bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 13794: Prevalence, Treatment Patterns and Outcomes of Acute Myocardial Infarction in Hospitalizations With Acute Ischemic Stroke - A Nationwide Analysis
Authors: Sheth Aakash , Patel Harsh P , Grewal Udhayvir , Thakkar Samarthkumar , Helmy Terek , Dominic Paari
Published: April 2024

Introduction:
AHA/ASA guidelines recommend measuring troponin in patients with acute ischemic stroke (AIS) to monitor for acute myocardial infarction (AMI). However, large scale data on the prevalence and outcomes of AMI complicating AIS are lacking.

Hypothesis:
AMI in patients with AIS is associated with poorer outcomes.

Methods:
All patients with principal diagnosis of AIS with and without AMI were identified in the Nationwide Inpatient Sample from 2005 to 2018. Using Jonckheere-Terpstra test, propensity score matching, and univariate and multivariate logistic regression, trends of prevalence of STEMI and NSTEMI, in-hospital outcomes, and treatment patterns were obtained and compared between the AIS groups with and without AMI.

Results:
A total of 5,329,107 hospitalizations with AIS were identified, of which 117,955 hospitalizations had AMI (20,289 STEMI and 97,756 NSTEMI). The prevalence of STEMI decreased while that of NSTEMI increased significantly over time. After propensity score matching, the AIS group with AMI had higher all-cause in-hospital mortality (11.42% vs 3.51%; p<0.0001), and a higher occurrence of adverse events (hemorrhagic transformation: 5.99% vs 4.31; p<0.0001, craniotomy: 0.12% vs 0.06%; p<0.0009) compared to the group without AMI. Among AIS patients, those with STEMI had higher all-cause in-hospital mortality (29.89% vs 15.57%; p<0.0001). After adjusting for baseline characteristics, the AMI group that received cardiac catheterization and percutaneous coronary intervention had lower in-hospital mortality (7.49% vs 18.93%; p < 0.0001) than the group that did not receive cardiac intervention. However, only 7.8% hospitalizations with AMI after AIS received cardiac interventions.

Conclusions:
Patients with AMI after AIS that underwent coronary angiography with or without intervention have improved survival. Large scale studies are needed to further prove the utility of cardiac intervention in these patients.
Abstract 13805: Accuracy of the Apple Watch Electrocardiogram to Detect Atrial Fibrillation in a Real-World Clinical Setting
Authors: Pepplinkhuizen Shari , Hoeksema Wiert F , van der Stuijt Willeke , Smeding Lonneke , Wilde Arthur A , Knops Reinoud E
Published: April 2024

Introduction:
The Apple Watch is the first commercially available wearable device with built-in electrocardiogram (ECG) electrodes to perform a one-lead ECG to detect atrial fibrillation (AF). Studies on the accuracy of the one-lead ECG of the Apple Watch (AW ECG) are limited and show inconclusive results. Our aim is to study the accuracy of the AW ECG in a real-world clinical setting.

Methods:
Patients with AF who were scheduled for electrical cardioversion (ECV) were included in this study. The Apple Watch series 6 was used with WatchOS 7.2 or 7.3. The AW ECG and 12-lead ECG were obtained pre-ECV. Post-ECV the ECGs were only obtained when the ECV resulted in sinus rhythm (SR). In case of an inconclusive measurement or poor recording, the AW ECG was repeated up to three times. All 12-lead ECGs were blindly adjudicated by two physicians. The AW ECG notification was compared to the physicians ‘gold-standard’ interpretation of the 12-lead ECG. Sensitivity and specificity of the AW ECG and Kappa coefficient between AW ECG and 12-lead ECG were calculated.

Results:
In total, 74 patients were included. Mean age was 67.1 ± 12.3 years, 20.3% were female, 18.9% had a cardiac implantable electronic device and the mean BMI was 28.1 ± 6.0 kg/m
2
. In total, 65 AF and 64 SR AW ECG and 12-lead ECG measurements were obtained. The first measurement with the Apple Watch compared to the 12-lead ECG showed a sensitivity of 93.5% and specificity of 100% (K=0.94). There were 7.0% inconclusive measurements and 17.8% poor recordings. A second measurement in patients with inconclusive or poor recordings resulted in a sensitivity of 94.6%, specificity of 100% (K=0.95) and 3.9% inconclusive measurements and 7.8% poor recordings. A third measurement in patients with two times an inconclusive or poor recording resulted in a sensitivity of 93%, a specificity of 96.5% (K=0.90) and 3.1 % inconclusive measurements and 5.4% poor recordings.

Conclusions:
The one-lead ECG of the Apple Watch shows a high accuracy for detecting AF in a real-world clinical setting. Repeating the measurement once decreases the total of unclassified recordings, however a third measurement resulted in a lower accuracy and the occurrence of false positive measurements.
Abstract 13806: In-Hospital Outcomes Among Patients With Septic Shock and Underlying Chronic Atrial Fibrillation
Authors: Vindhyal Mohinder R , Vasudeva Rhythm , Pothuru Suveenkrishna , Ablah Elizabeth , Choi Won , Kallail K James , Shah Zubair , gupta Kamal
Published: April 2024

Introduction:
Atrial fibrillation (AF) is the leading cause of arrhythmia among hospitalized patients. Altered hemodynamics with new-onset non-valvular atrial fibrillation, especially during sepsis/septic shock, causes decreased organ perfusion, lowers cardiac output, and increases the risk of organ dysfunction leading to increased intensive care unit (ICU) length of stay and mortality. However, little is known about the outcomes of patients hospitalized with septic shock and underlying chronic atrial fibrillation (UCAF).

Hypothesis:
Does UCAF increase in-hospital mortality in patients who have a diagnosis of septic shock during hospitalization.

Methods:
This was a retrospective analysis of the 2016 and 2017 Nationwide Readmission Database. ICD-10 codes were used to identify patients with septic shock, and these patients were stratified into those with and without a UCAF. Propensity matching analyses were performed to compare in-hospital mortality and clinical cardiovascular outcomes between the two groups.

