bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 12273: Circulating Monocyte Mitochondrial Function Reflects Myocardial Oxidative Metabolism in Humans With Heart Failure
Authors: Revathi Venkateswaran Vandana , Muzik Otto , Gupta Ramesh C , She Ruicong , Gupta Vinita S , Castle Kristina , Williams L. Keoki , Sabbah Hani N , Lanfear David E
Published: December 2023

Introduction:
We previously showed that mitochondrial function in circulating monocytes is abnormal in humans with heart failure (HF) compared to normal controls, and that it correlates to cardiomyocyte mitochondrial function in dogs with HF. But, there is no data in humans supporting a relationship between monocyte mitochondrial function and cardiac energy metabolism.

Hypothesis:
To test the association of circulating monocyte mitochondrial function metrics with myocardial energy metabolism in patients with HF and reduced left ventricular (LV) ejection fraction (HFrEF) quantified using C
11
acetate PET imaging.

Methods:
We studied 10 patients with stable HFrEF that underwent the PET imaging. Region of interest analysis was used to yield time-activity curves that represent multiple LV myocardial regions. The early phase of tracer washout curves were fitted mono-exponentially to obtain the constant Kmono (a measure of oxidative metabolism). Peripheral blood monocytes were isolated and mitochondrial function was quantified using SEAHORSE. We tested the correlation of mitochondrial metrics with Kmono, adjusted for mechanical energetic output of the heart (calculated as stroke volume index*mean BP*heartrate).

Results:
Among the 10 patients (aged 57-74), 3 were women, 4 self-identified as Black, and 4 had ischemic etiology. Mean EF was 35% (range 18-45%), mean systolic BP was 126 (range 100-147), and mean Kmono was 0.054 (range 0.038-0.102). Results are summarized in the table. After accounting for variation in mechanical cardiac work, we found significant positive correlations of each mitochondrial metric with Kmono.

Conclusions:
We find that mitochondrial function in circulating blood monocytes may be a biomarker of cardiac oxidative metabolism and cardiomyocyte mitochondrial function. If validated as a non-invasive measure of cardiac energetics, this could accelerate research in cardiac energy deprivation and its relationship to HF progression.
Abstract 12307: Machine Learning Model Predicting Bleeding Risk in Patients With Coronary Artery Disease
Authors: Ishii Masanobu , Nakamura Taishi , Yamanouchi Yoshinori , Otsuka Yasuhiro , ikebe sou , Tsujita Kenichi
Published: December 2023

Background:
Bleeding complication during antiplatelet therapy for coronary artery disease (CAD) is an adverse issue due to high risk of subsequent death and cardiovascular events. Although many bleeding risk scores have been proposed, simple and personalized risk assessment in routine clinical practice is challenging because of the heterogeneous and multifactorial pathophysiological condition. We aimed to develop a machine learning-based risk prediction for bleeding events in CAD patients treated with antiplatelet therapy.

Methods:
This study was a retrospective, observational cohort study using the Japanese nationwide electronic medical record database. Data from 49,324 CAD patients who underwent revascularization and received antiplatelet therapy between July 2008 through July 2022 were randomly assigned to the model derivation and validation sets. Data balancing technique: synthetic minority over-sampling technique was used to process the imbalanced data. Risk prediction model was developed using random forest (RF) after feature selection by the Boruta algorithm. Outcome was defined as bleeding events requiring hospitalization.

Results:
Of all, 1,684 (3.4%) bleeding events were observed during study period. The area under the curves of receiver operator characteristics of RF (95% confidence intervals) for bleeding were 0.977 (0.976-0.978) in derivation and 0.975 (0.972-0.977) in validation set. The performance metrics of the model were well acceptable (accuracy, 0.939; precision, 0.990; recall, 0.887; F1-score 0.936, respectively) in validation set. The sigmoid calibrated RF models resulted in well approximating observed bleeding events in the calibration plot and the Brier score of 0.042.

Conclusions:
This machine learning model could predict bleeding risk for CAD patients treated with antiplatelet therapy in real-world setting.
Abstract 12328: Impact of Female Sex on Cardiogenic Shock Outcomes - A Cardiogenic Shock Working Group Report
Authors: Ton Van-Khue , Kanwar Manreet , LI BORUI , Blumer Vanessa , Li Song , Zweck Elric , Sinha Shashank , Farr Maryjane , Hall Shelley , Kataria Rachna , guglin maya , Vorovich Esther , Hernandez-Montfort Jaime , Garan Arthur Reshad , Pahuja Mohit , Vallabhajosyula Saraschandra , Nathan Sandeep , Abraham Jacob , Harwani Neil , Hickey Gavin W , Wencker Detlef , Schwartzman Andrew , Khalife Wissam , Mahr Claudius , Kim Ju H , Bhimaraj Arvind , Sangal Paavni , Zhang Yijing , Burkhoff Daniel , Kapur Navin K
Published: December 2023

Introduction:
Studies reporting cardiogenic shock (CS) outcomes in women are scarce.

Hypothesis:
Among patients with CS complicating acute myocardial infarction (AMI-CS) and heart failure (HF-CS), women have worse survival at discharge and more vascular complications than men.

Methods:
We analyzed 5,083 CS patients in the Cardiogenic Shock Working Group. Propensity score matching (PSM) was performed using baseline characteristics. Logistic regression was performed for log odds of survival.

Results:
Among 5,083 patients, 1,522 were women (30%) with a mean age of 66.5±13.2 years. There were 30% women and 29.1% men with AMI-CS (p=0.03). More women presented with
de novo
HF-CS compared to men (26.2% vs. 19.3%, p<0.001). Before PSM, differences in baseline characteristics and sex-specific outcomes were seen in the HF-CS cohort, with worse survival at discharge (69.9% vs. 74.4%, p=0.009) (Figure A) and higher maximum SCAI stage E (26% vs. 21%, p=0.04) in women than men (Figure B). Women were less likely to receive pulmonary artery catheters (52.9% vs. 54.6%, p<0.001), heart transplant (6.5% vs. 10.3%, p<0.001) or left ventricular assist device (7.8% vs. 10%, p=0.01). Differences in AMI-CS cohort were less discrepant. Regardless of CS etiology, women had more vascular complications (8.8% vs. 5.7%, p<0.001), bleeding (7.1% vs. 5.2%, p=0.01), and limb ischemia (6.8% vs. 4.5%, p=0.001) (Figure C). More vascular complications persisted in women after PSM (10.4% women vs. 7.4% men, p=0.06).

