bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 13379: Perceived Stress and Cardiovascular Risk Among Older Persons With HIV
Authors: Mayfield Megan E , Waldrop Drenna , Paul Sudeshna , Gary Rebecca A
Published: June 2023

Background:
Cardiovascular disease (CVD) is highly prevalent among older persons with HIV (OPWH) occurring on average a decade earlier than non-infected individuals largely due to chronic inflammation, vascular pathology, and psychosocial stressors. Effective cardiovascular risk reduction strategies such as exercise have been shown to lower both physiological and psychosocial stressors but have not been widely reported in the HIV population.

Objective:
To evaluate the effect of a one-year, moderate intensity aerobic exercise intervention on perceived stress among OPWH with ≥ 2 CVD risk factors.

Methods:
A secondary analysis was performed utilizing data from Project FiTBRAiN, a 2-arm RCT that included Let’s Move (moderate intensity aerobic exercise intervention) or Let’s Flex (flexibility/stretching attention control) groups. The 14-item Perceived Stress Scale (PSS) was utilized to measure participants’ perceived stress. Data analysis included an analysis of variance with pairwise and between-group differences reported.

Results:
Participants (n=115) reported a mean age of 55±5.2, and the majority were African American (n=100, 87.0%) and male (n=66, 57.4%). The most common cardiovascular comorbidities were elevated: total cholesterol (n=114, 99.1%), systolic blood pressure (n=108, 93.9%), diastolic blood pressure (n=98, 85.2%), and participants had a mean BMI of 28.29. Baseline 14-item PSS scores for the Let’s Move Program and Let’s Flex Program were 19.49 (SD=7.94) and 21.13 (SD=8.64), respectively, indicating moderate stress levels. Over all time points, the control group (Let’s Flex) had higher perceived stress than the intervention group (Let’s Move), but were not significant.

Conclusions:
Our findings suggest that moderate levels of psychological stress were present in this population and may be a risk factor for CVD among OPWH. The consistent finding that perceived stress remained lower over time indicates that aerobic exercise may be beneficial for stress reduction. Additional research is needed to determine the optimal dose and mode of exercise that is most beneficial for stress reduction in this population.
Abstract 13382: Outcomes of Patients With Valvular Cardiogenic Shock Stratified by Treatment Strategy
Authors: Nair Raunak M , Alkhalaileh Feras , Chawla Sanchit , Abdelghaffar Bahaa , Khot Umesh N , Higgins Andrew , Lee Ran , Jaber Wael A , Cremer Paul C , Rampersad Penelope , Menon Venu
Published: June 2023

Background:
No prior studies have compared the outcomes of patients with valvular cardiogenic shock (VCS) depending on the treatment received. Our study aimed to assess this.

Methods:
All patients admitted to Cleveland Clinic Cardiac Intensive Care Unit (CICU) between Jan 1
st
, 2010, to Dec 31
st
, 2021, with a diagnosis of cardiogenic shock (CS) were retrospectively identified through electronic medical records and confirmed via physician directed chart review. Patients with CS were subsequently categorized into those with valvular cardiogenic shock (VCS) and non-valvular CS depending on the primary etiology responsible for hemodynamic instability. The impact of treatment strategy on 1-year all-cause mortality in patients with VCS was assessed with Kaplan-Meier (KM) estimates.

Results:
Overall 511 patients were admitted to our CICU with VCS during the study period. Out of these patients, 188 patients (37%) underwent surgery, 76 patients (15%) underwent percutaneous structural intervention, and 247 patients (48) % underwent conservative management. Comparison of baseline characteristics (Table 1) revealed that patients with VCS who underwent surgical treatment were significantly younger (median age 64 yrs vs 72 and 76 yrs, p<0.001), and less likely to have coexisting comorbidities such as diabetes, dyslipidemia, chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD). KM survival analysis revealed that VCS patients who underwent conservative management had the highest all-cause mortality at 1 year, whereas those patients who underwent surgery had the lowest all-cause mortality at 1 year (p<0.001) (Figure 1).

Conclusion:
Patients with VCS remain a high-risk cohort who are most likely to be conservatively managed. Of the patients who received a specific therapy, surgical management was associated with the best outcomes. The impact of early intervention in patients with VCS needs to be further explored.
Abstract 13384: Choice of Antihypertensive Agent in Isolated Systolic Hypertension and Isolated Diastolic Hypertension: A Secondary Analysis of the Allhat Trial
Authors: Wang Stephen Y , Hanna Jonathan M , Gongal Prajesh , Onuma Oyere , Nanna Michael
Published: June 2023

Introduction:
Although isolated systolic hypertension (ISH) and isolated diastolic hypertension (IDH) exhibit differing pathophysiology and phenotypes, it is unclear whether specific antihypertensive agents are preferred for each condition.

Methods:
Using data from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), we set out to determine whether certain antihypertensive agents had differential effects on clinical outcomes in patients with ISH or IDH. We defined ISH as SBP ≥140mmHg and DBP <90mmHg, and we defined IDH as SBP <140mmHg and DBP ≥90mmHg. We used risk-adjusted cox regression to evaluate the primary outcome (a composite of all-cause mortality, combined CHD, or stroke) by antihypertensive agent in cohorts of patients with ISH or IDH. We also evaluated achievement of normotension using risk-adjusted logistic regression.

Results:
We identified 12,845 patients with ISH and 1,259 patients with IDH. The adjusted hazard of the primary outcome was similar across antihypertensive agents for both ISH (aHR=1.01, 95% CI 0.94-1.09 for amlodipine vs chlorthalidone, and aHR=1.03, 95% CI 0.95-1.10 for lisinopril vs chlorthalidone) and IDH (aHR=1.06, 95% CI 0.80-1.41 for amlodipine vs chlorthalidone, and aHR=1.11, 95% CI 0.84-1.47 for lisinopril vs chlorthalidone) (Figure). There were no significant differences across antihypertensive agents in the achievement of normotension at six years for ISH (OR=1.01, 95% CI 0.89-1.15 for amlodipine vs chlorthalidone; and OR=0.97, 95% CI 0.85-1.10 for lisinopril vs chlorthalidone) or IDH (aOR=0.92, 95% CI 0.59-1.42 for amlodipine vs chlorthalidone; and aOR=0.77, 95% CI 0.49-1.21 for lisinopril vs chlorthalidone).