Results:
A total of 353,422 patients with hospitalization for septic shock were identified, 5.8% of whom (n=20,772) had UCAF. After 2:1 propensity matching, 41,438 patients were identified as having septic shock without UCAF, and 20,719 patients were identified as having septic shock with UCAF. In hospital mortality [34.4% vs. 34.1%, p= 0.049], incidence of ischemic stroke [2.5% vs. 2.2%, p = 0.012], acute heart failure [1.8% vs. 1.4%, p < 0.001], length of stay [11.46 days vs. 10.93 days, p< 0.001], mean total charges [$150 4094 vs. $140 4037, p < 0.001] were significantly higher in patients with septic shock and UCAF compared to patients with septic shock without UCAF.

Conclusions:
The study identified UCAF as an adverse prognosticator for inpatient mortality and severe cardiovascular clinical outcomes. The study suggests the need for future research to improve patient outcomes of patients with septic shock and UCAF.
Abstract 13809: Gender Based Difference in Outcomes of Myocardial Injury in COVID-19 Positive Patients in Low to Middle Income Country
Authors: adnan ghufran , Ullah Ihsan , Faheem Osman , Khan Maria , Farhad Awais , Ahmed Intisar
Published: April 2024

Introduction:
Myocardial injury is associated with poor outcomes in COVID-19 positive patients. We have limited data about gender-based differences, in terms of outcomes in COVID-19 associated myocardial injury, especially from low to middle income country.

Hypothesis:
Myocardial injury in COVID-19 positive patients has the same impact on outcomes in either gender.

Methods:
We prospectively collected data of patients admitted with COVID 19 (nasopharyngeal PCR positive) and myocardial injury (hsTrop I>99th percentile) at Aga Khan University Hospital (AKUH), Karachi, Pakistan from 26 Feburary’2020 to 26 November’2020. Both genders were compared in terms of presentation, complications, and mortality. Calculations were done separately for each variable between two groups keeping the significant criteria of p-value less than or equal to 0.05.

Result:
Among 171 patients fulfilling inclusion criteria, 28.07% (n=48) were female and 72% (n=123) were male. Baseline demographics demonstrated that hypertension was significantly high among females as compared to male patients (87.5% Female vs 65% Male, p=0.004). During the hospital stay, the need for supplemental oxygen, Noninvasive ventilation, and mechanical ventilation was significantly higher in males compared to females. A statistically non-significant trend towards increased mortality was noted in males.

Conclusion:
Our study signifies that COVID-19 associated myocardial injury in males is associated with worse hospital course as compare to females. The length of hospital stay, complications such as ARDS, and requirement of invasive and non-invasive ventilatory support were higher in males as compared to females. Further studies evaluating the cause of disparate hospital course based on gender are warranted
Abstract 13860: Prognostic Implication of Biventricular Global Longitudinal Strain in Patients Undergoing Tricuspid Valve Surgery for Severe Isolated Tricuspid Regurgitation
Authors: Kim Dae-Young , Seo Jiwon , Cho Iksung , Hong Geu-Ru , Ha Jong-Won , Shim Chi Young
Published: April 2024

Introduction:
Isolated tricuspid valve (TV) surgery can be performed for patients with symptoms due to severe isolated tricuspid regurgitation (TR), preferentially before the onset of significant right ventricular (RV) dysfunction. In patients with severe TR, chronic RV volume overload may mask intrinsic myocardial dysfunction. Ultimately, RV dysfunction promotes LV underfilling, which can lead to left ventricular (LV) mechanical dysfunction.

Hypothesis:
Pre and postoperative biventricular global longitudinal strain (GLS) would give prognostic information in patients with isolated severe TR.

Methods:
In 117 patients who underwent TV surgery with severe isolated TR in a single tertiary center, we comprehensively assessed LV, RV, and biventricular global longitudinal strain (GLS) by speckle tracking echocardiography before and at least 1 month after TV surgery. Biventricular GLS was defined as a summation of LV-GLS and RV free wall strain. Patients with a history of open-heart surgery, severe left-side valve disease, reduced LV ejection fraction, and who underwent concomitant coronary artery bypass surgery were not included. Primary outcomes were defined as a composite of death, heart failure hospitalization, re-do TV surgery, and heart transplantation.

Results:
During a mean of 4.3 ± 3.9 years after TV surgery, 26 patients (22.2%) had experienced primary outcomes. In patients with primary outcomes, a previous history of diabetes mellitus and atrial fibrillation were more common, and
Abstract 13894: Expenditures and Health Resource Utilization by Body Mass Index Among Those With and Without Atherosclerotic Cardiovascular Disease
Authors: Valero Elizondo Javier , Taha Mohamad , Grandhi Gowtham , Mahajan Shiwani , Patel Kershaw , Rana Jamal S , Cainzos Achirica Miguel , Nasir Khurram
Published: April 2024

Introduction:
Obesity represents a major health and economic burden worldwide and is a key target for cardiovascular disease prevention. With emerging therapeutic options to manage obesity, we aimed to quantify the overall expenditures and resource utilization in adults with and without atherosclerotic cardiovascular disease (ASCVD) across obesity categories.

Methods:
We used the 2018 Medical Expenditure Panel Survey (MEPS), a nationally representative US survey. BMI (calculated from self-reported height and weight) was divided into 4 groups: overweight (BMI 25 to 30), mild (BMI 30 to 35), moderate (BMI 35 to 40), and morbid obesity (BMI ≥40). Cardiovascular risk factors (hypertension, diabetes, hypercholesterolemia, insufficient physical activity) and ASCVD were ascertained by ICD10 codes and/or self-report. Two-part econometric models were used to study cost data; a generalized linear model with gamma distribution and link log was used to assess expenditures.

