bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 11889: Ischemic Evaluation in Patients Presenting With Advanced Atrioventricular Block - Experience From a Large County Health System
Authors: Kalsi Jasmeet K , alam mahboob , Liu Jing , Pickett June K , Suffredini John , Kayani Waleed T , Jia Xiaoming
Published: December 2023

Introduction:
Coronary artery disease (CAD) is a risk factor for advanced (2
nd
degree Mobitz II and 3
rd
degree) atrioventricular (AV) block.

Research Question:
While AV block in the setting of acute myocardial infarction (AMI) is often reversible, data is limited on utility of ischemic evaluation in advanced AV block without AMI.

Aim:
We assessed whether ischemic evaluation and revascularization was associated with reversibility of advanced AV block not in the setting of AMI.

Methods:
We queried the electronic medical records of a large county health system that serves the Houston metropolitan area for patients with diagnosis of advanced AV block between 1/1/2018 and 1/1/2022. Demographic, medical history, ischemic evaluation (by coronary catheterization or stress test) data and pacemaker interrogation reports were abstracted from the medical records. Patients with AV block from AMI were excluded.

Results:
Over a period of 4 years, there were 116 patients who presented with advanced AV block, of which 73 (62.9%) underwent ischemic evaluation either by coronary angiography or non-invasive imaging. Patients who underwent ischemic evaluation were associated with lower pacing burden on device interrogation compared to those with no ischemic evaluation (Table 1). In multivariable regression, ischemic evaluation was associated with lower odds of pacing burden >40% on device interrogation (OR -1.53, 95% CI -3.02, -0.03) but not AV block resolution (OR 0.41, 95% CI -1.76, 2.58). Of those who underwent ischemic evaluation, 26.0% had obstructive CAD, of which 78.9% underwent revascularization. AV block resolved in 13.3% who underwent revascularization.

Conclusion:
Among patients presenting with advanced AV block not in the setting of AMI, ischemic evaluation was associated with decreased pacing burden but not AV block resolution. In patients found to have obstructive CAD, a minority had resolution of AV block after revascularization.
Abstract 11891: Pulmonary Delivery of Novel BEPI/NO-Microparticle for Treatment of Pulmonary Arterial Hypertension
Authors: Jung Se Yong Y , Oh Yoogyeong , Kim Sanghoon , Hong Jinkee
Published: December 2023

Introduction:
Pulmonary arterial hypertension (PAH) is an incurable disease characterized by elevated blood pressure in the pulmonary artery causing right heart failure and even sudden cardiac death. Nitric oxide (NO) is a strong potent regulator of PAH. However, the therapeutic effects of exogenous NO depend on its concentration and its half-life is very short.

Hypothesis:
we prepared NO-releasing inhalers with controlled porous structures to modulate the deposition in lung.

Methods and Results:
NO-releasing inhalers with micro-sized pores showed improved nebulization efficiency. Furthermore, the cGMP expression and macrophage polarization were evaluated. The fluorescence intensity of Nile red was analyzed using photoluminescence spectroscopy to confirm the amounts of NO-MPs on the slide glass. As with confocal images, 0.8k BPEI/NO-MPs could arrive the lower region than 25k BPEI/NO-MPs. NO produced by endothelial nitric oxide synthase (eNOS) induce vasodilation by increasing cGMP in vascular smooth muscle cells. Hence, the delivery of NO mimicking the physical production of the endothelium in range of 0.05-0.4 nmol cm
-2
min
-1
is required to restore vascular homeostasis. Therefore, BPEI0.8k/NO-MPs release 0.277 nmol cm
-2
min
-1
of NO that mimics the environment in healthy endothelium, while BPEI25k/NO-MPs showed a higher concentration as 0.548 nmol cm
-2
min
-1
. BPEI0.8k/NO-MPs increased the synthesis of cGMP in cells, whereas BPEI25k/NO-MPs presented adverse effects due to an initial burst release. When cell populations were quantified, BPEI0.8k/NO-MPs increased the number of M2-like cells while decreasing the number of M1-like cells. Furthermore, using fluorescence activated cell sorting analysis, proteins and gene levels of cells, anti-inflammatory factors increased in BPEI0.8k/NO-MPs treatment groups

Conclusions:
novel BPEI/NO-releasing inhalers could deliver NO to deep lungs and has the potential for treatment of PAH
Abstract 11895: Efficacy of Maintaining Mean Aortic Pressure by Percutaneous Left Ventricular Assist Device for Hemodynamic Support in Ventricular Tachycardia Ablation - Relation to Cycle Length
Authors: Bernstein Hannah M , Fan Dali , Munir Bilal , Srivatsa Uma N
Published: December 2023

Introduction:
Percutaneous left ventricular assist device (pLVAD) has been used to maintain mean aortic pressure (MAP) during ventricular tachycardia (VT) ablation (ABL) and is a class II recommendation. We sought to assess the ability of pLVAD to maintain MAP and its relationship to VT cycle length (CL).

Methods:
All patients who underwent CA for VT with pLVAD support within a 3-year period were included. Type of pLVAD was determined by operator. Insertion of device was performed under fluoroscopy via femoral arterial sheath. Acute ablation success was defined as absence of inducible VT at end of procedure.

