bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 8890: Heart-Type Fatty Acid Binding Protein Impairs Angiogenesis via the Erk/stat1/vegf Signaling Pathway
Authors: Chang Ting-Ting , Chen Jaw W , Wu Yen-Wen
Published: April 2024

Introduction:
Angiogenesis is an important process for repairing tissues after damage, including ischemic stroke, myocardial infraction, and ischemia. The heart-type fatty acid binding protein (H-FABP) is a cytoplasmic protein and previous studies indicated that the increased level of H-FABP was associated with acute coronary syndrome and ischemic stroke. Given the potential contribution of H-FABP to the pathological of cardiovascular diseases, it is important to know the direct mechanisms of H-FABP in angiogenesis.

Methods and Results:
Human coronary endothelial cells (HCAECs) and endothelial progenitor cells (EPCs) were used for the in vitro study. H-FABP treatments impaired the tubular formation, migration, and wound healing abilities of HCAECs and EPCs cultured from both stable coronary artery disease (CAD) patients and healthy subjects. H-FABP directly enhanced the phosphorylation of ERK and STAT-1. The inhibition of ERK by U0126 or the knockdown of STAT-1 by siRNA could reverse the damage of cell tubular formation and migration from H-FABP. Furthermore, exogenous of H-FABP could down-regulate the expression of VEGF. The administration of STAT-1 siRNA could reverse the level of VEGF reduced by H-FABP. In the matrigel plug neovascularization assay, the H-FABP-treated group had attenuated angiogenesis with decreased hemoglobin and capillary density levels. On the other hand, ox-LDL and TNF-α were used as stimulators in the in vitro experiments. The expressions of H-FABP were increased and the cell functions were impaired in the ox-LDL and TNF-α-treated cells. And, administration of H-FABP siRNA could recover the damage from ox-LDL and TNF-α.

Conclusions:
To sum up, we proved that H-FABP could directly impair angiogenesis via the ERK/STAT1/VEGF signaling pathway in endothelial cells, suggesting the critical role of H-FABP for vasculopathy. The findings of this study may not only improve our understanding about the critical mechanisms of vascular disease, but also provide the important rationale to the potential role of H-FABP as a novel therapeutic target in angiogenesis.
Abstract 8898: Biventricular Function is Impaired in RV Septal Pacing - A Prospective Study Using Myocardial Strain Imaging
Authors: Toner Liam , Chen Janet , Ramchand Jay , Srivastava Piyush M , O'Donnell David , Calafiore Paul , Jones Elizabeth
Published: April 2024

Introduction:
Left ventricular (LV) dysfunction is observed after right ventricular (RV) pacing from both apical and septal positions.

Hypothesis:
The primary aim of this study was to assess the impact of RV mid-septal pacing upon RV function using the novel parameter of speckle-tracking derived RV global longitudinal strain (RVGLS), as well as the conventional parameters RV fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE) and tricuspid annular systolic velocity (RV S’). Secondary aims included assessing the impact on LV function and the correlation of pacing burden with echocardiographic parameters.

Methods:
Thirty-two consecutive patients (mean age 75 ± 10 years) with normal baseline LV and RV function requiring permanent pacemaker insertion were prospectively recruited at a tertiary hospital in Melbourne, Australia. 3 patients were excluded due to poor image quality. Echocardiography was performed prior to implantation, at 1-day, 1-month and 1-year post-implantation, with 29 patients completing follow-up.

Results:
Compared to 1-day post-implantation, at 1-year a significant decline was noted in mean RV S’ (15.1 to 12.2cm/s), TAPSE (24.2 to 21.9mm), RV GLS (-24.8 to -21.8%), LVEF (66.0 to 57.9%), LV GLS (-19.9 to 17.0), all p <0.01. There was no change in RV FAC (49.1 to 46.9%). Fourteen patients (44%) required a high proportion of ventricular pacing, defined as ≥10% at 1 year. These patients had a greater deterioration in RVGLS (5.0 vs 1.0%) and LVGLS (4.6 vs 0.68%), p <0.05. Changes in RV S’ (3.1 vs 2.7cm/s), TAPSE (1.5 vs 3.1mm), RV FAC (1.9 vs 5.64%) and LVEF (9.5 vs 5.6%) were not significantly different from those in patients with <10% ventricular pacing.

Conclusions:
RV and LV systolic function declined in all patients after 1 year of RV septal pacing. Further, patients with a high burden of ventricular pacing had a larger deterioration in RVGLS and LVGLS. Myocardial strain may be more useful than conventional echo parameters in detecting RV and LV dysfunction associated with RV septal pacing.
Abstract 9014: Difference in Contribution of Hypertension According to the 2017 American College of Cardiology/American Heart Association Guidelines to Cardiovascular Outcomes in Adult Cancer Survivors and General Population Without History of Cancer
Authors: Kim Kyuwoong , Oh Sanghyun , Lee Jihwan , Hong Yoo S.
Published: April 2024

Introduction:
The 2017 American College of Cardiology/American Heart Association (ACC/AHA) guideline changed the definition of hypertension, which has generated newly defined population with hypertension in the United States and elsewhere. However, there is limited evidence for the difference in contribution of hypertension according to the 2017 ACC/AHA guideline to cardiovascular outcomes in adult cancer survivors and general population without history of cancer.

Hypothesis:
We hypothesized that both adult cancer survivors and the general population with hypertension according to 2017 ACC/AHA definition (blood pressure ≥130/80 mm Hg) would be at higher risk of cardiovascular outcomes compared to those without hypertension and magnitude of this association would be different between the two populations.

Methods:
We used data from the National Health Insurance Service-National Sample Cohort (2002-2015) to identify adult (≥19 years) cancer survivors who survived more than 1 year after the first-ever cancer diagnosis and those without history of cancer matched for age and sex with 1:1 ratio. In both populations, those with history of cardiovascular disease were excluded. Cox proportional hazards model adjusted for the shared cardiovascular risk factors in the two populations and Q-statistic were used for analyses.