Results:
Among the 19,569 sampled MEPS adults (mean age 48 years [SD 14]), 6.2% had morbid obesity (~ 14 million). Among those without ASCVD, morbid obesity was associated with higher odds for prescription medication utilization, ED and outpatient visits when compared to those with overweight (Figure). Even though individuals with ASCVD reported higher prevalence of all metrics of resource utilization, we found no statistically significant differences between BMI categories in this group. The marginal overall per capita expenditure when comparing those with morbid obesity vs overweight was $2,165 (p=0.11) in those with ASCVD, and $1,605 (p=0.03) in those without ASCVD.

Conclusions:
Morbid obesity was associated with increased healthcare expenditures and resource utilization, especially in those without ASCVD. Our study findings could aid in policy discussions to discern appropriate candidates for emerging novel anti-obesity therapeutics, as well as apt resource allocation.
Abstract 13895: Impact of Coronary Revascularization on Cardiopulmonary Performance in Patients With Coronary Chronic Total Occlusion
Authors: Bakry Karim
Published: April 2024

Background:
—CTO PCI represents the tip of iceberg in interventional cardiology, however owing to lack of enough data, there is still debate about its benefit. CPET combines measurement of gas indices with standard exercise and ECG parameters giving a comprehensive way for patient evaluation also there is plenty of data about its use in many cardiovascular diseases and about its prognostic value in many occasions. So we thought of using CPET in evaluating value of CTO PCI on various CPET parameters.

Hypothesis:
CTO PCI improves cardiopulmonary performance evaluated by CPET.

Methods:
fifty nine patients underwent successful CTO PCI and CPET at baseline and at12 month follow up, of whom nine patients had suboptimal results in control angiography which is a higher than usual incidence of re-stenosis, we compared the results of the CPET pre and post-PCI in both groups.

Results:
In patent group, CPET at follow up revealed a significant increase of peak oxygen consumption (Peak VO
2
) (13.47±1.53 ml/kg/min vs. 17.84±0.99 ml/kg/min
p
<0.0001), VO
2
at anaerobic threshold (AT) (11.63 ± 1.14 ml/kg/min vs. 10.35 ±1.01ml/kg/min (
p
< 0.0001), peak oxygen pulse ( 16.02 ±1.34 vs. 11.15 ± 1.36,
p
< 0.0001) and significant increase in peak cardiac index (3.78 ± 0.5 vs. 2.98 ±0.6, p < 0.0001). Also there was significant decrease of Peak VE/VCO
2
(32.98 ± 3.2 vs. 42.98 ± 6.2,
p
< 0.0001).In patients with re-stenosis, CPET at follow up revealed a significant decrease of peak oxygen consumption (Peak VO
2
) (13.36±1.48 ml/kg/min vs. 12.41±0.97 ml/kg/min,
p
=0.02) and a significant increase of Peak VE/VCO
2
(42.73 ± 4.33 vs. 43.27 ± 3.29,
p
=0.01)also there was worse numerical values of other parameters despite not being statistically significant.

Conclusions:
CTO revascularization improves cardiopulmonary performance assessed by CPET in addition patients with re-occlusion after successful procedure had worse parameters even than their own baseline. CPET can provide a way for non-invasive follow-up of patients after PCI and earlier detection of in-stent re-stenosis that is more common in CTO.
Abstract 13903: Adipocyte PGC1-α and NOV/CCN3: Novel Targets in the Management of Obesity-Linked Cardiomyopathy
Authors: Waldman Maayan , Alex Ragin , Kornowski Ran , Hochhauser Edith , Arad Michael , Abraham Nader G
Published: April 2024

Introduction:
Chronic Obesity is frequently associated cardiac remodeling and the development of myocardial dysfunction. Oxidative stress and mitochondrial dysfunction are major factors in the development of obesity-related cardiomyopathy. Peroxisome proliferator-activated receptor-gamma coactivator 1 alpha  is key in maintaining energy homeostasis and promotes reprogram white adipose into beige adipose tissue. We have reported a downregulation in epicardial PGC-1α levels in human and mice are associated with a reduction in cardiac function while increases in nephroblastoma overexpressed NOV/CCN3 is associated with severe inflammation and oxidative stress in multiple tissues.

Hypothesis:
Concomitant activation of PGC-1α and inhibition of NOV in the epicardial fat promotes adipocyte browning and alleviates obesity-related cardiomyopathy.

Methods:
Effect of PGC-1α over expression and NOV inhibition  in transgenic mic selectively in adipose tissue on the heart in mice fed a high-fat diet  Mice were randomly divided into 4 groups  1; lean , 2; HFD , 3; transgenic mice on HFD + shNOV or 4; PGC-1α . Blood pressure, cardiac and adipose fibrosis and oxygen consumption , metabolic and mitochondrial markers were studied.

Results:
Mice fed a HFD developed decreased mitochondrial respiration. Inhibiting NOV expression in adipose tissue of obese mice in transgenic mice resulted in an increased heart mitochondria biogenesis , HO-1 and activation of mitophagy and autophagy . Transgenic PGC-1α mice exhibited increased mitochondria biogenesis, integrity and beige adipocyte markers , insulin receptor phosphorylation and reduced inflammation.

Conclusion:
Inhibiting NOV or overexpression of PGC-1α in the epicardial fat improve the quality of adipose tissue with a positive impact on the heart by inducing mitophagy and improving mitochondrial function. Tissue-targeted manipulation of the NOV and/or PGC-1α signaling to reprogram white fat into brown fat may constitute a novel therapeutic strategy in the treatment of obesity-related cardiomyopathy.
Abstract 13905: Radial vs Femoral Approach for Cardiac Catheterization With or Without Percutaneous Coronary Intervention in Patients With Prior Coronary Artery Bypass Grafting
Authors: Nasir Ayan , Dasalla Melissa , Gharacholou Shahyar M , Bhatia Unnati , Sandhu Gurpreet S , Pillai Dilip
Published: April 2024

Background:
Owing to reduced bleeding risks, radial is favored over femoral for access site selection in patients referred for coronary angiography, with specific benefits in patients presenting with acute coronary syndrome. However, studies were often limited to patients without coronary artery bypass grafts (CABG), given the technical challenges of the radial approach in these patients.

