolated mild aortic regurgitation accounted for the majority of Stage B (51%), and aortic stenosis was the most common valvular lesion in Stage C/D (80%). Over a median follow-up of 5.5 (IQR 3.7-7.7 years), Stage A, B, and C/D VHD were each associated with a heightened risk of incident HF, MI, AF, and death in multivariable models (Figure 1). VHD stages were not associated with incident stroke.

Conclusion:
Among older adults in the community, at-risk (Stage A, 39%) and progressive (Stage B, 17%) VHD is prevalent. Stage A and Stage B VHD are associated with a heightened risk of incident cardiovascular events independent of traditional cardiovascular risk factors.

Figure1: Forest plot for adjusted HR (95% CI) associated with stage A, B, and C/D (stage 0 was the reference group)
Abstract 9991: Can Isosorbide Dinitrate Save Lives of Hospitalized COVID Patients with Hypertension and a Defined Cardiac Injury?
Authors: Roesel Thomas
Published: April 2024

Introduction:
As defined by MB-CPK, hsTn-I, MB, or EKG and/or cardiac echo abnormalities, cardiac injury (CI) determines a median survival time (MST) of 10 days for hospitalized COVID patients (HCPs). HCPs without defined CI have an MST beyond 39 days (Huang,
et al
., see Figure). Hypertension (HTN) presents in 17-41% of HCPs in various studies, with COVID mortality independent of HTN. Therefore, a randomized clinical trial (RCT) is proposed for HCPs with CI and incidental BP elevation to compare IV isosorbide dinitrate (ISDN) with usual anti-HTN care (UC). Vasodilatory ISDN lowers BP, and has been proposed an an anti-SARS-CoV-2 drug. Others report improved survival of ISDN treated Coxsackie B3 virus-infected mice as evidence for anti-viral activity. The endpoint for this CI RCT pilot of 100 ISDN-treat HCPs and 100 UC controls is mortality. Secondary endpoints are interval biomarkers to dissect ISDN anti-viral action.

Methods:
Log-rank analysis was performed with 1:1 allocation. Accrual time was 180 days with a 60-day follow-up. Power was 0.8 with a type I error of 0.05.

Results:
For 200 total subjects, an MST greater than 14.9 days in the ISDN arm was significant if UC stays at 10 days (see Figure).

Conclusions:
Testing repurposed ISDN as a COVID drug is feasible. A successful pilot with improved MST suggests ISDN has anti-SARS-CoV-2 action, since COVID mortality is independent of HTN. Biomarkers could include viral clearance, oxygenation, D-dimer, IL-6, LDH, as well as platelet and lymphocyte counts. The need to treat HCPs with elevated BP per guidelines permits study entry. Cross-over treatment occurs if a regimen fails. Immunomodulators and remdesivir are administered per COVID treatment guidelines for all HCPs. IV ISDN, bolused and/or infused, avoids 1
st
pass hepatic effects. IV IDSN is approved in most countries, but not in the USA or Canada. A successful pilot would permit larger IV ISDN RCTs as IND RCTs, and can serve as a template for other treatments for HCPs with defined CI.
Transcatheter Aortic Valve Replacement in Large Annuli Valves With the Supra-Annular, Self-Expandable Evolut Platform in a Real-World Registry
Authors: Dallan Luis Augusto P. , Tang Gilbert , Forrest John K. , Reardon Michael J. , Szeto Wilson Y. , Kodali Susheel K. , Baeza Cristian , Eisenberg Ruth , Attizzani Guilherme F.
Published: April 2024

Background:

Transcatheter aortic valve replacement is approved for treatment of patients with severe aortic stenosis across the spectrum of risk. While considering broader indications for use, transcatheter aortic valve replacement in large native annuli has become increasingly important.

Methods:

Patients with tricuspid aortic stenosis undergoing transcatheter aortic valve replacement using the Evolut R or Evolut PRO+ 34 mm valves (Medtronic, Minneapolis, MN) in the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry between October 2016 and September 2020 were stratified according to in range (>12%) device oversizing and below range (0%–12%) device oversizing. Patients undergoing valve-in-valve procedures, having a baseline annulus size <26 or ≥34 mm, or without computed tomography angiography measured annulus size were excluded. Percentage of oversizing was calculated as [(valve diameter−annulus diameter)×100/annulus diameter].

