bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 11817: Calculating Aortic Root Z- Scores With Ideal Body Weight Reclassifies Risk in Overweight and Obese Patients
Authors: Ghosalkar Radhika , John Kevin , Li Jing , Steinhauer Rachael , Wessler Benjamin S , Patel Ayan R , Downey Brian C
Published: December 2023

Introduction:
Indexing transthoracic echocardiography (TTE) aortic root diameter (AoR diam) measurements using body surface area (BSA) is important in children and small adults in whom non-indexed values may under detect dilation. However, the commonly used formula for expected AoR diam uses actual body weight, which may bias results in obese adults as AoR diam does not increase with body weight. Z-scores compare a patient’s AoR diam relative to an age, size, and sex specific population mean such that z- score = (observed AoR diam - expected AoR diam) /0.261. A normal AoR diam z-score is -2 ≤ z-score ≤2.

Hypothesis:
We hypothesize that using ideal body weight (IBW) in place of actual weight when calculating z-score reclassifies a significant proportion of overweight and obese patients with z-score < 2 to z-score ≥2.

Methods:
We performed a retrospective review of all patients with a TTE at Tufts Medical Center in 2022 and Ao root diam ≥ 4 cm. We excluded patients < 20 years old and those with inadequate TTE images or missing aortic measurements. Expected AoR diam and z-scores were calculated using both actual weight and IBW. A z-score difference, z
diff
= z
actual weight
- z
ideal weight
, was calculated.

Results:
485 patients met our study criteria with a subset of 352 patients with BMI ≥ 25. The z
diff
was significantly different from zero across all BMI groups (p = 0.0003) and in the subset with BMI ≥ 25 (p<0.001). 17.9% of patients with BMI ≥ 25 with z
actual weight
< 2 were reclassified to z
ideal weight
≥ 2 (p<0.001) compared with 2.2% of patients with BMI < 25 (p<0.001). Among AoR diam subgroups of 4 - 4.5 cm, > 4.5 - 5 cm, and > 5 cm, all reclassification occurred in the 4 - 4.5 cm group. Within the 4 - 4.5 cm group, 24.1% of patients with z
actual weight
< 2 reclassified to z
ideal weight
≥ 2.

Conclusions:
Compared to current methods using actual weight, the use of IBW to calculate Ao root z-scores reclassifies nearly 2 in 10 patients with BMI ≥ 25 to Ao root dilation. Among patients with Ao root diam of 4 - 4.5 cm, nearly 1 in 4 are reclassified as dilated by z-scores calculated with IBW. Such reclassification would impact clinical decisions about increased surveillance and/or treatment. Further studies are needed to determine the optimal approach to indexing Ao root size and the implications for management.
Abstract 11836: A Rare Cause of Recurrent Myocardial Infarction: Genetic Testing Cracks the Case
Authors: Bostrom John A , Pande Ashvin N , Ruberg Frederick , Siddiqi Omar , Kopach Pavel , Ko Darae , Ahluwalia Monica
Published: December 2023

A 29-year-old man presented to our institution with acute, severe substernal chest pain. An ECG on arrival revealed 3mm ST-elevations in the lateral leads with reciprocal depressions in the inferior leads. Troponin-I was above assay (>50 ng/mL). Emergent coronary angiography showed normal coronary arteries, and left ventriculogram showed no wall motion abnormalities. A transthoracic echocardiogram showed normal biventricular size, wall thickness, and ejection fraction (EF). This was his fifth episode of chest pain over the past 10 years, consistent with prior presentations of ST-elevation myocardial infarction and angiographically normal coronary arteries. A prior cardiac magnetic resonance imaging (MRI, 6 years before the current presentation) revealed increased T2 signal intensity and subepicardial late gadolinium enhancement (LGE) in the septum, inferior, and inferolateral walls, suggestive of nonischemic acute myocardial injury. A repeat cardiac MRI during the current presentation showed mildly reduced biventricular systolic function (LVEF 52%, RVEF 36%), and again showed increased T2 signal intensity and subepicardial LGE involving the septum, inferior and inferolateral walls. The anterior and anterolateral walls were also now involved. Endomyocardial biopsy (EMB) showed focal interstitial fibrosis with no evidence of active myocarditis. On telemetry he was noted to have runs of non-sustained ventricular tachycardia (NSVT). Serologic evaluation was negative for parvovirus, cytomegalovirus, and Chagas disease. Erythrocyte sedimentation rate and C-reactive protein levels were normal. Genetic testing was performed at our newly established cardiovascular genetics program, which showed a pathogenic truncating mutation in the desmoplakin gene (DSP). DSP cardiomyopathy (CM) is an LV-predominant arrhythmogenic CM, which can present with episodic myocardial injury, and has a high disposition for ventricular arrhythmias with subepicardial LGE pattern often proceeding LV systolic dysfunction. A primary prevention implantable cardioverter-defibrillator was placed given extent of LGE and NSVT burden in the context of DSP variant. This case illustrates the importance of genetic testing in identifying rare CM phenotypes.
Abstract 11896: Contribution of Amino Acid Transporter SLC7A5 to Pathological Ventricular Hypertrophy and Heart Failure
Authors: Inserte Javier , Delgado Sara , Aluja David , Miro Elisabet , Ferreira Ignacio , Barrabes Jose A
Published: December 2023

Introduction:
Transition from compensatory to pathological ventricular hypertrophy and heart failure (HF) is associated with metabolic remodeling. It has been described that hypoxia signaling induces the expression of the amino acid (AA) transporter SLC7A5 (LAT1) and the activation of its downstream pro-hypertrophic target mTORC1.

Hypothesis:
Chronic pathologic stimuli induce AA metabolism reprogramming comprising increased AA transport through LAT1, which plays a key role in the development of hypertrophy and its progression to HF.

