bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 13744: The Association of Pre-Pregnancy Obesity on Postpartum Blood Pressure in Preeclampsia
Authors: Miller Eliza A , Minhas Anum A , Soleimani-Fard Alborz , Vaught Arthur J , Hays Allison G , Michos Erin D , Schulman Steven P , Ndumele Chiadi E
Published: June 2023

Background:
Women with preeclampsia have elevated risk of long-term cardiovascular disease, in part mediated by postpartum hypertension. Little is known about the association of pre-pregnancy obesity with postpartum blood pressure.

Hypothesis:
We hypothesized that women with pre-pregnancy obesity and preeclampsia will have higher postpartum blood pressure compared to women without preeclampsia.

Methods:
We included women with preeclampsia followed between 2021-2022 at a tertiary care academic center. An equal number of women without preeclampsia were then included, matched for body mass index (BMI). Pre-pregnancy weight (exposure variable) was categorized according to BMI (in kg/m
2
) at the initial antenatal visit as follows: normal weight (<25), overweight (25-<30), class I obesity (30-<35) and class II+ obesity (
>
35 kg/m
2
). MAP from the 6 week postpartum visit was the outcome variable. Adjusted linear regression was performed for the association of BMI category with MAP, stratified by preeclampsia status. Interaction between BMI category and preeclampsia on the outcome of MAP was tested in the fully adjusted model.

Results:
Among 426 women, 247 had preeclampsia. Mean age was 31
+
6 and 32
+
5 years for women with and without preeclampsia, respectively. 54% of women with preeclampsia and 43% without identified as Black. Chronic hypertension was present in 30% vs 11% of women with vs without preeclampsia. Among women with preeclampsia, obesity class II/III was associated with higher postpartum MAP than normal weight (Table). This association was not seen in women without preeclampsia (p-value interaction = 0.004).

Conclusion:
Higher pre-pregnancy BMI is associated with greater postpartum MAP in women with preeclampsia, but not in women without preeclampsia. These findings underscore the importance of reducing the burden of pre-pregnancy obesity in populations at risk for preeclampsia, to prevent long-term adverse cardiovascular outcomes after pregnancy.
Abstract 13762: Does Social Disadvantage Modify the Association Between Health Rating and Disruption Due to COVID-19 Among Adults With Hypertension
Authors: Kesiena Onoriode , Allahverdiyeva Aysha , Rizvi Mehdi , Braunstein Jacob , Hagan Kobina , Kumar Navin , Singireddy Shreyas , Seffah Kofi D , Olokunlade Temitope , Mszar Reed , Mossialos Elias , Sharma Garima , Nasir Khurram
Published: June 2023

Introduction:
The COVID-19 pandemic disrupted health care across diverse populations with negative outcomes. We evaluated the relationship between health rating, cumulative social risk (CSR), and disruption in health care due to COVID-19 among adults with hypertension.

Methods:
Data of 11,494 adults with hypertension from the 2020 National Health Interview Survey was used. Respondents with hypertension rated their health as fair/poor, good, or very good/excellent. Disruption in care was either delayed healthcare or not getting care due to COVID-19. CSR was a composite of economic stability, education, food insecurity, health care system, and physical environment grouped into quartiles, with the highest quartile representing the least social risk. Multiple logistic regression was used in the analysis.

Results:
The mean (SE) age was 60.1 (0.22) years, with 50.5% females. A fair/poor health rating and being in CSR quartile 2 [AOR 0.40 (0.19, 0.86), p=0.019] or CSR quartile 3 [AOR 0.42 (1.20, 0.91), p-0.028] were more likely to get care due to COVID-19 when compared to the CSR quartile 4. A similar relationship was seen in those who rated their health as good and belonged to CSR quartile 2 [AOR 0.49 (0.28, 0.87), p=0.015] or CSR quartile 3 [AOR 0.59 (0.35, 0.98), p=0.043]. Delaying medical care due to COVID-19 was increasingly less likely for those who rated their health as good and belonged to CSR quartile 1 [AOR 0.41 (0.17, 0.99), p=0.049], quartile 2 [AOR 0.43 (0.27, 0.67) p<0.001], and quartile 3 [ AOR 0.57 (0.36, 0.89), p=0.013] as compared to those in quartile 4.

Conclusions:
Individuals with hypertension and a poor to good health rating were less likely to delay or not get medical care due to COVID-19, with an average to high social risk being related to this increase likelihood.
Abstract 13774: Association Between Baseline Heart Failure During Acute Coronary Syndrome and Long-Term Cancer Risk. The ABC-9* Study on Heart Disease
Authors: Mahmoud Heba T , Cordiano Rocco , Cavuto Fiorella , Bagato Francesco , Petucco Stefania , Pasquinucci Mattia , mahmoud moemen mohammed M , Sitta Nadir , Nardi Tobia , Berton Giuseppe S
Published: June 2023

Introduction:
We aim to investigate the association between heart failure (HF) during hospitalization with acute coronary syndrome (ACS) and the long-term cancer risk.

Methods:
This prospective study included 571 patients admitted to 3 Italian hospitals and with ACS discharged alive and free from cancer. They were followed for 24 years or until death.

Results:
All except for three patients completed the follow-up, representing 6416 person-years. Patients' mean age was 66 ± 12 years and 70% were males. Baseline clinical HF was diagnosed in 192 (34%) patients. During follow-up, 129 patients (23%) developed cancer; of them, 103 with no HF [27% of patients without HF] and 26 had baseline HF [14% of patients with HF].The incidence rates for cancer were 21 and 18 per 1000 person-years for patients without and with baseline HF, respectively (p = 0.61).The risks for cancer associated with HF were (HR: 0.96; 95% CI: 0.62-1.47; p=0.84). Similar associations were observed among men, women, and patients younger than 75 years of age. Yet, in patients older than 75 years the unadjusted risk was (HR: 0.30; 95% CI: 0.09-0.92; p=0.04). Although, the fully adjusted risk was (HR: 0.39; 95% CI: 0.12-1.30; p=0.13). The unadjusted HRs for cancer development were (HR: 0.88; 95% CI: 0.45-1.74; p=0.73) and (HR: 0.91; 95% CI: 0.48-1.71; p=0.77) for patient with HFrEF and HFpEF respectively.We observed a positive interaction between age and LVEF for the risk of cancer onset (HR: 1.002; 95% CI: 1.0003 -1.004; p=0.02) in the unadjusted model. Results were the same in fully adjusted model.