Results:

Transcatheter aortic valve replacement in patients with large annuli was performed in 8017 patients with a mean (±SD) age 79.3±7.9 years and 94% were male. Below range (n=1096) was less common than in range oversizing (n=6921). At 1-year follow-up, mortality (19.6% versus 14.9%;
P
=0.001), aortic valve reintervention (2.1% versus 0.6%;
P
<0.001) and valve-related readmission rates (3.2% versus 2.0%;
P
=0.014) were higher in the below range device oversizing group versus in range group respectively. In a multivariable Cox proportional hazards regression model, when controlling for clinically relevant covariates, below range device oversizing was associated with higher 1-year all-cause mortality (HR, 1.28 [CI, 1.07–1.51];
P
=0.005).

Conclusions:

Results from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry in patients with large annuli valves using 34mm Evolut R/PRO+ valves suggest that in range (>12%) device oversizing delivered better clinical outcomes than implantation with below range (0%–12%) device oversizing.
Understanding Meaning through Human Evolution
Authors: Faye Jan
Published: April 2024

I argue that meaning is a result of our biological evolution, and that language evolved from primates’ ability to grasp conceptually the most important features of their environment. I hold that natural selection and adaptation ensure that primates both sense and conceptualize their world similarly, and that they therefore think similarly, whenever they receive the same sense impressions. This cognitive similarity enabled our predecessors to learn and develop a language because of the regular association of a particular sound and a particular image. The evolutionary pressure on our predecessors to develop a language was the advantage that such a language had for cooperation and survival. Finally, I argue that the old, but in wider circles frowned-upon theory of meaning, the expressive theory of language, provides the best explanation of the relationship between thought, meaning, and words, because it operates with words and not sentences as the basic semantic unit.
Learning in the Context of (Digital) University Teaching: Flexibilisation and Individualisation
Authors: Martin Anne , Pengel Norbert , Haag Maike , Wollersheim Heinz-Werner
Published: April 2024

This article explores the challenges and developmental landscapes of digital university education, focusing on fostering flexibility and individualization in learning. It examines how integrating online and in-person formats can serve these objectives and how evaluation techniques can enhance the quality of teaching offerings. The shift towards lifelong learning (LLL) and catering to individual student needs are regarded as pivotal concerns. The paper presents various developmental fields within higher education, emphasizing the need to cultivate a learner-centric culture that supports self-directed learning. The integration of online and in-person formats as part of a flexible teaching concept is discussed as a solution for individualizing and flexibilizing learning. Additionally, the evaluation of teaching as a quality measure is deliberated, emphasizing the importance of effective evaluation methodologies. The work concludes with a contemplation on the future of university education, advocating for a balanced blend of online and in-person formats. This strategy aims to foster flexibility and individualization in learning to meet the demands of self-directed and lifelong learning. The article notes that experiences from the pandemic should be integrated into future university teaching rather than reverting to previous norms. The open questions, particularly regarding the integration of AI applications like chatbots and their impact on instruction, are highlighted as pivotal for further developments in higher education.
Adopting a Student Centric Education Blockchain System
Authors: Subramanian Iyer Shankar
Published: April 2024