Conclusions:
Women with HF-CS had worse outcomes and more vascular complications than men with HF-CS. More studies are needed to identify barriers to advanced therapies, decrease complications and improve outcomes of women with CS.
Abstract 12353: Unveiling the Hidden Insights: Cardiac Magnetic Resonance Radiomics Signature of the Myocardial Disease in Non-Ischemic Dilated Cardiomyopathy
Authors: Amyar Amine , Nakamori Shiro , Ngo Long H , Ishida Masaki , Nakamura Satoshi , Omori Taku , Moriwaki Keishi , Fujimoto Naoki , Imanaka-Yoshida Kyoko , Sakuma Hajime , Dohi Kaoru , Manning Warren J , Nezafat Reza
Published: December 2023

Background:
There is a growing interest in CMR radiomic signatures as novel imaging biomarkers of cardiac diseases. The relationship between CMR radiomic signatures and myocardial tissue composition is unknown.

Goal:
To investigate the association of CMR myocardial radiomic signatures to histological features in non-ischemic dilated cardiomyopathy (DCM).

Methods:
CMR images from 132 DCM patients (71% male; 54±15 years) who underwent CMR and endomyocardial biopsy within 6 [2-15] days were used to investigate the association between myocardial radiomic signatures measured from native T
1
, extra-cellular volume (ECV), LGE and histological features. Radiomic first-order and textural features were computed for each sequence from the mid-septal myocardium near the biopsy region (1023 features). We applied consensus clustering to identify distinct radiomic clusters. A single representative feature, the medoid, was identified within each cluster based on its minimal dissimilarity from other features. We built logistic regression models using one medoid per model to assess the association between each medoid and histological features.

Results:
Clustering analysis unveiled three radiomic clusters for each sequence. For native T
1
, the medoids were textural features, with medoids 1 and 2 exhibiting associations with fibrosis and myocyte hypertrophy (AUC of 0.71/0.74 and 0.78/0.69, respectively). ECV medoids included first-order and textural features. The first-order medoid was associated with myocyte hypertrophy (AUC=0.75), while medoid 3 (texture) was associated with fat replacement (AUC=0.81). LGE medoid 1 (first-order) was associated with inflammation (AUC=0.61) and vacuolization (AUC=0.76), while medoid 3 (texture), associated with fibrosis (AUC=0.69) and fat replacement (AUC=0.67) (
Figure 1
).

Conclusions:
In DCM patients, CMR radiomic features were associated with myocardial tissue composition, as assessed by invasive biopsy.
Abstract 12354: Patient-Reported Discordances in Atrial Fibrillation Care: Results From a Nationwide Survey Across Diverse Patient Populations
Authors: Jackson Larry R , Zhao Michelle , Cappel David , Carter Jeffrey , Heggen Cherilyn
Published: December 2023

Background:
Adverse outcomes associated with atrial fibrillation (AF) including increased rates of stroke and mortality have been documented in Black patients compared to White patients.

Research Question:
What are key factors that contribute to racial and ethnic disparities in AF outcomes?

Methods:
This project aimed to identify underlying drivers of health disparities in AF management through patient surveys. Between February-March 2022, PRIME Education conducted a nationwide online survey in patients with AF through a collaboration with StopAfib.org.

Results:
Of the participants who completed the survey, 878 self-identified as non-Hispanic White and 37 as Black. Compared to White patients, Black patients had increased prevalence of co-morbidities (hypertension, 76% vs. 52%,
P = 0.006
; diabetes, 27% vs 8%;
P < 0.001
), increased hospitalizations due to AF-related causes (heart failure, 14% vs. 3%;
P = 0.006
), and more frequently experienced financial hardship affecting access to medical care (41% vs 17%,
P = 0.001
). Black patients were more likely to utilize primary care clinicians to manage AF compared to White patients (27% vs 5%,
P < 0.05
) and were less likely to have undergone procedural rhythm control strategies (catheter ablation, 19% vs. 45%,
P = 0.002
; electrical cardioversion, 14% vs. 39%,
P = 0.002
) (Fig. 1).

Conclusion:
Findings from this patient survey highlight several intervenable factors including improved treatment of co morbid medical conditions, economic stability, and healthcare utilization that may contribute to disparities in AF management between Black and White patients with AF.
Abstract 12367: Sex-Specific Differences in Quality of Life and Atrial Fibrillation Recurrence Following Ablation of Persistent Atrial Fibrillation: Insights From the DECAAF II Trial
Authors: Younes Hadi , Feng Han , Sohns Christian , Forkmann Mathias , Noujaim Charbel , Mekhael Mario , Assaf Ala' , Chouman Nour , Kreidieh Omar , huang chao , Lim Chanho , El Hajjar Abdel Hadi , donnellan eoin , Pandey Amitabh C , Marrouche Nassir , mahnkopf christian
Published: December 2023

Introduction:
Sex-specific differences have been observed in the literature in outcomes of catheter ablation of atrial fibrillation.

Objective:
We sought to evaluate sex-specific differences in persistent atrial fibrillation(PeAF) particularly in relation to quality of life and AF recurrence after ablation.

Methods:
We examined all PeAF patients in the DECAAF II trial and divided them into 2 groups, women and men. We evaluated sex-based differences in quality of life based on the SF-36 quality of life score. We assessed each component of the score before and after ablation as well as the total score. The Mann-Whitney U test was used. A time-to-event analysis was conducted to assess for AF recurrence.