Conclusions:
This prospective study of unselected ACS patients showed a lack of association between clinical heart failure at admission for ACS and the long-term cancer risk. A positive independent interaction between age and LVEF for the long-term risk of cancer was also observed.

Figure 1:
Cumulative hazards of cancer according to HF status (A) and interaction between age and LVEF for the risk of cancer (B) 24-years after ACS.
Abstract 13787: Characteristics and Occupational Trends of Military Tactical Athletes With Repeat Atrial Fibrillation Catheter Ablations
Authors: Wilson Andrew , Keithler Andrea , Tunzi Matthew , Tomlinson Richard E , Bush Kelvin
Published: June 2023

Introduction:
Atrial fibrillation (AF) ablation for military personnel aims to provide therapeutic endpoints, recognizing that a subset of personnel require repeat ablation.

Objective:
This study aims to identify differences in characteristics and occupations of military members who received single versus repeat AF ablation. Further, we aim to understand the rates retention and deployment in those with single versus repeat AF ablation.

Hypothesis:
We hypothesize that there are increased rates of AF repeat ablations in personnel with risk factors for AF recurrence.

Methods:
Military personnel who underwent elective AF ablation between 2004 to 2019 were reviewed. Characteristics and military dispositions of personnel with repeated AF ablations were compared to those without.

Results:
27 of 104 (26%) personnel received repeat AF catheter ablations on average 16.1±31 months after first ablation. There were no differences between age (34.5+9.5 vs 37.6+9.8 years, P=0.13), BMI (28.1±3.9 vs 28.7±3.4 kg/m2, P=0.48), presence of diastolic dysfunction (11.7% vs 7.4%, P=0.53), left atrial appendage emptying velocities (58.4+22 vs 59.7+23 cm/s, P=0.82), left atrial volume index (29.4+9.9 vs 29.6+8.8 ml/m2, P=0.87), left ventricular ejection fraction (60.4+6% vs 58.5+13%, P=0.31), CHA2DS2-VASc scores (0.37+0.6 vs 0.44+0.7, P=0.60) between those who received a single versus repeated AF ablation. Aviators (40%, 4/10) and healthcare workers (35%, 12/34) underwent repeated ablation at significantly increased rates when compared to 22% of administrators (4/18) and 10% of industrial workers (2/20), (P=0.032). Military retention rates were preserved in those requiring repeated ablation compared to those with single AF ablation (70%, 19/27 vs 78%, 60/77; P=0.60). Deployment rates were statistically similar between those requiring repeated AF ablation compared to single ablation (37%, 10/27 vs 43%, 33/77; P=0.43).

Conclusions:
Repeat AF catheter ablation rates in military tactical athletes may be driven by specific and individual occupational demands without increased traditional risk factors for AF recurrence. Military retention and deployment rates are preserved for those requiring repeated AF ablation compared to those with single ablation.
Abstract 13792: Different Trajectories of Specific-Disease QoL in Stroke Survivors and Their Associations With Caregiver Anxiety, Depression and Burden: A Longitudinal Study
Authors: Pucciarelli Gianluca , Bartoli Davide , Vellone Ercole , Alvaro Rosaria , Greco Andrea , Brugnera Agostino
Published: June 2023

Introduction:
Stroke symptoms often predict disability and low quality of life (QOL) in stroke survivors. Stroke survivors’ QOL could have an influence on their caregivers’ variables, such as anxiety, depression or burden and consequently caregivers’ QOL.

Hypothesis:
The aims of this study were to: 1) identify the distinct trajectories of the stroke specific QoLs in stroke survivors; 2) examine the associations between the stroke survivors’ QoL trajectories and caregivers’ anxiety, depression and burden over time.

Methods:
A longitudinal, multicentre study was conducted. A sample of 415 stroke survivors and their caregivers, after the stroke survivors’ discharge from rehabilitation hospitals, were enrolled. Stroke Impact Scale (SIS) 3.0 was used to assess the QOL of the stroke survivor. Caregiver trajectories for anxiety and depression were assessed with the Hospital Anxiety Depression Scale (HADS) while caregiver burden with Caregiver Burden Inventory (CBI). The Latent Class Growth Analyses (LCGA) were used to define the trajectories of the dimensions of the QOL.

Results:
Stroke survivors had similar trajectories on physical QOL dimensions. Differently, for SIS communication, emotional and memory dimensions, we identified two distinct trajectories. The first trajectory, representing 86% of survivors, included those who started with higher QOL levels and improved slightly to markedly in all psychological domains, with this improvement decelerating over time. The second trajectory (14% of survivors) included those who started with low overall levels of psychological QoL and experienced linear worsening of Memory and Communication, starting in the third month, and no change in Emotion and Participation. Caregivers of those patients in the second class experienced worse anxiety, depression and burden over time, compared to caregivers of patients in the first one.