Methods:
C57BL/6N mice were subjected to chronic pressure overload by constriction of the aorta (TAC). The selective LAT1 inhibitor JPH203 was chronically administered (ip) after TAC surgery. Dynamics of leucine were determined in heart samples from mice treated with 13C,15N-leucine using LC-MS/MS. Microarray-based gene expression profile, echocardiographic data, and markers of cardiac remodeling were measured at different time points.

Results:
Microarray results showed a profound AA metabolism remodeling consisting of a general increase in the expression of AA transporters, with LAT1 as the most overexpressed and reduced expression of enzymes involved in BCAA catabolism. Overexpression of LAT1 was confirmed in isolated cardiomyocytes. These changes correlated with a marked increase in labeled leucine uptake with respect to sham mice (310%), a moderate reduction in the formation of its ketoacid (51% α-ketoisocaproate), and potent inhibition of its catabolism (21% isovalerate and 13% 3-hydroxy-3-methyl-glutarate), and enhanced activation of mTOR pathway. Administration of JPH203 reduced leucine transport and mTOR activation, partially reversed the inhibition of BCAA catabolism, and attenuated hypertrophy and cardiac dysfunction induced by TAC.

Conclusions:
Pressure overload induces AA metabolic reprogramming characterized by enhanced AA transport and inhibited BCAA catabolism. LAT1 overexpression occurs in cardiomyocytes and contributes to adverse cardiac remodeling via mTOR pathway activation. We propose LAT1 inhibition as a novel therapeutic strategy against HF.
Abstract 11900: Potassium Magnesium Citrate is Superior to Potassium Chloride in Reversing Metabolic Side Effects of Chlorthalidone
Authors: Vongpatanasin Wanpen , Giacona John M , Pittman Danielle , Murillo Ashley , Khan Ghazi , Wang Jijia , Ren Jimin , Moe Orson W , Pak Charles
Published: December 2023

Thiazide-type diuretics (TD) are the first-line treatment of hypertension in many guidelines because of its consistent benefit in lowering BP and cardiovascular risk. TD is also known to cause excess risk of diabetes mellitus (DM), which may limit its long-term use. Although hypokalemia was thought to be the main mechanism of TD-induced dysglycemia, potassium (K) supplementation alone does not consistently prevent TD-induced elevation in fasting plasma glucose (FPG). In addition to reducing serum K, TD triggers magnesium (Mg) depletion. However, it is unknown if Mg supplementation attenuates metabolic side effects of TD. Accordingly, we conducted a randomized double-blinded clinical trial in 60 hypertensive patients without DM to compare effects of KCl (40 meq daily) vs. KMgCitrate (Cit) powder containing identical amount of K, 20 meq of Mg, and 74 meq of Cit daily during chlorthalidone (CTD) treatment. Each patient received CTD alone (25 mg/day) for 3 weeks prior to randomization. The primary endpoint was the change in FPG after 4-month of treatment from baseline (CTD alone) after adjusting for baseline FPG as a covariate. The mean age of subjects was 59±11 years (45% Female, 30% Black participants). We found that CTD induced a significant rise in FPG, insulin, and a significant fall in serum K and 24-h urinary citrate excretion (all p < 0.05). We found that KMgCit significantly increased serum K, 24-hour urinary Mg, and 24-hour urinary Cit excretion; and attenuated the rise in FPG which was not observed with KCl (Figure 1 A-C). There were no significant differences in liver fat by MRI or fasting plasma insulin between the 2 groups. In conclusion, our study showed beneficial effects of magnesium supplementation in maintaining serum K and reversing effects CTD on plasma glucose, which may improve safety profile and optimize long-term cardiovascular outcomes in hypertensive patients.
Abstract 11912: Temporal Trends in the Incidence of Non-Shockable In-Hospital Cardiac Arrest in Septic Patients
Authors: Pasha Arham , Ashraf Muddasir , Jahangir Arshad
Published: December 2023

Background:
Owing to increased awareness of the timely recognition and treatment of sepsis in the USA, sepsis care has improved over time with better outcomes.

Hypothesis:
We hypothesized that the incidence of non-shockable in-hospital cardiac arrest (IHCA) has also improved over time with improving sepsis care.

Aims:
The primary objective was to evaluate temporal trends of non-shockable IHCA in septic patients. The secondary objective was to evaluate these trends stratified by age, sex, and race.

Methods:
Using the National Inpatient Sample, we studied all adult patients hospitalized with sepsis from 2005 to 2019. We used multivariate logistic regression for trend analysis.

Results:
Of 26 million adult patients admitted with sepsis from 2005 to 2019 in the USA, with a mean age of 66 ±0.043 years, 50% were females. The mean age decreased from 68 years in 2005 to 65 years in 2019. The risk-adjusted rates of non-shockable IHCA in septic patients decreased from 2.4% in 2005 to 1.1% in 2019 (Figure 1, Panel A) after accounting for differences in age, sex, and comorbidity burden. The risk-adjusted rates were highest in the age group 45-64 and lowest in the oldest age group ≥85 years (Panel B). Furthermore, the sex-stratified analysis showed consistently higher rates of non-shockable IHCA in males than in females throughout our study (Panel C). Finally, the risk-adjusted rates of non-shockable IHCA were consistently highest in Black patients compared to other races throughout our study period (Panel D).

Conclusions:
The incidence of non-shockable IHCA in septic patients has significantly improved with increased awareness and improved care of sepsis. Initiatives like Surviving Sepsis Campaign need continued implementation in hospitals, with constant monitoring of compliance with these guidelines to further improve the incidence of non-shockable IHCA in septic patients.
Abstract 11916: An Elusive and Unusual Diagnosis of Cardiac Sarcoidosis
Authors: Kapcin Kyle , Johnston Alexandra
Published: December 2023

Introduction:
Cardiac sarcoidosis (CS) can present heterogeneously; presentations are often related to conduction system abnormalities in the form of AV block or ventricular arrhythmia, or heart failure. There are not yet widely accepted diagnostic guidelines for CS although diagnostic pathways such as the Japanese Ministry of Health and Welfare and the Heart Rhythm Society criteria exist.

