bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 17960: Lipoprotein(a) Testing Frequency and Predictors in a Multiethnic Health System
Authors: Brar Sumeet S , Huang Qiwen , Yan Xiaowei , Dudum Ramzi , Jose Powell , Sarraju Ashish , Palaniappan Latha , Rodriguez Fatima
Published: December 2023

Introduction:
Lipoprotein(a) [Lp(a)] is a causal risk factor for atherosclerotic cardiovascular disease (ASCVD). Contemporary practice guidelines recommend incorporating Lp(a) testing into routine clinical practice. We examined the prevalence of Lp(a) testing and characteristics that predicted which individuals underwent testing.

Methods:
This was a retrospective cohort study. Eligible individuals were patients of a large Northern Californian health system with 2 or more primary care visits between the years 2010 to 2021. Incident density matching was used to select controls matched with a case if a visit date was within ±6 months of the index date of initial Lp(a) test. Prevalence of Lp(a) testing was determined by year. Conditional logistic regression was used to assess the relationship between Lp(a) testing and sociodemographic, clinical, and healthcare utilization variables.

Results:
Of the 1,484,410 individuals in the cohort, 12,506 (0.84%) had their Lp(a) level checked. The median Lp(a) level was 35 mg/dL and 5,598 (37.78%) of those who underwent testing had a Lp(a) level > 50mg/dL. Among those with Lp(a) testing, there was a higher proportion of Asian individuals and a lower proportion of non-Hispanic Black and Hispanic individuals. In adjusted-analyses, those with a history of ASCVD had over twice the odds of undergoing testing (OR = 2.11 (95% CI = 1.98, 2.26)). South Asian individuals were three times more likely to have undergone Lp(a) testing as compared to non-Hispanic White individuals (OR = 3.25, (95% CI = 3.06, 3.46)), while those identified as non-Hispanic Black and Hispanic were significantly less likely to have undergone Lp(a) testing (OR = 0.7, (95% CI = 0.62,0.8) and 0.62 (95% CI = 0.57, 0.67), respectively).

Conclusions:
This study examined the real-world clinical testing patterns of Lp(a) over a decade within a large, diverse health system. Expanding access to Lp(a) testing may help reduce disparities within ASCVD risk assessment and treatment.
Abstract 17976: Delivery of Allogeneic Mitochondria Accelerates Revascularization in a Murine Model of Peripheral Arterial Disease and Reverses Metabolic Signatures of Endothelial Senescence
Authors: Headley Colwyn , Hu Caroline , Chiang Gladys , Oropeza Beu , Tsao Philip S , Huang Ngan F
Published: December 2023

Introduction:
Peripheral arterial disease (PAD) is characterized by limb ischemia and biological therapeutics to treat PAD are limited. PAD associated with mitochondrial dysfunction in both endothelial cells and skeletal muscle.

Hypothesis:
Therefore, we hypothesized that mitochondrial transplantation (mito-transfer) can alleviate the cellular abnormalities linked to mitochondrial dysfunction in PAD.

Methods:
Mitochondria from allogeneic fibroblasts were transferred into human microvascular endothelial cells (ECs) of varying passages (p5-14) by centrifugation. After mito-transfer (24h), the metabolic activity and proliferative capacity of ECs were respectively quantified by extracellular flux analysis and EdU incorporation into DNA.

Results:
Compared to non-manipulated ECs, mito-transferred ECs had lower oxygen consumption rates (OCR) related to mitochondrial respiration (basal, maximal, and spare respiratory capacity, and mitochondrial ATP production). No significant differences were observed in the extracellular acidification rates related to the glycolytic activity of ECs. However, the ATP index (ratio of mitochondrial ATP/ glycolytic ATP) of late passage (p10) ECs significantly decreased after mito-transfer. Furthermore, compared to non-manipulated ECs, mito-transferred ECs of late passage (p10-14) showed a 25% increase in proliferation. Mito-transfer to the ischemic limb induced a 2-fold increase in limb perfusion after 14 days (Fig. 1).

Conclusions:
Collectively, these data show that EC aging is associated with increased oxidative phosphorylation metabolism and that mito-transfer decreased the senescence-associated oxidative glucose metabolism of ECs, enhanced EC proliferation, as well as accelerated revascularization in PAD. Mito-transfer is a promising strategy to treat PAD to improve revascularization and mitochondrial function.
Abstract 17986: Impact of Race and Socioeconomic Factors on Hypertensive Emergency
Authors: Rizwan Affan M , Mace Hunter , Hamid Arsalan , Clark Donald , Hall Michael
Published: December 2023

Background:
Hypertensive emergency, defined as a blood pressure ≥ 180/110mmHg with target organ damage, is a major cause of cardiovascular morbidity and mortality. There is a lack of data on the impact of race and socioeconomic factors on hypertensive emergency incidence and outcomes. Thus, we investigated these associations in a diverse population at a large tertiary-care academic medical center.

Methods:
Utilizing the Patient Cohort Explorer Epic electronic health records system at the University of Mississippi Medical Center from 1/1/2013 to 7/31/2021, we identified patients diagnosed with hypertensive emergency. Sociodemographic factors related to hypertension and patient status (alive/deceased) were also examined. Descriptive statistics were used to examine differences in means across groups.

Results:
2,483 patients diagnosed with hypertensive emergency were included in this analysis. Among these patients, the mean (SD) age was 52 (17) years, 49% were women, and 82.2% were Black. Nearly half (44.4%) of those diagnosed with hypertensive emergency were uninsured, 46.7% had Medicaid or Medicare, and 7.9% had private insurance. Black patients with hypertensive emergency were significantly younger compared with White patients (51 vs 57 years, p<0.001). There was no significant correlation between race and insurance status in this population. Over the 8-year period, 14.1% were deceased at the time of analysis.

