bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 11242: Spatial-Temporal Deep Learning for Automatic Detection of Echocardiographic Predictors of Mortality in Patients Hospitalized With Covid-19 - Data From the PROVAR-COVID Study
Authors: Ramos Washington Luis S , Nascimento Bruno R , Pappa Gisele L , Araújo Júnior Edson R , martins João Francisco B , Meira Júnior Wagner , Pimentel Sander Luis G , Franco Juliane , Oliveira Kaciane , Nunes Maria D , Sable Craig A , Beaton Andrea Z , Ribeiro Antonio L , Nascimento Erickson R
Published: June 2023

Background:
Cardiac involvement seems to impact the prognosis of COVID-19. Bedside echocardiography (echo) holds promise for the early outcome prediction, and artificial intelligence has shown to be an additional tool to overcome personnel limitations. We propose a spatial-temporal deep learning-based approach for automatic prediction of mortality of inpatients with COVID-19 with echo images.

Methods:
Patients admitted to two hospitals in Brazil in 90 days with confirmed moderate and severe COVID-19 underwent clinical and laboratory evaluation, and focused bedside echo (GE Vivid IQ), following admission, with remote interpretation. Independent echo predictors of all-cause mortality were assessed, after adjustment for clinical variables. Our image dataset consists of 752 videos (Mpeg) acquired in three different probe positions: apical 4-chamber and parasternal long and short axis. We predicted the patients’ outcome (discharge or death) in a 10-fold cross-validation procedure manner, where we applied a 2-stream deep neural network composed of 2 identical ResNet-18 Convolutional Neural Networks (CNN) - pre-trained and developed for Rheumatic Heart Disease - followed by attention units to extract relevant spatial and temporal features from RGB and Optical Flow frames. A final softmax layer is used for classification.

Results:
A total of 163 patients were enrolled, the mean age was 64±16 years, 107 (66%) were admitted to intensive care and in-hospital mortality was 34% (N=56). Independent predictors of mortality were age≥63 years (OR=5.53, 95%CI 1.52-20.17), LVEF<64% (OR=7.37, 95%CI 2.10-25.94), and TAPSE<18.5 mm (OR=9.43, 95% CI 2.57-35.03), C-statistic=0.83. During training, utilizing a balanced set of 106 patients, we rescaled videos to 224x224 pixels and used temporal jittering to select a final clip with 32 frames per video in random batches of size 6. Our proposed method achieved an exam-wise accuracy of 62.22% (95%CI 52.40-72,04), sensitivity of 67.52% (95%CI 51.62-83.42), and specificity of 60.45% (95%CI 45.15-75.75) for mortality.

Conclusion:
Automatic detection of high-risk echo findings in COVID-19 inpatients at the bedside seems feasible and, with more research, can improve mortality prediction at the point of care.
Abstract 11250: Historical Neighborhood Redlining and Cardiovascular Risk in Patients With Chronic Kidney Disease: Results From Chronic Renal Insufficiency Cohort
Authors: Al-Kindi Sadeer , Motairek Issam , Nasir Khurram , Farkouh Michael E , Sperling Laurence , Wright Jackson T , Dobre Mirela A , Rahman Mahboob , Rajagopalan sanjay
Published: June 2023

Background:
Neighborhood redlining was established by the government-sanctioned Home Owners' Loan Corporation (HOLC) in the 1930s aimed to develop neighborhood risk assessment for mortgage applications in the United States. Redlining has resulted in residential segregation and has contributed to persistent systemic racism.

Objectives:
We sought to investigate the association between redlining and prevalent and incidence cardiovascular disease (CVD) in patients with chronic kidney disease (CKD).

Methods:
We linked participants from the Chronic Renal Insufficiency Cohort (patients with mild to moderate CKD enrolled 2003-2008 and followed prospectively) with historical redlining risk groups using participant residential address at enrollment. HOLC groups neighborhoods into risk groups (A-D, with A being lowest risk and D being highest risk). We examined the association between redlining groups with prevalent and incident cardiovascular events

Results:
A total of 1720 participants were included: 109 (6.3%) in group A, 305 (18%) in group B, 753 (44%) in group C, and 553 (32.2%) in group D. Overall, increasing neighborhood HOLC risk was associated with increased proportion of Black and Hispanic residents, younger age, proteinuria, higher systolic BP, and high sensitivity troponin levels (all P<0.01). In multivariable models, group B (Odds Ratio [OR] 2.34 (95% CI: 1.32-4.15), P=0.003), group C (OR 2.31 (1.34-3.98), P=0.003) and group D (OR 2.10 (1.21-3.65), P=0.009) were associated with increased CVD at baseline (vs group A). Among 1118 participants without baseline CVD, group D was associated with increased risk for HF or all-cause death (adjusted HR 2.63 (1.31-5.28), P=0.006) which remained unchanged after further adjustment for BNP and high-sensitivity troponins (D vs A: HR 2.55 (1.27-5.13), P=0.008).

Conclusions:
Historical neighborhood redlining is associated with prevalent CVD and incident heart failure/death in a contemporary cohort of patients with CKD, enrolled more than 6 decades after the redlining practices were abolished. Future studies should focus on investigating the mechanisms of this relationship and the impact of residential segregation on cardiovascular health.
Abstract 11251: Canagliflozin Therapy Improves Myocardial Function and Perfusion in a Swine Model of Chronic Myocardial Ischemia
Authors: Sabe Sharif A , Xu Cynthia M , Sabra Mohamed , Aboulgheit Ahmed , Stanley Madigan , Abid Ruhul , Sellke Frank W
Published: June 2023

Introduction:
Sodium-glucose cotransporter-2 (SGLT2) inhibitors have cardioprotective effects independent of glucose control, as demonstrated in animal models of acute myocardial ischemia and in clinical trials of patients with heart failure. The mechanisms of these effects require further investigation. The purpose of this study is to determine the effects of canagliflozin therapy on myocardial function, perfusion, and microvessel density in a large animal model of chronic myocardial ischemia.