Results:
A total of 9 patients were included. Most patients had ischemic cardiomyopathy (Table 1); pLVAD was inserted prophylactically in 66.67% of patients and for refractory VT/VF storm in 22.2%. One patient was had critical AS and underwent balloon valvuloplasty prior to VT ablation. Impella CP was used in 78%, and Impella 2.5 in 22%, mean cardiac output was 2.9 + 0.5 L at mean P flow rate 7.3 + 1.3. CARTO was used in 89% and ESI Navx in 11% for electroanatomic/activation mapping. There were no instances of electromagnetic interference, despite the use of magnetic mapping system in all cases (CARTO in 8, Stereotaxis in 1). Mean PCWP was 17.88 + 10.12 pre-ablation vs 23.57 + 8.30 post-ablation (p=ns). There were 24 VTs, 42% were sustained, with a mean CL 342 + 80 msec, ranging from 223 to 558 msec. Mean MAP pre-ablation was 67.44
+
12.85 mmHg vs 61.86
+
13.27 post-ablation with absent negative correlation to VT CL (p=ns). There was no difference in MAP between VT Cl > 300 msec vs < 300 msec: 66 + 11 vs 59 + 14 mm Hg, (p=ns). Mean dose of phenylephrine was 452 mcg. pLVAD was removed at the end of procedure, there were no femoral site complications.

Conclusions:
pLVAD utilization maintains stable MAP even with faster VT cycle length in patients undergoing VT ABL under general anesthesia obviating need for high dose pressor support.
Abstract 11930: Using Implementation Science to Develop a Familial Hypercholesterolemia Screening Program in Primary Care: The CARE-FH Study
Authors: Jones Laney K , Romagnoli Katrina M , Schubert Tyler J , Clegg Katarina , Kirchner H Lester , Hu Yirui , Cawley Dylan , Norelli Victoria , Williams Marc S , Gidding Sam S , Kulchak Rahm Alanna
Published: December 2023

Introduction:
Cholesterol screening in primary care is necessary to identify children and young adults with familial hypercholesterolemia (FH).

Research question:
What is the current state of FH screening and what barriers exist to screening? What implementation strategies informed by human centered design can be utilized to improve FH screening in primary care?

Aim:
We partnered with key stakeholders to sequentially define the current state of FH screening, assess acceptability, feasibility, and appropriateness of implementing an FH screening program, and select clinically usable strategies to be deployed as a package in the CARE-FH clinical trial.

Methods:
Data on the perspectives of primary care clinicians to implement an FH screening program were collected. Methods informed by implementation science and human centered design for data collections included: contextual inquiries, surveys, and deliberative engagement sessions.

Results:
Current screening for FH occurred rarely, and then only after a cardiovascular event or sometimes in primary care due to a family history of high cholesterol or early heart attack. Surveys of primary care clinicians suggested FH screening in primary care was acceptable, appropriate, and feasible. Reported and observed barriers and facilitators to screening identified where improvement in FH screening and diagnosis could occur. Data from the current state and perspectives on FH screening were used to identify multilevel implementation strategies that were presented to and modified by clinician and healthcare stakeholders. This package of strategies was pilot tested in one primary care clinic and further refined to a final implementation strategy package to be tested in a geographical cluster randomized stepped wedge trial.

Conclusion:
We created an implementation strategy package to be deployed and evaluated in the CARE-FH clinical trial to improve FH awareness, identification, and initiate guideline-based care.
Abstract 11949: Novel First-Trimester Serum Biomarkers for Early Prediction of Preeclampsia
Authors: Li Yan , Zhao Hong-Jin , Wei Daimin , Chen Zi-Jiang
Published: December 2023

Background:
Preeclampsia (PE) is a leading cause of maternal and perinatal mortality and morbidity worldwide, but effective early prediction remains a challenge due to the lack of reliable biomarkers.

Research questions:
Could potential imbalances in cytokines and autoimmune antibodies be detectable in the first trimester of pregnancy in women who later develop PE?

Goals:
Our study aims to discover novel biomarkers within the first trimester and construct an efficient predictive model to enhance early PE screening strategies.

Methods:
Based on the extensive human biobank of our large-scale assisted reproductive cohort platform, we measured the first-trimester serum levels of 48 cytokines, total immunoglobulins (Igs), anti-phosphatidylserine (aPS) antibodies, and several previously identified PE biomarkers—including placental growth factor (PlGF), soluble fms-like tyrosine kinase-1 (sFlt-1), and activin A—in 34 women diagnosed with PE and 34 matched normotensive controls.

Results:
Our analysis revealed that the PE group exhibited significantly elevated first-trimester serum levels of hepatocyte growth factor (HGF), interleukin (IL)-2Rα, IL-9, RANTES, tumor necrosis factor-β (TNF-β), total IgM, and total IgG, and aPS IgG optical density (OD) value, in addition to decreased first-trimester serum levels of PlGF and total IgA and aPS-IgG immune complexes (IC) OD value compared to the control group. The combination of the top five first-trimester serum biomarkers (total IgM, total IgG, PlGF, aPS IgG, and total IgA) achieved superior predictive value [area under the curve (AUC) and 95% confidence interval (CI): 0.983 (0.952-1.000)] for PE development compared to PlGF and PlGF/sFlt-1 independently [AUC and 95% CI: 0.825 (0.726-0.924) and 0.670 (0.539-0.800), respectively].

Conclusion:
We identified novel first-trimester serum biomarkers and developed an effective prediction model integrating immune-related factors and PlGF for early PE detection, which could facilitate the development of early diagnostic strategies and provide immunological insight into the further mechanistic exploration of PE.
Abstract 11950: Cardiometabolic Health Disparities in Sexual Minority Men
Authors: López Castillo Humberto , Blackwell Christopher W , Martínez Omar
Published: December 2023

Aim:
We summarize 3 meta-analyses conducted on hypertension, dyslipidemias, and obesity, comparing sexual minority men (SMM) and heterosexual men.

Methods:
We conducted a systematic search in 4 databases to identify studies comparing SMM and heterosexual men in measures for the three relevant outcomes. Prevalence rates, continuous, and inverse variance estimates were generated through random effect models and reported through proportions, mean differences (MDs), and odds ratios (ORs), respectively, with their corresponding 95% confidence intervals [in brackets].

