bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 13183: Effectiveness of a Telehealth-Based Behavioral Lifestyle Program for Hypertension Control in African Americans: Results From Heals Med-Tech Randomized Controlled Study
Authors: Clarke Amanda , EL Moudden Ismail , Wood LaWanda , Newby Olivia , Dodani Sunita
Published: June 2023

Background:
Hypertension (HTN) is a great concern because of its widespread prevalence, and associated racial health disparities. HTN is higher among African Americans (AAs) than whites. Among the many barriers to control HTN is poor adherence to needed lifestyle changes. The efficacy-tested HEALS Med-Tech behavioral lifestyle HTN control program may provide some solutions. We present the findings from the 1-year HEALS Med-Tech program in AAs.

Methods:
This is a randomized control community trial implemented in a primary care setting. HEALS Med-Tech program includes a) HEALS (Healthy Eating and Living Spiritually), a 12-month program modified from DASH and PREMIER programs; b) Med-component provides medications and social support; and c) Tech-component provides interactive telehealth contact. Primary outcomes of interest is change in systolic BP (SBP). Mixed Model repeated measure method was used for outcome analysis.

Results:
61 participants (50 females, 11 males) were enrolled and randomized to either HEALS Med-Tech or standard care (control). Participants’ mean age is 62.8 ± 10.8 years, majority (90%) had a family history of CVD and 26.5% had diabetes. At the baseline, the SBP was 139.52 mmHg and 146 mmHg for the HEALS and control groups, respectively (Figure 1), which significantly reduced after 1 year (p=0.0134) in HEALS group. Similarly, the DBP was 82.78 mmHg and 84.32 mmHg for HEALS and control groups, respectively, at the baseline (not shown). For DBP and SBP, the results showed a significant difference between the HEALS and Control groups at 6 and 12 weeks.

Conclusion:
HEALS Med-Tech behavioral lifestyle program could serve as an effective and sustainable model for BP among marginalized AAs. There is a need for implementation studies of longer duration, such as HEALS Med-Tech, to address social determinants for the programs to be sustainable. Further research is needed to explore the potential implementation of HEALS Med-Tech program into clinical practice.
Abstract 13211: Dysregulated Myocardial Calcium Handling is a Driver of Early Heart Failure in Type 1 and Type 2 Diabetes
Authors: Joshi Shruti S , Dattani Abhishek , Gulsin Gaurav , Singh Trisha , Kershaw Lucy , Yeo Jian , Singh Anvesha , Brady Emer , Spath Nick , Parke Kelly , Arnold Jayanth , Reynolds Rebecca , Forbes Shareen , Gibb Fraser , Williams Michelle , Semple Scott , DWECK MARC , McCann Gerry , Newby David E
Published: June 2023

Introduction:
Dysregulated myocardial calcium handling may be a precursor for heart failure in type 1 (T1D) and type 2 diabetes (T2D). Manganese-enhanced magnetic resonance imaging (MEMRI) is a novel non-invasive method of assessing
in vivo
myocardial calcium handling.

Hypothesis
Myocardial calcium handling is impaired in patients with either T1D or T2D, despite normal left ventricular (LV) systolic function.

Methods
Prospective, multicentre, study in patients with T1D (n=19), T2D (n=30), and healthy volunteers (n=28), all of whom were free of known cardiovascular disease. Cardiac MRI was performed including MEMRI, during which T1 mapping was performed at baseline and every 2.5 min for 30 min after manganese infusion (Figure 1a). The rate of myocardial manganese uptake, determined by Patlak modelling [1].

Results
No difference in LV systolic function was observed between groups, but those with T2D had more concentric LV remodelling compared to T1Ds and healthy volunteers (LV mass:volume 0.90±0.16 vs. 0.75±0.09 vs. 0.74±0.10 g/mL, respectively; p=0.001, Table 1). Mean myocardial manganese uptake was significantly lower in both T1Ds (6.47±0.99 mL/100g/min) and T2Ds (6.43±0.77 mL/100g/min) compared with healthy volunteers (8.33±0.77 mL/100g/min; p<0.001 for both, Figure 1b).

Conclusion
For the first time, we have demonstrated that myocardial calcium handling is impaired in patients with either T1D or T2D despite apparently normal LV systolic function. This may be a precursor to the development of diabetic cardiomyopathy and has implications for developing novel therapeutic targets for its prevention and treatment. [1] Skjold, A et al. J Magn Reson Imag 2006;24:1047-1055

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Abstract 13259: Genome Sequencing in Pediatric Patients With Pulmonary Vein Stenosis
Authors: Somerville Cherith , Manshaei Roozbeh , Ding Qiliang , Kalbfleisch Kelsey , Kim Raymond , Jobling Rebekah , Vanderlaan Rachel
Published: June 2023

Introduction:
Pulmonary vein stenosis (PVS) is a rare and progressive disease of the vasculature, characterized by neointimal proliferation and is frequently lethal in pediatric patients. PVS is clinically heterogeneous, and its etiology remains unknown. Insight into the genetic basis of PVS can help to direct treatment interventions and improve clinical outcomes.

Objectives:
To examine the genetic mechanisms underlying PVS and to compare the genetic architecture in patients with severe disease to patients with disease stabilization.

Methods:
We performed genome sequencing in a cohort of 18 pediatric patients with PVS. The genomic data was analyzed for clinically reportable variants and biologically plausible candidates. We used a statistical overrepresentation test to investigate the overrepresentation of gene ontology (GO) terms in patients with aggressive disease compared with stabilized patients.