Methods:
Yorkshire swine underwent placement of an ameroid constrictor to the left circumflex artery to induce chronic myocardial ischemia. Two weeks later, pigs received either no drug (CON, n=8) or 300mg canagliflozin (CANA) daily (n=8). Treatment continued for five weeks, followed by hemodynamic measurements and harvest. Perfusion, vessel density, and protein expression were measured by microsphere analysis, immunofluorescence, and immunoblotting respectively.

Results:
CANA therapy was associated with increased stroke volume (p=0.007) and stroke work (p=0.021), and decreased left ventricular stiffness (p=0.007) compared to CON. The CANA group had improved perfusion to ischemic myocardium at rest (p=0.036) and during pacing (p=0.038) compared to CON. There were no differences in arteriolar or capillary density between groups (p>0.5). In ischemic myocardium of the CANA group, there was increased expression of total AMPK (p=0.0047) and p-AMPK (p=0.038), decreased expression of p-eNOS (p=0.028) with unchanged total eNOS (p>0.5), and increased expression of antioxidant SOD2 (p<0.001) compared to CON. There were no differences in expression or activation of AKT and ERK1/2 (p>0.05).

Conclusions:
In the setting of chronic myocardial ischemia, canagliflozin therapy improves myocardial function and perfusion to ischemic territory, without changes in collateralization. Activation of AMPK and antioxidant signaling may contribute to these effects.
Abstract 11262: Effect of Active Cancer/Cachexia on the Development of Cardiac Dysfunction in Mice
Authors: Kiss Attila , Dostal Christopher , Szabo Luja Petra , Aioanei Casian S , Spona Daniel , Zins Karin , Abraham Dietmar , Bakiri Latifa , Wagner Erwin F , Podesser Bruno
Published: June 2023

Introduction:
Cancer is independently associated with the alteration of cardiac function prior to cardiotoxic chemotherapy (CCT) exposure. Similar to cancer associated cachexia (CAC), the elevation and the deleterious role of IL-6 in plasma was associated with a reduced cardiac function in heart failure (HF) patients subpopulation. Cancer cells manipulate BCL-2-associated athanogene 3 (BAG3)-HSP70-regulated pathways in tumor cells, which is a key regulator of protein turnover and contractility in cardiomyocyte.

Hypothesis:
Here, we aimed to characterize the progression of cardiac dysfunction and the expression of BAG3 and HSP70 in tumor-bearing mice.

Methods:
Colon-26 adenocarcinoma cells (C26; n=22) with/without shIL-6 (C26 shIL-6; n=22) were injected subcutaneously adult male BALB/c mice. Control mice were injected with PBS (n=13). Echocardiographic examinations and invasive hemodynamic measurements (
in vivo
and
ex vivo
using isolated working hearts system) were performed at 10 (early) and 20 (late) days post injection, respectively. The expression of BAG3 and Hsp70 were determined by Western blot.

Results:
The tumor size was comparable between the cancer groups. However, only C26 group showed a significant loss of subcutaneous fat and skeletal muscle (p<0.05, respectively), confirming cachectic condition. Echocardiography results show a tendency to decline of ejection fraction at the early phase (p~0.08 vs Control), and turned significance lower at late stage (p<0.05 vs Control) in tumor-bearing mice. In line with that, invasive hemodynamic and isolated working heart measurements confirmed LV systolic and diastolic dysfunction (late stage, p<0.05 vs Control, respectively). Interestingly, heart rate and aortic flow were predominantly declined in cachectic animals (p<0.05 vs Control). Importantly, cardiac dysfunction was associated with a significant reduction in both BAG3 and Hsp70 in the myocardium independently of cachexia.

Conclusions:
Cancer rather than CAC is a main driver for the development of cardiac contractile dysfunction prior to CCT exposure. In addition, our data suggest that targeting BAG3-Hsp70 complex in the cardiomyocytes may provide a novel strategy to improve the cancer associated cardiac dysfunction.
Abstract 11283: Induction of Interferon-Stimulated Gene 15 by Pressure Overload Facilitates Adverse Ventricular Remodeling
Authors: Yerra Veera Ganesh , Batchu Sri Nagarjun , Kaur Harmandeep , Kabir MD Golam , Liu Youan , Advani Suzanne , Sadeghian Shadi , Sedrak Phelopater , Billia Filio , Kuzmanov Uros , Gramolini Anthony , Connelly Kim , Advani Andrew
Published: June 2023

Introduction:
Inflammation promotes adverse ventricular remodeling, a common antecedent of heart failure. Here, we set out to determine how cardiomyocytes respond to accumulating inflammatory cells within the remodeling heart and how this response, in turn, affects heart function.

Methods:
Experiments were performed in mouse and rat models of pressure overload, cultured mouse and human cardiomyocytes and human heart failure tissue.

Results:
CCR2+ monocyte-derived macrophages from
Ccr2
gfp/+
mice accumulated early in mouse hearts after transverse aortic constriction (TAC) and
Ccr2
knockout attenuated cardiac function decline (ejection fraction, fractional shortening, cardiac output and stroke volume). Cardiomyocyte RNA sequencing revealed that the secretome of CCR2+ cells isolated from TAC hearts induced an interferon response in cardiomyocytes, characterized by upregulation of interferon-stimulated gene 15 (ISG15), which post-translationally modifies actively translated proteins through a process termed ISGylation. ISG15 upregulation or protein ISGylation were also observed in the hearts of mice infused with angiotensin II, uninephrectomized rats treated with DOCA-salt, rats after pulmonary artery banding; mouse and human cardiomyocytes exposed to recombinant interferons; and ventricular tissue of humans with non-ischemic cardiomyopathy. ISG15 accumulated at, or close to, cardiomyocyte intercalated discs and Nano LC-MS/MS, co-immunoprecipitation and co-localization experiments identified the myofibrillar protein filamin-C to be an ISGylation target at these sites. Lastly, knockout of
Isg15
attenuated cardiac function decline in mice following TAC, accompanied by a transcriptional profile indicative of preserved cardiac energetics.