Results:
We included 815 patients(21% women, 79% men). Women experienced more PeAF recurrence(53.3%) after 90 days of the blanking period than men(40.2%) [HR= 1.4311 (1.132, 1.809), p<0.01](Figure 1). SF36 Quality of Life scores showed significant differences between women and men in 9 out of 9 categories both before and after ablation at 12 months. Women consistently reported lower scores than men in physical functioning (p<0.01), physical health(p<0.01), emotional problems(p<0.01), energy and fatigue(p<0.01), emotional wellbeing(p<0.01), social functioning (p<0.01), pain(p<0.01), general health(p<0.01), and health change(p<0.01). Total scores for women remained lower both pre- and post-ablation(p<0.01)(Figure 2).

Conclusion:
Female patients with PeAF demonstrated more AF recurrence and consistently poorer quality of life compared to males before and after ablation, indicating the need for further investigation and targeted interventions.
Abstract 12374: Machine Learning-Based Evaluation of Elevated Left Ventricular End-Diastolic Pressure
Authors: Fang Michelle Z , Xu Bo , Zhou Yadi , Sanaka Krishna , Svensson Lars , Grimm Richard A , Griffin Brian P , Popovic Zoran B , Cheng Feixiong
Published: December 2023

Background:
Left ventricular end-diastolic pressure (LVEDP) is clinically relevant due to its association with diastolic dysfunction and other outcomes. The gold-standard method of measuring LVEDP is invasive intra-cardiac catheterization. Echocardiography is routinely used for non-invasive estimation of left ventricular (LV) filling pressures; however, correlation with invasive LVEDP is variable.

Goal:
We sought to use machine learning (ML) algorithms to predict elevated LVEDP (> 20 mmHg) using clinical, echocardiographic, and biochemical parameters.

Methods:
We used a cohort of 460 consecutive patients without atrial fibrillation or significant mitral valve disease who underwent transthoracic echocardiography within 24 hours of elective heart catheterization. We included patients’ clinical (e.g. age), echocardiographic (e.g. left ventricular ejection fraction), and biochemical (e.g. N-terminal brain natriuretic peptide) data. We fit logistic regression, random forest, gradient boosting, and support vector machine algorithms in a 20-iteration train-validate-test workflow and measured performance using average area under the receiver operating characteristic curve (AUROC). We also performed multi-class classification of the patients’ cardiac conditions and predicted elevated tau (> 45), the gold-standard parameter for LV diastolic dysfunction. For each outcome, logistic regression weights were used to identify clinically relevant variables.

Results:
ML algorithms predicted LVEDP > 20 mmHg with good performance (AUROC = 0.779). ML models showed excellent performance predicting elevated tau (AUROC = 0.830) and classifying a variety of cardiac conditions (AUROC = 0.837 - 0.973). We identified several clinical variables (e.g. BMI, heart rate) relevant to LVEDP prediction.

Conclusion:
Our study shows ML approaches can robustly predict elevated LVEDP and tau. ML may assist in the clinical interpretation of echocardiographic data.
Abstract 12380: Importance of Quantifying Lung Fluid Status in Patients With Heart Failure Using Chest Computed Tomography
Authors: Uzui Hiroyasu , Kataoka Tatsuhiro , Ishida Tomokazu , Shimizu Tomohiro , Nomura Ryouhei , Tsuji Toshihiko , Fujita Tomoharu , Fujita Hirotsugu , Mukai Moe , Aoyama Daisetsu , Sato Yusuke , Miyoshi machiko , Yamaguchi Junya , Tama Naoto , Ikeda Hiroyuki , Itoh Toshihide , Ishida Kentaro , Tada Hiroshi
Published: December 2023

Background:
Heart failure (HF) is a complex condition that requires accurate assessment for optimal management. B-type natriuretic peptide (BNP) has been widely used for diagnosis and monitoring, but its correlation with symptoms and prognosis can be inconsistent. This study investigates the utility of chest computed tomography (CT)-based evaluation of lung congestion as an additional tool in HF.

Methods:
CT imaging (SOMATOM Force, Siemens Healthineers) was performed in 129 HF patients on admission. Concurrently, BNP levels were measured. For image analysis, mean lung density (MLD), an index of lung congestion obtained from imaging, was analyzed by image analysis software (Syngo. CT Pulmo 3D, Siemens Healthineers). MLD was converted to fluid content (FC) in percentage units according to the equation: FC [%] = (MLD + 1000) / 10. The correlation between CT findings, BNP levels, clinical data, and prognosis was analyzed.

Results:
The FC of HF patients were significantly higher than those of non-HF patients (30.2 ± 6.2% vs. 18.2 ± 4.1%, p < 0.01), and showed a weak correlation with BNP levels at admission (r = 0.205, p = 0.020). The subjects were divided into four groups based on FC values (median 30.2%) and BNP levels (median 617 pg/mL): S1 (<30.2, <617), 2 (≥30.2, <617), S3 (<30.2, ≥617), and S4 (≥30.2, ≥617). During the observation period of 7 to 38 months (mean 19.5 months), 38 out of 129 patients died. FC values were significantly higher in patients who were readmitted (32.2 ± 6.2% vs. 29.4 ± 6.1%, p = 0.024). Cardiovascular death and survival were compared between groups (Figure). Group S1 showed significantly better survival compared to the other groups. Higher mortality rates were observed in groups with the higher FC values, even in those with lower BNP levels.

Conclusion:
The present data suggest that the evaluation of the lung congestion level (FC value) using CT imaging on admission in HF patients is an additional indicator for accurate prognostic evaluation, in addition to BNP.
Abstract 12411: Fatty Acid Saturation Status in Murine High Fat Diets Modulates Platelet Reactivity
Authors: Barrachina Maria , Becker Isabelle , Freire Daniela , Guo Karen , Hirsch Thomas , Italiano Joseph E , puder mark , Machlus Kellie R
Published: December 2023

Introduction:
We have recently shown that membrane fatty acids are key modulators of megakaryocyte differentiation and platelet formation. In obesity, patients have an altered plasma lipid composition, which coincides with enhanced platelet responsiveness to activation. However, the mechanism underlying this platelet phenotype remains unknown.

