bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 9365: Clinical Profiles and One-Year Outcome in Middle Eastern Patients With Atrial Fibrillation and Diabetes Mellitus: The Jordan Atrial Fibrillation Study
Authors: Abdin Basil , Hammoudeh Ayman J , Alrabadi Nasr , Krishan Mohammad , Haikal Lubna , Badaineh Noor , Ghanameh Yazan , Alhaddad Imad
Published: June 2023

Introduction:
Comorbid diabetes mellitus (DM) is highly prevalent and increases the risk of stroke and cardiovascular death in patients with atrial fibrillation (AF). The data on the impact of DM on Middle Eastern patients with AF including clinical features, use of oral anticoagulant agents (OACs) and the one-year outcome is scarce and not well studied.
Purpose:
To study the clinical characteristics, therapeutic strategies and one-year complications in AF patients with DM compared to non-diabetic AF patients.

Methods:
The Jordan AF Study enrolled consecutive patients with AF in 28 hospitals and cardiology clinics in Jordan from May 2019 through December 2020. Patients were followed up for one year. We compared the clinical features, use of pharmaceutical agents, and outcome in patients with DM compared to those with no DM.

Results:
Of the 2020 AF patients enrolled, 881(43.6%) had DM. Patients with DM were older than those with no DM (mean age +/- SD: 70.3 +/- 9.5 years vs. 66.0 +/- 14.8 years, p<0.001), more likely to be women, and had a significantly higher prevalence of hypertension, heart failure, and chronic kidney disease. Mean CHA2DS2-VASc and HAS-BLED scores were higher in DM patients than in those with no DM (4.5 +/- 1.5 vs. 2.7 +/- 1.7, p<0.001) and (1.9 +/- 1.1 vs. 1.4 +/- 1.0, p<0.001), respectively. Also, DM patients in comparison to those with no DM had a high-risk CHA2DS2-VASc score (of 2 points or more in men and 3 or more in women) (90.9% vs. 69.0%, p<0.001). OACs were prescribed equally in both groups (89.1% vs 89.5%, P=0.88). At one year, DM group compared to no DM had significantly higher rates of all-cause death (17.5% vs. 8.4%, p<0.001), cardiac death (9.5% vs. 5.1%, p=0.003), major bleeding events (3.8% vs. 1.7%, p=0.007), and higher incidence of stroke/systemic embolism (4.3% vs. 2.8%, p=0.10), but similar incidence of intracranial bleeding (0.6% vs. 0.5%, p=0.98). Multiple logistic regression analysis showed that DM was associated with a higher incidence of all-cause death (odds ratio 1.5, 95% confidence interval 1.1-2.1, p=0.01).

Conclusions:
In this contemporary study of Middle Eastern patients with AF, a coexisting DM was associated with a worse clinical profile, risk scores, and one-year outcome. Both groups had equally high utilization of OACs.
Abstract 9368: Association Between Concurrent Use of Amiodarone and DOACs and Bleeding Risk in Atrial Fibrillation Patients
Authors: Shurrab Mohammed , Jackevicius Cynthia , Austin Peter , Tu Karen , Qiu Feng , Singh Sheldon , Crystal Eugene , Caswell Joseph , Michael Faith , Andrade Jason , Ko Dennis T
Published: June 2023

Introduction:
Amiodarone is a commonly used pharmacotherapy in patients with atrial fibrillation (AF) with potential for drug-drug interactions (DDIs) with direct oral anticoagulants (DOACs). We aimed to assess the bleeding risk after co-prescription of amiodarone and DOACs among adults with AF.

Methods:
We conducted a population-based, nested case-control study in Ontario, Canada. The study population included all patients with AF > 66 years on a DOAC between April 1, 2011-March 31, 2018. Cases were patients admitted with major bleeding (index date). Controls were matched in a 2:1 ratio to cases. We categorized exposure to amiodarone before the index date as: a) current users (amiodarone within 60 days); b) past users (amiodarone within 61 to 140 days); and c) unexposed (no amiodarone prescription or amiodarone prescription >140 days before index date). Conditional logistic regression models were used to examine the association between bleeding and amiodarone co-prescription.

Results:
Among 86,679 AF patients on a DOAC, we identified 2,766 cases (3.2%) admitted with major bleeding. The median age of AF patients was 80 years (interquartile range 75-85); 48.3% were women. After multivariable adjustment, there was a significant association between major bleeding and current use of amiodarone (adjusted odds ratio (aOR) 1.53; 95% confidence interval (CI) 1.24-1.89, p<0.001) but no significant association between major bleeding and past use of amiodarone (aOR 1.13, 95% CI 0.76-1.68, p=0.545) as compared with the unexposed group.

Conclusions:
Among older patients with AF on a DOAC, there was 53% increased odds of current use of amiodarone in those with versus without major bleeding.
Abstract 9375: Role of Cardiac MRI in the Evaluation of T Wave Inversion in a Large Pre-Participation Cohort of Young Asian Males
Authors: Thiagarajan Nishanth
Published: June 2023

Introduction:
Abnormal T wave inversion (ATWI) in the pre-participation screening (PPS) electrocardiogram (ECG) may signify underlying myocardial disorders (e.g. cardiomyopathy, myocarditis) associated with sudden cardiac death. Current guidelines for competitive athletes recommend evaluation of ATWI with transthoracic echocardiography (TTE) and follow-on cardiac magnetic resonance imaging (CMR) if TTE is normal (i.e. echo-negative). However, data on evaluation of ATWI detected on PPS outside of competitive athletes (e.g. recreational athletes or military enlistees) is lacking.

Methods:
We studied the yield of ATWI evaluation in a large unselected cohort of 48115 young Asian male military enlistees who underwent PPS between 2019-2021. Individuals with ATWI meeting the International Criteria 2017 definition underwent TTE. Echo-negative individuals with persistent ATWI on repeat ECG further underwent CMR and were followed up for 12 ± 8 months. Routine demographic, anthropometric and ECG parameters were collected. Individuals with known heart disease or conduction abnormalities (e.g. RBBB) were excluded.