Results:
Seven patients (38.9%) had aggressive disease, resulting in death or lung transplant, 16 patients (88.9%) had concomitant congenital heart disease, and 11 patients (61.1%) had extracardiac anomalies. In two patients (11.1%) with a syndromic presentation, we identified Pathogenic/Likely Pathogenic variants in three genes:
ANKRD11,
associated with KBG syndrome,
FOXP1
, and
DYNC1H1
, associated with intellectual developmental disorders. In search of novel candidate genes, we identified
de novo
variants in
PAK4
,
AMBRA1
, and
ANKRD50
, involved in cytoskeletal remodeling, mTOR-regulated autophagy, and protein trafficking, respectively. In patients with severe PVS, we found an overrepresentation of rare (minor allele frequency <0.15%) coding variants in genes involved in blood vessel morphogenesis (FDR <0.05), protein phosphorylation (FDR <0.05), dynein intermediate chain binding (FDR <0.05), and ATP binding (FDR <0.05). No GO terms were overrepresented in the patients with stabilized disease.

Conclusions:
This exploratory cohort of patients with PVS provides further insight into the genetic contributions to PVS. These results suggest distinct genetic landscapes between progressive and stabilized disease. Genetic testing in larger cohorts is needed to further define the molecular pathology of pediatric PVS.
Abstract 13337: Left Atrial Ejection Fraction by Cardiac Magnetic Resonance Imaging as a Predictor of Adverse Outcomes in Patients With Advanced Ischemic Cardiomyopathy
Authors: Anthony Chris , Salam Donna , Obuchowski Nancy , Al-Deiri Danah , Turkmani Mustafa , Wang Tom Kai Ming K , Popovic Zoran B , Nguyen Christopher , Griffin Brian P , Flamm Scott D , Tang Wai Hong W , Kwon Deborah H
Published: June 2023

Background:
The prognostic significance of cardiac magnetic resonance (CMR) based left atrial ejection fraction (LAEF) is not well defined in the ischemic cardiomyopathy (ICM) cohort.We assess the additive effect of LAEF in a model to predict outcomes in patients with ICM.

Methods:
Patients with ICM,
who underwent CMR between April 2001 and March 2019 were retrospectively included.
Clinical characteristics and CMR parameters were collected and analyzed and LAEF was calculated in addition to myocardial infarct size (MIS) using late gadolinium enhancement (LGE) and CMR based mitral regurgitant fraction (MRF). The primary clinical endpoint was a composite of all-cause mortality and cardiac transplant. A multiple-variable Cox proportional hazards regression model which included established predictors of outcome was constructed, followed by the addition of LAEF. Four pre-specified interactions of LAEF with left ventricular end systolic volume index (LVESVi), MIS and mitral regurgitant fraction (MRF) were tested at a significance level of 0.05.

RESULTS:
LA functional data was measured in 718 patients. There were 416 deaths and/or transplants, with a median duration of follow up of 1763 days (4.8 years) The mean LA EF was 36 [2 ,74]. In univariate analysis, lower LAEF and higher LAVI were significant predictors of worse outcome, HR= 0.12, 95% CI [0.06, 0.25], p<0.001; HR 1.008, (1.003-1.014) p = 0.003. After addition to the multivariable model, a normal LAEF was highly predictive of reduced risk, HR 0.24, (0.12, 0.48), p<0.001. In the interaction between LAEF and MIS with MR Fraction, the highest risk was observed in patients with an LAEF < 20% and an MIS of > 30%, with MR Fraction of >35%, HR of 3.2 (1.73-5.93), p= 0.009. The lowest risk was in patients with an LAEF of >50% with an MIS of <15 and MR Fraction of <35%, HR 1.07 (0.81-1.42), p=0.009. Figure 1.

CONCLUSION:
Reduced LAEF is an important predictor of increased mortality in patients with ICM and additive to MIS and MR Fraction.
Abstract 13392: 3D TEE Aids in Assessment of Embolic Stroke Due to Aortic Atherosclerotic Plaque
Authors: Wen Songnan , Naqvi Tasneem Z
Published: June 2023

Case Presentation:
A 69-year-old right-handed man presented with new left-sided weakness and recurrent ischemic strokes. His had history of coronary artery disease, diabetes mellitus, hypertension, dyslipidemia, chronic kidney disease stage 3, obstructive sleep apnea and obesity. Plasma low-density lipoprotein was 127 mg/dL. Brain MRI showed diffusion restriction in the left caudate head, left corona radiata, left anterior lentiform nucleus, and left periventricular white matter from acute to subacute infarction. CT angiogram showed diffuse atheromatous disease in the anterior and posterior circulation, bilateral mild cervical internal carotid artery stenosis, and calcifications in the aortic arch (
Figure 1
). Transthoracic echocardiogram (TTE) showed mild generalized left ventricular hypokinesis (ejection fraction 45%) without thrombus. Transesophageal echocardiogram (TEE) showed complex mobile atherosclerotic plaques in the aortic arch (
Figure 2
) after which Apixaban & Clopidogrel were started and statins increased. At 1-year follow-up there was no recurrent stroke.

Discussion:
This case highlights the role of 3D TEE in the detection of complex aortic arch atherosclerotic plaque with mobile components as the etiology of recurrent embolic stroke. 2D TTE & TEE and CT chest were unable to show mobile components in the aortic arch plaque. Many patients identified as having “cryptogenic stroke” after 2D TTE & TEE may in fact have mobile aortic arch plaques which can only be delineated by 3D TEE, thus reducing the need for further workup and expediting appropriate treatment.
Abstract 13395: Truth in Advertising? Health Claims and Contents of Fish Oil Supplements
Authors: Assadourian Joanna N , Peterson Eric D , McDonald Samuel A , Gupta Anand , Navar Ann M
Published: June 2023

Background:
Fish oil supplement use continues to rise. Although prescription eicosapentaenoic acid (EPA) at 4 gm/day did lower cardiovascular risk, the vast majority of randomized trials have shown no benefit to fish oil dietary supplements. Information on health claims and contents of fish oil supplements is limited.

