bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 15576: The Association of Structural Racism With Cardiovascular Disease Death Rates
Authors: Williams Amaris , Adesanya T.M. Ayodele M , Brock Guy , Joseph Joshua J
Published: December 2023

Background
Structural racism is an upstream influencer of social determinants of health, which impact cardiovascular disease (CVD) death rates. The association between structural racism and CVD death rates has not been conclusively quantified, and this association may vary by race/ethnicity.

Method
Year 2020 census data on disparities in income, wealth, education, employment, and digital access and segregation were available at the census block group level and were used to quantify structural racism’s effects. Data from each block group and its 9 nearest neighbors were used to compute the structural racism sub-scores for that block group, which were transformed to a scale of 1-100 based on 100 quantiles. The composite score was then calculated as the weighted sum of the sub-scores (weights in Table 1).

Mean structural racism score (SRS), weighted by population of each block group, was computed for each county in the United States. Then SRS was fit as the exposure in linear models controlling for state and predicting 2020 county-level CVD death rates per 100,000 adults for all residents, non-Hispanic Black (NHB) residents, non-Hispanic White (NHW) residents, and Hispanic residents, as reported by the Centers for Disease Control.

Results:
Data from 50 states and the District of Columbia were used (3137 counties). A 1-point higher SRS score (range 1-100) was associated with 1.0 (95% CI: 0.8, 1.3) more CVD deaths per 100,000 adults. Among NHB residents, there were 1.5 (95% CI: 1.0, 2.0) more CVD deaths per 1-point higher SRS score. Among Hispanic and NHW residents, CVD deaths were 0.8 (95% CI: 0.4, 1.2) and 0.6 (95% CI: 0.3, 0.8) higher per 1-point higher SRS.

Conclusion:
Structural racism is associated with greater CVD mortality among all United States residents, but the magnitude of association is greatest among NHB residents. Eliminating structural racism is likely to reduce CVD mortality of all residents while reducing race-based disparities in CVD mortality.
Abstract 15597: Unlocking Rate Control in Atrial Fibrillation: A Closer Look at the Intravenous Diltiazem and Metoprolol Duel - An Updated Systematic Review and Meta-Analysis
Authors: Khan Syed Zamrak , khan Muhammad Aslam , Akbar Usman , Farooq Saad , Shafique Nouman , Bhatta Ghanshyam
Published: December 2023

Background:
Intravenous beta-blockers and calcium channel blockers remain first-line therapeutic agents for hemodynamically stable atrial fibrillation patients with a rapid ventricular rate (AF-RVR) in emergency medical settings.

Material and

Methods:
We conducted a thorough review of various sources, including PubMed, Embase, Cochrane databases, and clinicaltrials.gov registry. Our search covered the period from the inception of these databases up to May 20, 2023. We only selected studies that compared the effectiveness and safety of diltiazem and metoprolol in adult patients with AF-RVR who were in emergency medical settings or hospitalized. We focused on whether the drugs successfully controlled heart rate and if there were any cases of hypotension or bradycardia following drug administration.

Results:
Among the 150 identified studies, 19 were suitable. All these studies demonstrated a low to moderate risk of bias. The meta-analysis, using the Mantel-Haenszel random-effects model, revealed a higher success rate in achieving the rate control target with diltiazem compared to metoprolol [19 studies, n = 1732, Odds Ratio (OR): 1.65; 95% Confidence Intervals (CI):1.18 to 2.32; I^2 = 58%, P = 0.001]. In terms of safety, no significant difference was observed in the risk of hypotension with either drug [15 studies, n = 1477, OR: 1.12; 95% CI: 0.76 to 1.64; I^2 = 25%, P = 0.18]. However, an incidence of bradycardia was noticed with diltiazem [7 studies, n = 1203, OR: 2.85; 95% CI: 1.25 to 6.46; I^2 = 21%, P = 0.27].

Conclusions:
For patients with AF-RVR, intravenous diltiazem was more successful in achieving the desired rate control than metoprolol. Both drugs had similar rates of hypotension, but diltiazem had a slightly higher risk of bradycardia. These results indicate that diltiazem may be a better option for rate control in AF-RVR patients. However, high-quality randomized studies are needed to assess both medication's long-term safety and effectiveness in this group.
Abstract 15631: A Precision Medicine Approach to Predicting Pathogenicity Among Population Variants in Hypertrophic Cardiomyopathy-Associated Genes in the UK Biobank
Authors: Kurzlechner Leonie M , Bair Courtney , Monaco Gabrielle , Gurumoorthi Manasa , Sharaf Dabbagh Ghaith , Kishnani Sujata , Tadros Hanna J , Shah Ravi , Patel Viraj , Chahal Anwar A , Landstrom Andrew P
Published: December 2023

Introduction:
Genomic and precision medicine have opened the door to predictive genetic testing to identify those at risk of cardiac disease before its development. This is important for hypertrophic cardiomyopathy (HCM), the most prevalent heritable heart muscle disease. A major hurdle to accurate predictive testing is the markedly higher prevalence of HCM-associated variants than of disease. New approaches are needed to discern which disease-causative, “actionable,” variants.

Objective:
To develop and validate a precision medicine approach for predicting pathogenicity of population-identified HCM-associated variants.

Methods:
We used phenotypic and genotypic data from the UK Biobank (UKBB). We filtered for missense variants in “definitive” (ClinGen) HCM genes. Our novel precision medicine tool,
DiscoVari
, provides signal-to-noise (S:N) analysis comparing disease to population variant frequency to identify pathogenic genetic ’hotspots’. We used reverse phenotyping to correlate evidence of HCM and sequelae (sudden death, heart failure, ventricular arrhythmias, atrial fibrillation, chest pain, pacemaker/ICD) to S:N hotspots. Variants were re-evaluated using American College of Medical Genetics and Genomics (ACMG) criteria; those in S:N hotspots met PM1 criteria.