Conclusions:
In this large cohort of patients, clinical events were similar across antihypertensive agents for both ISH or IDH. These results lend credence to the flexible treatment recommendations in current hypertension guidelines.
Abstract 134: The Impact Of Alcohol Use On The Quality Of Cardiopulmonary Resuscitation: A Prespecified Analysis Of A Randomised Trial
Authors: Nas Joris , Thannhauser Jos , Vart Priya , Van Geuns Robert-jan M , Muijsers Hella , Mol Jan-Quinten , Aarts Goaris , Konijnenberg Lara , Gommans Frank , Ahoud-Schoenmakers Sandra , Vos Jacqueline , Royen Niels , Bonnes Judith , Brouwer Marc
Published: June 2023

Objectives:
Despite the undisputed impact of bystander cardiopulmonary resuscitation (CPR) in cardiac arrest, it is debated whether one should act as a rescuer after alcohol consumption, due to the perceived adverse effects. We provide the first objective data on the impact of alcohol use on CPR-quality and performance.

Methods:
Adult attendees of the Lowlands music festival (August 2019, the Netherlands) were randomized to virtual reality or face-to-face CPR-training. Randomisation was stratified according to alcohol level, measured using certified breathalyser tests. Alcohol levels are reported using the European unit of measure (‰), which is a factor of 10 higher than the US unit of measurement (%). Participants with an alcohol level ≥0.5‰ were only randomized if they successfully completed a tandem gait test. We studied three groups: alcohol level of 0‰ (Group 1), between 0 and 0.5‰ (Group 2) and ≥0.5‰ (Group 3).

Results:
We studied 352 participants, 56% female and median age 26 (22-31) years, with n=214 in Group 1, n=85 in Group 2 and n=53 in Group 3. There were no significant differences in compression depth and rate between the three study groups (depth: 57 [49-59] vs. 57 [51-60] vs. 55mm [47-59], p=0.16; rate: 115 [104-121] vs. 114 [106-122] vs. 111min
-1
[95-120], p=0.19), see also Figure 1. There was no significant difference in the proportions complying with guideline-endorsed depth or rate or in the overall CPR-scenario performance score. There were no significant correlations between alcohol level and compression depth (Spearman’s rho -0.113, p=0.19) or rate (Spearman’s rho -0.073, p=0.39).

Conclusion:
In this study on recently trained festival attendees, we found no association between alcohol level and CPR-quality or performance. These findings indicate that alcohol intake may not be a barrier for performing potentially lifesaving CPR.
Abstract 13404: Novel Sized-Based HDL Subspecies Demonstrate Inverse Associations With Incident Vascular Events
Authors: Deets Austin , Singh Kavisha , Chandra Alvin , Joshi Parag H , Khera Amit , Virani Salim S , Ballantyne Christie M , Otvos James D , Dullaart Robin , Gruppen Eke G , Connelly Margery A , Ayers Colby , Rohatgi Anand
Published: June 2023

Recent studies suggest that total high-density lipoprotein particle concentration (HDL-P) outperforms HDL cholesterol (HDL-C) in predicting atherosclerotic cardiovascular disease (ASCVD). Whether specific size-based HDL subspecies contribute to the atheroprotective effects of HDL-P remains unknown. Our objective was to assess size-based HDL subspecies for association with both incident myocardial infarction (MI) and ischemic stroke in a large, diverse cohort, expecting heterogeneous associations regarding subspecies and vascular endpoints.

Participants without prior ASCVD enrolled in the Dallas Heart Study, MESA, ARIC, and PREVEND were included as a single pooled cohort (N=15,371). Seven HDL size-based subspecies were quantified by NMR (LP4 algorithm; H1=smallest; H7=largest). The primary adjudicated outcomes over an average of 8-10 years of follow up were first MI and first ischemic stroke. Cox proportional hazards models included traditional ASCVD risk factors (except HDL-C) and all seven HDL subspecies.

As continuous variables, higher H1, H2 and H4 concentrations were associated with lower risk of MI (Panel A), whereas higher H2 and H4 concentrations were associated with lower risk of ischemic stroke (Panel B). The top vs bottom quartiles of H2 and H4 had 27-32% lower incidence of MI (HR Q4 vs. Q1 [95% CI]: H1 0.73 [0.58-0.91]; H2 0.69 [0.54-0.89]; H4 0.68 [0.54-0.86]) and no significant associations with ischemic stroke. Serial adjustment for HDL-C attenuated all associations with ischemic stroke. However, H1 and H4 retained significant inverse associations with MI adjusted for HDL-C (HR/SD [95% CI]: H1 0.88 [0.81-0.94]; H4 0.89 [0.82-0.97]).

H1 (small HDL) and H4 (medium HDL), but no large subspecies, demonstrated inverse associations with MI in a large multi-ethnic pooled cohort. Next steps include assessment of interactions by sex and race as well as incremental clinical utility of H1 and H4 compared to both HDL-C and total HDL-P in predicting MI.
Abstract 13405: Early Age at Menarche and Risk of Stroke - A Systematic Review and Meta-Analysis of Prospective Studies
Authors: BRERETON Brian , Bansal Prerna , Chintalapalli Patta Harika Varma , Jnaneswaran Geethu , Jasti Jaswanth Rao , Merugu Bhavyasri , Raju Athul Raj , George Blessy , Nunez Frailyn , Anil Peethambar Gowri , Desai Rupak
Published: June 2023

Background:
Despite previous studies exploring female reproductive factors, early menarche and its impact on stroke risk remains under-reported. This systematic review seeks to further explore this correlation.