Conclusions:
Our results identified several important risk factors for specific survival patterns that reinforce the need for more tailored interventions in order to improve stroke survivors’ QOL and consequently the caregiver anxiety, depression and burden. This requires a shift from a stroke survivor-centered approach to a stroke survivor and caregiver-centered approach.
Abstract 13798: Obstructive Sleep Apnea Severity and Abnormal Right Ventricular Flow Reserve in Adult OSA Patients Who Received Rubidium-82 Cardiac PET Perfusion Imaging
Authors: Aneni Ehimen C , Miller Edward J , Saeed Gul Jana , deKemp Robert , KLEIN RAN , Beanlands Rob S , Yaggi Henry K , Sinusas Albert J , Thorn Stephanie
Published: June 2023

Background:
Obstructive sleep apnea (OSA) is associated with right ventricular (RV) remodeling, RV dysfunction and pulmonary hypertension. Myocardial flow reserve (MFR), the ratio of stress-to-rest myocardial blood flow (MBF), is an index of coronary microvascular health. Recent evidence suggests that severe OSA is associated with abnormal left ventricular MFR (LVFR). However, little is known about MFR in the RV of patients with OSA. In this study we examined the relationship between measures of OSA severity and RV MFR (RVFR) in humans.

Methods:
We conducted RV MBF assessment in 47 persons with OSA who had a cardiac positron emission tomographic (PET) perfusion scan. All participants had in-laboratory polysomnography. RVFR <2.0 was chosen as threshold for abnormal RVFR to coincide with the 25
th
percentile of RVFR in our sample. Abnormal LVFR was also defined as <2.0 based on thresholds from previously determined studies. We compared the mean apnea-hypopnea index (AHI), oxygen desaturation index (ODI) and time spent with <90% oxygen saturation (T90%).

Results:
The mean age of the participants was 58 years and 63% were female. There was a strong correlation between RVFR and LVFR (Spearman Rho = 0.63, P<0.001). The mean AHI was greater among persons with RVFR <2 compared to those with RVFR≥2 [mean (SE) AHI: 63 (20) v. 32 (5), P=0.042]. This trend was observed with the ODI although it was not statistically significant. Given the RVFR and LVFR were strongly correlated, we created a ratio of RVFR to LVFR to account for the LV MBF. The mean AHI and ODI among persons with RVFR/LVFR <1 was greater than those with ≥1; p = 0.025 and p=0.031 respectively. See the figure for more details.

Conclusion
In patients with OSA, patients with reduced RVFR had higher AHI and ODI indicating greater severity of OSA. The exact mechanism behind this phenomenon is not known. Future studies should further characterize the relationship between RV myocardial blood flow and OSA.
Abstract 13826: Atrial Fibrillation Catheter Ablation in Patients With Inflammatory Bowel Disease
Authors: Haq Ikram-Ul , Abu Rmilah Anan , Alzu'bi Hossam , Deshmukh Abhishek , Desimone Christopher V
Published: June 2023

Introduction:
Patients with a history of inflammatory bowel disease (IBD) are at a higher risk of atrial fibrillation (AF). There is a lack of evidence supporting catheter ablation in this group and predictors of procedural outcomes are unknown.

Hypothesis:
We assessed the hypothesis that patients with a history of IBD have worse procedural outcomes with more peri-procedural complications, especially in those whose disease is less well controlled.

Methods:
A single-center 1:1 propensity matched study of patients with no history of IBD and patients with IBD who underwent primary AF catheter ablation from January 2010 to December 2021 was conducted. The primary outcome was procedural efficacy defined by clinical AF recurrence and repeat catheter ablation. The secondary outcome was an assessment of safety looking at eight peri-procedural events. Univariate and multivariate binary logistic regression analysis was conducted to determine predictors of AF recurrence.

Results:
Our cohort was comprised of 94 patients, 47 patients with a history of IBD (mean age 64.7 ± 6.4 years) and 47 patients with no history of IBD (66.7 ± 7.1 years). Both groups had similar echocardiographic, baseline, and arrhythmia characteristics. All patients underwent pulmonary vein isolation and procedural endpoints were ascertained in all patients. At one-year post-ablation, the study group was statistically more likely to develop AF recurrence (OR 2.38, 95% CI 1.09 - 4.86, p=0.03) but were equally likely to undergo repeat catheter ablation (OR 2.56, 95% CI 0.62 - 10.6, p=0.19). Procedural safety was statistically similar in both groups. Four patients in the study group and three patients in the control group developed subcutaneous hematomas at the site of instrumentation (p=0.70). Multivariate analysis found pre-procedural c-reactive protein (CRP) (OR 1.04, 95% CI 1.00 - 1.12) and AF diagnosis to ablation time (OR 1.15, 95% CI 1.03 - 1.24) were independent predictors of post-procedure AF recurrence.

Conclusions:
Our study suggests patients with IBD are at a higher risk of developing AF recurrence after catheter ablation. Multivariate analysis showed CRP and AF diagnosis to time to ablation were both independent risk factors.
Abstract 13843: Real World Outcomes of Concomitant Hybrid Convergent Ablation and Left Atrial Appendage Exclusion in Patients With Long Standing Persistent Atrial Fibrillation
Authors: Ahmed Adnan , Charate Rishi , Park Peter , romeya ahmed , Van Meeteren Justin , Gopinathannair Rakesh , Lakkireddy Dhanunjaya , Pothineni Naga Venkata K
Published: June 2023

Introduction:
Management of patients with long standing persistent atrial fibrillation (LSPAF) presents a clinical challenge. Hybrid convergent ablation has been shown to have superior efficacy compared to endocardial ablation in patients with LSPAF. However, real world outcomes of concomitant hybrid convergent ablation and left atrial appendage (LAA) exclusion with an atrial clip are sparse.

Hypothesis:
To evaluate effectiveness of concomitant hybrid convergent ablation and LAA clipping in patients with long standing persistent AF (LSPAF).

Methods:
We conducted a retrospective analysis of all patients with LSPAF that underwent hybrid convergent ablation (surgical ablation plus endocardial catheter ablation) and LAA clipping at our institution. All patients had implantable cardiac devices (27.9% CIED and 81.4% ILR). ILRs were programmed to detect >6-minute episodes of AF. Primary end point was recurrence of AF at 12 months.

