bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 11811: Cardiac Biomarkers Differentiate Kawasaki Disease From Multisystem Inflammatory Syndrome in Children Associated With Covid-19
Authors: Raghuveer Geetha , Sundraram Balasubramanian , Dahdah Nagib , Martin Garrido Luis , Selamet Tierney Elif Seda S , Harris Tyler , Khoury Michael , Hicar Mark , Braunlin Elizabeth A , Thacker Deepika , Khare Manaswitha , Dallaire Frederic , Lowndes Robert W , Glassmeyer Isabel , Ballweg Jean , Larios Goldenberg Guillermo , Merves Shae , Manlhiot Cedric , Farid Pedrom , McCrindle Brian W
Published: June 2023

Introduction:
Kawasaki disease (KD) and Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19 show considerable clinical overlap making differentiation challenging.

Hypothesis:
Cardiac biomarkers can differentiate KD from MIS-C.

Methods:
The International KD Registry enrolled 2566 contemporaneous KD, MIS-C and acute COVID-19 pediatric patients from 39 sites in 8 countries from January 2020 through January 2022. The study population included MIS-C patients meeting CDC criteria with confirmed or probable COVID-19 infection, and KD patients meeting AHA guideline criteria without COVID-19 infection. Included patients had to have at least one measurement of NTproBNP or troponin I. KD and MIS-C patients were compared, to assess factors associated with cardiac biomarkers and cardiac outcomes. Receiver operating characteristic curves were used to determine cut points differentiating KD from MIS-C.

Results:
Of 779 patients with KD, 168 had NTproBNP (median 381 ng/L) and 173 had troponin I (median <10 ug/L) assessed at presentation, while of 1207 patients with MIS-C, 427 had NTproBNP (median 1850 ng/L; p<0.001 vs KD) and 522 had troponin I (median 12.7 ug/L; p<0.001) assessed. Baseline NTproBNP and troponin were correlated mildly (r=0.09; p=0.05) and were associated with older age and higher creatinine levels. Lower LV ejection fraction (LVEF) was associated with MIS-C (vs KD), but not with baseline or peak troponin levels after adjusting for age and creatinine levels. Lower LVEF was significantly associated with higher baseline and peak NTproBNP levels after adjusting for diagnosis and age. Higher peak coronary artery Z score was associated with KD vs MIS-C, but neither cardiac biomarker. Baseline troponin I >10 ug/L predicted MIS-C vs KD with a sensitivity of 57% and specificity of 74% (c-statistic 0.61), and baseline NTproBNP >1600 ng/L with a sensitivity of 54% and specificity of 75% (c-statistic 0.69).

Conclusions:
Higher baseline troponin I and NTproBNP levels are more predictive of MIS-C compared to KD. Lower LVEF, more common with MIS-C, was associated with higher NTproBNP but not troponin I levels, and coronary artery involvement, more common in KD, was not associated with either cardiac biomarker.
Abstract 11819: Self-Care Adherence and Related Factors in Koreans With Heart Failure
Authors: Jeong Yujin , Yu Heajin , Hwang Boyoung
Published: June 2023

Introduction:
Self-care is pivotal in managing heart failure (HF). However, patients’ adherence to self-care and associated factors are not fully understood in Koreans with HF. The aim of this secondary analysis was to assess the level of adherence to self-care and to identify associated factors in patients with HF.

Methods:
We analyzed baseline data from 122 HF patients (mean age 66.22 [SD 13.58] years; 50.8% female) enrolled in a randomized controlled trial. To determine adherence to self-care behaviors, the proportion of patients answering “completely agree” or “agree” to each item in the European self-care behavior scale (EHFScBS) was calculated. Based on the situation-specific theory of HF self-care, we investigated the effects of person-related factors (i.e., age, sex, socioeconomic status, health literacy, and self-efficacy), problem factors (i.e., multimorbidity, physical functioning, and depression), environmental factor (i.e., social support), and knowledge on adequate self-care (EHFScBS score ≥ 70) using logistic regression analyses.

Results:
The mean EHFScBS score was 58.29 (SD 19.23), and 34 patients (27.9%) reported adequate self-care. The adherence rate was lowest for fluid restriction (25.4%) and low salt diet (36.1%). Self-care confidence, depressive symptoms, and social support were significantly associated with adequate self-care in univariate analyses (Table 1). After adjusting for other factors, higher levels of self-care confidence (adjusted odds ratio 1.03,
p
=.004) and lower levels of depressive symptoms (adjusted odds ratio 0.89,
p
=.03) were significant factors for adequate self-care.

Conclusions:
Efforts are needed to help patients with HF to engage in self-care practice. Self-care interventions should focus on promoting self-care confidence and reducing depressive symptoms in patients with HF. Routine assessment of self-care confidence and depressive symptoms may help clinicians to identify high-risk patients.
Abstract 11832: Impact of Social Determinants of Health on Sacubitril-Valsartan Accessibility: A Single Center Retrospective Review
Authors: Tanveer Ud Din Mian , Bosah Arinze , Amoateng Richard , pappan nikos , Kalaitzidis Grigorios , Alpert Craig , Venkat Divya
Published: June 2023

Introduction:
Angiotensin receptor-neprilysin inhibitors (ARNI) like sacubitril-valsartan reduce morbidity and mortality in heart failure with reduced ejection fraction (HFrEF). However, its higher cost relative to other guideline-directed medical therapy(GDMT) may ultimately limit access for patients, especially those impacted by social determinants of health (SDOH).

Methods:
A retrospective review of all patients at Allegheny General Hospital with HFrEF taking sacubitril-valsartan between January 1, 2016 and January 1, 2022 was conducted. Logistic regression was used to study the impact of various SDOH (Income, Employment, Transportation, Insurance) on medication adherence.