Results:
Hypertension.
20 studies showed men who have sex with men (MSM) were less likely (OR 0.34 [0.16, 0.70]) whereas bisexual men were more likely (OR 2.25 [1.54, 3.28]) to report hypertension. Bisexual men are more likely to use antihypertensive medication (OR 1.44 [CI 1.11, 1.85]) and all SMM had higher diastolic blood pressure (DBP; MD 1.46 [1.38, 1.55] mmHg).
Dyslipidemias.
10 eligible studies showed lower prevalence of elevated cholesterol for SMM (45.21%; χ
2
[1]=54.78;
P
<0.001) that does not hold with inverse variance analyses (OR 1.04 [0.91, 1.18]). While bisexual men—but not MSM—are more likely to take cholesterol-lowering medication (OR 1.47 [1.11, 1.93]) and present with lower cholesterol levels (MD –6.80 [–7.27, –6.34] mg/dL), MSM—but not bisexual men—present with lower triglyceride levels (MD –25.67 [–39.80, –11.55] mg/dL).
Obesity.
43 studies identified lower prevalence of overweight, obesity, and elevated BMI among SMM, consistent with lower body mass index (BMI; MD –1.50 [–1.93, –1.08] kg/m
2
) and decreased likelihood of overweight (OR 0.75 [0.64, 0.88]) and obesity (OR 0.84 [0.78, 0.90]).

Conclusions:
SMM present more frequently with a history of hypertension, linked to elevated DBP—a marker of hypertension at earlier ages. Bisexual men are prescribed cholesterol-lowering medication and present with lower cholesterol levels; MSM present with lower triglyceride levels. Lower rates/likelihood of overweight, obesity, and elevated BMI may point to the obesity paradox—a sustained catabolic state presenting with lower BMI but poor cardiovascular outcomes—which, in connection to other stressors, warrants further research on cardiovascular disparities.
Abstract 11966: Translational Cardioinformatics: Neutrophil-Derived Translocator Protein as a Novel Regulator of Myocarditis and Coronary Artery Aneurysm in Kawasaki Disease and Multisystem Inflammatory Syndrome in Children
Authors: Beltran Jan Vincent B , Lin Fang-Ping , Chang Chaw-Liang , Ko Taiming
Published: December 2023

Introduction:
Cardiovascular disease (CVD) in Kawasaki disease (KD) and multisystem inflammatory syndrome in children (MIS-C) lead to increased mortality through myocardial infarction.

Hypothesis:
Since KD and MIS-C are shaped by the same immune continuum, the cardiac pathologies and lethal complications may be averted by targeting a key regulator controlling both diseases; however, the pathogenic drivers are largely undefined.

Methods:
Through integrated, multi-cohort, single-cell meta-analysis of KD and MIS-C PBMC scRNA-seq profiles, we investigated the immunological drivers associated with systemic damage and cardiac pathologies, compared with other pediatric diseases, and validated across independent cohorts of KD, MIS-C, and myocardial infarction. Via cheminformatics approaches, we identified FDA-approved drugs for repurposing.

Results:
We found the expansion and hyperactivation of CD177
+
neutrophils in KD and MIS-C, but not in other pediatric diseases. CD177
+
neutrophils overexpressed markers and causal mediators of CVD development, supported by activation of prognostic CVD gene signatures (acute CVD, major adverse cardiovascular and limb events, and myocardial infarction). CD177
+
neutrophils’ overactivated effector repertoire may mediate systemic inflammation and molecular damage via a vascular homing mechanism. We identified a dysfunctional SPI1-dependent regulatory network shared by KD and MIS-C during neutrophil hyperactivation, as well as key regulators which may induce cardiac disorders. Importantly, we found that TSPO is associated with myocarditis and coronary artery aneurysm, disease severity, IVIG treatment, and patient recovery. Via independent cohorts analyses, we validated TSPO as a prime target against KD and MIS-C pathologies. Murine myocardial infarction model confirmed the cardiac hyper-infiltration of hyperactivated CD177
+
neutrophils. Lastly, we identified FDA-approved drugs against KD and MIS-C neutrophil hyperactivation.

Conclusions:
Collectively, CD177
+
neutrophils have a pivotal role in KD/MIS-C systemic pathologies, clinical severity, and prognosis. We suggest drugs that can be developed as a single therapeutic strategy against either KD or MIS-C for clinical translation.
Abstract 12013: Cardiac Arrhythmia After COVID-19 Vaccination versus Non-COVID-19 Vaccination: A Systematic Review and Meta-Analysis
Authors: Shi Ao , Tang Xiaoyi , Xia Panpan , Hao Meiqi , Shu Yuan , Ling Ryan R , RAMANATHAN KOLLENGODE , Nakanishi Hayato , Karen Smayra Karen , Farzad Armin , Hu Kaibo , Liu Qi , Wu Yue , CAI Peng , Yu Peng , Li Pengyang
Published: December 2023

Introduction:
Arrhythmia after COVID-19 vaccination is increasingly reported. Whether the risk from COVID-19 vaccines exceeds that of non–COVID-19 vaccines remains controversial. In this study, the incidence of arrhythmia after COVID-19 versus non–COVID-19 vaccination were investigated.

Methods:
Medline (via PubMed), Scopus, Cochrane Library, and Embase databases were searched for observational studies reporting the incidence of postvaccination arrhythmias from January 1, 1947 to November 27, 2022. Secondary endpoints included tachyarrhythmia incidence and all-cause mortality. Arrhythmia incidence by age, vaccine type, sex, and COVID-19 vaccine dose were analysed, and intrastudy risk for bias and certainty of evidence were evaluated.