Results:
In this age and sex matched cohort, we identified 5,163 adult cancer survivors matched to their controls. The adjusted hazard ratio (HR) and 95% confidence intervals (95% CI) for cardiovascular outcomes in adult cancer survivors with hypertension compared to those without hypertension was 1.95 (95% CI: 1.21-3.15). Hypertension was also associated with an increased risk of cardiovascular outcomes in the general population (adjusted HR=1.67, 95%: CI 1.07-2.66). However, magnitude of this association did not differ significantly between the two populations (
P
heterogeneity
=0.646).

Conclusions:
Both adult cancer survivors and the general population with hypertension according to the 2017 ACC/AHA guideline are at higher risk of cardiovascular outcomes compared to those without hypertension. Difference in the magnitude of increased risks for cardiovascular outcomes between the two populations was not discernable.
Abstract 9037: Effectiveness of Online CME at Improving Cardiologists’ and Pcps’ Knowledge and Confidence Related to Diagnosis and Treatment of Hereditary Transthyretin Amyloidosis
Authors: Harris Margaret , O'Connor Alison , Boutsalis George
Published: April 2024

Introduction:
Despite advances in hATTR management, patients experience delays in diagnosis and initiation of targeted treatment, resulting in suboptimal care. We sought to determine if online continuing medical education (CME) could improve the knowledge and confidence of cardiologists and primary care physicians (PCPs) related to diagnostic features of hATTR and targeted treatment strategies for hATTR.

Methods:
This CME intervention comprised of a 30-minute online video-based discussion between 2 expert faculty. Responses to 3 multiple-choice, knowledge questions and 1 self-efficacy, 5-point Likert scale confidence question were analyzed using a repeated pairs pre-/post-assessment study design. A chi-square test (P <.05 is considered significant) assessed pre- to post-activity change. The activity launched March 26, 2020 and data were collected through June 10, 2020.

Results:
In total, 144 cardiologists and 384 PCPs were included in the study. Overall, there were knowledge and confidence improvements seen among all groups from pre- to post-assessment: • 8% of cardiologists (P=ns) and 16% of PCPs (P<.0001) improved at identifying diagnostic features of hATTR • 23% of cardiologists (p<.001) and 27% of PCPs (p<.001) improved at selecting MOA of current treatment approaches targeting TTR in patients with hATTR • 40% of cardiologists and 56% of PCPs had a measurable increase in confidence in recognizing early diagnostic features in patients with hATTR Continued educational gaps: • 12% of cardiologists and 14% of PCPs failed to select diagnostic features of hATTR • 59% of cardiologists and 58% of PCPs failed to select MOA of current treatment approaches targeting TTR in patients with hATTR

Conclusions:
This study demonstrates the success of online CME on improving knowledge and confidence of cardiologists and PCPs related to recognition of diagnostic features in patients with hATTR. Continued gaps were identified for future educational targets.
Abstract 9085: Phenome-Wide Association Study (phewas) Identifies Clinical Factors Associated With Plasma Ketones from Four Large Studies
Authors: Selvaraj Senthil , Giamberardino Stephanie , Abdulrahim Jawan , Margulies Kenneth B , Kelly Daniel P , HAYNES CAROL , Mentz Robert J , Hernandez Adrian F , Holman Rury , Peterson Eric D , Shah Svati H
Published: April 2024

Background:
Ketosis is an adaptive mechanism to the stress imposed by cardiovascular disease, including heart failure (HF), with ketones constituting a more efficient myocardial fuel. Contributing factors to the development of ketosis and its association with adverse events have not been well studied.

Methods:
We performed a phenome-wide association study (PHeWAS) for serum ketone (beta-hydroxybutyrate [BHB]) levels in four cohorts with a total of 6,508 participants across a broad array of cardiovascular health, including CATHGEN (N=4,374), RELAX (N=161), TECOS (N=995), and EXSCEL(N=978). On cross-sectional analysis, we performed a random effects meta-analysis relating clinical and echocardiographic predictor variables to log transformed BHB using linear regression (with false discovery rate adjusted p-values). The relationship between BHB and HF metrics (HF history, ejection fraction, right ventricular systolic pressure [RSVP]) with markers of insulin resistance was assessed in each cohort. The association between BHB and death or HF hospitalization was assessed using Cox regression.

Results:
The mean age was 62 years, 36% female, and 75% white. Log BHB was associated with higher heart rate (beta-coefficient 0.009, p=0.001), HF (0.188, p=0.02), ejection fraction
<
55% (-0.138, p=0.008), RVSP (0.010, p=0.02), ischemic heart disease (-0.094, p=0.002), and statin use (-0.13, p=0.002). The association between HF phenotypes and BHB was not explained by markers of insulin resistance. Higher BHB levels were associated with increased risk for death and HF hospitalization (
Figure
), driven primarily by death.

Conclusions:
We identified several novel non-diabetic associations between ketosis and clinical measures in patients with cardiovascular disease. The link between ketosis and HF was independent of insulin resistance. BHB is a powerful predictor of outcomes, particularly death, across a spectrum of cardiovascular disease, including HF.
Abstract 9102: Cytosolic and Nuclear LncRNA HBL1 Crosstalk to Orchestrate Human Cardiogenesis via Interactions With MicroRNA-1 and PRC2 Epigenetic Complex
Authors: Liu Juli , Liu Sheng , Sheng Yi , Wan Jun , Yang Lei
Published: April 2024

Introduction:
Compared to rodents, human embryos exhibit unique dynamics of cardiogenesis, suggesting the existence of novel human-specific genetic programs underlying early-stage human heart development. Due to lack of in vivo model, human-specific mechanisms underlying cardiogenesis remain elusive.

Hypothesis:
Human Heart Brake LncRNA 1 (HBL1) functions as a new layer of regulator controlling cardiogenic gene transcription via coordinating with microRNA-1 and PRC2 epigenetic complex.