Results:
Variants of uncertain significance (VUSs) in HCM genes had a prevalence of 21.8% in the UKBB, with PM1 determining variant call in 25.7% [24.9-26.6] of HCM-gene variants. Using SN enriched for HCM (0.35% with HCM without PM1 and 0.83% with PM1, p < 0.01). InterVar did not enrich for HCM (0.71% with HCM with PM1 and 0.51% without PM1). DiscoVari reduced the likely pathogenic/pathogenic (LPP) variant burden in individuals without HCM (11.8% compared to InterVar (25.9%, p < 0.0001). DiscoVari enriched for LPP variants in those with HCM (36.1%, p < 0.0001) compared to healthy individuals, while InterVar did not.

Conclusion:
VUSs are common in HCM genes in the population and PM1 is crucial for accurate variant classification. Incorporating DiscoVari S:N into ACMG guidelines improves prediction of variants associated with HCM, or subclinical cardiomyopathy.
Abstract 15649: Human Induced Pluripotent Stem Cell-Derived Cardiac Fibroblast Assembled Extracellular Matrix Rescues Cardiac Function in an Acute Myocardial Infarction Mouse Model
Authors: Schmuck Eric G , Giles Jasmine , Hacker Timothy A , Rodgers Allison , Taylor Rachel , Kamp Timothy J , Raval Amish N
Published: December 2023

Background:
Acute myocardial infarction (AMI) is the leading cause of heart failure (HF). Therapies to curb post-AMI pathological left ventricular remodeling could reduce the burden of HF. Human iPSC derived cardiac fibroblast assembled extracellular matrix (iCFX) is a novel acellular biomaterial that consists of a unique blend of extracellular matrix proteins with tissue reparative potential. We hypothesize that direct cardiac injection of iCFX into the peri-infarct border in a mouse AMI model will restore cardiac function and reduce pathological remodeling.

Methods:
Acute MI was induced by permanent ligation of the left anterior descending coronary artery in 10-week immunocompetent C57BL/6 mice. iCFX was supplied by Cellular Logistics Inc, Madison, WI. One day post-AMI, mice were randomly treated with a 50 microliter epicardial injection of either PBS control, 1 mg iCFX or 10 mg iCFX. Baseline and 28-day echo were performed.

Results:
At baseline, there were no differences in any echo parameter between treatment groups. By 28 days post treatment, mice treated with 10 mg iCFX had increased ejection fraction ((25.8+/-3.1% (n=8) vs. (13.9+/-1.8% (n=11) p=0.001), fractional shortening ((15.5+/-2.0% (n=8) vs. 6.9+/-1.3%) (n=11) p=0.003), and cardiac output (16.0+/-2.3 ml/min (n=8) vs. 9.7+/-1.2 ml/min (n=11) p=0.002) compared to placebo treated animals. The 1 mg dosing group showed non-significant improvements in contractility parameters. Reduced end systolic and end diastolic volumes in the 10 mg group was observed, but these were not statistically significant.

Conclusions:
Therapeutic administration of human iCFX was associated with significant improvements in left ventricular contractility following AMI in an immunocompetent mouse model. Furthermore, a clear dose response pattern was observed.
Abstract 15654: Layered Plaques and Plaque Vulnerability in Patients With Stable Angina Pectoris
Authors: Niida Takayuki , Daisuke Kinoshita , Suzuki Keishi , Yuki Haruhito , Fujimoto Daichi , Dey Damini , Lee Hang , McNulty Iris , Ferencik Maros , Kakuta Tsunekazu , Jang Ik-kyung
Published: December 2023

Backgrounds:
Layered plaque, a signature of previous plaque destabilization and healing, is one of the predictors for rapid plaque progression, the mechanism of which is unknown.

Aims:
To investigate the level of vascular inflammation and plaque vulnerability in layered plaques to elucidate possible mechanisms of rapid plaque progression.

Methods:
Patients who underwent both coronary computed tomography angiography (CTA) and optical coherence tomography (OCT) were selected. Plaques were defined as any tissue (noncalcified, calcified, or mixed) within or adjacent to the lumen. Pericoronary adipose tissue (PCAT) attenuation was measured at the plaque level on CTA. OCT features of plaque vulnerability were assessed at the corresponding site.

Results:
A total of 475 plaques from 195 patients presented with stable angina pectoris were included. Layered plaques (n=241), compared to non-layered plaques (n=234), had a higher level of vascular inflammation (-70.94 [-77.86, -64.66] HU vs. -73.52 [-80.83, -67.66] HU, P=0.014, Figure 1). Layered plaques also had a higher prevalence of the features of plaque vulnerability (Figure 2), including lipid-rich plaque (83.8% vs. 66.7%, P<0.001), thin-cap fibroatheroma (TCFA) (26.1% vs. 17.5%, P=0.026), microchannel (61.8% vs. 34.6%, P<0.001), and cholesterol crystal (38.6% vs. 25.6%, P=0.003).

Conclusions:
Layered plaque was associated with higher levels of vascular inflammation and plaque vulnerability, which might play an important role in plaque progression.
Abstract 15659: Bupropion Overdose Requiring Veno-Arterial Extracorporeal Membrane Oxygenation
Authors: Golob Stephanie , Ting Peter , Pires Kyle , Soetanto Vanessa , Pagano Benjamin , Wan Kah-Loon , Hall Sylvie , Bianco Lauren , Hawkins Joseph , Schimmer Hannah , Yunaev Victoria , Howe William , Landau Jessica , Greco Allison , Postelnicu Radu , Harari Rafael , Smith Silas , Horowitz James , Park David , Keller Norma , Bangalore Sripal , Katz Stuart , Alviar Carlos
Published: December 2023

Introduction:
Bupropion is a monocyclic antidepressant that inhibits dopamine and norepinephrine reuptake, with significant risk cardiotoxicity in overdose cases.