Results:
The overall incidence of arrhythmia (1,528,500,116 vaccine doses, 43 studies) was 561·3 cases per million doses. Arrhythmias were more common after COVID-19 vaccination than non–COVID-19 vaccination (3790·4 vs 13·7 cases per million doses; p<0·001). Compared with COVID-19 vaccines, the influenza, pertussis, and human papillomavirus vaccines were associated with fewer cases of arrhythmia. The overall incidence of tachyarrhythmia was 910·5 cases per million doses; it was higher after COVID-19 vaccination than non-COVID-19 vaccination (6681·8 vs 34·3 cases per million doses; p<0·001). Pooled all-cause mortality postvaccination was 2·4 deaths per million doses. Mortality was comparable between COVID-19 and non–COVID-19 vaccination groups.

Conclusions:
Although arrhythmia was more frequent after COVID-19 vaccination than after non-COVID-19 vaccination, it was still uncommon. The safety and efficacy of COVID-19 vaccines should be assessed in light of other important factors as well, such as the incidence of regional outbreaks and effects from the COVID-19 infection itself.
Abstract 12026: Life Essential 8 is Positively Associated With a Higher Executive Cognitive Function in US Children - ABCD Study
Authors: Ferreira De Moraes Augusto Cesar , Nascimento-Ferreira Marcus V. , Hunt Ethan H , Virostko John , Tapert Susan S , Kohl Harold W
Published: December 2023

Background:
While the association between cardiovascular health components has been linked to a higher risk of cognitive decline in adults, the relationship between cardiovascular health indicators and executive/cognitive function in US children remains poorly understood.

Research Question:
Are measures of cardiovascular health associated with executive, cognitive function and in US children?

Aims:
The purpose of this study was to determine cross-sectional associations of Life Essential 8 components with executive and cognitive function.

Methods:
This was a baseline analysis from a multicenter, prospective cohort study, known as the Adolescent Brain Cognitive Development (ABCD) study. Data were analyzed from the baseline ABCD data release 1.0. Participants were children aged 9 to 10 years old recruited in 21 US cities. Participants with incomplete questionnaire data for dietary intake, physical activity, nicotine exposure, or sleep health; health evaluation for body mass index, blood lipids, glycated hemoglobin, or blood pressure; or covariate data were excluded. Each cardiovascular health indicator ranges from 0 to 100 points, enabling the calculation of a composite cardiovascular health score as the unweighted average of all components, which also ranges from 0 to 100 points. The National Institutes of Health Toolbox neurocognitive battery assesses general cognitive ability, executive function, and learning/memory using raw scores and age-corrected measures.

Results:
A total of 978 individuals were analyzed. The mean (SD) age was 9.9 (0.2) years, 44.9% were girls, and 53.4% were White. Individuals with more favorable cardiovascular health behaviors showed better executive cognitive function (β = 0.170; CI 95%, 0.076 to 0.265;
p
= 0.001), and overall cardiovascular health was associated with higher executive cognitive function (β = 0.209; CI 95%, 0.067 to 0.351;
p
= 0.002).

Conclusions:
Cardiovascular health behaviors and overall cardiovascular health were directly linked to cognitive and executive function in 9-10-year-old US children, supporting public health recommendations to promote these behaviors for their potential benefits to cognitive function and brain development.
Abstract 12030: Predicting Atrial Fibrillation in Critically Ill Patients: A Machine Learning Approach
Authors: Alomari Laith , Al-Fakhouri Zaid , Jarrar Yaman
Published: December 2023

Introduction:
Atrial fibrillation (AF) is the most prevalent arrhythmia in critically ill patients, with significant implications for morbidity and mortality. Early prediction of AF risk is crucial for proactive management. This study aims to develop and validate a machine learning-based risk prediction model for AF in intensive care unit (ICU) patients.

Methods:
Using the Medical Information Mart for Intensive Care (MIMIC-IV) database, we conducted a retrospective cohort study that included adult ICU patients and collected 47 clinical and laboratory variables. The primary outcome variable was the development of AF within the first 48 hours of ICU admission. Various machine learning models were evaluated for their performance in predicting AF, and the best-performing model was further optimized using hyperparameter tuning. A compact model, incorporating only 15 variables and two novel features, was also developed to facilitate potential clinical implementation. The first new feature, ‘
older septic
’ indicated patients aged 70 or older with sepsis, capturing the combined effect of age and sepsis as a risk factor for AF. The second new feature, ‘
cardiac risk score
’ was a composite score considering patient’s pre-existing cardiac risk factors. Model interpretability was assessed using Shapley Additive exPlanations (SHAP) analysis.

Results:
The cohort comprised 46,266 ICU patients, with 4.6% developing AF within 48 hours of admission. The CatBoost Classifier model demonstrated superior performance, achieving an area under the receiver operating characteristic curve (AUC) of 0.850 (95% CI: 0.811-0.889) on the test set. The compact model with new features yielded an AUC of 0.820 (95% CI: 0.782-0.858), which is a comparable performance using a fraction of the variables. SHAP analysis highlighted the importance of the newly created features as key predictors, indicating the significance of age, sepsis, and cardiac risk factors in AF development.

Conclusions:
This study underscores the potential of machine learning models in predicting AF development in ICU patients. The compact model, with a satisfactory AUC, can be a valuable tool for identifying high-risk patients, enabling timely interventions to mitigate the adverse outcomes associated with AF.
Abstract 12067: Association Between Practice Type and Psychological Well-Being of Interventional Cardiologists: An International, Anonymized Survey
Authors: Simsek Bahadir , Rempakos Athanasios , Alexandrou Michaella , Kostantinis Spyridon , Karacsonyi Judit , Rangan Bavana V , Mutlu Deniz , Mastrodemos Olga C , Kirtane Ajay J , Bortnick Anna E , Jneid Hani , Azzalini Lorenzo , Anastasios Milkas , Alaswad Khaldoon , Linzer Mark , Egred Mohaned , Allana Salman S , Rao Sunil V , Sandoval Yader , Brilakis Emmanouil S
Published: December 2023

Introduction:
The association between practice type (academic vs non-academic) and the psychological well-being of interventional cardiologists (ICs) has received limited study.