Conclusions:
Among patients admitted to a large academic medical center with hypertensive emergency, most were Black individuals with Medicaid or lacking health insurance. Black individuals present at significantly younger ages compared to White patients. Our findings are much different than data published from the Nationwide Readmissions Database reporting a mean age of 66 years and nearly 90% insured rate in patients with hypertensive emergency. Further, race was not reported in that analysis. Our findings suggest that hypertensive emergency disproportionately affects minority and underserved populations. Further work is needed to characterize risk factors and improve outcomes for this high-risk population.
Abstract 180: Brain Tissue Metabolomics Study Supports the Use of Multi-Drug Cocktail Approach for Neuroprotection After Asphyxial Cardiac Arrest in Rats
Authors: Choudhary Rishabh C , Shoaib Muhammad , Yin Tai , Hayashida Kei , Kuschner Cyrus , He Mingzhu , Al-Abed Yousef , Kim Junhwan , Becker Lance B
Published: December 2023

Background:
We have recently shown that using a multi-drug cocktail therapy targeting multiple pathways simultaneously could be a novel therapeutic approach to reduce ischemic brain injury following asphyxial cardiac arrest (CA) and resuscitation. To further validate the affected pathways using a multi-drug cocktail, we aimed to investigate changes in brain tissue metabolites after asphyxial CA and cardiopulmonary resuscitation (CPR) in rats.

Methods:
The multi-drug cocktail formulation included ten neuroprotective drugs (CoQ10, Cyclosporin A, Edaravone, Metformin, N- acetylcysteine, Poloxamer 188, SS-31, Sulbutiamine, Vitamin C, and Zoniporide) focusing on distinct metabolic pathways of ischemia-reperfusion injury. Male Sprague-Dawley rats underwent 12 min of asphyxial-CA followed by CPR and received either a multi-drug cocktail or a vehicle (n=6) immediately after resuscitation. At 2 hr post-resuscitation rats were euthanized, and the whole-brain tissue was processed for mass spectrometry for metabolomic analysis. Data were collected both in +ve and -ve ion modes and the collected data were analyzed using metaboanalyst 5.0.

Results:
A total of 139 metabolites were detected in +ve ion mode whereas 132 metabolites were detected in -ve ion mode. While combining and removing a duplicate number of metabolites a total of 234 metabolites were analyzed. Our principal component analysis (PCA) data showed a shift of overall metabolites towards sham groups with multi-drug cocktail treatment after 12 min CA. Out of 234 metabolites 40 were significantly increased and 19 were significantly decreased between cocktail and vehicle-treated groups (Suggested by Volcano Plot, p=0.05, fold Change =1). A total of 15 pathways were significantly impacted between cocktail and vehicle-treated groups (p= 0.05) suggesting the broad effect of a multi-drug cocktail therapy after asphyxial CA and resuscitation

Conclusion:
This study represents an innovative attempt that employs metabolomics research to elucidate the effects of a multi-drug cocktail in a severe CA rodent model, uncovering a notable alteration in the overall metabolic profile of the brain and suggesting an important role of multi-drug cocktails in ischemic injury.
Abstract 18001: Coronary Artery Vasospasm Secondary to Capecitabine: A Case Report
Authors: Mejia Morales Miguel , Maroo Praful
Published: December 2023

Case Description:
A 49-year-old male with recent diagnosis of rectal cancer presented to ED for chest tightness, which had never experienced before. He had started Capecitabine for chemotherapy three days before. The patient had no history of CV disease or risk factors, was a never smoker and never used illicit substances. He is a SWAT/police officer who runs an 8-minute mile every morning without problems. In ED, was initially chest pain free. ECG with 1 mm ST segment depressions in V1 - V3. Five hours later, developed chest tightness again, and ECG revealed diffuse ST-elevations. Was started on nitroglycerin drip and admitted for monitoring. His chest tightness and ST segment elevations resolved completely. High-sensitivity troponin T was initially 37, and down trended to 27 over 4 hours. He was transitioned to long-acting Nifedipine. The chest tightness did not recur and was discharged with discontinuation of Capecitabine. Outpatient CTA of coronary arteries and echocardiogram were normal. A diagnosis of coronary artery vasospasm secondary to Capecitabine was confirmed.

Discussion:
Coronary artery vasospasm is the most common cardiotoxic effect of Capecitabine. It happens more frequently during the first three doses and can occur in patients with no hx of CV risk factors. The management consists of discontinuation of the medication. Long-acting CCB can be used for prevention. CTA of coronaries can be used to assess patients at low-to-intermediate risk of CAD.
Abstract 18021: Environmental Circadian Desynchronization and Metabolic Stress Drive Heart Failure With Preserved Ejection Fraction (HFpEF)
Authors: Mandi Varun , Lee Jeongkyung , Jagannathan Rajaganapathi , Yang Ping , Negi Vinny , LI FENG , Wu Yijen L , Rajasundaram Dhivyaa , Yechoor Vijay , Moulik Mousumi
Published: December 2023

Background:
The pathogenic mechanisms underlying HFpEF (Heart Failure with preserved Ejection Fraction), which accounts for 50% of heart failure, remain unclear. Elevated endoplasmic reticulum (ER) stress has been implicated in HFpEF. Circadian disruption (CD) as seen in shift workers has been associated with an excess risk for chronic age-related disorders, including cardiovascular disease. Currently, the role of CD in HFpEF is not known.

Hypothesis:
The dual 'hits' of chronic metabolic stress and circadian disruption lead to increased ER stress, impaired unfolded protein response (UPR), and adverse cardiac remodeling resulting in HFpEF.