Results:
Out of 201 patients who met the inclusion criteria, ARNI was discontinued in 47 (23.4%) patients. Common reasons for discontinuation included cost/insurance coverage in 10 patients (21.3%), hypotension in 18 patients (38.3%), hyperkalemia (4.3%) and worsening renal function (10.6%). Lower income (OR:0.75 [95% CI 0.58 to 0.98] p = 0.03) and greater distance from clinic (OR:1.25 [95% CI 1.03 to 1.51] p = 0.02) was associated with higher odds of discontinuing ARNI. Discontinuation was observed more frequently in retired patients (55.3% vs 43.5%) compared to those actively employed. Compared to those with Medicare, Medicaid or no insurance, ARNI was continued more frequently in patients with private insurance.

Conclusions:
Patients with HFrEF live longer when treated with appropriate GDMT. However, given costs associated with novel agents, clinicians must acknowledge that SDOH substantially impact a patient’s ability to fill such expensive prescriptions regularly.
Abstract 11834: Ability of Machine Learning Algorithms to Predict Chronic Kidney Disease Using Health Examination Data From the Japanese General Population
Authors: Kawasoe Shin , Kubozono Takuro , SALIM ANWAR , Ojima Satoko , Kawabata Takeko , Ikeda Yoshiyuki , Miyahara Hironori , Koichi Tokushige , Ohishi Mitsuru
Published: June 2023

Introduction:
There is a large amount of specific health examination data in Japan. Efforts to utilize these data to predict the future onset of cardiovascular diseases are important from the perspective of improving prognosis and QOL as well as medical economy. We evaluated the prediction ability of machine learning algorithms for newly developed 5-year chronic kidney disease (CKD).

Methods:
Among those who underwent examinations from 2008 to 2018, individuals whose baseline (year X), 1 year later (year X+1), and 5 years later (year X+5) data were available were included. CKD was defined as estimated glomerular filtration rate (eGFR) <60mL/min/1.73m2. Those with CKD in year X or X+1 were excluded. Three different machine learning algorithms, Random Forrest (RF), Logistic Regression (LR), and Multilayer Perceptron (MLP) to predict CKD on year X+5 from single-year data (year X) or consecutive 2 years data (year X and X+1) were assessed, and the predictive ability was compared. Anthropometric measurements, blood pressure and pulse rate, laboratory measurements, and lifestyle related indices were included as explanatory variables.

Results:
A total of 43,084 participants (age 53.7±10.1 years, male 49.9%) were included and 2,928 individuals (6.8%) had CKD in year X+5. The indices of predictive ability from single-year data were as follows: RF, AUC 0.88, accuracy 0.93, recall 0.99, precision 0.93; LR, AUC 0.89, accuracy 0.93, recall 0.99, precision 0.94; MLP, AUC 0.89, accuracy 0.93, recall 0.99, precision 0.93. Those from multi-year data were as follows: RF, AUC 0.93, accuracy 0.95, recall 0.99, precision 0.95; LR, AUC 0.90, accuracy 0.97, recall 0.99, precision 0.97; MLP, AUC 0.89, accuracy 0.97, recall 0.99, precision 0.97. The variables with the highest importance features were serum creatinine (0.41), age (0.13), medication for hypertension (0.04), and systolic blood pressure (0.03).

Conclusions:
The ability to predict new onset of CKD was better when using data from two consecutive years than when using data from a single year. The AUCs ranged from 0.89 to 0.93 and were generally better than previously reported risk models using statistical methods. Serum creatinine levels, along with age and blood pressure have been identified as major contributors.
Abstract 11840: A Meta-Analysis of the Long-Term Outcomes of Acute Myocardial Infarction in Preexisting Coronary Artery Ectasia
Authors: Eid Mohamed , Mostafa Mostafa R , Al-Abdouh Ahmad , Mubasher Mahmood , Mohamed Sarah , Mamas Mamas
Published: June 2023

Introduction:
Coronary artery ectasia is associated with an increased risk of acute myocardial infarction.

Hypothesis:
This meta-analysis evaluates outcomes following acute myocardial infarction in patients with preexisting coronary artery ectasia.

Methods:
This meta-analysis was conducted according to PRISMA guidelines. A search strategy was designed to utilize PubMed/Medline, EMBASE, and Google scholar for studies showing the outcomes of acute myocardial infarction in patients with coronary artery ectasia from inception to February 10, 2022. We reported effect sizes as odds ratio (OR) with a 95% confidence interval (CI). We used
I
2 statistics to estimate the extent of unexplained statistical heterogeneity:
I
2 greater than 50% was considered a high degree of between-study statistical heterogeneity.

Results:
Of 217 studies initially identified, 7 studies comprising 13499 patients were included in the final analysis. There was no significant difference between patients with coronary ectasia and patients without coronary ectasia in terms of all-cause mortality (OR 0.95; 95% CI 0.58 to 1.56; p = 0.79;

I
2

=0%) , MACE (OR 4.04; 95% CI 0.34 to 47.57; p = 0.17;

I
2

=95%), myocardial reinfarction (OR 2.13; 95% CI 0.83 to 5.47; p = 0.08;

I
2

=59%), target vessel revascularization (OR 1.31; 95% CI 0.69 to 2.48; p = 0.21;

I
2

=0%), or requiring mechanical supportive devices (OR 1.32; 95% CI 0.22 to 7.83; p = 0.57;

I
2

=56%). (Figures 2-A, B, C, D)

Conclusions:
Acute myocardial infarction in the presence of coronary artery ectasia is not linked to an increased risk of death, major cardiovascular events, myocardial infarction, or the need for mechanical circulatory support.
Abstract 11850: Association Between SGLT2 Inhibitor Use and Risk of Clinical Events in Patients With Antineoplastic Therapy Associated Cardiomyopathy and Heart Failure
Authors: Avula Vennela , Sharma Garima , Kosiborod Mikhail N , Vaduganathan Muthiah , Neilan Tomas G , Lopez-Fernandez Teresa , Dent Susan F , Baldassarre Lauren A , Scherrer-Crosbie Marielle , Scherrer-crosbie Marielle , Barac Ana , Liu Jennifer , Deswal Anita M , Yang Eric H , Ky Bonnie , Lenihan Daniel , Lenihan Daniel , Nohria Anju , Nohria Anju , Dani Sourbha , Ganatra Sarju
Published: June 2023

Background:
Antineoplastic therapies can be cardiotoxic and increase the risk of cardiomyopathy and heart failure (HF). SGLT2i are shown to be efficaceous in patients across the spectrums of HF regardless of ejection fraction and presence of type 2 diabetes. However, the impact of these agents on outcomes in patients with antineoplastic therapy associated cardiomyopathy and HF has not been well established.