Methods:
A 65 year old female with a history of hypertension, HFpEF, CAD with remote DES to RCA, CKD3a, Obesity and biopsy proven pulmonary sarcoidosis presented with 3 days of sudden onset dyspnea and hypoxia. Labs included aa pro-BNP of 16,754 pg/mL (0-299) and high-sensitivity troponin of 35 ng/L (0-14). EKG showed sinus rhythm with left axis and QTc of 499 ms. Chest Xray revealed pulmonary edema consistent with heart failure exacerbation Echocardiogram revealed EF 60-64%, normal LV and RV wall motion and thickness, and GLS of-17.2%. Left heart catheterization revealed patent RCA stent and non-obstructive CAD. She was diuresed to euvolemic state. Inpatient cardiac monitoring, repeat EKGs, and an 8 day holter monitor showed no arrhythmia or conduction abnormality. Although clinical suspicion for CS was low due lack of arrhythmia, preserved EF and several independent risk factors for HFpEF. FDG-PET was performed to rule out CS and revealed defects in basal anteroseptal and apical lateral regions consistent with sarcoid related fibrosis (Figure 1). Disseminated disease was seen in mediastinal and splenic regions. The patient was started on prednisone and methotrexate therapy for immunosuppressive treatment of CS.

Conclusions:
In patients with known sarcoidosis, a high index of suspicion for CS is required due to lack of clear diagnostic guidelines. Although diagnostic criteria frequently highlight systolic heart failure and arrhythmias, CS can present in patients with HFpEF, and the presence of other risk factors for diastolic heart failure should not preclude CS investigation.
Abstract 11968: Association of Invasive Measures of Congestion With Short- and Long-Term Kidney Function Outcomes Among Patients With Acute Decompensated Heart Failure
Authors: Moises Amanda I , Tighiouart Hocine , Oka Tatsufumi , Tuttle Marcelle , Banlengchit Run , Sarnak Hannah , Ferguson Katie , Testani Jeffrey M , Kiernan Michael S , Sarnak Mark J , McCallum Wendy
Published: December 2023

Background:
Reduced kidney function as evaluated by estimated glomerular filtration rate (eGFR) is a powerful risk factor for adverse outcomes among patients with acute decompensated heart failure (ADHF). Mechanisms for eGFR declines remain unclear. Studies evaluating congestion as a risk factor have been inconsistent.

Hypothesis:
Greater degree of congestion in patients with ADHF is associated with worse short- and long-term kidney function.

Methods:
We examined patients admitted for ADHF who required right heart catheterization from 2015-2021. Initial CVP and PCWP were used as measures of right- and left-sided congestion, respectively. Restricted cubic splines and linear mixed models for eGFR slopes were used to examine the relation between CVP and PCWP with baseline eGFR and in-hospital eGFR slope. End stage renal disease (ESRD) events were obtained from linkage to the US Renal Data System. Cox proportional hazards regression models were used to examine the relation of CVP and PCWP with mortality and ESRD.

Results:
Among 755 patients, the mean (SD) age and baseline eGFR were 62 (14) years and 58 (27) ml/min/1.73m
2
respectively. 440 (58%) required inotropes during hospitalization. Initial mean (SD) CVP and PCWP were 13.4 (6.6) and 23.4 (8.7) mmHg, respectively. Higher initial CVP and PCWP were significantly associated with lower baseline eGFR and in-hospital eGFR decline (Figure). Over median follow-up of 30 (IQR 10, 56) months, 62 (8.2%) reached ESRD and 264 (35%) died. In multivariable models, higher CVP and PCWP were each associated with increased risk for ESRD (HR [95%CI] per 1 SD higher CVP or PCWP were 1.49 [1.17, 1.91]; 1.30 [1.04, 1.64] respectively). Models were repeated with death as a competing event for ESRD and associations remained largely consistent (sHR 1.36 [1.03, 1.81] for CVP; sHR 1.25 [0.99, 1.57] for PCWP).

Conclusion:
Congestion is associated with lower baseline kidney function, greater acute declines in kidney function and increased risk of ESRD.
Abstract 12000: Prolonged Arterial Phase is Caused of the Chest Pain in Takotsubo Cardiomyopathy A Dynamics Angiography and Artificial Intelligence Analysis
Authors: Vu LOC , Ho Dung , Vu Vu H , Nguyen Duc Chinh D , Tran Duc M , Le Anh D , Nguyen Hien Q , Le Trang , Mai Minh Q , Nguyen Thach N
Published: December 2023

Introduction:
Takotsubo Cardiomyopathy (TCM) known as “Broken Heart Syndrome” is triggered by extreme emotional or physical stress. The typical TCM patient features chest pain, ST elevation, elevated troponin, reduced ejection fraction (EF), patent coronary artery, and apical ballooning.

Hypothesis:
Could abnormal coronary flow explain chest pain in Takotsubo patients?

Methods:
The patient with severe chest pain, elevated troponin, ST change, patent coronary arteries, and apical ballooning underwent angiography and review with a new dynamic recording technique. Ten patients without ACS, normal EF, and no coronary artery disease served as control. At first, the angiographic recording started when the contrast was injected into the coronary artery. Then the recording continued with the blood in white color moving in until all contrast disappeared from the arteries. The angiogram was recorded at 15 images per second. The review of coronary images focused on the blood flow in white on top of a background of black contrast. The arterial phase (AP) calculation began when the blood moved in and ended when all the contrast was flushed out of the distal arterial vasculature. The two-layer artificial intelligence program was built based on U-net and Densenet-121. The first layer, with a segmentation model and Convolutional neural network is responsible for detecting the starting frame of AP with a full index of contrast. The second layer with a segmentation model will detect the ending frame of AP. All TCM patient was followed up in one year.

Results:
Fifteen TCM patients met the criteria (12/15 female). The AP in the TCM group was 3.17 +/- 0.53 seconds compared with 1.62 +/- 0.26 seconds in the control group (P<0.001). The TCM group had a mean EF 33.9 +/- 7.6 %, and all recovered to 58.8 +/- 12.6 % after two weeks. At one year follow-up, all patients had no chest pain and no re-admission, except for one case of non-cardiovascular mortality associated with septic shock from pneumonia 3 months after the index event.