Results:
133 (0.3%) individuals had ATWI, amongst whom TTE detected 3 (2.3%) individuals with cardiomyopathy. 105 echo-negative individuals had persistent ATWI and underwent CMR, which detected a further 5 (4.8%) cases of cardiomyopathy and 2 (1.9%) cases of prior myocarditis with residual scar. Echo-negative individuals with myocardial disorders on CMR had deeper ATWI of ≥ 2mm (p=0.047), ATWI in lateral (p=0.046) or all 3 territories (p=0.006), and concomitant ST segment depressions (p=0.030). ATWI depth of < 2mm demonstrated 100% negative predictive value for myocardial disorders on TTE or CMR.

Conclusions:
Evaluation of ATWI in our unselected cohort of young Asian males identified myocardial disorders in 7.5%, with follow-on CMR increasing the diagnostic yield by 3-fold compared to TTE alone. Our findings confirm that CMR has utility in the evaluation of ATWI detected by PPS even in unselected individuals outside the competitive athletic setting. ATWI depth of ≥2mm was present in all individuals with myocardial disorders, and may serve as a cut-off value for further CMR evaluation in settings with resource limitations.
Abstract 9391: Early Biomarkers to Predict a Worse Outcome After Acute Myocardial Infarction: Circulating Infectious Extracellular Vesicles From Archaea and
M. Pneumoniae
Are Present and Correlated to Cytokines IL-6 and IL-10
Authors: Moreno Camila R , Soeiro Alexandre M , Sato Maria N , Pereira Jaqueline J , Ikegami Renata N , Kawakami Joyce T , Reis Marcia M , Oliveira Luanda M , Higuchi Maria Lourdes
Published: June 2023

Acute myocardial infarction (AMI) is related to rupture of atheroma plaques containing pro-inflammatory cytokines, oxidized low-density lipoprotein (oxLDL) and MMP9, a microenvironment compatible with the presence of a pathogenic microbial community. Recently, infectious extracellular vesicles (iEVs) were discovered to be released in co-infections. Previously, we found iEVs positive for archaea DNA and
Mycoplasma pneumoniae
(Mp) antigens in vulnerable plaques. Now, looking for serum particles biomarkers to differentiate atherosclerotic clinical outcomes we studied 168 patients (pts) from groups: Atherosclerotic (ATR), AMI, AMI with major severity (sAMI) and healthy (CTL)

Methods:
We quantified and characterized serum iEVs (
0.79-1.34
μm) through their content using the
Flow Cytometry
technique and for cytokines using CBA kit, for exosomes (<100nm) we used
Nanosight
equipment and for correlations we used
Spearman
's test.

Results:
sAMI pts sera presented increased no. of iEVs positive for archaea DNA and Mp, MMP9, IL6 and IL10 cytokine antigens. TNFα was increased in CTL and ATR compared to both AMI groups. TNFα correlated with archaeal IEVs in sIAM group. There was a significant positive correlation between Mp and MMP9 in the AMI, CTL and ATR groups. A significant positive correlation was present between Mp and IL6 in AMI and sAMI groups. ATR and CTL groups had higher no. of exosomes than the sAMI group.

Conclusion:
Increased numbers of serum IEVs positive for archaea, Mp and MMP9 elements in association with increased levels of IL6, decreased numbers of protective exosomes and correlation between TNF-α vs archaea, are present in sAMI clinical outcome, which suggests that serum IEVs and cytokines levels may constitute new biomarkers to differentiate atherosclerotic clinical outcomes.
Abstract 9414: Machine Learning of Pressure-Strain Curve Analysis on Ultrasound Echocardiography Can Predict Cardiac Prognosis in Patients With Congestive Heart Failure
Authors: Shimizu Masato , Manno Tomoko , Tsunoda Takahiro , Miyazaki Hiroko , Misu Yoshiki , Ryo Tateishi , Yamaguchi Masao , Yamakami Yosuke , Kato Nobutaka , Shimada Hiroshi , Isshiki Ami , Kimura Shigeki , Fujii Hiroyuki , Suzuki Makoto , Nishizaki Mitsuhiro , Sasano Tetsuo
Published: June 2023

Introduction:
Machine learning (ML) of ultrasound echocardiography (UCG) has been developed, but the diagnostic performance of pressure-strain curve analysis by ML for cardiac prognosis in patients with congestive heart failure (CHF) was not studied.

Hypothesis:
ML of pressure-Strain curve analysis on UCG can predict cardiac prognosis in patients with CHF.

Methods:
We enrolled consecutive 141 sinus-rhythm patients who admitted for CHF (76.4±13.2years, 85men), in whom UCG was performed after initial treatment. Major adverse cardiac event (MACE) was defined as cardiac death during observation period and re-admission due to CHF. Eleven ML predictive models were constructed by PyCaret, compared their accuracy, and important predictors were evaluated by Shapley Additive exPlanations (SHAP) method.

Results:
Forty-five patients showed MACE (observation period: median 284 days). Ten significant predictors were extracted by logistic regression analysis. Mean of accuracy in 11 models were 0.712. Random Forest Classifier showed the highest accuracy (0.766). Diastolic blood pressure, E wave, and global positive work (derived from pressure-strain curve analysis) played essential role in the model.

Conclusion:
ML of pressure-strain curve analysis had powerful diagnostic performance for predicting cardiac prognosis of CHF patients.
Abstract 9439: Association of Renal Function With Abnormal Hemodynamics and Severity of Pulmonary Arterial Hypertension
Authors: Lai Chih-Hung
Published: June 2023

Introduction:
Pulmonary arterial hypertension (PAH) is characterized by increased pulmonary vascular pressure and resistance that ultimately resulted in right heart failure and the deterioration of related hemodynamic parameters, precipitating the alternation of renal function and prognosis. However, which hemodynamic parameter associating the severity of PAH might alter renal function remains uncertain.