Methods:
We evaluated patients with prior CABG undergoing coronary angiography with or without percutaneous coronary intervention (PCI) from 2015-2020 at our institution. We reviewed access site and bleeding outcomes as defined in the NCDR CathPCI registry. Additional outcomes included procedural duration, fluoroscopy time, contrast volume, and clinical events.

Results:
Of the 1,546 patients studied, 280 (18%) patients had radial access while 1,266 (82%) patients had femoral access. Over the study time period, frequency of radial access for post CABG catheterization procedures increased from 0% in 2015 to 45% in 2020. There were no statistically significant differences in comorbidities, bleeding events, complications, or mortality between radial vs femoral (Table). Fluoroscopy time was higher for radial vs femoral (14.9 mins vs 13.3 mins, p=0.04).

Conclusion:
Over time, radial access choice in post CABG patients increased, without significant differences with respect to bleeding events or complications as compared to femoral, though at increased fluoroscopy times.
Abstract 13915: Unsupervised Machine Learning Algorithm Identifies People From the General Population at Risk of Heart Failure Based on Speckle Tracking Patterns: The Copenhagen City Heart Study
Authors: Simonsen Jakob Oeystein , Skaarup Kristoffer G , Modin Daniel , Djernæs Kasper , Lassen Mats , Johansen Niklas D , Martinez Sergio S , Claggett Brian L , Marott Jacob , Jorgensen Peter G , Jensen Gorm , Schnohr Peter , Mogelvang Rasmus , Biering-Sørensen Tor
Published: April 2024

Background:
Peak global longitudinal strain (Peak-GLS) is recognized as a powerful predictor of heart failure (HF). However, the entire strain curve remain undiscovered and therefore important prognostic information regarding HF might be lost.

Hypothesis:
We hypothesized that analysis of the strain curve using unsupervised machine learning (uML) would reveal novel ventricular deformation patterns capable of predicting incident HF independently of Peak-GLS.

Methods:
Longitudinal strain curves from 3,767 subjects from the general population without prevalent HF were analyzed using uML.

Results:
Mean age was 56 years and 43% were male. During a median follow-up of 5.3 years, 94 subjects (2.5%) developed HF. The uML algorithm generated a hierarchical clustering tree (HCT)(Figure 1a) resulting in 9 different clusters with mean strain curves (figure 1b and 1c). Figure 1a summarizes the mean age, IRHF and number of subjects in each cluster. In multivariable Cox regression cluster 3 was significantly associated with reduced incidence of HF when compared to cluster 2 [HR 0.13, 95%CI: 0.04;0.41, P<0.001]. Cluster 4 was also significantly associated with reduced incidence of HF compared to cluster 2 [HR 0.21, 95%CI: 0.08;0.57, P=0.002]. Cluster 2 was associated with increased incidence of HF compared to cluster 3 and 4 even though cluster 2 displayed healthier clinical baseline characteristics as well as higher EF and Peak-GLS. The mean strain curve of cluster 2 had an increased absolute peak value, more rapid decline during systole, faster increase during diastole and a larger diastolic curvature compared to the mean strain curves of cluster 3 and cluster 4.

Conclusion:
uML was capable of identifying a cluster (cluster 2) exhibiting a deformation pattern associated with increased risk of HF despite having higher EF and peak-GLS. The deformation patterns of cluster 2 was characterized by a faster contraction, faster relaxation and a higher deacceleration after early filling.
Abstract 13920: Temporal Changes in Metabolism and Gene Expression in Murine Heart Following Exercise
Authors: Fulghum Kyle L , Collins Helen E , Hill Bradford G
Published: April 2024

Introduction:
Previous studies report that many systemic adaptations occur early in an exercise training program, but how exercise leads to cardiac adaptations remain unclear. In this study, we characterized time-dependent changes in cardiac metabolism and gene expression following an acute session of aerobic exercise.

Methods:
We used untargeted metabolomics to identify the temporal nature of metabolic changes in male and female mouse hearts after an acute bout of forced treadmill running. We freeze-clamped hearts immediately, 1 h, or 24 h following exercise to compare alongside sedentary controls. Additionally, we measured the expression of key metabolic enzymes known to influence cardiac growth via qRT-PCR and immunoblotting.

Results:
Untargeted metabolomics analyses of male and female mouse hearts (
n
=9/gp) revealed exercise-induced changes in branched chain amino acids as well as pentose phosphate, nucleotide, and Krebs cycle intermediates. In both male and female hearts, exercise acutely increased the abundances of corticosterone and 5-aminoimidazole-4-carboxamide ribonucleotide (AICAR), which could indicate a transient role in exercise-induced signaling. AICAR is known to activate AMPK, but immunoblots showed minimal changes in cardiac AMPK phosphorylation immediately after exercise. However, when measured 24 h following an acute bout of exercise, we saw a modest increase in phosphorylation (p=0.07,
n
=3-4/gp) which suggests time-dependent activation after exercise. Phosphorylation of AKT and PFKFB2 were acutely reduced in the heart following exercise (p<0.05,
n
=3-4/gp), but normalized 1 h post exercise. At these same timepoints, we observed few changes in expression of genes related to the physiological growth program; however, we did observe an increase in
Ppargc1a
expression 1 h following exercise (p<0.0001,
n
=3/gp).