Conclusions:
Chest pain in TCM was caused by slow flow (measured as prolonged arterial phase) which was detrimental to myocardial contraction. Their prognosis was benign because all patients recovered.
Abstract 12022: Transcatheter Aortic Valve Implantation Wait-Time Management: Derivation and Validation of the Canadian TAVI Triage Tool (CAN3T)
Authors: Miranda Rafael N , Qiu Feng , Manoragavan Ragavie , Austin Peter , Naimark David , Fremes Stephen E , Ko Dennis T , Madan Mina , Mamas Mamas , Sud Maneesh , Tam Derrick , Wijeysundera Harindra C
Published: December 2023

Introduction:
Transcatheter aortic valve implantation (TAVI) for patients with aortic stenosis has seen indication expansion and exponential growth in demand over the last decade. In many jurisdictions the growing demand outpaced capacity, increasing wait-times and pre-procedural adverse events.

Objective:
To derive prediction models that estimate the risk of adverse events on the waitlist that would inform the development of a triage tool for use by clinicians to identify patients who should be prioritized for TAVI.

Methods:
We conducted an observational retrospective cohort study using population-based administrative data from Ontario, Canada. Adult patients referred for TAVI from April 1
st
, 2012 to March 31
st
, 2020 were included and followed-up to the first of: death, TAVI procedure, removal from waitlist, or end of the observation period. We used competing risk subdistributions hazards models to find significant predictors for each of the following outcomes: (1) all-cause death while on the waitlist, (2) all-cause hospitalization while on the waitlist, (3) receipt of urgent TAVI, and (4) a composite of outcomes 1-3. The median predicted risk in our population at 12 weeks was chosen as a threshold for a maximum acceptable risk while on the waitlist, and was incorporated in the triage tool to recommend individualized wait-times.

Results:
We included 13,128 patients in the analyses. 586 (4.46%) patients died on the waitlist, and 4,343 (33.08%) had at least one all-cause hospitalization. 6,854 TAVIs were completed, of which 1,135 (16.56%) were urgent procedures. We were able to create parsimonious models for each outcome that included clinically relevant predictors. Optimism-corrected C-statistics varied from 0.63 to 0.75, optimism-corrected Brier scores from 0.03 to 0.19, and the calibration slopes from 0.79 to 0.99.

Conclusions:
We developed the Canadian TAVI Triage Tool (CAN3T), a triage tool to assist clinicians in the prioritization of patients who should have timely access to TAVI. We anticipate that the CAN3T will be a valuable support tool for patients and clinicians, with the potential of bringing meaningful changes to the health system as it may improve equity in access to care, reduce preventable adverse events and improve system efficiency.
Abstract 12025: Utility of Intracardiac Echocardiography for Prosthetic Valve Infective Endocarditis and Cardiovascular Device-Related Infection: A Contemporary Systematic Review
Authors: Sanchez-Nadales Alejandro , Cedeño Juan , Sonnino Alice , Sarkar Abdullah , Asher Craig R , Xu Bo
Published: December 2023

Introduction:
Infective endocarditis (IE), particularly prosthetic valve endocarditis (PVE) and cardiac device-related endocarditis (CDIE), presents significant diagnostic challenges. The efficacy of intra-cardiac echocardiography (ICE) for diagnosing IE and assessing intra-cardiac infections when transesophageal echocardiography (TEE) is contraindicated, is not extensively studied.

Methods:
We searched six databases, including PubMed, Embase, Scopus, Ovid, Science Direct, and Web of Science, for articles published between September 2002 and November 2022, related to the utility of ICE in IE. Eligibility screening followed the search.

Results:
From the 12 identified studies discussing ICE for IE diagnosis, ten cases of IE were highlighted in nine reports, and three cohort studies included 236 patients without individual patient details. ICE was not used in any native valve IE case. Predominantly male patients (90%) had a median age of 42 years, developing endocarditis 2.5 years post initial cardiac procedure. The most common microorganisms identified were Staphylococcus species. ICE proved beneficial in various scenarios, particularly PVE and CDIE, especially when echocardiography studies were inconclusive or contraindicated. As an alternative to TEE, ICE offers clear visualization of right heart structure, guiding interventions such as pacemaker lead extractions. It excels in detecting device lead abnormalities and small vegetations in CDIE cases, supporting risk stratification and preparation for infected device extraction. Notably, all PVE cases involved bioprosthetic valves, affecting various heart structures and valves.

Conclusion:
This systematic review highlights ICE as an adjunct imaging modality in IE, especially in PVE and CDIE when TEE is contraindicated. Preliminary data suggest its valuable role during intracardiac lead extractions.
Abstract 12039: Association Between Idiopathic Thrombocytopenic Purpura and Risk of Hemorrhagic Stroke: A Nationwide Inpatient Sample Study
Authors: Patel Aamir , Hashemzadeh Mehrnoosh , Guntu Rachna
Published: December 2023

Background:
Strokes are a major cause of morbidity and mortality worldwide. Low platelet counts are a known risk factor for hemorrhagic stroke, but the association between idiopathic thrombocytopenic purpura (ITP) and different types of strokes remains unclear.

Objective:
To investigate the impact of ITP on the prevalence of different types of strokes using the Nationwide Inpatient Sample (NIS) database.

Methods:
We analyzed data from 382,170,108 patients, including 535,602 patients with ITP, from the NIS database. We compared the prevalence of hemorrhagic and non-hemorrhagic strokes between patients with and without ITP.

Results:
From 2005 to 2014, hemorrhagic stroke occurred in 0.7% to 1.6% of ITP patients compared to 0.4% to 0.6% of patients without ITP. The odds ratio for hemorrhagic stroke in ITP patients was 1.75-2.19, with a statistically significant association in all ten years. Multivariate analysis adjusted for gender, age, race, and hypertension confirmed the positive association between ITP and hemorrhagic stroke across all ten years.