Methods:
The PAH cohort were extracted from the TAIPANS, a multicenter, prospective, observational registry of the clinical course and disease management of PAH patients. The COMPERA risk assessment strategy was used to grading the severity of PAH into low, intermediate, or high risk. The calculation of eGFR by using the MDRD formula.

Results:
A total 353 PAH diagnosed patients were included from TAIPANS registry. The higher risks group had been significantly older, higher WHO Fc, higher NT-pro BNP level, worse right hemodyanmic parameters (Table 1). The higher risk group carried lower eGFR. After adjustment, the intermediate and high risk groups were significantly decreased eGFR (p trend=0.01) (Table 2). The component of COMPERA risk factors, especially RAP level, showed significant negative correlation with eGFR (Figure A).

Conclusions:
The renal dysfunction is associated with PAH severity and associated with worse hemodynamic, especially elevated RAP.
Abstract 9449: Increased Neprilysin Expression Links Atrial Fibrotic Remodeling in Cardiovascular Surgery Patients
Authors: Nakajima Toshiaki , HARUYAMA AKIKO , Fukuda Taira , Minami Kentaro , Obi Syotaro , Inami Shu , Sakuma Masashi , Abe Shichiro , SHIBASAKI IKUKO , Fukuda Hirotsugu , Toyoda Shigeru
Published: June 2023

Introduction:
Deposition of extracellular matrix (ECM) such as collagen leads to fibrosis, which plays essential roles in structural remodeling in atrial fibrillation (AF). Neprilysin (NEP) is an integral membrane-bound metallopeptidase with a wide spectrum of substrates and physiological functions.

Hypothesis:
We investigated the association of NEP and the atrial fibrosis-related genes in cardiovascular surgery patients including heart valve disease.

Methods:
Atrial mRNA expression including collagen and NEP were analyzed by real-time reverse transcription polymerase chain reaction (RT-PCR) in 59 cases (sinus rhythm (SR) 24 patients, AF 35 patients) in which LA tissues were removed from the appendage during surgery. NEP mRNA expression was also analyzed in adipose tissues (AT) obtained from both epicardial and subcutaneous adipose tissues. The NEP protein expression was measured by western blotting analysis and immunohistochemistry staining, and serum level of NEP was measured by ELISA.

Results:
The immunohistochemical staining showed the expression of NEP in both AT and LA. Higher expression of NEP mRNA and protein in adipose tissues was observed, compared with LA. Serum NEP concentration did not significantly correlate with NEP mRNA and protein expression of AT and LA. The significant correlations were observed among ECM (COL1A1, COL3A1, fibronectin) and the five selected fibrosis-related genes (TGFβ1, CTGF, miR21, NOX2 and BAX) attributed to the fibrosis of myocardium in LA. NEP mRNA expression of LA also positively correlated with the ECM and the fibrosis-related gene expression level. The multiple regression analysis revealed TGFβ1, NOX2, and NEP as independent predictors of atrial COL1A1 mRNA expression level. In addition, it revealed NEP as an independent predictor of COL1A1 mRNA expression level, even adjusted by age, sex, and BMI. Serum NEP concentration did not correlate with the ECM and the fibrosis-gene expression level. Patients with AF had higher atrial expression of NEP protein, compared to those with SR.

Conclusions:
Increased atrial expression of NEP links atrial fibrotic remodeling and developing AF in cardiovascular surgery patients. However, serum NEP did not reflect atrial NEP expression in LA.
Abstract 9458: Ptfv1 Size is Associated With Development of Atrial Fibrillation in an Obstructive Sleep Apnea Cohort
Authors: Falk Zachary , Adedeji Omowunmi , Lee Maximillian , Mercader Marco
Published: June 2023

Introduction:
This study aimed to investigate the interaction between obstructive sleep apnea (OSA) and development of atrial fibrillation (AF) by analyzing P-wave terminal force in V1 (PTFV1), an ECG parameter related to left atrial (LA) abnormalities. ECG-defined LA abnormalities, indicative of some structural or electrical remodeling, is suggestive of a predisposition to AF.

Hypothesis:
In patients with OSA, the odds of having an ECG with an abnormal PTFV1 value (as defined by > -4000 μV*ms) are higher in those who developed AF, compared with controls.

Methods:
A retrospective review was conducted in patients who underwent a polysomnography (PSG). Inclusion criteria for data collection were completion of PSG, diagnosis of OSA, and record of ECG. Manual measurements which were done using the EP Calipers software (EP Studios, Inc.) to standardize our approach.

Results:
62 patients with AF and 377 control patients without AF were included for analysis. Baseline characteristics were similar between the two subgroups (relevant parameters are tabulated in table 1). PTFV1 was significantly higher in the AF subgroup (-4593.01 μV*ms) vs the control subgroup of -1906.2 μV*ms (p <0.001). Of the 62 patients who developed AF, 27 were noted to have an abnormal PTFV1 as defined as a value >[-4,000 μV*ms]. The odds ratio was calculated to be 3.32 (CI 1.89-5.84).

Conclusions:
We found that in a cohort of patients with OSA, the odds of having an ECG with an abnormal PTFV1 value (as defined by > -4000 μV*ms) were higher in those who developed AF, compared with those who did not. This value is comparable to previous odds ratios calculated in the general population, but appears elevated in our cohort, suggesting a heightened risk in individuals with OSA irrespective of OSA severity (as noted by AHI), arousal index, or CPAP usage. Future research should expand on these preliminary results to include a larger sample size and more robust patient demographic data.
Abstract 9486: miR-425/CFL2 Regulates Natriuretic Peptides Expression in Human CVD
Authors: Chen Yang , Ma Xiao , Iyer Seethalakshmi R , Reginauld Shawn , Sangaralingham Jeson , Burnett John C
Published: June 2023

Introduction:
Previously, miR-425 have been implicated in the inhibition of the cardiac natriuretic peptide (NP) ANP gene expression with their role on BNP undefined. The mechanism by which miR-425 modulates NP expression remains to be explored. In heart failure (HF), adrenergic and neurohormone pathways are aberrantly activated. Our goal was to investigate the role of miR-425 and its downstream target Cofilin 2 (CFL2) on ANP and BNP expression in human CV disease (CVD).

