bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 14994: A Propensity Score Analysis of Early and Long-Term Outcomes After Ticagrelor or Clopidogrel in Elderly Patients With Acute Myocardial Infarction: The Fast-MI 2015 Registry
Authors: Danchin Nicolas , Cottin Yves , Cayla Guillaume , Lemesle Gilles , Weizman Orianne , Ferrieres Jean , Schiele Francois , Puymirat Etienne , Simon Tabassome ,   FAST-MI investigators
Published: December 2023

Introduction:
Guidelines recommend ticagrelor (T) over clopidogrel (C) in AMI patients, irrespective of age. Real-world evidence in the very elderly is limited.

Question:
Whether T is superior to C for elderly patients regarding early and long-term outcomes in real-life conditions.

Goal:
To analyze in-hospital, one- and 5-year outcomes according to use of T or C in AMI patients ≥80 yo.

Methods:
FAST-MI 2015 included consecutive AMI patients over 1 month in 204 French centers. Patients ≥80 yo, receiving C or T ≤48 hours of admission were studied. Propensity scores (PS) for receiving T or C was used in multivariable analyses and for PS matching.

Results:
Of 5291 patients in the registry, 995 (19%) were ≥80 yo, of whom 870 (87%) met the inclusion criteria. Mean age was 85±4 years (86 ± 4 for C-treated; 84±3 for T-treated), 51% were women (50.5% and 53% respectively for C and T), and 40% had STEMI (33% and 49% respectively). PS-adjusted HRs for T vs C were 1.26, 95%CI 0.65-2.44 for 30-day death, 1.09, 95% CI 0.71-1.67 for death at one year and 0.86, 95% CI 0.67-1.11 at 5 years. After PS matching, the two cohorts (N=293 each) were well balanced for all baseline characteristics including medications given at the acute stage. In-hospital complications, including major bleeding, re-MI, stroke and death were similar for T and C. Thirty-day, one-year, and 5-year mortality were similar for the 2 medications, with a trend favouring T over time, suggesting the possibility of undetected confounders (Figure). In hospital survivors, however, T at discharge was associated with improved 5-year survival (PS-adjusted HR 0.64, 95%CI 0.46-0.90), compared with C.

Conclusions:
In this real-world population of elderly (mean age 85 years) patients with AMI, initial use of ticagrelor was not associated with improved survival, compared with clopidogrel. In hospital survivors, however, ticagrelor at discharge was associated with reduced long-term mortality.
Abstract 15005: Gender Differences in the Evaluation and Clinic Outcomes of Patients With Palpitations
Authors: Jeong Sun Young , Wang Jiexi , Onwuzurike James , Ghanshani Serena , Chen Aiyu , Wu Yi-Lin , Lee Mingsum S
Published: December 2023

Background:
Palpitations represent a common complaint in primary care clinics. Although usually benign, palpitations are occasionally a manifestation of cardiac arrhythmias.

Aims:
This study aimed to investigate whether there are gender differences in the cardiac testing pattern and clinical outcomes of patients evaluated in outpatient clinics for palpitations.

Methods:
This is a retrospective observational study that included adult men and women who presented to an outpatient primary care or cardiology office in an integrated health system in California with a chief complaint of palpitations. Cardiac testing pattern was captured using electronic health records. The primary endpoint was hospitalization for arrhythmia at one year. The secondary endpoint was all-cause mortality at one year. Logistic regression models were constructed to evaluate the association between female gender and the outcomes.

Results:
Between 2017 and 2021, 89,680 patients were evaluated for palpitations, among whom 61,064 (68.1%) were women. A high proportion of women were Hispanic. Women were more likely to be obese and less likely to have hypertension, diabetes, atrial fibrillation, heart failure, or a history of myocardial infarction. A slightly higher proportion of women were started on beta-blockers (12.8% women vs. 12.2% men, p=0.004). Women were more likely to be referred for cardiac rhythm monitoring (19.8% women vs. 18.8% men, p <0.001). At one year, women had a lower rate of hospitalization for arrhythmias (0.5% in men versus 0.3% in women, adjusted OR 0.73, 95% CI 0.58-0.91). All-cause mortality was also lower for women at one year (adjusted OR 0.55, 95% CI 0.48-0.62).

Conclusion:
Among patients with palpitations, women were more likely than men to be treated with beta-blockers and referred for cardiac rhythm monitoring. Women had a better clinical prognosis, with a lower risk of hospitalization for arrhythmias and death at one year.
Abstract 15017: Chromatin Regulators as Potential Players in Atrial Fibrillation: Locus Analysis and Regulatory Role Investigation
Authors: Xiao Yichao , Bao Yunong , Liu Qiming , Zhou Shenghua
Published: December 2023

Background:
Atrial fibrillation (AF), a prevalent cardiac arrhythmia, has multiple biomarkers identified, yet their roles remain partially understood.

Research Questions and Aims:
The study sought to investigate the expression and prognostic value of Chromatin Regulators (CRs) in AF, their correlation with the immune microenvironment, and to identify potential prognostic markers, therapeutic drugs, and miRNAs.

Methods:
We filtered three GEO database datasets containing AF and normal samples, identifying 23 differentially expressed CRs. Sequence analysis and protein-protein interaction (PPI) network construction led to the identification of 10 AF prognosis-related CRs. The biological roles and potential pathways of these CRs were analyzed through Gene Ontology (GO) and ssGSEA algorithm. Moreover, we examined the correlation between hub genes and immune cells/immune function, identifying the top 5 immunity-relevant CRs.

Results:
Ten CRs linked to AF prognosis were identified, achieving an AUC of 0.901997 in a nomogram model. GO analysis demonstrated the involvement of these CRs in processes associated with cardiovascular diseases. The ssGSEA algorithm showed a connection between the identified CRs and immune infiltration. The study also identified the top 5 immunity-related CRs, and potential drugs and miRNAs for AF therapy.