Conclusions:
Collectively, these studies reveal that ISG15 induction is a characteristic of non-ischemic ventricular remodeling and they identify protein ISGylation as an inflammation-induced post-translational modification that may contribute to heart failure development. Strategies that prevent the ISGylation of cardiomyocyte proteins occurring during ventricular remodeling may improve heart failure outcomes.
Abstract 11294: Rates of Testing in Syncope Patients in the United States Using a National Database
Authors: Smoot Madeline , Bai Chen , Edwards Emily S , Dasa Osama , Petersen John W , Kimmel Stephen E , Mardini Mamoun T , Ruzieh Mohammed
Published: June 2023

Introduction:
Syncope is a prevalent health problem. Most causes of syncope are benign and can be diagnosed based on history and physical examinations. Nonetheless, overtesting for syncope is a major healthcare problem associated with increased costs. In this study, we sought to assess the testing trends for the evaluation of syncope.

Methods:
We used data from the IBM MarketScan Research Database, which captures deidentified, individual-level information in the United States from approximately 100 commercial payers and self-insured corporations, not including Medicaid claims. We identified patients with the first diagnosis of syncope from 2010-2020 using ICD-9 and ICD-10 codes. Patients were followed up for three months to determine the rate of testing for syncope.

Results:
We identified 2,500,850 patients (57.9% women) with a mean age of 48.5 years. The overall rate of anatomical neurological testing was higher than cardiac anatomical testing (43.3% vs. 25.5%, p<0.001). The rate of the following tests decreased over time: cardiac stress testing (17.4% to 11.4%, p<0.001, figure 1A), carotid ultrasound (13.1% to 7.2%, p<0.001, figure 1C) and EEG (7.3% to 5.7%, p<0.001, figure 1C). The rate of CT chest angiography increased significantly (3.6% to 6.1%, p<0.001, figure 1B). The rates of long-term ECG monitoring, echocardiogram, chest x-ray, and neck and brain imaging remained the same (Figures 1A-C).

Conclusion:
Although prior studies demonstrated low yield for most cardiac and neurological evaluations for syncope and the reduction of testing over time (stress testing, carotid doppler, EEG), high rates of testing remained prevalent in syncope patients. Efforts are needed to reduce the use of low-yield diagnostic studies in syncope patients.
Abstract 11295: Design and Rationale for the BETTER CARE-HF Trial: A Pragmatic Cluster-Randomized Controlled Trial Comparing Two Targeted Approaches to Ambulatory Clinical Decision Support for Cardiologists
Authors: Mukhopadhyay Amrita , Reynolds Harmony , Xia Yuhe , Phillips Lawrence M , Aminian Rod , Diah Ruth-Ann , Nagler Arielle , Szerencsy Adam , Saxena Archana , Horwitz Leora , Katz Stuart D , Blecker Saul
Published: June 2023

Introduction:
Heart failure with reduced ejection fraction (HFrEF) is a leading cause of morbidity and mortality. However, shortfalls in prescribing of proven therapies, particularly mineralocorticoid receptor antagonist (MRA) therapy, account for several thousand preventable deaths per year nationwide. Electronic clinical decision support (CDS) is a potential low-cost and scalable solution to improve prescribing of therapies. However, the optimal timing and format of CDS tools is unknown. We developed two CDS tools to inform cardiologists of gaps in MRA therapy for patients with HFrEF and without contraindication to MRA therapy: 1) a best practice alert (BPA) that notifies cardiologists at the time of patient visit, and 2) an automated in-basket message that allows for review between visits (Figure).

Objective:
The BETTER CARE-HF (Building Electronic Tools to Enhance and Reinforce CArdiovascular REcommendations for Heart Failure) trial aims to compare the effectiveness of a BPA vs. in-basket message vs. usual care on the primary outcome of MRA prescribing.

Methods:
This is a pragmatic, cluster-randomized, three-arm intervention trial. Patients are randomized as a cluster at the level of their cardiologist in a 1:1:1 fashion (180 cardiologists included). The primary outcome is MRA prescription at the end of the study period, and secondary outcomes include prescribing of other GDMT, time to prescription, and provider-level changes in prescribing rates. We will require a total of 1,503 patients (501 per arm) to detect 10% improvement in prescribing with 80% power, and estimate a trial duration of 6 months.

Implications:
To our knowledge, no study has directly compared the efficacy of a BPA vs. in-basket message. If effective, our findings can be rapidly disseminated to improve morbidity and mortality for patients with HFrEF, and can also inform the development of future CDS interventions for other disease states.

Trial registration:
NCT05275920
Abstract 11306: Trajectories of Ticagrelor Adherence in Patients With Acute Coronary Syndromes
Authors: Moon Jungyeon , Ozaki Aya , Ko Dennis T , Chong Alice , Fang Jiming , Austin Peter , Sud Maneesh , Jackevicius Cynthia
Published: June 2023

Introduction:
Adherence is often measured using proportion of days covered (PDC), where the single average PDC that is estimated conceals the heterogeneity of the adherence patterns, each of which may require unique solutions. Novel group-based trajectory methods allow one to distinguish subgroups of adherence patterns. We examined the magnitude of variation in PDC estimates in these subgroups.

Methods:
We conducted a retrospective cohort study of patients aged ≥65 years who had filled ticagrelor within 7 days post-ACS discharge in Ontario, Canada between 4/2014-3/2018. Longitudinal patterns of adherence were measured using group-based trajectory models over 1 year and compared with traditional adherence metrics using PDC for the entire cohort and for each trajectory group.