Methods:
Human pluripotent stem cells (hPSCs) were utilized to model human cardiogenesis. CRISPR/Cas-9 was utilized to knockout HBL1 and coding genes, and disrupted microRNA-1 binding sites on HBL1. HBL1 interacting proteins were pulled down by Co-IP-MS. EMSA and RNA-IP tested HBL1 interactions with PRC2 subunits. ChIP-seq uncovered the impact of HBL1 on genome-wide PRC2 occupancy. Luciferase assay confirmed JARID2 is a target of microRNA-1.

Results:
HBL1 expresses in cytoplasm and nucleus of hPSCs. Gain-of-HBL1 represses, whereas loss-of-HBL1 increases cardiomyocyte differentiation from hPSCs. Cytosolic HBL1 modulates cardiac development from hPSCs by counteracting microRNA-1. In hPSCs, disruption of microRNA-1 binding sites on HBL1 phenocopies HBL1 deficiency. Nuclear HBL1 interacts with two PRC2 subunits, JARID2 and EED. Loss-of-JARID2 or EED phenocopies HBL1 deficiency to enhance cardiac differentiation from hPSCs. HBL1 deficiency disrupts genome-wide PRC2 occupancy and H3K27me3 deposition on essential cardiogenic genes, and consequently enhances their transcription in hPSCs. Both HBL1 and JARID2 are required for PRC2 deposition to determine the epigenetic state of critical cardiogenic genes in hPSCs. Furthermore, the cytosolic and nuclear fractions of HBL1 could crosstalk via a conserved “microRNA-1-JARID2” axis to modulate transcription of cardiogenic genes.

Conclusions:
Our findings delineate the indispensable role of human-specific HBL1 in early human cardiogenesis, and expand the mechanistic scope of lncRNA(s) that cytosolic and nuclear portions of HBL1 could coordinate to precisely control human cardiogenesis.
Abstract 9106: Comparing the Risk of Post-Discharge Bleeding from Dual Antiplatelet Therapy, after Percutaneous Coronary Intervention, Between US Black and White Adults
Authors: Heindl Brittain F , Clarkson Stephen A , Dillon Chrisly S , Narayan Renuka , Usifo Ebikere , Beasley Mark , Limdi Nita
Published: April 2024

Introduction:
Dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) reduces myocardial infarctions but increases bleeding. Guidelines recommend using risk scores to assess bleeding risk, but none have been validated in self-reported Black patients. We compared 1) post-discharge bleeding between US Black and White patients, and 2) the ability of three risk scores to predict bleeding between them.

Methods:
The PRiME-GGAT prospective cohort study enrolled patients (2014-2019) who underwent PCI and followed them for one year. Variables measured at PCI were included in the PRECISE-DAPT, PARIS, and ARC-HBR scores. The outcome was post-discharge BARC 2-5 events. Incidence rates were compared between Black and White patients, using incidence rate ratios (IRRs). Proportional hazards models measured the effect of self-reported Black ethnicity, adjusted for bleeding risk factors. Risk scores were compared between Black and White patients using: 1) IRRs, 2) Harrell’s C-indices, and 3) Kendall’s tau-b coefficients (τ
b
). τ
b
was not measured for the binary ARC-HBR score.

Results:
Of 1529 included patients, 342 (22.4%) self-reported as Black. The incidence rate was higher among Black patients compared to White patients (22.7 versus 16.3, respectively, per 100 person-years; IRR 1.39; 95% CI, 1.01-1.90). After adjustment, self-reported Black ethnicity was not a predictor of bleeding. For both groups, IRRs were largest for PRECISE-DAPT. Between Black and White patients, respectively, C-index was 0.65 vs. 0.61 for PRECISE-DAPT, 0.63 vs. 0.61 for PARIS, and 0.60 vs. 0.59 for ARC-HBR; and τ
b
, respectively, was 0.71 vs. 0.64 for PRECISE-DAPT, and 0.79 vs. 0.86 for PARIS.

Conclusions:
Post-discharge bleeding from DAPT was greater for Black patients, compared with White patients, but this difference was not present after adjustment. PRECISE-DAPT was superior among Black patients, but PARIS was superior among White patients.
Abstract 9127: The Impact of Iron Deficiency on Long-Term Outcomes in Patients with Acute Decompensated Heart Failure
Authors: Miyawaki Norihisa , Ishikura Masahiro , Murai Ryosuke , Okada Taiji , Toyota Toshiaki , Sasaki Yasuhiro , Taniguchi Tomohiko , Kim Kitae , Kobori Atsushi , Ehara Natsuhiko , Kinoshita Makoto , Furukawa Yutaka
Published: April 2024

Introduction:
Iron deficiency (ID) is a common co-morbidity in patients with heart failure (HF). However, the significance of ID as a prognostic factor has not been fully elucidated in patients with acute decompensated heart failure (ADHF).

Hypothesis:
ID is associated with a high cardiovascular event risk in ADHF.

Methods:
We retrospectively reviewed the ADHF patients who admitted to our hospital between December 2014 and March 2018. ID was defined as TSAT (transferrin saturation) < 20% at discharge. Primary outcome measure was a composite of all-cause death and HF rehospitalization. Patients who died or underwent transfusion during index hospitalization were excluded from the analysis.

Results:
Among 256 patients who enrolled in the analysis, 119 patients (46.5%) had ID and 137 patients (53.5%) did not. Patients with ID had significantly lower hemoglobin levels (11.0 vs 12.1g/dl; p<0.01) and estimated glomerular filtration rates (42.3 vs 48.1 ml/min/m2; p<0.01) than non-ID patients. During the median follow-up period of 2.8 years, patients (30.1%) died and 96 patients (37.5%) re-hospitalized for HF. Although HF rehospitalization was numerically higher in ID patients than in non-ID patients (44.5% vs 31.4%, p = 0.03), Kaplan-Meier analysis showed comparable risks for all-cause death (log-rank p=0.67) and HF rehospitalization (log-rank p=0.90) between ID and non-ID patients.