Conclusions:
This study elucidates the role of specific CRs in AF, presenting a promising risk model and potential therapeutic targets. Further validation and evaluation of potential therapeutic targets' efficacy and safety are required. This underscores CRs as potential biomarkers and therapeutic targets for AF.
Abstract 15019: Graded Relationships Between Blood Pressure Levels and Cardiovascular Mortality in Patients With Type 2 Diabetes: Results From a Large Registry Cohort in Asia
Authors: Seng Loraine , Puar Troy , Bee Yong Mong , Jafar Tazeen H
Published: December 2023

Introduction:
Elevated BP is associated with increased risk of cardiovascular mortality. However, there is ongoing debate whether intensive BP lowering may paradoxically increase the risk of cardiovascular disease (CVD) in patients with type 2 diabetes mellitus (T2DM). This study was undertaken to understand the association of BP with risk of CVD mortality in patients with T2DM.

Method:
This was a cohort study on 83,721 patients with T2DM age 40 years or older using data from a multi-institutional diabetes registry in Singapore from 2013 to 2019. The relationships between BP and CVD mortality were analyzed using Cox multivariable regression model, adjusting for covariates including gender, use of anti-hypertensive medications and presence of co-existing CVD.

Results:
Overall, the mean age was 65.3 years with 50.6% women, 78.9% on antihypertensive medications, 21.3% with pre-existing CVD and 7.6 per 1000 person-years experienced the outcome over 7 years. Compared to SBP 120-129 mm Hg, the risk of CVD mortality was higher in SBP 140 mm Hg in patients with and without pre-existing CVD, the elderly and non-elderly. The hazard ratios (HR) were 1.27 (95% CI: 1.12-1.45), 1.87 (1.65-2.12), 1.49 (1.35-1.64) and 1.87 (1.55-2.25), respectively. Using DBP 70-79 mm Hg as reference, DBP < 70 mm Hg was also associated with higher risk of CVD mortality in all patient groups, with corresponding HR 1.25 (1.12-1.39), 1.23 (1.11-1.36), 1.19 (1.10-1.29) and 1.54 (1.32-1.80), respectively. DBP 90 mm Hg was also associated with higher risk of CVD mortality in the elderly and those without pre-existing CVD.

Conclusion:
In patients with T2DM, higher SBP is associated with raised CVD mortality risk. Elevated DBP is independently associated with higher risk of CVD mortality albeit only in those without pre-existing CVD and the elderly. DBP < 70 mm Hg is also associated with risk of CVD outcome although reverse causality cannot be ruled out.
Abstract 15027: Predicting Recurrence of Myocardial Infarction in Post-PCI Patients Using Machine Learning
Authors: Okada Kozo , Kusu Kohtaroh , Kikuchi Shinnosuke , Etou Hijiri , Sugano Teruyasu , Seki Yusuke , Hibi Kiyoshi
Published: December 2023

Introduction:
While prevention of recurrent myocardial infarction (MI) is important in the management of patients after percutaneous coronary intervention (PCI), risk stratification of MI remains a significant challenge with increasingly diverse and complex patient backgrounds. This retrospective observational study aimed to explore whether machine learning (ML) methods can predict recurrent MI after PCI using a variety of features extracted from electronic medical records (EMRs).

Methods:
Seven machine learning algorithms were retrospectively applied to predict recurrent MI within two years after PCI (124 cases, 4.2%) from a total of 2984 PCI cases. The imbalance in the proportion of positive and negative data was resolved by introducing misclassification costs. Basic patient information (e.g., age, sex, risk factors) and laboratory test results were used for the analysis. Feature importance was calculated to identify key factors for MI recurrence. Five-fold cross-validation was used to calculate accuracy, sensitivity, specificity, positive predictive value, and negative predictive value (NPV) for each model.

Results:
As shown in Figure 1a, several ML models showed excellent diagnostic accuracies in the prediction of recurrent MI, demonstrating high NPV. Although the weighting of feature importance for MI recurrence varied among ML models, infarct size (peak CK levels), increased inflammatory status, acute coronary syndrome, and traditional coronary risk factors were identified as important features for predicting recurrent MI within two years after PCI (Figure 1b).

Conclusions:
It is suggested that ML using EMR data is promising for predicting recurrent MI within two years after PCI. Further studies are warranted to address whether ML-based risk stratification could lead to improved clinical decision-making after PCI.
Abstract 15033: Development of an Interpretable Machine Learning Model for Predicting Individual Response to Antihypertensive Treatments
Authors: Yi Jiayi , Wang Lili , Liu Yanchen , Liu Jiamin , Zhang Haibo , Zheng Xin
Published: December 2023

Introduction:
Accurate prediction of individual response to anti-hypertensive treatment is crucial in enhancing the safety and efficiency of offering appropriate regimens to attain desired blood pressure (BP) goals.

Hypothesis:
Machine learning (ML) based models could accurately predict the BP reduction of different antihypertensive regimens.

Methods:
We utilized data from the LIGHT study, a pragmatic, cluster-randomized trial conducted in 94 primary care institutions in China, involving 13146 visits of 5192 patients who were required to attend the clinic for hypertension management every 3 months during an overall study period of 1 year. Clinical and laboratory variables, baseline BP, and anti-hypertensive therapies at baseline and at follow-up were used to develop models for predicting post-treatment individual BP response. Five ML algorithms were applied as candidate models, and mean squared error (MSE) was used to evaluate the model performance (
panel A
).

Results:
The mean (standard deviation) age of the study population at baseline was 64.2 (14.0) years, and 2207 (42.5%) were female. 29 features selected by the least absolute shrinkage and selection operator method and purposeful selection were used to build the model, including age, sex, weight, waist circumference, BMI, baseline systolic and diastolic BP, smoking status, visit interval, history of coronary heart disease, diabetes, and dyslipidemia, and baseline and prescript antihypertensive drugs. Among all candidate models, the Catboost model had the best performance with a training MSE of 149.6 and a validation MSE of 135.2 (
panel
B
). The most important features include baseline BP, age, weight, and BMI (
panel
C and D
).