Methods:
Label information for on-market fish oil supplements was obtained from the National Institute of Health Dietary Supplement Label Database as of February 2022. Label text was analyzed to categorize health claims by type and organ system referenced. The total daily dose of EPA and docosahexaenoic acid (DHA) was evaluated for supplements made by 16 of the leading retailers and manufacturers of fish oil.

Results:
We evaluated 2,192 fish oil supplement labels, among which 1,647 (75.1%) made at least one health claim. Of these, only 22.0% (n=362) used from the FDA-approved qualified health claim for fish oil. The remaining 78.0% of labels made “structure & function” claims (e.g., “promotes heart health”, “supports brain and vision function”, etc.) across a variety of organ systems (Figure). Heart-health related claims were the most common (n=1,390, 63.4% of labels). Across 16 different brands/manufacturers, 239 product labels were reviewed for dose information. Wide variation in the doses of EPA and DHA was observed (median EPA+DHA dose 600 mg, interquartile range 250-1100 mg). Only 9.2% of supplements reviewed contained at least 2 gm of EPA+DHA, the minimum recommended for triglyceride lowering, and none contained an EPA dose shown to prevent cardiovascular events (≥4 gm/day).

Conclusions:
Fish oil supplement labels commonly make vaguely worded claims that imply a range of health benefits, almost none of which are supported by randomized trial data. The doses of EPA and DHA available in commonly used fish oil supplements vary substantially, yet none contain levels shown to reduce cardiovascular risk.
Abstract 13439: Trends in Spending for P2Y12 Inhibitors by Medicare and Medicaid
Authors: Essa Mohammed , Ross Joseph S , Dhruva Sanket , Desai Nihar R , Yeh Robert W , Faridi Kamil
Published: June 2023

Introduction:
Use of a P2Y12 inhibitor (P2Y12i) is standard of care for many conditions related to atherosclerotic cardiovascular disease. The more potent P2Y12is, prasugrel and ticagrelor, lead to improved outcomes in MI patients compared to clopidogrel. Generic prasugrel became available in 2017, while ticagrelor remains brand-name. The impact of generic P2Y12i availability on Medicare and Medicaid program spending is unknown.

Methods:
We evaluated P2Y12i total claims and inflation-adjusted spending in millions (M) of dollars using the 2015-2020 Medicare Part D and Medicaid prescription drug spending datasets. Total cost savings were estimated by switching from ticagrelor to generic prasugrel and clopidogrel.

Results:
From 2015 to 2020, total P2Y12i spending increased by Medicare (543M to 604M) and Medicaid (61M to 83M), although total claims decreased. In 2015, generic clopidogrel was the most prescribed P2Y12i within the Medicare program (94.2% of claims) and contributed the largest portion of total costs (45.0%). By 2020 ticagrelor contributed to most Medicare costs for P2Y12is (62.0%) despite constituting only 6.9% of claims
(Figure).
Generic prasugrel constituted 2.2% of Medicare P2Y12i claims in 2020 and contributed to 6.0% of total costs. Total 2020 Medicare savings by switching from ticagrelor to generic prasugrel or clopidogrel would have been 270M and 361M, respectively. In Medicaid, brand-name prasugrel had the largest contribution to costs in 2015 (48.1%) and ticagrelor constituted the most costs in 2020 (80.3% with 9.8% of claims). Total 2020 Medicaid savings by switching from ticagrelor to generic prasugrel or clopidogrel would have been 59.0M and 65.5M in 2020, respectively.

Conclusions:
Brand-name ticagrelor constitutes > 60% of total 2020 P2Y12i costs in Medicare and Medicaid, despite being used in < 10% of claims. Use of generic prasugrel remains low, despite its efficacy and potential to reduce prescription drug spending.
Abstract 13452: Age-Related Increases in Arterial Stiffness is Attenuated With Long-Term Senolytic Therapy in Mice
Authors: Tuday Eric , Islam Torikul , Kim Johntaehwan , Lesniewski Lisa A , Donato Anthony J
Published: June 2023

Introduction:
It has been established that with advancing age, large elastic arteries (i.e. aorta) demonstrate increased stiffening resulting in detrimental CV health outcomes. Cellular senescence, the permanent arrest of the cell cycle, within the vasculature is characterized by a population of cells that are profibrotic and proinflammatory. Profibrotic and proinflammatory environments have been shown to directly lead to increased large artery stiffness (LAS) with aging. We tested the hypothesis that treatment with the senolytic cocktail dasatinib and quercetin (D&Q) will attenuate LAS in aging mice.

Methods:
21-month-old C57Bl/6 mice were treated with D&Q or vehicle via oral gavage on a bi-monthly basis for three months. LAS was measured pre, mid and post treatment by quantifying the aortic pulse wave velocity (aPWV) using a combined Doppler and EKG recording system. Expression of inflammatory genes was assessed by quantitative polymerase chain reaction. Aortic tissue histology was assessed by standard histological methods.

Results:
D&Q treatment attenuated the age-associated increase in LAS in mice. In the vehicle group, we observed that aPWV increased steadily with age in the vehicle group at 21, 22.5 and 24 months of age (338.9 ± 10.84 cm/s, 351.6 ± 11.53 cm/s, and 369.5 ± 18.57 cm/s respectively, intragroup p=0.004). However, in the D&Q group, we observed a blunted response with corresponding aPWVs (339.5 ± 12.96 cm/s, 322.9 ± 13.9 cm/s, and 342.1 ± 5.67 cm/s; intragroup p=0.7729). Intergroup analysis confirms a significant difference with a p<0.001. Inflammatory markers (TGF-β and TNF-α) were significantly reduced in the D&Q compared to the vehicle group (p<0.05). Extracellular matrix collagen content was lower in aortic tissue from D&Q treated compared to vehicle mice (p<0.01).