Methods:
High fat diet (HFD) fed C57BL6 male mice were subjected to chronic shifted light-dark (LD) cycles mimicking shift work (Shift), with appropriate controls. Metabolic (glucose tolerance, insulin sensitivity, body fat) and cardiac function parameters (systolic and diastolic function by ECHO, MRI, and terminal PV-loops) were collected. Cardiac tissue was analyzed using qPCR, western blot, bulk RNA-seq, spatial transcriptomics, proteomics, and histology. For in vitro studies,
Bmal1
was deleted in H9C2 cells using CRISPR/Cas9.

Results:
‘HS’ mice (HFD & Shift) had the most insulin resistance, glucose intolerance, and obesity, compared to ‘HR’ (HFD & Regular LD), ‘CS’ (Normal Chow & Shift) and ‘CR’ (Chow and Regular LD) groups. ECHO and MRI revealed preserved EF in all groups, with diastolic impairment in both HS and HR (↑MV E/E’, ↓MV E/A, and ↓LV diastolic strain) groups, HS>HR. Only ‘HS’ mice showed ↓cardiac compliance (↑β in EDPVR) and ↑lung weight suggestive of HF consistent with HFpEF. Gene and protein expression revealed dysregulation of numerous UPR pathway molecules (Atf6, Chop, Bip, Perk, and others) in HS mice. Mechanistically,
Bmal1
deletion in CMs resulted in similar dysregulation of UPR genes. HS mouse hearts showed increased fibrosis, and spatial transcriptomics displayed enrichment of ATF4-related pathways in CMs and activated fibroblasts.

Conclusions:
The dual hit of metabolic and circadian stress induces HFpEF, which cannot be recapitulated by only one stressor. Our results identify previously unrecognized roles of UPR perturbation in driving HFpEF under circadian and metabolic stress.
Abstract 18033: Nationwide Trends in Major Adverse Cardiac and Cerebrovascular Events Hospitalizations and Cardiac Arrests in Young Women (18-44 Years), 2016-2019
Authors: Bondi Gayatri , Borra Vamsikalyan R , Yartha Sai Goutham Reddy , Prem Anand Dharshana , Jain Shruti Sandeep , Ramasahayam Karthikeya , prathipati reshmanth , Dudhat Ayushi Parsottambhai , Patel Simran , Pingilati Raja Akshay , Kakarla Hemaswini , Desai Rupak
Published: December 2023

Introduction:
Incidence of Major Adverse Cardiac and Cerebrovascular Events (MACCE) and cardiac arrests are increasing in younger women aged 18 - 44 years in the context of increasing metabolic syndrome and nontraditional risk factors such as stress, anxiety, and depression. We aim to assess recent trends in hospitalizations associated with MACCE and cardiac arrest in them.

Methods:
National Inpatient Sample database from 2016 - 2019 was used to examine temporal trends, risk factors, disparities, and outcomes related to hospitalization for MACCE and cardiac arrest in young women (18-44 years). We used the Chi-square test to evaluate the differences and multivariate logistic regression analysis for outcome analysis.

Results:
A total of 24,882,601 young women admissions were identified, in which 0.8% had MACCE and 0.1% had cardiac arrest. Between 2016 - 2019, there is a statistically significant increase in MACCE (0.7 % to 0.9 %) and cardiac arrests (0.1% to 0.2 %), p<0.001. African Americans experienced higher adjusted odds of MACCE compared to whites (OR 1.06, 95% CI: 1.02-1.09, p<0.001). Asian, white, and Hispanics experienced the lowest (0.1%) increase, while Native Americans experienced the highest (0.6%) increase in MACCE. There is a decrease in adjusted odds in Hispanics and Asians compared to whites in both MACCE and Cardiac arrest with statistical significance. Hypertension was African Americans’ most prevalent risk factor (62%). Length of stay was the same in all races (4 days) except in whites (3 days), with p value < 0.001. The total cost of hospitalization was highest in Hispanics (95067USD) and least in blacks (75074USD).

Conclusion:
The rise in MACCE and cardiac arrest cases among young women highlights the need to expand the literature on the causes of these trends, female specific risk factors and racial disparities. The declining cardiovascular health of this population demands targeted prevention, early treatment and management strategies.
Abstract 18034: Intracardiac Bullet: To Fish It Out or Let Love Take the Shot!
Authors: Earthineni Geethika , Verma Divya Ratan , Harjai Kishore , Maniar Hersh , Mehani Mina , Nafee Tarek , Mwansa Victor , Njoh Roland , Reddy Hanumanth K , Nagra Ajit
Published: December 2023

Background:
Gunshot wounds cause catastrophic injuries. When bullets embolize to heart, without penetrating cardiac injury, optimal management remains unclear.

Case:
25 year old male, presented after multiple gunshot wounds (GSW). On exam, perirectal GSW, 3 GSWs to right thigh and 2 GSW to left thigh noted. Lungs CTA bilaterally, CVS normal S1, S2. CTA chest showed Infra renal IVC injury and large retroperitoneal hematoma. (1,2). ECHO revealed a bullet in the dependent part of right atrium, abutting the tricuspid valve (3). No chest injury noted, suggesting migration of bullet from IVC, following the trajectory of venous return to right atrium. He underwent IVC patch repair. Percutaneous approach was unsuccessful to snare the bullet using 8-mm and 14-mm triloop snare, 15-mm gooseneck snare (4), bronchial forceps (5) and balloon. Multidisciplinary team decided to abandon further percutaneous or surgical extraction attempts as the bullet firmly lodged in sub-tricuspid chordo papillary apparatus with no valvular dysfunction.