Case:
A 32-year-old transgender man with a history of Human Immunodeficiency Virus (on anti-retroviral therapy), poly-substance use disorder, and depression presented with an intentional bupropion overdose. On arrival the patient was noted to have seizures and a decreased mental status. He was intubated and treated with anti-epileptic medication. Initial EKG was sinus tachycardia with a QTc of 456 milliseconds. Transthoracic echocardiogram (TTE) showed severely reduced left ventricular ejection fraction (LVEF) that worsened over a 6 hour period from 40% of 25%. Serial EKGs showed progressive QTc prolongation to 635 milliseconds. Cardiac catheterization demonstrated angiographically normal coronary arteries and a Cardiac Index of 2.5 L/min/m
2
. Due to the rapidly prolonging QTc and the significant risk of ventricular tachycardia (VT), the decision was to proceed with Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) cannulation after a multidisciplinary shock team discussion. A few hours after cannulation, patient suffered hemodynamically unstable VT, requiring electrical cardioversion (DCCV) with brief return to sinus rhythm (SR) and with subsequent VT recurrence, that responded to lidocaine and repeat DCCV. ECG normalized and the patient was decannulated from VA ECMO on hospital day 4. Repeat TTE showed recovery of LVEF to 60%. The patient was extubated and discharged to psychiatric rehabilitation.

Conclusion:
Cardiogenic shock and ventricular arrhythmias are well recognized complications from bupropion toxicity likely due to gap junction inhibition. VA ECMO cannulation should be considered as part of multidisciplinary team assessment for patients at high risk for hemodynamic or electrical collapse in toxidromes with marked cardiotoxicity.
Abstract 15685: Artificial Intelligence Analysis of Facial Photographs for the Prediction of Abdominal Aortic Aneurysms
Authors: Houghton Damon E , Arruda-Olson Adelaide A , Kaggal Vinod C , Prodduturi Naresh , Liedl David A , Casanegra Ana I , McBane Robert D , Wennberg Paul W , Rooke Thom W , Murphy Sean P
Published: December 2023

Introduction:
Predictive algorithms using multiple clinical variables can identify patients at higher risk for abdominal aortic aneurysms (AAA), however they are cumbersome and cannot used directly by patients. A simple, cheap, noninvasive, and readily available (virtual) screening tool for identification of AAA could aid in screening algorithms.

Aims:
We sought to determine if a machine learning algorithm could predict the presence of an AAA by using a image of the face

Methods:
Diagnostic imaging studies were extracted from the electronic health record (EHR) from 5/7/2018 through 1/1/2023 and analyzed by a natural language processing algorithm previously validated to identify abdominal aortic aneurysms. Patient EHR profile pictures were extracted and matched to imaging studies. Various deep neural network (DNN) architectures were explored, all trained as classifiers on the face images along with clinical variables to predict clinical outcomes. All models used were CNNs with an EfficientNet architecture. Model performance was evaluated by standard metrics such as the area under the curve (AUC), specificities (Sp), and sensitivities (Sn). All performance metrics reported results from the test subset of the primary dataset and did not contain any observations considered during training.

Results:
A total of 5522 patients with facial images and AAA diagnostic studies were analyzed, among whom 1314 (23.8%) had a AAA. The optimal model had an AUC of 0.72 (Sn 0.44, Sp 0.83) for predicting AAA and remained similar in women (AUC 0.7), men (AUC 0.65), age >65 (AUC 0.63), and age <=65 (AUC 0.72) (Table).

Conclusions:
Using only an image of a patients face, the presence of an AAA could be identified with moderate performance in men, women, and in those less than 65. The model’s performance in demographics not typically screened for AAA may allow for targeted screening programs in these groups.
Abstract 15697: Exposure to Serum From Exclusive Heated Tobacco Product Smokers Induces mTOR Activation and Fibrotic Features in Human Cardiac Fibroblasts
Authors: Picchio Vittorio , Pagano Francesca , Carnevale Roberto , D'Amico Alessandra , Cozzolino Claudia , Floris Erica , Bordin Antonella , Schirone Leonardo , Saade Wael , Miraldi Fabio , De Falco Elena , Peruzzi Mariangela , Sciarretta Sebastiano , Biondi-Zoccai Giuseppe , Frati Giacomo , Chimenti Isotta
Published: December 2023

Introduction:
Smokers are at higher risk of fibrosis-related atrial fibrillation. The use of heated tobacco products (HTPs) is rising worldwide with unclear effects on health. The SUR-VAPES chronic trial showed that exclusive HTP smokers have increased serum markers of oxidative/endothelial stress versus non-smokers (NS), comparable to cigarette smokers.

Hypothesis:
We hypothesized that the serological profile of HTP smokers can activate atrial fibroblasts towards a pro-fibrotic phenotype.

Methods:
CFs were isolated from discarded atrial tissue from elective cardiac surgery procedures, and exposed to serum lots (20 healthy young subjects each) from HTP smokers (mean exclusive use=1.5 years) or clinically matched NSs from the SUR-VAPES Chronic trial. ANOVA testing was applied.