Conclusions:
These findings show that aerobic exercise acutely changes cardiac metabolism, metabolic signaling pathways, and mitochondrial biogenetic capacity following one bout of aerobic exercise. Temporal changes in cardiac metabolism and gene expression could compound with chronic exercise training and facilitate an exercise-adapted phenotype.
Abstract 13927: Sustained Maximal Inspiratory Pressure: A Novel Measure of Inspiratory Muscle Performance and Its Relationship to Physiology and Function in Heart Failure
Authors: Shah Rohan V , Cahalin Lawrence P , Haus Jacob M , Allsup Kelly , Delligatti Amanda , Kostra James , Gottlieb Daniel J , Wolf Cody , Byard Thomas , Forman Daniel E
Published: April 2024

Introduction:
The sustained maximal inspiratory pressure (SMIP) is a novel measure of inspiratory muscle performance that reflects the ability of the inspiratory muscles to maintain force over time from residual volume (RV) to total lung capacity (TLC) and has been described as single-breath work capacity. In chronic obstructive pulmonary disease SMIP has been found to be more highly correlated to a greater number of physiologic and functional measures than maximal inspiratory pressure (MIP). This study examined the relationship of SMIP and MIP to a variety of physiologic and functional measures in patients with heart failure (HF).

Methods:
Fifty male Veterans (mean±SD age, BMI, LVEF = 69.9±8.0 years, 33.6±7.2 kg/m
2
, 40.1±14.4%, respectively) with HF underwent measurement of MIP and SMIP with the PrO2 device (Smithfield, RI) which were measured from RV during initial inhalation and to TLC, respectively. Pulmonary function and maximal expiratory pressure (MEP) were also assessed. Exercise capacity was assessed via cardiopulmonary exercise testing (CPET) and leg strength testing. Physical function was assessed with grip strength, 6-minute walk distance (6MWD), and sit-to-stand test (STS).

Results:
The mean±SD MIP and SMIP were 66.3±24.8 cmH
2
O and 351.3±151.4 PTU, respectively. Both MIP and SMIP were significantly (p<0.05) correlated to many physiologic (r=.33-.48) and functional measures (r=.38-.62) with the greatest correlate to MIP being MEP (r=.58) and the greatest correlate to SMIP being FEV
1
(r=.62). The greatest physiologic correlate to MIP and SMIP was CPET peak tidal volume with identical r-values (.48). Absolute and relative peak oxygen consumption (pVO
2
) were correlated to both MIP and SMIP with identical r-values for absolute pVO
2
(.33) and slightly higher r-values between MIP and relative pVO
2
(.37 vs .34). The greatest functional correlate to MIP and SMIP was leg strength/endurance (r=.53 and .46, respectively) followed by STS (r=.52 and .45, respectively) and 6MWD (r=.49 and .45, respectively).

Conclusions:
MIP and SMIP are significantly correlated in a positive direction to many physiologic and functional measures supporting the role of inspiratory muscle training and further study of SMIP and MIP in HF.
Abstract 13930: Trends in Aortic Dissection Mortality Rates by Race and Urban-Rural Classification in the United States, 1999-2019
Authors: Cash Ayla , Minhas Abdul , Ariss Robert W , Ahuja Keerat Rai , Nazir Salik
Published: April 2024

Introduction:
Despite evolving risk assessment and surgical interventions, acute aortic dissection (AD) remains a life-threatening condition with a high mortality rate. Here, we report urban-rural and racial differences in AD related mortality rates in the US.

Methods:
Death certificate data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database were used to determine all-cause AD-related mortality trends from 1999 to 2019 among adults older than twenty-five. The National Center for Health Statistics Urban-Rural Classification Scheme was used to divide our population into urban (≥1 million), medium metropolitan (50,000–999,999) and rural (<50,000) counties per the 2013 census classification. Age-adjusted mortality rates (AAMRs) per 100,000 people and annual percentage change (APC) with 95% confidence intervals (CI) were calculated.

Results:
Following a period of decreasing AAMRs prior to 2012, Non-Hispanic White (NHW) and non-Hispanic Black (NHB) AAMRs increased significantly between 2012 and 2019 (APC 2.6 [95% CI 2.0 to 3.2] and APC 4.0 [95% CI 2.5 to 5.5], respectively). Hispanic and/or Latino (HL) AAMRs also increased between 2014 and 2019. NHB AAMRs were consistently higher compared to NHWs and HLs. Similar trends emerge when stratifying by metropolitan area (Figure 1). Following a period of decreasing AAMRs prior to 2013, urban AAMRs increased significantly between 2013 and 2019 (APC 2.8 [95% CI 1.8 to 3.9]). Similarly, medium metropolitan and rural AAMRs increased between 2012 and 2019 (APC 2.6 [95% CI 1.6 to 3.7] and APC 3.3 [95% CI 1.6 to 5.0], respectively) following a period of decreasing AAMRs prior to 2012.

Conclusions:
AD death rates among all races and urban-rural subgroups are increasing over the past five to ten years, reversing a decreasing trend from the prior decade. To mitigate the burden of AD-related mortality, future studies are needed to examine the reasons for these observed trends.
Abstract 13938: Multi-Chamber Strain Characterization Provides Incremental Prognostic Value to Cardiac Damage Staging in Significant Aortic Stenosis
Authors: Ye Zi , Yang Li-Tan , Enriquez Sarano Maurice E , Michelena Hector I
Published: April 2024

Introduction:
The survival impact of impaired multi-chamber longitudinal strain in significant tricuspid aortic valve stenosis(TAV-AS) and its relation to cardiac damage staging(CDS) is unknown.

Hypothesis:
Impaired strain improves prognostication of CDS in significant TAV-AS.

Methods:
We performed 2D-semi-automated strain analysis in a retrospective cohort of consecutive patients with TAV-AS with mean pressure gradient≥30mmHg on echocardiogram. The outcome was all-cause death. Cutoffs of impaired left-ventricular global longitudinal strain(
Abstract 13946: Subclinical Atherosclerosis and Peri-Operative Cardiac Events in Patients Undergoing Peripheral Bypass Surgery
Authors: Sharma Swapna , Pritchard Abiah , Young Michael , Henkin Stanislav
Published: April 2024

Introduction:
Coronary artery disease (CAD) is associated with a higher risk of peri-operative adverse events after vascular surgery. Subclinical CAD, defined as presence of coronary calcium, has not been established as a risk factor for adverse events after vascular surgery.