Discussion:
In hemodynamically stable patient with intracardiac bullet, there is no standard treatment approach. 65% of bullets entering vena cava, migrate and lodge in chordo papillary apparatus or trabeculations. Low risk percutaneous extraction approaches have gained popularity, with about 50% success. When percutaneous extraction fails, clinicians face a critical decision to observe or perform open sternotomy extraction. Numerous case reports support observation only approach. This patient has done well with observation, suggesting non-operative initial management is reasonable in hemodynamically stable patient with intracardiac bullet.
Abstract 18044: Valvular Procedures in Pregnant Women With Congenital Heart Disease: The Magee Obstetric Maternal and Infant (MOMI) ACHD Substudy
Authors: Saraf Anita , Hindes Morgan , Berlacher Kathryn , Hoskoppal Arvind , Catov Janet M , Kalogeropoulos Andreas P , Pastena Paola
Published: December 2023

Introduction:
Pregnant women with adult congenital heart disease (ACHD) are at high risk of complications and may require interventions, including valvular surgery, after delivery. However, data on the long-term need for valvular surgery among pregnant women with ACHD are limited. Hypothesis: We hypothesized that increasing ACHD complexity and obstetric history are associated with the need for valvular surgery after delivery.

Methods:
Data from the University of Pittsburgh Medical Center clinical data warehouse were linked to all deliveries from 2004 to 2020 in pregnant women with ACHD (N=430) and without ACHD (N=876), who were included in the Magee Obstetric Maternal and Infant (MOMI) study. Women were matched at the delivery level for age, delivery year, and race. Valvular procedures were captured using Current Procedural Terminology codes until 8/31/2022.

Results:
Baseline characteristics and pregnancy outcomes are presented in
Table 1
. Prior to index delivery, 8 women (6 with ACHD, 2 controls) had a valve replacement, Table 1. After a median of 5.1 (2.8, 8.8) years, 23 women with ACHD had a total of 25 valve procedures, corresponding to 1.0% per year (95%CI: 0.6 to 1.4). Most procedures were aortic valve (n=11, plus aortic root in 5) and pulmonary valve replacements (n=11), followed by tricuspid (n=5) and mitral (n=1) procedures; some women had >1 valve replaced in the same procedure. There were no valvular interventions among controls. After adjusting for maternal age and race, the strongest predictor of need for valvular interventions was ACHD complexity. Compared to simple lesions; moderate ACHD had a HR of 6.58; 95%CI 1.85 - 23.4; P=0.004 and complex ACHD a HR of 9.35; 95%CI 1.37 - 64.0; P=0.023). The number of previous deliveries (or total pregnancies) was not associated with the need for valvular procedures.

Conclusions:
Women with moderate or complex ACHD have increased rates of valvular procedures after delivery, but multiple pregnancies do not modify this risk.
Abstract 18070: Amyloid Ambush: A Shocking Encounter With AL Cardiac Amyloidosis
Authors: Basheer Amjad , Azmeen Ayesha , Hovseth Chad , Zolty Ronald
Published: December 2023

Introduction:
We present a case of a 44-year-old female with multiple comorbidities with a catastrophic course of cardiac AL amyloidosis.

Case Presentation:
The patient initially presented with symptoms, including epigastric pain, nausea, vomiting, and chest discomfort. Notably, she had a previous diagnosis of carpal tunnel syndrome. Soon after, she developed cardiogenic shock, sustained ventricular tachycardia, and was transferred to our center.

Diagnostic Workup:
The echocardiogram showed mildly reduced LVEF and moderately depressed RVSF. Initial RHC revealed significantly elevated right and left filling pressures and a low cardiac index. Cardiac MRI exhibited abnormal gadolinium kinetics and parametric mapping consistent with cardiac amyloidosis. Endomyocardial biopsy with light chain mass spectrometry confirmed the presence of AL amyloidosis. The kappa/lambda ratio was 60, and a bone marrow biopsy showed 30% plasma cells.

Treatment and Outcome:
The patient's cardiogenic shock worsened despite intensive support with an intra-aortic balloon pump and multiple iono-pressors. Unfortunately, her deteriorating condition rendered her ineligible for chemotherapy, transplantation, and left ventricular assist device (LVAD) placement.

Conclusion:
This case unveils the elusive nature of AL cardiac amyloidosis, where cardiogenic shock can be the initial presentation. Clinicians must remain vigilant, recognizing LV hypertrophy coupled with a low-voltage EKG and a preceding history of carpal tunnel syndrome. We underscore the rapid progression and limited treatment options.
Abstract 18081: Using Evidence-Based Strategies, Including Coverage of Home-Based Cardiac Rehabilitation, to Increase Participation in Cardiac Rehabilitation - A Community Health Plan’s Experience
Authors: Magdon-Ismail Zainab , Murphy Sheree , Gauthier Vickie , Wyrick Tiana , Rowe Cori , Austin Rachael , Cuevas Pennie , Coplin Bruce
Published: December 2023

Introduction:
Barriers to referral, enrollment and participation in cardiac rehabilitation (CR) contribute to low rates of completion despite known benefits. Barriers are system, provider and patient related. We sought to examine the impact a non-integrated community health plan can have on addressing these barriers, given the absence of formal studies evaluating its impact.

Hypothesis:
Implementing evidence-based strategies would increase CR participation.

Methods:
Between October 2019-October 2022, The Capital District Physicians’ Health Plan (CDPHP) developed and implemented an enhanced cardiac rehabilitation initiative (ECRI) to increase CR rates using evidence-based strategies. CDPHP: 1) eliminated patient cost-share, 2) covered home-based cardiac rehabilitation (HBCR), 3) implemented physician valued-based incentives, 4) presented metrics to providers, 5) educated providers and patients, and 6) dedicated staff to facilitating enrollment. CR rates were evaluated between Q2 2021 and Q2 2022.