Methods:
A retrospective cohort analysis was performed on de-identified, aggregate patient data from the TriNetX research network. Patients ≥18 years of age with a history of exposure to potentially cardiotoxic antineoplastic therapy between Jan 1, 2013 and Apr 30, 2020 who subsequently developed cardiomyopathy or HF and treated with guideline directed medical therapy (GDMT) were identified. Patients with ischemic heart disease were excluded. Patients were divided into two groups based on SGLT2i use. Propensity score matching was performed to match the baseline characteristics. Odds ratio and log-rank test were used to compare the outcomes over a 2-year follow-up period.

Results:
In well matched cohorts (640 patients in each cohort with antineoplastic therapy associated cardiomyopathy/HF; mean age 67.6 years, women 41.6%, White 68%), patients on SGLT2i in addition to conventional GDMT faced lower risk of acute HF exacerbation (85 vs 154, OR 0.48, 95% CI: 0.36 - 0.65, p<0.001) and all-cause mortality (73 vs 194, OR 0.30, 95% CI: 0.22 - 0.40, p=0.001). Secondary outcomes of all-cause hospitalization or ER visit (OR 0.479, 95% CI: 0.383-0.599, p<0.001), atrial fibrillation/flutter (OR 0.397, 95% CI: 0.213-0.737, p=0.003), acute kidney injury (OR 0.486, 95% CI: 0.382-0.619, p<0.001), and renal replacement therapy (OR 0.398, 95% CI: 0.189-0.839, p=0.012) were also less frequent in patients on SGLT2i.

Conclusions:
SGLT2i use is associated with lower risk of clinical events in patients with antineoplastic therapy associated cardiomyopathy or HF.
Abstract 11861: Reach Out Behavioral Intervention for Hypertension Initiated in the Emergency Department Connecting Multiple Health Systems: A Randomized Control Trial
Authors: Skolarus Lesli E , Dinh Mackenzie , Kidwell Kelley , Lin Chun Chieh , Buis Lorraine , Brown Devin , Oteng Rockefeller , Trimble Deborah E , Whitfield Candace , Farhan Zahera , Flood Adam , Borgialli Dominic , Montas Sacha , Meurer William J
Published: June 2023

Introduction:
Hypertension (HTN) is the most important modifiable risk factor for cardiovascular disease and disproportionally impacts Black and low-income people. The emergency department (ED) cares for medically underserved populations, many of whom have HTN. Mobile health (mHealth) strategies initiated in safety-net EDs may be one approach to control blood pressure (BP) in a medically underserved population.

Hypothesis:
A multicomponent, ED initiated multiphase optimization strategy would identify intervention components that reduce BP at 12 months.

Methods:
Reach Out is a health system focused, health theory based, mHealth 2x2x2 factorial behavioral trial to reduce BP among hypertensive patients evaluated in a safety-net ED. Intervention components included: 1) healthy behavior text messaging (yes vs. no), 2) prompted BP self-monitoring (SMBP) (weekly vs. daily), and 3) facilitated primary care provider (PCP) appointment scheduling and transportation (yes vs. no). The primary outcome was change in systolic BP (SBP) from baseline to 12 months. We fit linear regression models accounting for intervention components, age, sex, race and prior use of BP medications.

Results:
We randomized 488 participants to the intervention and 211 (43%) participants completed 12-month follow-up. The mean age was 45.5 years, 61% were women, 54% were Black people, 22% did not have a PCP, 10% were uninsured, 21% lacked transportation, 21% did not have a previous diagnosis of HTN and 51% were not taking BP medications. SBP declined in all 8 groups. Overall, across all groups, SBP declined (-9.2 mmHg, 95%CI, -12.2 to -6.3) after 6 months and (-6.6 mmHg, -9.3 to -3.8) after 12 months. In fully adjusted models, no intervention components were associated with a change in systolic BP at 12 months.

Conclusions:
Higher intensity of the intervention components were not associated with greater reduction in BP. Overall, participants receiving lower intensity levels of our intervention had reductions of BP that were clinically relevant. Future studies should focus on further tailoring intervention components to the needs of participants.
Abstract 11864: Incidence and Predictors of Left Atrial Thrombus in Patients With Atrial Fibrillation Under Standard Anticoagulation Therapy
Authors: Lee Joong Min , Cho Min Soo , Cha Myung-jin , Kim Jun , Gi-Byoung Nam , Choi Kee-joon
Published: June 2023

Background:
The left atrial thrombus (LAT) formation is associated with thromboembolic events in atrial fibrillation (AF) patients.

Objective:
We investigated the incidence and associated factors of LAT in patients with AF who already on standard anticoagulation therapy.

Methods:
Medical records of 1,122 AF patients (mean 59.4 ± 11.0 years old, 58.3% male) who were on standard anticoagulation and underwent transesophageal echocardiography (TEE) from 2009 to 2019 were evaluated. Baseline clinical and echocardiographic data were analyzed. The main outcome of the study was the presence of LAT on TEE. The associated factors of the LAT were analyzed.

Results:
Warfarin and non-vitamin K oral anticoagulants (NOAC) were used in 74.4% and 25.6% of the patients. Among these patients, LAT was found in 60 patients (5.3%). The significant predictors of the LAT on TEE were elders (>75 years old, Odd ratio [OR] 1.99 [95% confidence interval 0.88-4.24]), persistent/permanent AF (OR 2.63 [1.45-4.95]), high CHA2DS2-VASc score (≥3 points, OR 2.06 [1.15-3.74]), low left ventricular ejection fraction (<40%, OR 2.12 [0.97-4.33]), and moderate-severe left atrial enlargement (LAE) (OR 3.92 [1.95-8.59]). Moderate-severe mitral regurgitation (MR) was associated with lower odds for LAT (OR 0.146 [0.04-0.37]). We gave each variable a score according to its weight (-3 points for MR, 2 points for LAE, and 1 point for the rest). If our risk score is 3 or more, the rate of LAT increases to 8.7% or more.