Results:
CFs treated with HTP serum increased expression of fibrotic genes, including PDGFA (1.18-fold, p<0.01) and THY1 (1.22-fold, p<0.01), and increased aSMA protein levels (1.87-fold, p<0.01), compared to NS serum. Connexin 43 was downregulated at both mRNA (1.17-fold, p<0.05) and protein levels (1.56-fold, p<0.01) in CFs after exposure to HTP serum versus NS. COL1A1 expression increased (1.46-fold, p<0.01), with higher soluble collagen release (1.56-fold, p<0.05). CFs pre-treated with HTP serum released lower levels of cardioprotective proteins (e.g. Adiponectin, Chi3L1, VEGF) by protein arrays/ELISA (p<0.05 vs NS). Paracrine support of CF-conditioned media to endothelial tube formation (63.3±4.7 vs 37.3±5.7 mesh #/well, p<0.05) and to cardiomyocyte viability under starvation (0.60±0.04 vs 0.47±0.01 normOD vs t0, p<0.001) were reduced when pre-treated with HTP versus NS serum. Array screening of 37 phospho-proteins in CFs exposed to HTP serum for 1h found several beneficial pathways blunted, with many inhibiting mTOR, including decreased P-PRAS40 (-2.43-fold) and P-p53 (-2.32-fold, p<0.05). Western blot analysis on CFs after 48h of HTP serum treatment confirmed increased P-mTOR (1.40-fold), and its targets P-S6K (1.39-fold) and P-4EBP1 (1.83-fold, all p<0.05).

Conclusions:
The serological profile of chronic exclusive HTP smokers induces CF activation and fibrotic features pointing to a potential risk for atrial fibrosis.
Abstract 15698: Association of Social Factors on Sex-Specific Management of Atrial Fibrillation
Authors: Tertulien Tarryn , Swabe Gretchen , Magnani Jared W
Published: December 2023

Introduction:
Prior studies have reported disparities by sex in managing atrial fibrillation (AF), with many studies having limited analysis of the effects of social risk factors. We examined the effect of social risk factors on sex differences in the management of AF in a large, socially diverse cohort of insured patients.

Hypothesis:
We hypothesized that women with AF would receive less AF care, including the receipt of AF-related medications, pulmonary vein isolation ablation, and cardiology follow-up, compared to men.

Methods:
We identified individuals with AF from 2013-2019 captured by Optum’s de-identified Clinformatics® Data Mart Database. Sex was categorized as men and women. Covariates included demographics (age, sex, race, and ethnicity), Elixhauser variables, and social factors such as estimated annual household income and race or ethnicity. We used stepwise multivariable-adjusted Cox proportional hazards models to assess the effect of race, ethnicity, and household annual income on sex-specific differences in the receipt of AF-related medications, pulmonary vein isolation ablation, and cardiology follow-up.

Results:
We identified 190,760 individuals (age 74.0±11.4 years; 49.9% women) with incident AF. Women with AF were less likely to receive pulmonary vein isolation ablation and cardiology follow-up over a six-year follow-up than men. Prescriptions of antiarrhythmic were identical among both sexes. When stratified by race and ethnicity, women of Black (HR 0.75, 95% CI 0.61,0.92) and White race (HR 0.83, 95% CI 0.78, 0.88) were less likely to receive pulmonary vein isolation ablation than men. Women of Asian (HR 0.90, 95% CI 0.83,0.97) and White race (HR 0.93, 95% CI 0.92,0.94) were less likely to have cardiology follow-up after initial diagnosis of AF than men. Higher household income did not attenuate sex-specific differences in AF care. Across all income categories, women were less likely to have pulmonary vein isolation and cardiology follow-up.

Conclusions:
We identified sex differences in AF management that were not attenuated when considering race, ethnicity, and annual household income. Our findings suggest continued evidence of sex, racial, ethnic, and socioeconomic inequities in contemporary AF management.
Abstract 157: Differences in Mid-Term Neurological Changes From 30 to 90 Days According to Age; is Plasticity Following Brain Injury After Cardiac Arrest Observed in Children or Young Adults?
Authors: Miyoshi Hiromi , Nishikimi Mitsuaki , Masuka Yuki , Namba Takeshi , Ohshimo Shinichiro , Shime Nobuaki
Published: December 2023

Introduction:
In clinical practice, younger patients following cardiac arrest (CA) are usually expected to recover, even though they are at high risk for poor neurological outcome. The aim of this study was to evaluate the differences of mid-term neurological improvements from 30 to 90 days after CA according to age.

Methods:
A retrospective observational study was conducted using data from the Japanese Association for Acute Medicine (JAAM) out-of-hospital cardiac arrest (OHCA) registry; a nationwide, prospective database including information on OHCA patients. All CA patients of any age except <1years who had recovered spontaneous circulation and survived after 30 days were analyzed. Patients who already showed cerebral performance category (CPC) (or pediatric CPC [PCPC]) of 1 at 30 days were excluded. We evaluated the proportion of patients in each age category (aged 1-17 [children and adolescents], 18-39 [young adults], 40-64 [middle-aged adults], 65-79 [older adults], ≥80 [elderly] years) who improved in either CPC or PCPC between the 30 and 90 days after CA by using a multivariate logistic regression analysis.

Results:
Of the 68,111 patients in the registry, 1,449 patients for whom 30- and 90-day CPC (or PCPC) data were available were analyzed. Among them, a total of 186 patients (13%) showed improvement in their 90-day CPC (or PCPC). Multivariate logistic regression analysis showed that patients aged 18-39, 40-64 and 65-79 years were more likely to have improved 90-day CPC compared with those aged ≥ 80 years (Odds ratios: 2.67 [1.19-5.96], 2.33[1.37-3.95] and 1.87 [1.13-3.11], respectively). Adjusted spline curve showed that patients ranging from children to middle-aged adults had an expectation of improved neurological changes (Figure).

Conclusions:
The expectation of improved neurological changes following an OHCA was higher in patient aged 18-39, 40-64 and 65-79 years compared to those aged >80 years, while it was not in patients aged 1-17 years.
Abstract 15707: Dietary Potassium and Sodium Intake and Cardiovascular Fitness in United States Community Dwelling Young Adults
Authors: Zangenah Nikki , Waikar Sushrut S , Verma Ashish
Published: December 2023

Introduction:
Low cardiovascular fitness strongly predicts cardiovascular disease and all-cause mortality in adults. Higher sodium (Na) and lower potassium (K) intakes have shown to be associated with adverse cardiovascular events. However, the association of K and Na intake with cardiovascular fitness is unknown in young adults.