Results:
Time from ECRI program conception to implementation was 18 months. Enrollment in HBCR went from 4% (19/485) (Q2, 2021) to 7.8% (33/422) (Q2, 2022). Enrollment in center-based cardiac rehab (CBCR) went from 11% (53/485) to 11.4% (48/422) respectively. Total enrollment in CR increased from 14.8% (72/485) to 19.2% (81/422).

Conclusions:
The ECRI created a call-to-action among providers to address modifiable barriers such as patient identification for CR and referral and enrollment processes. The introduction of HBCR increased CR rates and were additive to CBCR rates, suggesting the introduction of HBCR can increase CR rates and not displace CBCR. Increasing CR engagement and amplifying the results found in this demonstration, requires coordinated effort from all stakeholders-cardiology providers, hospitals, CR providers and health plans.
Abstract 18085: Effect of Therapies on Quality of Life in Heart Failure With Reduced Ejection Fraction: A Systematic Review and Meta-Analysis
Authors: Akhtar Khawaja Hassan , Agarwal Siddharth , Ford Lance , Zhao Yan Daniel , Dasari Tarun W
Published: December 2023

Introduction:
Minnesota Living with Heart Failure (MLWHF) questionnaire is a validated tool to assess quality of life in patients with heart failure with reduced ejection fraction (HFrEF)

Hypothesis:
We performed this systematic review and meta-analysis to evaluate the effect of therapies on improvement in MLWHF; analyzed across randomized controlled trials (RCTs) of drug based therapy, device based therapy, autonomic modulation, and exercise.

Methods:
We conducted a systematic search of MEDLINE and EMBASE for RCTs measuring MLWHF at baseline and follow-up in patients with HFrEF. Primary outcome was improvement in MLWHF. Meta-analysis was stratified in groups based on medical therapy, device based therapy (cardiac resynchronization therapy and cardiac contractility modulation), autonomic modulation (vagus nerve stimulation and baroreflex activation therapy), and exercise. Mean difference (MD) with 95% Confidence Interval (CI) were reported across multiple studies included in meta-analysis.

Results:
A total of 23 studies met the inclusion criteria. Analysis showed statistically significant improvement in MLWHF at follow-up for drug based therapy (MD: -2.77; 95% CI: -5.10, -0.44) (Panel A), device based therapy (MD: -6.86; 95% CI: -9.60, -4.12) (Panel B), autonomic modulation (MD: -15.21; 95% CI: - 19.25, -11.17) (Panel C), and exercise group (MD: -10.05; 95% CI: -16.66, -3.43) (Panel D). Sub-group analyses based on various treatment modalities showed statistically significant improvement in MLWHF at follow-up for cardiac resynchronization therapy (MD: -8.11; 95% CI: -11.88, -4.33), cardiac contractility modulation (MD: -5.47; 95% CI: -9.46, -1.49), and baroreflex activation therapy (MD: -19.79; 95% CI: -24.90, -14.67).

Conclusions:
Drug based therapy, device based therapy, autonomic modulation, and exercise are associated with improvement in quality of life in patients with HFrEF.
Abstract 181: Adiponectin Alleviates Acute Murine Pulmonary Injury Post Cardiopulmonary Resuscitation
Authors: He Yarong , Jiang Yaowen , Tang Shiyuan , Yu Haifang , Cao Yu
Published: December 2023

Objective:
Patients with cardiac arrest (CA) are often suffering from pulmonary ischemia-reperfusion injury after active cardiopulmonary resuscitation (CPR) and return of spontaneous circulation (ROSC). In recent years, previous studies have found that acute lung injury (ALI) after ROSC could be an independent risk factor for the prognosis of out of hospital cardiac arrest (OHCA). However, there is still a lack of effective therapy for pulmonary injury caused by CA-CPR-ROSC with no side effects.

Methods:
C57BL/6 male mice, aged from 8 to 10 weeks were purchased from Dossy Experimental Animals Co. Ltd (Chengdu, China). All the mice were feeding and drinking freely in the animal room of Sichuan University West China Science and Technology Park for one week. The experiments involving mice were approved by the Ethics Committee from West China Hospital of Sichuan University (approval No.2017071A). At the day before experiment, mice were given fasting treatment but allowed to drink water freely. CA-CPR-ROSC could cause global cerebral ischemia injury in vivo. APN (10μg/0.05ml per mice) was intravenously injected to mice at 10 min after restoration of spontaneous circulation (ROSC). Computed tomography (CT) scan of the lungs was performed before executing the animals. We used the Opal Color Manual IHC staining Kit for multiplex immunofluorescence staining measurement. Western blot detected the expression of Nrf2, OCLN, and CLDN5 in murine pulmonary tissues.

Results:
The results of CT scanning and routine histological measurements showed that APN could protect mice against murine pulmonary injury caused by CA-CPR-ROSC, compared to that of mice in CA-CPR-ROSC group. The results of western blot suggested that the expression of Nrf2 significantly increased in mice pulmonary tissues in CA-CPR-ROSC, whereas the expression of OCLN and CLDN5 obviously decreased in murine pulmonary tissues in CA-CPR-ROSC.