Results:
We identified 9,764 ticagrelor users (mean age 73.6; 65.4% men). Three distinct trajectory patterns of ticagrelor adherence were identified: a consistently adherent, a gradually nonadherent, and a rapidly nonadherent group, comprising 67.8%, 17.1% and 15.1% of the cohort, respectively. The 1-year mean PDC (±SD) was 80.8±29.2 for the whole ticagrelor post-ACS cohort. After differentiating by adherence trajectory group, mean PDC (±SD) was 97.4±4.5 % in the consistently adherent, while it was 69.1±15.6% and 20.2±11.6 over 1 year in the gradually and rapidly non-adherent trajectory groups, respectively.

Conclusions:
The overall ticagrelor adherence of ~80% 1-year post-ACS instills a false sense of comfort. The 3 distinct trajectory groups revealed divergent patterns not reflected by this overall mean estimate. The two-thirds of patients who were consistently adherent maintained nearly perfect ticagrelor adherence, while the rapidly non-adherent group only took ticagrelor on average for 2.5 months of the year. The trajectory method approach allows us to distinguish adherence subgroups, and better identify patients at risk of nonadherence who need targeted interventions.
Abstract 11309: Lipoprotein(a) and the Pooled Cohort Equations for Risk Prediction: The Multi-Ethnic Study of Atherosclerosis
Authors: Bhatia Harpreet S , Rikhi Rishi , Allen Tara , Yeang Calvin , Guan Weihua , Garg Parveen K , Tsai Michael Y , Criqui Michael H , Shapiro Michael D , Tsimikas Sotirios
Published: June 2023

Introduction
Lipoprotein(a) [Lp(a)] is an independent risk factor for atherosclerotic cardiovascular disease (ASCVD) but is not included in the ACC/AHA ASCVD Risk Estimator based on the Pooled Cohort Equations (PCE).

Methods
We evaluated the association between Lp(a) >50 mg/dL and risk for cardiovascular disease (CVD) events using multivariable Cox proportional hazards models stratified by ASCVD risk category in individuals free of baseline ASCVD with elevated Lp(a) in the Multi-Ethnic Study of Atherosclerosis (MESA). We then evaluated actual versus PCE-predicted risk by comparing 10-year CVD event rates in those with Lp(a) >50 mg/dL versus Lp(a) ≤50 mg/dL using Poisson regression with adjustment for the components of the PCE by strata of risk (<5%, 5-7.5%, 7.5-20%, ≥20%). We then evaluated the change in the C-index and continuous net reclassification improvement (NRI) with the addition of Lp(a) to the PCE.

Results:
In participants with borderline risk (5-7.5%), elevated Lp(a) was associated with greater risk for CVD events (HR 2.59, 95% CI 1.41, 4.78). Among patients with elevated Lp(a), the greatest discrimination of risk was present in those with borderline (5-7.5%) predicted risk, where the PCE significantly underestimated risk (observed rate: 8.9% for Lp(a) >50 mg/dL vs 4.1% for Lp(a)≤50 mg/dL, risk ratio 2.54, 95% CI 1.35-4.62,
Figure
). In this group, addition of Lp(a) to the PCE resulted in C-index improvement of 0.063. The continuous NRI with the addition of Lp(a) for CVD was 0.0386 (95% CI -0.0115, 0.1087) overall, but 0.3142 (95% CI 0.0350, 0.6083) among those at borderline predicted risk.

Conclusions:
The PCE underestimates risk in individuals with borderline predicted risk and elevated Lp(a). The addition of Lp(a) to the PCE improves risk prediction in individuals with borderline risk, for whom the greatest opportunity to guide treatment decisions exists.
Abstract 11315: Clinical Utility of Machine Learning-Derived Vocal-Biomarker in the Management of Heart Failure
Authors: Okada Kozo , Omiya Yasuhiro , Mizuguchi Daisuke , Endo Koji , Kobayashi Yusuke , matsuzawa yasushi , Iwahashi Noriaki , Kosuge Masami , Ebina Toshiaki , Tamura Kouichi , Hibi Kiyoshi
Published: June 2023

Introduction:
Previous studies have suggested that early therapeutic intervention could prevent heart failure (HF) worsening, while early detection of signs and symptoms of cardiac decompensation remains challenging. For the first time, this study focused on voice symptoms and aimed to explore its potential utility in the management of heart failure.

Methods:
This single-center, prospective, observational study included 38 patients admitted due to worsening HF. A total of 726 voice data were recorded during the therapeutic time course at the hospital. Changes in clinical symptoms (New York Heart Association [NYHA])) evaluated by an experienced cardiologist and B-type natriuretic peptide (BNP, pg/ml) during the time course were also evaluated. Here we tested if the acoustic features of the patient voice could predict the NYHA class and BNP levels, using the machine learning (ML) models trained with a gradient boosting algorithm. A 5-fold cross-validation was applied to evaluate the model performance.

Results:
There were significant correlations of some acoustic features with clinical symptoms and BNP levels (data not shown). We created the prototype of the ML model on the acoustic features extracted from the data set. Receiver operating characteristic (ROC) analysis revealed a good diagnostic accuracy of our ML model to predict NYHA class ≥2 (sensitivity 0.78, specificity 0.75, area under the curve (AUC) 0.79, and accuracy 0.77). There was also a significant correlation between voice-derived BNP and actual BNP levels (Figure). AUC of ROC analysis for predicting NYHA class ≥2 from BNP was 0.688.