Hypothesis:
We sought to describe the epidemiology and peri-operative outcomes in patients with subclinical coronary atherosclerosis (SCA) undergoing supra- and infra-inguinal peripheral bypass.

Methods:
Using the Vascular Quality Initiative, we identified patients at a single institution undergoing supra- and infra-inguinal peripheral bypass surgery (2009-2020). Retrospective chart review was performed to identify chest computed tomography (CT) within one year prior to revascularization; imaging was reviewed for presence of coronary calcifications, a marker of SCA. Individuals were stratified by: no atherosclerosis, SCA, and CAD. Comorbidities and peri-operative outcomes were compared among groups with the chi-square or ANOVA, as appropriate.

Results:
Of 1018 patients undergoing peripheral bypass surgery, 199 (20%) had a CT available. SCA was noted in 96 patients (48%) while 72 (36%) had known CAD. Patients with SCA had similar comorbidities to patients with CAD (Table) but were less likely to be on a pre-operative beta-blocker or P2Y12 inhibitor. The incidence of postoperative myocardial infarction and congestive heart failure was similar in patients with SCA (13% and 9%, respectively) as those with CAD (10%, 6% respectively), compared to those without atherosclerosis (3% and 0, respectively).

Conclusions:
SCA is common in patients undergoing peripheral bypass surgery and is associated with a risk of peri-operative myocardial infarction or congestive heart failure similar to occult CAD. Aggressive secondary prevention measures should be considered in patients with polyvascular disease, including subclinical CAD.
Abstract 13954: Family Caregivers’ Experience of Caring for Patients Implanted With Left Ventricular Assist Device: A Mixed-Method Study
Authors: Xu Ashley J , Li Mengchi , Byiringiro Samuel , Wenzel Jennifer , Dennison Cheryl
Published: April 2024

Introduction:
Informal caregivers of patients with left ventricular assist device (LVAD) juggle benefits and burdens of caregiving and experience uncertainty of LVAD trajectory. This study explored the experience of caring for patients with LVAD and factors leading to uncertainty among caregivers.

Methods:
This mixed-methods, descriptive study included online surveys and focus groups. Family caregivers (N=140) were recruited from Facebook communities for the online survey (demographic variables, patient factors, Uncertainty in Illness Scale, Medical Outcome Study Social Support Survey, and CAregiver Perceptions About Communication with clinical Team member measure) and a subset of these (N=20) were recruited for online focus groups. Data were summarized and quantitative / Qualitative data compared for convergence.

Results:
Caregivers averaged 54 years (SD=12), were female (89%) spouses (66%) who had been caregiving for less than 5 years (83%). The quantitative results regarding uncertainty and its associated variables: social support, perception of change after implant, and communications with health care providers were mirrored in the content of three of the categories that evolved from the qualitative analysis. Caregivers with lower social support reported high uncertainty in focus groups and had higher uncertainty scores. Those with higher social support reported lower uncertainty. Caregivers with higher uncertainty reported varying levels of communication with providers. Majority of caregivers reported life changed for the worse (increase burdens, lifestyle adjustments, patient care regime) after LVAD implantation regardless of their uncertainty levels.

Conclusions:
Caregivers' experiences varied as they adjusted to this complex life-transforming experience. Overall, the survey and focus group data were convergent. Caregivers with higher social support and better communication with health care providers may experience less uncertainty. This study underscores the need to enhance social support and communication with healthcare team to decrease uncertainty and improve the caregiver experience.
Abstract 13959: Topographical Impedance Patterns Within Epicardial Ventricular Scar
Authors: Kawamura Iwanari , Reddy Vivek Y , Turagam Mohit , Musikantow Daniel , Chu Edward , Miller Marc , Whang William , Dukkipati Srinivas , Koruth jacob s
Published: April 2024

Introduction:
During pericardial electroanatomical mapping of the ventricles, impedance changes within regions of epicardial scar can be observed, but their extent and relevance are not well understood. We aimed to characterize the impedance maps within the epicardial scar of patients who underwent first-time epicardial scar ablation.

Methods:
In this retrospective single center analysis, we identified 69 consecutive patients with structural heart disease that underwent successful first-time pericardial mapping with an irrigated contact force-sensing catheter (ThermoCool ST; Biosense Webster Inc) between 2015-2020. Among them, 37 patients were included as they had both available voltage map with epicardial scar regions and its compatible impedance map. Characteristics of impedance variations with the epicardial low voltage zone (0.5-1.5 mV) were analyzed. Abrupt impedance increases (
AIi
) were defined as impedance delta of >100Ω increase between points <1 cm apart.

Results:
Among 37 patients (61.4 ± 14.5 years old, male 94.6%, LVEF 38.2±14.2% and ischemic cardiomyopathy 32.4%),
AIi
was observed in 11 of 37 patients (29.7%). Baseline characteristics of those with
AIi
was similar to those without. Lateral right ventricle and apical locations demonstrated
AIi
more frequently compared to other sites (P<0.01). The maximum impedance was significantly higher at sites with
AIi
than without (425.5±58.6 vs 242.9±60.8 Ω, P<0.01) despite similar average contact force. However, impedance at sites of ablation were noted to be not significantly different between those with and without
AIi,
in consequence of avoiding ablation in the regions of high impedance.

Conclusion:
This study identified different topographical characteristics of the impedance over the ventricular epicardium. This epicardial impedance variation within low voltage regions needs to be further characterized and its clinical implications better understood.
Abstract 13962: Understanding Hospital-Acquired Venous Thromboembolisms in Pediatric Cardiology Patients
Authors: Song Nancy , Martinez Mulet Yessica , Banuet Gonzalez Andrea , Loh Ling , Shin Andrew , Donnelly Lane , Scheinker David
Published: April 2024

Objective:
This study set out to determine risk factors for hospital-acquired venous thromboembolisms (VTEs) in pediatric cardiology patients in the setting of the 2016 Solutions for Patient Safety prevention guidelines.