Conclusion:
Our study provides evidence of a positive association between ITP and hemorrhagic stroke, highlighting the need for increased vigilance in managing patients with ITP. The findings have important implications for clinical practice and suggest the need for further studies to elucidate the mechanisms underlying this association.
Abstract 12052: Association Between the Shock Index on Admission and In-Hospital Mortality in the Cardiac Intensive Care Unit
Authors: Padkins Mitchell , Kashani Kianoush , Tabi Meir , Gajic Ognjen , Jentzer Jacob C
Published: December 2023

Introduction:
An elevated shock index (SI) predicts worse outcomes in multiple clinical arenas. We aimed to determine whether the SI can aid in mortality risk stratification in unselected CICU patients.

Methods:
We included admissions to the Mayo Clinic from 2007 to 2015 and stratified them based on admission SI, defined as heart rate divided by systolic blood pressure. The primary outcome was in-hospital mortality, and predictors of in-hospital mortality were analyzed using multivariable logistic regression.

Results:
We included 9,939 unique CICU patients with available data for SI. The mean age was 69 years old (37% female). Median HR, SBP, and shock index for our cohort were 79 beats per minute (BPM), 121 mmHg, and 0.65 BPM/mmHg, respectively. Patients were grouped by SI as follows: < 0.6, 3,973 (40%); 0.6-0.99, 4,810 (48%); and ≥ 1.0, 1,156 (12%). After multivariable adjustment, both HR (adjusted OR 1.06 per 10 BPM higher; CI 1.02-1.10; p-value 0.005) and SBP (adjusted OR 0.94 per 10 mmHg higher; CI 0.90-0.97; p-value < 0.001) remained associated with higher in-hospital mortality. As SI increased there was an incremental increase in in-hospital mortality (adjusted OR 1.07 per 0.1 BPM/mmHg higher, CI 1.04-1.10, p-Value < 0.001). A higher SI was associated with increased mortality across all examined admission diagnoses, including acute coronary syndromes, heart failure, and cardiogenic shock.

Conclusions:
The SI is a simple and universally available bedside marker that can be used at the time of admission to predict in-hospital mortality in CICU patients across a variety of cardiac conditions.
Abstract 12091: Actual Management of Venous Thromboembolism Complicated by Antiphospholipid Antibody Syndrome in Japan. From the Command VTE Registry-2
Authors: Kuno Takahiro , Koitabashi Norimichi , Ohyama Yoshiaki , Takama Noriaki , Chatani Ryuki , kaneda kazuhisa , Nishimoto Yuji , Ikeda Nobutaka , Kobayashi Yohei , Yamashita Yugo , Ishii Hideki
Published: December 2023

Background:
Venous thromboembolism (VTE) complicated with antiphospholipid antibody syndrome (APS) requires long-term anticoagulation to prevent the recurrent thrombosis. Direct oral anticoagulants (DOACs) have been widely used for VTE, but the guideline recommendations for their use are less favorable for APS-complicated VTE. There are no reports on the actual practice of APS complicated VTE in Japan in the DOAC era. So we investigated the actual practice and prognosis in APS-associated VTE, particulary with regard to the use of DOACs.

Methods:
COMMAND VTE Registry-2 is a multicenter registry enrolling 5,197 consecutive acute symptomatic VTE patients among 31 centers in Japan between January 2015 and August 2020. In this cohort, we examined the differences in actual VTE practice between patients with and without APS.

Results:
The current study population consisted of 83 APS-complicated VTE (mean age, 55; 53 male patients [63.9%]), and 5,114 VTE patients without APS (mean age, 68; 3010 male patients [58.9%]). Compared with patients without (w/o) APS, those with (w/) APS were more likely to have proximal deep vein thrombosis (DVT) than distal DVT, but the rate of pulmonary embolism was comparable. There was no difference in the rate DOAC use between patients w/[74.7%] and w/oAPS [79.5%]. All-cause mortality was significantly lower in the APS group (w/APS 6 [7.2%]; w/oAPS 1317 [25.8%]), VTE recurrence rates were similar (w/APS 8 [9.6%]; w/oAPS 275 [5.4%]), and the interval to VTE recurrence was significantly longer in the APS group (median: w/APS, 1050 days; w/oAPS 724 days). Major bleeding event rate was comparable (w/APS 8 [9.6%]; w/oAPS 462 [9.0%]).

Conclusions:
DOACs were used equally in long-term anticoagulation of VTE complicated with APS compared with VTE without APS, with better outcome.
Abstract 12105: Cardioprotective Effect of Antiviral Therapy Among Hepatitis C Infected Patients: A Meta-Analysis
Authors: Jaiswal Vikash , Jaiswal Akash , Hanif Muhammad , Ang Song Peng , Shrestha abhigan babu , Jha Mayank , Halder Anupam , Nasir Yusra , Chia Jia Ee E , Rajak Kripa , Patel Nirmit , Iturburu Alisson
Published: December 2023

Background:
Hepatitis C (HCV) infections have been shown to be associated with a higher risk of atherosclerotic cardiovascular disease (CVD). However, the use of antiviral therapy (AVT) and the risk of CVD has not been well established with limited literature.

Objective:
We sought to evaluate the association between AVT use post-HCV infection and cardiovascular outcomes.

Methods:
We performed a systematic literature search using PubMed, Embase, and Scopus for relevant articles from inception until 10th March 2023. Primary clinical outcomes were the incidence of any CVD. Secondary endpoints were all-cause of mortality, stroke, myocardial infarction, peripheral artery disease, and heart failure.