Conclusions:
We developed an ML-based model for predicting the response to antihypertensive regimens for assisting clinicians to achieve individualized antihypertensive treatment effectively and safely.
Abstract 15034: Characteristics of Sudden Cardiac Death According to BMI Group: The FinGesture Study
Authors: Mantyniemi Lassi , Pakanen Lasse , Holmstrom Lauri , Tikkanen Jani T , Vahatalo Juha , Eskuri Anette , Perkiomaki Juha , Huikuri Heikki , Junttila Juhani
Published: December 2023

Background:
The prevalence of obesity has increased significantly in Western Societies. Obesity increases the risk of sudden cardiac death (SCD), but the etiology and mechanisms of obesity-related SCD are unclear.

Hypothesis:
We hypothesized that obesity is associated with specific SCD characteristics which may explain the increased risk of SCD in obesity.

Aims:
We aimed to investigate the characteristics of SCD according to the BMI group.

Methods:
This study is derived from the FinGesture study, which has prospectively collected all out-of-hospital SCD cases from Northern Finland since 1998 (population ~700,000). As required by Finnish law, all sudden deaths undergo medicolegal autopsy, and the Fingesture study has included all sudden deaths from Northern Finland with autopsy-verified cardiac etiology (i.e., SCD). The determination of the cause of death was based on a combination of autopsy findings, medical records, and police and emergency medical service reports.

Results:
The study population consisted of a total of 5,869 autopsy-verified SCD victims. Mean age was 64.9±12.4 and 78.9 % were male. The mean age decreased along with increasing BMI class (Table) (p < 0.001). The proportion of non-ischemic cardiac disease (p < 0.001, Figure) and the mean heart weight at autopsy (p < 0,001, Table) increased along with increasing BMI.

Conclusions:
Obesity-related SCD is associated with younger age and a higher proportion of non-ischemic cardiac disease with hypertrophy. These results suggest that early development of non-ischemic cardiac disease may contribute to obesity-related SCD.
Abstract 15054: Impact of Sarcoidosis-Related Admission in Patients With Heart Failure: A Nationwide Readmissions Database Analysis (2017-2020)
Authors: Ang Qi Xuan , Tan Min Choon , Tan Jia Yi , Tan Jian Liang
Published: December 2023

Background:
Sarcoidosis is an infiltrative systemic disorder that commonly involves the heart. Despite a higher prevalence of herat failure (HF) among patients with cardiac sarcoidosis (CS), data on these patients’ outcomes remain scarce.

Objective:
This study aimed to assess the impact of concomitant CS in patients admitted for HF on in-hospital outcomes and 30-day readmission rates.

Methods:
Using the all-payer, nationally representative Nationwide Readmissions Database, our study included patients aged 18 years or older who were admitted with a primary diagnosis of HF between 2017 and 2020. We stratified the cohort into two groups depending on the presence of sarcoidosis diagnosis. The in-hospital outcomes of both groups were assessed with weighted propensity score matching and multivariable analyses.

Results:
Our analysis included 1,902,068 patients with a primary diagnosis of HF, whereby 9,343 (0.49%) patients had sarcoidosis. Via multivariable analysis, sarcoidosis was associated with an increased risk of prolonged hospital stays (aOR: 1.15 [95% CI: 1.08 - 1.23], p<0.01), 30-day readmission (aOR: 1.18 [95% CI: 1.11 - 1.25], p=0.01), and higher cumulative cost of hospitalization ($16,179 vs $13,421, p<0.01) among HF cohort. Sarcoidosis was not associated with an increased risk of early mortality. Among HF patients with sarcoidosis, the most common cause of 30-day readmission was cardiovascular causes (59%), where decompensated HF accounted for 50% of the readmission, followed by ischemic heart disease (2%), valvular heart disease (1%), and pulmonary embolism (1%).

Conclusion:
In conclusion, our study suggests that HF patients with sarcoidosis had poorer in-hospital outcomes with prolonged hospital stays, higher 30-day readmission rates, and increased cumulative hospitalization costs. These findings merit increased effort in the early diagnosis and treatment of CS to improve outcomes in HF patients with sarcoidosis.
Abstract 15069: Perceived Susceptibility to and Severity of Cardiovascular Disease is Associated With Intent to Change Behavior Among Women 25-55 Years Old
Authors: Rountree Lauren , Fukuoka Yoshimi , Sagae Kenji , Zhang Jingwen , Pike Nancy A , Brecht Mary-Lynn , Rezk-Hanna Mary , Devon Holli A
Published: December 2023

Background:
Risk factors for cardiovascular disease (CVD) among young and middle-aged women have increased while knowledge and awareness of CVD remain low. To reverse these trends, it is important to assess whether knowledge and awareness of CVD are associated with intent to change behavior.

Aims:
Describe the relationship between stage of behavior change and awareness, knowledge, and perceptions of CVD among women 25-55 years and identify the predictors of stage of behavior change.

Methods:
A cross-sectional, descriptive study of women ages 25-55 living in the United States without a self-reported CVD history was conducted. Participants were recruited through flyers and social media campaigns. Awareness was measured with the question, “What is the leading cause of death for women in the United States?” Knowledge, perceptions, and stage of behavior change were measured with the Heart Disease Fact Questionnaire, Health Beliefs Related to CVD, and the Precaution Adoption Process Model surveys, respectively. All data were collected online via REDCap.

Results:
A total of 149, primarily minority women, were included (mean=37.15±7.86 years). Over half (53.7%) of the sample had not decided to make changes in their behavior to reduce their likelihood of CVD. A binary logistic regression of stage of behavior change on awareness, knowledge, and perceptions of CVD showed that the perception subscales of susceptibility and severity were significantly associated with intent to change behavior (OR 1.247, p<0.001 and OR .809, p=.004 respectively). Awareness and knowledge of CVD were not associated with stage of behavior change. There were no significant sociodemographic and health condition predictors of stage of behavior change, although susceptibility and severity remained significant when controlling for these covariates (OR 1.242, p=.002 and OR=.801, p=.004, respectively).