Methods:
This retrospective cohort study considered all hospitalized patients discharged between 1/1/2019 and 12/31/2020, inclusive, in an university-affiliated children’s hospital. Demographic data for all patients, including service, presence of central venous catheters, administered intravenous medications, and initial Braden QD scores were included. Hospital-acquired VTEs as defined by the National Healthcare Safety Network were included. Standard descriptive statistics were utilized. Univariate analyses were conducted using the appropriate test as appropriate based on data distribution. Regularized regression using elastic net was performed to ascertain significant risk factors with p<0.05.

Results:
Over the study period, 28,409 patients were included. Contemporary guidelines for VTE prevention in pediatric patients only include patients greater than 12 years of age and only prevent VTEs not related to central venous catheters. However, of the 143 hospital-acquired VTEs within the study period, 67.8% occurred in patients younger than 12 years of age and 66.0% were related to a central venous catheter. The majority (54.5%) of hospital-acquired VTEs occurred in patients on the cardiology service. In a subsequent multivariable regression analysis performed on pediatric cardiology patients, risk factors for hospital-acquired VTEs included having two or more central lines simultaneously (OR 4.46, p=0.03) and treatment with IV antidiuretics (OR 3.08, p=0.04). Total Braden QD score and Braden QD subscores were not associated with hospital-acquired VTEs. (OR 1.02, p=0.99 and OR 1.37, p=0.53, respectively).

Conclusion:
We found that the current prevention guidelines for hospital-acquired VTEs are not applicable to the majority of pediatric cardiology patients who develop hospital-acquired VTEs. A better understanding of risk factors for hospital-acquired VTEs is needed to inform future interventions.
Abstract 13963: Smooth Muscle Cells Promote Hypertensive Cardiac Hypertrophy Through Sox6 Signaling
Authors: Gomez Jose A , Barturen-Larrea Pierina , Payne Alan , Hodgkinson Conrad
Published: April 2024

Introduction:
Hypertension is the predominant risk factor for mortality. To compensate for pressure overload and reduce stress on the left ventricle, cardiomyocytes become hypertrophic. Recently, several laboratories have suggested that cardiomyocyte hypertrophy is regulated by factors released from adjacent non-cardiomyocytes. Stretching induced in cultured cardiomyocytes, fibroblasts, endothelial cells and smooth muscle cells (SMCs) to secrete factors which cause cardiomyocyte hypertrophy. We hypothesized that cardiac SMCs promote hypertensive cardiac hypertrophy through molecular signals controlled by the transcription factor Sox6.

Methods:
We used a SMCs tamoxifen inducible Sox6 knock out mice (Myh11
CreERT2
/Sox6
fl/fl
-Sox6KO) to define if Sox6 was involved in hypertensive cardiomyopathy. Hypertension was induced by Angiotensin II (Ang II-1000 ng/kg/min x 28 days) infusion after tamoxifen. Cardiac function was measured by ultrasound; cardiomyocyte shape was defined by staining tissue sections with cardiac troponin-T and wheat germ agglutinin; and blood pressure was determined by tail cuff.

Results:
Ang II induced hypertension in Sox6KO and the Myh11
CreERT2
/Sox6
wt/wt
(Myh11
CreERT2
-wild type for Sox6) (SBP mm Hg, 150 vs. 153, SEM= 11 n=3-4). The Myh11
CreERT2
developed cardiac hypertrophy with decreased ejection fraction (65 vs 58, SEM= 2, n=7, p<0.001) and increased systolic (1.33 mm vs 1.8 mm, SEM= 0.1, n=7, p<0.01) and diastolic LVD (1.33 mm vs 1.52 mm, SEM= 0.08, n=7, p< 0.01). Cardiomyocyte area was increased in the Myh11
CreERT2
mice compared to the Sox6KO animals (area - square microns, 300 vs 100, SEM= 36, n=3, p<.001). The Sox6KO mice had a higher base line LVD in both diastole and systole. However, the cardiomyocytes area was similar to normotensive Myh11
CreERT2
mice.

Conclusion:
Hypertension in control Myh11
CreERT2
animals was associated with impaired cardiac function. In contrast, there was no decrease in cardiac function in hypertensive Sox6KO mice. While in Myh11
CreERT2
mice, Ang II induced significant cardiomyocyte hypertrophy, in Sox6KO mice, Ang II did not induce cardiomyocytes hypertrophy. These results suggest that Sox6 signaling in SMCs is a critical mediator of hypertension induced cardiomyocyte hypertrophy.
Abstract 13976: Upstroke Time per Cardiac Cycle: Screening Index for Severe Aortic Stenosis
Authors: Higashihara Tasuku , Nakano Takayuki , TAKEDA ATSUSHI , Morita Yuichi , Watanabe Noriaki , Sada Yoshiharu , Ikenaga Hiroki , Utsunomiya Hiroto , Fukuda Yukihiro , Nakano Yukiko
Published: April 2024

Introduction:
AS is one of the most common valvular heart diseases in the elderly population. Since the TAVR era, the indications for AS invasive treatment have expanded to patients at high risk of surgery and even those at moderate risk. Therefore, a simplified screening test is needed to extract patients with severe AS.

Hypothesis:
Brachial-ankle pulse wave analysis, which is a non-invasive well-established test, is useful for screening patients with severe AS in routine clinical practice.

Methods:
We recruited patients who were admitted to Hiroshima University Hospital for scrutiny of AS. Severe AS was defined as an aortic valve area (AVA) of <1.0 cm
2
or peak transaortic velocity >4 m/s or a mean pressure gradient of >40 mmHg. Pulse wave measurement was performed with the VP-1000 device (Omron, Kyoto, Japan), and upstroke time per cardiac cycle (UTCC; [upstroke time/cardiac cycle] x 100%) was calculated. We excluded patients with peripheral artery disease (ABI <0.9) or lack of UTCC data.