Results:
A total of 43 patients underwent hybrid convergent ablation and LAA exclusion from 2019-2020. Mean age of the cohort was 64.9
+
8.9 years and 62.8% were male. 61.9% patients had previous AF catheter ablation and majority (84%) were on anti-arrhythmic drugs (AAD). LAA clipping was performed in all patients with a median clip size of 45. Mean time between the surgical and endocardial catheter ablation procedure was 2.6
+
1.7 months. All patients were continued on AAD following the hybrid procedure. Overall AF free survival on continued anti-arrhythmic drugs at 12 month follow up was 68.3%.

Conclusions:
Concomitant hybrid convergent ablation and LAA exclusion with an atrial clip provides reasonable long term AF free survival in patients with LSPAF.
Abstract 13858: The Epidemiological Characteristics & Outcome Trend of Cannabis Abuse Among Stroke Hospitalizations in the United States - A Nationwide Study
Authors: Patel Neel , Patel Urvish K , Dhiman Aakriti , Patel Arpankumar , Tatineni Mahesh Babu , Jyothsna Goranti , Rakhunde Vipul Vihar , Sajnani Pardeep Kumar , khurana mahika , Nagdeo Kiran , Sonani Hardik , Shah Shamik , Hennig Nils
Published: June 2023

Background:
With the legalization of cannabis in many states for medical or recreational purposes, cannabis utilization has been increased to treat various health concerns. However, little is known about the prevalence of cannabis abuse and outcome trend among acute ischemic stroke (AIS) patients. This study examines the epidemiological characteristics and outcome trend of cannabis abuse among adults with AIS hospitalizations in the USA.

Methods:
We performed a population-based retrospective analysis of the Nationwide Inpatient Sample over year from 2003 to 2017 in adult hospitalizations for AIS to compare the outcomes [death, risk mortality & discharge disposition (short-term hospital / skilled nursing home/home health care)] in cannabis abusers using ICD 9 & 10 codes. We performed weighted analyses using chi-square, t-test, and Cochran-Armitage trend test.

Results:
Amongst the total of 5,690,773 AIS hospitalizations, 50,895 (0.89%) cannabis users were identified from 2003 to 2017. The prevalence trend of cannabis abuse has increased among stroke hospitalizations (2003: 0.22% to 2017:1.64%; p-trend < 0.0001). The cannabis abuse was higher among the younger to middle age compared to older aged stroke hospitalization (<50 year: 3.89% vs 50-75 year: 1.09% vs >75 year: 0.02%; p <0.0001). Cannabis abuse was more prevalent among the male (1.32% vs female: 0.50%), Black (2.29% vs White: 0.61%; p<0.0001). The cannabis abusers had lower median household income (1.39% vs higher income:0.44%), medicaid insurance (3.61% vs medicare: 0.31%), highly prevalent in midwest (1.05% vs northeast: 0.57%; p<0.0001). There was also increased trend in mortality (2003: 0.38% to 2017: 0.97%), extreme/major likelihood of dying (2003: 0.21% to 2017: 1.22%), extreme/major loss of function (2003: 0.19% to 2017: 1.52%), discharge to non-home (2003: 0.14% to 2017: 1.25%; p-trend<0.0001) among cannabis abusers following stroke hospitalizations.

Conclusion:
This study identified a higher prevalence of abuse, abuse-related poor outcomes, and higher stroke-related mortality among stroke survivors. Cannabis use in patients with neurovascular insults has raised safety concerns, and more long-term research is needed to determine its risks and benefits in stroke patients.
Abstract 13870: Ventricular Fibrillation Arrest in a 27-Year-Old Woman Due to Takotsubo Cardiomyopathy
Authors: Bodair Ramez , Botheju W. Savindu Pasan , Mishra Suraj , Kron Jordana
Published: June 2023

Introduction:
Sudden cardiac death in young patients may be due to coronary artery disease, primary electrical disease, cardiomyopathy, or congenital anomalies. We explore potential causes for sudden cardiac arrest in a young patient.
Case Description:
A 27-year-old woman was found unconscious. Initial rhythm showed ventricular fibrillation. Cardiopulmonary resuscitation was done for 5 minutes before return of spontaneous circulation. ECG showed ST elevations in aVL, V4, and V5. She was admitted for therapeutic temperature management. Troponin peaked at 1.86 ng/mL on the evening of arrival. Transthoracic echocardiography (TTE) demonstrated hypokinesis of the mid to distal septum, anterior wall, and apex (Figure 1). Repeat TTE 3 days later showed resolution of the wall motion abnormalities. She reported marijuana use and a domestic dispute with her significant other the night prior. Coronary CT angiography showed calcium score of 0 with normal coronary anatomy, no significant coronary artery stenosis, and incidental finding of bilateral pulmonary artery filling defects. Lower limb venous duplex was unremarkable. Therapeutic dose of enoxaparin was started. Cardiac MRI showed no myocardial infarction, scar, or infiltrative disease. An electrophysiology study revealed adequate QT shortening during epinephrine infusion and no inducible ventricular arrhythmias. Genetic testing was unremarkable. She was discharged with a wearable defibrillator before ultimately receiving a subcutaneous implantable cardioverter-defibrillator.

Discussion:
The presentation of transient regional wall motion abnormalities, with ST-segment elevations and negative ischemic workup, is highly suggestive of Takotsubo cardiomyopathy, mid-ventricular variant. Marijuana use is a risk factor, and the domestic dispute is a potential emotional trigger. This case highlights Takotsubo cardiomyopathy as a possible cause of sudden cardiac arrest in young patients.
Abstract 13877: Robotic Exercise Rehabilitation of Older Adults With Cardiovascular Disease Appears Safe and Effective
Authors: Hirashiki Akihiro , Shimizu Atsuya , Kokubo Manabu , Nomoto Kenichiro , Kondo Izumi , Arai Hidenori
Published: June 2023

Introduction:
Recent research has focused on the effects of physical exercise in improving the functional capacity of frail older adults. Training with a balance exercise assist robot (BEAR) system is effective for improving posture. We compared the clinical safety and efficacy of postural strategy training using a BEAR system with those of conventional resistance training or no training in older patients with cardiovascular disease (CVD).