Methods:
We included data on participants aged 20 to 49 years from three cycles (1999-2004) of the National Health and Nutrition Examination Survey. Estimated VO2max was measured using submaximal exercise test. 24-hour dietary interview format was used to estimate Na and K intake. The main exposure of interest was Na and K intake per 1000mg/day, and a nine-category variable for joint Na and K intake was generated by dividing Na and K intake into tertiles (low, moderate, high). The main outcome measure was eVO2max scaled to standard deviation (1-SD). The cross-sectional association between Na and K intake and eVO2max was assessed using survey design-based multivariable linear regression adjusted for clinically and biologically plausible confounders.

Results:
There were 3222 participants, with mean age 33.9 years; 48% were female and 70.6% identified as White. Only 27 (0.8%) participants met the dietary recommendation goal for Na (<2g) and K (>3.5g) intake per the World Health Organization. K intake per 1000mg was positively associated with a (1-SD) increase in eVO2max (β estimate = 0.04,
P value
= 0.01) in a fully adjusted model. Na intake per 1000mg was positively associated with (1-SD) increase in eVO2max (β estimate = 0.004,
P value
= 0.80) without reaching statistical significance in a fully adjusted model. The association of K intake and eVO2max was modified by Na intake (
P value
= 0.01). The joint category with moderate Na intake and high K intake was positively associated with eVO2max (β estimate = 0.21,
P value
= 0.009) compared to the joint category with low Na and K intake in a fully adjusted model.

Conclusion:
These findings suggest that higher potassium intake is associated with higher cardiovascular fitness independent of blood pressure, especially in conjunction with lower sodium intake. Higher potassium intake may have a role in improving cardiovascular fitness in young adults and could prevent future cardiovascular events.
Abstract 15709: Antagonist of Growth Hormone-Releasing Hormone Receptor Protects Against Cardiopulmonary Injury Induced by rVSV-SARS-CoV-2-S Virus Through Rag2 Regulation
Authors: Condor Jose Manuel , Robleto Emely , Kamiar Ali , Cui Tengjiao , Saad Ali , Wong Amanda , Villano Jason , Pekosz Andrew , Ranek Mark J , Webster Keith A , Schally Andrew , Jackson Robert M , Shehadeh Lina A
Published: December 2023

Background:
SARS-CoV-2 (COVID-19) transmits a multi-systemic disease that can lead to acute respiratory distress syndrome. Growth hormone-releasing hormone receptor (GHRH-R) and its splice variant are expressed in murine and human lung and heart. GHRH-R antagonist, MIA-602, has been shown to regulate inflammation in animal models and immune cell responses to bleomycin lung injury. Using a BSL2-compatible recombinant VSV-eGFP-SARS-CoV-2-S virus (rVSV-SARS-CoV-2-S) which mimics native SARS-CoV-2 infection in K18 hACE2tg mice, we tested our hypothesis that MIA-602 attenuates COVID-19-induced cardiopulmonary injury by reducing inflammation.

Methods:
Male and female K18-hACE2tg mice were infected with SARS-CoV-2/USA-WA1/2020, rVSV-SARS-CoV-2-S, or PBS and lung viral load, weight-loss and histopathology were compared (N=8). Mice infected with rVSV-SARS-CoV-2-S were subject to daily subcutaneous injections of 10 μg MIA-602 or vehicle (control) starting at 24h post-infection. Pulmonary function was measured via whole-body plethysmography on day 0, day 3, and day 5 (n=7). Five days after viral infection mice were sacrificed, and blood and tissues collected for histopathological analyses, H&E staining, RNA and protein work. Heart and lung tissues were used for RNASeq (n=3 per group). T-test or One-way ANOVA-test was used for statistical analysis.

Results:
SARS-CoV-2 and rVSV-SARS-CoV-2-S presented similar pathology for weight loss, infectivity (~60%) and histopathologic changes. Daily treatment with MIA-602 ameliorated weight loss, reduced lung inflammation, pneumonia and pulmonary dysfunction evidenced by rescued respiratory rate, expiratory parameters, and dysregulated airway parameters (p<.05). MIA-602 normalized the high expression of the inflammatory protein ICAM-1 in heart and lung (p<0.01), and master immune modulator Rag2 in lung (RNA:10-FC; Protein: 2-FC; p<.001).

Conclusions:
The results indicate a possible role for pulmonary Rag2 in protecting against pulmonary dysfunction and heart/lung inflammation by peptide GHRH-R antagonist MIA-602 in a novel animal model of COVID-19 pneumonia.
Abstract 15711: Association Between State Tobacco Surcharge Policy and Health Insurance Enrollment, Health Care Utilization, and Smoking Cessation Behaviors
Authors: Wang Yu , Chase Paul J , Honeycutt Sally , Whitsel Laurie P
Published: December 2023

Introduction:
The Patient Protection and Affordable Care Act allows insurers to charge up to 50% higher premiums to people who use tobacco. Several states have outlawed tobacco surcharges or capped the surcharges to lower levels. Evidence on the impact of state policies limiting tobacco surcharges is limited. This study aims to examine the association between state tobacco surcharge policies and individuals’ health insurance enrollment, health care utilization, and smoking cessation behaviors.

Methods:
This study used data from the Population Assessment of Tobacco and Health (PATH) Study Wave 6 (Mar-Nov 2021). The study sample was adults 18-64 years old who reported smoking cigarettes 20 or more days in the past 30 days (N=4,235). Exposure was living in states limiting tobacco surcharges (outlawed or capped). Outcome variables were currently covered by health insurance, seen a health professional in the past 12 months, intention to quit within 12 months, and any quit attempt in the past 12 months. Single-wave sample weights and balanced repeated replication method were applied to generate representative estimates and variances. Multivariate logistic regressions were used to estimate the associations between exposure and outcomes, controlling for socio-demographic variables, other tobacco use status, and state Medicaid expansion and tobacco control policies.