Hypothesis:
We hypothesized that the obese plasma lipidome alters the composition of the megakaryocyte membrane, which ultimately leads to the generation of hyper-reactive platelets.

Aim:
To investigate the impact of high fat diets with different fatty acid compositions on megakaryocyte development and platelet reactivity.

Results:
Mice were fed chow or high fat diets enriched in either saturated fatty acids (50% SFAs) or polyunsaturated fatty acids (50% PUFAs, omega-6-enriched). Neither high fat diet resulted in changes in megakaryocyte numbers, but both caused a significant increase in the size of bone marrow megakaryocytes, suggesting diet-derived lipid uptake into megakaryocytes. When examining platelet reactivity, we found that mice fed the SFA-enriched high fat diet exhibited increased expression of the active form of integrin αIIbβ3 (JON/A) in resting platelets and that both JON/A and P-selectin expression were significantly decreased after platelets were stimulated with ADP and the thromboxane A
2
analogue U46619. In contrast, platelets from mice fed the PUFA omega-6-enriched high fat diet had no differences in platelet reactivity compared to mice fed normal chow.

Conclusions:
Our data reveal that dietary fatty acid saturation status affects platelet reactivity, consistent with previous human studies showing variability in platelet reactivity in obese individuals. Further explorations will elucidate if plasma and/or platelet lipid content may be an indicator of risk for thrombosis or cardiovascular disease.
Abstract 12423: CAD Polygenic Risk Score, a Novel Screening Tool for Predicting Likelihood of Coronary Artery Disease, Was Not Superior to Coronary Calcium Score in Predicting MACE
Authors: Maryniak Andrii , Nadkarni Ninad , Singh Aditya , Hajek Catherine , Larson Eric , Bartaria Shubhi , GU SHAOPENG , Weaver Max , Rotter Jerome I , Guo Xiuqing , Rajpurohit Naveen , Petrasko Marian S , Stys Adam , Stys Tom P
Published: December 2023

Introduction:
Coronary artery calcium (CAC) score is a well-established tool for risk assessment of coronary artery disease (CAD). Alternatively, CAD polygenic risk score (PRS) is an emerging modality for assessing risk of CAD. Our study aims to compare the sensitivity and specificity of the above scores in predicting major adverse cardiovascular events (MACE).

Hypothesis:
CAD PRS is a better predictor of MACE than CAC score.

Methods:
Adult patients had CAD PRS, CAC and baseline characteristics documented through the Sanford Heart Screening Program from 2011 to 2021. Incidence of MACE, defined as myocardial infarction, stroke, death, and revascularization, was analyzed. Chi-squared tests were used to examine the impact of stratified risk scores and MACE. A logistic regression model was trained on 70% of the data to assess prediction accuracy on 30% of the data.

Results:
A total of 1,380 patients were analyzed. Mean age was 63, with female (65%) and Caucasian (99%) predominance. The prevalence of diabetes mellitus, hyperlipidemia, and hypertension was 8%, 32%, and 7%, respectively. The incidence of MACE was 6.6%. Patients with MACE had higher CAC (527.1±856.2 vs. 98.3±294.3) and CAD PRS (15.5±.62 vs. 15.24±.61). Sensitivity and specificity are represented by the receiver operating characteristic curve, which was used to assess prediction accuracy whereby area under the curve (AUC) was used as a measure of fit ranging from 0 to 1. The curves showed that CAC had better AUC than PRS (Figure 1).

Conclusions:
In our study CAD PRS failed to be a better predictor of MACE compared to CAC score.
Abstract 12480: Characterization of Symptoms and Diagnostic Procedures Prior to Diagnosis Among Patients With Pulmonary Arterial Hypertension in the United States
Authors: DuBrock Hilary M , Germack Hayley D , Gauthier-Loiselle Marjolaine , Linder Jörg , Satija Ambika , Manceur Ameur M. , Cloutier Martin , Lefebvre Patrick , Panjabi Sumeet , Frantz Robert P
Published: December 2023

Introduction:
Pulmonary arterial hypertension (PAH) is a progressive, fatal disease associated with non-specific symptoms, which may lead to diagnosis delays and poor outcomes.

Research Question:
Which symptoms and diagnostic procedures occur prior to PAH diagnosis and do they vary based on diagnosis delay?

Aim:
To describe PAH symptoms and diagnostic procedures among patients newly diagnosed with PAH.

Methods:
Adults with PAH were identified from Optum’s de-identified Clinformatics
®
Data Mart Database (2016-2021). Eligible patients had continuous health plan enrollment ≥12 months (mo) before the first recorded PAH-related symptoms (i.e.,
index date
) and from the index date until the first recorded PAH diagnosis on a medical claim (i.e.,
study period
). Patients also had ≥1 fill for a PAH treatment and ≥1 right heart catheterization at any time post-index. PAH symptoms and diagnostic procedures were described during the study period, overall, and stratified by time between the index date and first PAH diagnosis (i.e.,
diagnosis delay
; ≤12 mo, 12–24 mo, and >24 mo).

Results:
The sample included 538 patients (≤12 mo: N=327; 12–24 mo: N=126; >24 mo: N=85). Mean age was 66 years, 60.6% were female, and mean (range) diagnosis delay was 11.8 (0.0–50.2) mo. During the study period, most patients had ≥2 unique symptoms recorded, but those with longer delay had more fatigue (≤12 mo: 26.6%; 12–24 mo: 55.6%; >24 mo: 54.1%), edema (29.1%; 42.9%; 51.8%), and dizziness (10.1%; 23.0%; 18.8%), among others. Mean delay was shorter when the first symptoms were ascites (4.2 mo) and syncope (6.4 mo) and longer for fatigue (14.2 mo) and dizziness (14.0 mo). On average, patients with longer delay had more diagnostic procedures pre-diagnosis (≤12 mo: 4.3; 12–24 mo: 8.2; >24 mo: 8.7), driven by more electrocardiograms (ECG; 1.9; 4.2; 4.5). Overall, 85.5% of patients had an ECG and 83.5% had a transthoracic echocardiography pre-diagnosis.