Methods:
PubMed, SCOPUS and EMBASE databases were systematically reviewed for studies reporting long-term incidence and odds of stroke in patients who had menarche at an early age vs. menarche at a normal age. Random effects models were used for the meta-analysis and subgroup analysis. I2 statistics were used to identify substantial (>75%) heterogeneity. A sensitivity analysis was performed using the leave-one-out method.

Results:
Ten prospective studies with a total of 1,971,454 patients were included and the odds of stroke were evaluated for patients with early menarche vs controls. Overall unadjusted odds for stroke with early menarche was 1.14 (95%CI 1.08 -1.20, p<0.01, I2=0%). (Fig.1b) Adjusted odds ratio; [aOR 1.22 (95% CI 1.08 - 1.39), I2=86.85%, p<0.01]. (Fig. 1a) Leave-one-out sensitivity analysis confirmed equivalent results. (Fig.1c) On subgroup analysis, studies from the USA with early menarche had the highest stroke risk of countries reported (1.48, 95%CI 1.04-2.09) followed by China (1.26, 95% CI 1.09-1.45) and the UK (1.08, 95%CI 0.96-1.21). There was stronger stroke association with mean/median age cohort ≥ 60 yrs (1.43, 95% CI 1.08 - 1.89) vs <60 yrs (1.18, 95% CI 1.03 - 1.36).

Conclusions:
This meta-analysis revealed that early menarche is associated with a higher risk of stroke with the strongest association in women from the USA.
Abstract 13413: Clinical Outcomes of Right Ventricular Systolic Dysfunction in Patients With Heart Failure With Preserved Ejection Fraction: A Systematic Review and Meta-Analysis
Authors: Leelaviwat Natnicha , Mekraksakit Poemlarp , Kewcharoen Jakrin , Thangjui Sittinun , Saowapa Sakditad , Trongtorsak Angkawipa
Published: June 2023

Background:
Right ventricular systolic dysfunction (RVSD) is a known predictor of survival in patients with heart failure with reduced ejection fraction. However, the association between RVSD and heart failure with preserved ejection fraction (HFpEF) remains unclear.

Objectives:
We, therefore, conducted a systematic review and meta-analysis to assess the association between RVSD and HFpEF.

Method:
Two investigators independently searched the databases of MEDLINE and EMBASE from inception to April 28, 2022 to identify the study that reported outcomes of interest in HFpEF with or without RVSD. Primary outcome was a composite outcome of death and heart failure rehospitalization. Secondary outcome was all-cause mortality. RVSD was defined as right ventricular ejection fraction < 50% by echocardiography or cardiovascular magnetic resonance. Data from each study were combined using the random-effects model to calculate pooled hazard ratio (HR) and 95% confidence interval (CI).

Results:
Five observational studies involving 1,181 patients with HFpEF from December 2014 to May 2021 were included in our meta-analysis. The presence of RV systolic dysfunction in HFpEF patients was associated with a significantly higher risk of composite outcome of death and heart failure rehospitalization (HR 3.29; 95% CI 1.92-5.65; I2 = 52%) and all-cause mortality (HR 1.72; 95% CI 1.16-2.53; I2 = 68%) compared to those without RV systolic dysfunction.

Conclusions:
Our meta-analysis demonstrates that HFpEF patients with RVSD is associated with a worse outcome compared to those without RVSD.
Abstract 13419: Racial Differences in Patients With Spontaneous Coronary Artery Dissection: A Report of the ISCAD Registry
Authors: Wells Bryan J , Kim Esther S , naderi sahar , Leon Katherine , Gibson C M , Chi Gerald C , Grodzinsky Anna , Gornik Heather L , Lewey Jennifer , Taylor Angela , Kadian Dodov Daniella , Hess Connie N , Henkin Stanislav , Lindley Kathryn J , Morris Gretchen , Orford James L , Tam Lori M , Kumbhani Dharam J , Norris Samuel , Reyes Cassandra , Alkhalfan Fahad , Vitarello Clara , Martinez Andrea , Wood Malissa
Published: June 2023

Introduction:
Spontaneous coronary artery dissection (SCAD) is a nonatherosclerotic cause of myocardial infarction. The demographics and clinical differences based on race in patients with SCAD are not well understood.

Methods:
Demographics and clinical variables were obtained from the prospective, multicenter iSCAD Registry. Characteristics of study participants (including demographics, past medical history, timeline, imaging studies, follow-up visits, SCAD presentation, and treatment) were compared between white and non-white patients. Race and ethnicity was self-reported by a patient questionnaire.

Results:
A total of 505 patients were included in the analysis. Among them, 427 (84.6%) were characterized as white and 78 (15.4%) were characterized as non-white. White patients were 49.5 years and non-white patients were 46.8 years at the time of the initial SCAD presentation (p=0.0435). White patients were more likely to be married (77% vs 51%, p<0.0001) and were more likely to have a college degree (42 vs 28%, p<0.0001). White patients were more likely to present to the hospital in less than 24 hours (85% vs 75%, p=0.07) and have an angiogram in less than 24 hours (78% vs 58%, p=0.004). White patients were more likely to present with STEMI (30% vs 11%, p=0.004) and were more likely to receive revascularization (25% vs 11%, p=0.0147). A multivariable analysis explored the variables associated with angiography greater than 24 hours. STEMI vs NSTEMI [OR 0.090 (0.035 to 0.231), p<0.0001] and white vs non-white [OR 0.376 (0.188 to 0.755), p=0.0059] remained significant. White patients were more likely to have fibromuscular dysplasia (FMD), (43% vs 30%, p=0.0336). There was no significant difference in the number of non-coronary vascular imaging studies between the two groups.