Hypothesis:
We hypothesized miR-425, via CFL2, supresses NPs expression in vitro. MiR-425, CFL2 and NP levels were also determined in CVD patients.

Methods:
In vitro, human cardiomyocytes (HCM) were treated with vehicle (Veh), catecholamine isoproterenol (ISO) and cytokine endothelin (ET), miR-425 mimic. Cells were transfected with CFL2 plasmid or CFL2 siRNA. Normal (NM, n=100), Hypertension (HTN, n=30) and Acute HF (AHF, n=74) cohorts were studied. A confirmatory cohort was recruited. Plasma NT-proBNP, miR-425 were measured. In left ventricles (LV) from NM or HF (n=5 each), NP, CFL2 and miR-425 expression were assessed. Data expressed as means±SEM. * p<0.05 vs NM or Veh.

Results:
In vitro in HCM, treatment with ISO or ET in HCM reduced miR-425 and elevated NP mRNA levels. Furthermore, miR-425 mimic reduced
Nppa
(Veh: 1.0±0.03, mimic: 0.7±0.02*) and
Nppb
levels (Veh: 1.0±0.03, mimic: 0.5±0.01*). We showed that a top predicted target of miR-425, CFL2, was also reduced by the mimic. Further, NP mRNA was elevated by CFL2 overexpression and reduced by the knockdown of CFL2. In humans, MiR-425 was lower in HTN and AHF patients (NM: 0.15±0.03, HTN: 0.03±0.005*, HF: 0.01±0.003*) than NM. MiR-425 negatively correlates with NT-proBNP in NM and AHF cohorts. Downregulation of miR-425 was validated in a second AHF cohort. Similarly, in HF LV tissues, miR-425 (NM: 2.5±0.5, HF: 1.0±0.5*) was lower than NM group, while CFL2 and NP gene and protein expression were increased.

Conclusion:
In vitro, cardiac stress hormones downregulate miR-425 and increase NP gene expression, potentially through a novel target, CFL2. In CVD patients, miR-425 is lower, accompanied by an elevation of CFL2 and NP. Our findings implicate the pathway of stress hormones/miR-425/CFL2/NP production in CVD.
Abstract 9492: Transcatheter Amplatzer Occluder Device Closure of Post-Myocardial Infarct Pseudoaneurysm: A Case Report
Authors: Yuvaraj Yaswanraj , Girard Michael , Patton Marquand B
Published: June 2023

Introduction:
Left Ventricular Pseudoaneurysm (LVP) is defined as cardiac wall rupture leading to a formation of wall with thrombus, pericardial, or scar tissue functioning as a pouch for blood. A loculated pericardial effusion (LPE), and right ventricular pericardial fistula (RVPF) have never been reported in literature. Here, we report the first case of a 70 year old male who developed a LVP, LPE, and RVPF.

Case Description:
A 70 year old male with a past medical history of hypertension presented with inferior wall STEMI. Cardiac catheterization demonstrated left anterior descending (LAD) with 80% occlusion and right coronary artery (RCA) with 100% occlusion. Percutaneous intervention of RCA with aspiration thrombectomy and two drug eluting stents was performed. Echocardiogram the following day demonstrated a LVP. A transesophageal echocardiogram (TEE) demonstrated LVP near the mid-inferior interventricular septum draining into the pericardial space, and LPE from the apical inferior left ventricle (LV) extending to the apical cap of the right ventricle (RV). Computed tomography angiography (CTA) demonstrated a multiloculated collection at the inferior septal aspect of LV contained by the pericardial space. Patient was a high risk for surgery. LVP was closed via a 24 mm atrial septal defect (ASD) occluder device. Intraoperative TEE demonstrated an ASD occluder device at the mid inferior septum at the location of the LVP neck with minimal residual flow into the LPE and a fistula connecting the LPE space with RV. RVFP was managed conservatively. LAD was managed medically. Patient was discharged home safely on guideline directed medical therapy.

Discussion:
LVP rate is 0.0026% following myocardial injury. It is reported that untreated LVP have a rupture risk of about 30% and a mortality rate of 50%. Prompt treatment is required to prevent mortality. Surgical management is the standard of care. A multidisciplinary heart team deemed the patient a high risk. Therefore, transcatheter treatment was sought in the patient above.

Conclusions:
Surgical treatment is standard of care for LVP, but transcatheter wall closure with an ASD device is a promising technique not only for high-risk surgical candidates such as above, but as a gold standard of treatment for LVP.
Abstract 9495: Deep Learning Algorithm for Predicting Atrial Fibrillation Based on Chest Radiography
Authors: Kim Yujeong , Bae SungA , Yoon Dukyong
Published: June 2023

Introduction:
Atrial fibrillation (AF) is a common risk factor for stroke and heart failure, with gradually increasing prevalence. AF is usually diagnosed on the basis of electrocardiography. Chest radiography is commonly performed as a screening test among patients with cardiac diseases but cannot be used to detect AF because of its unclear radiographical findings.Hypothesis: We hypothesize that deep learning methods, particularly convolutional neural networks (CNN), can be used to detect AF on chest radiographs.

Methods:
Chest radiographs used for training were obtained from Yongin Severance Hospital, South Korea. A total of 11,044 images acquired from patients with normal sinus rhythm or AF were used, whereas images from patients with other rhythms, such as paced rhythm or left bundle branch block, were excluded. The training, validation, and test datasets were split 8:1:1, and Resnet was applied as a model architecture. The accuracy, area under the receiver operating characteristic (ROC) curve, area under the precision-recall curve (PRC), precision, and recall were calculated. Gradient-weighted class activation mapping (Grad-CAM) was used to determine the area focused on by the model to predict AF.