Methods:
Elderly patients (n = 130; mean age, 77.5 years) admitted to our hospital for worsening CVD were randomly allocated to two cardiac rehabilitation (CR) groups: conventional resistance training (group R, n=65) and use of the BEAR (group B, n=65). After appropriate medical therapy, patients underwent cardiopulmonary exercise testing, including assessment of comfortable walking speed, timed up-and-go (TUG), and a short physical performance battery (SPPB), just before discharge and after a weekly for 4 months of CR. We followed up the patients for fall-related fractures and cardiac events, which were defined as hospitalization for worsening CVD or cardiac death, and then compared with non-CR group (group N, n=165). Patients were followed for a mean of 2.1 years.

Results:
BEAR use had no adverse effects in any patient. Comfortable walking speed, TUG, and SPPB had improved significantly in both groups at 4 months compared with baseline but did not differ significantly between groups. No fall related fractures occurred in group B and 2 in group R, there was no significant difference between the two exercise groups. On the other hand, although there was no significant difference in event-free survival rates between the two exercise groups, event-free survival was significantly greater in these groups than in group N (
P
˂ 0.001).

Conclusions:
Exercise training by using a BEAR system is safe and effective for older adults with CVD. We demonstrated here that BEAR use is comparable to conventional resistance training for improving exercise capacity and balance in elderly patients with CVD. Both exercise groups were better prognosis compared with non-exercise.
Abstract 13909: Use of Advanced Lipoprotein Testing in Real-World Data: A Cross Sectional Study Across Multiple Health Systems
Authors: Boricha Hetal , Alish Yousef , Becich Michael , Bradley Alison , Fernandez Soledad , Ford Dan , Hwang Wenke , Jeong Jong , Jurczak Martha , Kirchner H Lester , McTigue Kathleen M , Morgan Richard , Paranjape Anuradha , Thomas Neena , Williams David , Arnold Jonathan
Published: June 2023

Introduction:
Per AHA guidelines, adults between 40-75 with borderline (5-7.5%) 10-year ASCVD risk (approximately 2.5% of this population in prior studies) should have the decision to start statin therapy personalized. Per AHA guidelines, elevated apolipoprotein B-100 (apoB) and elevated lipoprotein(a) (Lp(a)) are risk enhancing factors that may be considered in this decision.

Hypothesis:
We hypothesize that <10% of the estimated borderline 10-year ASCVD risk population between 40-75 years of age are tested for apo(B) or Lp(a).

Methods:
We performed a hypothesis-driven secondary analysis of a cross-sectional dataset of adults with LDL-c assessed in the most recent year of available data from 7 health systems participating in PaTH, a Partner Network in PCORnet. Participating sites reported summaries of demographics, diagnoses and lab testing for their health system populations as well as sub-cohorts of patients with prior ASCVD events, diabetes (DM), and a history of LDL > 190mg/dl. We evaluated the lifetime testing for apo(B) and Lp(a) in the whole population and subtracted out the testing in the high-risk cohorts.

Results:
From a population of 784,406 adults, we identified a cohort of 301,235 aged 40-75 without prior ASCVD event, DM, or LDL > 190. We estimated that 2.5% of this population (7,531) had borderline 10-year ASCVD risk. A total of 730 individuals were tested for apoB and 892 for Lp(a) across the entire non-high-risk cohort (0.2% and 0.3%). Assuming only the borderline risk group was tested, this represents testing rates of 9.7% for apoB and 11.8% for Lp(a), ranging across healthcare systems from 0-27% for apoB and 0-42% for Lp(a).

Conclusions:
Within the constraints of our population-based cross-sectional study, we found it plausible that >10% of the borderline-risk population utilized either apoB or Lp(a) testing for further risk stratification. Future work should be done to directly evaluate the use of these parameters in the borderline-risk population.
Abstract 13914: Additional ASCVD Risk Factors for Patients With Diabetes: FIB-4 Score and NLR Are Higher in Adults With Diabetes and Current Risk Enhancers vs No Risk Enhancers in Real-World Evidence
Authors: Chapagain Himal , Alish Yousef , Becich Michael , Bradley Alison , Fernandez Soledad , Ford Dan , Hwang Wenke , Jeong Jong , Jurczak Martha , Kirchner H Lester , McTigue Kathleen M , Morgan Richard , Paranjape Anuradha , Thomas Neena , Williams David , Arnold Jonathan
Published: June 2023

Introduction:
Obesity, chronic inflammation, and elevated levels of atherogenic lipids have been associated with increased risk of ASCVD events. Current AHA/ACC guidelines identify existing risk enhancers for ASCVD including persistently elevated LDL-C or triglycerides, chronic kidney disease, chronic inflammatory conditions, and elevated inflammatory markers.

Hypothesis:
We hypothesized that in a population-level study of adults with diabetes mellitus (DM) without a history of prior ASCVD events, the average body mass index (BMI), hepatic fibrosis score (FIB-4), and neutrophil to lymphocyte ratio (NLR) are higher in the cohort of patients with other, AHA-identified ASCVD risk enhancers.

Methods:
We performed a hypothesis-driven secondary analysis using a cross-sectional dataset of EHR data from 7 health systems participating in PaTH, a Partner Network in PCORnet. Adults over 40 with DM and without ASCVD were included if they had LDL-c assessed in the most recent year of available data and had >6 months of pre-index data available. We describe cohort-level averages and standard deviations of the most recent lab values and clinical measurements for cohorts with and without AHA/ACC defined ASCVD risk enhancers.