Conclusions:
Chronic, intermittent administration of D&Q prevented the progression of aortic stiffening with advancing age as measured in a longitudinal preclinical mouse study. Aortic inflammatory markers were reduced in the treatment group and similarly the treatment group had attenuated fibrosis vs. vehicle controls. Overall, senolytic therapy represents a potential therapy for aortic fibrosis and age-related increases in large artery stiffness.
Abstract 13496: Sequencing in Over 50,000 Cases Identifies Coding and Structural Variation Underlying Atrial Fibrillation Risk
Authors: Jurgens Sean J , Choi Seung H , Haggerty Christopher M , Xiao Ling , Morrill Valerie N , Marston Nicholas A , Weng Lu C , Pirruccello James P , Hill Matthew C ,   Atrial Fibrillation Genetics (AFGen) Consortium,   NHLBI TransOmics for Precision Medicine (TOPMed) Consortium,   NHGRI Cntrs for Common Disease Genomics (CCDG) Consortium,   Regeneron Genetics Cntr,   Massachussetts General Brigham Biobank - Arrhythmia Group,   Broad Institute Genomics Platform, Ruff Christian T , Sabatine Marc S , Lunetta Kathryn , Lubitz Steven A , Ellinor Patrick T
Published: June 2023

Introduction:
Atrial fibrillation (AF) is the most common sustained arrhythmia and is associated with substantial morbidity and mortality. AF is known to have a heritable component, with >100 associated common variant loci. Rare variant studies have yielded limited robust associations for AF. We aimed to utilize large genome and exome sequencing data to discover rare genetic variants conferring large effects on AF risk.

Methods:
We meta-analyzed genome and exome sequencing data from 36 studies, including TOPMed, CCDG, UK Biobank and FOURIER. We performed exome-wide gene burden testing of rare (MAF<0.1%) loss-of-function and deleterious missense variants, and single variant testing of low-frequency and rare (MAF<1%) coding variants. Within genome sequenced samples, we performed gene burden testing of rare structural variants. Novel signals were replicated in MyCode. Finally, we functionally validated a novel gene by siRNA knockdown in pluripotent-induced atrial cardiomyocytes.

Results:
We included 52,416 AF cases and 277,762 controls, of which 49.6% were female, 83.4% were of European ancestry, and the mean baseline age was 56 years. In analysis of rare coding variation, we identified 4 novel genes associated with AF, including
MYBPC3
(OR 3.5,
P
=2.1x10
-15
),
LMNA
(OR 5.7,
P
=8.8x10
-11
),
PKP2
(OR 1.9,
P
=5.2x10
-8
) and
KDM5B
(OR 2.3,
P
=3.0x10
-6
). These signals were robust to removal of heart failure and cardiomyopathy cases and were replicated in independent datasets. Single variant analysis identified 2 novel signals in
FAM189A2
(OR 3.9,
P
=7.86x10
-8
) and
ZFC3H1
(OR 5.9,
P
=9.7x10
-8
). Rare deletions in
CTNNA3
(OR 4.5,
P
=7.0x10
-9
) were associated with increased AF risk and were supported by independent coding variant analyses, while duplications of
GATA4
(OR 0.24,
P
=2.1x10
-5
) were associated with reduced AF risk. In functional studies, knockdown of
KDM5B
resulted in shortening of the atrial action potential duration.

Conclusions:
Our analyses show the contribution of rare coding and structural variants to AF risk, highlight the shared genetic pathways underlying cardiomyopathy and AF, and implicate the histone demethylase gene
KDM5B
in AF susceptibility. In sum, we expanded our understanding of the rare variant architecture of this common arrhythmia.
Abstract 13527: The Development of a Remote Pulmonary Arterial Hypertension Risk Score Utilising Remote Monitoring Technology to Monitor Parameters Associated With Mortality in Pulmonary Arterial Hypertension
Authors: Middleton Jennifer T , Binmahfooz Sarah , Zafar Hamza , Patel Junaid , Neelam Naganathan Dharshan Giri , Battersby Christian , Toshner Mark , Reddy Ashwin , Lewis Robert , Swift Andrew J , Condliffe Robin , Elliot Charlie , Hameed Abdul , Charalampopoulos Athanasios , Thompson Alfred , Kiely David G , Rothman Alex M
Published: June 2023

Background:
In patients with pulmonary arterial hypertension (PAH) risk stratification is used to aid clinical decision making and guide treatment categorising patients as low (<5%), intermediate (5-10%), or high mortality risk (>10%) at 1 year based on hospital investigations. Risk stratification based on remote parameters may facilitate early evaluation of clinical efficacy following treatment change or indicate clinical stability/deterioration, thereby permitting early intervention.

Methods:
Patients with PH were identified from the ASPIRE (6/YH/0352) database 2/2001-6/2019. Random allocation was used to form a derivation (n=3832). Univariate Cox Regression and stepwise forward multivariate analysis were undertaken in the derivation cohort to identify parameters that may be remote monitored that were associated with mortality. Mortality weighted z-scores of age, incremental shuttle walk test (ISWT), heart rate (HR) and total pulmonary resistance (TPR) were summed to give an individual remote risk score value. LOESS regression was used to determine 1 year risk thresholds applied to a PAH validation cohort (n=590).

Results:
Multivariate analysis of the derivation cohort demonstrated that ISWT, HR and TPR had statistically significant relationships to mortality. Survival analysis showed increased mortality with each decile of baseline risk score with the 10
th
decile at increased risk of mortality compared the 1
st
decile (OR 5.5, 95%CI 4.3-7.0, each decile p<0.01, Figure). In patients with PAH, LOESS derived thresholds identified patients at low, intermediate and high risk with 1 year mortalities of 4.6, 9.8 and 15.1% respectively (low-int OR 1.9, low-high OR 2.7,p<0.01,Figure).