Methods:
We examined the association between practice type and the well-being of ICs using an online, anonymous, and international psychological well-being survey.

Results:
Out of the 1,093 participating attending ICs, 33% worked in academic positions. Most IC attendings were from the United States (53%) and men (91%). Academic ICs had similar hours worked per week (60 [52-70] vs 61 [53-70], p=0.34) and vacation >3 weeks/year (73% vs 69%, p=0.238) with non-academic ICs. However, academic ICs were less often on call ≥3 times/week (21% vs 30%, p=0.001), reported lower emotional exhaustion (6.0 [2.8-7.2] vs 6.5 [3.9-7.7], p=0.002), numerically higher life satisfaction (7.4 [5.6-8.5] vs 7.0 [4.9-8.2], p= 0.064), less frustration with their work (5.3 [2.5-7.4] vs 6.4 [3.0-8.0], p=0.005), and less stress (6.8 [5.0-7.9] vs 7.0 [5.1-8.0], p=0.027) (Figure). Burnout contributors were similar between the groups, except for stress related to COVID-19 (2.2 [1.0-5.2] vs 3.0 [1.0-6.6], p=0.003) and excessive regulations (4.8 [1.8-7.0] vs 5.3 [2.2-7.5], p=0.003), which were rated lower by academic ICs. Academic ICs were less likely to request better hospital infrastructure (7.1 [4.9-8.7] vs 7.8 [5.9-9.5], p=0.001), but more likely to request higher compensation (7.6 [6.1-9.2] vs 7.3 [5.2-8.8], p=0.05) to improve their well-being.

Conclusions:
Our survey demonstrates that an academic setting is associated with better psychological well-being. Elucidating the underlying reasons for this finding may help to improve well-being for ICs working in non-academic centers.
Abstract 12077: Temporal Trends in the Prevalence of Atrial Fibrillation and Atrial Flutter in Septic Patients From 2010 to 2019
Authors: Ashraf Muddasir , Jahangir Arshad
Published: December 2023

Background:
Increased awareness of the importance of timely treatment of sepsis has led to improved sepsis care and outcomes over time in the USA.

Research question:
We evaluated the prevalence of atrial fibrillation (AF) and atrial flutter (AFL) in septic patients over time.

Aims:
The primary objective was to evaluate temporal trends in the prevalence of AF and AFL in septic patients. The secondary objective was to evaluate these trends stratified by age, sex, and race and ethnicity.

Methods:
Using the National Inpatient Sample, we studied all adult patients hospitalized with sepsis in the USA from 2010 to 2019. The year 2015 was not included due to changes in ICD coding in the last quarter.

Results:
Of 18.4 million adult patients admitted with sepsis from 2010 to 2019 in the USA, with a mean age of 65±0.038 years, 50% were female. The risk-adjusted rates of AF and AFL in septic patients showed an increasing trend over time (Panel A) after accounting for differences in age, sex, and comorbidity burden. AF and AFL occurred more frequently in the elderly than the young (Panel B). Sex-stratified analysis showed consistently higher rates of AF and AFL in males than females throughout the study period (Panel C). Finally, the risk-adjusted rates of AF and AFL were consistently highest in White patients, followed by Asian patients, compared with other races and ethnicities throughout the study period (Panel D).

Conclusion:
Despite improved treatment of sepsis, as evidenced by improving outcomes shown by many studies, the prevalence of AF and AFL in patients with sepsis in the USA has increased over time. This is likely due to sicker patients with sepsis now than in the past or to residual confounding owing to an increase in the elderly and comorbid patient population, which is not captured completely by the comorbidity index. White and Asian patients with sepsis had higher rates of AF than other racial and ethnic groups.
Abstract 12080: Comprehensive Proteomics Profiling of Human Myocardium Reveals Signaling Pathways Dysregulated in Severe Forms of Hypertrophic Cardiomyopathy
Authors: Hartman Heidi , Sherrid Mark , Hasegawa Kohei , Adlestein Elizabeth , Swistel Daniel , Tower-Rader Albree , Fifer Michael A , Topkara Veli K , Maurer mathew S , Reilly Muredach P , Shimada Yuichi
Published: December 2023

Introduction:
Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiovascular disease, affecting 1 in 200-500 people. There is significant heterogeneity in disease severity. The signaling pathways that link gene mutations to severe HCM disease remain unknown. Analysis of the myocardial proteome is a novel approach to understanding severe forms of HCM.

Hypothesis:
Comprehensive proteomics profiling of myocardium identifies signaling pathways that are differentially regulated in severe forms of HCM.

Methods:
Proteomics profiling of 7289 proteins from myocardium was performed on patients with HCM. Univariable analysis with the Wilcoxon rank sum test or Spearman’s rank correlation test was used to determine the association between protein concentration and 5 clinical indicators of severe HCM: 1) left ventricular ejection fraction (LVEF), 2) atrial fibrillation (AF), 3) ventricular arrhythmias, 4) maximum septal thickness, and 5) late gadolinium enhancement (LGE) by cardiac magnetic resonance (CMR). Pathway analysis of proteins with significantly different concentrations (i.e., nominal p<0.05) in association with each clinical indicator was executed.

Results:
There were 106 patients with HCM included in the study. Pathway analysis of proteins associated with each indicator of severe HCM revealed dysregulation of inflammatory pathways and Ras-MAPK-related pathways (
Figure
). Metabolic pathways and adhesion pathways were dysregulated in association with LVEF and AF. Dysregulation of angiogenesis pathways (e.g., HIF-1, VEGF) was associated with LGE (FDR<0.05).