The purpose of this paper is to portray an integrated Education Model which proposes to be student-centric and using technologies like Blockchain technology which can offer security, authenticity, immutability, longevity, data, information, decentralization, no intermediator, reliability, and data integrity. Education Blockchain 4.0 is a part of the Industrial revolution 4.0 which is disrupting the education sector. Blockchain technology is in focus in the last decade amongst users, researchers and practitioners. Despite the growing interest in Blockchain technology, the education sector has not seen much progress in terms of applications. This system uses the research of blockchain-based educational applications. The world is accelerating with IoT and AI. Industry revolution 4.0 is becoming a mandatory standard and necessity in globalization and a logical outcome is Education Blockchain 4.0. It is the need in the educational system due to the disruption initiated by technologies. Quantitative Methodology will be used to prove the conceptual model that proves the relationship between various constructs using PLS-SEM, which statistically can prove these relationships. Smart Blockchain System in education will make everything digital, easily storable, immutable, secured, longevity, easy access, cost-effective, User friendly and integrable to other technologies. The proposed Education Blockchain 4.0 smart system is poised to achieve these objectives across domains and to integrate further technologies making it the most suitable choice for these applications, which is the major contribution of this study. Also, the integration of the system theory of the new student centric education ecosystem, the disruption theory for Blockchain technology in education and the stakeholder theory applied to the education. Education Blockchain 4.0 will be useful for educational organizations to be cost-effective, achieve volumes of scale by integrating various functionalities, sectors. It will be useful for making policy decisions to enhance revenue, profitability and deliver stakeholder satisfaction.
Anti-Poaching for Endangered Megafauna Conservation in Assam, India: Examining Stakeholder Perception
Authors: Balajapalli Sudha , Kim Younsung
Published: April 2024

India is the stronghold for endangered species and poaching and illegal trade have seriously threatened wildlife conservation. Against this backdrop, Indian regulatory authorities have strengthened workforce capacity for monitoring and enforcement actions against poaching, employed patrolling systems, and adopted lethal deterrence-based policies. However, efforts to control poaching and conserve biodiversity are often at odds with local communities' needs and interests, and stakeholder participation in management is integral to successful wildlife conservation. This research aims to understand stakeholder perception of anti-poaching management practices and tribal customs in protected areas. A survey was conducted to gather information from forest staff and fringe villagers at the four national parks and one wildlife sanctuary in Assam, India. The results indicate that villagers around protected areas generally perceive that the Forest Department and patrolling effectively prevent poaching. However, stakeholders' perceptions of the lethal deterrence-based policies and tribal customs were split, depending on the local communities' unique social, economic, and political situations. Leveraging these responses, wildlife managers in India can collaborate with villagers around the protected areas to address the threats of poaching to wild megafauna. Further, this research underpins the reason to strengthen the enforcement capacity of forest staff, as they stand at the frontline of endangered species protection in biodiversity-rich, developing countries.
A geometric approach for homography-based visual servo control of underactuated UAVs
Authors: Qian Zhenyu , Dong Yuanshuai , Hou Yun , Zhang Hong , Fan ShuangWen , Zhong Hang
Published: April 2024

This paper proposes a new geometric control method for homography-based visual servo control of Underactuated UAVs. In order to solve the application difficulties of geometric control in HBVS and explore a visual servo control technology that can be applied to aerial detection operations, this paper integrates the geometric control into the visual servoing framework and design a new homography-based geometric visual servoing controller. The outer loop is used as feedback information using the virtual homography matrix between the two images. The inner loop controls the orientation of the UAVs through geometric control. The stability of the proposed controller is proved based on Lyapunov’s theory. The proposed method has better transient performance and dynamic performance than the conventional visual servo method. The excellent performance of the controller has been proven by a large number of experiments. In addition, the application of the controller on an unmanned aerial manipulator is demonstrated.
Capable but Not Empowered? How Emancipative Values Affect Protest Participation Across Different Contexts
Authors: Wegscheider Carsten , Mauk Marlene
Published: April 2024

Political protest and citizen participation are important drivers of democratic change. While previous research has identified both micro-level attitudes such as emancipative values and macro-level factors as drivers of protest behavior, we know little about how citizens’ value-driven motivations interact with the political context. We argue that the effect of emancipative values on protest participation depends on both democratic institutions and the capacity of civil society mobilizations. Specifically, we expect the positive effect of emancipative values to be stronger in countries with higher democratic quality and more pro-democratic mass mobilizations, and weaker in countries with more pro-autocratic mass mobilizations. By combining survey and macro data for 88 democratic and autocratic regimes, we find that citizens’ value orientations interact with democratic quality and the prevalence of pro-autocratic mass mobilizations in shaping protest participation. These results contribute to a better understanding of the structural and societal preconditions for democratic change.