Conclusion:
A score of remote monitored parameters, when applied at diagnosis, accurately categorised patients as low, intermediate, or high risk. This system may be applied to remote monitored physiological data to provide real time risk stratification.
Abstract 13528: Sex Differences in Healthcare Resource Utilization in Patients With Atrial Fibrillation Receiving Dronedarone versus Sotalol Following Ablation
Authors: Zeitler Emily P , Stein Dara , PREBLICK RON , Kabadi Shaum , MCKINDLEY David , Rashkin Jason , Huse Samuel , Stamas Nicole , Kim Michael H
Published: June 2023

Introduction:
Patterns of anti-arrhythmic drug therapy for atrial fibrillation (AF) treatment and outcomes may differ by sex. Dronedarone has shown clinical benefit vs sotalol post-ablation in males and females with AF; however, the impact of these drugs on healthcare resource utilization (HCRU) remains unknown among sex subgroups.

Methods:
We conducted two retrospective, observational cohort analyses using IBM MarketScan® data (Jan 2012-Mar 2020) in adult male and female patients with AF who received dronedarone or sotalol post-ablation. Patients were required to have had 12 months’ available pre-ablation data; follow-up ended at the earliest of health-plan disenrollment, death or end of data availability (Dec 2020). Prevalence (per 100 patient-years [PY]) during the post-ablation period was calculated for all-cause HCRU (hospitalizations; emergency room [ER] visits; outpatient office visits; other outpatient services). Patients receiving sotalol were propensity score matched 1:1 to patients receiving dronedarone and outcomes were compared using univariate generalized linear models with Poisson distribution.

Results:
In females (n=460 per cohort ; age at ablation: ~64 years; mean follow-up: ~29 months; prior heart failure: ~14.6%; mean Charlson comorbidity index [CCI]: ~0.8), post-ablation prevalence of ER visits, outpatient office visits, and other outpatient services were significantly lower with dronedarone than sotalol (Table). In males (n=1112 per cohort; age at ablation: ~60 years; mean follow-up: ~29 months; prior heart failure: ~12%; mean CCI: ~0.8), post-ablation prevalence of hospitalizations was significantly lower with dronedarone than sotalol, but other HCRU measures were similar.

Conclusions:
In females post-AF ablation, dronedarone was generally associated with lower HCRU than sotalol. In males, dronedarone was associated with lower hospitalization prevalence than sotalol, but other HCRU was similar.
Abstract 13572: Feasibility and Preliminary Efficacy of a Novel YouTube Based Physical Activity Intervention in Adults With Overweight/Obesity
Authors: Kariuki Jacob K , Burke Lora E , Barone Gibbs Bethany , Erickson Kirk , Kriska Andrea , Ogutu David , Milton Heather , Wagner La’Vette , Rao Neel , Sundheim Breanna , Daley Abigail , Hirshfield Sabina , Sereika Susan M
Published: June 2023

Background:
Only 14% of adults with obesity attain the national recommended guidelines for physical activity (PA). Yet, there is a paucity of interventions designed to address individuals’ barriers to PA. We designed a web-based Physical Activity for The Heart (PATH) intervention to address this gap.

Purpose:
To test the feasibility and preliminary efficacy of PATH in promoting PA and reducing cardiovascular disease (CVD) risk in adults with overweight/obesity.

Methods:
In a randomized controlled trial (RCT) with 12-week follow-up, participants were randomized to PATH (n=41) or wait-list control (n=41) groups. The PATH group received access to the PATH website and met twice/month with a remote coach. The control group received a self-help PA guide and twice/month newsletters on general health. Moderate-to-vigorous intensity PA (MVPA) was assessed via waist-worn Actigraph GT3X, steps via Fitbit Charge 2™, weight via smart scale, blood pressure (BP) via Omron BP machine, and lipids and HbA1C via dry blood spot. Generalized linear mixed modeling was applied to examine between- and within-group differences in PA, adherence to PA, and CVD risk factors.

Results:
The sample (N=82) was on average 55.9 ±8.2 years old; 57.3% white; 80.5% female; 79% obese (BMI 35.5 ±6.2 kg/m
2
;) and 62.2% had ≥4yr of college. Recruitment lasted 6 months, and retention was 96.3%. Nearly all intervention participants accessed the PATH website ≥twice/week (92.1%), spent ≥10 min/visit (89.5%), and reported that the site was very appealing (68.4%), navigable (97.4%) and culturally appropriate (79%). At 12 weeks, the PATH group had greater mean changes in weekly MVPA (+59.2 min vs. +1.1 min, p=.024) and daily steps (+1,243.9 steps vs. -61.1 steps, p=.002) compared to the control group. While no between-group differences were detected for meeting the national PA guidelines or CVD risk factors over time, the PATH group showed modest but significant improvements in weight, BMI, body fat, waist circumference, and systolic BP (all p<.05).

Conclusion:
This pilot RCT demonstrated that the PATH intervention is feasible and acceptable and provided preliminary efficacy in promoting PA among adults with overweight/obesity. Work is in progress to test the PATH intervention in a larger scale RCT.
Abstract 13603: Racial and Socioeconomic Differences Among Children With Kawasaki Disease in the South
Authors: Padilla Luz A , Maxwell Kathryn , Tremoulet Adriana H , Lau Yung R , Shrestha Sadeep
Published: June 2023

Introduction:
Kawasaki Disease (KD) is a leading cause of pediatric acquired heart disease in the U.S. Children of Black race seem to have more vulnerability to developing KD and face worse clinical outcomes. It is unknown if this is due to socio-economic disadvantages faced by this minority group or by host factors. The objective of this study is to identify racial and socio-economic differences among Black children with KD compared to other races.