Conclusions:
The number of non-white patients enrolled in the iSCAD registry is low. White patients with SCAD were more likely to present with STEMI and were more likely to have a diagnosis of FMD. Further research is needed to study associations between race and differences in presentation, comorbidities, and treatment in patients with SCAD.
Abstract 13420: Association of Digital ECG Biomarkers With Heart Failure Status
Authors: Najarro Gabriel , Li Louis , Andres Perez Alday Erick , Al-Abboud Omar , Anderson Blake J , Bahrami Rad Ali , Robichaux Chad , Clifford Gari , Shah Amit J
Published: June 2023

Introduction:
Electrocardiography (ECG) may be useful as an adjunct method for evaluating heart failure (HF) severity, but few studies have systematically examined the electrocardiographic parameters associated with heart failure volume status. This may include effects of hypervolemia on thoracic impedance, autonomic function, and subendocardial ischemia. We hypothesized that ECG parameters related to these mechanisms co-vary over time with brain natriuretic peptide, a measure of HF severity.

Methods:
A retrospective cohort was obtained from the Emory Clinical Data Warehouse for patients who had >2 ECGs performed >3 days apart and repeated BNP measures within 24 hours of each ECG. We quantified the change in HF status by calculating the differences in BNP value between each ECG acquisition time point. A total of 37 metrics were extracted from digitized ECGs as primary predictors and evaluated using multiple linear regression.

Results:
We evaluated 10,376 pairs of ECGs from 7,171 unique patients. The mean age was 66.9 years, 48% were women, and 51.4% were black . The median absolute change in BNP over time was 178 pg/mL (IQR 52-532), and the median sampling interval was 106 days (IQR 27-357). We evaluated interval, duration, and axis metrics from the P, QRS, and T vectors from the raw digital ECG and found 8 co-varied with BNP changes, including heart rate, P wave axis, QRS amplitude, QRS duration, QRS axis, ST segment, T wave amplitude, and frontal T wave axis (see table).

Conclusions:
We found several ECG metrics that quantify autonomic activity, depolarization, and repolarization associated with changes in HF status as measured by BNP. These findings may help to understand the downstream effects of hypervolemia on cardiovascular risk and also understand the potential role for certain ECG metrics in helping determine volume status, especially in low-resource settings not offering BNP.
Abstract 13432: Association Between a Deep Learning Enabled Algorithm Using ECG Signals to Predict Coronary Calcium and Survival
Authors: Medina-Inojosa Jose R , Medina-Inojosa Betsy , Shelly Michal , Attia Zachi , Sheffeh Mohammad Ali , Baez Suarez Abraham , Friedman Paul , Carter Rickey , Lopez-Jimenez Francisco
Published: June 2023

Background:
We developed a deep learning algorithm to predict elevated coronary artery calcium (CAC) score from 12-lead electrocardiograms (CAC- ECG). We tested the hypothesis that this CAC-ECG algorithm will independently predict long-term survival.

Methods:
We leveraged a historical cohort of 43,210 consecutive patients who from the years 1997-2020 underwent clinically indicated ECG-gated unenhanced chest computed tomography (CT) to identify and quantify CAC and had an ECG within 1 year of the CT. Data on cardiovascular risk (CV) factors, and to calculate the Pooled Cohort Equation (PCE) for ASCVD was collected as part of preventive cardiology or general medical evaluations. We used the oldest CAC in record and excluded those taking statins at the time of the CAC. The algorithm was trained in 60% of the cohort, and the association between CAC-ECG and survival was evaluated with multivariate cox proportional hazard models in 40% of the remaining observations.

Results:
Of the 17,284 evaluated patients, mean ± SD age 55.9 ± 9.9, 33% female, 3,714 (21%) had elevated CAC ≥ 300. During an average of 15±5.9 years follow-up, 848 (5%) patients died. The algorithm’s area under the receiving operating characteristics curve (ROC), sensitivity, specificity, and accuracy to detect a CAC ≥ 300 were 0.83, 0.90%, 0.56%, 0.60%. Those with elevated CAC had a nearly two-fold risk of death, a value similar to those deemed positive by the ECG-CAC algorithm (
Figure A
). Risk of death increased with CAC-ECG probability quartiles (
Figure A
). The CAC-ECG algorithm enhanced predicted capabilities of the PCE across all ASCVD risk subgroups (
Figure B
), as well as in those with no CAC and elevated CAC (
Figure C
), all
p
for trend <0.001.

Conclusions:
A deep learning-enabled CAC-ECG algorithm was independently associated with long-term survival and enhanced current risk prediction paradigms. The CAC-ECG algorithm could help identify individuals at risk in primary prevention of CV disease.
Abstract 13446: Predicting Cardiovascular Risk and Preempting Major Cardiovascular Events During CAR T Therapy
Authors: Eljalby Mahmoud , Christensen Bradley , Rao Anjali , Stephens Edward , Chandra Alvin , Vallabhaneni Srilakshmi , Zhang Kathleen , Ramakrishnan Praveen , Anderson Larry , Kaur Gurbakhahs , Awan Farrukh , Zaha Vlad G
Published: June 2023

Chimeric antigen receptor (CAR) T cell therapy is a breakthrough personalized, genetically engineered therapy that has been proven effective for the treatment of refractory multiple myeloma and large B cell lymphoma. However, significant major adverse cardiovascular events (MACE) have been reported with its application. To further investigate associated risk factors for MACE, we performed a retrospective analysis of a cohort of consecutive patients treated with CAR T therapy at our center. Clinical, laboratory and imaging parameters were collected for 48 patients. Of these, 7 patients (14.6%) had a MACE event. Variables analyzed included age, sex, body mass index, coronary artery calcium, lipid profile, baseline medications, preceding anthracycline or carfilzomib exposure, cancer type, cytokine release syndrome (CRS), immune effector cell-associated neurotoxicity syndrome (ICANS), tocilizumab, among others (Table). Peak C-reactive protein (CRP, median [IQR]) level was 76.00 (73.1) mg/dL in patients without MACE and 121.30 (133.22) mg/dL in patients with MACE,
p
= 0.028). CRS and ICANS grades were associated with MACE events (
p
= 0.039 and 0.03, respectively). No echocardiographic differences were found. Our results indicate that the degree of inflammatory response, reflected by peak CRP level, is associated with MACE events in patients receiving CAR T therapy. These data suggest that inflammatory markers may be clinically relevant predictors of subsequent MACE complications in patients receiving CAR T therapy. Prospective inflammation monitoring and anti-inflammatory strategies may preempt MACE in this patient population.
Abstract 13473: Impaired Atrial Natriuretic Peptide Potency in Human Acute Decompensated Heart Failure and Therapeutic Potential of a Novel Designer Peptide (MANP) Using an Innovative Ex-Vivo Precision Medicine Assay
Authors: Reginauld Shawn H , Zheng Ye , Moroni Dante , Ma Xiao , Chen Horng , CANNONE Valentina , Sangaralingham Jeson , Burnett John C
Published: June 2023