Conclusions:
Several clinical and echocardiographic predictors were useful for predicting presence of LAT in AF patients who are already on anticoagulation treatment. Screening for LA thrombus before left atrial interventions such as cardioversion, ablation procedure, or appendage occluder, should be warranted in patients with high risk score.
Abstract 11879: Von Willebrand Factor Activity and Closure Time With Adenosine Diphosphate During Transcatheter Mitral Valve Repair
Authors: Hadjadj Sandra , Gravel Caroline , Marsit Ons , Rouabhia Dounia , Clavel Marie-Annick , Salaun Erwan , bernier mathieu , O'Connor Kim , Pibarot Philippe , Rodes-Cabau Josep , Paradis Jean-Michel , Beaudoin Jonathan
Published: June 2023

Introduction:
Residual mitral regurgitation (MR) is associated with worse outcomes after transcatheter edge to edge mitral valve repair (TEER) but is difficult to assess by echocardiography. Shear-stress induced by MR leads to altered Von Willebrand factor activity (vWF:Act), also reflected by increased closure time with adenosine diphosphate (CT-ADP), representing potential ways to screen for residual MR. CT-ADP can be assessed easily during TEER and is known to normalize swiftly after the correction of turbulent flow.

Hypothesis:
The improvement of CT-ADP is quick enough to allow real-time procedural guidance.

Methods:
We enrolled 39 patients undergoing TEER. MR severity was assessed by echocardiography during the procedure, 24-hours and 1-month post-TEER. CT-ADP was measured before TEER, 8 minutes after each clip deployment, 1 hour and 24 hours after the procedure. CT-ADP values were related with vWF:Act and MR severity at each time point.

Results:
Of 39 patients after TEER, 6 (15%) and 8 (21%) patients had residual MR ≥ moderate at 24-hours and 1-month respectively. There was no significant change in CT-ADP values during the procedure. The decrease of CT-ADP was however significant 1-hour post-TEER with stable values at 24-hours (last clip deployment: 136 [110-193]; 1 hour: 99 [82-131] and 24 hours: 95 [82-121] seconds, p<0.001). Concomitant increase in vWF:Act was observed after the procedure (baseline: 1.76 [1.29-2.05]; 1 hour: 1.84 [1.79-1.85] and 24 hours: 2.32 [1.84-2.5] IU/ml, p=0.002). Patients were stratified into 3 groups according to the residual MR grade at 1 month (≤ mild vs. moderate vs. >moderate). CT-ADP was not different among the groups (p=0.74). However, the difference in CT-ADP (1 month vs baseline values) was associated with MR improvement at the same time points (r=0.50; p=0.007).

Conclusions:
Although CT-ADP decreases after TEER and correlates with vWF:Act and MR improvement at 1 month, this decrease is first observed 1 hour after the procedure and does not seem to be quick enough to provide real-time monitoring of MR severity during TEER.
Abstract 11881: Association of Post-Vaccination Adverse Reactions After Influenza Vaccine With Mortality and Cardiopulmonary Outcomes in Patients With High-Risk Cardiovascular Disease: The INVESTED Trial
Authors: Peikert Alexander , Claggett Brian L , Kim KyungMann , Udell Jacob A , Joseph Jacob , Desai Akshay S , Farkouh Michael E , Hegde Sheila M , Hernandez Adrian F , Bhatt Deepak L , Gaziano Michael , Talbot H Keipp , Yancy Clyde W , Anand Inder S , Mao Lu , Cooper Lawton S , Solomon Scott D , Vardeny Orly
Published: June 2023

Introduction:
Influenza vaccination is associated with reduced cardiopulmonary morbidity and mortality among patients with heart failure or recent myocardial infarction. The immune response to vaccination frequently results in mild adverse reactions (AR), which leads to vaccine hesitancy. We assessed the association between vaccine-related AR and morbidity and mortality in patients with high-risk cardiovascular disease.

Methods:
The INVESTED trial randomized 5260 patients with recent acute myocardial infarction or heart failure hospitalization to high-dose trivalent or standard-dose quadrivalent inactivated influenza vaccine. We examined the association between vaccine-related AR and adverse clinical outcomes in propensity-adjusted models.

Results:
Overall, 1968 participants (37.4%) experienced a vaccine-related AR. Compared to those without AR, post-vaccination AR, most commonly injection site pain (60.3%), were associated with lower adjusted risk for the composite of all-cause death or cardiopulmonary hospitalization, cardiopulmonary hospitalizations, all-cause death, cardiovascular hospitalizations and non-cardiopulmonary hospitalizations (Figure 1; Table 1).

Conclusions:
Post-vaccination reactions after influenza vaccine were associated with reduced risk of cardiopulmonary hospitalizations and all-cause mortality in patients with high-risk cardiovascular disease in propensity adjusted models, and may be a marker of a better immune response or overall health status, and should not deter future vaccinations.
Abstract 11885: Optimal Timing and Prognostic Value of Follow-Up Cardiac Magnetic Resonance in Patients With Acute Myocarditis
Authors: Ciabatti Michele , Camporeale Antonia , Tavanti Valentina , Saletti Elisa , Felici Massimo , Martinese Lucia , Chioccioli Marco , Sabini Alessandra , Lombardi Massimo , Pieroni Maurizio , Bolognese Leonardo
Published: June 2023

Background:
cardiac magnetic resonance (CMR) is central for diagnosis, follow up and prognostic stratification of acute myocarditis. Late gadolinium enhancement (LGE) extent and persistence at follow-up represents a negative prognostic marker. However, time course of oedema resolution and LGE stabilization and optimal timing to repeat CMR are unclear.