Results:
AF was detected from chest radiographs with an accuracy, AUC, and PRC of 0.95, 0.81 and 0.39 in the validation set, respectively, and 0.94, 0.76, and 0.35 in the test set, respectively (Figure 1-A, B). Grad-CAM showed that the highest predictive value images from each dataset focused on the heart and its border, while the lowest predictive value images focused on the ribs (Figure 1-C, D, E, F).

Conclusions:
Deep learning algorithms can be used to detect AF on chest radiographs, which can be used as a screening tool for AF patients.
Abstract 9504: Endothelial Shear Stress Metrics Correlate With Inflammatory Markers at the Culprit Site of Erosion in Patients With an Acute Coronary Syndrome: An OPTICO-ACS Substudy
Authors: Ahmed Mona , Leistner David M , Hakim Diaa , Abdelwahed Youssef , Coskun Ahmet U , Maynard Charles , Seppelt Claudio , Cefalo Nicholas , Libby Peter , Landmesser Ulf , Stone Peter H
Published: June 2023

Introduction:
The pathobiological mechanisms of coronary plaque erosion are unclear. Low endothelial shear stress (ESS) is a proinflammatory/proatherogenic stimulus associated with coronary plaque progression/destabilization. Intravascular imaging studies suggest that high ESS gradient (low ESS areas adjacent to high ESS areas), and steepness of plaque upslope/downslope correlate with plaque erosion. We investigated the relationship of local fluid hemodynamics to the inflammatory microenvironment at the culprit site of erosion in patients with an acute coronary syndrome.

Hypothesis:
ESS metrics associate with proinflammatory/proatherogenic cells and cytokines, and contribute to plaque erosion.

Methods:
We studied 30 patients with erosion from the OPTIcal-COherence Tomography in Acute Coronary Syndrome study (OPTICO-ACS). OCT images were segmented, co-registered with the angiogram to create a 3D-reconstruction of the coronary artery. ESS metrics were calculated by Computational Fluid Dynamics. Systemic and local blood samples and thrombectomy specimens were collected at the culprit lesion and analyzed by flow cytometry-based immunophenotyping and plasma cytokine and chemokine profiling, and statistically tested for correlations of continuous variables using Spearman rank correlation (r).

Results:
Proinflammatory cytokines (IL6, MIP-1, IL1β, IL2) and local concentration of T-cells, including subsets of T-cells (CD4+, CD8+, and NKT-cells), were significantly higher at the culprit site of erosion and correlate with local adverse ESS metrics (Min ESS, Max ESS, Plaque Topographical Slope) (Table).

Conclusion:
Biomechanical features likely trigger activation of the adaptive immune system, including T-lymphocytes and their cytotoxic effector molecules. These results provide novel insights into the links between fluid hemodynamics, inflammatory activation, and mechanisms involved in the pathogenesis of coronary plaque erosion.
Abstract 9517: Effects of Adjunct Metolazone in Patients Hospitalized With Heart Failure
Authors: Castroreale Jake , Choi Ruth , Bagsic Samantha , Pandey Amitabh , Lew Michelle , Mohan Rajeev , Khedraki Rola , Sarsam Luay , Heywood J Thomas
Published: June 2023

Introduction:
Loop diuretics are a first-line treatment for patients hospitalized with congestive HF, yet diuretic resistance affects 25-30% of patients and is a predictor of death, readmission, or renal complications. The addition of metolazone can help overcome resistance, however there is a lack of large-scale trials to establish clinical efficacy and safety of dual diuretic therapy. Our study aims to determine the effects of metolazone in combination with a loop diuretic on net urine output, weight change, absolute change in BUN, length of stay, in-hospital death and hospital readmissions.

Methods:
In the Scripps Health system, 10,713 chronic HF patients experienced a HF admission from June 2019 through June 2021. Of these, 9,755 patients received loop diuretics while hospitalized, and 958 received metolazone with loop diuretics. Patients were propensity-matched 1:1 based on age, sex, left ventricular ejection fraction, tricuspid valve regurgitation, glomerular filtration rate and blood urea nitrogen, leaving 309 matched patients in each group. The primary outcome was net urine output of the hospitalization. Secondary outcomes include net change in weight for the hospitalization, absolute change in BUN, 30-day readmissions, 90-day readmissions, length of stay and in-hospital deaths.

Results:
During HF admissions, adjunct metolazone with a loop diuretic was associated with a significantly larger net urine output (-5.6 L vs. -2.1 L, p < 0.0001), net weight change (-10.1 lbs vs. -3.9 lbs, p < 0.0001), and absolute change in BUN (38 mg/dL vs. 24.6 mg/dL, p < 0.0001) for the hospitalization compared to patients who adequately responded to loop diuretics in this patient population. Adjunct metolazone showed no difference in in-hospital deaths (8.7% vs. 8.7%, p > 0.9999) or 30-day readmissions (23.3% vs. 17.5%, p = 0.089), however, it was associated with a significantly higher 90-day readmission rate (33.98% vs. 26.21%, p = 0.044) and length of stay (IQR 5-16 days vs. 3-10 days, p < 0.0001).