Results:
We identified 50,749 patients in our baseline risk cohort and 67,593 patients in our enhanced risk cohort across the 7 sites. The enhanced risk cohort had a higher mean (SE) BMI 34.1 (0.28) vs 33.7 (0.29) kg/m2, FIB-4 score 1.5 (0.01) vs 1.4 (0.01) and NLR 62.5 (0.24) vs 61.2 (0.23) compared to the baseline risk cohort. NLR and FIB-4 demonstrated consistently higher averages in the enhanced-risk cohorts across sites.

Conclusions:
FIB-4 score and NLR both have higher population averages in cohorts with other markers of enhanced ASCVD risk in an adult diabetic patient population. The role of these markers in independently predicting ASCVD risk should be further explored with adjusted analyses in longitudinal datasets.
Abstract 13915: Man vs. Machine: A Direct Comparison of the Diagnostic Efficacy of Novel Automated WCT Differentiation to Traditional Manual ECG Interpretation Approaches
Authors: LoCoco Sarah , Kashou Anthony H , Deshmukh Abhishek , Asirvatham Samuel , Noseworthy Peter A , Desimone Christopher V , Cooper Daniel , Cuculich Phillip S , Sodhi Sandeep , May Adam
Published: June 2023

BACKGROUND:
Differentiation of wide QRS complex tachycardias (WCTs) into ventricular tachycardia (VT) and supraventricular wide QRS tachycardia (SWCT) through 12-lead electrocardiogram (ECG) interpretation is one of the most critical yet challenging tasks in clinical practice. Recent research highlights novel automated methods that successfully diagnose WCTs. We sought to directly compare the diagnostic efficacy of these novel automated WCT differentiation methods (i.e., WCT Formula, VT Prediction Model, and WCT Formula II) to traditional ECG interpretation approaches (i.e., Brugada and Vereckei aVR algorithms).

METHODS:
A collection of paired WCT and baselined ECGs were retrospectively analyzed. Next, an electrophysiologist blindly and prospectively applied the Brugada and Vereckei aVR algorithms. Separately, computerized measurements were used to apply the three automated WCT differentiation methods. The diagnostic performance of each method was then evaluated.

RESULTS:
213 WCTs (111 VT and 102 SWCT) from 105 patients were analyzed. The WCT Formula demonstrated superior overall accuracy (84.7% vs. 64.8%), specificity (86.2% vs. 35.3%), positive predictive value (PPV) (85.7% vs. 60.7%), and positive (+) likelihood ratio (LR) (6.06 vs. 1.42) compared to Vereckei aVR algorithm. Similarly, the WCT Formula attained higher specificity (86.2% vs. 61.8%), PPV (85.7% vs. 71.9%), and (+) LR (6.06 vs. 2.36) than the Brugada algorithm. The WCT Formula II demonstrated superior overall accuracy (89.2% vs. 64.8%), specificity (84.3 % vs. 35.3%), PPV (86.7% vs. 60.7%), and positive (+) LR (5.97 vs.1.42) compared to Vereckei aVR algorithm as well as higher specificity (84.3 % vs. 61.8 %), PPV (86.7% vs. 71.9%), and (+) LR (5.97 vs. 2.36) than the Brugada algorithm. The VT prediction model yielded superior specificity (79.4% vs. 35.3%), PPV (79.8 vs. 60.7%) and (+) LR (3.63 vs.1.42) compared to the Vereckei aVR algorithm but did not demonstrate superior diagnostic performance to the Brugada algorithm.

CONCLUSIONS:
Novel automated WCT differentiation methods achieved similar or superior diagnostic performance metrics compared to traditional ECG interpretation approaches.
Abstract 13921: Substance Use Disorders and Prevalence of Stroke Amongst the US Population
Authors: Patel Urvish , Tavrawala Dr.Krishna , Mohammad Zeeshan , Krishnakumar Anjali N , Varghese Anitta , Ashwini Maria Sneha , Prabhu Tanvi R , Patil Sushmita , Shrivastav Tanvi Yogesh , kumar sushil , Tarimci Baris , Chelikam Nikhila , Shah Shamik
Published: June 2023

Introduction:
Globally, stroke is one of the top five leading causes of death. Although it was being mostly reported in the elderly population, recently a significant number of young adults are being diagnosed with stroke. The increasing prevalence of comorbidities like diabetes, & hypertension, along with a rise in substance use disorders (SUDs) could be attributed to increased stroke diagnosis among young adults.
Aims & Objectives:
The aims of the study include an evaluation of the prevalence of stroke in the US population & prevalence of SUDs amongst patients with a history of Stroke.

Methods:
Our population was obtained from the National Health and Nutrition Examination Survey (NHANES) from 2013 to 2018. We identified respondents who were diagnosed with stroke & SUDs based on the questionnaire. We performed univariate analysis using chi-square & Mann-Whitney tests using SAS software (Version 9.4). A p-value of <0.05 was considered statistically significant.

Results:
264,740 respondents were included in this study, of which 10435 (3.94%) had a history of stroke. Respondents with history of stroke were older (median age: 68 years) & more prevalent among males (3.98% vs 3.90% females), non-Hispanic Blacks (5.07% vs 4.76% non-Hispanic Whites vs 2.92% other Hispanics), population, & those belonging to lower annual household income (6.76% $0-$25,000 vs 1.50% >$100,000).(p<0.0001). Consumption of cocaine [89.91% vs 95.56%], marijuana/hashish [63.72% vs 52.97%], methamphetamine [45.81% vs 39.71%], alcohol use disorder-heavy drinking [36.44% vs 47.21%], heroin [23.43% vs 15.21%], e-cigarettes [12.71% vs 17.09%], & injectable drugs [4.21% vs 2.49%] were prevalent amongst people had stroke in comparison to without stroke history.