Results:
A total of 394,452 patients were included in the analysis (111,076 in the AVT group and 283376 patients in the NAVT group). The mean age of patients among AVT and NAVT groups was comparable (58.7 vs. 58.18). The pooled analysis of primary outcomes showed that AVT was associated with a significantly reduced risk of any CVD (HR, 0.55(95%CI: 0.41-0.75), P<0.001) compared with the NAVT group of patients. Secondary outcomes including ACM (HR, 0.38(95%CI: 0.32-0.46), P<0.001), MI (HR, 0.62(95%CI: 0.41-0.94), P=0.02), and PAD (HR, 0.62(95%CI: 0.41-0.93), P=0.02) were significantly lower among AVT groups compared with NAVT groups of patients with HCV infection. However, the risk of stroke was comparable between both groups of patients (HR, 0.79(95%CI: 0.58-1.07), P=0.13).

Conclusion:
Our analysis shows HCV-infected patients post-AVT have a significantly lower risk of any CVD, MI, ACM, and PAD compared with NAVT groups of patients.
Abstract 12145: Intraoperative Anemia Mediates Sex Disparity in Operative Mortality After Coronary Artery Bypass Grafting
Authors: Harik Lamia , Habib Robert , Dimagli Arnaldo , Rahouma Mohamed , PEREZGROVAS OLARIA ROBERTO , Soletti Giovanni , Alzhgari Talal , An Kevin , Rong Lisa Q , Sandner Sigrid , Bairey Merz C Noel N , Redfors Björn , Girardi Leonard N , Gaudino Mario F
Published: December 2023

Introduction:
Women undergoing coronary artery bypass grafting (CABG) have higher mortality compared with men, yet its drivers are unclear.

Hypothesis:
The association of female sex with the risk of operative mortality after CABG may be mediated by intraoperative anemia.

Aim:
To investigate the relationship between sex, intraoperative anemia, and operative mortality.

Methods:
Retrospective cohort study of 1,434,225 isolated primary CABG patients (344,357 women) from the Adult Cardiac Surgery Database of the Society of Thoracic Surgeons (2011-2022). The primary outcome was operative mortality. The attributable risk (AR, quantifying the risk-adjusted strength of the association of female sex with CABG outcomes) was calculated. Causal mediation analysis adjusted for 42 baseline risk factors was used to derive the total effect of female sex on mortality risk and the proportion of that effect mediated by intraoperative anemia (nadir hematocrit). Spline regression evaluated the relationship of operative mortality and nadir intraoperative hematocrit.

Results:
Women had lower median preoperative hematocrit (36.9%, interquartile range [IQR] 33.3-40.0 vs 41.0% [37.4-44.0], standardized mean difference [SMD] 74.0%) and nadir intraoperative hematocrit (22.0% [20.0-25.0] vs 27.0% [24.0-30.0], SMD 97.0%) compared with men. Women had higher operative mortality than men (2.8% vs 1.7%, p<0.001, adjusted odds ratio 1.36, 95% confidence interval [CI] 1.30-1.41). The AR of female sex for operative mortality was 1.21 (95% CI 1.17-1.24). After adjusting for nadir intraoperative hematocrit, the AR was reduced by 43% (1.12, 95% CI 1.09-1.16). Intraoperative anemia mediated 38.5% of the increased mortality risk associated with female sex (95% CI 32.3-44.7%). Spline regression showed a stronger association between operative mortality and nadir intraoperative hematocrit at hematocrit values below 22.0% (p<0.001).

Conclusions:
The association of female sex with increased CABG operative mortality is mediated to a large extent by intraoperative anemia. Avoiding nadir intraoperative hematocrit values below 22.0% may reduce sex differences in CABG operative mortality.
Abstract 12161: Trends in Age, Sex and Racial Differences in the Incidence of Infective Endocarditis in Florida and New York
Authors: Anuforo Anderson C , Aneni Ehimen , Akintoye Emmanuel O , Anikpezie Nnabuchi , Patel Smit D , Soipe Ayorinde , Olojakpoke Eloho H , Burke Devin , Latorre Gene , Khandelwal Priyank , Chaturvedi Seemant , Ovbiagele Bruce , Otite Fadar O
Published: December 2023

Introduction:
How the incidence of infective endocarditis (IE) changed in various demographic subgroups of the United States along with the worsening opioid epidemic over the last decade is unknown.

Methods:
This retrospective cohort study used data from the 2005-2018 State Inpatient Databases of Florida and New York. Cases of incident IE were combined with census data to compute age, sex- and race-specific incidence. Joinpoint regression was used to quantify the annualized percentage change (APC) in incidence over time.

Results:
Of 98,221 incident IE admissions, 70.0% were Non-Hispanic White (NHW) and 60.6% were ≥ 65 years old (yo). The average annual age and sex-standardized incidence of IE in cases/100,000 population was 19.2 (95%CI 18.7-19.6) but this varied by age, sex, and race. Incidence was ≈20% higher in men (20.9 [95%CI 20.2-21.7]) compared to women (17.5 [95%CI 16.8-18.2]) and increased with age in both sexes. Incidence was higher in Black: 22.5 (95%CI 21.0 - 23.9) vs NHW: 20.0 (95%CI 19.3 - 20.6), Hispanic: 13.2 (95%CI 12.3 -14.1) and Asian/Pacific Islander patients: 5.9 (95%CI 4.7 - 7.1). The age and sex-standardized incidence did not change over time (APC 0.5%, p=0.646). However, incidence increased in women 18-44 (APC 11.0%, p<0.001), men 18-44 (APC 7.3, p<0.001) and men 45-64 yo (APC 1.5%, p=0.002) but declined in women ≥ 65 yo(APC -2.8, p=0.049). Most of this increased incidence occurred in NHW women and men 18-44, NHW men 45-64 and Hispanic Men 18-44 yo (Figure 1). Incidence did not change over time in other age/sex groups. Prevalence of opioid use disorder increased by >2-fold in all age/sex groups over time but the pace of increase was faster in NHW women and men 18-44 yo compared to other races of similar demography (p-for-time interaction <0.001).