Conclusions:
Symptoms such as fatigue, edema, and dizziness were more common in patients with longer time to diagnosis and these patients had more diagnostic procedures. Greater physician awareness and new screening tools (e.g., predictive algorithms using ECG data) could accelerate PAH diagnosis and treatment aiming at improving patient outcomes.
Abstract 12486: Predictive Value of Chronotropic Incompetence for Clinical Outcomes in Heart Failure: Findings From the MyoVasc Study
Authors: Belanger Noemie , Zeid Silav , Buch Gregor , Kazemi-Asrar Fawad , Velmeden David , Mueller Felix , Heidorn Marc W , Dinh Wilfried , Lackner Karl J , Gori Tommaso , Muenzel Thomas , Prochaska Jürgen H , Wild Philipp S
Published: December 2023

Introduction:
Chronotropic incompetence (CI), an important aspect of exercise intolerance, is related to adverse clinical outcomes in heart failure (HF). However, the lack of standardized evaluation of CI results in inconsistent evidence.

Aim:
To evaluate CI with regard to clinical and medical determinants and relationship to clinical outcomes in HF.

Methods:
Data from the MyoVasc study (NCT04064450), a prospective cohort on HF, were analyzed. Subjects underwent deep clinical phenotyping, including cardiopulmonary exercise testing on a cycle ergometer. Measures of CI were evaluated, with continuous predicted heart rate reserve (pHRR) emerging as the most clinically relevant definition for operationalizing CI. Clinical and medical determinants of CI were assessed in multivariable linear regression models and outcomes in Cox regression models.

Results:
The analysis sample included 886 subjects (median age 63 years [interquartile range (IQR) 55; 72]; 29.9% women) who achieved maximal exertion (respiratory exchange ratio>1.0). Symptomatic HF stage C/D was present in 42.8% (379) of the subjects. Sixteen drug groups were identified as CI modulators including β-blockers (β-estimate per SD -0.83 [95% confidence interval -0.95;-0.70], p<0.0001) and antiarrhythmics (β
SD
-0.93 [-1.30;-0.56], p<0.0001). New York Heart Association functional class, smoking, fatty liver index (FLI), and diabetes mellitus (DM) were the strongest determinants of CI in all subjects independently of sex, age, and previously identified medication. Determinants differed according to left ventricular ejection fraction [LVEF] (≥50 vs <50%), being strongly associated with markers of HF (NT-proBNP) and lung function (FEV1) in HF with reduced EF and more linked to DM or the FLI in HF with preserved EF. In Cox regression analysis adjusted for clinical profile, pHRR independently predicted all-cause death (HR
SD
1.86 [1.41;2.45], p<0.0001) and worsening of HF (HR
SD
1.37 [1.04;1.81], p=0.025).

Conclusions:
CI strongly predicted clinical outcomes and revealed relevant differences between HF with preserved and reduced EF. This highlights the relevance of impaired response to exercise in the clinical course of HF with implication for risk stratification and intervention.
Abstract 12590: Association of Iron Deficiency With the Recurrence of Atrial Fibrillation After Pharmacological Cardioversion
Authors: Valeev Marat , Khastieva Dilyara , Tarasova Natalia , Khasanov Niiaz
Published: December 2023

Introduction:
Anemia and iron deficiency (ID) are common conditions in patients with atrial fibrillation (AF). The presence of anemia may be associated with worse outcome in patients with AF. The potential role of ID in the development of AF has been discussed recently, however the issue is considered only in the context of anemia. Thus, information on the direct impact of ID on AF development and on the sinus rhythm maintenance remains limited.

Methods:
The purpose of this article is to study the effects of ID on the frequency of recurrence of AF within 12 months in patients with paroxysmal AF after pharmacological cardioversion with amiodarone.198 patients (120 men) with nonvalvular paroxysmal AF with successful pharmacological cardioversion were included in the study between 2019-2021 years. The Me of the patients age is 71 (63,2–77) year. ID is assumed to be present when serum ferritin <100 ng/mL or 100 ng/mL ≤ serum ferritin ≤299 ng/mL with transferrin saturation (TSAT) <20%. The primary outcome was AF recurrence within 12 months after pharmacological cardioversion. AF recurrence is statistically tested by the Kaplan-Meier test.

Results:
The patients were divided into 2 groups: group 1 - 116 patients with ID, group 2 - 82 patients without ID. The groups did not differ in the main clinical parameters, comorbidities and medications. After cardioversion, all patients received treatment according to the current guidelines. The significant difference in AF recurrence was observed between groups. Within 12 months of observation, AF recurrence was developed in 49 (42.2%) patients in group 1 and in 16 (19.5%) patients in group 2 (p=0.0008). The RR of the recurrence of AF in patients with ID is 2.64 [95% CI: 1.5-4.65] (p=0.0003).

Conclusion:
ID is associated with the higher chances of AF recurrence within 12 months after pharmacological cardioversion. ID increases the risk of AF recurrence by 2,64 times within 12 months after pharmacological cardioversion.
Abstract 12614: Procedural Volume and Outcomes With Atrial Fibrillation Ablation: A Report From the NCDR AFib Registry
Authors: Kattel Sharma , Tan Zhen , Lin Zhenqiu , Friedman Daniel , Mszar Reed , Zeitler Emily , Zei Paul , Bunch T J , Mansour Moussa , Akar Joseph , Curtis Jeptha P , Freeman James V
Published: December 2023

Introduction:
Operator and hospital procedure volumes are associated with outcomes in many cardiac procedures.