Conclusions:
Comprehensive proteomics profiling of human HCM myocardium was used to identify dysregulated signaling pathways associated with clinical features of severe HCM. Findings from this study support the role of both known (e.g., inflammation, metabolism, adhesion, and angiogenesis) and novel (e.g., Ras-MAPK) pathways in the development of severe forms of HCM.
Abstract 12085: Emergency Heart Failure Mortality Risk Grade (EHMRG) Score Quintiles Correlate With Short and Long-Term Healthcare Costs
Authors: Parikh Harsh , John-Baptiste Ava , Chu Steven , Santiago Maria , Fang Jiming , Austin Peter C , Porter Joan , Ross Heather J , Lee Douglas S
Published: December 2023

Introduction:
The use of the EHMRG model in the emergency department (ED) has been demonstrated to improve outcomes for patients presenting with acute heart failure (HF). It is unknown if the EHMRG model also correlates with healthcare costs, which has not been examined in other HF risk models.

Hypothesis:
We hypothesized that patients with higher EHMRG risk scores, i.e., sicker, would have higher costs of care in short-term (30-day) and longer-term (up to 2 year) time horizons.

Methods:
We examined direct costs of care from a health payer perspective using the original EHMRG derivation cohort of 11,857 patients hospitalized with acute HF in Ontario, Canada (from 2004) and linking to population-based case-costing databases. Costs were stratified by the quintiles of the EHMRG risk score (Q1 = lowest risk, Q5 = highest risk). Costs (in 2021 Canadian dollars) were categorized into hospital, physician, drug, home care, long term care (LTC), and other costs.

Results:
Patients in the lowest EHMRG risk quintile (Q1), compared to higher quintiles (Q2-Q5) had lower total cost of care in both the short-term ($8,113 vs $9,442, $10,557, $12,078 and $15,005, p <0.001) and long-term ($46,661 vs $55,904, $58,904, $63,286 and $64,229, p<0.001). This positive correlation between EHMRG risk quintile and cost of care was also observed for hospital costs ($26,388 [Q1] vs $35,659 [Q5], p<.0001) and LTC costs ($1,236 [Q1] vs $6,316 [Q5], p<.0001) at all time intervals, including at 2 years shown here. Physician costs and drug costs were positively correlated with EHMRG risk quintiles at 30 days (physician: $1,241 [Q1] vs $1,762 [Q5], p<0.0001; drug: $219 [Q1] vs $282 [Q5], p<.0001), and negatively correlated at 2 years (physician: $7,943 [Q1] vs $7,175 [Q5], p<.0001; drug: $4,539 [Q1] vs $4,377 [Q5], p<.0001). There was an increasing trend of costs irrespective of the formulation of the EHMRG risk score as 7-day risk quintile, 30-day risk quintile, or 30-day risk tertile.

Conclusion:
The EHMRG7 risk score was positively correlated with healthcare costs from 30 days to 2 years after initial ED presentation. This novel correlational study demonstrated that in the absence of an associated intervention, higher mortality risk in HF patients portends higher costs in short and long-term follow-up.
Abstract 12088: Left Ventricular Non-Compaction, Coronary Artery Fistula, and Infective Endocarditis: A Rare Combination
Authors: Kim Kyung An , Ahn Yuran , Lee Soyoung , Jung Hae-Ok
Published: December 2023

Description of Case:
A 48-year-old man underwent echocardiography for multifocal subacute infarctions found on brain MRI. No intracardiac shunts were found, but prominent LV trabeculae raised suspicion of LV non-compaction (LVNC). LV ejection fraction was 53%, and LV volume was within upper-normal range. Cardiac MRI confirmed these findings, although non-compacted:compacted myocardium ratio was 1.9. (Panel A-B) A right coronary artery to LV fistula was also diagnosed. (Panel C-D) The patient was followed-up uneventfully, but 10 months later was admitted after a generalized seizure episode. Brain MRI detected multiple new hemorrhagic infarcts, and echocardiography revealed a 10.8mmх10.1mm mobile mass and high-speed diastolic flow near the basolateral LV wall. (Panel E-F)
Gemella morbillorum
was identified on two blood cultures. The patient underwent surgery for fistula closure and vegetation resection. Vegetation pathology and culture however was negative for bacterial growth. Paroxysmal atrial fibrillation was also detected, before discharge with full recovery.

Discussion:
LVNC and coronary artery fistula (CAF) are both caused by arrest in embryonic myocardial compaction. Despite a hypothetical common origin, reports of co-occurrence are extremely rare. This is the first to report the association of a mild form of LVNC and a single large CAF. This is also the first to report infective endocarditis due to CAF by
G. morbillorum
.
G. morbillorum
infective endocarditis is rare, subacute in course, and causes significant destruction. The extensive, prolonged embolism found here has not been reported in other cases of CAF-associated infective endocarditis and may be due to
G. morbillorum
.
Abstract 12109: Infective Endocarditis Post-Transcatheter Edge-to-Edge Mitral Valve Repair: A Systematic Review
Authors: Jaiswal Vikash , Hanif Muhammad , Agrawal Vibhor , Shrestha abhigan babu , Jha Mayank , Evbayekha Endurance O , Ghadvaje Gayatri , Chia Jia Ee E , Ang Song Peng , Evbayekha Endurance O
Published: December 2023

Background:
Infective Endocarditis (IE) post-MitraClip procedure has not been well recognized, with very limited reports published to date.

Objective:
We aim to systematically evaluate the clinical characteristics, management, outcomes, and prognosis among IE patients after Mitral valve repair with the MitraClip device.

Methods:
We conducted a systematic literature search in PubMed, Embase, and Scopus from inception till 10th March 2023 by using predefined MESH terms and "AND" and "OR." The following search terms were used: “Infective Endocarditis” AND “Transcatheter mitral valve repair”.