Conclusions:
Over the last decade, among residents of Florida and New York, incidence of IE increased in several demographic groups, but the most prominent rise was among young NHW patients, especially young NHW women.
Abstract 12199: Mid-Term Survival of Low-Risk Patients Treated With Transcatheter versus Surgical Aortic Valve Replacement: Meta-Analysis of Reconstructed Time-to-Event Data
Authors: Pompeu Sa Michel , Jacquemyn Xander , Van den Eynde Jef , Serna-Gallegos Derek , Chu Danny , Clavel Marie-Annick , Pibarot Philippe , Sultan Ibrahim
Published: December 2023

Background:
We performed a meta-analysis of reconstructed time-to-event data from randomized controlled trials (RCTs) and propensity-score matched (PSM) studies comparing transcatheter versus surgical aortic valve replacement (TAVR versus SAVR) to evaluate mid-term outcomes in patients considered low risk for SAVR.

Methods and Results:
Study-level meta-analysis of Kaplan-Meier-derived time-to-event of RCTs and PSM studies published by December 31, 2022. Eight studies (3 RCTs; 5 PSM studies) met our eligibility criteria and included 5,444 patients (2,639 patients underwent TAVR and 2,805 patients underwent SAVR). TAVR showed a higher risk of all-cause mortality at 8 years of follow-up [hazard ratio (HR) 1.22, 95% confidence interval (CI) 1.03-1.43, P=0.018]. Up to 2 years of follow-up, TAVR was not inferior to SAVR (HR 1.08, 95%CI 0.89-1.31, P=0.448); however, we observed a statistically significant difference after 2 years with higher mortality with TAVR (HR 1.51; 95% CI 1.14-2.00; P=0.004). This difference was driven by PSM studies; our sensitivity analysis showed a statistically significant difference between TAVR and SAVR when we included only PSM studies (HR 1.41, 95%CI 1.16-1.72, P=0.001), but no statistically significant difference when we included only RCTs (HR 0.89, 95%CI 0.69-1.16, P=0.398). At 8 years of follow-up after the primary intervention, the treatment difference in restricted mean survival time (RMST) is statistically significant, resulting in a benefit of 187.2 days (95% CI, 85.1-289.2, P<0.001) in the SAVR arm.

Conclusion:
In comparison with TAVR, SAVR appeared to be associated with improved survival beyond 2 years in low-risk patients. However, the survival benefit of SAVR was only observed in PSM studies and not in RCTs. The addition of data from ongoing RCTs as well as longer follow-up in previous RCTs will help to confirm if there is a difference in mid- and long-term survival between TAVR vs. SAVR in low-risk population.
Abstract 12210: Repeated Systolic Blood Pressure Measures During Intensive Treatment Show a Loss Of Protective Effect Over Time. A Secondary Analysis of the SPRINT Trial
Authors: Herrera-Sanchez Lyda M , Rueda-Ochoa Oscar L
Published: December 2023

Introduction:
The SPRINT trial showed a 25% reduction in the primary outcome with SBP intensive treatment using Cox proportional risk analysis. A recent secondary analysis by the SPRINT group assessed the post-trial maintenance of this protection by considering repeated SBP measurements and using a mixed linear regression model. They found that the intervention lost its protective effect post-trial, possibly due to the loss of intensive blood pressure control. Could this loss of protective effect also be found during the clinical trial, when considering repeated measurements of systolic blood pressure in the analysis?

Methods:
Secondary analysis of the SPRINT study database included 9,068 patients with repeated measures of SBP and complete baseline information. Cox proportional hazards and mixed linear models were used to analyze the primary endpoint and repeated SBP measures, respectively. A Cumulative Joint Model Analysis was conducted to combine the direct and indirect effects of the intervention on the primary outcome. R Studio V12.0 software was used for the analyses.

Results:
The protective effect is lost during the trial, both in the total population (3.4 years) as well as in subgroups such as women (1.1 years), patients with CVD (1.3 years), CKD (1.3 years), black patients (1.8 years), younger than 75 years (2.1 years) and in patients who present serious adverse events (3.4 years) compared to those who do not present SAEs (4.2 years). Beyond the loss of blood pressure control, other factors such as cumulative BP, adverse events, and the increase in SBP variability could be considered.

Conclusions:
Including repeated measures of SBP revealed a loss of protective effect in the intervention during the trial and generated Simpson's paradox. This highlights the need to consider alternative statistical methods in clinical trial analysis beyond Cox proportional hazard analysis for a comprehensive perspective on intervention efficacy.
Abstract 12226: Aging Impairs the Neuro-Vascular Interface in the Heart
Authors: Wagner Julian U , Tombor Lukas , Malacarne Pedro F , Manickam Nivethitha , Abplanalp Wesley T , John David , Buchmann Giulia Karolin K , Angendohr Stephan , Amin Ehsan , Scherschel Katharina , Nikolaj Klöcker , Kelm Malte , Schüttler Dominik , Clauss Sebastian , Guenther Stefan , Braun Thomas , Boettger Thomas , Baer Christian , Pham Minh-Duc , Krishnan Jaya , Hille Susanne S , Mueller Oliver , Bozoglu Tarik , Kupatt Christian , Nardini Eleonora , Osmanagic-Myers Selma , Meyer Christian , Zeiher Andreas M , Brandes Ralf P , Luxan Guillermo , Dimmeler Stefanie
Published: December 2023

Aging is a major risk factor for impaired cardiovascular function. The aging heart is characterized by vascular dysfunction, increased hypertrophy, fibrosis and electrophysiological alterations. However, the interaction between the different age-associated changes in cardiac remodelling is poorly define. Since vessels are aligned with nerves, and this interplay is critical for tissue homeostasis, we investigated whether an impairment of the neuro-vascular interface may contribute to age-associated pathologies in the heart.