Hypothesis:
we assessed time course of oedema and LGE evolution to identify optimal timing to repeat CMR in acute myocarditis.

Methods:
36 acute myocarditis patients (35M, 28,8±10,3 years) underwent CMR at clinical presentation (CMR-1), after 3 months (CMR-2) and after 12-months (CMR-3). We assessed oedema and LGE and measured left ventricular ejection fraction (LVEF) and indexed mass (iLVM). After CMR-3 all patients were followed up yearly with clinical evaluation, Holter ECG and echocardiography.

Results:
all patients had oedema and LGE at CMR-1. At CMR-2 significant reduction of oedema (T2 positive segments 0,4±0,9 vs 4,1±3,2 p<0.0001) and LGE (4,3±3,9 vs 7,5±5,6 p<0.0001) was observed compared to CMR-1, with improvement of LVEF (62,7±5,6 vs 58,5±12,2% p<0.05) and reduction of iLVM (71,2±13,7 vs 78,1±15,2 g/m2 p<0.0001). At CMR-3 no further LGE reduction nor LVEF and iLVM improvement were observed. At 60±23-months follow-up, no major cardiovascular events nor myocarditis recurrences occurred. At Holter ECG 8/36 patients (28%) had non-sustained ventricular tachycardias. Ventricular arrhythmias were associated with lower LVEF at CMR-1 (46.25±19.55 vs 62.00±6.02 p=0.001) and higher LGE at CMR-2 (10.19±8.01 vs 3.60±3.14 p=0.007) but not with LGE at CMR-1 (10.05±7.14 vs 6.80±4.65 p=0.13).

Conclusions:
most patients with acute myocarditis present oedema resolution and LGE stabilization after 3 months. LVEF at baseline and LGE extension at second CMR correlates with ventricular arrhythmias persistence. Our findings redefine follow up and imaging-based prognostic stratification of acute myocarditis.
Abstract 11910: Contemporary In-Hospital Outcomes of Bifurcation Percutaneous Coronary Interventions: Update From the Prospective Global Registry for the Study of Bifurcation Lesion Interventions (PROGRESS-BIFURCATION)
Authors: Simsek Bahadir , Kostantinis Spyridon , Karacsonyi Judit , Vemmou Evangelia , Nikolakopoulos Ilias , assali maen , Burke M Nicholas , Garcia Santiago , Wang Yale , Goessl Mario , Traverse Jay , Poulose Anil , Chavez Ivan , Sorajja Paul , Mooney Michael R , Mastrodemos Olga , Rangan Bavana V , Brilakis Emmanouil S
Published: June 2023

Introduction:
Bifurcation percutaneous coronary intervention (PCI) techniques are rapidly evolving and can be challenging to perform.

Methods:
We examined the angiographic, procedural characteristics, and outcomes of 472 bifurcation PCIs in Prospective Global Registry for the Study of Bifurcation Lesion Interventions (PROGRESS-BIFURCATION, NCT05100992).

Results:
A total of 472 bifurcation PCIs were included. Mean age was 67±12 years, 74% were men with a high prevalence of comorbidities: hypertension (81%), diabetes mellitus (36%), dyslipidemia (90%). Overall technical success was 95%. The incidence of in-hospital major adverse cardiovascular events (MACE) was 5.1%. The most common stenting strategy was provisional (71%), double-kissing (DK) crush (12%), mini-crush wish 2 stents (3%), culotte (3%), T-and protrusion (4%), and T-stenting (1.5%). Patients treated with the DK-crush had more severe stenosis of the left main (35%±38 vs. 19%±30, p<0.001), proximal left anterior descending (68%±29, vs. 52%±35, p=0.001), and side branch lesion (82%±15, 51%±36, p<0.001). Medina classification was more often 1,1,1 (79% vs. 39%, p<0.001), with higher use of intravascular ultrasound/optical coherence tomography (57% vs. 31%, p<0.001) compared to non-DK crush. The DK-crush required use of more contrast and took longer to perform (Table).

Conclusions:
Despite high patient comorbidity, bifurcation PCI can be performed with high technical success and low in-hospital MACE rates. DK-crush technique was more commonly preferred in bifurcation lesions with more severe/proximal vessel involvement.
Abstract 11924: Nicorandil Attenuates Ventricular Dysfunction in a Piglet Model of Cardiopulmonary Bypass and Cardioplegic Arrest
Authors: Peng Yunwen , Schneider Bailey , Johnson Matthew , Hayes McKenzie , Tchouta Lise , Toomasian John , Rojas-Pena Alvaro , Charpie John R
Published: June 2023

Introduction:
Nicorandil is a coronary vasodilator for treatment of ischemia-induced angina. Studies suggest nicorandil may offer myocardial protection against regional ischemia-reperfusion (IR) injury during coronary artery bypass grafting in adults. The impact of nicorandil on global IR-induced myocardial injury and left ventricular (LV) dysfunction after cardiopulmonary bypass (CPB) and cardioplegic arrest (CA) has not been investigated in children.

Hypothesis:
Nicorandil attenuates myocardial IR injury and LV dysfunction after CPB and CA in an immature animal model.

Methods:
Anesthetized piglets (4-5 weeks-old, 8.8±0.4 kg) were cannulated via the right atrium and ascending aorta for initiation of full-flow CPB (100 mL/kg/min). Following 30 mins of aortic cross-clamp (ACC) and CA, hearts were reperfused on full CPB for 60 mins, followed by partial CPB for 30 mins, and separation from CPB for 30 mins. Nicorandil (0.2 mg/kg IV bolus + 0.02 mg/kg/min IV continuous infusion) or saline (N=6 per group) was initiated 5 mins before ACC and continued throughout the protocol. Temperature, ECG, mean arterial pressure (MAP), and LV function (via high-fidelity Millar pressure catheter) were continuously recorded. Serial plasma samples were collected for measurement of oxidant stress, inflammation, and multi-organ injury (heart, lung, kidney, and brain).