Results:
A total of 26 publications describing 29 cases of IE following percutaneous edge-to-edge mitral valve repair were identified. The mean age of the patients was 72.62 ± 12.76 years, of which 62.96% were male. The etiology of MR was mostly functional/secondary in 54.55% of cases, while the mean number of implanted clips was 1.65 ± 0.68 (Mode = 1), and the most common location for MitraClip® implantation was the A2-P2 segment. The mean duration from MitraClip® intervention to readmission with IE was 44.44 ± 57.11 weeks. Echocardiography findings showed severe MR in 70.83% of patients. Staphylococcus aureus was the most common infectious organism involved in 56% of cases. Surgical mitral valve replacement with a bioprosthesis was performed in 55.17% of the patients, and 34.48% were managed medically. The most common antibiotic regimen was vancomycin, in addition to rifampicin and gentamycin. Mortality was higher in the medically managed patients as compared to the ones that underwent surgical MVR (40% vs. 37.5%).

Conclusion:
IE post-TEER of the mitral valve is a rare complication but is associated with a higher mortality rate. Aggressive antibiotic medication and proper prophylaxis during index procedures can be beneficial.
Abstract 12123: Descending Aortic Diastolic Flow Reversal in Aortic Regurgitation: Optimizing Definitions and Assessment on Cardiac Magnetic Resonance
Authors: Saeed Mujtaba , Malahfji Maan , Nguyen Duc T , Ahmed Ahmed Ibrahim I , Crudo Valentina , Al-Mallah Mouaz , Zoghbi William A , Graviss Edward A , Shah Dipan J
Published: December 2023

Introduction:
Holodiastolic flow reversal (HDR) in the descending aorta (DA) may indicate hemodynamically significant aortic regurgitation (AR). However, the optimal definition and quantification of flow reversal on cardiac magnetic resonance (CMR) is unknown.

Methods:
We studied 346 chronic AR patients with regurgitant volume (RegVol) ≥30 mL or regurgitant fraction (RegF) ≥30%. The presence of HDR and quantitation of reverse volume in the DA (DA-RVol) was performed by a blinded observer. The threshold for DA-RVol that identified ≥ moderate-severe AR (RegVol ≥45 mL and RegF ≥40%) was established by derivation (50% random sample), validation (50% remaining sample), and ROC curve analysis. Multivariable logistic regression models adjusting for age, gender, NYHA Class, and indexed left ventricular end-diastolic volume were performed to compare HDR and DA-RVol.

Results:
The median age was 61 (IQR 50-70) years, 79.2% men, and 30.3% with bicuspid aortic valve. The median RegF was 37% (IQR 32-44) and DA-RVol was 12 mL (IQR 5-27). HDR was observed in 150 (43.2%), with 63% sensitivity and 77% specificity for detecting ≥ moderate-severe AR. The threshold of DA-RVol which identified ≥ moderate-severe AR was 17 mL (AUC 0.82, sensitivity 68%, and specificity 87%). The ROC curve analysis revealed a higher AUC for DA-RVol ≥17 mL relative to HDR (0.78 vs 0.70,
P
<0.001) for predicting ≥ moderate-severe AR. On multivariable analysis models, DA-RVol ≥17 mL was superior to HDR (AUC 0.83 vs 0.80,
P
=0.008).

Conclusion:
Quantitation of flow reversal in the descending aorta is a more reliable method to identify hemodynamically significant AR compared to simple presence of holodiastolic flow reversal.
Abstract 12128: Catheter Ablation Outperforms Implantable Cardioverter Defibrillator Therapy in Improving Arrhythmic Outcomes of Brugada Syndrome
Authors: Li Le , Yao Yan , Zhou Likun , Ding Ligang , Wu Lingmin
Published: December 2023

Background:
Brugada syndrome (BrS) is characterized by ventricular arrhythmias that pose a significant risk to affected individuals. While ICD therapy is the primary treatment, it does not prevent VF episodes. Catheter ablation (CA) has shown promise in improving arrhythmic outcomes. This study aims to compare the efficacy of CA with ICD therapy in symptomatic BrS patients.

Methods:
A total of 49 symptomatic BrS patients were enrolled, with 21 patients undergoing CA and 28 patients receiving ICD therapy. Substrate modification techniques, including endocardial and epicardial approaches, were utilized along with VF-triggering PVC ablation strategies. The primary outcomes assessed were the occurrence of VF episodes and sudden cardiac death during the follow-up period.

Results:
The study population had a mean age of 44.3±10.4 years, with 44 patients (89.8%) being male. Among the participants, 40 (81.6%) exhibited the typical type 1 BrS electrocardiogram pattern, and 12 (24.5%) had a positive SCN5A mutation. VF-triggering PVCs were successfully ablated in 3 patients (14.3%), while VF substrates were eliminated in 18 patients (85.7%). Epicardial ablation was performed in 14 patients (66.7%). During a median follow-up of 46.2 (15.6-68.8) months, the primary outcomes occurred more frequently in the ICD group compared to the CA group (4.8% vs. 57.1%, Log-rank P = 0.006).

Conclusion:
Our findings suggest that CA is a more effective therapy for improving arrhythmic outcomes in symptomatic BrS patients compared to ICD implantation. These results highlight the potential of CA as a first-line therapeutic approach for managing symptomatic BrS.
Abstract 12132: The Intercellular Adhesion Molecule-1 Missense Variant rs5491, High-Sensitivity C-reactive Protein, and Heart Failure With Preserved Ejection Fraction Risk
Authors: Giro Pedro , Taylor Kent D , Shah Sanjiv J , Patel Ravi B
Published: December 2023

Introduction:
Intercellular adhesion molecule-1 (ICAM-1) is a cell surface protein involved in leukocyte transmigration, thereby promoting inflammation. A missense genetic variant in
ICAM1
, rs5491, is common among Black individuals but rare in other race/ethnic groups, and has been associated with increased risk of heart failure with preserved ejection fraction (HFpEF). The pathways by which rs5491 may lead to HFpEF, however, are not known.