Results:
Among study sample, 19.8% (95% CI: 16.0%-24.3%) lived in states limiting tobacco surcharges. Bivariate associations showed that people living in states limiting surcharges were more likely to be covered by health insurance (84.5%, 95% CI: 81.2%-87.3% vs. 75.0%, 95% CI: 72.9%-77.1%, p < 0.001). After adjusting for covariates, the association between state policies and health insurance coverage became statistically insignificant (adjusted odds ratio, aOR=1.09, 95% CI: 0.80-1.47). Participants living in states limiting surcharges were less likely to have intention to quit within 12 months (aOR=0.78, 95% CI: 0.65-0.94). Other associations were not statistically significant.

Conclusions:
This study indicated that people living in states limiting tobacco surcharges had lower intention to quit smoking. More studies are needed to evaluate the impact of tobacco surcharge policies.
Abstract 15723: Assessing Revascularization Strategies: The Impact of Heart Flow Analysis on Coronary Computed Tomography Angiography
Authors: Belcher Adam M , Crews Cassidy , Ahmed Fatima , Annie Frank , Vazquez Figueroa Jesus G , Rinehart Sarah
Published: December 2023

Introduction:
Fractional Flow Reserve (FFR) is a technique used to assess the severity of coronary artery disease.

Hypothesis:
This study aimed to compare the impact of Heart Flow analysis, a CT-based FFR analysis, on patients who underwent Coronary Computed Tomography Angiography (C-CTA) at an Appalachian hospital.

Methods:
We collected data from January 2nd, 2019, to March 1st, 2023, from the data warehouse at Charleston Area Medical Center. The study included 5,470 patients with CTA, which were divided into two cohorts: 4,750 patients without Heart Flow analysis and 900 patients with Heart Flow analysis. Propensity score matching (PSM) was used to create two well-matched cohorts for comparative analysis.

Results:
Out of the total patients, 900 (16.4%) received Heart Flow analysis in addition to C-CTA, while 4,750 (83.6%) had C-CTA alone. The group of patients undergoing Heart Flow analysis had a higher prevalence of key comorbidities, including hypertension, diabetes, and prior history of myocardial infarction. After matching, both groups consisted of 900 patients each. Interestingly, while HDL cholesterol levels were similar between the groups, the Heart Flow group demonstrated lower levels of non-HDL cholesterol (102.0 vs 110 mg/dL, p=0.05), total cholesterol (147.6 vs 156 mg/dL, p=0.01), and LDL cholesterol (74.1 vs 81.8 mg/dL, p=0.05). The all-cause mortality rate was similar between the Heart Flow group and the non-Heart Flow group (2.3% vs 2.3%, p=1.00), as was the rate of myocardial infarction (3.5% vs 3.5%, p=1.00). However, the Heart Flow group exhibited a significantly higher rate of stent implantation (21.0% vs 9.2%, p<0.001) and bypass surgery (31.1% vs 1.3%, p=0.01).

Conclusions:
Heart Flow analysis integrated with C-CTA provides valuable insights into the selection of revascularization strategies for patients with coronary artery disease. While it did not significantly impact all-cause mortality and myocardial infarction rates compared to C-CTA alone, the utilization of Heart Flow analysis was associated with higher rates of stent implantation and bypass surgery. These findings highlight the potential of Heart Flow analysis in guiding the choice of optimal revascularization methods and improving outcomes.
Abstract 15793: Impact of Cardiac Rehabilitation on Cardiovascular Disease Risk Factor Management at 1 and 3 Year Follow-Up
Authors: Alejos Carlos L , Cherukuri Akhila S , Bonikowske Amanda R , Svatikova Anna , Smith Joshua R
Published: December 2023

Introduction:
Cardiac rehabilitation (CR) is a cornerstone of secondary prevention for cardiovascular disease (CVD). CR participation is associated with improvements in secondary CVD risk factor management. However, it is unclear if CR participation is associated with maintained improvements in CVD risk factor management following CR completion.

Purpose:
The aim of this study was to assess the impact of CR participation on CVD risk factor management at 1 and 3 years following CR completion.

Methods:
This retrospective study analyzed 911 patients (73% male) enrolled in the CR program at Mayo Clinic from 2013 to 2020. Patient demographics, clinical characteristics, and CVD risk factor management were examined pre and post CR as part of clinical practice and assessed passively at 1 and 3 years following CR. Secondary prevention CVD risk factor goals included total cholesterol (<200 mg/dL), HDL cholesterol (>40 mg/dL), LDL cholesterol (<100 mg/dL), triglycerides (<150 mg/dL), systolic and diastolic blood pressure (<130 and <80 mmHg), and body mass index (BMI) (18.5-24.9 kg/m
2
).

Results:
The mean age was 66±12 years and on average 33±9 CR sessions were attended. Table 1 shows the percentage (%) of patients meeting the secondary prevention CVD risk factor goals. The % of patients meeting the goals for total cholesterol, LDL, triglycerides, and diastolic blood pressure were higher post than pre CR. There were no changes in the % of patients meeting the goals for total cholesterol or LDL at 1 and 3 year follow up compared to post CR. At 1 and 3 year follow up, there was a lower % of patients meeting the goals for systolic and diastolic blood pressure and triglycerides (at 1 year follow up only) than post CR. No changes were present in the % of patients meeting the goals for HDL and BMI at any timepoint (all, p>0.09).

Conclusions:
CR participation was associated with maintained improvements in lipid management, but not in triglycerides or blood pressure control at 1 and 3 years following CR.
Abstract 15794: Incidence & Complications of Myocarditis in US Active-Duty Service Members Hospitalized With COVID-19 Infection
Authors: McClelland Patton , O'Gorman Kevin , Sabado Raphael John , Thorneloe Nicholas , Soderstrom Matthew , Dean John Henry , gore rosco , Fentanes Emilio
Published: December 2023

Introduction:
Cardiovascular complications of coronavirus disease 2019 (COVID-19) infection, including myocarditis, have been widely reported.