Introduction:
Atrial natriuretic peptide (ANP) is the most potent endogenous activator of the guanylyl cyclase A receptor (GC-A) mediating cardiorenal protective actions by increasing cGMP production. To test the hypothesis that acute decompensated heart failure (ADHF) is associated with increased circulating ANP but with reduced GC-A potency, we developed an ex-vivo precision medicine assay to quantify the potency of circulating ANP in plasma from healthy and ADHF subjects. Further, we assessed the ex-vivo potency of MANP, a novel ANP analog with greater cGMP activation than ANP, also using plasma of healthy and ADHF subjects.

Methods:
For the potency assay, we engineered HEK293 cells to overexpress human GC-A. Plasma from individual healthy (n=4) and ADHF (n=4) subjects was incubated in the assay and cGMP was assessed. The endogenous ANP derived cGMP was evaluated against the cGMP response of equimolar synthetic ANP (S
ANP
) to assess potency of ANP from each cohort. MANP mediated cGMP generation was also assessed in the assay using healthy and ADHF plasma.

Results:
Healthy plasma, in which plasma ANP was 26±5 pg/mL, generated 10.3±0.7 pmol/mL of cGMP. S
ANP
added to the assay to mimic endogenous ANP levels in healthy subjects produced 7.8±0.5 pmol/mL of cGMP. ADHF plasma with markedly elevated ANP (350±57pg/mL) generated 23.5±3.1 pmol/mL of cGMP. S
ANP
mimicking plasma ANP in ADHF produced 59.7±13.8 pmol/mL of cGMP, which was greater than cGMP generated from ADHF patient-derived plasma (p<0.05), consistent with reduced potency of endogenous ANP in ADHF. Low treatment dose of MANP (LD
MANP
; 10
-8
M) in healthy plasma increased cGMP to 45±5.5 pmol/ml while high treatment dose (HD
MANP
; 10
-6
M) increased cGMP to 167.1±14.1 pmol/mL. In markedly elevated ANP ADHF plasma, LD
MANP
increased cGMP to 60.4±9.7 pmol/mL while HD
MANP
increased cGMP to 200.8±5.4 pmol/mL (p<0.03 for both) demonstrating similar cGMP production by MANP in healthy and ADHF plasma.

Conclusions:
Employing a novel ex-vivo precision medicine ANP/GC-A/cGMP assay, we conclude that ADHF is characterized by elevated ANP yet with impaired potency in GC-A activation and cGMP generation. MANP overcomes this impairment and serves as a potential efficacious GC-A activating therapeutic in heart failure.
Abstract 13488: Strain versus Right Heart Catheterization in Decompensated Heart Failure With Preserved Ejection Fraction
Authors: Tran Nathanael , Shaar Mohammad , Al Sudani Hussein , Sedhom Ramy , Akhtar Hamza , Lo Kevin , Pressman Gregg S
Published: June 2023

Background:
Heart Failure (HF) is a complex cardiovascular (CV) disease with half of patients having preserved ejection fraction (HFpEF). Right heart catheterization (RHC) is often used to prognosticate and guide therapy in decompensated HFpEF while strain echocardiography is increasingly being used as an alternative modality.

Purpose:
To evaluate the prognostic impact of strain imaging compared to RHC in hospitalized patients with decompensated HFpEF.

Methods:
This was a retrospective cross-sectional study with patients hospitalized for acute HFpEF exacerbation with echo and RHC data available during index admission. Strain analysis was performed using 2D strain imaging software. Demographic and clinical parameters were obtained with mortality data via National Death Index. The outcomes of interest were 6 month, 1 year and 5 year all cause mortality and a composite of CV death with HF readmissions. Separate models incorporating all variables were done using survival analysis by multivariable Cox regression after adjusting for age, gender and race.

Results:
A total sample of 178 patients was included in the analysis. The mean age±SD was 69.4±13.5. Majority were African American (50%) and female (62%). Half(53%) had diabetes while 88% had hypertension. The 5 year all cause mortality rate was 45% with CV death at 18% and overall readmission rate was 29%. Only mean pulmonary artery pressure (mPAP) was significantly predictive of 6 month all cause mortality HR 2.01; 95% CI (1.07-3.78) p=0.031 and 5 year all cause mortality 1.91; 95% CI (1.46-2.51) p<0.001. For the composite outcome of combined CV death and HF readmissions, right atrial reservoir strain was significant at the 6 month and 1 year time periods with HR 0.65; 95% CI (0.44-0.96) p=0.03 and HR 0.60; 95% CI (0.41-0.89) p=0.01 respectively.

Conclusions:
RHC and strain variables may be predictive of different outcomes in decompensated HFpEF.
Abstract 13493: Microalbuminuria During Acute Coronary Syndrome: Association With Very Long-Term Mortality and Causes of Death. The ABC-8* Study on Heart Disease
Authors: Berton Giuseppe , Mahmoud Heba T , Cordiano Rocco , Palmieri Rosa , Cavuto Fiorella , Mahmoud Moemen M , Sitta Nadir , Merotto David , Menegon Francesco , Palatini Paolo
Published: June 2023

Background:

Microalbuminuria is associated with adverse outcome in acute coronary syndrome (ACS) patients.