Results:
Temperature, heart rate, and MAP were similar between nicorandil- and saline-treated groups. However, 120 mins after ACC removal, nicorandil treatment significantly improved LV contractility [LV +dP/dt: 2,962±678 mmHg/sec (nicorandil) vs. 1,278±332 mmHg/sec (saline), p=0.004] and LV relaxation [LV -dP/dt: -2,670±454 mmHg/sec (nicorandil) vs. -1,347±339 mmHg/s (saline), p=0.002]. Also, nicorandil significantly attenuated the IR-induced increase in circulating biomarkers for oxidant stress, inflammation, and multi-organ injury.

Conclusions:
In a piglet model of CPB with CA, nicorandil attenuates LV systolic and diastolic dysfunction and improves oxidant stress, inflammation, and multi-organ injury. These results suggest that nicorandil may prove beneficial to mitigate IR injury and accelerate LV functional recovery after open heart surgery in infants and children.
Abstract 11930: Ascension Health System Experience With Extended Ambulatory Electrocardiographic Monitoring: Implementation of a Novel Integrated Approach to Better Characterize Disparities in Healthcare
Authors: Pickett Robert A , Ellis Jeffrey T , Hytopoulos Evangelos , Crosson Lori , Khan Mohammed N , Heinzman Kristopher M
Published: June 2023

Introduction:
Atrial fibrillation (AF) is an established risk factor for stroke, hospitalization and mortality. Whether AF differs by race has not been well characterized in the real world setting due to inherent challenges in linking large datasets across multiple databases.

Methods:
Extended ambulatory electrocardiographic (AECG) monitoring with Zio XT allows for continuous recording of cardiac rhythm data for up to 14 days in indicated patients. A preliminary dataset from the Ascension Health System electronic health records (EHR) archive on patients prescribed the Zio XT patch was retrospectively analyzed. The study population consisted of 6,293 patients treated at 34 Ascension centers in 6 states between January 2020 and April 2022. Patient EHR data were linked to proprietary device-specific rhythm reports for analyses.

Results:
Among 6,293 patients in whom EHR data were matched to Zio XT findings, the median (IQR) age was 63 (47, 73) years, 3,816 (60.6%) were female, and 1,038 (16.5%) were non-Caucasian. Median device wear time was 7.2 (5.0, 13.9) days. AF was detected in 749 (11.9%) patients, including 326 (5.2%) with 100% AF. Median AF burden was 37.0% (3.4%, 100%). Older white males had the highest risk of AF events, whereas younger non-white females had the lowest risk (Figure 1). Non-white subgroups demonstrated greater freedom from AF compared to whites.

Conclusions:
In these preliminary findings, the use of Zio XT for extended AECG monitoring in the Ascension Health System is in predominantly older patients. Patients were racially and geographically diverse, and females were well represented. More than 10% of patients had AF detected during the monitoring period. Despite small sample sizes, differences in AF detection by subgroups demonstrate that a tailored approach to managing AF remains a critically important research question. Linkage of patient EHR data with device-specific outcomes can be a useful approach to address this important unmet need.
Abstract 11944: Surfactant Protein a Promotes Smooth Muscle Cell Phenotype Modulation Through Inhibiting the Myocardin-Smad3 Interaction
Authors: King Skylar D , Cai Dunpeng , Fraunfelder Mikayla M , Chen Shiyou
Published: June 2023

Vascular smooth muscle cell (SMC) transition from a differentiated to dedifferentiated phenotype and subsequent neointima formation/vascular remodeling plays a critical role in the development of a number of vascular diseases such as atherosclerosis, restenosis after angioplasty or bypass, diabetic vascular complications, arteriopathy transplants, asthma and cancer. However, mechanisms that regulate SMC phenotype modulation and neointima formation are not completely understood. We have found that Surfactant protein A (SPA), an innate immune system collectin that reduces membrane surface tension and protects lung function during exhalation, is critical for SMC phenotype and vascular modeling. SPA is induced during SMC phenotypic modulation and injury-induced vascular remodeling in both rat and mouse carotid arteries. Knockdown of SPA increased contractile protein expression while enhancing the expression of Myocardin and TGF-β1 in SMCs. Moreover, SMCs from SPA knockout mice had increased Smad3 phosphorylation which was blocked by TGF-β1 neutralizing antibody. To understand the contribution of SMC SPA to vascular remodeling, we generated SMC specific SPA-deficient (SPAsm
-/-
) mice with hypercholesteremia by injection of AAV-PCSK9. By using mouse carotid artery wire-injury model, we found that SPA deficiency in SMCs markedly inhibits neointimal formation and the Myocardin-Smad3 interaction in the injured artery. Our data demonstrated that SPA mediates proliferative/synthetic phenotype and neointimal hyperplasia by blocking Myocardin-Smad3 interaction.
Abstract 11966: ﻿Dlk1 Derived Adiposity Stimulates Lipids Retention in Aortic Valve
Authors: Bouchareb Rihab
Published: June 2023

Calcified aortic valve disease (CAVD) is the most prevalent valvular heart disease in western populations affecting nearly 2.5% of individuals over 65. Currently, there is no viable pharmacological treatment to stop the progression of the disease or to activate mineral regression. The only effective therapy to treat CAVD is surgical valve replacement or trans-catheterization. Obesity is the major common nutritional disorder worldwide and is one of the important risk factors for CAVD. It has been shown before that DLK1
-/-
mice have increased abdominal adiposity. Indeed Dlk1 plays an essential role in regulating adipocytes differentiation and proliferation. Recently, it has been shown that there is an association between fat tissue accumulation and an increased risk of aortic stenosis. We
hypothesize
that dysregulation of DLK1 stimulates adiposity, increases circulating lipids, enhances valve lipids retention, and stimulates calcification. Herein, our
objective
is to examine the expression of DLK1 in calcified aortic valve and its impact on lipid retention.

Method:
We examined the effect of Dlk1 loss of function on lipid retention in aortic valve tissue in ApoE
-/-
Dlk1
-/-
mice fed with a high-fat diet and in human explanted aortic valves using immuno-staining.