Research question/hypothesis:
What was the incidence and clinical implications of viral myocarditis resulting from COVID-19 infection in hospitalized United States active-duty service members (US ADSM)?

Goal/aims:
Report the incidence of complications in US ADSM who suffered COVID-19 associated myocarditis.

Methods:
This retrospective observational cohort study from the Joint Trauma Service COVID-19 Registry included 399,284 US ADSM who contracted COVID-19 infection. Our team independently reviewed records of hospitalized US ADSM who were determined to have COVID-19 associated myocarditis.

Results:
Among the 399,284 US ADSM who contracted COVID-19, 1,629 (0.4%) required hospitalization and 18 (1.1%) met criteria for myocarditis. The most common presenting symptoms were chest pain (72%) and dyspnea (67%). Half of the patients required ICU level care of which 44% required inotropes or vasopressors, and one patient required mechanical circulatory support. Eight (44%) patients had clinical findings consistent with acute heart failure and two (11%) patients suffered intermittent advanced heart block that did not require permanent pacing. No patients died in the hospital. In the patients who had a left ventricular ejection fraction of less than 50% during their illness, 75% had full recovery of their left ventricular systolic function during follow up imaging.

Conclusions:
While myocarditis was an uncommon complication in US ADSM hospitalized for COVID-19, its clinical course was not benign.
Abstract 15810: Relationship Between Left Ventricular Ejection Fraction and ICD-10 Codes Among Patients Hospitalized for Heart Failure
Authors: Gluckman Ty J , Chiu Shih-Ting , Rider deanna , Tseng Pu-kai , Mudd James , Remick Joshua , Granowitz Craig , Carroll Amy , Sikirica Slaven , Canonico Mario Enrico , Hsia Judith A , Bonaca Marc P
Published: December 2023

Introduction:
International Classification of Diseases (ICD)-10 codes are routinely used to classify patients with heart failure (HF). Although these codes play an important role with case identification and reimbursement, they are perceived to lack clinical specificity.

Goals/Aims:
We sought to describe the relationship between HF type (based on left ventricular ejection fraction [LVEF]) and assigned HF ICD-10 code in a large real-world dataset.

Methods:
We performed a retrospective cross-sectional analysis of patients admitted to a large health system within the western US between 1/1/18 and 10/1/2022 with a principal diagnosis of HF (ICD-10 codes: I50.2, systolic HF; I50.3, diastolic HF; I50.4, combined systolic and diastolic HF; I11.0, hypertensive heart disease with HF; and I13.0 and I13.2, hypertensive heart disease with HF and chronic kidney disease [CKD]). The analysis was further limited to patients with an LVEF by echocardiography in the 3 months preceding hospital discharge.

Results:
Over nearly 5 years, 61,238 HF hospitalizations occurred, of which 49,772 (81%) had an LVEF available. Most patients admitted with systolic HF (4.4% of the cohort) as well as systolic and diastolic HF (3.2% of the cohort) had an LVEF ≤40% (86.2% and 74.8%, respectively); similarly, most patients admitted with diastolic HF (3.1% of the cohort) had an LVEF ≥50% (94.0%) (Figure). Those admitted with hypertensive heart disease with HF (36.3% of the cohort) and hypertensive heart disease with HF and CKD (52.9% of the cohort) had a much wider LVEF distribution (Figure).

Conclusions:
Although relatively good concordance was noted between LVEF and ICD-10 codes for systolic HF, diastolic HF, and systolic and diastolic HF, this was not the case for most HF hospitalizations. This should be considered when performing analyses with HF ICD-10 codes.
Abstract 15849: Studying the Effects of Race, Community Health, and Vascular Inequities on Outcomes for Peripheral Artery Disease: Principal Components Analysis of Community Health Metrics Using the Agency for Healthcare Research and Quality Social Determinants of Health Database
Authors: Bunte Matthew C , Fu Zhuxuan , Sadik Kay , Jones Philip
Published: December 2023

Introduction:
Healthcare disparities associated with peripheral artery disease (PAD) are influenced by differences in healthcare quality and social determinants of health (SDOH).

Hypothesis:
We used principal components analysis (PCA) to summarize key themes of community-level SDOH variables.

Methods:
This retrospective analysis used data from a single health system quality improvement database of patients diagnosed with PAD between 2016-2019. Subjects were geocoded to census tracts and variables from the Agency for Healthcare Quality and Research SDOH database were obtained to examine small-area variability in social, economic, educational, physical infrastructure, and healthcare contexts. PCA was used to identify major themes in SDOH heterogeneity across communities. Relevant SDOH variables were normalized within a data matrix and those with a loading value >0.2 were retained in a principal component (PC). PCs with an eigenvalue > 1.0 were identified to parsimoniously exemplify key themes.

Results:
Among 7,187 subjects with PAD, the mean age was 72.2 11.1 years, 45.9% were female, 9.4% self-reported as non-Hispanic Black, and 86.6% as non-Hispanic White. PCA was applied to 29 SDOH variables relevant to vascular health. PCA retained 6 PCs to an SDOH matrix describing 73.8% of variance in census tract level data. The greatest variance in data was attributed to socioeconomic advantage (PC1) and urbanicity/migration context (PC2) with some overlap in Black neighborhood context (PC3), income inequality (PC4), multi-race cohesion (PC5), and underrepresented minority context (PC6).