Conclusions:
Young and middle-aged women who believed that they were susceptible to CVD and did not perceive CVD as a serious condition were more likely to report an intent to change their behavior to reduce their risk of CVD. These may be key factors to leverage when educating young and middle-aged women on heart disease in order to facilitate heart healthy behaviors.
Abstract 15082: Novel Imaging/Hemodynamic Based Right Ventricular Phenotypes in Patients With Pulmonary Hypertension
Authors: Janowski Alexandra M , Visovatti Scott H , Benza raymond , Vanderpool Rebecca
Published: December 2023

Introduction:
Right ventricular function and ventricular dynamics associate with outcomes in pulmonary hypertension (PH). Measures of RV strain describe ventricular mechanics but are not included in RV function assessments. This study aimed to develop novel RV imaging-hemodynamic phenotypes using unsupervised machine learning.

Methods:
Participants with cardiac magnetic resonance (CMR) and right heart catheterization data were identified from The Ohio State University CMR PH registry (n=81). RV areas were segmented from CMR 4-chamber images and used to determine RV free wall (RVFW) and septal strain. K-medoids clustering was used on imaging features, RV hemodynamics, and RV function (Figure A). Correlation analysis was used to reduce collinearity. Significance was measured with Kruskal Wallis and chi-squared tests. A p-value < 0.05 was considered significant.

Results:
Participants were assigned to three clusters and top contributors to cluster assignment were RVEF, RVFW strain, and Ea. RV phenotypes progress from mild/no RV dysfunction (Cluster 1) to severe RV dysfunction (Cluster 3) (Figure A). Cluster 1 had normal RV function with high RVEF and PA compliance, preserved LVEF, low RVSP, and low Eed. Compared to cluster 1, cluster 2 demonstrates more RV dysfunction with reduced RVEF, stroke volume, and PA compliance with an increase in RVSP but no change in Eed. In addition to more RV dysfunction (decreased RVEF and stroke volume), cluster 3 had increased RA pressure and Eed. In terms of RV strain, (Figure B), cluster 2 had less negative RVFW and septal strain compared to cluster 1. In cluster 3, RV septal strain is similar to cluster 2 but with decreased RVFW strain.

Conclusions:
Imaging and hemodynamic RV variables contribute to identification of novel RV-centric phenotypes and should be included in phenotyping efforts to better describe altered ventricular dynamics contributing to RV dysfunction in PH.
Abstract 15099: Sex Disparities in Patients With Cardiac Sarcoidosis Undergoing Implantable Cardioverter-Defibrillators Implantation in the United States
Authors: Ahmed Raheel , Ramphul Kamleshun , Hasan Ali , Farhan Muzammil , Hassan Azeem , Ahmad Hasan , Okafor Joseph , Carver Caleb , Durrani Taimurzeb , Jadoon Ayesha , Amanullah Khadija , Jamil Yumna , Bilal Maham , Ahmed Sajeel , Memon Rahat A , Sakthivel Hemamalini
Published: December 2023

Introduction:
In patients with cardiac sarcoidosis (CS), implantable cardioverter-defibrillators (ICDs) are utilized to avoid sudden cardiac death. We aimed to compare the sex disparities in CS patients undergoing ICD implantation.Hypothesis:Higher ICD implantation would be observed in male CS patients as compared to females.

Methods:
Males and females with CS receiving ICD were identified and compared from the 2016-2020 National Inpatient Sample (NIS) database whilst adjusting for confounders via logistic regression models.

Results:
Of the 760 cardiac sarcoidosis patients undergoing ICD implantation, 505 (66.4%) were males and 255 (33.6%) were females. Around 94.1% of all procedures (715 cases) were conducted in urban teaching centres. In comparison to females, males were younger (55.0 vs 56.9 years, p<0.01) with higher prevalence of diabetes (31.7% vs 21.6% p<0.01) and chronic kidney disease (CKD) (16.8% vs 7.8% p<0.01) and a lower occurrence of reported depression (5.0 vs 19.6 p<0.01). Atrial fibrillation (AF) (23.5% vs 11.9%, p<0.01), sick sinus syndrome (SSS) (7.8% vs 4.0%, p=0.024) and ventricular fibrillation (VF) (15.7% vs 9.9%, p=0.02) were more prevalent in female CS receiving ICD. The percentages of ICD use in those with a history of hypertension, smoking, obesity, lipid disorder, previous myocardial infarction, supraventricular tachycardia, ventricular tachycardia, 2nd degree AV block and complete AV block were similar for both male and female CS patients. Following ICD implantation, the mean length of stay and mean hospital charges were comparable between the two groups. Incidence of acute kidney injury (AKI) post-ICD was more common in males (23.8% vs 15.7%, p=0.01) (Table 1).

Conclusion:
AF, SSS and VF are more prevalent in female CS patients with ICD. However, ICD use in CS patients is generally more common in males who also have a greater prevalence of diabetes, CKD and post-ICD AKI.
Abstract 15111: The Combination of Vagal Nerve Stimulation and Intra-Aortic Balloon Pumping Rapidly Modulates Heart Rate and Cardiac Load While Maintaining Hemodynamics in a Dog Model of Acute Heart Failure
Authors: Morita Hidetaka , Kakuuchi Midori , Yokota Shohei , yuki yoshida , kei sato , Sakamoto Kazuo , Ishida Eiko , Tohyama Takeshi , Matsushita Hiroki , Todaka Koji , Saku Keita
Published: December 2023

Background:
In acute heart failure (AHF) condition, excessive tachycardia increases myocardial oxygen consumption (MVO
2
). Recently, we have developed an intravenous vagal nerve stimulation (iVNS) catheter which can stimulate right vagal nerve and induce HR reduction (Fig. 1). Since inappropriate bradycardia in AHF condition leads to hemodynamic instability, the use of intra-aortic balloon pumping (IABP) may serve as a beneficial adjunctive therapy for iVNS.