Objective:
To determine the association between hospital/physician procedural volume and safety/success for atrial fibrillation (AF) ablation in the current era.

Methods:
Procedures reported to the NCDR AFib Registry between 7/2019 to 6/2022 were analyzed. Physician and hospital procedural volumes were annualized and stratified into quartiles (Q) to compare procedural success and major adverse events (MAE). Three level hierarchical (patient, hospital and physician) generalized linear models were used to assess the adjusted relationship between procedural volume and likelihood of acute outcomes.

Results:
A total of 70,296 first time AF ablation patients' at 186 US hospitals were studied. Mean age was 66.1 ± 10.3 years. 36% were women; mean CHA2DS2-VASc score was 2.7±1.6, and 57.4% were of paroxysmal AF. The median annual procedural volumes for hospitals and physicians were 230 and 66 respectively. Acute procedural success was 98.5% and the MAE rate was 1.0%. With Q4 (highest) hospital procedural volume as a reference, the adjusted likelihood of procedural success was significantly less among Q1 (OR: 0.44, CI: 0.3-0.7), Q2 (OR:0.50, CI:0.3-0.8) and Q3 (OR:0.60,CI:0.4-0.9). Similarly, for physician volume, the adjusted likelihood of success was less among Q1 (OR: 0.38,CI: 0.3-0.5), Q2 (OR: 0.51,CI: 0.4-0.7) and Q3 (OR:0.55,CI:0.4-0.7). With regards to MAE, compared to Q4, there was an inverse relationship to procedural volume for hospitals in Q1 (OR: 1.78, CI:1.3-2.5) but not in Q2 (OR: 1.06, CI 0.8-1.5) or Q3 (OR: 1.19, CI: 0.9-1.6) and for physicians in Q1 (OR: 1.93, CI 1.4-2.6) and Q2 (OR:1.49, CI: 1.1-2.0) but not in Q3 (OR: 1.22, CI: 0.9-1.6)(figure).

Conclusions:
In this national cohort of first time AF ablations, hospital and physician procedural volume were directly related to acute procedural success and inversely related to the rate of MAE.
Abstract 12619: Positional Obstructive Sleep Apnea and Risk of Atrial Fibrillation
Authors: Logan Jeongok G , Byon Ha Do , Kwon Younghoon
Published: December 2023

Introduction:
Obstructive sleep apnea (OSA), a common sleep disorder, has been associated with the risk of atrial fibrillation (AF). OSA is a heterogenous condition but is heavily position-dependent. Positional OSA (POSA) is a common form of OSA in which OSA is predominantly manifested in a supine position. The implication of POSA in cardiovascular risks is unclear. This study aimed to examine whether the risk of AF is different between individuals with POSA and those with non-positional OSA (nPOSA).

Methods:
We identified individuals with OSA (AHI ≥ 5/h) from the Sleep Heart Health Study (SHHS) cohort. POSA was defined if overall AHI ≥ 5/h, supine AHI ≥ 5/h, and supine AHI greater than twice the non-supine AHI based on the SHHS visit 1 sleep study. Incident AF was deemed present if detected on a 12-lead ECG during the SHHS visit 2 or confirmed by the parent cohorts at any time between the baseline PSG and the final follow-up date for AF assessment. Multiple logistic regression analysis was conducted with covariates including age, race, gender, body mass index, smoking status, systolic blood pressure, use of hyperlipidemia medication, use of diabetes medication (oral or insulin), use of hypertension medication, cholesterol, triglyceride, and high-density-lipoprotein, and other sleep characteristics (total sleep duration, sleep efficiency, and sleep onset latency).

Results:
The study included a total of 1712 participants (females, 45%; mean age, 65 years old) with OSA. Compared with individuals with nPOSA, those with POSA were more likely to be white (p=.002), older (p<.043), have lower AHI (p<.001), lower BMI (p<.001), lower systolic blood pressure (p<.001), and lower triglyceride (p=.029), longer sleep duration (p=.002), and less likely to take hypertension medication (p<.001). After accounting for these differences, the odds of incident AF were about 30% lower in the individuals with POSA compared with those with nPOSA (OR=0.7, p=.037).

Conclusions:
Individuals with OSA exhibit a lower risk of AF when they have POSA. While it is possible that residual confounding could account for this finding, we conclude that POSA might represent a unique phenotype with distinct cardiovascular implications.
Abstract 12625: Characterising Mechanisms of Ischemia in Patients With Myocardial Bridges
Authors: Sinha Aish , Rahman Haseeb , Demir Ozan , Rajani Ronak , Gulati Ankur , Li Kam Wa Matthew , Morgan Holly , Ezad Saad , Ellis Howard , Hogan Dexter , Shah Ajay M , Webb Andrew , Marber Michael , Perera Divaka
Published: December 2023

Background:
Myocardial bridges (MB) have been associated with ischemic syndromes. Abnormal cardiac coronary coupling is implicated but has not been systematically evaluated. We sought to determine the substrates for ischemia in patients with angina, nonobstructive coronary arteries (ANOCA) and a MB in the left anterior descending artery.

Methods:
Patients with ANOCA underwent acquisition of intracoronary pressure and flow during rest, supine bicycle exercise and adenosine infusion. Coronary wave intensity analysis was performed, and perfusion efficiency defined as accelerating wave energy/total wave energy (%). Endothelial dysfunction was defined as a reduction in epicardial vessel diameter by >20% with intracoronary acetylcholine. Patients with ANOCA and a MB were compared to those with microvascular angina (CMD: coronary flow reserve, CFR, <2.5) or ANOCA with normal CFR (controls).