Conclusions:
ID in patients with ADHF were common and associated with anemia and renal impairment. However, ID might not be a significant prognostic factor in ADHF patients.
Abstract 9146: Efficacy and Safety of Esaxerenone in Hypertensive Patients with Heart Failure with Reduced Ejection Fraction
Authors: Ono Ryohei , Iwahana Togo , Kato Hirotoshi , Okada Sho , Kobayashi Yoshio
Published: April 2024

Introduction:
Esaxerenone, a mineralocorticoid receptor blocker (MRB), is a new antihypertensive agent. However, esaxerenone-related data with respect to hypertension with heart failure are limited.

Hypothesis:
Esaxerenone is safe and effective for hypertensive patients with heart failure with reduced ejection fraction (HFrEF).

Methods:
Hypertensive patients with HFrEF treated with esaxerenone were retrospectively analyzed at two timepoints (short-term: 35±15 days; mid-term: 167±45 days) for hyperkalemia (K
+
>5.5 mEq/L), worsening renal function (WRF; estimated glomerular filtration rate (eGFR) reduction by >20%), and hypotension (systolic blood pressure <90 mmHg) along with brain natriuretic peptide (BNP) level. Patients administered esaxerenone as their first MRB (first-MRB cohort, n=20) and those who converted from another MRB (conversion cohort, n=30) were separately analyzed as sub analysis.

Results:
Fifty patients (56±10 years old, 37 males) were enrolled in this study. At the short-term assessment, hyperkalemia or hypotension was not observed at a dose of 2.0±0.9 mg/day. Seven patients (14%) showed WRF. K
+
and serum creatinine (Cre) were elevated (4.12±0.41 to 4.25±0.39 mmol/L,
p
=0.07, and 0.95±0.34 to 1.01±0.34 mg/dL,
p
=0.01, respectively), and eGFR was significantly reduced (66.9±19.6 to 62.4±19.7 mL/min/1.73 m
2
,
p
=0.006). At the mid-term assessment, there were no significant changes regarding K
+
, Cre and eGFR compared to those at the short-term. BNP levels were consistently lowered at the short-term and mid-term assessment. Sub analysis at the short-term assessment showed the changes in K
+
, Cre, and eGFR were significant in the first-MRB cohort, while they were not significant in the conversion cohort.

Conclusions:
Esaxerenone was safe for hypertensive patients with HFrEF. Hyperkalemia and hypotension were rarely noted while eGFR was significantly reduced. Moreover, esaxerenone was effective for HFrEF with respect to BNP levels.
Abstract 9147: Reduced Delta-6-Desaturase Activity May Be Associated With Major Adverse Cardiac Events During 2 Years Follow Up in Elderly Patients With a Recent Myocardial Infarction
Authors: Nilsen Dennis W , Myhre Peder L , Kalstad Are Annesoenn , Schmidt Erik Berg , Arnesen Harald , Seljeflot Ingebjorg
Published: April 2024

Background:
Low levels of dihomo-gamma linolenic acid (DGLA) have been related to a bad outcome in patients with acute coronary syndromes. Reduced levels of DGLA may result from reduced conversion of its precursor linoleic acid (LA). An increase in the ratio of LA to DGLA (LA:DGLA) has been shown to reflect reduced delta-6-desaturase activity.

Aim:
To evaluate the association between the LA:DGLA ratio, reflecting delta-desaturase activity, and the risk of major adverse cardiovascular event (MACE, comprising nonfatal myocardial infarction (MI), unscheduled revascularization, stroke, hospitalization for heart failure, or all-cause death), in patients with a recent MI.

Methods:
Baseline samples from the OMEMI (Omega-3 Fatty acids in Elderly with Myocardial Infarction) trial* in which a total of 1027 patients, age 70 to 82 years, were included 2-8 weeks after an MI and followed up for 2 years, were used. FAs were measured in serum phospholipids, and the LA:DGLA ratio was calculated at baseline and related to incident MACE by univariate and multivariable Cox regression analyses, adjusted for age, sex, body mass index, omega-3 supplementation at baseline and hypertension.

Results:
A total of 208 patients experienced MACE during follow-up. The univariate hazard ratio (HR) for MACE in the fourth quartile (Q4) of LA:DGLA compared to the lowest quartile (Q1) was 1.49 (95% confidence interval (CI), 1.00-2.23), p=0.005. After adjustment, the HR for Q4 was weakened [1.47 (0.97-2.25), p=0.072]. The HR for Q2-4 combined as compared to Q1 was borderline significant [1.42 (0.99-2.03)], p=0.055. Although the number of total deaths were more than two-fold higher in Q4 as compared to Q1 [HR 2.30 (1.04-5.06), p=0.038], this did not reach significance in the adjusted models [HR 2.26 (0.95-5.37), p=0.065], and remained non-significant when comparing Q2-4 combined to Q1 [HR 1.74 (0.80-3.77), p=0.16].

Conclusion:
Higher levels of LA:DGLA ratio were found to be associated with MACE in elderly patients with a recent MI, suggesting a mechanism to why low levels of DGLA may be associated with increased adverse events. * Circulation 2021; 143(6): 528-39.
Abstract 9149: The Novel Wnt-Pathway Inhibitor Podocan is Not Associated with All-Cause Mortality or Cardiovascular Outcome in Patients Admitted with Suspected Acute Coronary Syndrome
Authors: Andersen Thomas , Nilsen Dennis W , Grundt Heidi , Staines Harry , Ueland Thor , Aukrust Pal , Kontny Frederic P
Published: April 2024

Introduction:
Podocan, a novel extracellular matrix glycoprotein, is a smooth muscle cell regulator and abundantly expressed in human atheroma. The association of Podocan with cardiovascular outcome remains unclear. The aim of this study was to assess the predictive value of Podocan concerning adverse outcome in patients admitted with acute chest pain suspected to be acute coronary syndrome (ACS).