Conclusions:
The prototype of the ML model was related to clinical symptoms of HF decompensation and BNP levels, demonstrating greater diagnostic accuracy for NYHA prediction than actual BNP levels. Further studies are warranted to investigate the possible contributions of our ML model to the early detection of worsening HF as ML-derived vocal-biomarkers.
Abstract 11331: Correlations Between Coronary Artery Calcium From Non-Gated Computed Tomography and Conventional Estimates of Peri-Operative Risk by Age and Sex
Authors: Hayes Dena , Choi Daniel , Maidman Samuel D , Dhaduk Nehal , Donnino Robert , Smilowitz Nathaniel R
Published: June 2023

Introduction:
Perioperative risk estimation prior to non-cardiac surgery is a common clinical challenge. Coronary artery calcification (CAC) is more common in men and older individuals. We sought to determine if an index of coronary calcium derived from pre-operative non-gated chest computed tomography (CT) is associated with conventional estimates of peri-operative risk in subgroups by age and sex.

Methods:
We retrospectively identified men and women age ≥45 years who had undergone non-cardiac surgery at a large urban health system between 2016 and 2020 and had a non-gated chest CT within 1 year prior to surgery. Coronary calcium in each coronary artery (LAD, LCX, RCA) was graded as absent, mild, moderate, or severe with a corresponding numeric score (range: 0-3). A novel coronary calcium index (CCI) was determined as the sum of these scores. Correlations between the CCI and Revised Cardiac Risk Index (RCRI), a conventional measure of perioperative risk, were assessed in subgroups by age and sex using Spearman's correlation coefficient (𝜌;).

Results:
Among 2,560 patients, 49.8% (1,273) were female and 60.0% (1,538) were ≥65 years old. The CCI exhibited a correlation with RCRI in men (𝜌;: 0.204, p<0.001) and women (𝜌;: 0.200, p<0.001), with no differences by sex (p=0.95). Correlations between the CCI and RCRI were also observed in younger (age 45-64 years; 𝜌;: 0.180, p<0.001) and older (age ≥65 years; 𝜌;: 0.204, p<0.001) adults, with no differences by age group (p=0.53)

Conclusion:
An index of coronary calcium derived from non-gated chest CT imaging prior to surgery correlated with RCRI among all subgroups by age and sex. Coronary calcium from non-gated imaging represents a potentially promising approach to pre-operative risk evaluation.
Abstract 11337: Impact of Covid-19 Pandemic and Telemedicine on Cardiac Rehabilitation Compliance
Authors: Gustafson Shanshan , Eichner Natalie , Saha Sudip , Berry Natalia
Published: June 2023

Introduction:
The COVID-19 pandemic changed healthcare access and delivery. This study aims to evaluate the effect of the COVID-19 pandemic on cardiac rehabilitation compliance.

Methods:
A total of 1888 patients enrolled in Kaiser Permanente Mid-Atlantic States Cardiac Rehabilitation (CR) Program from 2014 to 2022 were included. Demographic data including sex, age, smoking status, weight, HbA1c, and entry diagnosis were evaluated retrospectively from patient charts. Compliance was defined as >/=75% attendance of a total of 12 virtual sessions. Baseline characteristics and compliance were compared between patients who enrolled prior to (N=1496) and after (N=392) the start of the COVID-19 pandemic in March 2020. Data was analyzed using Chi-squared and t-test models. Significance was defined as p<0.05.

Results:
A significant increase in CR compliance was observed after the start of the pandemic (74% vs 56%, p<0.001). The compliant patients in the pandemic group were younger, had better glycemic control, and less tobacco use (all p < 0.05). They were also more likely to have multiple cardiovascular diagnoses on enrollment of the program. Sex and starting BMI did not significantly defer between the groups.

Conclusion:
While the pandemic has limited access to care in some areas, we report an increase in virtual CR compliance since the start of the pandemic, particularly among younger patients with better risk factor control. Increased virtual visit options may partly account for this increase, and future work should focus on how to increase accessibility to virtual care for patients of all ages across the spectrum of cardiovascular risk.
Abstract 11359: Safety and Efficacy of DOACs Compared to Vitamin K Antagonist in the Treatment of Left Ventricular Thormbus
Authors: Pasha Ahmed K , Siddiqui Muhammad U , Anzelmi Alexander , Muneeb Altif , Patel Keyoor , Yarkoni Alon , McBane Robert D
Published: June 2023

Introduction:
The Safety and efficacy of DOACs is unknown in patients with left ventricular thrombus as these patients were excluded from DOAC trials.

Hypothesis:
The safety and efficacy of DOACs is comparable to vitamin K antagonists

Methods:
Databases including Medline, Scopus and Cochrane Central Registration of Controlled Trials were queried from inception to March 30
th
2022. Studies reporting efficacy and safety outcomes were selected for the analysis.

Results:
We included 11 studies comprising 1920 patients with left ventricular thrombus. The mean age in the DOAC group was 57.5 years (SD 12.8) and 58.6 years (SD 13.0) in the VKA group; 26.8% were females. Pooled results showed no difference in mortality (RR, 0.64 [95% CI, 0.16-2.52]) embolic events (RR, 0.94 [95% CI, 0.59-1.50]) or major bleeding (RR, 0.95[95% CI, 0.66-1.36]) in the DOACs compared to VKA groups. Event rate for DOAC group compared to VKA group was 12.7 vs 17.5 per 100 patient-years (mean follow up of 4.0 months) for mortality, 19.5 vs 26.5 per 100 patient-years (mean follow up of 8.9 months) for embolic events and 8.0 vs 10.0 per 100 patient-years (mean follow up of 9.5 months) for major bleeding.