Conclusion:
Current study indicated the protect role of Adiponectin against acute murine pulmonary injury caused by CA-CPR-ROSC. The protective role of Adiponectin against acute murine pulmonary injury caused by CA-CPR-ROSC might be associated to the Nrf2 signaling pathway.
Abstract 18113: O
2
Pulse is Not Stroke Volume: Changes in Oxygen Pulse Do Not Reliably Track Changes in Stroke Volume During Exercise in Health or Heart Failure
Authors: Tovar Carlos , Wakeham Denis J , Brazile Tiffany L , Samels Mitchel , De Oliveira Gomes Diana , Howrey Matthew M , Hearon Christopher M , MacNamara James P , Levine Benjamin D , Sarma Satyam
Published: December 2023

Background:
Oxygen Pulse (O2P) is often used to index peak stroke volume (SV) during cardiopulmonary exercise testing (CPET) when measures of cardiac output are not possible. O2P is calculated as Oxygen uptake (V˙O
2
) / heart rate (HR) and based upon rearrangement of the Fick equation (V˙O
2
= [HR x SV] x arterial-venous O
2
difference [Δa-vO2]; Δa-vO2 is not included in the O2P calculation). As little data exist to validate the use of O2P, we assessed whether O2P tracks changes in SV during exercise in health and disease.

Methods:
We studied 401 individuals: 232 healthy adults (healthy; 51% males; age: 61 ± 11 [28-88] years); 119 adults at high-risk for future development of heart failure (high-risk; 47% males; age: 51 ± 6 [40-64] years); and 50 adults with heart failure with preserved ejection fraction (HFpEF; 36% males; age: 71 ± 7 [56-86] years). Participants were studied at rest, during light (~30% V˙O
2
max), moderate (Mod; ~60% V˙O
2
max) and maximal exercise (Max). V˙O
2
(indirect calorimetry) and cardiac output (Q˙c; acetylene rebreathing) were measured, enabling calculation of SV (Q˙c/HR) and O2P. Data were compared via two-way (measure*stage) ANOVA.

Results:
We observed a significant measure*stage interaction for all three groups (all,
P<
0.001; Figure), suggesting different responses to exercise between measures. Specifically, SV and O2P increased from rest to light exercise in all groups (all,
P
<0.001; Figure). Thereafter, O2P continued to increase from light-Mod (all, P<0.001) and Mod-Max (all,
P
<0.001; other than for Mod-Max in HFpEF,
P
=0.124). However, actual SV did not increase from light-Mod exercise (all groups, P>0.917) or from Mod-Max exercise in high-risk (Δ0±13 ml,
P
=0.999) and HFpEF (Δ-3±14 ml,
P
=0.564), but fell slightly in healthy individuals from Mod-Max (Δ-5±13 ml,
P
<0.001).

Conclusions:
Changes in O2P do not reflect changes in SV between exercise stages during CPET in health or disease and should therefore be used with caution.
Abstract 18121: Gaps in Initiation of Evidence-Based Medical Therapies in Patients With Ischemia With Nonobstructive Coronary Artery Disease
Authors: Ramchandani Juhi , Shah Chirag , Landrigan Luke , Zala Harshvardhanan , Miguel Andres Unai , Mastouri Ronald , Tamarappoo Balaji
Published: December 2023

Introduction:
Ischemia with nonobstructive coronary artery disease (INOCA) is associated with major adverse cardiovascular events (MACE) due to atherosclerotic plaque progression, rupture of high-risk plaque and microvascular dysfunction. While there is evidence for use of ACE inhibitors/ARBs and statins to reduce MACE in patients with coronary artery disease (CAD), gaps in implementation of maximal medical therapy in patients after diagnosis of INOCA is not well described. We hypothesize that cardioprotective medications may be underutilized in patients with INOCA.

Methods:
Patients (n=443) with ischemic symptoms associated with ECG changes or troponin rise, no history of CAD and with nonobstructive CAD on noninvasive or invasive coronary assessment between 2010-2021 at Indiana University Health, Indianapolis, were included in this study.

Results:
In 226 women and 217 men with mean age 58.5 yrs, 315 underwent invasive angiography and 128 coronary CTA. Compared to baseline, initiation rates of cardioprotective agents were low after INOCA diagnosis for statins (37.9%) and aspirin (ASA, 36.1%) (Figure 1A). Among eligible patients, statins and ASA were underutilized in 42% and 44% respectively. There were no statistically significant differences in prescribing patterns of ASA and statin based on gender or race (Figure 1B).

Conclusions:
There are significant gaps in the prescription of cardioprotective medications including statins, ASA, ACEI/ARB and beta blockers in patients with INOCA at a quaternary care hospital. If this pattern is similar to the rest of the country, the factors associated with underutilization of these medications needs to be explored further.
Abstract 18128: How Long Should We Tilt?: Challenging the 10-Minute Cutoff in the Diagnosis of Postural Tachycardia Syndrome (POTS)
Authors: Gupta Mohak , Honnekeri Bianca , Vajapey Ramya , Hutt Erika , Mayuga Kenneth
Published: December 2023

Background:
Postural tachycardia syndrome (POTS) is defined by symptoms of orthostatic intolerance (OI) that correlate with an orthostatic tachycardia response. Current diagnostic criteria require a sustained increase in HR by ≥30 bpm [accentuated postural tachycardia (APT)], without a concurrent BP drop, within 10 minutes of standing or head-up tilt testing (HUTT). In many centers, the HUTT duration is predetermined to be 10 mins. However, many patients may exhibit APT after this cutoff.

Research Question:
How many patients with symptoms consistent with POTS demonstrate APT during HUTT after the 10-min cutoff, and what factors influence onset time?

Methods:
Using a cohort of 255 patients with OI, we characterized the temporal distribution of APT onset time during 45-minute HUTT at our referral center. We used multivariate linear regression to identify predictors influencing onset time, and plotted Kaplan-Meier failure function stratified by predictors.