Methods:
Plasma Podocan was measured with an enzyme immune assay in samples taken upon hospital admission from patients with suspected ACS who were enrolled in the Risk markers in Acute Coronary Syndrome (RACS) study (NCT00521976). RACS was a Norwegian single center study including patients from November 2002 to September 2003. The primary outcome was a composite of all-cause mortality, myocardial infarction, or stroke within 7 years. Additional analyzes included these individual components at 1, 2, and 7 years, and cardiac death at 1 and 2 years. Associations between quartiles of Podocan and the primary outcome, its individual components, and cardiac death were assessed in both univariate analyzes and in stepwise multivariable Cox regression analyzes fitted with significant clinical variables, past medical history, medication, TnT, BNP, and eGFR before Podocan was introduced.

Results:
Samples were available from 815 patients (mean age: 69.6 years, male: 61.3%, elevated TnT: 53.0%). Mean Podocan level was 1.03 ng/mL (CI 0.93-1.13). Podocan was neither associated with the primary composite endpoint within 7 years in univariate analyzes (X
2
analyzes (p=0.426), AUROC 0.518 (p=0.374), Kaplan Meier analyzes (log-rank test p=0.594), and Cox regression (p=0.595)), nor in multivariable Cox regression analyzes (p=0.744). Similar results were found by analyzes of the individual components of the primary outcome and of cardiac death for all time points, as well as in subgroup analyzes of patients with elevated TnT (p>0.05 for all).

Conclusions:
This first report in the literature on Podocan in acute chest pain did not reveal any significant predictive value of this novel wnt-pathway inhibitor concerning the combination of all-cause death, MI, or stroke, its individual components or cardiac death in patients admitted with suspected ACS, irrespective of TnT status.
Abstract 9159: Mindfulness Training, Cognitive Function and Interoceptive Awareness in Heart Failure Outpatients: Preliminary Findings
Authors: Salmoirago-blotcher Elena , Walaska Kristen , Trivedi Dyuti , Dunsiger Shira , Levine Daniel , Breault Christopher , Wu Jia-Rong , Cohen Ronald
Published: April 2024

Introduction:
Cognitive impairment affects up to 2/3 of patients with heart failure (HF) and is an important barrier to HF self-care. Adequate interoceptive awareness (the ability to sense and interpret signals from within the body) is also relevant in this context, in that it allows patients to recognize the worsening of symptoms, receive treatment sooner, and prevent hospital re-admissions. As a secondary analysis from a single arm pilot RCT (NCT03571581), we explored effects of phone-delivered Mindfulness Training (MT) on cognitive function and interoceptive awareness in outpatients with NYHA class I-III HF.

Methods:
Participants received a weekly, 30-minute phone-delivered MT session for 8 weeks integrated with daily guided individual practice. Assessments of memory, attention, and executive function (NIH Toolbox); interoceptive awareness (Multidimensional Assessment of Interoceptive Awareness/MAIA), and exercise capacity (6-min walk test/6MWT), were conducted at baseline and end of treatment (EOT).

Results:
We enrolled 33 patients (32% women; 32% minorities; mean age 62 years). Baseline cognitive function was normal. At EOT, we observed improvements in all the cognitive domains considered (Table 1A; p <.05 for the Flanker test) and in MAIA scores (p < .05 - Table 1B). 6MWT distance increased from 349.9 (92.6) to 377.7 (97) meters, p <.05).

Conclusions:
MT was associated with improvements in cognitive function, interoceptive awareness, and functional status. If confirmed in a large RCT, these findings could pave the way to the integration of MT into rehabilitation programs to improve clinical outcomes in this vulnerable population.
Abstract 9161: Referral Patterns Do Not Contribute to Racial Differences in Catheter Ablation for Atrial Fibrillation
Authors: Marot Jessica E , Pool Lindsay R , Tanaka Yoshihiro , Witting Celeste , Khan Sadiya S , Passman Rod S
Published: April 2024

Introduction:
Non-Hispanic Black (NHB) adults with atrial fibrillation (AF) are less likely to undergo catheter ablation (AFCA) compared with non-Hispanic White (NHW) adults even among those with heart failure and even though previous studies have shown that NHB patients with AF were more symptomatic.

Hypothesis:
We hypothesize that differences in outpatient referrals to Cardiology and Electrophysiology (EP) contribute to the racial disparity in AFCA.

Methods:
Using data from the Northwestern Medicine Enterprise Data Warehouse, we curated a retrospective cohort of NHB and NHW patients with newly diagnosed AF between 1/1/2011 and 12/31/2019 in an outpatient office visit to Internal Medicine/Primary Care (IM/PC), Cardiology, or Heart Failure (HF). Rates of AFCA and referral rates from IM/PC to Cardiology or EP and from Cardiology and HF to EP were compared between NHB and NHW patients using logistic regression models adjusted for demographic characteristics and comorbidities.

Results:
Of the 5,555 included patients, the mean age was 68 years (SD 13.4), 61% were male, 15% were NHB, and the mean CHA
2
DS
2-
VASc score was 3.5 (SD 2.0). 373 patients (6.7%) underwent AFCA. NHB patients had a higher prevalence of comorbidities. NHB patients were significantly less likely to undergo AFCA compared with NHW patients (OR 0.61, 95% CI 0.40-0.92,
p
= 0.02), and this difference persisted even when limited to the subset of patients who had visited EP (N=1,840, OR 0.65, CI 0.42-0.98,
p
= 0.04). Among patients diagnosed in IM/PC, NHB patients were 1.47 times more likely to be referred to Cardiology than NHW patients (CI 1.09-1.97,
p
= 0.01), but the rates of referral to EP were similar (OR 0.94, CI 0.72-1.24,
p
= 0.68) (
Figure
).