Methods:

To evaluate the very long-term association between microalbuminuria during ACS and the overall mortality and causes of death, we prospectively studied 579 ACS patients admitted to three Italian hospitals. The baseline albumin-to-creatinine ratio (ACR) was measured on days 1, 3, and 7 in 24-h urine samples. Patients were followed for 22 years or until death.

Results:

Virtually all patients completed the follow-up, representing 6756 person-years. During follow-up, 449(78%) had died: 41% due to non-sudden cardiac death (non-SCD), 19% sudden cardiac death (SCD), 40% due to non-cardiac (non-CD) death. The unadjusted Cox regression analysis showed that ACR is a significant predictor of all-cause mortality (HR:1.26; 95%CI 1.22-1.31; p˂0.0001) and the 3 causes of death (HR:1.40; 95%CI 1.32-1.48; p˂0.0001), (HR:1.22; 95%CI 1.12-1.32; p˂0.0001) and (HR:1.16; 95%CI 1.09-1.23; p˂0.0001) for non-SCD, SCD and non-CD respectively. Yet the fully adjusted model showed that ACR is a significant independent predictor of all-cause mortality (HR:1.12; 95%CI 1.08-1.16; p˂0.0001) and only non-SCD (HR:1.21; 95%CI 1.14-1.29; p˂0.0001).A positive interaction between ACR and history of AMI (HR:1.15; 95%CI 1.03-1.29; p=0.01), and the presence of heart failure during admission (HR:1.11; 95%CI 1.01-1.24; p=0.04), and a negative interaction with LVEF (HR:0.89; 95%CI 0.80-0.99; p=0.03) for all-cause death was also observed at the multivariable level.

Conclusion:

This prospective study shows that baseline ACR during ACS seems to be a strong independent predictor of the very long-term mortality risk, chiefly associated with non-sudden cardiac death. A positive independent interaction with indicators of heart failure has been also observed.

Figure 1:
Relative hazard estimates for all-cause and cause-specific mortality 22 years after ACS according to baseline ACR.
Abstract 13504: The New Cigarette? Cannabis Use as a Potential Risk Factor for Acute Coronary Syndrome
Authors: Alshami Abbas , Douedi Steven , Ramirez Luz , Museedi Abdulrahman , Hussaini Najia , Douedi Hani , Varon Joseph
Published: June 2023

Introduction:
With new legislation becoming more lenient regulating recreational cannabis use in the United States, the prevalence of cannabis has doubled since 2002 and continues to rise. While there have been some reports of the benefits of cannabis, medical literature has identified several adverse cardiovascular events. Cannabis as a significant risk factor for the acute coronary syndrome (ACS) has been suspected to be attributed to vascular inflammation and platelet activation as well as elevation in heart rate and blood pressure through sympathetic stimulation.

Methods:
We conducted a case-control study utilizing the Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS) 2019 database to investigate hospitalizations for patients aged 18 years old or older with the primary diagnosis of ACS. Comorbidities were identified through their international classification of diseases, 10th revision (ICD-10 codes) recorded in the discharge record for each hospitalization. Records having cocaine or other stimulants were excluded. An alpha (p) value less than 0.05 was considered statistically significant.

Results:
Of the 34,948,093 records included in the study, 225,275 had a primary diagnosis of ACS, and 767,525 had evidence of cannabis use. The rate of cannabis use in the ACS group (2%, n= 4,490) was lower than the non-ACS group (2.2%, n=763,035, p<0.001), while the rate of smoking was higher in the ACS group [49.5% (n=111,405) vs 31.2% (n=10,840,496), p<0.001] . However, after adjusting for other cardiovascular risk factors in a multivariable logistic regression model, the odds of cannabis use were comparable to smoking (Table 1).

Conclusions:
In this retrospective case-control study, the odds of cannabis use were similar to the odds of smoking in the records with a primary admission diagnosis of ACS, highlighting cannabis as a strong potential cardiovascular risk factor. Prospective cohort studies are warranted to establish the causality.
Abstract 13505: COVID-19 and Cardiovascular Disease Patient Hearts Harbor Sympathetic Remodeling and Altered Angiotensin Converting Enzyme 2 Localization
Authors: Kellum Creighton L , Nelson Tasha K , Benson Paul V , Wagener Brant M , Hoover Donald B
Published: June 2023

Cardiac complications of COVID-19 have been well described and are associated with significant morbidity and mortality. Concomitantly, various pre-existing cardiovascular diseases (CVDs) are established risk factors for developing severe COVID-19 illness and death. The mechanisms of cardiac injury after COVID-19 remain incompletely understood. Further, whether and how SARS-CoV-2 directly infects the heart is unclear. In this study, we investigated cardiac sympathetic innervation and the cellular localization of angiotensin converting enzyme 2 (ACE2) to test the hypothesis that pre-existing or acute changes in these parameters could contribute to cardiac complications of COVID-19. We performed immunohistochemical (IHC) analysis on sections of left ventricular (LV) wall from twenty autopsied human hearts consisting of a control group, a CVD group, and COVID-19 ARDS and COVID-19 non-ARDS groups. Using tyrosine hydroxylase as a noradrenergic marker, we observed substantial sympathetic nerve loss in CVD LVs compared to the control group, which is consistent with previous work suggesting loss of sympathetic activity in severe heart failure. Additionally, we observed mild and heterogeneous nerve loss in both COVID-19 groups. Using an ACE2 antibody, we observed robust transmural staining localized to pericytes in the control group. The CVD hearts displayed significant loss of ACE2 in pericytes and increased ACE2 in cardiomyocytes. Both COVID-19 groups displayed a modest increase in cardiomyocyte ACE2 compared to controls, and pericyte ACE2 staining was generally maintained. We also performed IHC for PDGF receptor β, an established marker for pericytes, and confirmed ACE2 localization to pericytes. The observed sympathetic nerve remodeling could play a key role in arrhythmogenesis in acute or post-acute COVID-19 patients. Further, if SARS-CoV-2 does infect the heart, then our data demonstrate the primary target would be through microvasculature associated pericytes, not cardiomyocytes. Finally, the upregulation of cardiomyocyte ACE2 in both CVD and COVID-19 groups could play a contributing role in COVID-19 associated cardiac injury or a compensatory role in cardiac pathogenesis by attenuating the local effects of angiotensin II.
Abstract 13507: Early Diastolic Strain Rate Before Coronary Artery Bypass Grafting Predicts Atrial Fibrillation Following Hospital Discharge
Authors: Lassen Mats C , Lindberg soeren , Olsen Flemming J , Fritz-Hansen Thomas , Pedersen Sune H , Iversen Allan , galatius soeren , Mogelvang Rasmus , Biering-Srensen Tor
Published: June 2023