Conclusions:
Adjunct metolazone use may be an effective strategy for this patient population with inadequate response to loop diuretics, keeping 30-day readmission rates and in-hospital mortality similar to patients who adequately respond to loop diuretics.
Abstract 9535: The Effect of Vascular Smooth Muscle Cell miR-33a Expression on apoAI-Mediated Cholesterol Efflux and Macrophage-Like Cell Transdifferentiation
Authors: Esobi Ikechukwu , Oladosu Olanrewaju , Echesabal-Chen Jing , Powell Rhonda , Bruce Terri , Stamatikos Alexis D
Published: June 2023

Background:
ABCA1 removes cellular cholesterol by participating in apoAI-mediated cholesterol efflux. MiR-33a is an SREBP-2 intronic miRNA that silences ABCA1, which impairs ABCA1-dependent cholesterol efflux. Thus, miR-33a expression may be atherogenic and previous data suggests inhibiting miR-33a in certain cells is atheroprotective. However, current data is scant on whether miR-33a expression in vascular smooth muscle cells (VSMC) is atherogenic. Moreover, cholesterol accumulation in VSMC results in these cells to transdifferentiate into an atherogenic macrophage-like cell (MLC). Therefore, ablating miR-33a expression in VSMC may be atheroprotective via hindering cholesterol accumulation and MLC transdifferentiation in these cells by enhancing apoAI-mediated cholesterol efflux.

Methods:
An immortalized VSMC line MOVAS cells were used to generate miR-33a knockout (KO) MOVAS cells via using CRISPR/Cas9. We used these cells and parental wild-type (WT) MOVAS cells in our studies to assess whether apoAI-mediated cholesterol efflux is increased in MLC of VSMC origin when miR-33a expression is ablated. We also analyzed whether miR-33a ablation rapidly restores VSMC phenotype in MLC of VSMC origin when cholesterol-loaded cells were exposed to apoAI.

Results:
We used PCR to confirm that miR-33a was deleted in miR-33a KO MOVAS cells. We also showed that miR-33a-5p and miR-33a-3p expression was absent in miR-33a KO MOVAS cells via RT-PCR. SREBP-2 functionality remained intact in miR-33a KO MOVAS cells, as determined by upregulation of SREBP-2 target genes in serum-starved conditions. When we cholesterol-loaded miR-33a KO MOVAS cells to induce MLC transdifferentiation, we observed increased apoAI-mediated cholesterol efflux when compared to WT MOVAS cells exposed to the same conditions. Based on RT-qPCR analysis, we also observed a rapid restoration in VSMC phenotype when cholesterol-loaded miR-33a KO MOVAS cells were incubated with apoAI when compared to WT MOVAS cells treated with the same conditions.

Conclusions:
MiR-33a expression in VSMC appears to promote MLC transdifferentiation by impairing apoAI-mediated cholesterol efflux. Future studies are underway to determine if these effects are mediated by miR-33a-5p and/or miR-33a-3p.
Abstract 9541: Comparing Patient Reported Outcomes and New York Heart Association Class Among Patients Hospitalized for Heart Failure
Authors: Cosiano Michael F , Vista Andrew , sun jie-lena , Alhanti Brooke , Harrington Josephine , Butler Javed , OConnor Christopher M , Hernandez Adrian F , Starling Randall , Mentz Robert J , Greene Stephen J
Published: June 2023

Background:
The New York Heart Association (NYHA) classification remains a cornerstone nomenclature for quantifying health status of patients with heart failure (HF). How this clinician-reported classification compares with patient-reported outcomes among patients hospitalized for HF is unclear.

Methods:
ASCEND-HF was a global randomized trial comparing nesiritide versus placebo among patients hospitalized for HF, irrespective of EF. Among patients with complete baseline data for NYHA class and the patient-reported EuroQOL-5 dimensions (EQ-5D), each scale was organized into 4 levels (NYHA Class I-IV; EQ-5D utility index [UI] 0.75-1.00, 0.50-0.74, 0.25-0.49, <0.25 and EQ-5D visual analogue scale [VAS] 75-100, 50-74, 25-49, <25). Levels of NYHA class and EQ-5D were then mapped to each other from “best” to “worst.” Minor and moderate-severe discordance were defined as NYHA class and EQ-5D differing by 1 level and ≥2 levels, respectively. Factors associated with moderate-severe discordance were then assessed via backwards selection multivariable regression.

Results:
Among 5,741 patients, concordance, minor and moderate-severe discordance between NYHA class and EQ-5D UI occurred in 22%, 40% and 38% of patients, respectively. For EQ-5D VAS, this categorization occurred in 29%, 48% and 23%. Discordance was more often due to worse NYHA class. Patients with moderate-severe discordance were more likely to have worse NYHA class and higher EQ-5D scores. NYHA Class IV, higher EQ-5D scores, race and geographic region were among multiple patient factors independently associated with moderate-severe discordance (Figure 1).

Conclusions:
In patients hospitalized for HF, the majority exhibited discordance between the clinician-reported NYHA class and patient-reported health status. Discordance was more often due to worse NYHA class. Multiple patient factors were independently associated with higher likelihood of moderate-severe discordance.
Abstract 9568: Sodium-Glucose Cotransporter 2 Inhibitors Prevent New-Onset Type 2 Diabetes in Adults With Prediabetes: Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: Mori Yuichiro , Duru Obidiugwu K , Tuttle Katherine R , Fukuma Shingo , Taura Daisuke , Harada Norio , Inagaki Nobuya , Inoue Kosuke
Published: June 2023

Introduction:
Although the preventive effect of sodium-glucose cotransporter 2 (SGLT2) inhibitors for new-onset diabetes was investigated as secondary analyses of recent randomized controlled trials (RCTs), the synthesized evidence is lacking. We thus aimed to summarize the effects of SGLT2 inhibitors on preventing new-onset diabetes.

Hypothesis:
We assessed the hypothesis that SGLT2 inhibitors reduce the incidence of diabetes among patients with prediabetes and heart failure or chronic kidney disease.

Methods:
In this systematic review and meta-analysis of RCTs, MEDLINE and EMBASE were searched through February 11, 2022. Two independent authors screened the search results and extracted data from eligible RCTs (including both original and post hoc analyses) comparing SGLT2 inhibitors and placebo for the risk of new-onset diabetes among adults with prediabetes. No restrictions on publication date and language were applied. Meta-analysis was conducted using random-effects models to calculate risk ratios and 95% confidence intervals (CIs).