Methods:
EMR (2000-2019) ICD codes served to identify KD children admitted to a single tertiary Southeast U.S. center. Subjects diagnosed and treated according to American Heart Association criteria were included. Socio-economic status was defined using a validated neighborhood deprivation index associated with the child’s ZIP-code at the time of KD hospitalization. Data was stratified and compared by deprivation status and race.

Results:
A total of 525 subjects (32% non-deprived White, 17.5% deprived White, 18.7% non-deprived Black, 31.8% deprived Black) were included. Deprived White children with KD had the highest proportion of intravenous immune globulin (IVIG) response (86.1%) compared to deprived Black children with the lowest (75.3%; p 0.02). Deprived Black children presented with KD at an earlier median age than any other group (26 vs ~40 months; p 0.008).

Conclusions:
This study suggests that factors like race and socio-economic status may affect KD age at presentation and outcomes among Black children with KD. Future studies that explore the attributable proportion from different factors that drive the disparate outcomes among Black children with KD are needed.
Abstract 13685: Eicosapentaenoic Acid (EPA) Inhibits Low-Density Lipoprotein (LDL) Oxidation Compared to Docosahexaenoic Acid (DHA) and Mineral Oil
in vitro
Authors: Sherratt Samuel C , Libby Peter , Bhatt Deepak L , Mason Preston
Published: June 2023

Introduction:
Oxidized LDL triggers inflammation during the initiation and progression of atherosclerotic plaque. The omega-3 fatty acid (n3-FA) EPA administered as icosapent ethyl (IPE), reduced cardiovascular (CV) events in REDUCE-IT due, in part, to potential antioxidant and anti-thrombotic activity. By contrast, mixed n3-FA containing docosahexaenoic acid (DHA) have failed to reduce CV events in similar high-risk patients (STRENGTH). Some have raised concerns over the relationship between these discordant outcomes and placebo choice (mineral oil) as well as DHA content. We compared the effects of these compounds on oxidation of LDL where such ingested fatty acids are concentrated and transported.

Methods:
LDL was isolated from human plasma by isopycnic centrifugation, separated into test samples of 100 μg/mL, and incubated at 37°C for 30 min with pharmaceutical grade mineral oil, EPA, DHA or vehicle at equimolar levels (10 μM). All samples were then subjected to copper sulfate-induced oxidation (20 μM) monitored by formation of malondialdehyde (MDA). Ascorbic acid at equimolar levels served as a control.

Results:
LDL oxidation increased 30-fold (0.28±0.03 vs 8.72±0.54 μM;
p
<0.001) after 4 h and the rate was unaffected by addition of mineral oil. By contrast, EPA significantly inhibited LDL oxidation; after 4 h, EPA inhibited MDA levels by 75% compared with vehicle (8.72±0.54 vs 2.20±0.36 μM;
p
<0.001). While DHA exhibited antioxidant activity at 2 hours at a level less than EPA (1.15±0.54 vs 3.00±1.08 μM;
p
<0.05), it exhibited no antioxidant activity after 4 h. Like DHA, ascorbic acid also reduced LDL oxidation only up to 2 h.

Conclusions:
These data support sustained LDL antioxidant effects for EPA compared with DHA, ascorbic acid, or mineral oil. The longer-term antioxidant actions of EPA may contribute to reduced events in outcome trials compared to mixed n3-FA formulations, independent of placebo selection.
Abstract 13750: Substernal Extravascular Implantable Cardioverter-Defibrillator System Infection in Large Animals
Authors: Thompson Amy , Christie Melissa , Lentz Linnea R
Published: June 2023

Background:
The Extravascular ICD (EV ICD) with substernal lead placement may provide clinical advantages to transvenous and subcutaneous systems. An understanding of substernal infection manifestation and treatment is required.

Methods:
The EV ICD system was implanted in 13 large animals (canine, porcine, ovine), and porcine were co-implanted with a transvenous CRT-D system. Animals were monitored for clinical presentation of infection over 12-18 weeks of follow-up, and cultures were collected to confirm infection. Treatment was bifurcated, with some animals receiving antibiotics while EV ICD leads remained
in situ
, and other animals treated with system removal and antibiotics. Histopathology was conducted at the end of study.

Results:
Five infections were confirmed over the course of study, 4 of which involved infection of the EV ICD system and 1 of which involved infection of only the concomitantly implanted CRT-D system without infection of the EV ICD system. Two of the EV ICD-related infections were treated with system removal and antibiotic course, and both infections resolved. Two additional EV ICD-related infections were treated with antibiotics alone without explant of the EV ICD leads; histology showed that neither infection resolved. The transvenous CRT-D system infection progressed to septicemia and endocarditis, requiring early study end. No EV ICD-related infection progressed to blood stream infection, and the sternal bone did not become infected when infection was present in the substernal tissues.

Conclusions:
Study findings suggest that EV ICD-related infections are treatable with system removal and antibiotic therapy.
Abstract 13842: Changes in Patient Selection and Outcomes in the New Heart Transplant Allocation Era
Authors: Quintao Ritchelli , Shorbaji Khaled , Welch Brett , Kilic Arman
Published: June 2023

Objectives

The adult heart allocation policy in the United States was changed in October 2018. This study evaluates changes in patient selection and outcomes of heart transplantation over the past 3 years under this new policy.

Methods:
The United Network for Organ Sharing database was queried for adults undergoing isolated heart transplantation under the new allocation system between October 18, 2018 to September 25, 2021, with follow-up through September 2021. To evaluate temporal changes, the study cohort was divided at the midpoint of the study period to define early and late groups. Kaplan-Meier and multivariable Cox proportional hazards models were used for unadjusted and risk-adjusted analyses, respectively.