Conclusion:
NHB patients diagnosed in the outpatient setting are less likely to undergo AFCA compared with NHW patients, but referral patterns do not explain these findings. Exploration of other factors should be considered to mitigate disparities in care related to AFCA.
Abstract 9170: Medication Reconciliation: Much Remains to Be Done
Authors: Bizanti Anas , Al-abdouh Ahmad , Haddadin Sadam , Mohammed Mohammed , Michael Mina , Patel Roshniben , Patel Gina , Ahmed Samir , Kuehl Sapna
Published: April 2024

Introduction:
Medication reconciliation had been a persistently national patient safety issue. Despite several efforts, the rate of error is still significantly high, and the measures that had been taken to improve this process are lacking data to prove their efficacy in reducing medication errors. In this retrospective study, we will measure the efficacy of medication grouping intervention on the discharge platform ion order to reduce medication error. The intervention was grouping medication according to pharmaceutical class, in addition, bundling home and inpatient medication.

Methods:
This retrospective study was conducted in a single-center teaching hospital. A multidisciplinary team changed the discharge medication platform. This intervention was done in July 2019. Afterwards a total of 1395 patients were screened. The control group were 760 patients, versus 635 patients in the intervention group. Patients who were not admitted under the medical team service were excluded, and patients who had less than 7 medications on admission were also excluded. After screening, the remaining patients were subjected to detailed charting for medication error, which was done in 179 subjects in the control group vs 176 intervention groups. The primary outcome was medication error on discharge, which was measured by 2 different independent physicians. Furthermore, a subgroup analysis was done comparing residents' vs hospitalists' medication reconciliation errors on discharge.

Results:
A total of 329 patients were studied. In the control group, the percentage of errors noted was 42/161 (26.08%), while in the intervention group errors were noted in 37/168 patients screened (22.02%) a significant reduction of 4.06% in the percentage of errors noted.

Conclusion:
The electronic intervention of grouping medication by pharmaceutical class and bundling home and inpatient medication resulted in a reduction of medication error upon discharge medication reconciliation.
Abstract 9176: Quarterly versus Annual ECG Screening for Atrial Fibrillation in Older Chinese (AF-CATCH): A Prospective, Randomised, Controlled Trial
Authors: Zhang Wei , Chen Yi , Wang Jiguang
Published: April 2024

Introduction:
Screening for atrial fibrillation before symptoms manifested and subsequent initiation of oral anticoagulants (OACs), could prevent stroke and death. The most cost-effective strategy to screen atrial fibrillation in high-risk population aged 65 and over remains unknown.

Methods:
We performed a randomised controlled trial that compares different screening frequencies of 30-second single-lead ECG (AliveCor® Heart Monitor) in the detection of atrial fibrillation in Chinese residents (≥65 years old) in 5 community health centres in Shanghai. Only participants without atrial fibrillation history and atrial fibrillation rhythm at baseline were eligible for inclusion in the trial. Participants were randomised in a 1:1 ratio into annual (G1) and quarterly screening (G2) groups: the quarterly screening group was further randomised in a 3:1 ratio into subgroups of quarterly screening (G2-1) and quarterly screening PLUS (G2-2, ECG weekly for 1-month then quarterly). The primary outcome was the detection rate of atrial fibrillation. The intention-to-treat analysis was performed for all randomised patients who had at least one ECG recording during follow-up. This trial was registered at ClinicalTrials.gov, number NCT02990741.

Results:
Between April 17, 2017, and June 26, 2018, a total of 8240 participants were randomised into G1 (n=4120), G2-1 (n=3090) and G2-2 (n=1030), with a mean of 1.6, 3.5 and 5.2 ECG records respectively during a median of 2.1 years follow-up (13,284 person-years). 73 incident cases of atrial fibrillation occurred: 26 in G1 (4.1/1000 person-years) and 47 in G2 (6.7/1000 person-years; hazard ratio with G1, 1.71; 95% confidence interval [CI] 1.06-2.76;
P
=0.03). 40 incident cases were detected in G2-1 (7.2/1000 person-years; hazard ratio with G1, 1.83; 95% CI 1.12-3.00;
P
=0.02) and 7 in G2-2 (4.8/1000 person-years; hazard ratio with G1, 1.24; 95% CI 0.54-2.86;
P
=0.61). No significant difference was noted between G2-1 and G2-2 (hazard ratio with G2-1, 0.68; 95% CI 0.30-1.52;
P
=0.35).

Conclusions:
Quarterly 30-second single-lead ECG screening significantly increased the detection rate of incident atrial fibrillation, additional weekly screening in the first month did not yield added predictive value.
Abstract 9185: Diagnostic Utility of R-R Interval Variations Under Deep Breathing Load in Patients With Cardiac Amyloidosis
Authors: Nagayoshi Yasuhiro , Kawano Hiroaki , Sakaino Naritsugu , Nishihara Taiki , Morikawa Kei , Hanatani Shinsuke , Usuku Hiroki , Tsujita Kenichi
Published: April 2024

Introduction:
Autonomic disorder is one of important characteristics of cardiac amyloidosis. However, the prevalence of autonomic disorder in wild-type transthyretin amyloidosis (ATTR
wt
) remains to be elucidated. Analysis of coefficient of variation of R-R interval (CVR-R) is a non-invasive method to measure the autonomic nervous system. In normal subjects, CVR-R values are higher during deep breathing load than those at rest. Diminished response of CVR-R to deep breathing reflects the parasympathetic nervous system disorder. We aimed to assess autonomic disorder of ATTRwt and investigate the utility of CVR-R for the detection of ATTRwt from other cardiac disease.

Methods:
Fifty patients with chronic heart failure (HF) patients aged >70 were investigated. The etiology of HF was as follows: ATTR
wt
, n=10; previous myocardial infarction (MI), n=20; and left ventricular hypertrophy (LVH) due to other disease (e.g. aortic stenosis); n=20. Serum cardiac troponin I and plasma brain natriuretic peptide (BNP) were measured in all patients. Cardiac function was evaluated by echocardiography. We measured CVR-R at rest (CVR-R
rest
), CVR-R with deep breaths (CVR-R
beath
) and their change rate (CVR-R
diff rate
). Relative change formula is CVR-R
diff rate
= (CVR-R
beath
- CVR-R
rest
)/ CVR-R
rest
.