Results:
The complete deletion of DLK-1 in ApoE
-/-
mice were associated with an increased oxidized-LDL deposit in aortic valve tissue. In addition, circulating cholesterol (420 ± 8 mg/dl vs 250± 12 mg/dl, P=0.002) and triglyceride concentration (200 ± 3 mg/dl vs 50± 10 mg/dl, P<0.001) were higher in ApoE
-/-
DLK1
-/-
compared to apoE
-/-
mice. An increased valvular calcification accompanied these changes, as shown by the over-expression of RUNX2 and the increased aortic jet velocity in ApoE
-/-
DLK1
-/-
mice. Interestingly the overexpression of DLK1 in isolated human valve cells decreased calcification and lipid retention
in vitro.

Conclusion:
This study showed the significant role of Dlk1-derived abdominal adiposity in valve-lipid retention and calcification.
Abstract 11972: Economic Burden of Congenital Heart Surgery in China: Results From the National Center for Cardiovascular Diseases
Authors: He Qiyu , Dou Zheng , Li Shoujun
Published: June 2023

Introduction:
According to Reports on the Prevention and Control of Birth Defects in China, the total lifelong economic burden of new congenital heart diseases (CHD) cases was more than 12.6 billion Chinese Yuan. We aim at exploring the economic burden driven by congenital heart surgery and filling the gap in the health economics in China.

Methods:
We used data from CDCHS database (Registry No. ChiCTR1800014577) to prospectively analyze the economic burden of congenital heart surgery. The total expenditures were divided into eleven subjects and classified by STAT category, year, and different types of CHD. Stepwise multivariable linear regression model was utilized to analyze the contributing factor to the total expenditure. National economic data was accessed to better describe the burden.

Results:
A total of 6568 hospitalizations were enrolled from 2018 to 2020. The median of total expenditure of all enrolled patients during hospitalization was 63,129.14 (≈9,910.52 USD), and significant cost-related difference was defined among the five STAT categories (P<0.001) with the lowest in STAT-1 (55,720.43, ≈8,747.46 USD) and highest in STAT-5 (190,587.01, ≈29,919.94 USD). The median total costs during the 3-year 2018 to 2020 period were 57,248.72 (≈8,987.38 USD), 63,423.45 (≈9,956.74 USD) and 67,867.37 (≈10,654.39 USD), respectively. Multivariable linear regression model showed that STAT category, complication, emergent operation and delay sternal closure were the major contributing factor to the total expenditure.

Conclusions:
For the first time, the economic burden of congenital heart surgery in China is delineated not only in terms of total expenditure but also the detail components. Also, the current healthcare policies in China were analyzed, and combined with the expenditure information, this analysis provides substantial information about specific factors driving to the economic burden with the purpose of aiding policy adjustments.
Abstract 11993: Area Deprivation Index and Risk of Poly-Vascular Disease: Insights From Houston Methodist Cardiovascular Disease Learning Health System Registry
Authors: Sammour Yasser , Thakkar Samarthkumar , Khan Safi U , BOSE BUDHADITYA , Gullapelli Rakesh , Nicolas Charlie , Nwana Nwabunie , Lahan Shubham , Roy Trisha , Lumsden Alan B , Kleiman Neil S , Al-Kindi Sadeer , Sharma Garima , Patel Kershaw , Cainzos Miguel , Jones Stephen , Zoghbi William A , Nasir Khurram
Published: June 2023

Introduction:
Poly-vascular disease (PVD), defined as presence of atherosclerotic disease in >1 vascular territory, typically coronary artery disease (CAD), peripheral arterial disease (PAD), or cerebrovascular disease, is associated with worse CV prognosis. The impact of social vulnerability among this very high-risk subgroup has not been well studied. We aim to leverage readily available measures of neighborhood-level social vulnerability (area deprivation index, ADI) associated with increasing burden of overall and premature (<65 years) PVD in a large integrated healthcare system.

Methods:
Cross-sectional study using data from 1.12M patients aged 18+ years in Houston Methodist CVD Learning Health System Registry (2016-2022). Patients were ranked by ADI quintiles (Q1-Q5) as validated index of neighborhood socioeconomic disadvantage built from 17 metrics at census tract level quantified using Geographic Information Systems. CAD, PAD, and stroke were identified using ICD 10-CM codes.

Results:
We included a total of 1.1M adults with ADI ranking. Overall, prevalence of CAD, PAD and stroke was 5.7%, 1.7% and 3.2% respectively with 1.4% & 0.3% having vascular disease in 2 and 3 vascular beds respectively. Age-adjusted prevalence of any & premature PVD was higher with worse ADI groups (
Table
). Overall, 35% and 41% of patients with premature 2-3 PVD were in the highest 4-5
th
ADI quintile (most deprived neighborhood) compared to 28% with premature single vascular CVD. After adjusting for age, sex, race/ethnicity, CV risk factors, adults in the highest ADI quintile had odds of 1.18(1.11-1.26) of PVD in 2 territories & 1.33(1.15-1.54) in 3 vascular beds compared to ADI quintile 1 (least deprived neighborhood).

Conclusion:
Readily available neighborhood social deprivation such as ADI is strongly associated with worsening poly-vascular CVD. It can be used to inform comprehensive preventive and management strategies for this vulnerable population at health system level.
Abstract 12000: Ventricular Arrhythmias and Sudden Death Events Following Acalabrutinib Therapy Initiation for Hematology Malignancies
Authors: Gambril John , Bhat Seema A , Azali Leylah , Chen Sunnia , Rosen Lindsay , Palettas Marilly , Wiczer Tracy , Kalathoor Sujay , Zhao Qiuhong , Rogers Kerry , Kittai Adam , Grever Michael , Awan Farrukh , Ruz Patrick , Byrd John C , Woyach Jennifer , Addison Daniel
Published: June 2023

Introduction:
Acalabrutinib, a next generation Bruton’s tyrosine kinase inhibitor (BTKi) associates with dramatic efficacy against hematology malignancies. Unexplained ventricular arrhythmias (VAs) with next generation BTKi therapy have been reported. Yet, whether acalabrutinib associates with VAs in long-term follow up is unknown.