Results:
87 patients were enrolled (25 MB [age 56±9 years], 34 CMD [57±11 years], 28 control [57±8 years]). FFR in these 3 groups was 0.86±0.05, 0.92±0.04 and 0.94±0.05; CFR was 2.6±0.5, 2.0±0.3 and 3.3±0.6. Perfusion efficiency improved during exercise in controls (61±11% to 65±15%, p=0.044), but decreased in patients with CMD (63±11% to 44±10%, p<0.001) and MB (59±9% to 50±9%, p=0.001). In CMD, the reduction in perfusion efficiency was driven by diminished microcirculation derived accelerating energy in early diastole, whereas in MB this was driven by diminished accelerating energy arising from the upstream epicardial vessel in early systole (
Figure
). 55% of patients with MB, versus 33% of patients with CMD and 29% controls, had endothelial dysfunction.

Conclusions:
MBs result in impaired coronary perfusion efficiency during exercise, which is due to diminished accelerating wave energy. Additionally, there is a high prevalence of endothelial dysfunction; both mechanisms may cause ischemia and, therefore, represent distinct treatment targets.
Abstract 12637: Sociodemographic Measures and Disparities in Obesity in US Rural vs Nonrural Counties, 2004-2019
Authors: Tabatabaei Yeganeh Hanieh Sadat , Lahr Brian D , Mielke Michelle M , Vella Adrian , Bailey Kent , Dugani Sagar
Published: December 2023

Introduction:
US rural, compared with nonrural, counties have a higher burden of CVD. Obesity is a major CVD risk factor with 40% prevalence in adults. However, the rural-nonrural disparities in obesity are incompletely described. We aimed to evaluate differences in prevalence of obesity by county-level rurality.

Methods:
We used CDC county-level data for adults aged ≥20 years, 2004–2019, available for 97.6% of US counties (n=3148/3226). CDC defined obesity (body mass index ≥30 kg/m
2
) using self-reported weight and height. Rurality was based on six levels from large central metro (most urban) to noncore (most rural). We compared prevalence by rurality level using weighted least squares regression, adjusting for 13 county-level sociodemographic measures, and reported prevalence ratios (95% CI).

Results:
Counties with increasing rurality reflected older populations, as indicated by higher median age (from 35.6 years to 42.4 years). Also, increasing rurality was associated with differences in income and proportion uninsured. In age and sex ratio adjusted analysis (model 1), obesity prevalence was 1.05- to 1.06-fold higher in medium metro, small metro, and micropolitan counties compared with large central metro counties (global test,
P
<.001). With further adjustment for sociodemographic measures (model 2; model 1 covariates plus race, state, income, proportion uninsured) these relative differences were preserved but attenuated (each 1.03-fold higher), while a greater difference was revealed for large fringe metro (1.06-fold higher) counties. In both models, differences in obesity prevalence between noncore and large central metro counties were minimal. (Table)

Conclusion:
Counties with intermediate rurality were associated with higher obesity prevalence. The association was partly accounted for by nonmodifiable and modifiable sociodemographic measures, which may be targeted to reduce rural-nonrural disparities in obesity.
Abstract 12649: Harnessing Ambulatory Monitoring Data to Improve Prediction of Heart Failure
Authors: Schwennesen Hannah , Li Zhen , Hammill Bradley G , Clark Amy , Pokorney Sean , Greiner Melissa , Hytopoulos Evangelos , Turakhia Mintu , Cambra Justin , Piccini Jonathan P
Published: December 2023

Introduction:
Despite growing evidence that atrial fibrillation (AF) burden impacts clinical outcomes, few clinical risk scores incorporate individual-level arrhythmia characteristics. We analyzed predictors of hospitalization for heart failure (HF) in patients using both clinical history and ambulatory cardiac monitoring data.

Methods:
We evaluated patients who underwent Zio XT ambulatory monitoring in the US (2014-2020). The monitoring data were linked with clinical data from Centers for Medicare and Medicaid Services. Patients on anticoagulation or anti-arrhythmic therapy and those with evidence of sustained VT, known ventricular fibrillation/flutter, prior ablation, prior left atrial appendage occlusion, or cardiac arrest in the prior year were excluded. We randomly divided our dataset into a 70% training dataset and 30% testing dataset. Predictive models were generated using LASSO Cox regression for variable selection in the training dataset and evaluated on testing dataset among ambulatory ECG variables and the components of CHA
2
DS
2
-VASC.

Results:
Among 224,682 patients in the training dataset, 4,021 (1.8%) were hospitalized for HF within 1 year. A model that included components of the CHA
2
DS
2
-VASC and all ECG variables (excluding multicollinear variables) had greater discrimination and calibration for HF hospitalization (C-statistic 0.85 [0.84-0.86]), compared with the CHA
2
DS
2
-VASC score alone (C-statistic 0.73 [0.72-0.74],
Figure
). ECG findings with the greatest predictive value were the presence of premature ventricular couplets (HR 1.54 [1.43-1.65]) and presence of AF (HR 1.53 [1.35-1.72]).

Conclusion:
A model that incorporates both ECG variables from ambulatory monitoring data and the components of the CHA
2
DS
2
-VASC provides better discrimination for the risk of HF hospitalization compared with the CHA
2
DS
2
-VASC risk score alone. Premature ventricular couplets and AF are highly associated with HF hospitalization.
Abstract 12670: Trends in Patients With COVID-19 and Device Related Infections: A National Inpatient Sample Trend From 2020
Authors: Ferraro Bruce , Desai Spandan , Roma Nicholas , Modi Vivek , Traub Darren
Published: December 2023

Background:
Cardiac implantable electronic devices (CIED) are essential for managing arrhythmias, improving hemodynamics, and preventing sudden cardiac death. However, device-related infections (DRI) remain a significant complication of CIED and are associated with primary adverse outcomes. However, limited data exists on concomitant Covid-19 infection and its effects on outcomes of DRI.

Methods:
National Inpatient Sample 2020 was used to identify patients hospitalized for DRI based on ICD-10 codes. DRIs were further stratified into concomitant Covid-19 infected patients and non-Covid-19 infected groups. Logistic regression was used to compare in-hospital outcomes.