Results:
There was no difference in age among the three groups. Plasma BNP levels, troponin I levels and left ventricular mass index were significantly higher in ATTR
wt
group. There was no difference in CVR-R
rest
levels among the three groups. CVR-R
diff rate
levels in ATTR
wt
group were significantly lower (ATTR
wt
: -8.77 [-43.8-10.9]; LVH: 67.4 [38.7-89.4]; MI: 83.7 [60.4-142.9], respectively). In the ROC analysis to identify ATTR
wt
in HF, the best cutoff value for CVR-R
diff rate
was 1.197 (AUC: 0.848).

Conclusions:
Autonomic nervous disorder is frequently observed in the patients with ATTR
wt
. Measurement of CVR-R is convenient support tool for detection of ATTRwt.
Abstract 9186: Maslinic Acid Alleviates Atherosclerosis by Suppressing Mitochondrial ROS-Dependent NLRP3 Inflammasome Activation in Vascular Endothelial Cells via SIRT1/Nrf2 Pathway
Authors: Zhuqing Li , Chengzhi Lu
Published: April 2024

Introduction:
Maslinic acid (MA), a pentacyclic triterpenoid primarily found in food plants, has exhibited multiple inhibitory effects on proatherogenic factors, such as obesity, dyslipidemia, and inflammation. However, its effect on atherosclerosis remains unknown. In this study, we determined if MA can inhibit atherosclerosis progression and explored the underlying molecular mechanisms.

Methods:
To assess the anti-atherogenic effect of MA in vivo, ApoE deficient mice were treated with MA contained in high-fat diet for 16 weeks. After treatment, mouse aorta and serum samples were collected to determine atherosclerotic lesions, lipid profile, mitochondrial morphology and expression of related molecules. Additionally, human aortic endothelial cells (HAECs) were treated with ox-LDL to induce the endothelial injury model. Prior to the procedure, vehicle or MA were treated in the absence or presence of a SIRT1 inhibitor nicotinamide (NAM) and an Nrf2 inhibitor ML385. Concurrently, we investigated the effects and mechanisms of MA on mitochondrial dysfunction, oxidative stress injury and apoptosis in HAECs.

Results:
In vivo, MA conferred an anti-atherosclerotic effect as shown by reduced en face and aortic root sinus lesions size. From the electron microscopic analysis, MA ameliorated the mitochondrial damage in aortic endothelium. MA could promote the protein expression of SIRT1 and Nrf2, and enhance the expression of mitochondrial antioxidant enzymes. In addition, MA suppressed NLRP3 inflammasome activation to reduce apoptosis in vascular endothelium. In vitro, MA could inhibit ox-LDL-induced mitochondrial ROS generation by activating SIRT1/Nrf2 pathway, thereby inhibiting NLRP3 inflammasome activation and apoptosis in HAECs. NAM and ML385 eliminated the MA-mediated endothelial protective effect by restraining the expression of SIRT1 and Nrf2, respectively.

Conclusions:
In conclusion, our findings suggested that MA ameliorated endothelial apoptosis by suppressing mitochondrial ROS-dependent NLRP3 inflammasome activation via SIRT1/Nrf2 pathway and showed efficacy in exerting an anti-atherogenic effect.
Abstract 9193: Peripheral Artery Disease and the Risk of Venous Thromboembolism
Authors: Sykora Daniel , Bhatt Shubhang K , Tseng Andrew S , Girardo Marlene , Firth Christine , Chamberlain Alanna M , Wennberg Paul W , Liedl David , Shamoun Fadi E
Published: April 2024

Introduction:
Peripheral artery disease impacts 202 million patients worldwide and is commonly diagnosed via ankle-brachial index. PAD is associated with endothelial dysfunction, which is also common to venous thromboembolism formation. Despite the suspected overlap in pathogenesis, few studies exist investigating the association between these pathologies. We investigated whether PAD with low or elevated ABI is an independent risk factor for VTE.

Methods:
We reviewed medical records of patients ≥18 years old undergoing ABI measurement with or without PAD symptoms from 01/01/1996 to 08/31/2018 and classified patients by ABI: severely low (ABI 0.00-0.39), moderately low (0.40-0.69), mildly low (0.70-0.90), borderline (0.91-0.99), normal (1.00-1.40), and elevated (>1.40). The primary outcome was incident VTE event after ABI measurement, defined as deep vein thrombosis or pulmonary embolism. Multivariable Cox proportional regression was used to calculate hazard ratios (HR) with 95% confidence intervals after adjusting for age, sex, active smoking, cancer or VTE history, thrombophilia, anticoagulation, and revascularization within 14 days of VTE.

Results:
In 39,384 unique patients (mean age 66.3±14.2 years, median follow-up 34 months), 5,141 VTE events were observed. Increased VTE risk was observed in PAD patients with severely low ABI (HR 1.26, 95%CI [1.02, 1.29]) compared to patients with normal ABI after multivariable regression. Patients with elevated ABI did not demonstrate an increased risk of VTE.

Conclusions:
Patients with severe PAD are at higher risk for VTE than patients with normal ABI, which may be due to a multifactorial pathophysiology of profound endothelial injury as well as immobility due to claudication. Further exploration of VTE incidence in patients with severe PAD stratified by functional status is warranted to determine the optimal strategy to minimize thromboembolic morbidity and mortality in this population.
Abstract 9201: Association Between Remnant Cholesterol, High-Sensitivity C-reactive Protein, and Risk of Atherosclerotic Cardiovascular Disease Events in the Multi-ethnic Study of Atherosclerosis (MESA)
Authors: Chevli Parag A , Islam Tareq , Pokharel Yashashwi , Rodriguez Fatima , Virani Salim S , Blaha Michael J , Bertoni Alain G , Budoff Matthew , Otvos James D , Shapiro Michael D
Published: April 2024

Background:
Elevated remnant-like particle (RLP)-cholesterol (RLP-C) and high-sensitivity C-reactive protein (hsCRP) are each associated with atherosclerotic cardiovascular disease (ASCVD) individually. Whether a serum marker of systemic inflammation modifies RLP-C associated ASCVD risk is unknown. The purpose of this study was to evaluate the interplay of nuclear magnetic resonance (NMR)-derived RLP-C and hsCRP and their association with ASCVD risk in the Multi-Ethnic Study of Atherosclerosis (MESA).