Introduction:
Early mitral inflow velocity indexed to early diastolic strain rate (E/e’sr) is a novel echocardiographic parameter to non-invasively estimate early left ventricular (LV) filling pressure.

Hypothesis:
E/e’sr is associated with development of atrial fibrillation (AF) following coronary artery bypass grafting (CABG) and that it is superior to the conventionally used E/e’, as E/e’sr reflects the global relaxational properties of the LV whereas E/e’ only considers the myocardial movement at the level of the mitral annulus.

Methods:
A cohort of 623 consecutive patients undergoing isolated CABG at a single center was included. Prior to the CABG procedure, all patients had an echocardiography performed including two-dimensional speckle tracking (2DSTE). The outcome was incident AF after hospital discharge. Cox hazard regression models were used to assess the association between E/e’sr and incident AF. Restricted cubic splines were used to assess linearity of the relationship between E/e’sr and AF.

Results:
The mean age of the cohort was 67±9 years, 84% were male and mean left ventricular ejection fraction (LVEF) was 50±11%. During follow-up (median: 3.7 years, IQR: 2.6, 4.9) a total of 67 patients (11%) developed AF. E/e’sr and E/e’ were both significantly associated with the outcome in univariable models (p=0.029 and p=0.006, respectively). Increasing E/e’sr was found to be linearly associated with an increased risk of AF (
Figure
). Following multivariable adjustment for age, sex, hypertension, diabetes, EuroSCORE II, serum cholesterol, smoking status, heart rate, number of culprit arteries, LVEF, LV mass index, and left atrial volume index, E/e’sr remained significantly associated with AF (HR:1.06 [1.01-1.12], p=0.038, per 10cm increase) whereas E/e’ did not (HR:1.05 [0.99-1.11], p=0.068, per 1 unit increase).

Conclusions:
Preoperative E/e’sr as measured by 2DSTE was found to be independently associated with development of AF following CABG.
Abstract 13515: LDL-Cholesterol, Coronary Plaque, and Resilience to Coronary Atherosclerosis in a Middle-Aged Asymptomatic US Population: The Miami Heart Study at Baptist Health South Florida
Authors: Hagan Kobina , Cainzos Achirica Miguel , Mszar Reed , Ali Shozab S , Arias Lara , Saxena Anshul , Cury Ricardo C , Budoff Matthew , Feldman Theodore , Lahan Shubham , Blaha Michael J , Shapiro Michael D , Sharma Garima , Santos Raul D , Fialkow Jonathan , Nasir Khurram
Published: June 2023

Introduction:
The interplay between LDL-C and coronary plaque has not been described in contemporary, asymptomatic US cohorts undergoing CCTA assessment. Also, the prevalence of resilience to coronary atherosclerosis despite high LDL-C in the general primary prevention population is poorly understood.

Methods:
Cross-sectional analysis using data from the ongoing, prospective Miami Heart Study. Descriptive statistics were computed among statin-naïve participants by LDL-C levels (<70, 70-100, 100-130, 130-160, 160-190, ≥190 mg/dL) and a combined group of statin-naïve with LDL-C≥190 and statin users with LDL-C≥130 (“high LDL-C”). Study outcomes included CAC=0 vs >0, any plaque on CCTA, maximal stenosis ≥50%, and ≥1 and ≥2 high-risk plaque features. Logistic regression models evaluated associations between LDL-C and the outcomes, adjusting for other risk factors.

Results:
The demographics and outcomes of 1,808 participants not on statin are summarized in the Table by LDL-C levels. Higher LDL-C levels were strongly and independently associated with CAC>0 (fully adjusted OR for LDL≥190 vs <70 mg/dL: 2.62, 95%CI 1.04, 6.60) and had a marginally significant association with any plaque (fully adjusted OR: 2.26, 95%CI 0.95, 5.37). However, among participants with LDL-C≥190, 54% had CAC=0, and 40% no plaque. Similar numbers were observed among participants with “high LDL-C” (N=159), in which 45% had CAC=0 and 35% no plaque. Among those with high LDL-C and CAC=0, approximately 28% had non-calcified plaque on CCTA, although the prevalence of high-risk plaque findings was very low.

Conclusions:
LDL-C is strongly associated with coronary atherosclerosis. However, in this cohort (mean age 53 years; 54% women), CAC=0 and the absence of coronary plaque were frequent findings among individuals with high LDL-C. These observations may be used to inform more personalized paradigms in ASCVD risk assessment and in the allocation of novel LDL-C-lowering therapies in this group.
Abstract 13522: Gender Disparities in Low Density Lipoprotein Cholesterol Management Across the Spectrum of Atherosclerotic Cardiovascular Diseases: Insights From the Houston Methodist Cardiovascular Disease Learning Health System Registry
Authors: Shahid Izza , Satish Priyanka , Gullapelli Rakesh , Nicolas Charlie , Nwana Nwabunie , BOSE BUDHADITYA , Lahan Shubham , Mahajan Shiwani , Roy Trisha , Sharma Garima , Andrieni Julia , Jones Steven R , Cainzos Achirica Miguel , Nasir Khurram
Published: June 2023

Introduction:
Statin utilization for LDL-C lowering remains the cornerstone management strategy to reduce the risk of ASCVD. While lower statin utilization has been reported among women compared to men, contemporary studies evaluating sex disparities in LDL-C management across the spectrum of ASCVD are lacking, particularly across age and racial/ethnic subgroups. We aimed to provide detailed insights into this using data from a large US healthcare system.