Conclusions:
These data, from observational and randomized studies, demonstrate promising safety and efficacy of DOACs for treatment of left ventricular thrombus. Elevated embolic and mortality rates regardless of anticoagulant choice emphasize the need for further research to improve outcomes for patients with this complication.
Abstract 11371: Exacerbation of Pre-Existing Cardiovascular Disease Following COVID-19 mRNA Vaccination
Authors: Simone Anthony , Herald John , Chen Aiyu , Nayak Rohith , Shen Albert Yuh-Jer , Lee Mingsum S
Published: June 2023

Introduction:
Reactogenicity with systemic reactions including fatigue, fever, and chills have been reported with COVID-19 mRNA vaccination, with the incidence substantially greater after the second dose. Patients with pre-existing cardiovascular disease may be particularly vulnerable to secondary cardiac complications from the proinflammatory cascade and activation of immunogenic pathways in response to mRNA vaccination. This study aims to evaluate the risk of exacerbation of pre-existing cardiovascular disease after COVID-19 mRNA vaccination.

Methods:
We included individuals aged 18 years or older with a known history of cardiovascular disease who received at least one dose of COVID-19 mRNA vaccine. Cardiovascular hospitalizations were assessed within 30 days of COVID-19 mRNA vaccination. The observed incidence of cardiovascular hospitalization following vaccination or COVID-19 infection was compared with the expected incidence using data obtained from the same population during the same 30-day calendar period two years prior (a baseline period before the COVID-19 pandemic). Odds ratio (OR) and 95% confidence intervals (CIs) were calculated.

Results:
A total of 229,829 patients were identified as having a history of cardiovascular disease. In this group, 165,711 received at least one dose of COVID-19 mRNA vaccines (39.9% mRNA-1273 and 32.2% BNT162b2), and 160,482 received at least two doses (38.7% mRNA-1273 and 31.2% BNT162b2). The median age was 72 years (interquartile range 62, 80), 42.8% were women, 52.2% White, 25.4% Hispanic, 10.4% Asian, and 10.2% Black. Within 30 days after receiving dose one vaccination, 844 patients were hospitalized for a cardiovascular cause. During a baseline 30-day window, there were 1012 cardiovascular admissions, corresponding to an OR of 0.86 (95% CI 0.76-0.91) after vaccination. After dose two vaccination, there were 812 cardiovascular admissions, compared to 960 at baseline (OR 0.85, 95% CI 0.77-0.93). No cardiovascular hospitalization was observed in patients with a history of myocarditis.

Conclusions:
In this diverse cohort of patients with a history of cardiovascular disease, there was no increase in the risk of cardiovascular hospitalization after COVID-19 mRNA vaccination.
Abstract 11379: Libman-Sacks Endocarditis Mimicking Intracardiac Tumor in a Patient With Systemic Lupus Erythematosus and Secondary Antiphospholipid Syndrome
Authors: Orozco -Sepulveda Dayana , Hernandez del Rio Jorge Eduardo , SANTALO RAMON E , Miranda - Aquino Tomas
Published: June 2023

A 43-year-old woman, with history of SLE for 12 years and secondary APS for 10 years. Hospitalized in 2016 by pulmonary embolism, finding on that occasion the presence of intracardiac mass in the right atrial, at that time, she was pregnant and had full anticoagulation with LMWH until the end of the pregnancy. Since then, in treatment with azathioprine, hydroxychloroquine and acenocoumarin irregularly. She presented to the ER with a 21-day history of abdominal distention and diffuse pain, dyspnea at rest, and bilateral lower extremity pitting edema. On presentation patient was normotensive and tachycardic, in anasarca and with a loud holosystolic murmur at the parasternal border, in fifth intercostal space. Was admitted for acute heart failure. In TTE, the persistence of the right atrial mass dependent on interatrial septum with greater growth than the previous one was observed. The tumor protruded within the entrance tract of the right ventricle during diastole and during systole a doble jet of severe tricuspid regurgitation is observed. The tricuspid valve was thickened. A contrasted enhanced cardiac magnetic resonance confirmed the presence of the tumor described above without contrast uptake. The patient underwent mass excision surgery with preoperative diagnosis of atrial myxoma. Microscopic examination of the excised material revealed dispersed lymphohistiocytic infiltrate and thrombi without evidence of microorganisms, compatible with Limban-Sacks endocarditis. Because of the size and location of the lesion, Libman-Sacks endocarditis was considered highly unlikely. Only few cases of a vegetation simulating an intracardiac mass have been reported and in these patients analysis of serologic markers showed that lupus anticoagulant was positive, anticardiolipin antibodies IgM-G and antiphospholipid antibody were high.
Abstract 11386: Double Whammy Complicating Management of Pulmonary Hypertension
Authors: Salahuddin Ayesha , Tuwairqi Khaled W , Harris Ian , Agarwal Anushree , Mahadevan Vaikom , Kouretas Peter , Sabanayagam Aarthi
Published: June 2023

Introduction:
When presented with challenging cardiac cases, in addition to obvious diagnoses, it is critical to maintain high level of suspicion about other subtle conditions. We describe one such case of pulmonary arterial hypertension (PAH) from severe mitral stenosis (MS) and another less obvious congenital cardiac condition that significantly impacted the clinical course.

Case:
32-year-old immigrant male with known heart murmur presented with palpitations due to atrial fibrillation. His resting oxygen saturation was 95% in all extremities and he had no clubbing. He had pectus carinatum and scoliosis, prominent right ventricular lift, normal S1, loud S2, opening snap, rumbling diastolic murmur at the apex, and an ejection systolic murmur at the left upper sternal border. Echocardiogram revealed normal biventricular size and function, severely enlarged left atrium, rheumatic severe MS, moderate mitral regurgitation, a restrictive ventricular septal defect (VSD), and elevated right ventricular systolic pressure. Cardiac catheterization demonstrated mixed pre- and post-capillary PAH with mean pulmonary artery pressure of 80 mmHg, wedge pressure 30 mm Hg and pulmonary vascular resistance of 3.0 woods unit which was underestimated. Since pre-capillary component of the PAH could not be entirely explained by the small VSD, a congenital cardiac CT was performed revealing moderate sized patent ductus arteriosus (PDA). Further management decisions were complicated since MS was not amenable to percutaneous intervention and surgical risks were high given severe pre-capillary PAH- management of which with pulmonary vasodilators was itself high risk in the setting of severe MS and high wedge pressures. After optimal medical management, a multidisciplinary team carefully considered the risks and benefits of multiple interventions. Ultimately, the patient underwent surgical mitral valve replacement, fenestrated patch closure of the PDA, and then initiation of pulmonary vasodilators. The patient continues to do well on oral pulmonary vasodilator therapy 6 months after surgery.