Results:
A total of 6,485 adults underwent heart transplantation in the new allocation era (2,746 early, 3,739 late). A comparison of recipient, donor, and transplant characteristics demonstrated that patients in the latter half were older, more likely blood type O, underwent durable LVAD bridging more frequently, were in the intensive care unit prior to transplant less frequently, had a higher proportion of bridging with Impella devices and lower proportion of bridging with intra-aortic balloon pumps. Donors of patients in the latter half more likely had drug overdose as the mechanism of death and more frequently had diabetes. Unadjusted and risk-adjusted 1-year survival were similar between early and late patients. Center-level analysis demonstrated that 44.6% of centers had better 1-year survival rates, 33.7% had worse, and 21.7% had similar in the latter half (Figure 1).

Conclusion

There have been several changes in recipient and donor characteristics in heart transplants performed in the latter half of the new allocation era although post-transplant outcomes remain similar across the study period.

Figure 1
Change in center 1-year mortality rates after policy change.
Abstract 14050: A Giant Free-Floating Ball Thrombus or a Tiny Fibroelastoma: Which Causes Multiple Strokes?
Authors: Konje Swiri , Khachatoorian Yeraz , Kaur Arpanjeet , Krishnamurthi Nirupama , Talebi Soheila
Published: June 2023

Background:
Left atrial (LA) thrombus is not rare in patients with mitral valve stenosis, but in patients with nonvalvular atrial fibrillation on anticoagulation, the formation of a "ball thrombus" in the LA is uncommon.

Case:
A 73-year-old man with nonvalvular atrial fibrillation on eliquis presented with frequent syncope and slurred speech. .The appearance of the infarcts on brain MRI and involvement of different vascular territories suggests embolic phenomena as the cause. On transthoracic echo a large, highly mobile echo density in the left atrium was noted. Transesophageal echo revealed smoke in the left atrium and the left atrial appendage. A large round mobile echo density mass measuring 4.7 cm X 3.6 cm was seen in left atrium with no attachment to left atrium. A mobile round density measuring 0.7x0.7 cm was seen on the right coronary cusp. Absence of perfusion, no enhancement, and high signal intensity on T1 and T2 weighted images on cardiac MRI was suggestive organized clot in left atrium.

Decision-making:
Both masses were removed successfully. Pathology confirmed a large intact spherical organized clot from the LA and a small fibroelastoma attached to the aortic leaflet.

Conclusion:
This was a rare case of giant round-shaped left atrium thrombus, which occurred in a patient with nonvalvular atrial fibrillation on anticoagulation. An aortic fibroelastoma was also discovered by transesophegeal echo as another potential cause of stroke. The left atrial thrombus is thought to have developed from a small mural thrombus caused by prolonged blood stagnation, which gets rounded by the sculpting impact of multiple complex encounters with the atrial wall. This may then detach from the LAA and form a floating "ball thrombus.
Abstract 14102: The Joint Effect of Arterial Stiffness and High Central Blood Pressure on Risk of Stroke Among Hypertensive Adults
Authors: Cao Tianyu , Ding Congcong , Huang Xiao
Published: June 2023

Introduction:
The increases in arterial stiffness and central blood pressure (cBP) suggest significant status of vascular damages with different physio-pathological progress. However, the joint effect of them on risk of first stroke have remained uncertain. And the predictive value of CAP over peripheral blood pressure (bBP) is controversial.

Hypothesis:
This study aims to test the hypothesis that the combination of elevated arterial stiffness and central systolic blood pressure (cSBP) can predict first stroke and is associated with highest risks among hypertensive adults.

Methods:
A total of 7531 hypertensive adults without prior history of stroke were analyzed. cSBP was measured noninvasively using A-Pulse CASPro device. Arterial stiffness was measured by carotid-femoral pulse wave velocity using the noninvasive PulsePen device (WPP001-ET, DiaTecne s.r.l). Whole data was collected from July 2016 to December 2019. Increased arterial stiffness was defined as cfPWV ≥10 m/s. The primary outcome was first all-cause stroke.

Results:
Of the 7531 participants, mean age was 61.3 ± 9.3 years, 37.2% were male, the mean brachial blood pressure is the mean cfPWV was 9.4 ± 2.2 m/s, the mean cSBP is 131.3 ± 12.8 mmHg. During a mean follow-up time of 3.3 years, 432 (5.2%) participants developed stroke, of which 380 were ischemic strokes. Compared with the reference group (low cfPWV and cSBP), only the group with both high cfPWV and cSBP was significantly associated with risk of stroke after adjusted for covariates (HR: 1.51, 95% CI 1.10, 2.07). Similar result was found in Kaplan Meier Curve. Such association appears robust in different sub-group analysis.

Conclusion:
The combination of higher arterial stiffness and central systolic blood pressure is associated with highest risk of first stroke compared to other groups. The combined control of arterial stiffness and central blood pressure serves the purpose of primary prevention of first all-cause stroke among hypertensive population.
Abstract 14459: Case Report: Unusual Presentation of
Cardiobacterium Hominis
Bioprosthetic Valve Endocarditis
Authors: Nigam Priya , Mhanna Christiane , Bhat A. Majeed , O'Neil Karen , Campbell Matthew J
Published: June 2023

Introduction:
Cardiobacterium hominis
, part of the oropharyngeal flora, is a gram-negative bacteria reported to cause infection in less than 5% of patients with infective endocarditis (IE). In children, congenital heart disease (CHD) is a predominant risk factor for developing IE. Herein we describe an unusual presentation of
C. hominis
bioprosthetic valve endocarditis.