Results:
In 2020, there were 59,270 admissions for DRIs. 1,890 (3.2%) DRI cases were observed to have concomitant Covid-19 infection. Racial disparities observed included higher rates of DRI and concurrent Covid-19 infection in the African American (30.6% -vs- 20.2, p=0.002) and Hispanic (18.2% -vs- 9.4%, p=0.002) population. Lead extraction rates were lower in the Covid-19 infection with DRI group (5.33% -vs- 11.17%, p<0.001). Cases with DRI and concurrent Covid-19 infection also had a significantly longer length of stay (LOS, 21.6 -vs- 11.5 days, p<0.001), higher total hospital cost (305,644 -vs- 172,711, p<0.001), and higher mortality (23.1% -vs- 6.6%, p<0.001). This group was also observed to have increased needs for ICU level of care including higher proportion of ARDS, shock, mechanical ventilation and vasopressor use as listed in Table 1.

Conclusion:
DRIs with concurrent Covid-19 infection had higher all-cause mortality, complication rates, LOS and total hospital costs. Further research needs to be performed to delineate long-term outcomes in this patient population.
Abstract 12696: Association Between Aortic Valve Calcification and Aortic Valve Size in Patients With Severe High Gradient Aortic Stenosis
Authors: Mousavi Roya Anahita , Lamm Gudrun , Will Maximilian , Hoebart Philipp , Kammerlander Andreas , Voith Nikolaus , Schwarz Konstantin , Vock Paul , Krackowizer Philip , Hoppe Uta , Mascherbauer Julia
Published: December 2023

Introduction:
It is known that women require less aortic valve calcification (AVC) to develop severe aortic stenosis (AS) than men. Thus, gender specific AVC thresholds for the diagnosis of severe AS are recommended by the ACC/AHA guidelines. However, it is also known that women have smaller hearts and aortic valves (AV) than men.

Hypothesis:
We hypothesize that AVC is associated with AV size independently from sex.

Methods:
Consecutive patients with severe high gradient AS who underwent cardiac computed tomography (CT) were included in our study. AV annulus area and AVC assessed with the Agatston score were measured in CT. Linear regression model adjusted for age and sex as well as spearman correlation analysis were performed.

Results:
437 patients with severe high gradient AS (mean age 80±6 years, 47% female) were included. Significant differences in AVC (3363 [2582-4398] AU vs. 1984 [1354-2856] AU, p<0.001) and AV annulus area (509 ± 75 mm
2
vs. 408 ± 67 mm
2
, p<0.001) between men and women were found. We observed a significant correlation of AV annulus area with AVC (r=0.6, p<0.001). On multivariate regression AV annulus area was significantly associated with the Agatston score (β=7.5, p<0.001). Furthermore, separate regression analyses for men and women confirmed the significant association of AV annulus area with AVC independent from sex (β
(men)
=7.0, p<0.001; β
(women)
=8.2, p<0.001).

Conclusions:
In patients with severe high gradient AS AV annulus area is associated with AVC independent from sex. Thus, an indexation of AVC thresholds to AV size should be applied rather than using fixed sex-dependent AVC cut-offs for the definition of severe AS.
Abstract 12714: Superior Longitudinal Aortic Strain and Ventriculoarterial Coupling in Older Women is Independent of Body Size, Blood Pressure, and Moderately Correlated With Framingham 10-year Risk
Authors: WONG JIE JUN , Zhang Hongzhou , Gao Fei , Leng Shuang , Tan Ru-San , ZHAO XIAODAN , Tan Kieran , Zhong Liang , Koh Angela Su-Mei
Published: December 2023

Background:
Traditional risk factors are less helpful in predicting cardiovascular (CV) risk in women (1, 2). We used a novel cardiac MRI (CMR) method to determine sex differences in aortic global longitudinal strain (AoGLS), pulse wave velocity (AAPWV), and ventriculoarterial coupling (VAC) and correlated to Framingham Risk Scores (FRS).

Methods:
Community adults without CV disease underwent CMR. AoGLS was the maximal absolute Lagrangian strain tracking the phasic distance between brachiocephalic artery origin and aortic annulus. VAC was calculated as AAPWV divided by LVGLS. Sex-specific simplified FRS 10-year risk (TYR) and Heart/Vascular Age (HVA) were derived from pooled cohort equations (3).

Results:
These n=202 subjects (46% female) were similar in age (69.7 vs. 70.7, p=0.433). Women had better AAPWV (8.4m/s vs. 9.1m/s, p=0.020), AoGLS (6.2% vs. 5.2%, p=0.030), LVGLS (-21.9% vs. -20.1%, p=0.021), RVGLS (-32.8% vs. -29.9%, p=0.020), VAC (-0.39m/s·% vs. -0.47m/s·%, p=0.006), and smaller cardiac volumes (Table A). Female sex was associated with better AoGLS (β=0.838, p=0.030; R
2
=0.103) and VAC (β=-0.93, p=0.006; R
2
=0.113) independent of smoking, DBP, and BSA. Age only weakly correlated with AoGLS (β=-0.128 p<0.001; R
2
=0.277). AoGLS correlated moderately with FRS in women (TYR r=-0.400 p=<0.001; HVA r=-0.621 p<0.001) and weakly in men (TYR r=-0.354 p=<0.001; HVA r=-0.365 p=<0.001). VAC was associated with adverse TYR (β=-6.915, p=0.017; R
2
=0.145) and HVA (β=-14.948, p=0.001; R
2
=0.084); VAC correlated moderately with FRS in women (TYR r=-0.233 p=0.024; HVA r=-0.364 p<0.001) but not in men (TYR r=-0.175 p=0.068; HVA r=-0.183 p=0.056).

Conclusion:
Novel CMR-derived aortic strain identified sex differences in aortic age correlating with 10-year CV risk. Women had better aorto-ventricular strain and coupling independent of DBP and BSA. Chronological age was not useful in estimating aortic age. Advanced aortic imaging may augment CV risk assessment in women.