Methods:
Lipoprotein particles were measured using NMR spectroscopic analysis among MESA participants. RLP-C includes very-low-density lipoprotein (VLDL)-cholesterol and intermediate-density lipoprotein (IDL)-cholesterol. Four groups were created as follows: Group 1: RLP-C ≤ median (≤29.14 mg/dL) and hsCRP < 2 mg/dL; Group 2: RLP-C ≤ median (≤29.14 mg/dL) and hsCRP≥ 2 mg/dL; Group 3: RLP-C > median (>29.14 mg/dL) and hsCRP level < 2 mg/dL; and Group 4: RLP-C > median (>29.14 mg/dL) and hsCRP level ≥ 2 mg/dL. Kaplan-Meier survival curves and multivariable adjusted Cox proportional hazard models were used to examine the relationship between RLP-C and hsCRP with incident ASCVD.

Results:
A total of 6,720 MESA participants (mean age 62.2 y, SD 10.2, 53% female) who had baseline NMR-derived RLP-C and hsCRP measurements were included. At a median follow-up of 15.6 years, a total of 1,032 ASCVD events were observed. In the fully adjusted model, compared to those in the reference group (Group 1), participants in Group 2, Group 3, and Group 4 demonstrated a 24% (95%CI, 1.02 - 1.50), 22% (1.01 - 1.46), and 47% (1.22 - 1.77) increased risk of incident ASCVD events, respectively (p <0.001).

Conclusion:
We found an independent association of NMR-derived RLP-C and hsCRP with incident ASCVD in an ethnically and geographically diverse population. Notably, the combination of increased RLP-C and hsCRP was associated with a markedly increased risk of future ASCVD events.
Abstract 9205: Cardiovascular Health Metrics in Patients Hospitalized With an Acute Coronary Syndrome
Authors: Mehawej Jordy , Ding Eric , Abu Hawa O , Lessard Darleen , Saczynski Jane , McManus David D , KIEFE Catarina I , Goldberg Robert
Published: April 2024

Background:
The Life’s Simple 7 (LS7) is a guiding metric for primordial/primary prevention of cardiovascular disease. However, little is known about the prevalence and distribution of LS7 metrics in patients with an acute coronary syndrome (ACS) at the time of hospitalization.

Methods:
Data were obtained from patients hospitalized for an ACS at six hospitals in Central Massachusetts and Georgia (2011-2013). The LS7 assessed patient’s smoking, diet, and physical activity, based on self-reported measures, while patient’s body mass index, blood pressure, and serum cholesterol and glucose levels were abstracted from medical records. All items were operationalized into three categories: poor (0), intermediate (1), or ideal (2). A total summary cardiovascular health (CVH) score (0-14) was obtained and categorized into tertiles (0-5, 6-7, and 8-14).

Results:
The average age of study participants (n=1,110) was 59.6 years and 35% were women. CVH scores ranged from 0-12 (mean=6.2). Patients with better CVH scores were older, White, had lower burden of comorbidities, had less symptoms of anxiety, depression, and stress, better quality of life, more social support, and greater healthcare activation. One-third of patients had only one ideal CVH measure, less than 1% had five ideal measures, and no participant had more than five ideal CVH factors.

Conclusions:
Our results indicate that ACS patients have low CVH. Sociodemographic, clinical, and psychosocial characteristics differed across CVH groups. These findings highlight potential areas for educational and therapeutic interventions to reduce the risk of cardiovascular disease and promote CVH in adult men and women.
Abstract 9209: Type 1 Brugada Syndrome Diagnosed in a Patient With an Unaffected Identical Twin
Authors: SCHWARTZ CODY , Jain Neeraj
Published: April 2024

Introduction:
Brugada syndrome is a rare arrhythmia disorder due to a cardiac channelopathy with a predisposition to ventricular arrhythmias or SCD. It is characterized by an ECG pattern of complete or incomplete right bundle branch block and ST segment elevation in leads V1-V3. It is normally inherited in an autosomal dominant pattern however environmental factors such as viral infections and inflammation may create myocardial cell damage that may induce an ECG pattern consistent with the diagnosis of Brugada syndrome.

Case:
A 39-year-old male with no significant past medical history presented to the hospital for two weeks of intermittent dizziness and nocturnal symptoms of being “jolted” awake. ECG on admission was suggestive of a Type 2 Brugada pattern. He denied a family history of first-degree relatives with cardiac disease, SCD or unexplained syncope but did note that he had an identical twin brother. Given symptoms and ECG findings, he was given 400 mg of oral flecainide for a sodium blockade challenge. Four hours after administration of flecainide he developed an overt Type 1 Brugada pattern. Due to issues with the MRI, a cardiac CTA was performed to assess for ARVD. Cardiac CTA showed a mild amount of fat in the apex of the right ventricular wall but was otherwise unremarkable. He was discharged with a wearable external defibrillator and outpatient follow up with EP. During outpatient follow up he reported resolution of symptoms. Interrogation of the defibrillator did not reveal any arrhythmias. An ECG was done on his identical twin brother which did not show evidence of a Type 1 Brugada pattern. He completed a cardiac MRI that showed normal morphology and motion of the right ventricle without evidence of fat dysplasia or late gadolinium enhancement. Given resolution of his symptoms with a normal cardiac MRI and an unremarkable ECG from his identical twin, he was diagnosed with an acquired Brugada syndrome likely due to a viral myocarditis.

Conclusion:
While Brugada syndrome is normally an inherited genetic disorder, there are instances of acquiring the syndrome through environmental factors. As demonstrated by our case of identical twin brothers with the same genetic makeup, one was diagnosed with Brugada syndrome while the other had an unremarkable ECG.