Conclusions:
The use of marijuana was most prevalent among respondents with a history of stroke followed by the use of methamphetamine & heroin. With the legalization of marijuana in 19 states for recreational use, the government should plan appropriate policies to lessen the stroke burden among the population with SUDs in the USA. Recall bias & geographic variations in response rate by participants of the study were the limitations of our survey-based study.
Abstract 13930: The Impact of a Remote Patient Monitoring Program on Blood Pressure Control, Glycemic Control, and Lipids in Patients With Hypertension: A 3.5-year Retrospective Analysis Across 39 Physician Practices
Authors: Wang Li , Liu Zhiyu , Ghamrawi Nina , Liu Shuo , Wong Nathan
Published: June 2023

Introduction
​​Self-measured blood pressure monitoring (SMBP) is recommended for hypertension (HTN) management and remote patient monitoring (RPM) can empower clinicians to manage HTN more efficiently. We examined the impact of a digital health program integrating RPM, SMBP, and nutrition/lifestyle coaching for patients with HTN.

Methods
37 primary care practices and 2 cardiology practices across 10 US states enrolled patients with HTN diagnosis (regardless of their baseline BP control status) into the iHealth Unified Care program from 2018 to 2022. Bluetooth connected devices with mobile app or WIFI connected BP monitors, a web-based clinical care platform, and real time data analytics were utilized. Physicians and their care team, including registered dietitians, provided assessment, goal setting, continuous monitoring, and follow up visits if needed. The 7-day average BP value at baseline and the most recent measurement 7-day period were calculated to analyze BP control status.

Results
3364 patients (age: 65.7 ± 12.1 years, 48.7% female) with baseline and endpoint BP data were included. Enrollment was continuous with an average duration in the program of 1.5 years. The baseline average BP was 138/81mmHg and the overall SBP/DBP reduction was -5.3 ± 15.1 / -3.1 ± 8.4 mmHg (P<0.0001) at the endpoint. The proportion with HTN controlled to <130/80 mmHg was increased from 21.8% to 36.0% (P<0.0001), and those controlled to <140/90 mmHg increased from 53.9% to 63.7% (P<0.0001). In a subgroup analysis on patients with Stage II HTN at baseline (n=1552), the SBP/DBP reduction was -11.9 ± 15.4 /-6.3 ± 8.7 mmHg (p<0.0001) and more significant BP reductions were observed after 6 weeks, and further improved at 3 months, 6month, and 12months respectfully. Of patients with diabetes, HbA1c was reduced by 0.5 ± 1.4% (n=337, p<0.001) and of those with hyperlipidemia (LDL-C >100mg/dL) at baseline (n=264), LDL-C also was reduced significantly (-19.6 ± 38.4 mg/dL, P<0.001).

Conclusions:
The digital BP monitoring program significantly improved the BP control in patients with HTN as well as HbA1c and LDL-C in those who also had diabetes and hyperlipidemia, respectively. Long term and randomized control trials are needed to further evaluate the impact on cardiovascular risk.
Abstract 13934: Low Estimated Protein Intake is Associated With Poor Prognosis in Patients With Acute Heart Failure
Authors: Dotare Taishi , Maeda Daichi , Matsue Yuya , Nakamura Yutaka , akama yuka , tsujimura yuichiro , Sunayama Tsutomu , Ishiwata Sayaki , Yatsu Shoichito , Iso Takashi , Kato Takao , Suda Shoko , Hiki Masaru , Kasai Takatoshi , Minamino Tohru
Published: June 2023

Introduction:
Although a higher protein intake has been related with lower mortality rates in general population, the association between protein intake and nutritional status/mortality in patients with acute heart failure has yet to be clarified.

Methods and Results:
We retrospectively analyzed 694 patients who were admitted due to acute heart failure in our hospital (mean age, 75±13 years; male 60%). The estimated protein intake was defined as a validated formula: [13.9 + 0.907*body mass index (kg/m
2
) + 0.0305*urinary urea nitrogen level (mg/dL)] using spot urine samples on admission. All patients were divided into three groups according to the estimated protein intake: low (≤43.6 g/day, n=232), middle (43.7 to 51.5 g/day, n=231), and high (≥51.6 g/day, n=231) group. The primary outcome of this study was regarded as all-cause mortality. Patients with low protein intake were older and had lower albumin compared with other two groups. A lower protein intake was associated with worse nutritional status evaluated using Geriatric Nutritional Risk Index (P<0.001). Kaplan-Meier analysis revealed that the low protein intake group was significantly associated with higher incidence of the primary outcome. Compared to the high protein intake group, Cox proportional hazard analysis demonstrated the low protein intake group was independently associated with all-cause mortality (hazard ratio, 1.80; 95% confidence interval, 1.07-3.02; P=0.026) even after adjustment for confounding factors.

Conclusions:
Low protein intake was associated with poor nutritional status and all-cause mortality in patients with acute heart failure.
Abstract 13942: Circular RNA-HIPK3 Suppresses Aortic Valve Calcification by Dual Inhibition of the Wnt/β-catenin Pathway in Aortic Valve Interstitial Cells
Authors: Xian Gaopeng , Huang Rong , Jingxin Zeng , Zhao Hengli , Shuwen Su , Li Shunyi , Xu Dingli , Zeng Qingchun
Published: June 2023

Introduction:
Calcific aortic valve disease (CAVD) has become an increasingly important worldwide medical problem without effective pharmacological intervention. Circular RNAs (circRNAs), a large class of non-coding RNAs, have been shown to play a critical role in the occurrence and progression of cardiovascular disease. However, the role of circRNAs in CAVD remains unclear.