Results:
We included 4 RCTs with 5655 participants who had prediabetes. All studies had a low risk of bias and were conducted for treatments of heart failure or chronic kidney disease. Based on the random-effects meta-analysis, SGLT2 inhibitors were significantly associated with a lower risk of new-onset diabetes (relative risk, 0.79; 95% CI, 0.68 to 0.93, I2 =0·0%). The relative risks of new-onset diabetes in dapagliflozin and empagliflozin were 0.68 (95% CI, 0.52 to 0.89) and 0.87 (95% CI, 0.72 to 1.04), respectively (p-for-heterogeneity =0.14). The frequency of severe hypoglycemia was not elevated in the SGLT2 inhibitors group compared to the placebo group.

Conclusions:
In this meta-analysis, SGLT2 inhibitors were associated with a reduced risk of new-onset type 2 diabetes among adults with prediabetes and heart failure or chronic kidney disease. These findings indicate the potential usefulness of SGLT2 inhibitors as a pharmaceutical approach to prevent diabetes in conjunction with lifestyle modification among high-risk adults with prediabetes.
Abstract 9569: Unplanned Readmission Rate in Tobacco Use Population After Percutaneous Coronary Intervention vs Coronary Artery Bypass Grafting: Propensity Matched Comparison
Authors: Park Kyeeun , Watts Abi , Aung Pyi Phyo , Sikha Nikhil
Published: June 2023

Introduction:
Tobacco use is a well-established risk factor for atherosclerotic cardiovascular disease (ASCVD) and associated with cardiac intervention complications. However, there is a lack of data on the effect of smoking status on the post cardiac procedural results.

Methods:
We conducted a retrospective analysis of the 2018 to 2019 Nationwide Readmission Database (NRD). Adult patients (Age > 18) with tobacco use who underwent either PCI or CABG were selected using the ICD-10-CM diagnosis and procedure code. Discharge-level weight analysis was used to produce a national estimate. Propensity score matching (1:1) with age, sex, and comorbidity burden was performed and the outcomes were compared between matched cohorts.

Results:
During the study period, 1,392,730 patients underwent PCI (991,730; 71.2%) or CABG (401,000; 28.8%) of which 18,574 patients (1.3%) used tobacco. Patients who underwent PCI with tobacco use were younger (59.7 SE 0.1 vs 62.4 SE 0.2) and with more female population (25.7% vs 18.2%) compared to those who underwent CABG with tobacco use. In discharged patients with tobacco use, unplanned 30-day readmission rate was 9.0%. The majority of the readmission was due to ischemic heart diseases (89.4%) and 2.7% was due to complications of cardiac implants or grafts. A half of readmission occurred within 9 days after the discharge. 9,223 discharged patient with tobacco use who underwent PCI or CABG were propensity-matched. 30-day readmission rate was significantly lower in patients with PCI (8.5% vs 10.7%; p = 0.006). Furthermore, PCI was associated with shorter length of stay (3.5 days SE 0.1 vs 10.1 days SE 0.1; p < 0.001) and lower total hospital cost ($111,492.2 SE 1,188 vs $231,603.6 SE 3,558.3; p < 0.001). In-hospital mortality was similar in PCI and CABG groups (2.0% vs 1.8%, p = 0.26).

Conclusions:
9.0% of tobacco use patients with ASCVD who underwent PCI or CABG had unplanned readmissions. The most common reason for readmission was ischemic heart disease, with more than 50% of patients returning to the hospital within the first two weeks of hospital discharge. Tobacco use patients who underwent PCI had statistically significantly lower readmission rates, length of stay, than their propensity-matched peers who underwent CABG.
Abstract 9576: Trends and Outcomes of Sudden Cardiac Arrest in Diabetes Patients With STEMI in the US
Authors: Mhaimeed Omar , DARGHAM SOHA , al suwwaidi jassim , Jneid Hani , Abi Khalil Charbel
Published: June 2023

Introduction:
Sudden cardiac arrest is a serious ST-elevation myocardial infarction (STEMI) complication.Objective: We aimed to assess the impact of diabetes on sudden cardiac arrest (SCA) in patients hospitalized with STEMI and analyzed the recent cardiovascular and socioeconomic temporal trends in those patients.

Methods:
We used the National Inpatient Sample (2005-2017) data to identify adult patients admitted with STEMI as the primary diagnosis. The secondary diagnosis was sudden cardiac arrest. Diabetes was used as comorbidity. The primary outcome was in-hospital death. Secondary outcomes included ventricular tachycardia (VT), ventricular fibrillation (VF), atrial fibrillation (AF), cardiogenic shock (CS), stroke, acute renal failure (ARF), and the revascularization strategy. Socioeconomic outcomes consisted of the length of stay (LoS) and total charges/stay.

Results:
The number of STEMI patients experiencing a SCA significantly increased from 2005 to 2017, and the mean age of participants decreased from 68 (11) to 66 (10) years old (p=0.003). While a temporal increase in risk factors was observed, mortality decreased from 65.7% to 48.6% (p<0.001). However, VT, VF, AF, CS, stroke, and ARF followed an upward trend. Compared to non-diabetic patients, those with diabetes were older and more likely to be females and blacks. They had a higher risk of mortality, ARF, and pacemaker requirements (adjusted OR = 1.72 [1.68-1.83], 1.52 [1.43-1.63], 1.19 [1.06-1.34], respectively), but not stroke, VT, VF or AF. Those patients were less likely to have PCI (OR = 0.70 [0.66-0.73] and more likely to have CABG (OR = 1.18 [1.07-1.30]). Total charges/stay increased by almost 2.5-fold in all STEMI patients who develop SCA, but diabetes was associated with higher charges; no difference in the LoS was noted.