Results:
The cohort's mean age was 33 years, 91% were female, 16% were obese, 13% had hypertension, 1.6% had diabetes, and 26% were smokers. Mean APT onset time was 17.5 mins (SD 10), and median onset time was 13 mins (IQR 11-22). About 15% had APT onset within 10 min, 60% in 15 mins, 75% in 20 mins, 90% in 30 mins, and 95% in 40 mins. Increasing age and BMI were associated with later APT onset time, whereas sex, diabetes, hypertension, and smoking were not influential

Conclusion:
The 10-min cutoff captured only 15% of patients with APT; extending the cutoff just 5 minutes longer captured an additional 60% patients. Our findings suggest that the current 10-min cutoff for POTS diagnosis is likely too restrictive, as a significant proportion of patients exhibit APT after this period but otherwise fit the clinical scenario of POTS. Increasing age particularly ≥40 yrs, and obesity were associated with a later APT response. Future definitions should consider extending the testing duration and cutoff time in the evaluation of POTS.
Abstract 18170: Microvascular Complications of Type 2 Diabetes in Patients With Heart Failure With Mildly Reduced or Preserved Ejection Fraction in the DELIVER Trial
Authors: Presslie Calum , Yang Mingming , Desai Akshay S , Claggett Brian , Vaduganathan Muthiah , de Boer Rudolf A , Hernandez Adrian F , Inzucchi Silvio E , Kosiborod Mikhail N , Lam Carolyn S , Martinez Felipe , Shah Sanjiv J , Petersson Magnus , Langkilde Anna Maria , Solomon Scott D , McMurray John J , Jhund Pardeep S
Published: December 2023

Introduction:
The role of microvascular complications of type 2 diabetes mellitus (T2DM) in heart failure (HF) with mildly reduced or preserved ejection fraction is poorly understood.

Aim:
To assess outcomes and the response to dapagliflozin in the DELIVER trial by the presence of microvascular complications of T2DM.

Methods:
DELIVER was a multicentre, double-blind randomised controlled trial in patients with an ejection fraction >40% that compared the efficacy of dapagliflozin to placebo. Data on past medical history of T2DM and microvascular complications (nephropathy, angiopathy, retinopathy, peripheral neuropathy, and autonomic neuropathy) were collected at the initial trial visit. Patients were classed as no T2DM, T2DM only and T2DM and microvascular complications. The primary composite outcome was worsening HF or cardiovascular death. Secondary outcomes were HF events, cardiovascular death, and all-cause mortality.

Results:
6263 patients were analysed. 3457 (55.1%) patients did not have T2DM, 1840 (29.4%) had diabetes only and 966 (15.4%) had diabetes with a microvascular complication. The unadjusted and adjusted hazard ratio for the primary and secondary outcomes is shown in the Table for those with T2M and T2DM with MVC compared to no T2DM.The risk of outcomes was highest in those with T2DM and microvascular complications but was not significant after adjustment. There was no difference in the effect of dapagliflozin on each outcome by T2DM status (Table).

Conclusions:
In HF and an ejection fraction >40%, T2DM with MVC is associated with poorer outcomes. The efficacy of dapagliflozin did not differ by diabetes status or the presence of MVC.
Abstract 18173: Spinal Cord Protective Strategy Before Extensive Surgical Procedure for Patients With Acute Type A Aortic Dissection
Authors: Xu Fei
Published: December 2023

Introduction:
Spinal cord injury (SCI) is a devastating complication following total arch replacement (TAR) with frozen elephant trunk (FET) procedure in acute type A aortic dissection (ATAAD). This study aims to evaluate the efficacy of spinal cord protective strategy (SCPS) implemented before this extensive procedure.

Methods:
Between January 2013 and December 2021, a total of 1105 ATAAD patients underwent TAR with FET procedure. SCPS included preoperative assessment of segment number of the false lumen closest to the spinal cord between T9-L3 level. If segment number exceeded 5, indicating high risk of postoperative SCI, prophylactic cerebrospinal fluid drainage would be conducted. SCPS was performed since June 2017 at our institution (703 patients). The remaining 402 patients were served as the control group. The two groups were compared to assess the efficacy of SCPS in preventing SCI.

Results:
The average age was significantly higher in the SCPS group (48.9±11.1 vs 46.6±10.0, P<0.001). The patients in SCPS group presented with higher percentage of coma (P<0.001). The mean duration of cardiopulmonary bypass was significantly longer in SCPS group (P<0.001), while the mean duration of hypothetical cardiac arrest was significantly lower (P<0.001). Propensity score matching was conducted, resulting in a matched sample of 186 patients from each group to adjust for differences in patient characteristics. The incidence of postoperative SCI was significantly lower in SCPS group (1.7% vs 7.2%, P<0.001). Propensity score matching demonstrated higher estimated incremental protective efficacy of SCPS (1.1% vs 9.7%, P<0.001). Multivariate logistic regression analysis revealed that preoperative SCPS was an independent protective factor for postoperative SCI (OR=0.226, 95% CI: 0.114-0.448, P<0.001).

Conclusions:
The implementation of preoperative SCPS is an effective strategy for reducing the incidence of SCI follow extensive surgical procedure in ATAAD.
Abstract 18185: A Multicenter Prospective Trial of Therapeutic Angiogenesis Using Bone Marrow-Derived Mononuclear for Patients With Critical Limb-Threatening Ischemia Caused by Thromboangiitis Obliterans
Authors: Yanishi Kenji , Fujioka Ayumu , Yukawa Arito , Yoshimura Jun , Ozawa Takaaki , Goto Daiki , Kawamata Hirofumi , Matoba Satoaki
Published: December 2023

Background:
Thromboangiitis obliterans (TAO) can develop critical limb-threatening ischemia (CLTI). Despite conventional treatments, such as smoking cessation or revascularization, young patients require limb amputation. Therapeutic angiogenesis using bone marrow-derived mononuclear cell (BM-MNC) implantation has demonstrated long-term efficacy and safety in patients with CLTI, particularly those with TAO. To expand BM-MNC implantation in clinical practice, further evidence is required in CLTI patients with TAO. We aimed to determine the efficacy of BM-MNC implantation in a prospective trial.