Methods:
We induced AHF by the direct ethanol injection (0.5-2 ml/kg) to myocardium. The specialized basket catheter was inserted through the right femoral vein and placed in the superior vena cava. The IABP with 20-cc balloon was inserted through left femoral artery. We also calculated MVO
2
by the product of coronary flow and the difference of oxygen saturation between coronary artery and coronary sinus. We compared HR, MVO
2
, and hemodynamics between baseline and 3-min after iVNS (n=11). In addition, we examined the impact of IABP on hemodynamics during iVNS in AHF condition (n=8).

Results:
The direct ethanol injection increased LAP (+3.6±7.2 mmHg) and decreased left ventricular ejection fraction (-28±9.8%). The iVNS (20Hz, 10-22 V) rapidly reduced HR (-13±6.9%, P<0.01) and MVO2 (-11±8.1%, P<0.05), while slightly decreased CO (-10±7.3%) and increased LAP (+2.0±3.5 mmHg) (Fig. 2). An adding of IABP during iVNS increased CO (1.2±0.24 vs. 1.3±0.30 l/min, P<0.05) and decreased LAP (14±8.6 vs. 13±8.2 mmHg, P<0.05) .

Conclusion:
The combination of iVNS and IABP shows clinical potential as a novel therapy for effectively modulating excessive cardiac load in cases of unstable hemodynamics.
Abstract 15128: Impact of Paternal and Maternal Obesity on Offspring Systolic and Diastolic Function, and Liver Steatosis Early in Life
Authors: Docarmo Jussara M , Hall John E , Dai Xuemei , Aitken Nikaela , Larson Kylie M , Wang Zhen , Omoto Ana C , Mouton Alan J , Li Xuan , Da Alexandre A
Published: December 2023

Introduction:
Obesity in women and men of reproductive age may lead to adverse cardiovascular and metabolic developmental programing in their offspring. For example, we observed signs of cardiac diastolic dysfunction in offspring from obese rats as early as 3 weeks of age. However, the contribution from paternal and maternal obesity to increased susceptibility for developing cardiac dysfunction in their offspring early in life is unknown.

Hypothesis:
We hypothesized that paternal and maternal obesity both play important roles in causing impaired cardiac function and metabolic disorders such as fatty liver in their offspring early in life.

Methods:
Livers from male newborn Sprague-Dawley rats born from obese fathers (fHFD-offs), obese mothers (mHFD-offs), or from both parents being obese (fmHFD-offs) were weighed and analyzed for fat content by oil red-O and ECHOMRI. Additionally, within 1-3 days after weaning, male offspring were submitted to cardiac catheterization for assessment of cardiac function. Age-matched offspring from lean rats (ND-Offs) were used as controls.

Results:
fmHFD-Offs and mHFD-offs groups were heavier compared to fHFD-offs and ND-offs groups (61±4 and 64±2 vs 57±2 and 48±2 g, respectively) at 1-3 days after weaning. Newborn rats with at least one obese parent had more liver fat infiltration compared to ND-offs controls. Compared to ND-offs, only offspring from obese mothers (mHFD-offs) exhibited reduced dP/dt
max
(8998±466 vs. 10560±807, 11869±1171, and 11611±436 mmHg/s for mHFD-offs vs fHFD-offs, fmHFD-offs and ND-offs, respectively); fmHFD-offs and mHFD-offs showed additional signs of impaired diastolic function as indicated by increased Tau values (5.7±0.2 and 5.6±0.3 vs. 4.7±0.2 and 5.0±0.1 ms for fmHDF-offs and mHFD-offs vs ND-offs and fHFD-offs, respectively).

Conclusions:
These results indicate that while increased liver steatosis develops independent of which parent is obese, the presence of maternal obesity appears to be more critical for male offspring to develop cardiac dysfunction early in life. Additional studies in adult and aged offspring are needed to test if the impact of paternal and maternal obesity on offspring cardiometabolic function gets stronger with aging.
Abstract 15158: Prognostic Impact of Right Ventricular-Pulmonary Arterial Coupling Ratio in Patients Undergoing Transcatheter Aortic Valve Replacement
Authors: Kanzaki Hideaki , Irie Yuki , Amaki Makoto , Takagi Kensuke , Kawamoto Naonori , Fukushima Satsuki , Kitai Takeshi , Izumi Chisato
Published: December 2023

Introduction:
Right ventricular (RV) dysfunction is known as an important prognostic factor in heart failure. As reduced RV systolic reserve, RV contractility no longer increases against afterload, resulting in lower ratios of RV function to pulmonary artery (PA) pressure, known as RV-PA coupling ratios.

Hypothesis:
The assessment of RV-PA coupling ratios provides prognostic information for patients undergoing transcatheter aortic valve replacement (TAVR).

Methods and Results:
A total of 540 patients with TAVR (age, 84 ± 6 years; 186 men, 354 women) were included in this study. The RV-PA coupling ratio was calculated by dividing the tricuspid annular plane systolic excursion (TAPSE) by the PA systolic pressure (PASP) using transthoracic echocardiography before TAVR. Based on the median TAPSE/PASP (0.584 mm/mmHg), the patients were divided into two groups. Kaplan-Meier analysis demonstrated a higher incidence of adverse cardiac events (cardiac death and heart failure hospitalization) in the group with a low TAPSE/PASP ratio (log-rank test,
P
<0.001). In multivariate Cox regression analysis, TAPSE/PASP was identified as an independent prognostic parameter (adjusted hazard ratio, 0.259;
P
= 0.028), whereas neither TAPSE alone nor PASP alone demonstrated any significant prognostic value.

Conclusion:
The RV-PA coupling ratio serves as a prognostic predictor for adverse cardiac events in patients undergoing TAVR.
Abstract 15161: Prediction of Decompensated Heart Failure Using an Implanted Cardiac Device Risk Analysis
Authors: Ganapathy Archana , Li Brian , Langley Samantha , Clark Rebecca , Dimarco Anthony , Barbagallo Rossella , Dungu Jason , Savage Henry Oluwasefunmi
Published: December 2023

Introduction:
TriageHF is a Heart Failure Risk Status (HFRS) diagnostic tool available on Medtronic implantable cardiac devices which reports dynamic statuses of risk of Heart Failure related Hospitalization (HFH) within the next 30 day, as high, medium or low. We investigated the accuracy of TriageHF in predicting 30-day HFH for patients attending a tertiary heart failure clinic.