Conclusion:
The recent temporal trend of SCA in patients with STEMI and diabetes shows a steady decline in mortality. Diabetes patients in STEMI patients who develop a SCA have a higher likelihood of mortality and other adverse outcomes when compared to those without diabetes.
Abstract 9582: Septin-4 Induces Cardiac Fibrosis After Pressure Overload
Authors: Yucel Dogacan
Published: June 2023

Introduction:
Under cardiac stress, the mammalian heart undergoes ventricular remodeling to maintain cardiac function. Although these remodeling changes are viewed as beneficial at first, they eventually lead to pathological fibrosis and apoptosis. The role of the small GTPase Septin-4 (Sept4) in regulating apoptosis and regeneration through survival of stem cells has been established in several organs. However, the role of Sept4 in the heart, an organ without stem cells, and a potential role in regulating the cardiac stress response is currently unknown.

Hypothesis:
Sept4 induces fibrosis and apoptosis in the mammalian heart after injury.

Methods:
10-week-old Sept4 knockout (KO) and wild type (WT) mice underwent transverse aortic constriction injury (TAC). Functional and molecular analyses on KO and WT hearts were done either at baseline, 1- or 4-weeks post-injury timepoints depending on the assay.

Results:
Cardiac function was comparable between KO and WT mice under homeostatic conditions. After TAC injury, ejection fraction and fractional shortening were decreased significantly in WT mice but maintained in KO mice. The level of cardiomyocyte apoptosis was lower in KO hearts after injury with reduced development of fibrosis compared with WT hearts. We performed transcriptomic and proteomic analyses showing that KO hearts exhibited reduced levels of ECM deposition under both baseline and post-injury conditions. Furthermore, KO hearts were more compliant and demonstrated enhanced diastolic function compared to WT hearts. Mechanistically, Sept4 deletion blunted TGF-B signaling and Postn expression in cardiac fibroblasts after injury. In cultured cardiac fibroblasts, both Sept4 knockout and knockdown significantly decreased fibroblast activation after TGF-B treatment.

Conclusions:
We identified Sept4 as a crucial regulator of ECM remodeling in the heart. Sept4 deletion leads to reduced levels of cardiac fibrosis and alleviation of pressure overload-induced cardiac dysfunction. Overall, our study highlights Sept4 as a potential target to prevent pathological fibrosis in the heart.
Abstract 9613: Short- and Long-Term Vascular Responses of Stent With Biodegradable Graft for Artery Dissection in Rabbit Iliac Model
Authors: Park Sang Min
Published: June 2023

Introduction:
Arterial dissection or rupture during percutaneous angioplasty is rare but can be lethal. We invented a balloon-expandable stent with a very thin membrane typed biodegradable graft for the treatment of arterial dissection (BioGard).

Hypothesis:
The efficacy and safety of BioGard were evaluated in the rabbit iliac artery rupture model. The devices would be helpful to seal the emergent blood extravasation due to arterial perforation and reduce unfavorable vascular events in long-term follow-up.

Method:
Twenty iliac arterial dissections by balloon over-inflation were induced under the guidance of angiography. Twelve rabbits with huge contrast extravasation to retroperitoneal space (Ellis type 3) were treated using BioGards. Serial histologic examinations and micro-computed tomography (CT) were performed at 1, 2, and 8 weeks and 3, 6, 9, and 12 months. Final angiography at 1 year was performed to evaluate any vascular complication.

Results:
There are no significant adverse cardiovascular events after one year of BioGard implantation. Micro-CT and follow-up angiography at one year revealed no case of significant in-stent restenosis and thrombotic occlusion in vivo. Early-stage histologic examination demonstrated that disrupted vessels were completely sealed up by BioGard with mural hematoma, inflammatory cell infiltration, and red thrombi. Mid- and long-term histologic examination revealed patent stents and neointimal coverage over the stents with biodegraded graft material and mild peri-strut area inflammatory response.

Conclusions:
Twelve months post-BioGard implantation in rabbit iliac artery dissections demonstrated good efficacy and safety. BioGard at a severely dissected artery would be an option for preventing lethal vascular events. Further clinical evaluation of this novel technology would be warranted.
Abstract 9624: Major Adverse Cardiac Events of PCSK9 Modulation by Monoclonal Antibodies vs Small Interfering Ribonucleic Acid Inhibitors. A Meta-Analysis of 92,775 Patients
Authors: Diaz Acevedo Jesus , Soto Mariana , Penaherrera Carlos , Castro Adela , Buitrago Andres F , Navas Viviana , Pino Jesus
Published: June 2023

Introduction:
Incliciran, a small interfering ribonucleic acid (siRNA), is the new modulator of the proprotein convertase subtilisin kexin 9 (PCSK9) that has proven safe and effective in reducing LDL-C and ASCVD. However, it is unclear if incliciran is superior to the already established PCSK9 monoclonal antibodies (mAb) in reducing major adverse cardiac events (MACE).

Methods:
We performed a meta-analysis of randomized controlled trials of patients with high cardiovascular risk who underwent PCSK9 inhibition by either mAb or siRNA. The primary outcome was the reduction of MACE.

Results:
Thirty RCTs with a total of 92,775 patients were included. For patients with a high cardiovascular risk profile, the modulation of PCSK9 by mAb decreases the risk of MACE (HR 0.84, 95% CI 0.8 - 0.89, p<0.0001) compared with statins and/or ezetimibe. Similar effects occurred when siRNA (HR 0.78, 95% CI 0.63 - 0.97, p=0.024) was compared to statins alone. The impact on MACE was no different between mAb and siRNA modulation of PCSK9 (p=0.49) (figure 1). When PCSK9 inhibitors were compared to statins monotherapy, only evolocumab and incliciran were statistically significant in reducing MACE (p<0.0001 and p=0.024, respectively). An additional analysis of all studies, including those with statins plus ezetimibe, showed that all therapies except bococicimab (p=0.309) reduced MACE (figure 2).

Conclusions:
This study suggests that PCSK9 inhibition by siRNA is as effective as mAb PCSK9 for reducing MACE in patients with a high cardiovascular risk profile, with the convenience of being administered twice a year.