Case Presentation:
A 23-year-old woman with bicuspid aortic valve and aortic valve stenosis underwent aortic bioprosthetic valve placement in 2017. In March 2022, she presented to an emergency room with left lower abdominal pain. A CT scan demonstrated occlusion of the left iliac artery. Medications at that time included oral contraceptive pills and baby aspirin. No echocardiogram was obtained at that visit. She presented for a routine cardiology follow-up in May 2022 at which time she was asymptomatic. Transthoracic echocardiogram demonstrated moderate to severe aortic insufficiency, though the mechanism could not be delineated. There was concomitant development of mild mitral valve and tricuspid valve insufficiency. She denied dyspnea, chest pain, or fevers. Laboratory investigation showed mild elevation of CRP and a normal ESR. A transesophageal echocardiogram demonstrated that the severe aortic regurgitation was through a paravalvar leak (figure 1). There was no evidence of vegetations. Three separate blood cultures grew
C. hominis
. The patient was admitted for IV antibiotic therapy prior to bioprosthetic replacement.

Conclusions:
C. hominis
is an infrequent cause of endocarditis and most cases present with fever and elevated ESR. This patient had an unusual presentation with left iliac thrombus, which in retrospect was likely due to embolism of a vegetation. She also developed aortic bioprosthetic paravalvar leak. This case highlights the need for a high degree of suspicion for endocarditis in patients with CHD and bioprosthetic valves.
Abstract 14574: Cellular Population Evolution and Differential Gene Expression Patterns of Human Aorta in Different Life Stages Revealed by Single-Cell Transcriptome Analysis
Authors: Zhang Bin , Guan Ruicong , zeng kuan , Jiang Huiqi , Gao Minnan , Zhang Lu , CongYong Liu , Li Jianfen , Li Jingwen , Han Jingjing , Deng Baoping , Deng David YB , Zhang Qing , Yang Mo , Yang Yanqi
Published: June 2023

Introduction:
Cellular characteristics and gene expression patterns of human aortic tissue is biological basis for understanding pathogenesis of aortic diseases, and still unclear. Our aim was to investigate cellular population evolution and differential gene expression patterns of human aorta in different life stages.

Methods:
Single-cell transcriptome sequencing was applied to study differential gene expression pattern and cellular population of entire ascending aortic walls from six healthy donors: 4 in younger group (3 months, 1 year, 3 and 12 years of age) and 2 in aged group (57 and 58 years of age), 50% males. Pseudotime trajectory and cell-to-cell communication analysis of the annotated cell subclusters were preformed to analyze development and evolution of cells. Histological examination of the specimens was carried out by using routine and immunohistochemical stains to validate findings of single-cell sequencing.

Results:
Ten main cell types (27 high-resolution subtypes, totally 65,470 cells) were identified in the specimens, including endothelial cell, smooth muscle cell, fibroblast, mesenchymal cell, mesenchymal-fibroblast cell, macrophage, and T cell. As donors age increased, proportion of non-immune cells such as endothelial cell decreased from 22.47% to 10.37%, smooth muscle cell from 20.40% to 18.50%, fibroblasts from 30.21% to 13.29%, and mesenchymal cell from 5.12% to 1.55%; while proportion of immune cells such as macrophages increased from 10.94 % to 17.02 % ; and T cells from 3.80% to 26.01%. Synthetic smooth muscle cell, fibroblasts of extracellular matrix synthesis, and mesenchymal cells expressing osteocalcin/matrix Gla family genes (MAG, logFC: 4.0, P<0.01) were significantly increased in the aged donors as well as the ligand-receptor pairs between macrophages and T cells mainly in endocrine resistance related pathway. M1 (CD86) and M2 (CD163) macrophage signature antibodies were slightly elevated in the aged donors which correlated well to the findings from single-cell sequencing.

Conclusions:
Cellular population and differential gene expression patterns in human aortic tissue are under dynamic evolution in the life circle. Immune cells infiltration increases while non-immune cells decrease as age increases.
Abstract 14875: Topological Data Analysis of Electronic Health Record Features Predicts Major Cardiovascular Outcomes After Revascularization for Acute Myocardial Infarction
Authors: Lopez Javier E , Datta Esha , Ballal Aditya , Izu Leighton T
Published: June 2023

Introduction:
Topological data analysis (TDA) is an emerging mathematical technique that imposes structure on a dataset and examines the shapes (or topological features) that arise. The TDA algorithm Mapper Plus is proposed to study the spatial characteristics of clinical data for the purpose of patient classification. This is a data-driven and hypothesis-free approach to clinical risk stratification.

Hypothesis:
The hypothesis is that Mapper Plus can classify distinctive subsets of patients receiving optimal treatments post-acute myocardial infarction (AMI). Our goal is to identify subgroups who remained at risk of having a future adverse event (AE) i.e., death, heart failure hospitalization, or recurrent MI

Methods:
A single-center, retrospective analysis of 31 clinical variables from the electronic health record (EHR) was conducted on 798 AMI subjects. Risk was defined as high or low in relation to the average probability of survival without AE for the entire cohort at the 1 year mark.

Results:
TDA identified six subsets of patients. Four subsets (n=597) had > 1-fold change on the probability of survival free of AEs; these became the low-risk subgroup. Two subsets (n=344) had < 1-fold change on the probability of survival free of AEs; these became the high-risk subgroup. Because Mapper Plus allows for subject overlap across subgroups, 143 subject (18%) were shared between the high (n=201, 25%)- and low-risk (n=454, 57%) subgroups and were extracted into a 3rd intermediate risk subgroup (see figure).

Conclusions:
TDA significantly stratified AMI patients into 3 subgroups with distinctive incidences of AE up to 3 years post AMI. This is a new framework for EHR-based risk stratification that requires no additional patient interaction, is agnostic to prior knowledge, and is driven by the topological features of the included data. Further studies will be needed to validate TDA across different patient cohorts before it can be applied to clinical practice.