We show that aging reduces sympathetic and sensory nerve fibers, which both align to arteries and arterioles. Aging induced a dysregulation of vascular-derived neuro-regulatory genes, especially the axon repellent factor Sema3A, which was augmented by 2.4±0.1-fold in old heart endothelial cells. Consistently, endothelial Sema3a overexpression reduced axon density in vivo, thus mimicking the observed aged heart phenotype. Since cellular senescence was induced at the same time point when nerve density declined (16 months of age) and senescence endothelial cells showed a higher expression of Sema3a, we hypothesized that endothelial senescence may contribute to cardiac denervation. Indeed, supernatants of senescent endothelial cells reduced neurite outgrowth in vitro in a Sema3A-dependent manner. In vivo studies further confirmed that endothelial-specific induction of senescence by overexpression of Progerin induced left ventricular denervation and induced Sema3a expression. By contrast, the pharmacological removal of senescent cells by the senolytic drugs dasatinib and quercetin rescued age-induced denervation and prevented the age-induced induction of endothelial Sema3a expression. Functional studies additionally demonstrated that endothelial senescence reduced heart rate variability, while senolytics preserved heart rate variability, restored age-associated declines in sympathetic and parasympathetic activity and reduced age-associated increase in arrhythmias.

These data suggest that senescence-associated regulation of neuro-regulatory genes in endothelial cells is associated with reduced nerve density and, thereby, contributes to age-associated cardiac dysfunction.
Abstract 12240: A Systematic Review and Network Meta-Analysis of Metastatic Hormone-Sensitive Prostate Cancer Therapy Cardiotoxicity
Authors: Aziz Moez K , Molony Donald , Smith Catrin T , Holder Travis , Mody-Bailey Neal , Brunckhorst Oliver , Magill Resa , Fatakdawala Mariya , Roland Jerry , Kostrzanowska Gabriela , Iacobucci Alexander Samuel , Zarker Andrew , Thames Emma , Swaby Justin , Xiao Daniel , Choi Lily , Owen Christopher , Galan Jacob , Sanchez Darren , Ranganath Shreyas , Gandaglia Giorgio , Howell Skyler , Koutroumpakis Efstratios , Ziaolhagh Ali , Ali Abdelrahman , Plana Juan C , Iliescu Cezar , Yusuf Wamique , Canfield Steven E
Published: December 2023

Introduction:
The European Association of Urology (EAU) guidelines consider efficacy and safety when recommending metastatic hormone sensitive prostate cancer (mHSPC) therapies but do not account for cardiotoxicity. For patients with low tumor burden ineligible for docetaxel, first-line therapies include androgen deprivation therapy (ADT) plus either apalutamide, enzalutamide, or abiraterone with prednisone.

Hypothesis:
We expect differences among first-line therapies for the five International Cardio-Oncology Society (IC-OS) cardiotoxicity domains: heart failure, myocarditis, vascular toxicity, hypertension, and arrhythmias.

Methods:
We searched Ovid Medline, Elsevier Embase, and the Cochrane Library for randomized clinical trials (RCTs) from inception until August 2022. Studies reporting at least one first-line therapy and cardiotoxicity domain were included. Network meta-analysis with a frequentist fixed-effect model was performed to estimate risk ratio (RR) and 95% confidence intervals (CI).

Results:
For heart failure and arrhythmias, 3 studies with 3376 patients were found with a similar placebo population treated with ADT alone (Figure 1). Four studies with 4526 patients were found assessing hypertension and vascular toxicity. Median follow-up times of studies ranged from 22.75 to 41.00 months. There were no statistically significant differences in heart failure, vascular toxicity, or arrhythmias. However, hypertension was significantly lower in patients treated with ADT plus apalutamide compared to ADT plus abiraterone with prednisone (RR 0.69, 95% CI 0.49 to 0.95). No studies reporting myocarditis were found.

Conclusions:
Apart from hypertension, no major differences in cardiotoxicity were found among mHSPC first line treatments. Therefore, when selecting therapy, clinicians can prioritize treatment efficacy over concerns regarding cardiotoxicity as long as blood pressure is appropriately controlled.
Abstract 12257: The Relationship Between Histological Features of Epicardial Adipose Tissue and Aortic Valve Calcification Assessed on Computed Tomography
Authors: Kitagawa Toshiro , Sentani Kazuhiro , Ikegami Yuki , Takahashi Shinya , Nakano Yukiko
Published: December 2023

Background:
It has been hypothesized that epicardial adipose tissue (EAT) biologically contributes to the pathogenesis of cardiac diseases. However, it remains unclear how EAT correlates with the progression of aortic valve calcification (AVC). We evaluated if histological features of EAT are specifically related to AVC assessed on computed tomography (CT).

Methods:
We enrolled 35 patients undergoing cardiac CT examination before elective cardiac surgery (coronary artery bypass graft [CABG] and/or cardiac valve surgery), in which AVC was detected on CT. Each patient was evaluated with EAT volume, coronary calcium score (CCS), AVC score, and the presence of high-risk coronary plaque (HRP) on CT. During each cardiac surgery, histological samples for immunohistochemistry were obtained from EATs adjacent to the left anterior descending and right coronary arteries. Each patient was assessed with the numbers of CD-68
+
and CD-11c
+
individual macrophages and osteocalcin
+
individual cells in a total of 6 random high-power fields (x400) of EAT samples.

Results:
In the histological findings of EAT, osteocalcin
+
cells showed a weak correlation with CD-68
+
macrophages (
r
= 0.40, p = 0.016) and a moderate correlation with CD-11c
+
macrophages (
r
= 0.60, p = 0.0001). The AVC score on CT correlated with CD-11c
+
macrophages and osteocalcin
+
cells in EAT (Fig 1), whereas CCS had no correlation with such histological findings. On multivariate analysis adjusted for age, sex, CABG vs. non-CABG, EAT volume, CCS, and the presence of HRP, the AVC score independently correlated with increased CD-11c
+
macrophages (β = 0.58; p = 0.0036) and osteocalcin
+
cells (β = 0.59; p = 0.0021) in EAT. Fig 2 shows representative cases with different levels of AVC and EAT histology.

Conclusions:
The inflammatory and osteogenic activity in EAT significantly correlate with the progression of AVC, which may indicate a specific contribution of EAT to aortic valve degeneration through biological activities.