Methods:
We retrospectively recorded HFRS between November 2021 and May 2023, from patients implanted with Medtronic Cardiac Resynchronization Therapy (CRT) or Internal Cardioverter Defibrillator (ICD) devices. We then correlated HFRS with HHF within 30 days of these alerts. Two thresholds were tested: T1 where High & Medium HFRS were considered a positive alert and Low HFRS a negative alert and T2 where High HFRS was considered a positive alert and Medium & Low HFRS a negative alert. The sensitivity and specificity of each threshold in predicting 30-day HFH was tested in a contingency table.

Results:
Over 18-months, we recorded 135 consecutive alerts from 32 patients. Median age was 72 years, 25% were female and 56% had an ischaemic substrate. 36, 88 and 11 alerts were high, medium, and low risk respectively. 0% of low HFRS and 19% of the high HFRS resulted in a 30-day HHF. 10 high HFRS alerts led to clinical interventions which was associated with a higher rate of HHF, compared to 26 high HFRS alerts where no contact was made (HHF 40% vs 11% p=0.05). The sensitivity and specificity of TriageHF in predicting 30-day HFH was 46.7% and 76.03% respectively for T1 and 100% and 9.1% respectively for T2.

Conclusions:
This real-world analysis suggests that TriageHF risk prediction using T2 correctly predicted HHF at 30 days with the caveat of a high false positive rate. The potential exists for viable clinical use, however research into the amalgamation of clinical data may improve it and consequently lead to better utilisation of limited clinical resources.
Abstract 15181: Sensitivity and Specificity of the Artificial Intelligence-Based 5-Lead 3D Vectorcardiography in Patients With Suspected or Confirmed Coronary Heart Disease
Authors: Schmidt-Lucke Caroline , Lischke Betty , Weber Eugenia , Günther Daniel , Schomoeller Anne , Steen Henning , Schmidt-Lucke André
Published: December 2023

Introduction:
Artificial Intelligence-based 5-lead 3D-vectorcardiography (5L3DVCG-AI) offers additional information over 12-lead electrocardiography (ECG) identifying coronary vascular disease (CVD) in need for coronary intervention. Hypothesis: We tested the hypothesis of 5L3DVCG-AI being able to detect patients with mild to overt signs and / or history of CVD.

Methods:
In this monocentric retrospective study, consecutive data of 331 patients with 5L3DVCG-AI were included. The Perfusion (P)-Factor for cardiac ischaemic pathologies, based on the P-Index including 731 parameters and in-house features calculated in time and frequency domains (e.g. beat moments), classified patients as high, medium or low risk for CVD
.
Diagnosis of CVD was based upon current guidelines by 2 independent blinded cardiologists and categorised as exclusion of CVD (control), mild signs or overt CVD. The P-Index was validated against clinical CVD. Cardiovascular risk factors (CVRF) were quantified with modified PROCAM score.

Results:
Of 331 patients (m:w 60:40%, 50.0 ± 19.8 years) of mixed ethnicity and moderate CVRF (2.1 ± 1.2), 71% were controls, 20% had mild signs of CVD and 9% overt CVD. Follow-up period was 16.2 ± 7.5 months. CVRF was significantly higher in CVD compared to controls (2.7 ± 0.5 vs. 2.0 ± 1.2, p<0.05), and P-Factor correlated with number of CVRF (p<0.01), with significantly higher CVRF in higher P-factor (KW p<0.001). P-Factor indicated significantly more often higher risk in CVD compared to controls (0.78 ± 0.4 vs. 0.34 ± 0.48, p<0.01). P-Index from 5L3DVCG-AI at rest differentiated between CVD and controls (Chi2= 6.7, p=0.01). ROC curve showed correlation between P-Index and presence of CVD (R2=0.72, p<0.05). ECG at rest was not able to differentiate between CVD and controls.

Conclusions:
These data extend the previous findings of 5L3DVCG-AI identifying CVD with cardiac ischaemia from those without to now differentiating healthy controls from CVD and those with higher risk for CVD. 5L3DVCG-AI may thus be a further scalable screening method to identify patients at risk for CVD in need for risk modification or further diagnostic procedures. Ongoing prospective large-scale clinical trials will have to confirm these data to verify diagnostic accuracy.
Abstract 15184: Moderate-to-Vigorous Intensity Physical Activity and Incident Left-Sided Degenerative Valvular Heart Disease
Authors: Li ziang , Wu Yongjian
Published: December 2023

Hypothesis:
This study aimed to examine the impact of moderate-to-vigorous intensity physical activity (MVPA) on the prevention of left-sided degenerative valvular heart disease (VHD) among middle-aged adults.

Methods:
In the UK biobank study, data from wrist-worn accelerometer and physical activity questionnaires were utilized to assess the role of MVPA volume on the incidence of aortic valve stenosis (AS), aortic valve regurgitation (AR), and mitral valve regurgitation (MR). The primary cohort involved 90,865 participants ( median 8.1-year follow-up period) without prevalent VHD and heart failure, who wore accelerometers for one week. The validation cohort included 397,335 participants (median 13.8-year follow-up period) who completed physical activity questionnaires. MVPA volume was categorized according to the American Heart Association’s recommendation.

Results:
Accelerometer-measured MVPA showed a curvilinear relationship with reduced AS risk, with the risk reduction plateauing above 300 min/week. Compared to no MVPA, those engaging in 150-299 minutes of MVPA per week showed the most significant risk reduction [1-149 min/week: adjusted hazard ratio (HR), 0.79 (0.58, 1.08); 150-299 min/week: HR, 0.52 (0.36, 0.75); ≥300 min/week: HR, 0.57 (0.39, 0.83)]. Similar results were found when repeating the above analyses in self-reported MVPA cohort, with a relatively smaller reduction in HR ratio [150-299 min/week: HR, 0.81 (0.73, 0.91)]. No significant association was found between the MVPA volume and the risk of AR and MR in both cohorts.