Methods:
Leveraging a cohort of 290 consecutive hematologic malignancy patients treated with acalabrutinib (2014-2020), we assessed VA incidence. The primary endpoint was incident VA development (ventricular fibrillation, ventricular tachycardia, and symptomatic premature ventricular contractions). Probability Scores determined likelihood of acalabrutinib association. Incident rates as function of time on therapy were calculated. Weighted average incidence rates were compared to observed rates in a large contemporary similar aged general population using relative risk. Absolute excess risk (AER) for acalabrutinib associated VAs was estimated.

Results:
Over 1,063 person years of follow up, there were 8 incident VA cases, including 6 in those without coronary disease (CAD) or heart failure (HF), and 1 sudden death; median time to event was 14.9 months. Among those without prior ibrutinib use, CAD, or HF, weighted average incidence was 394 per 100,000 person years. This compares to 596 for ibrutinib related VAs (RR 0.66, P<0.01; figure) and 48.1 among similar aged non-BTKi treated subjects (RR 8.2, P<0.001; AER 346). Outside of age, no cardiac or electrocardiographic variables associated with VA development .

Conclusions:
Acalabrutinib associates with increased risk of incident VAs. Collectively, these data suggest VAs may be a class effect of BTKi therapies.
Figure:
Ventricular arrhythmia (VA) crude (A) and cumulative (B) incidence rates in acalabrutinib users versus ibrutinib and non BTKi treated populations. *Those without prior ibrutinib use or structural heart disease. **Assumes linear a event rate over time.
Abstract 12011: Troponin Elevation a Marker of Mortality in COVID-19 Patients
Authors: Echeverry Tatiana , von Gizycki Christian , Iqbal Talha , Anthony Jamal , Williams Karlene , Anghel Sharen
Published: June 2023

Introduction:
Troponin I test has been used as a biomarker for the diagnosis of ACS since 1965. Troponin I has a prognostic value in hospitalized patients with non-cardiac diagnosis. In 2019, The WHO declared COVID-19 as a deadly infectious disease. Given the global impact of this disease, there is a need to identify biomarkers associated with mortality in hospitalized patients. Biomarkers associated with mortality are an important tool for escalation of care in patients deemed at risk of clinical decompensation. The following study demonstrated an association between troponin I elevation and increased mortality among COVID-19 patients.

Hypothesis:
We sought to determine if Troponin I elevation within 24 hours of admission is associated with increased mortality in COVID-19 patients.

Methods:
In a retrospective, multicenter study at Atlantic Health System in New Jersey, we analyzed 10,980 first-drawn troponin I values within 24 hours of admission in 34,625 patients between 12/2020-02/2021. Data was analyzed using logistic regression and cox proportional hazard ratio to determine our primary outcome, which is the association of troponin elevation and mortality among COVID-19 patients.

Results:
The characteristic of 10,980 patients that survived COVID-19 and patients that expired due to COVID-19 during the hospitalization were analyzed. Total of 6,083 were male and 4897 were females. In the survival group, the mean age was 60 with STD 17.2, while in the deceased group the mean age was 74 with STD 13. Logistic regression revealed thatpatients with elevated troponin have increased odds of death compared to others with non-elevated troponin levels
(Point estimate 3.301665
). Females with elevated troponin have greater odds of death than males with elevated troponin (
point estimate 4.484406 in females vs point estimate men 3.301665
). Patients with elevated troponin have increased hazard by a factor of 1.78 or increased chance of death by 78%. As supporting evidence of our hypothesis patients with an elevated troponin in the first 24 hours have 3.74 increase odds of death.

Conclusions:
In conclusion, Troponin I elevation within 24 hours of admission is associated with increased mortality in hospitalized COVID-19 patients with 3.7 increase odds of death.
Abstract 12018: Coronary Microvascular Dilatory Dysfunction According to the Types of Coronary Functional Abnormalitiescoronarymicrovascular Dilatory Dysfunction According to the Types of Coronary Functional Abnormalities
Authors: Teragawa Hiroki , Oshita Chikage , Uchimura Yuko
Published: June 2023

Introduction:
Recently, there has been an increasing interest in coronary functional abnormalities (CFA), which include epicardial coronary spasm (ECS), microvascular spasm (MVS) and microvascular vasodilatory dysfunction (MVD). However, the frequency of MVD according to the types of CFA remains unclear.

Hypothesis:
Thus, this study aimed to investigate the frequency of MVD according to the types of CFA in patients with ischemia with non-obstructive coronary arteries (INOCA).

Methods:
This study included 63 patients with INOCA who underwent coronary angiography (CAG) and coronary function tests (CFT) to evaluate chest pain. In CFT, acetylcholine was first administered intracoronarily in a stepwise manner, followed by chest symptoms, electrocardiographic ST-T changes and CAG. ECS was defined as coronary vasoconstriction of >90% on CAG accompanied by chest symptoms or electrocardiographic ST-T changes. Additionally, a focal spasm was defined as a transient vessel narrowing of >90% within the borders of one isolated coronary segment (as defined by the American Heart Association), and a diffuse spasm was defined as a 90% diffuse vasoconstriction in ≥2 adjacent coronary segments of the coronary artery. Moreover, MVS was defined as the presence of both chest symptoms and ST-T changes with non-significant coronary vasoconstriction (<90%) on CAG. After nitroglycerin administration, coronary flow reserve (CFR) and the index of microcirculatory resistance (IMR) were subsequently obtained by transvenous adenosine triphosphate infusion using a pressure wire. MVD was defined as CFR of <2.0 or IMR of ≥25 units.

Results:
CAG and CFT were performed on 91 coronary arteries in 63 patients with INOCA, the results of which are shown below.

Conclusions:
These findings suggest that the frequency of MVD differs according to the types of CFA. Properly evaluating the MVD and reflecting this in the therapeutic strategy in patients with INOCA is desirable in clinical settings.