Methods:
Cross-sectional study using data from ∼1.1 million patients aged 18+ years in the Houston Methodist Learning Health System Registry (2016-2022). Prevalent ASCVD including CAD, PAD, and stroke were identified using ICD 10-CM codes. Statin use and dose were identified in the database using ATC codes, and this information was recorded based on medication reconciliation reviews with patients at each clinical encounter. Individuals (n=973,720) without established ASCVD were excluded.

Results:
The study population consisted of 97,819 patients with prevalent ASCVD (55% men; 45% women, mean age: 69 years, 19% NHB, 12% Hispanic). Women with ASCVD reported lower statin use (64.3% vs 72.6%) and lower high-intensity statin use (29.8% vs 42.5%) compared with men. Women were also less likely to have on-treatment LDL-C <70, and this was true for total ASCVD (21.8% vs 30.6%), CAD (24.9% vs 32.9%), PAD (23.2% vs 32.6%), and stroke (20.9% vs 30.1%). These disparities persisted across age (<45, 45-64, >65 years) and racial/ethnic (NHW, Hispanics, NHB, Asian/Other) strata.

Conclusion:
Significant gender disparities exist in contemporary LDL-C management among US patients with ASCVD, with women being less likely to receive any and high-intensity statin therapy, and reach the guideline defined goal of LDL-C <70 mg/dL than men across age and racial/ethnic subgroups. These disparities underscore the need for further research to understand their drivers, and targeted systemwide programs to overcome care gaps.
Abstract 13523: The Role of Mitochondrial-Associated-Membranes in Ca-Dependent Arrhythmias
Authors: Deb Arpita , ADEKANYE OLUWABORI , Knollmann Bjorn C , Liu Bin
Published: June 2023

Introduction:
Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a stress-induced arrhythmic syndrome due to genetic defects of the sarcoplasmic reticulum (SR) Ca release channel complex of ryanodine receptor 2 (RyR2). Recent studies suggest that mitochondria function as a protective Ca buffer to absorb RyR2-mediated aberrant Ca release in CPVT. However, the molecular mechanism underlying the protective Ca buffering function of CPVT mitochondria remains unclear.

Hypothesis:
We hypothesize that the tethering between SR and mitochondria, also known as mitochondria-associated-membranes (MAMs) are promoted in CPVT to facilitate SR-mitochondria Ca transfer. Moreover, manipulating SR-mitochondria tethering or MAMs impacts arrhythmogenesis in CPVT.

Methods:
Ventricular myocytes were isolated from a CPVT model of CASQ2 knockout (Cnull) mouse. Cellular immunofluorescence assays and western blots were employed to detect MAMs remodeling in CPVT cells. Pharmacological approach was employed to disrupt MAMs and examine its effect on cellular arrhythmogenesis using live-cell imaging.

Results:
SR-mitochondria tethering was assessed by examining the interaction between RyR2 and Voltage-dependent anion channel (VDAC), a protein localized in the mitochondrial-outer-membrane. As compared with wild-type (WT), we detected a higher degree of colocalization of immunofluorescence between RyR2 and VDAC in Cnull cells, as well as increased RyR2-VDAC interactions by proximity ligation assay. The expression of SR-mitochondria tethering protein Mitofusin2 was increased in MAMs isolated from CPVT hearts. Colchicine was employed to induce a partial disruption of MAMs in Cnull cells. In intact Cnull cells perfused with β agonist isoproterenol, colchicine exacerbated arrhythmogenic Ca waves. In permeabilized cells, colchicine increased the frequency of arrhythmogenic Ca waves and reduced mitochondrial Ca uptake.

Conclusions:
Our results support that MAMs are promoted in CPVT cells to facilitate SR-mitochondria Ca transfer so mitochondria can function as a protective Ca buffer. Pharmacological disruption of SR-mitochondria tethering limits SR-mitochondria Ca transfer, thus exacerbating cellular arrhythmic burden.
Abstract 13533: Communication With Family Caregivers is Beneficial for Improving Health-Related Quality of Life in Patients With Heart Failure
Authors: Chung Misook L , Lennie Terry A , Miller Jennifer , Cha Geunyeong , Moser Debra K
Published: June 2023

I
ntroduction:
Supportive relationships within dyad members involved in heart failure (HF) self-management are beneficial in improving the outcomes of patients. Perceived control over a health condition and depressive symptoms are known to affect health-related quality of life (QoL). Little is known about how mutual support enhances health-related QoL in patients with HF. The purpose of this study was to examine the association between supportive relationship and QoL and whether the association is mediated by perceived control and depressive symptoms in patients with HF.

Methods:
A total of 155 patients with HF (mean age = 60 years, 65% male, 77% married) completed questionnaires including supportive relationships in communication, decision-making, and reciprocity (Shared Care Instrument [SCI]), perceived control (Control Attitude Scale-Revised), depressive symptoms (Patients Health Questionnaire), and QoL (Minnesota Living with HF). A parallel mediation model was conducted adjusted for age, sex, and functional status (Duke Activity Status Index).

Results:
Decision-making and reciprocity were not associated with QoL directly and indirectly through the two mediators. Communication was also not directly associated with QoL (Figure 1), but was indirectly related through perceived control (indirect effect = -.177, 95% CI -.288 to -.004) and depressive symptoms (indirect effect = -.576, 95% CI -.883 to -.310). It means that patients who were highly communicative with family caregivers were more likely to have better QoL because of increased perceived control over health conditions and decreased depressive symptoms.

Conclusion:
HF management involves interdependent interactions between patients and family caregivers. The findings suggest that the use of supportive communication strategies to increase perceived control and depressive symptoms between dyad members in HF management may be beneficial in improving the quality of life in patients with HF.