Conclusions:
PCA transforms high-dimensional SDOH data into distinct typologies of community health while retaining complex features of the data. Future analysis will weight these results within a hierarchical model that accounts for patient-level characteristics and quality of care to inform a more complete social-ecological model of whole-person vascular care.
Abstract 15886: High Visceral to Subcutaneous Fat Ratio is Correlated With Increased Cardiovascular Events in Elderly Patients With Suspected Coronary Artery Disease
Authors: Oyama Yushi , Otagiri Kyuhachi , Miyagi Takuya , Sakai Takahiro , Kitabayashi Hiroshi
Published: December 2023

Introduction:
Although abdominal fat distribution (AFD), presented as the ratio of visceral adipose tissue (VAT) to subcutaneous adipose tissue (SAT) area (V/S ratio), is possibly associated with an increased risk of cardiovascular disease (CVD), the relationship between V/S ratio and its long-term outcomes have rarely been studied.

Methods:
We assessed 942 consecutive patients with suspected coronary artery disease who underwent computed tomography (CT) angiography. The patients also underwent plain abdominal CT to measure VAT and SAT areas. The V/S ratio was calculated to assess the AFD. The patients were classified into four groups based on the median V/S ratio and median age (i.e., 0.625 and 69 years, respectively). We examined the association between the V/S ratio and its long-term outcomes in each age group. The primary outcome was major adverse cardiac events (MACEs), including all-cause death, any coronary revascularization, acute coronary syndrome, and emergent hospitalization due to CVD.

Results:
Over a median follow-up of 1507 days, the incidence of any cardiovascular event was not associated with the V/S ratio among younger patients; however, among older patients, the incidence of MACEs, all-cause death, and any coronary revascularization was higher in the high V/S ratio group than in the low V/S ratio group. According to the Kaplan-Meier analysis, only older patients had a significantly lower MACE-free survival rate in the high V/S ratio group than in the low V/S ratio group, and no differences were noted among the younger patients in both groups. After adjusting for traditional coronary risk factors, high V/S ratio was independently associated with incidence of MACEs in older patients (Figure).

Conclusion:
A high V/S ratio was associated with an increased risk of MACEs in older patients only. Therefore, a high V/S ratio may be an important risk factor for CVD, particularly in older patients. However, AFD did not affect CVD prognosis among younger patients.
Abstract 15896: Disparities in Awareness and Treatment Among Women With Hypertension: Insights From the American Heart Association Research Goes Red Registry
Authors: McLaughlin Megan M , Beatty Alexis
Published: December 2023

Introduction:
Hypertension is a significant modifiable risk factor for cardiovascular disease among women in the United States. We sought to evaluate whether health concerns, awareness, and treatment of hypertension differed by race/ethnicity and other demographic characteristics in a national cohort of women.

Methods:
We used data from participants with self-reported hypertension enrolled in the AHA Research Goes Red registry, an online platform powered by Verily, who responded to the Research Goes Red questionnaire. We analyzed differences in health concerns, awareness of blood pressure (BP) and cholesterol levels, and treatment using Chi-squared tests.

Results:
Of 6,170 women who responded as of February 2023, 1,835 (30%) reported a history of hypertension. The top health concerns reported among women with hypertension were weight (17%), access to care / paying for healthcare (16%), and hypertension (13%). Health concerns varied significantly by age and race/ethnicity; younger women and Black and Hispanic women were more likely to report hypertension as their top concern (p-value <0.001). Among women with hypertension, 77% reported knowing their BP, 33% reported knowing their cholesterol levels, and 90% reported being on an anti-hypertensive. Black and Hispanic women were less likely to know their BP (p-value 0.003) and cholesterol (p-value 0.001) compared to White women. Treatment for hypertension did not vary significantly by race/ethnicity, income, or education (Table 1). However, younger women were less likely to be treated (p-value <0.001); only 58% of women 18-29 years old were on anti-hypertensives. There were also disparities in treatment by employment status (p-value 0.002) and among uninsured women (p-value 0.046).

Conclusions:
In this national cohort of women with hypertension, gaps and disparities exist in awareness and treatment of hypertension. This analysis highlights targets for quality improvement in hypertension care for women.
Abstract 15898: Appropriateness of Cardiology Clinic Notes Transcribed by a Popular, Publicly Available Artificial Intelligence Model (GPT-4)
Authors: Sarraju Ashish , Rodriguez Fatima , Laffin Luke , Bruemmer Dennis , Cho Leslie , Ouyang David
Published: December 2023

Introduction:
Artificial intelligence large language models (LLMs) such as GPT-4 have gained millions of users and public attention. GPT-4 may have the potential to support medical workflows, especially clinical note transcription. However, whether GPT-4 can appropriately transcribe simple cardiology clinical encounters into notes has not been evaluated.

Research Question
Can GPT-4 accurately and appropriately transcribe clinic encounters of simple cardiology presentations into medical notes?

Methods:
Five hypothetical encounters were created as detailed dialogue between a physician and patient, covering subjective and objective data, assessment, plan, and counseling. Encounters covered presentations of stable angina, primary prevention, secondary prevention, familial hypercholesterolemia, and acute pericarditis. GPT-4 was prompted to transcribe each encounter using three prompts: 1) to transcribe a medical note; 2) to transcribe a medical note and add additional relevant recommendations; and 3) to transcribe a medical note and add additional relevant recommendations with reference to specific AHA guidelines. Each note was graded by a board-certified cardiologist at a tertiary center as appropriate (accurate transcription and recommendations) or inappropriate (inaccurate transcription or recommendations).

Results:
With prompts 1 and 2, all GPT-4 notes were classified as appropriate (Table). With prompt 3, all notes were transcribed accurately but had inaccurate references to AHA guidelines and were classified as inappropriate.

Conclusion:
GPT-4 has the potential to appropriately transcribe dialogue-based clinic encounters of simple cardiology conditions to medical notes. However, beyond direct transcription, supportive guidelines or references provided by GPT-4 for encounters may be inappropriate. Efforts to develop LLMs for cardiology clinical encounter transcriptions should account for these limitations.