Conclusion:
We describe an astute critical thought process of a multidisciplinary team utilized to manage a challenging case of mixed PAH from severe rheumatic MS and PDA.
Abstract 11397: Circulating Human Metabolites Resulting From TOTUM-070 Absorption (a Plant-Based, Polyphenol-Rich Hypocholesterolemic Ingredient) Improve Lipid Metabolism in Human Hepatocytes: Lessons From an Original ex vivo Clinical Trial
Authors: WAUQUIER Fabien , Langhi Cedric , wittrant line , Otero Yolanda F , Le Joubioux Florian , MAUGARD Thierry , ROUX VÃ©ronique , MACIAN Nicolas , pickering gisele , Bargetto Maxime , Cazaubiel Murielle , PELTIER Sébastien , Sirvent Pascal , Wittrant Yohann
Published: June 2023

Introduction:
TOTUM-070 is a patented polyphenol-rich compound which has shown hypocholesterolemic properties in preclinical studies. However, clinically validated approaches and further investigations on the mode of action at cellular level especially in humans are required for optimized care management. In this study, we designed an ex-vivo clinical innovative approach considering the metabolites produced by the digestive tract following the ingestion of TOTUM-070 in humans.

Methods:
Human serum was collected in healthy subjects before and following acute intake of 5g of TOTUM-070. Availability of circulating metabolites was confirmed and characterized by UPLC-MS. Human serum enriched with metabolites deriving from TOTUM-070 absorption was further incubated with human hepatocytes, pretreated or not with palmitate (250 μM). In such lipotoxic environment, hepatocyte behavior was monitored to determine whether and how TOTUM-070 metabolites may improve cholesterol metabolism in human.

Results:
In the presence of the human metabolites from TOTUM-070, human hepatocytes were protected from an induced lipotoxic stress. No effect on cell toxicity was detected in the presence of enriched sera. Hepatocyte protection was characterized by (1) the inhibition of both triglycerides (-41%, p<0.001) and cholesterol (-50%, p<0.001) storage, (2) a reduced de novo cholesterol synthesis (HMG-CoA reductase activity reduced by 44%, p<0.001), (3) a lowered fatty acid synthase expression (p<0.001), (4) the stimulation of the Lecithin Cholesterol Acyl Transferase (LCAT) activity (p<0.05) and finally (5) a higher CYP7A1 expression (p<0.05). All together, these data provide new biochemical insights into the mechanisms underlying, in humans, the beneficial impact of TOTUM-070 on lipid metabolism in liver cells.

Conclusion:
Using a pioneering clinical
ex vivo
approach considering the digestive processes of nutrients, we give clues on the role of circulating metabolites produced following TOTUM-070 intake in humans in hepatocyte protection.
Abstract 11407: A Novel Electronic Frailty Index as a Predictor of Clinical Outcomes After ST-Elevation Myocardial Infarction in Older Patients
Authors: Annabathula Rahul V , Pruitt Zachary , Withers Katie , Zhao David X , alvarez manrique , Richardson Karl , Rangel Maria O
Published: June 2023

Introduction:
Adverse outcomes after ST-elevation myocardial infarction (STEMI) are significant in frail patients. Standard metrics of frailty may not be reliable in acute STEMIs. This study aims to assess a novel, health record-based Electronic Frailty Index (eFI) to evaluate clinical outcomes after STEMI.

Methods:
Single site, retrospective study of 120 STEMI patients aged ≥65 years from 10/2017-1/2021. Data came from the ACC Chest Pain-MI Registry and health record. Patients were grouped as Fit (eFI ≤0.1) and Not Fit (eFI ≥0.1). Analysis included descriptive statistics and binary logistic regression. Primary outcome was mortality; other outcomes included MACE, bleeding complications, resource utilization, and discharge medications.

Results:
Mean age and standard deviation of the cohort was 75 (±7.49) years; 45 (38%) were female. 89 (74%) were classified as Not Fit (eFI ≥0.1). Individuals in this group had lower systolic blood pressure (SBP) on presentation, longer times to revascularization, and more comorbidities (Table 1). In-hospital mortality was significantly higher in the Not Fit group (19% vs. 3%, p 0.03); no significant difference in other outcomes (Table 2). Binary logistic regression analysis identified only initial SBP as a significant predictor of in-hospital mortality and not eFI.

Conclusions:
Increasing frailty, as assessed by the eFI, is associated with greater in-hospital mortality after STEMI. This association was driven by lower initial SBP, which is likely a result of decreased physiological reserve associated with frail status. Larger studies may provide better understanding on the use of eFI in risk stratification of STEMI patients.
Abstract 11434: Soluble Programed Cell Death Ligand-1 is Associated With Future Heart Failure Hospitalization in Patients With Atherosclerotic Cardiovascular Disease
Authors: Nozuhara Atsushi , Miyazaki Shuhei , Fujisue Koichiro , Yamanaga Kenshi , Yamamoto Eiichiro , Egashira Koichi , Komorita Takashi , Sueta Daisuke , Usuku Hiroki , Araki Satoshi , Takashio Seiji , Matsushita Kenichi , Tsujita Kenichi
Published: June 2023

Heart failure following atherosclerotic cardiovascular disease (ASCVD) is a significant problem worldwide. Chronic inflammation is a crucial pathogenesis both in heart failure and ASCVD. Programmed cell death-1(PD-1) and its ligand (PD-L1) regulate immune response through T cell proliferation and secretion of cytokines as immune checkpoint protein. However, the prognostic significance of immune checkpoint protein on ASCVD and heart failure is unknown. We investigated the association between the serum levels of PD-L1 (sPD-L1) and heart failure-related events in patients with ASCVD.