Hypothesis:
We hypothesized that rs5491 is associated with systemic inflammation as measured by high-sensitivity C-reactive protein (hsCRP) and that the association between rs5491 and HFpEF is mediated by higher hsCRP.

Methods:
Among Black individuals within the Multi-Ethnic Study of Atherosclerosis, we evaluated the association of rs5491 with hsCRP at Exam 1 and performed a formal mediation analysis of hsCRP on the association between rs5491 and incident HFpEF.

Results:
Among 1558 Black participants (mean age 62±10 y, 47% female), individuals with at least one copy of rs5491 (N=580) had higher hsCRP in unadjusted analysis (2.78 mg/L [IQR: 1.11-6.25] vs 2.25 mg/L [IQR: 0.99-4.82], P=0.009). After covariate adjustment, each additional rs5491 allele was significantly associated with higher hsCRP (β: 0.15, SE: 0.07, P=0.02;
Figure
). Each additional rs5491 allele remained significantly associated with incident HFpEF after adjustment for hsCRP in addition to clinical covariates and principal components of ancestry 1-10 (HR 1.86, 95% CI: 1.15-3.01, P=0.01). On mediation analysis, hsCRP did not significantly mediate the association between rs5491 and HFpEF (percent mediated: 0%, 95% CI: 0-31%, P= 0.08).

Conclusions:
In Black individuals, the
ICAM1
missense variant rs5491 is associated with incident HFpEF and systemic inflammation, as measured by hsCRP. The relationship between rs5491 and HFpEF is not mediated by hsCRP, suggesting that other inflammatory pathways may drive HFpEF risk among individuals with this variant.
Abstract 12135: Quality of Life in Early-Stage Hypertrophic Cardiomyopathy: A Secondary Analysis of the VANISH Trial
Authors: Ireland Catherine G , Day Sharlene , Axelsson Anna , Russell Mark W , Zahka Kenneth G , Pereira Alexandre , Canter Charles E , Bach Richard G , Wheeler Matthew T , Rossano Joseph W , Owens Anjali T , Bundgaard Henning , Mestroni Luisa , Taylor Matthew R , Amit Patel R , Wilmot Ivan , Soslow Jonathan H , Becker Jason R , Orav Endel J , Ho Carolyn Y
Published: December 2023

Background:
The VANISH trial (Valsartan for Attenuating Disease Evolution in Early Sarcomeric Hypertrophic Cardiomyopathy) showed valsartan improves LV remodeling in early-stage HCM, but its effects on quality of life (QOL) are unknown. A better understanding of QOL may impact patient wellness.

Aims:
Describe baseline QOL in early-stage HCM. Assess the impact of valsartan on QOL in early-stage HCM.

Methods:
We evaluated QOL using age-adjusted versions of the Pediatric Quality of Life Inventory in VANISH participants (ages 8-45): 166 with early-stage HCM, 34 with subclinical HCM (sarcomere variant present but normal LV wall thickness/no HCM diagnosis). Demographic, imaging, CPET, and biomarker correlates of baseline QOL were studied. The impact of valsartan on QOL was analyzed in the early-stage HCM cohort.

Results:
Participants with early-stage HCM reported good baseline QOL, better than an earlier published healthy validation cohort but diminished compared to subclinical participants (mean overall/physical/psychosocial scores 85/87/84 for early-stage, 90/92/89 subclinical, 82/84/81 earlier validation cohort). Race and ethnicity influenced QOL, with non-white and Hispanic participants reporting lower scores (Table 1). Valsartan improved physical QOL (p=0.03), with suggestion of differential effect by sex and pubertal status, but limited power to detect effect modification (Figure 1).

Conclusion:
Baseline QOL is lower in patients with early-stage HCM compared to subclinical participants despite NYHA I status. Non-white and Hispanic participants and those with lower baseline peak VO
2
may have lower quality of life. Valsartan treatment improved physical QOL.
Abstract 12142: Treadmill Exercise Stress Echocardiography Exposes Impaired Left Ventricular Function in Patients Recovering From Hospitalization for COVID-19 versus Historical Controls
Authors: Goldstein Robert E , Hulten Edward A , Arnold Thomas B , Thomas Victoria M , Walker Erika N , Fox Keiko , Lee Hyun , Libbus Joya , Markos Bethelhem , Hood Maureen , Harrell Travis E , Haigney Mark C
Published: December 2023

Usual clinical testing rarely reveals persisting cardiac abnormalities in patients after hospitalization for Covid-19. Such testing may overlook residual changes responsible for increased adverse cardiac events seen post-discharge. To further elucidate patients’ long-term status, we performed exercise stress echocardiography (ESE) in 15 patients age 30-63 without myocarditis 3 to 31 months after hospital discharge. We compared patient outcomes to published data in healthy controls (HC) exercising according to the same protocol. Patients’ treadmill exercise (Bruce protocol), averaging 8.2 min, was halted by dyspnea or fatigue. Baselines before stress averaged the same in recovering patients (RP) and HC except for heart rate (HR): 81±13 bpm for RP and 63±8 for HC (p<0.0001). Peak stress values in RP were compared with HC:

Stress revealed significantly lower LVEF and raised E/e’ soon after peak effort in RP compared with HC performing the same exercise. Thus, when stressed, patients with no known cardiac impairment before or during Covid-19 hospitalization showed modest but consistently diminished systolic contractile function and diastolic LV compliance during recovery compared to HC. Peak HR during stress was significantly elevated in RP vs. HC; peak SBP also trended higher. Average systolic pulmonary artery pressures among RP remained normal. Our measurements during ESE uniquely identified residual abnormality in cardiac contractile function not evident in the unstressed condition. This finding exposes a previously-unrecognized residual influence of Covid-19 that may relate to underlying autonomic dysfunction, microvascular disease, or diffuse interstitial changes after subclinical myocarditis and may have long-term implications for clinical management and later prognosis.