Results:
A total of 235 patients with AVA and UTCC available data were analyzed. In these patients, UTCC was correlated with AVA (r = -0.279; p <0.001, Figure). In 121 patients who underwent TAVR and had available data of UTCC before and after TAVR, UTCC was significantly shortened after TAVR (from 20.7% [IQR; 18.6, 23.3] to 18.7% [16.7, 21.0]; p <0.001). After adjustment by LVEF, LVEDV, BSA, and AF, UTCC was still correlated with AVA (β= -0.012, p = 0.001).

Conclusions:
UTCC from brachial-ankle pulse wave analysis might help identify severe AS patients in routine clinical practice.
Abstract 13985: Targeting the Activin Receptor Type IIA for Therapeutics in Atrial Fibrillation
Authors: Castro Claire , Yu Andy , Hobson Ryan , Bapat Aneesh , Yeri Ashish , Lee Se-Jin , Ellinor Patrick T , Rosenzweig Anthony , Roh Jason D
Published: April 2024

Introduction:
Atrial fibrillation (AF) is the most common cardiac arrhythmia and a leading cause of stroke and heart failure. However, limited treatment options are available. The adipo-fibrokine Activin-A has been associated with AF in humans, and genome-wide association studies have implicated the Activin receptor type IIA (ActRIIA) in AF.

Hypothesis:
Our aim was to investigate the potential functional role of ActRIIA in AF pathophysiology.

Methods:
We used an Activin-A overexpression murine model (AOE) to determine if Activin-A/ActRII signaling increases AF inducibility and explored potential mechanisms by performing RNA sequencing. Comparative studies between the Activin-A binding receptors, ActRIIA and ActRIIB, were then conducted
in vitro
using siRNA knockdown (KD) in isolated cardiomyocytes and
in vivo
using cardiac specific ActRIIA or ActRIIB mouse knockouts (KO) in a high fat diet (HFD)-induced model of AF.

Results:
AOE mice displayed increased cardiac ActRII signaling, including increased FSTL3 mRNA expression (3.4-fold; p=0.005) and SMAD3 phosphorylation (2.7-fold; p=0.005). AF inducibility was markedly increased in AOE mice (75%
versus
0% in controls), and was associated with decreased atrial conduction velocity (RA: 0.46±0.07
vs
0.61±0.09 m/s, p=0.005; LA: 0.54±0.18
vs
0.73±0.14 m/s, p=0.06). Pathway analysis of the cardiac transcriptome in AOE mice identified gap junctions as one of the most downregulated pathways (normalized enrichment score -2.8, FDR<0.001) with 50% decreased expression of the AF-associated connexin, CX43 (p
adj
=1.2x10
-9
). Conversely, ActRIIA KD increased CX43 expression in cardiomyocytes (mRNA: 2-fold; p=0.005; protein: 1.8-fold; p=0.07), which was not observed with ActRIIB KD (mRNA: 1-fold; p=0.9; protein: 0.9-fold; p=0.3). ActRIIA KO mice also displayed lower AF inducibility rates (67%) to HFD, compared to ActRIIB KO mice (80%) and controls (αMHCcre 83%, ActRIIA flox/flox 89%, ActRIIB flox/flox 100%).

Conclusions:
Activin-A/ActRII signaling increases AF inducibility in part by decreasing cardiomyocyte CX43 expression and atrial conduction. This effect is specifically mediated through the ActRIIA, not ActRIIB, suggesting Activin receptor specificity in AF pathophysiology.
Abstract 14104: Levosimendan Effects on In-Hospital Outcomes in Patients With Cardiogenic Shock
Authors: VENUTI ANGELA , Sacchi Stefania , cinel elena , Gattari Bianca , Baldetti Luca , Calvo Francesco , Pazzanese Vittorio , Gramegna Mario , Cappelletti Alberto Maria
Published: April 2024

Introduction:
Cardiogenic Shock (CS) is a life-threatening condition characterized by low cardiac output, end-organ hypoperfusion and hypoxia. Inotropic pharmacological support is recommended to restore proper hemodynamic in these patients. Levosimendan is a calcium-sensitizer with unique features, since it exerts inotropic effects preventing myocardial oxygen consumption. In CS patients, its effects on in-hospital outcomes are not well known.

Hypothesis:
The aim of the study was to assess whether in CS patients, levosimendan administration on top of standard inotropic support could affect in-hospital outcomes.

Methods:
We retrospectively reviewed clinical data of 41 CS patients admitted to Cardiac Intensive Care Unit (CICU). We compared clinical course and outcomes, including length of stay (LOS), length of mechanical support (LMS) and in-hospital mortality, between CS patients receiving levosimendan on top of standard inotropic support (group 1) and not-receiving ones (group 2).

Results:
Overall, 41 patients [83% males, mean age 65.8 ± 13.01 years, mean left ventricular ejection fraction (LVEF) 26.75 ± 13.28%] with CS due to acute coronary syndrome (ACS) in 19 (46.34 %), acute decompensated heart failure (ADHF) in 21 (51.22 %) and myocarditis in 1 (2.44%) were included. Eleven (26.83%) patients received levosimendan on top of standard inotropic support (group 1) while 30 (73.17%) were not-receiving (group 2). Between the two groups, any difference was observed in baseline LVEF (p= 0.14), ACS and ADHF aetiologies (p=0.98, p=0.14). Mechanical support rate was similar between patients receiving and not receiving levosimedan (p=0.05), while LMS was higher in group 1 (p= 0.001). Both CICU and in-hospital LOS were longer in group 1 (p=0.0001, p= 0.004). Conversely, CICU and in-hospital mortality did not differ between the two groups (p=0.9, p=0.72).

Conclusion:
In CS patients, levosimendan administration on top of standard inotropic support did not improve in-hospital outcomes.