Methods:
This multicenter, prospective, interventional trial was performed under an advanced medical care program. We enrolled 22 patients with CLTI and skin perfusion pressure (SPP) <30 mmHg; they underwent BM-MNC implantation within 28 days (Figure.1). The follow-up period was 180 days, and the primary endpoint was an improvement in the SPP value in the affected target limb 180 days after the implantation. One patient dropped out from the follow-up.

Results:
The mean age was 47.6 years (male: 90.5%, Fontaine classification IV: 57.1%). The SPP value significantly improved on day 180 (p<0.001) (Figure. 2). The secondary endpoints, i.e., numerical rating scale scores and transcutaneous oxygen pressure values significantly improved within day 180. The 3-year major amputation-free and overall survival probability in the safety analysis set were 95.5% and 89.5%, respectively (Figure. 3). No severe adverse events occurred.

Conclusions:
We believe that the BM-MNC implantation will likely become a feasible and safe therapy for CLTI patients caused by TAO.
Abstract 18196: Relationship Between Napping with Brachial-Ankle Pulse Wave Velocity (BAPWV) and Coronary Heart Disease in a Chinese Community Prospective Cohort Study
Authors: Zhao Xiaolei , Cai Qiujing , Tian Tao , Zhou Xian-Liang , Zhang Yuqing , Zhang Weiguo , Liu Lisheng , Hu Aihua
Published: December 2023

Introduction:
To this date, many studies have proposed an association between napping and multiple cardiovascular events. The brachial-ankle pulse wave velocity (baPWV) level can be used as an indicator of vascular stiffness and is becoming a non-invasive indicator of diseases such as atherosclerosis and coronary artery disease (CAD). However, few associations between napping and baPWV levels combined with cardiovascular disease are known. Therefore, we investigated the association of napping with baPWV and CAD in a prospective cohort study.

Hypothesis:
To study the association of napping with baPWV and CAD in a prospective cohort study, and to guide the lifestyle of the population.

Methods:
Interviews, physical examinations, laboratory tests, and bapwv testing were part of baseline assessments of 3636 participants who were continuously followed from 2012 to 2018. The population was divided into three groups based on nap frequency that non-siesta group, intermittent siesta group and continuous siesta group. The association of napping with baPWV and CAD were determined using survival curve, COX regression models and multivariate linear regression.

Results:
Among all participants, the different groups have a significant difference of baPWV and the highest was in the continuous siesta group (2012: 1668.59cm/s, 2019: 1723.69cm/s). After χ2 test, the incidence of abnormal baPWV showed an ascending trend as the frequency of napping increased, siesta was positively correlated with baPWV (P<0.001). Of the participants, 45, 97 and 47 (6.4% vs 5.5% vs 4.0%) persons in three groups newly found CHD after baseline (P<0.001). According to Cox regression analysis, in the fully controlled model, participants in the continuous siesta group [ HR 1.519 (95%CI 1.004-2.296); P<0.05] exhibited a 1.519-fold risk of CAD occurrence when setting the non-siesta group as reference. After adjusting for multiple variables in multiple linear regression analysis, we found the positive relationship between nap frequency and baPWV values (P=0.008)

Conclusions:
An elevated baPWV and danger of CAD were shown to influenced by increased frequency of siestas. These results need to be verified by additional lab work.
Abstract 18199: Relationship Between Hospital Care Team Segregation Index and Cardiovascular Care for Black and White Patients
Authors: Johnson Adedoyin , Knapp Shannon , Quintero Bisono Janina , Trabue Dalancee , Yee Ryan , Williamson Francesca , Watty Stephen , Pool Natalie , Thomas Hebdon Megan , Moore Wanda F , Yankah Ekoh , Ezema Nneamaka , Kimbrough Nia , Washington Johnnie , Lightbourne Karen , Edmonds Brownsyne , Capers Quinn , Brown David , Johnson Denee , Evans Jalynn , Foree Brandi , Holman Anastasia , Blount Courtland , Nallamothu Brahmajee K , Hollingsworth John , Breathett Khadijah
Published: December 2023

Background:
High levels of hospital health care team segregation has been associated with worse outcomes for Black patients. We sought to determine whether hospital level segregation index (SI, degree of dissimilarity between composition of teams that care for Black versus White patients) was associated with care by a cardiologist, 30-day readmission, and 1-year survival for Black versus White patients with heart failure (HF).

Methods:
Using Optum’s de-identified Clinformatics® Data Mart Database, for commercial and Medicare plans, we examined SI among Black and White patients admitted with primary diagnosis of HF from 2010-2018. Hospitals were stratified into three SI groups based on tertiles from least to most segregated hospital teams. Generalized linear mixed-effects models were used to evaluate each outcome including effects of race, SI, race by SI as well as gender, age-adjusted Charlson Comborbidity Index, and hospital factors. For 30-day readmission and 1-year survival, we included effects of cardiology care, 2 and 3-way interactions of race, SI, and cardiology care.

Results:
Among 119, 272 patients, Black patients were less likely to be seen by a cardiologist compared to White patients across SI tertiles, particularly medium SI hospitals (OR 0.833, 95% CI 0.770-0.902). There was no significant difference in odds of readmission between races across hospital SI levels and whether seen by a cardiologist. For 1-year survival, the odds were significantly higher for Black patients compared to White patients across all SI levels (
Figure
).

Conclusion:
Black patients with commercial or Medicare insurance were less likely to be seen by a cardiologist for HF care than White patients across SI levels, particularly medium SI. Hospital SI levels did not demonstrate a consistent relationship between 30-day readmission and 1-year survival.

Figure

.