Methods and Results:
High-throughput sequencing of circRNAs expression profiles in human calcified aortic valves and normal controls revealed that circRNA-HIPK3 (circHIPK3) was abundant in aortic valves but decreased in calcified aortic valves. Infecting the CAVD mouse model with adeno-associated virus subtype 9 expressing circHIPK3 (AAV9-circHIPK3) revealed that circHIPK3 overexpression reduced thickness and calcium deposition of the aortic valve leaflet
in vivo
. Gain- or loss-of-function experiments showed that circHIPK3 inhibited osteogenic responses in human aortic valve interstitial cells. MeRIP and RIP experiments showed that circHIPK3 enhanced the stability of suppressor of morphogenesis in genitalia 1 (SMG1) mRNA in an N6-methyladenosine (m
6
A)-dependent manner. Meanwhile, RNA pull-down and ChIP-Seq indicated that circHIPK3 increased the transcriptional activity of Chibby family member 1(CBY1) by promoting TATA-box binding protein-associated factor 15 (TAF15) intranuclear translocation. Furthermore, SMG1 and CBY1 negatively regulated the activity of Wnt/β-catenin pathway, and rescue experiments showed that circHIPK3 inhibited the Wnt/β-catenin pathway through increasing the expression of SMG1 and CBY1.

Conclusions:
Deficiency of circHIPK3 results in activation of the Wnt/β-catenin pathway and thereby induces aortic valve calcification. Exogenous circHIPK3 supplementation shows the ability to inhibit aortic valve thickening and calcification
in vivo
. Therefore, targeting circHIPK3 may be a potential strategy to prevent the development of CAVD.
Abstract 13945: Patients Admitted With Type 2 Acute Myocardial Infarction Without Standard Modifiable Risk Factors Have Worse Outcomes Compared to Patients With Standard Modifiable Risk Factors
Authors: Sokhal Balamrit Singh , Matetic Andrija , Paul Timir K , Velagapudi Poonam , Lambrinou Ekaterini , Figtree Gemma A , Rashid Muhammad , Moledina Saadiq , Vassiliou Vassilios , Mallen Christian D , Mamas Mamas
Published: June 2023

Introduction:
Patients without standard modifiable cardiovascular risk factors (SMuRF; hypertension, diabetes, hypercholesterolaemia, smoking) have worse outcomes in Type 1 acute myocardial infarction (AMI). The relationship between type 2 AMI (T2AMI) and outcomes in patients with and without SMuRF is unknown. This study aimed to determine the prevalence, characteristics and clinical outcomes of patients hospitalized with T2AMI based on the presence of SMuRF.

Methods:
All hospitalizations with a primary discharge diagnosis of T2AMI in the National Inpatient Sample were stratified according to SMuRF status (SMuRF and SMURF-less). Primary outcome was all-cause mortality while secondary outcomes were major adverse cardiovascular and cerebrovascular events (MACCE), major bleeding and ischemic stroke. Multivariable logistic regression was used to determine adjusted odds ratios (aOR) with 95% confidence intervals (95% CI).

Results:
Among 17,595 included hospitalizations, 1,345 (7.6%) were SMuRF-less. After multivariable adjustment, SMuRF-less patients were more likely to develop all-cause mortality (aOR 2.43, 95% CI 1.83 to 3.23), MACCE (aOR 2.32, 95% CI 1.79 to 2.90) and ischaemic stroke (aOR 2.57, 95% CI 1.56 to 4.24) compared to their SMuRF counterparts (
Figure 1
).

Conclusions:
T2AMI in the absence of SMuRF was associated with worse in-hospital outcomes compared to SMuRF-less patients. Further longitudinal studies are necessary to define the impact of SMuRF on longer term T2AMI outcomes.
Abstract 13954: Cardiovascular Imaging Markers and Atherosclerotic Cardiovascular Disease in Lung Cancer Survivors
Authors: Zhang Lili , Daraz Yasmeen M , Kawalet Mariana , Ippolito Paul , Neshiwat Patrick , Ohri Nitin , Pu Min , Garcia Mario J , Slipczuk Leandro , Rodriguez Carlos
Published: June 2023

Introduction:
Lung cancer survivors have heightened risk of atherosclerotic cardiovascular disease (ASCVD) due to shared risk factors. Chest computed tomography (CT) is routinely performed for cancer staging and radiotherapy (RT) planning. However, the extent of coronary artery calcium (CAC) and thoracic aortic calcium (TAC) is not routinely evaluated for ASCVD risk assessment.

Methods:
We evaluated the extent of CAC and TAC from chest CTs obtained for routine care prior to RT in a cohort of lung cancer survivors from 2007 to 2021 at a single academic health system that serves a large multiracial community. The demographics, baseline cardiovascular risk factors and baseline ASCVD (the composite of myocardial infarction, cerebrovascular disease, or peripheral arterial disease) were compared between survivors with and without CAC or TAC. The primary end point was incident ASCVD.

Results:
The cohort studied 603 subjects, including 19% non-Hispanic Whites, 33% non-Hispanic Blacks and 32% Hispanics. Mean age was 65±11 years, with 45% women. CAC was present in 72% of subjects and TAC in 85%. Individuals with CAC had higher prevalence of hypertension (75% vs 57%, p<0.001), diabetes (41% vs 20%, p<0.001) and hyperlipidemia (49% vs 26%, p<0.001). Survivors with CAC had a higher prevalence of baseline ASCVD (33% vs 18%, p=0.001). Survivors with TAC yielded similar findings. In individuals without prior ASCVD, 10-year ASCVD risk score was higher in survivors with CAC (20%±21% vs 12%±13%, p=0.009) or with TAC (19%±20% vs 8%±8%, p=0.007). In a median follow-up time of 15 months, the new development of ASCVD appeared higher in survivors with CAC (23% vs 14%, p=0.04, Figure A) and with TAC (22% vs 8%, p=0.01, Figure B).

Conclusions:
In a large cohort of multiracial lung cancer survivors, presence of CAC or TAC based on routine chest CT at baseline is associated with a higher burden of ASCVD risk and predicts a higher risk of the new development of ASCVD during follow- up.