Conclusions:
Meeting current MVPA recommendations (150-300 min/week) was associated with the lowest AS risk. Targeting adherence to accelerometer-measured MVPA thresholds may enhance AS risk reduction. Additionally, MVPA showed limited effectiveness in preventing valvular regurgitation, indicating distinct mechanisms between stenotic lesions and regurgitation lesions in degenerative VHD.
Abstract 15199: Pyridoxamine Limits Mitochondria-Dependent Ferroptosis in a Rat Model of Doxorubicin-Induced Cardiotoxicity
Authors: Haesen Sibren , Verghote Eline , Delaet Anouk , Wolfs Esther , Deluyker Dorien , Bito Virginie
Published: December 2023

Background:
The use of doxorubicin (DOX) chemotherapy is limited by cardiotoxicity characterized by mitochondrial iron accumulation and ferroptosis, both interesting targets for cardioprotection. We found that pyridoxamine (PM) protects against DOX cardiotoxicity in rats. In this study, we hypothesized that PM is cardioprotective by restoring iron regulation and limiting mitochondria-dependent ferroptosis.

Methods:
Female Sprague Dawley rats of six weeks old were divided into a DOX group (2 mg/kg/week, 8 weeks, IV, N=7) or control group (CTRL, saline, N=7). Others were treated with PM via drinking water (1 g/L) while receiving DOX or saline (DOX+PM, N=9 and CTRL+PM, N=8). Iron regulation, lipid peroxidation and mitochondrial damage in cardiac tissue were evaluated by qPCR, 4-hydroxynonenal (4-HNE) staining and transmission electron microscopy. Data were compared by 1-way ANOVA or Kruskal-Wallis test with posthoc tests. P values are presented with a mean difference (MD) and [95% CI] or mean rank difference (MRD).

Results:
DOX significantly increased ZIP14 (P=0.049 vs CTRL, 11.20 MRD) and mitoferrin-1 expression (P=0.0002 vs CTRL, 1.49 MD [0.71, 2.28]), indicating increased cytosolic and mitochondrial iron import. The DOX group showed features of ferroptosis including swollen mitochondria with disrupted cristae (Fig. 1), decreased mitochondrial density (P=0.085 vs CTRL, –0.12 MD [–0.24, 0.01]) and increased 4-HNE levels (P=0.029 vs CTRL, 6.90 MD [0.56, 13.24]). PM treatment significantly decreased ZIP14 (P=0.0055 vs DOX, –12.90 MRD) and mitoferrin-1 expression (P=0.0008 vs DOX, –1.17 MD, [–1.88, –0.46]), indicating restored iron regulation. PM also significantly increased mitochondrial density (P=0.0028 vs DOX, 0.22 MD [0.06, 0.37]) and limited mitochondrial damage (Fig. 1).

Conclusion:
In conclusion, we show that PM limits DOX-induced mitochondria-dependent ferroptosis, and could be a promising cardioprotective strategy for cancer patients.
Abstract 15200: Impact of Nocturnal Blood Pressure Fall on Long-Term Outcome for Recurrence of Atrial Fibrillation After Catheter Ablation
Authors: Watanabe Tomonori , Hoshide Satoshi , Hachiya Hitoshi , Watanabe Hiroaki , Okuyama Takafumi , Yokota Ayako , Kamioka Masashi , Komori Takahiro , Makimoto Hisaki , Kabutoya Tomoyuki , Imai Yasushi , Kario Kazuomi
Published: December 2023

Introduction:
Hypertension is known as a risk factor to progress the etiology of atrial fibrillation (AF). However, influence of non-dipper on AF recurrence after pulmonary vein isolation (PVI) remains unknown.

Methods:
We investigated the clinical impact of non-dipper evaluated by 24-hour ambulatory BP monitoring on the long-term outcome for AF recurrence in 76 AF patients underwent the PVI.

Results:
All of 76 patients (mean age:66±9 years, hypertension:78%, non-paroxysmal AF:24%) had procedural success of PVI. Twenty patients had AF recurrence during follow-up of median of 1158 days post-PVI. There was no difference in BP level between the AF recurrence and non-recurrence groups (average 24h-systolic BP:126±17 vs. 125±14mmHg, P=0.84). On the other hand, the patients with non-dipper had a higher AF recurrence than those with dipper (38.9% vs. 15.0%, P=0.018). In Cox hazard analysis adjusted by age, non-paroxysmal AF, and average 24h-systolic BP level, the non-dipper was an independent predictor of AF recurrence (HR 2.78 [95%CI: 1.05-7.34], P=0.039). The patients with non-dipper had a larger left atrial (LA) volume index than those with dipper (45.9±17.3 vs. 38.3±10.2ml, P=0.037). In 58 patients underwent the high-density voltage mapping in LA, 11 patients had low voltage area (LVA) defined as an area with a bipolar voltage < 0.5mV. There was no difference in existence of LVA between patients with non-dipper and those with dipper (22.2% vs. 16.1%, P=0.555).

Conclusions:
Non-dipper is an independent predictor of AF recurrence after PVI. Management for abnormal diurnal BP variation may be important in patients after PVI.
Abstract 15219: High-Sensitivity Cardiac Troponins and Sex-Differences in Prognostic Value for Cardiovascular Events and All-Cause Mortality
Authors: Saeed Nasir , Langoergen Joerund , Steiro Ole-Thomas , Tjora Hilde L , Bjorneklett Rune , Skadberg Oyvind , Bonarjee Vernon V , Mjelva Øistein , Norekval Tone M , Vikenes Kjell , Omland Torbjorn , Aakre Kristin Moberg M
Published: December 2023

Background:
Cardiac troponin (cTn) concentrations and the associated long-term cardiovascular risk differ between women and men in the general population.