We prospectively measured sPD-L1 using a commercially available enzyme-linked immunosorbent assay kit in patients with ASCVD admitted to Kumamoto University Hospital. The occurrence of cardiovascular events was observed between December 2017 and January 2020. The primary outcome was heart failure hospitalization. We excluded patients complicated with cancer, hemodialysis, active collagen diseases, and inflammatory diseases.

We screened 792 patients with ASCVD. 200 patients met exclusion criteria. Finally, 592 patients with ASCVD were enrolled. Median follow-up period was 490 days. A total of 37 events were recorded during study period. Kaplan-Meier curve revealed that the higher sPD-L1 group (sPD-L1≧136pg/dL, median) showed significantly higher rate of heart failure hospitalization than the lower sPD-L1 group (9.1% vs. 3.4%, log-rank test:
P
=0.006). Univariate Cox proportional hazards analysis identified estimated glomerular filtration rate (eGFR), B-type natriuretic peptide (BNP), and higher sPD-L1 as significant factors associated

with heart failure hospitalization. Multivariable Cox proportional hazards analysis by significant factors from univariate analysis identified that higher sPD-L1 [hazard ratio (HR): 1.003, 95% confidence interval (CI): 1.000-1.005,
P
=0.042) and BNP (HR: 1.001, 95% CI: 1.000-1.001,
P
=0.007)] were significantly and independently associated with heart failure hospitalization.

The higher levels of sPD-L1 were significantly associated with future heart failure hospitalization in patients with ASCVD.
Abstract 11444: Pattern of V
E
/VCO
2
Abnormalities in Chronic Thromboembolic Pulmonary Hypertension
Authors: Barillas Lara Maria I , Bonikowske Amanda , Csecs Ibolya , Frantz Robert , Allison Thomas G
Published: June 2023

Introduction:
Breathing efficiency (V
E
/VCO
2
slope or nadir) predicts mortality in heart failure (HF). The usual pattern of V
E
/VCO
2
vs. exercise intensity is a characteristic “shallow bowl” configuration allowing estimate of a V
E
vs. VCO
2
slope both in normal controls (C) and HF patients. Slope or nadir in HF is generally > 33 vs. 25-30 in C. This pattern of V
E
/VCO
2
may not be true for other CV diseases.

Objective:
Compare V
E
/VCO
2
versus exercise time curves in patients with history of chronic thromboembolic pulmonary hypertension type 4 (PHT4) to HF and C referred for dyspnea on exertion.

Methods:
We identified 40 consecutive cases of PHT4 versus 40 HF and 40 C over the same age range retrospectively selected from our cardiopulmonary exercise test (CPX) database. V
E
/VCO
2
was plotted against exercise time (minutes of exercise ≈ METs), and groups were compared statistically for V
E
/VCO
2
and peak VO
2
by ANOVA followed with Tukey test, with significance set at P < .05.

Results:
Figure shows higher V
E
/VCO
2
in PHT4 vs. HF and C with a different pattern vs. exercise intensity. In severe cases (example shown) V
E
/VCO
2
may increase continuously without plateau reaching peak values > 80. There was statistically significant difference between peak VO
2
between C group vs HF and PHT4, but not among HF and PHT4, although V
E
/VCO
2
was significant different among the three groups. Age and sex was not different among them.

Conclusion:
V
E
/VCO
2
was elevated in PHT4 compared to HF and C. We interpret continuously increasing V
E
/VCO
2
as a marker of progressively worsening ventilation: perfusion mismatch. Interpretation of V
E
/VCO
2
in PHT4 cannot be based simply on nadir or slope as in HF, but a plot of the data should be visually examined to gain full understanding of the ventilatory abnormality.
Abstract 11448: Feasibility and Septal Perforation Rates in Left Bundle Branch Area Pacing
Authors: Mian Muhtashim , Khan Habib R
Published: June 2023

Introduction:
Left Bundle Branch area Pacing (LBBaP) is gaining prevalence as a more physiologic alternative to conventional right ventricular pacing. Given limited literature on LBBaP, this retrospective study assessed feasibility and septal perforation rates following LBBaP.

Methods:
Procedure reports and electrophysiologic parameters were reviewed of patients that underwent LBBaP since 2019. Partial septal perforation was defined as any two of: a) reduction of impedance by 200 ohms b) increase in capture threshold by 50% and c) decrease in ventricular sensing by 50% during follow-up compared to approximately 1-week post pacemaker implant.

Results:
Since 2019, LBBaP was attempted in 168 patients and was successful in 102 (60.7 %), partial successful in 55 (32.7%) defined as QRS reduction of >20ms and duration <140ms, and unsuccessful in 11 (6.6%). QRS duration shortened or remained short after successful LBBaP compared to unsuccessful (113 vs 147 ms, p < 0.001). Left ventricular ejection fraction was similar following successful LBBaP (p = 0.92). Five patients (3%) had potential septal perforation based on above criteria. Lead revisions were not arranged for these patients as pacing requirements were not high and it was clinically appropriate to continue 3 monthly observations in clinic.

Conclusions:
We report success rates of LBBaP recently adopted in a large tertiary center. In a medium-term follow-up, we show that changes in electrophysiologic parameters likely consistent with partial septal perforation may occur spontaneously in some patients (3% in our cohort) over time. Clinical significance of these changes and confirmation with imaging requires further study.