Research question:
In patients with acute chest pain, does the prognostic value of cTn differ between sexes as assessed by different cTn assays?

Methods:
This prospective cohort study included 1500 patients (906 men and 594 women) admitted with suspected NSTE-ACS. Admission cTn was measured with three different high-sensitivity assays: hs-cTnT (Roche), hs-cTnI (Siemens) and hs-cTnI (Abbott). Patients were followed for a median of 1687 (range 4-2208) days. The primary endpoint was a composite of all-cause mortality, myocardial infarction, revascularization and heart failure. The secondary endpoint was all-cause mortality. Discriminatory performance was calculated by the receiver-operating characteristics area under the curve (ROC-AUC) whilst prognostic value was calculated by hazard ratios (HR) in unadjusted and adjusted Cox proportional hazard models.

Results:
The primary endpoint occurred in 18.1% of men and 15.0% of women. The secondary endpoint occurred in 10.3% of men and 8.9% of women. Women were older than men (median 65 years vs. 59 years, P<0.001), and had higher cTn concentrations (P<0.001 for all assays). All cTn assays had significantly higher discriminatory value in women compared to men for both endpoints (Table 1). Ln-transformed cTn for all assays were associated with increased risk of the primary endpoint and all-cause mortality in both sexes. Unadjusted HRs were higher in women than men with increasing hs-cTn, while in multivariate Cox model the adjusted HRs exhibited similar values between sexes (both endpoints) with no interaction between sex (P>0.05 for all) (Table 1).

Conclusions:
In patients with suspected with NSTE-ACS, there is a difference in the discriminatory value of hs-cTn, but no clear trend between sexes regarding its prognostic in adjusting for a range of factors, including age.
Abstract 15227: Venous Thromboembolism and Effects of Statin and Hormone Therapy: A Case-Control Study of 250,000 Women Aged 50-64
Authors: Davis John W , weller susan C , Porterfield Laura , Chen Lu , Wilkinson Gregg
Published: December 2023

Background:
Post-menopausal hormone therapy (HT) may elevate the risk of venous thromboembolism (VTE), while statin therapy may lower risk.
Purpose.
To estimate VTE risk from HT exposure with/without statin therapy in women 50-64 years of age.

Methods:
This was a case-control study in a large database of commercially insured subjects. We matched cases of VTE diagnoses (1:10) to controls without VTE on age, +/- 2 years. Conditional logistic regression estimated odds ratios (ORs) for recent HT exposure (any estrogen and/or progestogen within 60 days) and current statin therapy (
>
90 days continuous exposure) controlling for VTE risk factors, comorbidities, and coronary artery disease. We assessed risk by current exposure to a statin of any intensity (Model 1) and then by increasing intensity (Model 2).

Results:
In a comparison of cases (n=20,359) and matched controls (n=203,590), 9% (n=19,558) had recent HT exposure and 16% (n=36,238) had current/continuous statin exposure. After adjustment for all covariates, the OR for any recent HT exposure (regardless of statin exposure) was 1.51 (95% CI: 1.43, 1.60) compared to no HT exposure. The OR for current statin therapy (regardless of HT exposure) was 0.88 (95% CI: 0.84, 0.93). For those with HT exposure without statin therapy the OR was 1.53 (95% CI: 1.44, 1.63), for those with HT exposure with statin therapy the OR was 1.25 (95% CI: 1.10, 1.43), and for those exposed to statin therapy without HT exposure the OR was 0.89 (95% CI: 0.85, 0.94), compared those not exposed to either statin or HT. HT with statin therapy had a 18% significantly lower odds ratio than HT without statin therapy (OR=0.82, 95% CI: 0.71, 0.94). Exposure to high intensity statin therapy trended towards greater risk reduction for VTE compared to low/moderate exposure.

Conclusion:
Statin therapy may reduce VTE risk associated with HT.
Abstract 15233: Stem Cell Therapy for the Treatment of Chronic Ischemic Heart Disease: A Review
Authors: Carbone Roberto G G , Negrini Simone , Murdaca Giuseppe , Puppo Francesco
Published: December 2023

Introduction:
Chronic ischemic heart disease remains a major cause of morbidity and mortality. Several clinical trials have been performed to evaluate benefit of stem cells transplantation to restore cardiac function.

Aim:
The review reports potential benefit of stem cells therapy in chronic ischemic heart disease.

Methods:
Trials were selected applying as search terms “bone marrow cells”, “stem cells”, “mesenchymal cells”, and “chronic ischemic heart disease” in www.pubmed.gov and Cochrane library from 2005 to 2023. Studies were included if they were randomized blinded trials, randomized unblinded trials, non-randomized trials. Left ventricular ejection fraction (LVEF) increase and New York Heart Association (NYHA) class decrease were the outcome parameters at 6 and 12 months follow up.

Results:
We analyzed 20 trials including 1812 patients (939 treated, 789 males, mean age 62 years). Bone marrow (BMC), peripheral blood (PBC), cardiac (CDC) or mesenchymal (MES) stem cells were utilized in 8, 5, 7 trials, respectively. Total number of transplanted cells ranged from 5 x 10
6
to 1,300 x 10
6
(median 70 x 10
6
) depending on cell type, cell population purification, and transplantation route. Transplant procedure was intracoronary in 9 trials and intramyocardial in 11 trials. At baseline mean LVEF was 33.5 % (range 27.1 - 46.0 %). Eleven trials reported a statistically significant percent LVEF increase between 4% to 19% (mean 9.6%) at 12 months after stem cells transplantation (
p
values ranging from 0.05 to 0.001). BMC and PBC stem cells were utilized in all these studies. A significant correlation was found between number of transplanted cells and percent LVEF increase (Pearson correlation coefficient 0.74,
p
= 0.01).

Conclusions:
Results seem to favor a moderate positive effect of stem cells transplantation in chronic ischemic heart disease at 12 months follow up. The positive effect was correlated with the number of transplanted cells. However, caution should be exercised in the evaluation of clinical trials due to the different stem cells utilized, transplant protocols and endpoints.